An Overview of Eligibility and Services

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1 An Overview of Eligibility and Services

2 Agenda DDD as of March 2013 is now referred to as the Developmental Disabilities Administration DDA Intake and Eligibility Rules and Process Overview of Major Categories Describing Primary Services Medicaid Personal Care Individual and Family Support Waivers Specialized Behavioral Health services February 20,

3 DDA Eligibility overview February 20,

4 What is a developmental disability? "Developmental disability" means a disability attributable to intellectual disability, cerebral palsy, epilepsy, autism, or another neurological or other condition of an individual found by the secretary to be closely related to intellectual disability or to require treatment similar to that required for individuals with intellectual disabilities, which disability originates before the individual attains age eighteen, which has continued or can be expected to continue indefinitely, and which constitutes a substantial handicap to the individual. RCW 71A February 20,

5 WAC criteria for eligibility Must have a diagnosed eligible condition that is not expected to improve or go away Must have evidence that the condition was present prior to age 18 Must have evidence of substantial functional limitations IQ scores Physical assistance needs Adaptive functioning test scores ICAP February 20,

6 What are the DDD eligibility age groups? Children under age 6: Only developmental delays are used to determine eligibility. Children age 6 through 9: May be determined eligible due to developmental delays applicable to children under age 6 or other eligible conditions applicable to persons age 10 and older. Applicants age 10 and older: Must meet eligibility criteria for intellectual disability, cerebral palsy, epilepsy, autism, another neurological or other condition similar to intellectual disability or be under the age of 18 and eligible for the Medically Intensive Children s Program. (WAC ) February 20,

7 For clients under age 10, what evidence is required to prove eligibility in the category of Developmental Delay? Developmental delay of at least 1.5 standard deviations or 25% of the chronological age in the following developmental areas: (WAC ) Physical skills (fine or gross motor) Self-help/adaptive skills Expressive or receptive communication, including American Sign Language Social/emotional skills Intellectual, academic or problem solving skills The number of areas in which you are required to have delays to meet the evidence is specific to your age: (WAC ) Age 0-3: One qualifying delay Age 3-10: Three qualifying delays February 20,

8 For clients under age 10, what evidence is required to prove eligibility in the category of Developmental Delay? Children under the age of 10 also qualify for DDA eligibility with: a diagnosis of Down Syndrome from a licensed physician, through eligibility for the Medically Intensive Children s Program, or, a diagnosis from a physician/psychologist of a condition that is so severe that the child can not complete a developmental examination. February 20,

9 Eligibility Conditions Current DDA WAC identifies six different permanent eligibility categories (age 6+): Intellectual Disability (ID) Cerebral Palsy (CP) Epilepsy Autism Another neurological condition Other condition similar to ID February 20,

10 Intellectual Disability Diagnosis of ID by appropriate professional FSIQ of 69 or below (depending on the test used) Adaptive functioning tested at a qualifying score Communication Self care Home living Social/interpersonal skills Use of community resources Self direction Work Leisure Health & safety February 20,

11 Cerebral palsy Diagnosis by a licensed physician of Cerebral palsy Quadriplegia Hemiplegia/Hemiparesis Diplegia Symptoms that existed prior to age three and impair control of movement, AND, Need for direct physical assistance in 2 or more areas: Toileting Bathing Eating Dressing Mobility Communication February 20,

12 EPILEPSY Diagnosis of epilepsy or seizure disorder by a qualified professional Uncontrolled seizures Physical incapacitation due to seizures resulting in requirement for physical assistance Adaptive functioning tested at more than two standard deviations below the mean February 20,

13 AUTISM Diagnosis of Autism (DSM-IV-TR ) by a qualified professional Evidence of onset prior to age 3 Delay or abnormal functioning in Social interaction, Language, Communication, or Symbolic or imaginative play Adaptive functioning tested at more than two standard deviations below the mean *Diagnoses of Asperger s Disorder, PDD-NOS, and Autism Spectrum Disorder do not meet WAC criteria for Autism February 20,

14 Another neurological condition Diagnosis of an impairment of the central nervous system involving the brain and/or spinal cord made by a licensed physician A FSIQ of 78 or below Need for direct physical assistance in 2 or more areas: Toileting Bathing Eating Dressing Mobility Communication February 20,

