Transcript ODMRDD Waivers - CP Parent Columbus

ODMRDD Waivers
What is a Waiver?
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A waiver is another way that Medicaid can
pay for services to keep people with
disabilities in their homes so they do not have
to move to a long-term care facility or nursing
home. The local county board is required to
pay 40% of the cost of waiver services and
Medicaid pays the remainder
Types of Waivers
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There are two waivers that ODMRDD oversees:
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Individual Options Waiver
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Level One Waiver
Both of these waivers are administered at the local
county board level
Individual Options
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Services available with the IOW include:
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Homemaker Personal Care
Transportation
Environmental accessibility modifications
Adaptive & Assistive equipment
Social work*
Interpreter*
Home delivered meals*
Nutritional services*
Adult Day Waiver Services
*exclusive to the individual options waiver
Level One
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Services available with LV1 waiver include:
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Homemaker/Personal Care
Respite*
Transportation
Personal Emergency Response Systems
Specialized Medical Equipment and Supplies
Environmental Accessibility Adaptations
Emergency Assistance*
Adult Day Waiver Services
*exclusive to the level one waiver
Assessments
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Assessments are required to determine:
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Level of Care (ICF/MR LOC is required)
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Budget Range for Waiver Services
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Qualifying Diagnosis (indefinite) or Areas of Delay
Functional Limitations
Need for Skill Acquisition
Individual Options only
Prescreen for Level One
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Level One relies heavily on natural support
Developmental Delays
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To meet ICF/MR Level of Care, those birth
thru 5 must have at least 3 areas of delay:
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Adaptive behavior
Physical development or maturation, fine and
gross motor skills, growth
Cognition
Communication
Social or emotional development
Sensory Development
Functional Limitations
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To meet the ICF/MR Level of Care, those 6 years
and older must have functional limitations in at least
3 areas:
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Self Care
Understanding/Use of Language
Learning
Mobility
Self Direction
Capacity for Independent Living
Economic Self-Sufficiency (Age 16+ only)
**Assessments can be found at http://odmrdd.state.oh.us/
Click on forms at the bottom of the page
Medicaid
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A Medicaid Card is included with the Waiver service
package and may cover therapies, hospital services,
nursing services, home health aides, doctor & dental
appointments and medical equipment
A person must receive and continue Medicaid
eligibility to receive waiver services
Medicaid eligibility is determined by the local Job &
Family Services office and takes into consideration:
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Income
Assets
Disability and age
Waiting Lists in Delaware County
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Delaware County Board of DD currently has waiting
lists for funding for both waivers
Placement on the waiting list is determined by
priority scoring which gives points for:
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Refinancing of supported living and/or adult services
Those who are 22 years and older
Those with a caregiver over the age of 60
Those with intensive behavioral needs, medical needs
and/or at risk of institutionalization
Waiting Lists in Franklin County
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Franklin County Board of MRDD currently
has waiting lists for funding for both waivers
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Priority status is determined by an assessment
tool based on the waiting list rule
Sorted by priority group and then date and time
Adult Services
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Both MRDD waivers include adult services, called
Adult Day Waiver Services, in the service package
These services include:
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Adult Day Support
Vocational Habilitation
Supported Employment-Enclave
Supported Employment-Community
Non-Medical Transportation
Limited Supported Employment Equipment and
Modifications
Adult Services
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The Adult Day Waiver Services are available to all
waiver recipients who are no longer eligible for
educational services
An Acuity Assessment Instrument is utilized to
determine the service need for each individual and
assigns each participant one of four acuity groups
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Acuity groups are separated by staff to participant ratio
and funding limits
Providers have the option of billing a daily rate or 15
minute unit rate depending on the length of participation
Any Questions?
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Ohio Department of MR/DD
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Delaware County Board of DD
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www.dcbdd.org
Franklin County Board of MRDD
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http://odmrdd.state.oh.us/
www.fcbmrdd.org
Ohio Department of Job & Family Services
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http://jfs.ohio.gov/
Ohio Developmental
Disabilities Profile
What is the ODDP?
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The Ohio Developmental Disabilities Profile is an assessment
tool for individuals enrolled on the Individual Options
Waiver. The ODDP contains a series of questions created and
designed to determine an individual’s service needs. The
answers to these questions provide information about an
individual’s needs and circumstances. The answers to the
questions are scored by the Ohio Department of MR/DD
The purpose of the ODDP is to ensure that individuals across
the State of Ohio who have similar needs and circumstances
receive services at levels of funding through the IO waiver
that are comparable
When to do an ODDP?
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When a person enrolls on Individual Options waiver,
the assessment will be completed as part of the
enrollment process. Service & Support
Administrators (SSAs) complete the assessment with
the entire team. Individuals have the right to know
the funding range that resulted from the ODDP
assessment
There are 9 funding ranges associated with the
ODDP allowing annual budgets from $5001 to
$500,000
ODDP Questions
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There are 40 questions on the ODDP
These questions cover 10 areas of life:
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Identifying Information
Residential
Disability Description
Medical Information
Sensory/Motor Information
Cognitive/Communication Information
Behavior
Self Care and Daily Living Skills
Routine Voluntary Caregivers
Clinical Services
Revisions to the ODDP
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Any time there is a substantial change in the way
services are provided, the team needs to update the
ODDP to reflect the change in need:
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Change in routine voluntary care being provided
Change in residential setting, including a change in the
number of persons living together who share waiver
services
Changes in behavior issues
Changes in medical conditions
Prior Authorization
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If the service needs addressed in the ISP cost more than the
assigned ODDP range, a process called Prior Authorization
may be requested
Prior Authorization allows a person to receive waiver services
that result in an individual funding level above his/her
funding range
Reasons to request Prior Authorization:
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Behavioral Issues
Medical Issues
Changes in ability of unpaid caregivers
Changes in staffing ratio outside of a person’s control
Emergency situations
Due Process
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DCBDD Due Process Procedure
FCBMRDD Due Process Procedure
Once a person receives Medicaid services, they have
a right to a State Hearing
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ODJFS
State Hearings
30E Broad Street, 32nd Floor
Columbus, OH 43215-3414
Fax 614-728-9574
Questions?
Melinda Draper
Karin Crabbe
Waiver Coordinator
[email protected]
740-368-5802 ext 506
SSA Supervisor
[email protected]
614-342-5523