Licking County Board of Developmental Disabilities Administrative Policy Manual

Transcription

1 Section: 4.6 Page 1 of 7 POLICY It is the policy of the Licking County Board of Developmental Disabilities, hereinafter referred to as the Board, to establish and manage waiting lists when available resources are inadequate to meet the needs of all individuals who have a current need for the services. These waiting lists will be consistent with ORC and OAC 5123: DEFINITIONS A. "Alternative services" means various services and supports not funded by a home and community-based Medicaid waiver. These include: 1. Services funded by the Board and provided by agencies and individuals certified by the Ohio Department of Developmental Disabilities; 2. Services funded by the Board and provided by agencies and individuals that are not certified by the Ohio Department of Developmental Disabilities; 3. Services provided and funded outside the developmental disabilities service system; 4. Services provided at the state level; and 5. Services provided directly by the Board. B. "Date of request" means the earliest date and time of any written or other documented request for home and community-based services. The request, including the date and time of request, shall be included in an individual's record maintained by the Board. Documentation of the date of request may include the Ohio Department of Job and Family Services form 02399, "Request for Medicaid Home and Community-Based Services," with signature and date. C. "Emergency status" means an individual is facing a situation that creates for the individual a risk of substantial self-harm or substantial harm to others if action is not taken within thirty (30) days. Emergency status may result from, but is not limited to, one or more of the following: 1. Loss of present residence for any reason, including legal action; 2. Loss of present caretaker for any reason, including serious illness of the caretaker, change in the caretaker's status, or inability of the caretaker to perform effectively for the individual;

2 Section: 4.6 Page 2 of 7 3. Abuse, neglect, or exploitation of the individual; 4. Health and safety conditions that pose a serious risk to the individual or others of immediate harm or death; or 5. Change in emotional or physical condition of the individual that necessitates substantial accommodation that cannot be reasonably provided by the individual's existing caretaker. D. "Home and community-based services" means services and supports funded in part by a home and community-based Medicaid waiver as specified in division (B)(1) of section of the Revised Code and provided under Medicaid components administered by the Ohio Department of Developmental Disabilities pursuant to section of the Revised Code. E. "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, his or her guardian in accordance with section of the Revised Code. GENERAL WAITING LIST REQUIREMENTS A. No waiting list will be created or maintained for the following services: 1. Medicaid state plan services; 2. Home and community-based services for individuals already enrolled in a home and community-based services waiver; 3. Home and community-based services for children who are subject to a determination under section of the Revised Code and require the services; and 4. Home and community-based services for individuals who are transferred from one Board-administered waiver to another. B. Waiting list for home and community-based services: 1. When the Board determines that available resources are not sufficient to meet the needs of all individuals who request services and supports for which a home and community waiver is necessary to help pay for those services, the Board will establish a waiting list. a. With the agreement of an individual who requests these services and supports, place the individual's name on the waiting list; b. Inform the individual, the individual's guardian, and in accordance

3 Section: 4.6 Page 3 of 7 with section of the Revised Code, the individual's family, as applicable, of the individual's position on the waiting list and the individual's Medicaid due process rights in accordance with chapters 5101:6-1 to 5101:6-9 of the OAC; c. Identify the individual's immediate needs; and d. Assist the individual in identifying and obtaining services that meet those needs, including applying for Medicaid. An individual who accepts alternative services may choose to remain on the waiting list in his or her current position. 2. An individual's date of request is the controlling date for placement on a waiting list for home and community-based services and will be documented at the time of any such request. 3. When there is a dispute regarding an individual's date of request, the individual or a person with legal authority to act on behalf of the individual, may appeal using procedures described in the Due Process section of this policy. 4. When an individual relocates or expresses a desire to relocate from one county to another county, any waiting list for home and community-based services shall be reordered in the new county based on the individual's date of request for such services. 5. When resources become available to enroll an individual on a home and community-based waiver to pay for services and/or supports for which there is a waiting list, Board staff will offer the services to the individual next scheduled on the waiting list to receive the services subject to a determination of the individual's eligibility for the services. If the individual refuses the services, the individual may choose to remain on the waiting list in his or her current position. C. Annually, the Board will: 1. Review the current status, reassess the service needs, and notify the individual, the individual's guardian, and in accordance with section of the Revised Code, the individual's family, as applicable, of the individual's position on the waiting list; and 2. Provide contact information for Board staff who can provide resource information to address, to the extent possible, immediate needs of the individual and who can respond to questions about the notice.

