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LOC Process

LOC Process. October 2017. HCBS Level of Care Process:. 1) Funding Request DHS-DD-800 --Updated form (02/17)-- Note expected start date Identify transition SSI status* Current funding source is a dropdown box now Identify types of services a person may need

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LOC Process

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  1. LOC Process October 2017

  2. HCBS Level of Care Process: • 1) Funding Request • DHS-DD-800 • --Updated form (02/17)-- • Note expected start date • Identify transition • SSI status* • Current funding source is • a dropdown box now • Identify types of services • a person may need • Note additional information's as needed • Submit form to assigned CMProgram Specialist

  3. HCBS Level of Care Process: • *SSI Status: • If not receiving or denied, the Program Specialist will need to send to DICT for approval. This could take a couple weeks. • Remember the last date of any of the signed required documents is the start date, this if DICT approval is required, the DICT date is the earliest date that can count towards a person's start date. • EXAMPLE: If a person started services 7/2/16 and the LOC is submitted 7/15/16 and then needs to go through DICT and DICT makes a determination 7/24/16, the earliest that HCBS funding can be provided for the participant is 7/24/16.

  4. Documents Required for LOC: • 1) Current Psychological of Qualifying Psycho-educational Evaluation (Documentation shows diagnosis, disability prior to 22, IQ score or related condition, and adaptive behavior) • 2) ICAP Eligibility (DHS-DD-ICAP) • 3) ICAP Booklet (all sections marked and legible) • 4) ICAP Compuscore Sheet • 5) Significant Change Request (SCR) as provisional plan of care (DHS-DD-810)(all fields must be completed unless not applicable) • 6) HCBS Waiver Rights (DHS-DD-717) • 7) HCBS Eligibility Determination Form (DHS-DD-716) • All documents must be dated prior • to or on the start date of • Waiver services. • A transfer from provider to • provider requires: • SCR(s) • ICAP (if needed)

  5. Provisional Plan of Care (DHS-DD-811)

  6. Effective Date: • Again, the documents required for LOC must have dates prior to or on the proposed effective date of service for a participant. • If any of the dates are beyond the start date, the date beyond will become the start date for services. • EXAMPLE: DHS-DD-717 wasn't completed until 7/11/16 but a participant started services on 7/4/16, the start date for funding for services will be 7/11/16. Any funding for services provided 7/4-7/10 will not be paid out. • After the SMART review by the OWM, packet goes to DSS and the Benefits Specialist will issue the approval form. • The application to DSS has a 45 day timeframe which can be extended by DSS in some circumstances. It is suggested to submit the DSS–EA- 265 at the same time as the LOC to DDD, not the funding request.

  7. ERT: • Eligibility Review Team (ERT): At times the Program Specialist alone is unable to make a determination of eligibility, therefore, the PS may request ERT review the LOC submitted. • The ERT will meet and review, possibly asking for additional information. • Note that this process can take a couple of weeks or longer depending on whether additional information is requestedand needs to be reviewed again. • There is no set reoccurring meeting of ERT; sessions are called when LOCs come in. • The ERT approval date will not affect the • date of funding for services like the DICT • date does. However, if the participant is found • not eligible by ERT, funding will not • be approved.

  8. CTS: • Community Training Services (CTS): A General Funds source of funding for services for participant. CTS has the same eligibility requirements, but has more flexibility with the usage of these funds. • No Funding Request is necessary for CTS applicants. • Documents Required: • DHS-DD-700 (Financial Eligibility) –Check FY on this document. • DHS-DD-810 (Provisional Plan of Care) - all fields must be completed, especially funding source • Copy of Psychological Evaluation with same criteria as HCBS • DHS-DD-ICAP, signed, dated, and legible • ICAP Booklet • ICAP Compuscore

  9. CTS: • CTS services are paid by units not by a daily rate as HCBS funding. Units are hourly or in 15 minute increments based on the contract • No approval letter is sent from DSS or DDD. • Instead, the processed SCR/Plan of Care will • act as the CTS funding approval. • If moving from HCBS to CTS discharge process • must be completed. • Even if a participant had been on HCBS, CTS • LOC is still required.

  10. CTS: • If a participant doesn’t meet eligibility criteria but your agency is requesting to provide CTS under emergency provision outlined in the contract, “Emergency Provision Only” part of DHS-DD700 form needs to be completed and submitted.

  11. Questions?noemi.borcea@state.sd.us

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