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DD Waiver Provider Training

Department of Medical Assistance Services. DD Waiver Provider Training. Department of Medical Assistance Services Division of Long-Term Care 2013. http://dmasva.dmas.virginia.gov. 1. Today’s Training Goal.

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DD Waiver Provider Training

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  1. Department of Medical Assistance Services DD Waiver Provider Training Department of Medical Assistance Services Division of Long-Term Care 2013 http://dmasva.dmas.virginia.gov 1

  2. Today’s Training Goal • To enhance the knowledge of Direct Services Providers in areas of service provision, documentation, utilization review and billing procedures, and to provide updates on the current status of the Individual and Families Developmental Disabilities Support Waiver

  3. Crisis Stabilization Services

  4. Service Definition • Crisis stabilization is direct intervention to persons with developmental disabilities who are experiencing serious psychiatric or behavioral problems, or both, that jeopardize their current community living situation.

  5. Service Definition (cont.) • Must provide temporary intensive services and supports to prevent emergency psychiatric hospitalization, institutional placement, or other out-of-home placement • Must be designed to stabilize individuals and strengthen current living situations so individuals can be maintained in community during and beyond crisis period.

  6. Service Definition (cont.) • Services shall be designed to stabilize consumers and strengthen current living situations so individuals can be maintained in community during and beyond crisis period.

  7. Crisis Stabilization Services Shall Provide: 1. Psychiatric, neuro-psychological, psychological, functional assessments, and stabilization 2. Medication management and monitoring 3. Behavior assessment and support; and, 4. Intensive care coordination with other agencies and providers

  8. Crisis Stabilization Goals 1. Planning and delivery of services and supports to maintain community placement 2. Training of family members and other caregivers and service providers in positive behavioral supports to maintain individual in community; and 3. Temporary crisis supervision to ensure safety of individual and others.

  9. Assessment of Need Individual must meet at least one of the following criteria: • Marked reduction in psychiatric, adaptive, or behavioral functioning; • Extreme increase in emotional distress; • Need for continuous intervention to maintain stability; or • Causing harm to self or others.

  10. Assessment of Need (cont.) The individual must be at risk of at least one of the following: • Psychiatric hospitalization; • Emergency ICF/MR placement; • Disruption of community status (living arrangement, day placement, or school); or • Causing harm to self or to others

  11. Authorization • A documented face to face assessment conducted by a qualified mental health professional must occur prior to authorization. • Supporting documentation (DMAS 457) based on this assessment must be developed and submitted to the case manager within 72 hours for authorization to occur.

  12. Allowable Settings for Crisis Stabilization Services • Individual’s home • Day program • Respite care setting

  13. Crisis Supervision • May be provided as a component of this service only if clinical or behavioral interventions allowed under this service are also provided during the authorized period. • If provided during the authorized period as a component, it is billed in hourly service units.

  14. Service Limitations • Crisis stabilization may not be used for continuous long term care. • Room and board and general supervision are not components of this service. • Service can be provided no more than 60 days in a calendar year.

  15. Service Units • Service is billed in hourly service units and can be authorized for a time period of up to 15-days. • Actual service units per episode based on documented clinical needs of individual receiving services.

  16. Service Units • Extension of services, beyond 15-day limit period, must be authorized following documented face-to-face reassessment conducted by qualified professional.

  17. Provider Documentation Requirements: • The Case Manager gives the provider the following information: • DMAS-225 • DMAS-456 and DMAS-457 • Any relevant evaluations, therapeutic consults or MD evaluations relevant to developing plan of care

  18. Provider Documentation Requirements (cont.) The provider must keep individual records including the following information: • Information provided by Case Manager • Supporting documentation (DMAS 457) developed by provider • Dates and times of crisis stabilization services and amount and type of service provided

  19. Provider Documentation Requirements (cont.) • Documentation of staff qualifications must be maintained for review by DMAS.

  20. Thank You For Coming! • We look forward to partnering with you to provide services to our DD Waiver beneficiaries • Any Questions? Please Ask

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