The DMH Division of Developmental Disabilities Difference Wanda Russell Division Provider Relations Lead.

The DMH Division of Developmental

Disabilities DifferenceWanda Russell

Division Provider Relations Lead

Purpose

Provide prospective agencies with knowledge of Division of DD processes and provide

informationessential to a successful partnership with Division

of DD,individuals, families, and stakeholders.

Overview• Division Mission• Division Structure• Eligibility • Utilization Review• Division Funding Sources• Home and Community Based Services Final Rule• Services • Certification • Provider Staff and P&P• Applying for a contract• Contract Implementation

Priorities

Division StructureCentral Office5 Regional Offices and 6 Satellite Offices

Individual and Family SupportsIntake/EligibilityUtilization Review CoordinatorBehavior Resource TeamQuality Enhancement Provider RelationsInquiry CoordinatorBusiness Office

EligibilityRegional Office determines eligibility (9 CSR 45-2.010)Individual must have a developmental disabilityDevelopmental disability must have occurred prior to age 22To be eligible for services from the Division, persons with these disabilities must be substantially limited in their ability to function independently.If found eligible, the individual is assigned a Support Coordinator (SC).

Eligibility for WaiverIndividual found eligible for DD servicesDevelopmental disability is likely to continue indefinitelyResults in substantial limitations in 3 or more areas

Self-CareCommunicationLearning, MobilitySelf-DirectionCapacity for independent living plus need for the level of care provided in an ICF/ID

In addition, a determination must be made that the individual is at risk of needing ICF/ID institutional services if unable to access waiver services. Individual may not reside in ICFs/ID or other MO HealthNet-funded nursing facilities (ICF’s) unless person has a transition plan to move into the community

Utilization Review9 CSR 45-2.017 A formal committee established at each regional office or at an SB40 Board to review PON assessments, proposed service plans and budgets.Makes recommendations utilizing the PON and attached documentation before services are approved and authorized.Review of new services or increasing the dollar amount of services.Applicable Medicaid State Plan services shall be accessed first when the individual is Medicaid-eligible and the services will meet the individual’s needs.Service may be approved, denied, or placed on a wait list.No service may start until UR approval and authorization is received.

Division Funding SourcesPurchase of ServiceShared UnitWaiver

ComprehensiveSupport PartnershipAutismMissouri Children with DD (MOCDD or Sarah Jian Lopez)

Home and Community Based Services

CMS has published a final rule that supports what we have learned over time about individuals served in the HCB waivers

The final rule includes where and how services are to be provided offering definitions and descriptions in detail for the first time. States are required to develop a plan for how they will make sure the definitions and descriptions in their waivers match the definitions in the final rule.

Effective March 17, 2014

Final HCBS RuleSetting Requirements

42 CFR 441.30(c)(4) and 441.710

HCBS Rule requires that an HCB Waiver Service setting:

Is fully integrated in and supports access to the greater community

Provides opportunities to seek employment and work in competitive integrated settings, engage in community life, and control personal resources

Ensures the individual receives services in the community to the same degree of access as individuals not receiving Medicaid home and community based services

Is selected by the individual from more than one setting option, including non-disability specific settings and an option for a private room in a residential setting

Final HCBS RuleSetting Requirements

42 CFR 441.30(c)(4) and 441.710

Supports individual choice of services and supports

Ensures privacy, dignity, respect, and freedom from coercion and restraint

Optimizes individual initiative, autonomy, and independence in making life choices

Facilitates individual choice regarding services and supports and who provides them

Final HCBS RuleSettings Requirements

Settings presumed not to be HCB (Heightened Scrutiny)

Settings in a publicly or privately-owned facility providing inpatient treatment

Settings on the grounds of, or adjacent to, a public institution

Settings with the effect of isolating individuals from the broader community of individuals not receiving Medicaid HCB services

Transition Plan

Assessment ComponentDetermines whether transition actions are needed for compliance, states must determine their current level of compliance with the settings requirements

Provider surveysSettings analysisCrosswalk of final rule to waiver

A description of the state’s oversight process to ensure continuous complianceAssess individual settings/types of settings to further document compliance

ServicesAssistive Technology Behavior Analysis Service Communication Skills Instruction Community Employment Community Specialist Community TransitionCounseling Crisis Intervention DentalEnvironmental Accessibility Adapt. Group Home Host Home In Home Respite

Independent Living Skills Dvlpmnt Day Hab, CI, In HomeIndividualized Supported LivingJob Discovery Job Preparation Occupational Therapy Out of Home Respite Personal Assistant Physical Therapy Professional Assessment & Monitoring Specialized Medical & Supplies Speech Therapy Support Broker (Self-Directed Service)Transportation

Certification The following services require Certification or Accreditation

Independent Living Skills DevelopmentCommunity Employment, Job Preparation and DiscoveryAll residential services

Provisional initially for 6 months, full Certification occurs every two yearsCertification is provided by the State at no cost to the agency and is based on health and safety

Provider Staff and P&PMust have a Professional Manager

A four year degree or relevant field experienceEach service definition lines out required qualifications and trainings for staff

Direct Care staff typical training18 years old, High School Diploma or GEDCPR, First Aide, Medication Administration, MANDT, Abuse and Neglect, PCS, ISP

Policies and ProceduresDHSS policies and expectations do not equal to Division of DD policies

Why Apply for a Contract?

Many individuals and families receive services from state plan and from the DivisionDual contracted providers have the opportunity to offer continuity of staff over services to the entire family

Applying for a ContractProvider Enrollment

Review Division Directivehttp://dmh.mo.gov/docs/dd/directives/5060.pdf

Review standardized statewide application and frequently asked questions

http://dmh.mo.gov/docs/dd/faqpursuingcontract.pdf

Contact your local Regional Office Provider Relations TeamComplete application and all requirements, submit to the Regional Office Provider Relations Team

Contract ImplementationSupport Coordination (SC) entities will be notified that the agency contract is available for useSC’s must provide individuals with choice

Having a contract does not guarantee authorization of services

Use of Referral Database for residential servicesSubsequent to providing services, all staff must be trained according to service definitions

Contract ImplementationTCM MonitoringProvider Relations Review every three years

http://dmh.mo.gov/docs/dd/directives/4090.pdf

Quality Enhancement Review every three years http://dmh.mo.gov/docs/dd/directives/3100.pdf

Certification every 2 years or Accreditation visit based on granted yearsFiscal Reviews from the Regional Office for POS FundingMMAC Reviews

Contract ImplementationAs a result of any single or combined reviews on the previous slide, or from other information sources, Integrating Quality Functions Directive may be implemented

Proscribes the systematic process for integrating and synthesizing information from all Quality Functions. The information is used to evaluate the performance of the service delivery system, remediate identified issues, and develop systems improvements in partnership with contracted providers.http://dmh.mo.gov/docs/dd/directives/4080.pdf

ReviewDivision MissionDivision StructureEligibility Utilization ReviewDivision Funding SourcesHome and Community Based Services RuleServices CertificationProvider Staff and P&PApplying for a contractContract Implementation