# Slots/Average. Type/Name of Waiver Eligibility Services. Virginia Waiver Analysis (SOLUTIONS Consulting Group, LLC) January 2007 Page 1 of 6

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1 Elderly or Disabled with Consumer Direction (EDCD) Elderly or Disabled with Consumer Direction (EDCD) Waiver became effective February 1, It is the combination of two waivers, the Elderly and Disabled and the Consumer-Directed Personal Attendant Services Waivers. These two waivers ended on January 31, Five alternative services are provided under this waiver to the elderly and persons with disabilities who are eligible for institutional placement under the Medicaid Program. To receive the services under the EDCD Waiver, individuals must meet the waiver s target population. The target population includes those individuals who (1) meet the nursing facility level of care criteria (i.e., they are functionally dependent and require medical and nursing supervision of care), (2) are determined to be at risk of nursing facility placement and for whom community-based care services under the waiver are the critical services that enable the individual to remain at home rather than being placed in a nursing facility. Community-based care services under the waiver cannot be offered to individuals unless it can reasonably be expected that the individual would, without those services, enter a nursing facility. Provision of home and communitybased care must be determined by a Pre-Admission Screening Team to be a medically appropriate, costeffective alternative to Personal Care Respite Care Adult Day Health Care Personal Emergency Response System (PERS) PERS Medication Monitoring Consumer-Directed Services Facilitation Virginia Waiver Analysis (SOLUTIONS Consulting Group, LLC) January 2007 Page 1 of 6

2 Individual and Family Developmental Disabilities Supports (IFDDS) Children <age 6 not eligible to apply Technology Assisted (Tech) institutionalized care. Individuals may not receive services under any other home and communitybased waiver while receiving services under this waiver. The waiver year runs concurrently with the state fiscal year. The IFDDS Waiver provides services to individuals 6 years of age and older with a condition related to mental retardation, but who do not have a diagnosis of mental retardation, and who have been determined to require the level of care provided in an ICF/MR. An individual is eligible for services based on three factors: diagnostic eligibility, functional eligibility, and financial eligibility. The Technology Assisted Waiver began in This waiver is a program designed to allow eligible recipients to be cared for in the community rather than remain institutionalized. Eligible recipients are children under the age of 21, who have exhausted available third party benefits for private duty nursing and are dependent on a technology to substitute for a vital body function and adults, over age 21. All recipients must require substantial and ongoing skilled Day Support Companion Services (Agency or Consumer Directed) Supported Employment In-home Residential Support Therapeutic Consultation Personal Care Services Respite Care (Agency or Consumer Directed) Supported Employment Skilled Nursing Services Attendant Services Family and Caregiver Training Crisis Supervision Environmental Modifications Assistive Technology Personal Emergency Response System (PERS) Support Coordination Prevocational Services Personal care (Adults Only) Private duty nursing Respite care Environmental Modifications Assistive Technology Number on Urgent Waitlist (Including DD Waiver: 1751 Number of Nonurgent waitlist (including DD waiver): 1746 Number of slots obligated from 80 Facility 07 Slots: 14 Virginia Waiver Analysis (SOLUTIONS Consulting Group, LLC) January 2007 Page 2 of 6

3 nursing services. While assistance with the cost of room and board is not available through Medicaid waivers, waivers provide supports that help individuals to live as independently as possible in the community. Individuals who require ongoing skilled nursing care. Individuals 21 and older who are dependent at least part of each day on a mechanical ventilator or meet complex tracheotomy criteria. Individuals under the age of 21 who meet certain criteria based on various methods of respiratory or nutritional support. Individuals who meet Medicaid eligibility criteria as determined by the local department of social services. Parents income and resources are not considered by DSS when making a financial eligibility determination for a child under the age of 18 who is enrolling in the Tech Waiver. Tech Waiver services may be limited or denied for those individuals who are able to receive services through a thirdparty payment source. Eligibility Criteria for Emergency Access to the IFDD Waiver Virginia Waiver Analysis (SOLUTIONS Consulting Group, LLC) January 2007 Page 3 of 6

4 Subject to available funding, individuals must meet at least one of the emergency criteria to be eligible for immediate access to waiver services without consideration to the length of time an individual has been waiting to access services. In the absence of waiver services, the individual would not be able to remain in his home. The criteria are: 1. The primary caregiver has a serious illness, has been hospitalized, or has died; 2. The individual has behaviors which present risk to personal or public safety; or 3. The individual has been determined by the Department of Social Services to have been abused or neglected and is in need of immediate Waiver services, 4. The individual presents extreme physical, emotional, or financial burden at home and the family or caregiver is unable to continue to provide care. In addition to meeting emergency criteria, individuals must meet Medicaid financial eligibility requirements to be eligible for the DD Waiver Mental Retardation (MR) Diagnostic Eligibility: Individuals six years of age or older must have a psychological evaluation completed by a licensed The following services are available to individuals meeting the specific service criteria who have been 5,536 Slots Number of MR Waiver Slots Obligated: 6819 Virginia Waiver Analysis (SOLUTIONS Consulting Group, LLC) January 2007 Page 4 of 6

5 professional that states a diagnosis of mental retardation and reflects the individual s current level of functioning. Individuals under age six must have a psychological or standardized developmental evaluation that states that the child has a diagnosis of mental retardation or is at developmental risk and reflects the child s current level of functioning. Functional Eligibility: All individuals receiving MR Waiver services must meet the ICF-MR (Intermediate Care Facility [for persons with] Mental Retardation) level of care. This is established by meeting the indicated dependency level in two or more of the categories on the Level of Functioning Survey. Financial Eligibility: An eligibility worker from the local Department of Social Services determines an individual s financial eligibility for Medicaid. Some individuals who would not ordinarily qualify financially for Medicaid may be eligible by receipt of MR Waiver services. assigned an MR Waiver slot: Residential Support Services Supported employment Prevocational services Personal assistance Respite Companion Assistive technology: Environmental modifications Skilled nursing services: Therapeutic consultation: Crisis stabilization Personal emergency response systems (PERS) * Consumer-directed services offer the individual/family the option of hiring workers directly, rather than using traditional agency staff. Waiting Lists identify urgent and nonurgent criteria; Planning list is not formally a part of the waiting list. This includes individuals who have no urgent or immediate needs but are eligible, and may have needs in the future. Virginia Waiver Analysis (SOLUTIONS Consulting Group, LLC) January 2007 Page 5 of 6

6 Day Support Medicaid regulations specify that, once an individual has been determined eligible by the CSB/BHA case manager, he or she must be offered a choice between institutional and Waiver services. Connected to the MR Waiver. See above category for other services. Day support Number of Day Support Waiver Slots obligated: 289 Virginia Waiver Analysis (SOLUTIONS Consulting Group, LLC) January 2007 Page 6 of 6