STATE OF MISSOURI MANUAL DISABILITIES WAIVERS …

1 STATE OF MISSOURIDEVELOPMENTAL DISABILITIES WAIVERS MANUALDD WaiverPRODUCTION : 03/01/20212 Introduction to Medicaid WAIVERS in A: Eligibility and Documentation Support Children with Developmental DISABILITIES (MOCDD or Sarah Jian Lopez) for Hope B: Degreed Professional Management Professional C: Documentation D: Self Directed E: Organized Health Care Delivery System (OHCDS)..23 Section F: Service Behavior Accessibility Adaptations (EAA) Home/Vehicle Peer Support Skill Supported of Home Centered Strategies Assessment and WaiverPRODUCTION : 03/01/20213 Shared Medical Equipment and Supplies (Adaptive Equipment)..94 Speech Residential G: Telehealth H: Waiver of Care and Welfare Accountability WaiverPRODUCTION : 03/01/20214 Developmental DISABILITIES WAIVERS ManualComprehensive, Community Support, MOCDD (otherwise known as the Sara Jian Lopez Waiver), and Partnership for Hope Waiver ManualIntroduction to Medicaid WAIVERS in MissouriThe MISSOURI Department of Mental Health's Division of Developmental DISABILITIES (Division of DD) administers four Medicaid Home and Community-Based Services (HCBS) Waiver programs for individuals with developmental DISABILITIES .

2 The four WAIVERS are the Comprehensive Waiver; MISSOURI Children with Developmental DISABILITIES Waiver (MOCDD or Lopez Waiver); Community Support Waiver; and Partnership for Hope Waiver (PfH). Authority for the Division of DD WAIVERS is the result of a federal law enacted by Congress in 1981 that added a new section to the Social Security Act in 1915(c). Under home and community-based WAIVERS , a STATE may use Medicaid funding for HCBS provided only to a target group of people who have intellectual and developmental DISABILITIES and whose care needs would otherwise require services in an institution. Federal law also allows a STATE to target services by geographic region. The Division of DD uses general revenue funds and local county dollars to match federal dollars to pay for HCB waiver Behavior AnalysisACREA ssociation of Community Rehabilitation EducatorsADLA ctivities of Daily LivingALFA ssisted Living facilitiesAOTAA merican Occupational Therapy AssociationAPSEA ssociation of People Supporting Employment FirstASDA utism Spectrum DisorderBCBAB oard Certified Behavior AnalystBSHCNB ureau of Special Health Care NeedsBSPB ehavior Support PlanCARFC ommission on Accreditation of Rehabilitation FacilitiesCESPC ertified Employment Support Professional CFRCode of Federal RegulationsCICommunity IntegrationCIMORC ustomer Information Management.

3 Outcomes & ReportingCITC risis Intervention TrainingCMSC enters for Medicare and Medicaid ServicesCMTC ertified Medication TechnicianCNAC ertified Nursing AssistantCOTAC ertified Occupational Therapeutic AssistantCPRC ardiopulmonary ResuscitationCPTAC ertified Physical Therapeutic AssistantCQLC ouncil on Quality and Leadership/The CouncilDD WaiverPRODUCTION : 03/01/20215 CSRCode of STATE RegulationsDDDevelopmental DisabilitiesDHDay HabilitationDHSSD epartment of Health and Senior ServicesDOLD epartment of LaborDRDesignated RepresentativeDMED urable Medical EquipmentDMHD epartment of Mental HealthDSDSD ivision of Senior and Disability ServicesDSSD epartment of Social ServicesDVDD igital Versatile DiscEAAE nvironmental Accessibility AdaptationsEPSDTE arly and Periodic Screening, Diagnostic and TreatmentESPCCE mployment Support Professional Certification CouncilFBAF unctional Behavior AssessmentF/EAFiscal/Employer AgentFFPF ederal Financial ParticipationFMSF iscal Management ServiceFSDF amily Support DivisionFSPF amily Support PartnerGEDG eneral Education DevelopmentHCBSHome and Community-Based ServicesHIPAAH ealth Insurance Portability and Accountability ActHSHigh SchoolI&AInformation and AssistanceIADLI nstrumental Activities of Daily LivingICF/IDDI ntermediate Care Facility/Intellectual and Developmental DisabilitiesI/DDIntellectual/Development al DisabilityIRSI nternal Revenue ServiceISDI ndividualized Skill DevelopmentISLI ndividualized Supported LivingISPI ndividual Support PlanLaBALicensed Assistant Behavior AnalystLBAL icensed Behavior AnalystLIMAL evel I Medication AideLOCL evel of CareLPNL icensed Practical

4 NurseMMACM issouri Medicaid Audit and Compliance UnitMOMissouriMOCABIM issouri Critical Adaptive Behavior InventoryMOCDDM issouri Children with Developmental DISABILITIES Waiver (or Lopez Waiver)MRSM edication Reminder SystemsNADSPN ational Alliance for Direct Support ProfessionalsNCIN onviolent Crisis InterventionOHCDSO rganized Health Care Delivery SystemOTOccupational Therapy/Occupational TherapistDD WaiverPRODUCTION : 03/01/20216 PAPersonal AssistantPAMP rofessional Assessment and MonitoringPCAP ersonal Care AssistancePCSCP erson Centered Strategies ConsultationPERSP ersonal Emergency Response SystemsPfHPartnership for Hope WaiverPICPERS Client s Medical Identification CodePONP rioritization of Need/Priority of NeedPOSP urchase of ServicePTPhysical Therapy/Physical TherapistQHCPQ ualified Health Care ProfessionalRBTR egistered Behavior TechnicianRCFR esidential Care FacilityRNRegistered NurseRSMoRevised Statutes of MissouriSB 40 Senate Bill 40 BoardSDSSelf-Direct Services/Self-Directed SupportsSILSemi-Independent LivingSLPS peech-Language PathologistSMES pecialized Medical Equipment and SuppliesSTSpeech Therapy/Speech TherapistTCMT argeted Case ManagementTVTelevisionUAPU nlicensed Assistive PersonnelULUnderwriters Laboratories.

