This list may include some individuals who have a documented developmental disability and have recently refused DD services and chosen APD services.

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1 Dual Service Question and Answer Document The following are frequently asked questions related to the movement of individuals with developmental disabilities off the Adults and Persons with Physical Disabilities (APD) waiver. The information provided will assist in the collaborative planning and communication with partners, individuals, and families. GENERAL QUESTIONS 1. What is the problem? Why are things changing? Federal regulations do not allow a person with disabilities to receive services from more than one Home and Community-Based Waiver as an alternative to an institution. Persons over 65 or having a physical disability, access the APD waiver to divert nursing facility placement. Persons with developmental disabilities (DD) access the Comprehensive Service Waiver or the Support Services Waiver. CMS has directed Oregon SPD to correct two present situations that exist: Dual waiver -persons receiving residential, employment and other funded services from 2 waivers Dual service persons receiving residential and other funded services on one waiver they are not eligible for and having both a DD and APD case manager. 2. How does SPD want this change to happen? SPD is committed to have all stakeholders work together to: a) Jointly establish a local implementation strategy; b) Provide clear information to clients; c) Provide the full array of supports that are available under a DD waiver and identified as needed within the Plan of Care or Individual Support Plan (ISP); d) Continue to use chosen providers, whenever possible; e) Minimize disruption to present services; f) Allow everyone time to get to know one another and prioritize needs within required conditions and benefit levels. 3. Who is transferring now? Individuals already determined to have a developmental disability and presently on the Dual Waiver/Dual Service List distributed to local DSO/MSO/AAA and County DD Program (CDDP) offices. There are about 200 persons presently on the list. Persons under 65 will transfer. Persons over 65 have a choice of the APD or DD waivers. This list may include some individuals who have a documented developmental disability and have recently refused DD services and chosen APD services. 1

2 These individuals, if under the age of 65, must return to DD in order to receive essential case management and supports. 4. DD has 2 waivers and structures, what are they? Who goes where? Planning and referral always starts with the CDDP. (Contact lists are available) Individuals will than be referred and identified on a particular waiver and design of service. Comprehensive or Other County Services are those with annual plans of $20, 000 or more. Each individual s services are planned and arranged by a case manager who works through a County DD Program. At this time the County also provides supports to persons with lower cost annual plans, who will go to a Brokerage at a latter date. This includes four dual waivered individuals receiving DD 47 semi-independent Living Program (SILP) supports. Transfers to comprehensive and County services represent about 30% of the present list. OR Support Services assist a client to maintain at home and in their community in a manner that uses all resources available and at a cost less than $20,000 annually. Support Services are planned and arranged by a Personal Agent (PA) who works for a designated local Brokerage. Transfers to support services represent about 70% of the present list. Brokerage contact information is being made available to all stakeholders. 5. When will transitions happen for persons on the list? SPD expects the transitions will occur no latter than April 30, County DD staff will work to gather referral information on all clients and work on planning for persons transferring to the Comprehensive Waiver. Individuals transferring to Support Services and a Brokerage may transition earlier than April 30, 2004, if all necessary planning is completed. If early transition is possible, the enrollment date is on the 1st day of the month after all required steps are completed. This means if an SPD Foster payment ends on 2/28/04, the service agreement allowing payment of In home supports by the Brokerage (with customer approval) must be in place to begin 03/01/04. In any event, all transitions should be completed by April 30, Individuals transferring to DD County Services will end APD services on April 30 th and begin DD funded services on May 1 st 2

3 6. How do SPD partners get started in this transition process? AR outlines roles and responsibilities of partners. The local DSO/MSO/AAA representative is asked to host initial planning meetings. 1. Meet with the local DD Program Manager or their representative to identify total plan costs and determine the identified waiver for each individual. 2. Designate local staff from each of major partners to develop a strategy clearly identifying: Specific staff assignments; Parties responsible for contacting clients and families The number of new plans and agreements necessary per month in order to meet target dates; Questions and information needed; and Methods for monitoring how things are going. Tools available include: AR with Attachments on Roles and Responsibilities and Referral Packet Transfer Information Cheat Sheet Comparison of ADP and DD Waivers for Dual Waiver/Service Clients Only Recommended Steps In Planning For Dual Waiver Clients 7. Are Brokerages ready to start this process and will they be able to take some persons earlier than April 30 th or May 1 st? Local planning will determine a specific Brokerage s ability to respond before April 30 th. 8. How and when are effected clients and families notified? The State SPD Office will send an initial informational letter on February 9, This is not the formal required notification of waiver status and does not contain appeal and hearing rights. The local DSO/MSO/AAA must send formal notice with appeal and hearing rights at least 10 days prior to the actual date of closure of APD services. The State SPD Office will develop further information and guidance related to Administrative Hearings, Aid Paid Pending and Coding. 9. What should we do if the person gets the wrong letter? Discuss it with your local team and contact Nancy Herrin at or nancy.j.herrin@state.or.us. 10. What if the DSO/MSO/AAA or CDDP think there are more persons who may be MR/DD and should be considered for transfer? 3