15 Other condition similar to ID Diagnosis of an impairment of the central nervous system involving the brain and/or spinal cord or chromosomal disorder made by a licensed physician Disorder results in intellectual and adaptive skills deficits FSIQ of 78 or below (depending on the test used), or Academic delays, and Adaptive functioning tested at more than two standard deviations below the mean February 20,

16 Impact of unrelated injury or illness DDA must be able to determine that the functional limitations are not a result of Mental illness Behavior problems Injuries or illness not related to the qualifying diagnosed condition Injuries or illness occurring after age 18 February 20,

17 INTAKE process (NEW APPLICATION) Applicant signs and submits a Request for DDD Eligibility Determination and other required forms. DDA will assist with getting documentation. Process can take up to 90 days but this can be shortened if documentation is submitted with application. I & E staff enter information into CARE system and make eligibility determination based on information available. February 20,

18 INTAKE process (NEW APPLICATION) Applicant will receive written notice (Planned Action Notice) regarding eligibility decision. Applicant has the right to appeal if they disagree with eligibility determination and forms are included with the PAN. Contact information for DDA is provided on PAN. DDA eligibility does not guarantee access to a paid service from DDA February 20,

19 Eligibility Expirations DDA eligibility expires at the following times: On the 4 th birthday (all clients) On the 10 th birthday (clients eligible under Developmental Delay or Down Syndrome) Clients are sent notice of expiration at 6 months and 90 days prior to eligibility expiration. Paid services terminated upon expiration Clients must complete reapplication materials and send them to DDA. If reapplication is not submitted timely, client s eligibility will expire and subsequent application will be treated as a new intake application. February 20,

20 Eligibility reviews DDA reviews eligibility at the following times: at age 17 (all clients) unless the initial determination was made at age 17; or Prior to authorization of services if the client is age 18 or older and the most recent determination is prior to July 1, 2005 or When there is evidence that the current eligibility determination is based on insufficient, mistaken, or fraudulent information. Clients are sent notice of eligibility review at age 17. Clients must return consent forms for DDA to obtain updated information. If client does not return consent forms, DDA makes an eligibility determination based on information available (usually in client file). February 20,

21 ADMINISTRATIVE HEARINGS Clients have a right to an administrative hearing for all DDA eligibility decisions (except for expirations). Must request hearing within 90 days of receiving the official department notice (Planned Action Notice). Clients have the right to legal representation. Hearing process involves: Prehearing Conference (in most cases). Exchange of documents and witness lists. Department presentation of documents used in the eligibility determination process. Opportunity to have your day in court with an Administrative Law Judge who will determine whether or not DDA followed their rules. Further Appeals available (Board of Appeals, Superior Court.) February 20,

22 DDD Services Overview Case Management As of Jan. 2011, about 1/3 on No-Paid Services list with no case manager Medicaid Personal Care Individual and Family Support Program Home and Community-Based Service Waivers Specialized Behavioral Health services ACCESS to paid services starts with a request placed to the Case Manager If no case manager? Call in King County Call in Snohomish County February 20,

23 Medicaid Personal Care (MPC) Who is eligible for MPC? Is Categorically Needy (CN) per Medicaid Is functionally eligible per CARE Assessment Has an unmet or partially met need for assistance with Activities of Daily Living Who can provide MPC services? Individual Providers (IP), Home Care Agencies, Licensed Assisted Living/Adult Family Home providers Where can MPC service be provided? Client s own home; licensed AFHs/Assisted Living; Nursing home February 20,

24 Medicaid Personal Care MPC is a program that provide assistance in the following Activities of Daily Living (ADLs): Bathing Bed Mobility Dressing Eating Locomotion Toilet Use Transfer Personal Hygiene Med Management Body Care February 20,

25 What doesn t the Personal Care program provide? Childcare Respite to primary caregivers Yard work Teaching skill development Skilled nursing services Services provided over the phone Services to assist other non-eligible household members Pet Care Managing Finances February 20,

26 Individual and Family Support Program (IFSP) IFSP is a state only funded program that provides an array of services to families to help maintain and stabilize the family unit. Who is eligible? A DDA client age 3 or older; Must live with Family Not enrolled in a DDA Waiver; not receiving residential/foster care services; have an assessed need for IFS program services To Access Program? Request that Case manager put individual s name on IFSP waitlist When funding available, new clients entered on to program February 20,

