HCBS Waiver Training

1. HCBS Waiver Training

2. Objective To gain basic knowledge of the HCBS Waiver services and the waiver like program called Habilitation: • History • Philosophy • Waivers

3. Why do we call it “waiver”? • From 5 months to 3 years-old, Katie Beckett lived in a Cedar Rapids, IA hospital due to an infection that made a ventilator necessary. Medicaid would only pay for the expensive treatment if she stayed in the hospital. • In 1981 President Reagan was contacted by Katie’s parents and after hearing about Katie’s situation he changed the law so that Katie and others like her could receive the care they needed at home. This change resulted in care costing 1/6 of the cost of hospital care. • This change was known as “The Katie Beckett Waiver” and allowed all children with disabilities to receive Medicaid supports in their homes instead of being forced to remain hospitalized.

4. Because of the waiver program, Katie was able to live in her own apartment, go to college and was hoping to obtain her teaching certifi-cate. • Katie Beckett died on May 18, 2012 of complications of her illness. The impact of her life will forever change the lives of others….

5. The OLMSTEAD Act In Olmstead v. L.C., the Supreme Court construed Title II of the Americans with Disabilities Act (ADA) to require states to place qualified individuals with mental disabilities in community settings, rather than in institutions, whenever treatment professionals determine that such placement is appropriate, the affected persons do not oppose such placement, and the state can reasonable accommodate the placement, taking into account the resources available to the state and the needs of others with disabilities. The Department of Justice regulations implementing Title II of the ADA require public entities to administer their services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities.

6. The OLMSTEAD Act • In Olmstead, the Supreme Court stated that institutional placements of people with disabilities who can live in, and benefit from, community settings perpetuatesthe unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life. The Supreme Court state that "recognition and unjustified institutional isolation of person with disabilities is a form of discrimination reflect[ed] two evident judgements": 1) "Institutional placements of people with disabilities who can live in, and benefit from, community settings perpetuates the unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life"; and 2) "confinement in an institution severely diminishes everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment." Olmstead, 119 S.Ct. 2176, 2179, 2187

7. Philosophy Every individual has value and dignity, and DAC, Inc. exists to enhance this dignity, self-esteem and worth of each individual and his/her right to self-determination as a member of the community.

8. How does a Medicaid Waiver Work? • A person eligible for a Medicaid waiver “waives” his/her entitlement to receive services in an institution. • The type of waiver is determined by diagnosis (for example: intellectual, mental health, or physical disability) • Approximately 2/3 of the cost of waiver services is covered by the Federal Government and 1/3 of the cost of waiver services is covered by the county or the state.

9. Waivers Are • Based on a philosophy of • Individual Choice • Individual Rights and Dignity • Alternatives to institutionalization • Intended to keep individuals in their own home and community • Designed specifically for each individual based on their needs • For all ages

10. Waivers Are Not • Group homes • Residential facilities • Daycare • Academic education • Emergency services • Replacement of parental responsibility • Cadillac services • End all / Be all

11. Iowa’s Medicaid Waivers DAC, Inc provides services to people under these Iowa Medicaid waivers: Intellectual Disability Habilitation Brain Injury _______________________________________________________________________ DAC, Inc currently does not provide services to people under these waivers: Physical Disability Children’s Mental Health Health and Disability Aids/HIV Elderly

12. Common Service Elements INDIVIDUAL PLANNING • All individuals who receive waiver services and supports have a Personal Outcome Plan (POP). • Plans include important information about • Goals the individual wants to works towards • Steps to take to reach the goal • Supports needed to remain in the most integrated environment possible.

13. Common Service Elements • The Interdisciplinary Team is made up of…….. • The Individual • The Case Manager • The Service provider(s) • The Guardian (if applicable) • Other people chosen by the individual • The team supports the individual in making decisions. • The individual has the right and responsibility of voicing their hopes, dreams, wants and needs.

