HCBS WAIVER TRAINING

OBJECTIVE

To gain basic knowledge of the HCBS Waiver services and the waiver like program called Habilitation: History

Philosophy

Waivers

WHY DO WE CALL IT “WAIVER”?

From 5 months to 3 years-old, Katie Beckett lived in a Cedar Rapids, IA hospital due to an infection that made a ventilator necessary. Medicaid would only pay for the expensive treatment if she stayed in the hospital.

In 1981 President Reagan was contacted by Katie’s parents and after hearing about Katie’s situation he changed the law so that Katie and others like her could receive the care they needed at home. This change resulted in care costing 1/6 of the cost of hospital care.

This change was known as “The Katie Beckett Waiver” and allowed all children with disabilities to receive Medicaid supports in their homes instead of being forced to remain hospitalized.

Because of the waiver program, Katie was able to live in her own apartment, go to college and was hoping to obtain her teaching certifi-cate.

Katie Beckett died on May 18, 2012 of complications of her illness. The impact of her life will forever change the lives of others….

THE OLMSTEAD ACT

In Olmstead v. L.C., the Supreme Court construed Title II of the Americans with Disabilities Act (ADA) to require states to place qualified individuals with mental disabilities in community settings, rather than in institutions, whenever treatment professionals determine that such placement is appropriate, the affected persons do not oppose such placement, and the state can reasonable accommodate the placement, taking into account the resources available to the state and the needs of others with disabilities. The Department of Justice regulations implementing Title II of the ADA require public entities to administer their services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities.

T H E O L M S T E A D A C T

In Olmstead, the Supreme Court stated that institutional placements of people with disabilities who can live in, and benefit from, community settings perpetuates the unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life. The Supreme Court state that "recognition and unjustified institutional isolation of person with disabilities is a form of discrimination reflect[ed] two evident judgements": 1) "Institutional placements of people with disabilities who can live in, and benefit from, community settings perpetuates the unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life"; and 2) "confinement in an institution severely diminishes everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment." Olmstead, 119 S.Ct. 2176, 2179, 2187

PHILOSOPHYEvery individual has value and dignity, and DAC, Inc.

exists to enhance this dignity, self-esteem and worth of each individual and his/her right to self-determination

as a member of the community.

HOW DOES A MEDICAID WAIVER WORK?

A person eligible for a Medicaid waiver “waives” his/her entitlement to receive services in an institution.

The type of waiver is determined by diagnosis (for example: intellectual, mental health, or physical disability)

Approximately 2/3 of the cost of waiver services is covered by the Federal Government and 1/3 of the cost of waiver services is covered by the county or the state.

WAIVERS ARE

Based on a philosophy of Individual Choice

Individual Rights and Dignity

Alternatives to institutionalization

Intended to keep individuals in their own home and community

Designed specifically for each individual based on their needs

For all ages

WAIVERS ARE NOT

Group homes

Residential facilities

Daycare

Academic education

Emergency services

Replacement of parental responsibility

Cadillac services

End all / Be all

DAC, Inc provides services to people under these Iowa Medicaid waivers:

Intellectual Disability

Habilitation

Brain Injury

_______________________________________________________________________

DAC, Inc currently does not provide services to people under these waivers:

Physical Disability

Children’s Mental Health

Health and Disability

Aids/HIV

Elderly

IOWA’S MEDICAID WAIVERS

COMMON SERVICE ELEMENTS

INDIVIDUAL PLANNING

All individuals who receive waiver services and supports have a Personal Outcome Plan (POP).

Plans include important information about

Goals the individual wants to works towards

Steps to take to reach the goal

Supports needed to remain in the most integrated environment possible.

COMMON SERVICE ELEMENTS

The Interdisciplinary Team is made up of……..

The Individual

The Case Manager

The Service provider(s)

The Guardian (if applicable)

Other people chosen by the individual

The team supports the individual in making decisions.

The individual has the right and responsibility of voicing their hopes, dreams, wants and needs.

COMMON SERVICE ELEMENTS

SERVICE COORDINATION

A case manager/service worker is there to help plan for and get the services and supports needed.