5 ReviewUSCU nited States CodeUSCISU nited States Citizenship and Immigration ServicesVCRV ideo Cassette RecorderVRVocational RehabilitationSection A: Eligibility and PlanningEligibilityAn individual must meet the following eligibility requirements to be eligible for any waiver services that the STATE of MISSOURI Intermediate Care Facility/Intellectual and Development DISABILITIES (ICF/IDD) level of care (LOC) requires the presence of developmental DISABILITIES (DD) as defined in federal rule (42 CFR ) as an Intellectual Disability or related condition as described below:DD WaiverPRODUCTION : 03/01/20217 Persons with related condition as follows: Persons with related conditions means individuals who have a severe, chronic disability that meets all of the following conditions:a)It is attributed to (1) Cerebral palsy or epilepsy; or(2) Any other condition, other than mental illness, found to be closely related to DD because this condition results in impairment of general intellectual functioning or adaptive behavior and requires treatment or services similar to those required for these persons;b)It is manifested before the person reaches age 22;c)It is likely to continue indefinitely;d)It results in substantial functional limitations in three or more of the following areas of major life activity:(1) Self-care;(2) Understanding and use of language;(3) Learning;(4) Mobility;(5) Self-direction;(6) Capacity for independent living, plus a need for the LOC provided in an addition, a determination must be made that the individual is at risk of needing ICF/IDD institutional services if unable to access waiver services.

6 To access waiver services, Medicaid eligible applicants must first be determined eligible for services by the Division of DD regional office through an assessment process. The assessment includes the MISSOURI Critical Adaptive Behavior Inventory (MOCABI) for adults or the Vineland or other age appropriate instrument(s) for children. Observations, interviews and collateral information are also used. Once eligibility for Division of DD services is determined, a support coordinator uses the gathered information and any other information needed to evaluate the applicant s eligibility for the Division of DD waiver addition to the criteria listed above each waiver has particular eligibility criterion that must be met to participate in the specific waiver as noted Limitations The person must be eligible for Medicaid in an allowable eligibility category when the services are delivered.

7 Medicaid does not cover services for individuals residing in a jail or detention facility. Medicaid waiver services are not available to individuals who are inpatients in a nursing home, ICF/IDD or a WaiverPRODUCTION : 03/01/20218 Special Documentation RequirementsThe documents discussed in this section are required for Division of DD Waiver services of Need for ICF/IDD Level of Care and Eligibility for the Developmental DISABILITIES WaiversBefore a person enters the DD WAIVERS , a support coordinator employed by a Division of DD regional office, or other approved targeted case management (TCM) entity that contracts with Division of DD to provide TCM services, gathers collateral information and assures that social history and medical information is current. The support coordinator also ensures that results of any testing or previous habilitative program experience are summarized, and that any additional professional assessment necessary for determining LOC or individual planning is requested.

8 The support coordinator then completes a functional screening instrument designed to provide general information on what a person with DD can and cannot do and lists any types of adaptations and supports which are in MOCABI is the instrument used for adults and for older children, when appropriate. Other age appropriate instruments, such as the Vineland, may be used for younger children. Based on the MOCABI, Vineland or other appropriate instrument, and on observation, interviews, collateral information and assessments, the support coordinator documents on the Evaluation of Need for ICF/IDD Level of Care Form: That the individual has DD and/or a disability that meets the federal definition of a related condition; That the individual has limitations, which if not for home and community-based waiver services, may require active treatment in an ICF/IDD; and Why the individual is at risk of entering an ICF/IDD; Based on the results documented on this form, the individual may be determined eligible for waiver services; Only support coordinators employed by a regional office, other approved TCM entities contracting with Division of DD, have authority to evaluate ICF/IDD LOC for the DD WAIVERS .

9 All LOC evaluations must be administratively approved through a regional of Level of CareSupport coordinators associated with the TCM entities described above shall re-evaluate each individual at least every 365 days for continued eligibility for DD WAIVERS , which includes continued need for an ICF/IDD LOC. The re-evaluation includes the reviewing and/or updating all assessments on which the previous evaluation was based, including the MOCABI, and re-documentation of conditions of eligibility as listed above. Ensuring the re-evaluation is done at least every 365 days and maintaining copies of the initial evaluation, all assessments and subsequent reevaluations, is the responsibility of the DD TCM entity. As part of annual planning, LOC determinations must be completed within 90 days prior to the DD WaiverPRODUCTION : 03/01/20219 ISP implementation date.

10 LOC implementation date will be effective with the ISP implementation Assessment and Individual Support (also called Service) PlanNo later than 30 days from the date of eligibility for DD services, the individual and his or her planning team develops an Individual Support Plan (ISP), also known as the support plan. The person-centered planning process is implemented to develop the ISP, facilitated by the support coordinator. As required by 42 CFR (c) (1), the person-centered planning process will be led by the individual where possible. In addition to being led by the individual receiving services and supports, the person-centered planning process: Includes people chosen by the individual; Provides adequate information and support to ensure the individual directs the process to the maximum extent possible, and is enabled to make informed choices and decisions; Is timely and occurs at times and locations of convenience to the individual; Reflects cultural considerations of the individual and is conducted by providing information in plain language and in a manner that is accessible to individuals with DISABILITIES and persons who has limited English proficiency; Includes strategies for solving conflict or disagreement within the process including clear conflict of interest guidelines for all planning participants.