4 These transitions will occur as a part of the on-going Plan of Care review. Local program managers are asked to contact Nancy Herrin or nancy.j.herrin@state.or.us if additional individuals are identified. They will help facilitate any necessary evaluation and assessment. If an individual is found eligible, local partners will work together to complete the appropriate transfer by the annual plan date. 11. What action should the DSO/MSO/AAA take if someone voluntarily leaves the APD waiver? Complete Form DHS 457D REVIEW OF SERVICES AND FUNDING AVAILABLE 12. How can we compare the services available on the APD Waiver and the DD waivers? Please see the Cheat Sheet Comparison of ADP and DD Waivers for Dual Waiver/Service Clients Only. 13. How do we determine if the person will receive comprehensive or support services? Planning and referral starts with the CDDP and the local DSO/MSO/AAA. Each partner has been asked to identify all on-going annual expenses. This task is essential. Based on the total of these 2 budgets and other criteria described in Question 4, the CDDP will identify the appropriate service waiver. 14. What level of funding and support will be available to individuals when they transfer? For the initial year or 365 days of Individual Support Plan (ISP) or Plan of Care, the client in Support Services will have access to a budget up to the present level of funding if that is: a) What is needed based on their plan; and b) What is available under the applicable DD waiver Some transferees to Support Services now have only a Relative Foster Care (RCF) payment of $700 a month. Since the basic benefit for Medicaid eligible customers of the DD Support Services waiver is up to $800 a month, if needed; these individuals may increase available funding. Persons in Comprehensive Services will have the total funds allocated at transfer (both DD and APD). No additional funds above they anount will be available for plan implementation. 4

5 15. What level of funding or benefit will be available to persons in Support Services after the first year following transfer? For all persons with developmental disabilities, the annual ISP process review services needs and resources. Title XIX and Medicaid eligible customers of Support Services are eligible for up to $9600 a year or up to $19,999 a year if there is documented evidence of extraordinary need. By May 1, 2005, or within 365 of transfer date for persons transitioning earlier, all Brokerage customers will be required to have plans within their established benefit levels Why are dual waiver persons in SILP remaining in County services and what is their benefit level? Any person receiving SILP services is not due to move to the Support Services waiver until next biennium. The APD level of funding will transfer to the county and may be designated for the individual and incorporated with special conditions into the DD 47 SILP program contract. CLIENT/CUSTOMER RIGHTS AND RESPONSIBILITIES 17. Does a person transferring have appeal and hearing rights? YES, these rights will be clearly identified in the formal notice sent by the DSO/MSO/AAA. An IM providing guidance to all Program Managers will be distributed before formal notice is required. 18. For persons now receiving APD funded Relative Foster Care (RFC), how will the responsibility of the customer/family change on the DD waiver? There are significant differences. With the assistance of a Personal Agent from a Brokerage or Case Manager from the CDDP, the individual and family must: Participate in the development of a new plan based on services available under the DD waiver; Develop job descriptions for in-home supports to be provided; Identify the paid care provider; Sign an agreement; Maintain records of work done; Identify a process for certifying the work done; and Address payment of taxes and Fiscal Intermediary services within the current plan amount. 19. Will payment methodologies change? 5

