Navigating the Service System

1. Navigating the Service System

2. Introductions • What would you like to cover today?

3. The Arc of Virginia • 26 local chapters in the Commonwealth • Non-profit • Promote and protect human rights • Support full inclusion

4. Department of Justice Settlement Agreement • Waiver slots, IFSP • Crisis Services • Employment • Community Living • Regional Support Teams, Community Resource Consultants, community Integration Managers • Discharge Planning • Quality, Risk Management • Transition to Community Based System • Independent Reviewer

5. New Virginia Way Ensures all people with ID/DD has access to truly integrated community based services. Emphasizes and promotes competitive employment, integrated housing, meaningful relationships and community inclusion. Demonstrates a strong commitment to safety, quality and protection of human rights. Embraces the principles of self determination, helping people with ID/DD have freedom, authority and control over their own lives.

6. What You Can Do • Tell your story • Budget Priorities • General Assembly letter writing • Stay Connected • Join The Arc

7. The Infant and Toddler Connection of Virginia • The Department of Behavioral Health and Developmental Services has served as the lead agency since the initial implementation of Part C in 1987.

8. Purpose of Early Intervention To partner with families in supporting the development of their children in the context of daily routines and activities.

9. Virginia’s Early Intervention System Serves familieswith infants and toddlers birth-3 Eligibility: • Developmental Delay • Diagnosed Condition • Atypical Development

10. Child is referred to the Central Directory or to the local Part C System’s single point of entry. • Referrals can be made by parents, family members, physicians, clinics, other agencies, etc. • Central Directory Number is 1-800-234-1448. • Local Systems’ Information: www.infantva.org.

11. Understanding your Private Health Insurance • Read a copy of your policy. • Children can not be excluded.

12. Type of Plan • Fee for Service • Managed Care Plan HMO PPO POS

13. Individual or Group Plan • Group Plan • Individual Plan

14. If You Have a Group Plan… • Fully Insured • Self Insured

15. Transitioning to School - Minimizing The Problems • Begin early. • Talk about the new setting in a positive way. • Encourage the child to ask questions and express fears. • www.imdetermined.org/

16. School • Pre-school • IEP • Transition

17. Name: Address: DOB: Date: • My Strengths • My Interests • My Preferences • My Needs

19. What Am I Doing Here? • As parents of children with disabilities, developmental delays, we will be members of many teams throughout our children’s lives. These teams include: • the ones to provide medical services to our child • the early intervention Individualized Family Service Plan (IFSP) team and later • a school’s Individualized Education Program (IEP) team.

20. speaking on behalf of your child and family. • Use family stories, pictures and your own positive attitude and ideas to set the tone for the meeting. • Do whatever it takes to help the other team members see your child as you do.

21. Who is the expert? • Learn about everything the system offers and is required to offer • Define the goals • Respect • Trust • Communication • Choose your battles • Emotion • Keep it in perspective

22. Medicaid Waivers Waivers give States the flexibility to develop and implement alternatives to institutionalization.

23. Waivers Must be Cost Effective

24. Providing Waiver Services Consumer Directed or Agency Directed Who? When? Where? How?

25. Getting Started Employer of Record Over Seeing Employees Service Facilitator

26. Waiver Eligibility Process • Screening (no cost) • “At risk” of being placed in an institutional setting • Financial eligibility - $2,000 resource limit process

27. There are Six Waivers Administered by the Commonwealth of Virginia • Elderly or Disabled with Consumer Direction (EDCD) • Individual and Family Developmental Disabilities Supports (IFDDS) • Technology Assisted (Tech) • Intellectual Disability Waiver (ID) • Day Support • Alzheimer’s Assisted Living (AAL) Waiver managed by the Facility and Home-Based Care Unit

28. Reviewing Today: • Elderly or Disabled with Consumer Direction Waiver (EDCD) • Individual and Families with Developmental Disabilities Waiver (DD) • Intellectual Disability Waiver (ID)

29. Elderly or Disabled with Consumer Direction Waiver • Medical Need • No waiting list • Can receive EDCD Waiver and be on the waiting list for another waiver

30. Screening

31. Focus on the Challenges

32. Examples • Functional Capacity: bathing, dressing, toileting, transferring, eating/feeding • Medical and nursing needs: catheter care, supervision for adequate nutrition and hydration, therapeutic exercise and positioning, management of those with sensory, metabolic, or circulatory impairment.

33. Getting Started • Fill out the Medicaid application and return to the Department of Social Services. • Put “EDCD Waiver” at the top of your completed Medicaid application. • Include the Child’s information only on the application!