14. Common Service Elements • SERVICE COORDINATION • A case manager/service worker is there to help plan for and get the services and supports needed. • The Person Centered Approach assures the individual is: • Respected • Valued • An Equal partner

15. Common Service Elements QUALITY ASSURANCE • It is important to make sure that people are satisfied with the services and supports they receive. This is reviewed and measured through: • Satisfaction surveys • Complaints and/or Grievances • Participant Experience Surveys (PES) • The State must also assure that HCBS waiver funds (Medicaid) are used appropriately and in a fashion that meets federal and state requirements.

16. Difference Among the Waivers • Eligibility requirements • Availability • Target populations • Level of care requirements • Caps on dollar amounts available • Menu of services available

17. Intellectual Disability (ID) Waiver ServicesDacservices are underlined • Adult Day Care • Personal Emergency • CDAC • Prevocational • Day Habilitation • Respite • Home & Vehicle Mod • Supported Community Living (SCL) • Interim Medical Monitoring & Treatment (IMMT) • Supported Employment (SE) • Nursing • Home Health Aide • Transportation

18. Habilitation (Hab) Services(Chronic Mental Illness) • Day Habilitation • Home Based Habilitation (HBH) • Prevocational • Supported Employment (SE)

19. Brain Injury(BI) Waiver Services • Adult Day Care • Behavioral Programming • CDAC • Family Counseling • Home & Vehicle Modification • IMMT • Transportation • Personal Emergency Response • Prevocational Services • Respite • Specialized Medical Equipment • Supported Community Living (SCL) • Supported Employment (SE)

20. Physical Disability (PD) Waiver • Must be at least 18 but less than 65 years of age • Individual Directed Attendant Care • Home & Vehicle Modification • Personal Emergency Response • Specialized Medical Equipment • Transportation

21. Children's Mental Health Waiver (CMH) • Children with a diagnosis of a serious emotional disturbance • Environmental Modifications & Adaptive Devices • Family & Community Support Services • In Home Family Therapy • Respite

22. Health and Disability Waiver • Adult Day Care • Homemaker • CDAC • IMMT • Counseling • Nursing • Home & Vehicle Modification • Nutritional Counseling • Personal Emergency Response • Home Delivered Meals • Home Health Aide • Respite

23. AIDS/HIV Waiver • Adult Day Care • individual Directed Attendant Care • Counseling Services • Home Delivered Meals • Home Health Aide • Homemaker • Nursing • Respite

24. Elderly (EW) Waiver 65+ • Adult Day Care • Assistive Devices • Case Management • Chore • CDAC • Home & Vehicle Modification • Home Delivered Meals • Home Health Aide • Homemaker • Mental Health Outreach • Nursing • Nutritional Counseling • Personal Emergency Response • Respite • Senior Companion • Transportation

25. Waiver Stakeholders DAC, Inc.

26. The individual’s Role • Exercise control • Learn and understand his or her rights and responsibilities • Actively participate in their plan • Right to refuse and/or change services or service provision

27. The Case Manager’s Role • Act as advocate • Facilitate the individual’s access to the service system • Promote self-determination • Emphasize and promote individualism • Coordinate services with other providers • Ongoing communication • Request information • Help providers • Monitor service utilization

28. The Provider/DSP’s Role • Develop and carry out service provision based on the plan developed by the individual with his/her team • Communicate with all team members about all changes in service provision, limitations of rights, or other concerns regarding the individual • Advocate for the individual’s right to live in the most integrated – least restrictive environment • Provide for the safety of the individual with the LEAST amount of intrusion as possible

29. Plan Implementation Plans should reflect: • Individualism • Self-determination • Inclusion • Least restrictive environment • Quality • Safety

30. Plan Implementation • It is important that direct support professionals are: • Flexible • Remember you are working in the individual’s home – not a group home! • Provide individualized supports to individuals • Use the approach that works best for each individual. No two people are ever exactly alike! • Direct support professionals also need to provide services according to the agency philosophy.

31. Resources • http://www.npr.org/blogs/health/2012/05/21/153202340/katie-beckett-defied-the-odds-helped-other-disabled-kids-live-longer • http://www.worksupport.com/resources/printView.cfm/376 • http://parenting.blogs.nytimes.com/2012/06/06/because-of-katie-children-with-severe-disabilities-can-live-at-home/ • http://www.ime.state.ia.us/docs/HCBSbrochure102606.pdf