4 Section: 4.6 Page 4 of 7 D. If at any time it is determined that an individual on a waiting list for home and community-based services is not eligible for services and supports paid for in part by a home and community-based Medicaid waiver, the Board will remove the individual's name from the waiting list and assist the individual with contacting other agencies/programs for which the individual may be eligible. Individuals removed from the waiting list have a right to due process as set forth in Chapters 5101:6-1 to 5101:6-9 of the OAC. EMERGENCY STATUS A. Individuals on a waiting list with emergency status, as defined in the Definitions section of this policy, will receive first priority for services and supports paid for in part by a home and community-based Medicaid Waiver. 1. No individual may receive priority for services and/or supports paid for in part by a home and community-based Medicaid waiver over an individual placed on a waiting list with emergency status. 2. When two or more individuals have emergency status, the Board will offer the services in the order the individuals were placed on the waiting list based on their date of request. PRIORITY CATEGORIES A. Unless an emergency as defined above exists, the Board will give priority for enrollment on a home and community-based Medicaid waiver to individuals in the following categories: 1. Individuals twenty-two years of age or older who receive supported living or family support services; 2. Individuals residing in their own home or family home who will continue to reside in that home after enrollment in a home and community-based Medicaid waiver and receive adult services provided or paid for by the Board. 3. The individual needs services and/or supports in the individual's current living arrangement or will need services in a new living arrangement, and has a primary caregiver who is sixty years of age or older; 4. The individual has at least one of the following service needs that is unusual in scope or intensity: a. Severe behavior problems for which a behavior support plan is needed;

5 Section: 4.6 Page 5 of 7 b. A mental health diagnosis for which medication has been prescribed; c. A medical condition that leaves the individual dependent on lifesupport medical technology; d. A condition affecting multiple body systems for which a combination of specialized medical, psychological, educational, or habilitation services is needed; or e. A condition the Board determines to be comparable in severity to any of the conditions described in a. thru d. above and places the individual at significant risk of institutionalization. ORDER FOR OFFERING SERVICES TO INDIVIDUALS WITHIN PRIORITY A. If two or more individuals on a waiting list for services and/or supports paid for in part by a home and community-based Medicaid waiver are in a priority category as described in the previous section of this policy, the Board will use the following criteria to determine the order in which the individuals with priority are offered the services: 1. The maximization of federal funding; 2. A mix among the individuals in each of the priority categories; and 3. Support of an individuals' ability to choose other individuals in a priority category with whom to live if the individuals have an existing relationship and the sharing of services among any individuals in a priority category when the services are appropriate for the individuals. B. When individuals are offered services and/or supports paid for in part by a home and community-based Medicaid waiver and two or more individuals are in a priority category, the Board will enroll the individuals in the order they were placed on the waiting list based on their date of request. TRANFER TO A SELF-EMPOWERED LIFE FUNDING (SELF) WAIVER A. An individual who is already enrolled in the individual options or level one Medicaid waivers may request enrollment in the SELF waiver. Board staff will initiate the transfer when: 1. The individual s needs can be more appropriately met on the SELF waiver; 2. The individual meets all eligibility criteria for the SELF waiver; and

6 Section: 4.6 Page 6 of 7 3. Any additional resources to pay the local match obligation are determined to be available. B. At any time within one hundred eighty (180) days of enrollment in the SELF waiver, at the individual's request, the Board will request that the individual be re-enrolled on the waiver from which the transfer was made. WAITING LISTS FOR NON-MEDICAID PROGRAMS AND SERVICES DUE PROCESS A. When the Board determines that available resources are not sufficient to meet the needs of all individuals who request services and supports not funded in part by a home and community-based Medicaid waiver, the Board will establish a waiting list for such services in accordance with the Board s strategic plan developed to comply with Section of the ORC. A. Due process is available to an individual aggrieved by an action of the Board related to: 1. The approval, denial, withholding, reduction, suspension, or termination of services and/or supports paid for in part by a home and community-based Medicaid waiver; and 2. The establishment or maintenance of, placement on, the failure to offer services in accordance with, or removal from any waiting list. B. Due process shall be provided in accordance with Chapters 5101:6-1 to 5101:6-9 of the Administrative Code when the service involved is funded in part by a home and community-based Medicaid waiver and in accordance with rule 5123: of the Administrative Code when the service involved is not Medicaid-funded. C. If an individual is aggrieved, the Board may attempt to informally resolve the matter. Access to the informal resolution process described in Section 1.4 of the Board s administrative policy titled Complaint Resolution will not affect the right of the individual to due process in accordance this policy. D. The Board will give notice annually to each individual on the waiting list, the individual's guardian, and in accordance with section of the Revised

7 Section: 4.6 Page 7 of 7 Code, the individual's family, as applicable, of the individual's due process rights. The Board will document that such notice was given and the content of the notice. E. The Board will provide to the Ohio Department of Developmental Disabilities documentation related to its waiting list for services and supports funded in part by home and community-based Medicaid waivers. It will also provide information to the Ohio Department of Developmental Disabilities, when requested, on any waiting list for services not funded in part by Medicaid including information regarding individuals who requested services or were removed from the waiting list.