Transcript Department of Health Services Bureau of Long

SW 644: Issues in Developmental Disabilities
Supports for Children with Long-Term Support Needs
Julie Bryda, MSSW
Alice Thorson, MSSW
Department of Health Services,
Bureau of Long-Term Support, Children’s Section
Department of Health Services
Bureau of Long-Term Supports
Overview of Supports for Children
with Long-Term Support Needs
Funding Options for Children
 Medicaid card
 Katie Beckett Program
 Birth to 3 Program
 Family Support Program
 CLTS waivers
Eligibility Process
Functional Screen is used to determine a
child’s “level of care”
Child’s disability must result in a substantial functional limitation
in three or more of the following five areas:
a. Self care
b. Receptive or expressive language
c. Learning
d. Mobility
e. Self direction
Functional Screen
Determines eligibility for:
 Family Support Program
 Katie Beckett Program
(MA Eligibility)
 CLTS Waivers
 Community Options
Program
 CCS Services
 Mental Health Wrap
Around Services
Does not determine for:
 Birth to 3 Program
 Special Education
Services
 Regional Children with
Special Health
Care Needs
Centers
Medicaid Card
Ways to access a Medicaid card:
• Healthy Start, SSI, Badger Care, Katie
Beckett Program
• Services must meet the definition of
Medical Necessity
• Some services require Prior Authorization
Which Program?
If a child is eligible for multiple programs and
meets multiple levels of care the county needs to
determine which target group, programs, and
services are most appropriate to meet the needs
of the child. The county will utilize the program
most appropriate to the child’s need.
The Katie Beckett
Program
The Katie Beckett Program
 Special Medicaid eligibility for children
under 19 years old with long-term
disabilities or complex medical needs,
living at home with their families
 Must meet Level of Care for DD, PD or
SED
 Disability determination required
The Katie Beckett Program
 Child’s income/assets within current MA
guidelines
 Does not incur a cost at home to the
Medicaid Program that exceeds the
potential institutional cost
 Approximately 5100 children currently
enrolled
The Family Support Program
The Family Support Program
 Founded on belief that parents of children with
severe disabilities know best what they need
 Individual services and supports to families with a
child with severe disabilities
 Offers information and help in finding services,
maximizing community resources, connecting
families with other families to strengthen natural
supports
The Family Support
Program
Provides flexible funding for up to
$3,000 per year per eligible child
Can help fill gaps of other programs by
funding needed services & goods
that can’t be obtained through other
sources
Average FSP allocation $1,500
Children’s Long Term
Support Waivers
CLTS Waivers
There are three CLTS Waivers:
 Developmental Disabilities (DD)
 Severe Emotional Disturbance (SED)
 Physical Disabilities (PD)
CLTS Waiver Eligibility
 Waiver eligible level of care for appropriate target
group
 DD, PD, or SED
 For state matched slots, Disability Determination
by Disability Determination Bureau (DHS)
 Resides in eligible setting
 Meets any applicable residency requirements
 Financial Eligibility
 Determined to have need for waiver services
 Additional criteria for Intensive In-Home Autism
Treatment services
CLTS Waiver Funding
Different ways for a child to receive funding
through the CLTS Waivers:
 Local match (local dollars)
 Family Support Program
 Community Options Program
 State match
CLTS Waiver Services
 Specific Services are based on
individual need
 Experimental or Aversive
Services will not be funded
CLTS Waiver Services
 Adaptive Aids
 Child Care & Foster Care Services
 only supplemental costs related to meeting
additional needs for the child’s disability are eligible
to be covered
 Communication Aids
 Consumer and Family-Directed Supports
 Consumer Education and Training
 Counseling and Therapeutic Resources
 Daily Living Skills Training
 Day Services
CLTS Waiver Services (continued)
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Home Modifications
Intensive In-Home Autism Treatment Services
Personal Emergency Response Systems
Respite Care
Specialized Medical and Therapeutic Supplies
Specialized Transportation
Support and Service Coordination
Supported Employment
Supportive Home Care
HISTORY OF CHILDREN’S
LONG TERM SUPPORT
WAIVERS
What is a Waiver?