34. Services • Adult Day Health Care • Personal Care* (agency or consumer directed) • Respite* (agency or consumer directed) • Personal Emergency Response System (PERS) • Transition Services ($5000 max) • Transition Coordination

35. Individual and Family Developmental Disability Supports Waiver • Waiting list –new slots July 2013 - 130 • DMAS oversees this waiver • Must be 6 to be placed on the waiting list • May not have a diagnosis of intellectual disability • The Level of Functioning (LOF) screening tool

36. Screening • Level of Functioning (LOF) Survey which is the assessment instrument used to determine eligibility to for an ICF/MR • Request for Screening • www.dmas.virginia.gov

37. RELATED CONDITIONSalso referred to as developmental disability • Severe chronic disability • Attributable to a condition, other than mental illness • Manifested before the age of 22 • Likely to continue indefinitely • Results in substantial limitations in 3 or more areas of major life activity • Self-care • Understanding and use of language • Learning • Mobility • Self-direction • Capacity for independent living

38. Transitioning from ID to DD Waiver • Annually each child receiving ID Waiver services who will be 6 years of age the following year can be up for consideration for transfer to the DD Waiver. • If the child meets DD Waiver eligibility the child can transition to the DD Waiver.

39. Services • Therapeutic Consultation • PERS – Personal Emergency • Response System • Family/caregiver training • (80 hours a year) • Respite care* (CD & Agency) • Personal care services(CD or Agency) • MFP Transition Services ($5000) • Adult Companion (CD & Agency) • Assistive Technology ($5000) • Crisis Stabilization • Environmental Modifications ($5000) • In-home Residential • Prevocational and Day Support • Skilled Nursing • Supported Employment

40. Intellectual Disability Waiver (ID) • Waiting List –June 30th – 6,672 • 575 new slots – July 1st • Contact your local Community Services Board for screening - LOF

41. Eligibility • Individuals must have an evaluation that reflects their current level of intellectual and adaptive functioning. • Six and over – a psychological evaluation with a diagnosis as having an intellectual disability. • Six and under – either a psychological or standardized developmental evaluation that states the child has a diagnosis of intellectual disability or is at developmental risk.

42. Waiting List • Urgent • Non-Urgent

43. ID WAIVER WAITING LISTS • CSB’s and DBHDS maintain Urgent and Non-Urgent lists • CSB provides individual with written notice if placed on a waiting list and if there is a change in status to another list • Only after all Urgent needs are met statewide will Non-urgent needs be served • Slot moves with you to a different town in VA, not out of the state. • Non-urgent = meet criteria for the ID Waiver, including needing services within 30 days, but don’t meet Urgent criteria.

44. Urgent Criteria for the ID Waiver • Primary caregivers are both 55 yrs. or older (or if 1, is 55 or older) • Living with a primary caregiver who is providing the service voluntarily and without pay and they can’t continue care • There is a clear risk of abuse, neglect, or exploitation • Primary caregiver has chronic or long term physical or psychiatric condition significantly limiting ability to provide care

45. Individual is aging out of a publicly funded residential placement or otherwise becoming homeless • Individual lives with the primary caregiver and there is a risk to the health or safety of the individual, primary caregiver, or other individual living in the home because: • Individual’s behavior presents a risk to himself or others OR physical care or medical needs cannot be managed by the primary caregiver even with generic or specialized support arranged or provided by the CSB.

46. Services • Adult Companion Care (CD & Agency) • Assistive Technology ($5000) • Crisis Stabilization • Day Support and Prevocational services • Environmental Modifications ($5000) • Residential Support (Individual’s home or group home) • PERS – Personal Emergency Response System • Personal Care* • (Agency or Consumer Directed) • Skilled Nursing • Respite Care* • (CD & Agency) • Therapeutic Consultation • Supported Employment • MFP Transition Services ($5000)

48. Early, Periodic Screening, Diagnosis, and Treatment (EPSDT) Medicaid benefits available to children under the age of 21 Must be eligible for Medicaid  Monitor to prevent health and disability conditions from occurring or worsening, including services to address such conditions  Treatment to “correct or ameliorate conditions,” including maintenance services

49. EPSDT • Immunizations • Check ups and lab tests • Mental health assessment and treatment • Health education • Eye exams and glasses • Hearing exams and hearing aids & implants • Dental services • Personal care, nursing services • Other needed services, treatment and measures for physical and mental illnesses & conditions

50. HIPP • Application must be completed separately from the Medicaid application. • 1-800-432-5924