The Person Centered Approach assures the individual is:

Respected

Valued

An Equal partner

COMMON SERVICE ELEMENTS

QUALITY ASSURANCE

It is important to make sure that people are satisfied with the services and supports they receive. This is reviewed and measured through:

Satisfaction surveys

Complaints and/or Grievances

Participant Experience Surveys (PES)

The State must also assure that HCBS waiver funds (Medicaid) are used appropriately and in a fashion that meets federal and state requirements.

DIFFERENCE AMONG THE WAIVERS

Eligibility requirements

Availability

Target populations

Level of care requirements

Caps on dollar amounts available

Menu of services available

INTELLECTUAL DISABILITY (ID) WAIVER SERVICES

D A C S E RV I C E S A R E U N D E R L I N E D

Adult Day Care

Personal Emergency

CDAC

Prevocational

Day Habilitation

Respite

Home & Vehicle Mod

Supported Community Living (SCL)

Interim Medical Monitoring & Treatment (IMMT)

Supported Employment (SE)

Nursing

Home Health Aide

Transportation

HABILITATION (HAB) SERVICES(CHRONIC MENTAL I LLNESS)

Day Habilitation

Home Based Habilitation (HBH)

Prevocational

Supported Employment (SE)

BRAIN INJURY(BI) WAIVER SERVICES

Adult Day Care

Behavioral Programming

CDAC

Family Counseling

Home & Vehicle Modification

IMMT

Transportation

Personal Emergency Response

Prevocational Services

Respite

Specialized Medical Equipment

Supported Community Living (SCL)

Supported Employment (SE)

PHYSICAL DISABILITY (PD) WAIVER

Must be at least 18 but less than 65 years of age

Individual Directed Attendant Care

Home & Vehicle Modification

Personal Emergency Response

Specialized Medical Equipment

Transportation

CHILDREN'S MENTAL HEALTH WAIVER (CMH)

Children with a diagnosis of a serious emotional disturbance

Environmental Modifications & Adaptive Devices

Family & Community Support Services

In Home Family Therapy

Respite

HEALTH AND DISABILITY WAIVER

Adult Day Care

Homemaker

CDAC

IMMT

Counseling

Nursing

Home & Vehicle Modification

Nutritional Counseling

Personal Emergency Response

Home Delivered Meals

Home Health Aide

Respite

AIDS/HIV WAIVER

Adult Day Care

individual Directed Attendant Care

Counseling Services

Home Delivered Meals

Home Health Aide

Homemaker

Nursing

Respite

ELDERLY (EW) WAIVER 65+

Adult Day Care

Assistive Devices

Case Management

Chore

CDAC

Home & Vehicle Modification

Home Delivered Meals

Home Health Aide

Homemaker

Mental Health Outreach

Nursing

Nutritional Counseling

Personal Emergency Response

Respite

Senior Companion

Transportation

WAIVER STAKEHOLDERS

DAC, Inc.

THE INDIVIDUAL’S ROLE

Exercise control

Learn and understand his or her rights and responsibilities

Actively participate in their plan

Right to refuse and/or change services or service provision

THE CASE MANAGER’S ROLE

Act as advocate

Facilitate the individual’s access to the service system

Promote self-determination

Emphasize and promote individualism

Coordinate services with other providers

Ongoing communication

Request information

Help providers

Monitor service utilization

THE PROVIDER/DSP’S ROLE

Develop and carry out service provision based on the plan developed by the individual with his/her team

Communicate with all team members about all changes in service provision, limitations of rights, or other concerns regarding the individual

Advocate for the individual’s right to live in the most integrated – least restrictive environment

Provide for the safety of the individual with the LEAST amount of intrusion as possible

PLAN IMPLEMENTATION

Plans should reflect:

Individualism

Self-determination

Inclusion

Least restrictive environment

Quality

Safety

PLAN IMPLEMENTATION

It is important that direct support professionals are:

Flexible Remember you are working in the individual’s home

– not a group home!

Provide individualized supports to individuals Use the approach that works best for each

individual. No two people are ever exactly alike!

Direct support professionals also need to provide services according to the agency

philosophy.

RESOURCES http://www.npr.org/blogs/health/2012/05/21/153202340/katie-beckett-defied-the-odds-helped-o

ther-disabled-kids-live-longer

http://www.worksupport.com/resources/printView.cfm/376

http://parenting.blogs.nytimes.com/2012/06/06/because-of-katie-children-with-severe-disabilities

-can-live-at-home

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http://www.ime.state.ia.us/docs/HCBSbrochure102606.pdf