 The Medicaid Home and Community Based Waiver
(HCBW) programs were authorized by Congress in
1981, and began in Wisconsin in 1983 with the
Community Integration Program for the adult population
 The Medicaid waivers represented a significant step,
taken to mitigate the Medicaid program’s institutional
bias that had led to the extensive development and
utilization of nursing homes and Intermediate Care
Facilities for the Mentally Retarded (ICF-MR),
 Recognizing the problem, Wisconsin had taken its own
steps to reverse the trend toward institutionalization with
the creation of numerous waiver programs
HISTORY OF CLTS Waivers
 There are three CLTS Waivers, one waiver for
children with:
 Developmental Disabilities (DD)
 Severe Emotional Disturbance (SED)
 Physical Disabilities (PD)
 The CLTS Waivers started Jan. 1, 2004
 Children are eligible up to age 22 in nonFamily Care Counties and age 18 in Family
Care Counties
History of CLTS Waivers
 1997 CLTS Redesign
 Review what is working well with the current
system and the issues that need to be
addressed
 Recommend Best Options about how long-term
care services for children should be designed
and managed
 The Children’s Waivers were approved by the
federal Centers for Medicare and Medicaid
Services (CMS) under the Medicaid rules that
permit states to flexibly use Medicaid funds for
community supports and services.
Why CLTS Waivers?
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Other HCBS Waivers written for adults
CLTS Waivers maximize match options
for state funded programs (Family
Support Program, Community Options
Program)
Flexible and family-directed
Provide services beyond what Medicaid
fee for service can supply
County Responsibilities
 On September 15, 2006 the Department of Health and
Family Services (DHFS) released DDES Memo 2006-21
directing the counties to implement the CLTS Waivers.
 http://dhfs.wisconsin.gov/dsl_info/NumberedMemos/DDES/CY2006/NMemo200621.htm
 Every county is required to implement operation of all
three CLTS Waivers. The CLTS Waivers must be
operated statewide for all target groups per federal
HCBSW requirements. A county may choose to have
different county departments administer different target
groups for the CLTS Waivers, or may choose to contract
with another county to offer services for a particular
target group.
County Responsibilities
 For children from any target group whose families contact
the county for long-term support services, the county must
assess the child's eligibility for services under the CLTS
Waivers or other relevant programs including the Family
Support and Community Options Program.
 If the child is eligible for the CLTS Waiver for any target
group, but funding is not available for a slot, the county
must create and maintain a waiting list of those children.
The county agency does not need to complete a
comprehensive assessment until such time that funding is
available. This waiting list may be maintained concurrently
with the Family Support or Community Options Program
wait lists. All policies regarding HCBSW waiting lists may
be found in the DHFS Interim HCBS Waiver Manual.
Progress to Date – Quality of
Children’s Services
New methods to assure
quality services:
 Family Outcome Survey
 Outcome-based
Individual Service Plans
Number of Children Served in 2010
 Total of 4327 children being served
 2262 children in state-funded slots receiving
autism services (intensive and ongoing)
 1233 children in local match slots
 832 children in other state-matched slots
 DD-2855 PD-311
SED-1161
Funding options for
Children with Mental
Health needs
Funding options for Children
with Mental Health needs
 Comprehensive Community
Services (CCS)
 Children’s Long Term Support MH
Waiver
 Autism Treatment Services
 Family Support Program
CCS Eligibility
 A child is screened using the same functional
screen used for CLTS Home and Community
Based Waivers
 Counties may limit CCS service on the eligibility
of the child to receive Medicaid
 Additional eligibility criteria identifies functional
limits attributed to a diagnosed mental health or
substance use condition
 Family members may also be eligible for CCS
Comprehensive Community
Services (CCS) -- HFS 36
 Medicaid State Plan Service
 Provides services and supports to eligible adults, older adults,
children and their families
 Services are provided based on need for mental health and or
substance abuse services to eligible participants
 Available to counties as an option since 2004, 21 counties are
currently certified and 8 more are completing applications using
technical assistance and start-up funding
 The CCS program is not intended for treatment services for children
with an autism spectrum disorder since CCS services are
considered rehabilitation services. The Center for Medicare and
Medicaid Services (CMS) issued a decision that autism treatment is
rather a habilitation service. However if the child has another mental
health disorder the child may be eligible for the CCS program.