27 Individual and Family Support program IFSP Provides: Annual Financial Award of: $1200., $1800., $2400., or $3600. depending on assessed need With Pre-approval, can use $$ for: Respite Care, Therapies, Architectural and vehicular modifications, Specialized Equipment and supplies, Specialized nutrition and clothing, Excess medical costs not covered by another source, Co-pays for medical and therapeutic services, Transportation, Training and Counseling, Behavior management, Parent/Sibling education, Recreational opportunities February 20,

28 DDA Waiver Overview Home and community based services (HCBS) waivers are services approved by the Centers For Medicare and Medicaid Services (CMS) under section 1915 (c) of the Social Security Act as an alternative to placement in an intermediate care facility for the intellectually disabled (ICF/ID). Certain federal regulations are "waived" enabling the provision of services in the home and community to individuals who would otherwise require the services provided in an ICF/MR. The waiver allows states to offer additional services and supports, not available under the state plan. February 20,

29 DDA Waiver There are approximately 11,800 DDA clients served on one of our Home & Community Based Service Waivers DDA offers services under FOUR waivers (as of 9/1/12): Basic Plus; Core; Community Protection; Children s Intensive In- Home Behavioral Supports Capacity limited by federal agreement and the state s ability to provide half of the funding. February 20,

30 Waiver Services PROFESSIONAL SERVICES (Behavior Management, Skilled Therapies) PERSONAL CARE RESPITE CARE ADULT EMPLOYMENT/DAY PROGRAM SERVICES MENTAL HEALTH STABILIZATION SERVICES EMERGENCY ASSISTANCE SUPPORTED LIVING (Core and Community Protection Only) ACCESS? Ask Case manager to write Waiver Enrollment Request-- ALL SERVICES SUBJECT to Assessed Need, Annual Spending Limits, and Prior Approval for Professional and Emergency services February 20,

31 Children s Intensive In-home Behavioral Support Washington State has designed the Children s Intensive In-home Behavioral Support (CIIBS) Waiver to address the needs of children and youth with: Autism Spectrum Disorders (ASD); or Other developmental disabilities; and who are At high or severe risk of outof-home placement due to significantly challenging behaviors. February 20,

32 Children s Intensive In-home Behavioral Support The CIIBS model has three primary components: Positive Behavior Support Intensive Case Management Wraparound ACCESS? Ask Case manager to forward child s name and needs to CIIBS Program Manager February 20,

33 Specialized Behavioral Health Services Through DDA funding BeST: Behavior Support Team at Seattle Children s Home serves children and families age 3 through 17 (King County Only) FREE--- Access at: Contracted Providers if funds available via Family Support or Waiver Programs Psychologists, Behavior Specialists, Psychiatry, Mental Health Counseling Ages 18 to 20 and beyond: DD Crisis Stabilization- FREE Access: Sound Mental Health Crisis Respite Beds- Community Psychiatric Clinic- FREE Access: through DDD Case Manager, SMH February 20,

34 Children s Respite and Crisis Services Paid Respite: - individual uses paid respite hours identified in their CARE Plan - *provided in a home licensed as a staffed residential. - available when vacancies exist Dedicated Respite Bed These homes are licensed staffed residential homes that provide services for youth who receive Voluntary Placement Services (VPP) - used for short-term planned respite regardless of funding available to the client. - *ALL RESPITE REQUESTS MUST GO THROUGH THE DDA CASE MANAGER February 20,

35 Children s Respite and Crisis Services cont. Enhanced Respite -provides a break in caregiving -opportunity for behavior stabilization and to partner with families, client, providers, DDA Case Managers and other professionals who share a common goal for the child to remain in the home -development of an ISP -max. stay 30 days Community Crisis Stabilization Service (CCS) -CCS is stated operated community behavioral health stabilization program -for youth ages 8 to 17 years old or 21 years if school enrolled who are at risk of hospitalization Provides intensive supports/ collaborative treatment plans for up to 180 days Goal of youth returning to family home February 20,

36 Region 2 South DDA/ DSHS Offices & Contacts Seattle- Capitol Hill 1700 E. Cherry St., #200, Seattle, WA Phone: (800) Regional Address: dd4fso@dshs.wa.gov Kent Outstation 1313 W. Meeker St., Suite 100, Kent, WA Phone: (800) No Paid Services? - Call Leave message with request February 20,

37 Questions about State DDA services??? February 20,

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