6 YES, in some instances. The best example may be in RFC (see previous question). Changes may occur in planning for services, providers, and timelines in which payment will be received. 20. If the parent is the legal guardian can they be paid to provide in-home supports? YES parents who are guardians can be paid to provide in-home supports. They cannot be paid for Personal Care Will the State provide additional tools to assist in talking about RFC? YES. A tool to help with conversion from RFC payments to in-home supports and allocating available funds for support, taxes and FI services will be distributed as soon as possible. 22. For persons now receiving APD funded In-Home Supports, will the customer s responsibility change? A LITTLE. The Case Manager or Personal Agent may be able to easily translate the Plan of Care into the ISP. The individual may continue to pay their present employee. The only change will be the need to budget and pay for Fiscal intermediary services (FI) for persons on the comprehensive waiver. 23. How will SPD address the Medicaid on-going financial eligibility requirements for the transferred individuals? SPD meets this federal requirement for all its clients. The DSO/MSO/AAA talk about client liability or pay in and use SDS Form 0450 as a Worksheet to determine the monthly contribution mailed to the state by a client. The County DD Program uses the state determination of the residential off-set and deduction to the provider payment for persons in residential settings. The Brokerage completes a Resource Analysis and identifies the amount of the plan that is the responsibility of the customer. The DD systems will use the information from the Client Liability Worksheet provided by the DSO/MSO/AAA to identify the amount of the plan that is the responsibility of the customer. Training and orientation will be provided to Personal Agents and Case Managers. PROVIDER OR FAMILY CERTIFICATION ISSUES 24. How are we going to deal with Criminal History Checks (CHC)? Current people providing services funded through the APD waiver have already completed a CHC. This will be accepted in the transfer. All DSO/MSO/AAA staff is asked to copy relevant material and include it in the Referral Packet. 6

7 25. What qualifications must be met for approved provision of In- home supports for DD clients? Individuals chosen are employees of or independent contractors hired by the client. They must meet the requirements in related Oregon Administrative Rules OAR through addresses provider and employee standards for In-Home Supports for Adults with DD-Comprehensive. OAR through identifies similar standards for providers of Support Services for Adults with DD. Check lists summarizing these standards are available to PAs and Case Managers in Section XV and Appendix 1 of the Support Service and Self-Directed Supports Guidebooks. 26. Does this mean that present Home Care Workers will not receive benefits if they choose to work for persons with DD? The contract for Home Care Workers applies only to the client employed provider program, supporting seniors and people with physical disabilities. A home care worker hired by a person with developmental disability and paid using either a fiscal intermediary or county system will not be covered under the bargaining agreement. 27. Are there any vendors now being used that may require DD certification prior to May 1, 2004 for continuation of services? PERHAPS. This will depend on the information secured from the DSO/MSO/AAA. Any site based Adult Day Care setting that may be used for respite, community inclusion, or day habilitation will require DD certification and a visit by the Licensing Unit. If this situation is identified, please contact Molly Holsapple ASAP or molly.s.holsapple@state.or.us so that a coordinated plan to facilitate provider preparation and certification can be initiated. 28. Can the DD system use a provider certified for use by persons under the APD waiver? A foster home may be able to be accessed since it is funded on the DD comprehensive waiver, but only if DD funds are identified and available. An Assisted Living site could not be used because it is not a fundable service on a DD waiver. DD SERVICE ISSUES 29. Do persons living where there is more than one Brokerage have a choice about where they get service? 7

8 YES. In a few counties (Marion, Multnomah and Clackamas) there is more than one available Brokerage. This referral process will be handled, as have others. Local partners will work together to determine how to support choice within the established contracted service levels. 30. Is this like the Voc Only transfer to the Brokerages that was just completed? YES and NO. YES it is the same Same goals and values Same 365 day maintenance of present benefit levels if in Support Services Same need to develop both ISP and Provider organization service agreements Same rules about persons transferring with a voc slot (rates, keeping slot amounts etc) Same must have authorized plan at time of transfer NO it is not the same This is not a plan translation, Present APD Plans of Care may offer services not available through DD or may need revision to meet waiver requirements. Development of new ISP with goals, priorities, plan, and resource analysis. 31. Must all funds for persons transferred into comprehensive service be in DD 49? NO. There is no need to move funds more than necessary. 1. For persons in comprehensive service, the designated APD funds will be placed in DD 49. If an individual already has funds in DD 54 (voc) or DD 53 (transportation, there is no need to move these monies. 2. For persons in DD 47 SILP services, the designated transferred APD funds will be added to this service element. If you have any questions contact Nancy Herrin at or nancy.j.herrin@state.or.us. 32. What services and funding must be shown on the ISP done by the Case Manager or Personal Agent? The plan should reflect all services needed by and provided to the individual including those through DD (DD 49, DD 54, DD 53), paid for by the client, or the result of natural supports. 8

9 33. Who is responsible for CPMS changes? The CDDP 9