The CCS Service Array
 Each county chooses services from an
array to meet the needs of children and
families in their community
 Services are identified to be provided
within Assessment Domains specified by
the CCS rule
 Counties may request approval of unique
services specific to their county program
CCS Services
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Assessment
Recovery Planning
Service Facilitation
Communication and
Interpersonal Skills
Training
 Community Skills
Development and
Enhancement
 Diagnostic Evaluations
and Specialized
Assessments
 Employment Related
Skill Development
 Medication Management
 Physical Health and
Monitoring
 Psycho-education
 Psychosocial
Rehabilitative Residential
Supports
 Psychotherapy
 Recovery Education and
Illness Management
 Substance Abuse
Treatment
 Other: Individually
tailored psychosocial
rehabilitative service
Children’s Long Term
Supports Mental
Health Waiver
CLTS MH Waiver Eligibility
Children with Severe Emotional Disturbance must meet
all of the following criteria:
 Under the age of 22
 Emotional disability has persisted at least 6 months
except:
 If the disability has not persisted 6 months but the
nature of the acute episode is such that
impairment in functioning is likely to be evident
without intensive mental health treatment
 Condition expected to persist for more than one
year
 Diagnosed by a psychiatrist or licensed psychologist
using DSM-IV
CLTS MH Waiver Eligibility
(continued)
 Impairment in two or more of the following capacities
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Self care
Community involvement
Social relationships
Family relationships
School or work
 Impairment is such that the child is at risk of
hospitalization
 The child is receiving services from two or more of the
following service systems:
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Juvenile justice,
Child protective services
Social services
 Or one system only if the intensity of treatment needed is
three hours or more of MH services
CLTS MH Waiver services
 Adaptive Aids
 Child Care & Foster Care Services
 only supplemental costs related to meeting
additional needs for the child’s disability
are eligible to be covered
 Communication Aids
 Consumer and Family-Directed Supports
 Consumer Education and Training
 Counseling and Therapeutic Resources
 Daily Living Skills Training
 Day Services
CLTS MH Waiver Services (continued)
 Home Modifications
 Intensive In-Home Autism Treatment
Services
 Personal Emergency Response Systems
 Respite Care
 Specialized Medical and Therapeutic
Supplies
 Specialized Transportation
 Support and Service Coordination
 Supported Employment
 Supportive Home Care
CLTS MH Waiver Services
 Specific Services are based
on individual need
 Experimental or Aversive
Services will not be funded
Autism Services
 A unique component of the CLTS Waivers
is the state funded autism services
provided to children with autism,
Asperger’s, or Pervasive Developmental
Disorders-not otherwise specified (PDDNOS).
 Children referred for this funding must
meet specific criteria.
Criteria for State-funded Autism Services
 Verified DSM IV Axis I diagnosis of one of the three
disorders within the Autism Spectrum Disorders
Category
 One year commitment from family to participate in the
intensive services
 Qualified provider ready to start serving child
 Child must be under 8 years of age prior to be added
to the state wait list
 Child has not already received 3 years of intensive inhome autism from any funding source
 Child meets level of care for DD or SED
 Child has been determined disabled by DDB
 Child has been a WI resident for at least the last 6
mos.
Resources:
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CLTS Waiver Manual weblink:
 http://dhfs.wisconsin.gov/bdds/waivermanual/index.htm
 Appendix E has all the CLTS Waiver forms, policies and
procedures
 Chapter IV has all the services offered through the CLTS
Waivers
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CLTS Council weblink:
 http://dhfs.wisconsin.gov/bdds/clts/council/index.htm
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Autism Council weblink:
 http://dhfs.wisconsin.gov/bdds/clts/autism/council/index.htm
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CLTS Functional Screen weblink:
 http://dhfs.wisconsin.gov/LTCare/FunctionalScreen/
See Transcript for Biographical Information