HCBS W AIVER T RAINING. O BJECTIVE To gain basic knowledge of the HCBS Waiver services and the...
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Transcript of HCBS W AIVER T RAINING. O BJECTIVE To gain basic knowledge of the HCBS Waiver services and the...
HCBS WAIVER TRAINING
OBJECTIVE
To gain basic knowledge of the HCBS Waiver services and the waiver like program called Habilitation: History
Philosophy
Waivers
WHY DO WE CALL IT “WAIVER”?
From 5 months to 3 years-old, Katie Beckett lived in a Cedar Rapids, IA hospital due to an infection that made a ventilator necessary. Medicaid would only pay for the expensive treatment if she stayed in the hospital.
In 1981 President Reagan was contacted by Katie’s parents and after hearing about Katie’s situation he changed the law so that Katie and others like her could receive the care they needed at home. This change resulted in care costing 1/6 of the cost of hospital care.
This change was known as “The Katie Beckett Waiver” and allowed all children with disabilities to receive Medicaid supports in their homes instead of being forced to remain hospitalized.
Because of the waiver program, Katie was able to live in her own apartment, go to college and was hoping to obtain her teaching certifi-cate.
Katie Beckett died on May 18, 2012 of complications of her illness. The impact of her life will forever change the lives of others….
THE OLMSTEAD ACT
In Olmstead v. L.C., the Supreme Court construed Title II of the Americans with Disabilities Act (ADA) to require states to place qualified individuals with mental disabilities in community settings, rather than in institutions, whenever treatment professionals determine that such placement is appropriate, the affected persons do not oppose such placement, and the state can reasonable accommodate the placement, taking into account the resources available to the state and the needs of others with disabilities. The Department of Justice regulations implementing Title II of the ADA require public entities to administer their services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities.
T H E O L M S T E A D A C T
In Olmstead, the Supreme Court stated that institutional placements of people with disabilities who can live in, and benefit from, community settings perpetuates the unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life. The Supreme Court state that "recognition and unjustified institutional isolation of person with disabilities is a form of discrimination reflect[ed] two evident judgements": 1) "Institutional placements of people with disabilities who can live in, and benefit from, community settings perpetuates the unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life"; and 2) "confinement in an institution severely diminishes everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment." Olmstead, 119 S.Ct. 2176, 2179, 2187
PHILOSOPHYEvery individual has value and dignity, and DAC, Inc.
exists to enhance this dignity, self-esteem and worth of each individual and his/her right to self-determination
as a member of the community.
HOW DOES A MEDICAID WAIVER WORK?
A person eligible for a Medicaid waiver “waives” his/her entitlement to receive services in an institution.
The type of waiver is determined by diagnosis (for example: intellectual, mental health, or physical disability)
Approximately 2/3 of the cost of waiver services is covered by the Federal Government and 1/3 of the cost of waiver services is covered by the county or the state.
WAIVERS ARE
Based on a philosophy of Individual Choice
Individual Rights and Dignity
Alternatives to institutionalization
Intended to keep individuals in their own home and community
Designed specifically for each individual based on their needs
For all ages
WAIVERS ARE NOT
Group homes
Residential facilities
Daycare
Academic education
Emergency services
Replacement of parental responsibility
Cadillac services
End all / Be all
DAC, Inc provides services to people under these Iowa Medicaid waivers:
Intellectual Disability
Habilitation
Brain Injury
_______________________________________________________________________
DAC, Inc currently does not provide services to people under these waivers:
Physical Disability
Children’s Mental Health
Health and Disability
Aids/HIV
Elderly
IOWA’S MEDICAID WAIVERS
COMMON SERVICE ELEMENTS
INDIVIDUAL PLANNING
All individuals who receive waiver services and supports have a Personal Outcome Plan (POP).
Plans include important information about
Goals the individual wants to works towards
Steps to take to reach the goal
Supports needed to remain in the most integrated environment possible.
COMMON SERVICE ELEMENTS
The Interdisciplinary Team is made up of……..
The Individual
The Case Manager
The Service provider(s)
The Guardian (if applicable)
Other people chosen by the individual
The team supports the individual in making decisions.
The individual has the right and responsibility of voicing their hopes, dreams, wants and needs.
COMMON SERVICE ELEMENTS
SERVICE COORDINATION
A case manager/service worker is there to help plan for and get the services and supports needed.
The Person Centered Approach assures the individual is:
Respected
Valued
An Equal partner
COMMON SERVICE ELEMENTS
QUALITY ASSURANCE
It is important to make sure that people are satisfied with the services and supports they receive. This is reviewed and measured through:
Satisfaction surveys
Complaints and/or Grievances
Participant Experience Surveys (PES)
The State must also assure that HCBS waiver funds (Medicaid) are used appropriately and in a fashion that meets federal and state requirements.
DIFFERENCE AMONG THE WAIVERS
Eligibility requirements
Availability
Target populations
Level of care requirements
Caps on dollar amounts available
Menu of services available
INTELLECTUAL DISABILITY (ID) WAIVER SERVICES
D A C S E RV I C E S A R E U N D E R L I N E D
Adult Day Care
Personal Emergency
CDAC
Prevocational
Day Habilitation
Respite
Home & Vehicle Mod
Supported Community Living (SCL)
Interim Medical Monitoring & Treatment (IMMT)
Supported Employment (SE)
Nursing
Home Health Aide
Transportation
HABILITATION (HAB) SERVICES(CHRONIC MENTAL I LLNESS)
Day Habilitation
Home Based Habilitation (HBH)
Prevocational
Supported Employment (SE)
BRAIN INJURY(BI) WAIVER SERVICES
Adult Day Care
Behavioral Programming
CDAC
Family Counseling
Home & Vehicle Modification
IMMT
Transportation
Personal Emergency Response
Prevocational Services
Respite
Specialized Medical Equipment
Supported Community Living (SCL)
Supported Employment (SE)
PHYSICAL DISABILITY (PD) WAIVER
Must be at least 18 but less than 65 years of age
Individual Directed Attendant Care
Home & Vehicle Modification
Personal Emergency Response
Specialized Medical Equipment
Transportation
CHILDREN'S MENTAL HEALTH WAIVER (CMH)
Children with a diagnosis of a serious emotional disturbance
Environmental Modifications & Adaptive Devices
Family & Community Support Services
In Home Family Therapy
Respite
HEALTH AND DISABILITY WAIVER
Adult Day Care
Homemaker
CDAC
IMMT
Counseling
Nursing
Home & Vehicle Modification
Nutritional Counseling
Personal Emergency Response
Home Delivered Meals
Home Health Aide
Respite
AIDS/HIV WAIVER
Adult Day Care
individual Directed Attendant Care
Counseling Services
Home Delivered Meals
Home Health Aide
Homemaker
Nursing
Respite
ELDERLY (EW) WAIVER 65+
Adult Day Care
Assistive Devices
Case Management
Chore
CDAC
Home & Vehicle Modification
Home Delivered Meals
Home Health Aide
Homemaker
Mental Health Outreach
Nursing
Nutritional Counseling
Personal Emergency Response
Respite
Senior Companion
Transportation
WAIVER STAKEHOLDERS
DAC, Inc.
THE INDIVIDUAL’S ROLE
Exercise control
Learn and understand his or her rights and responsibilities
Actively participate in their plan
Right to refuse and/or change services or service provision
THE CASE MANAGER’S ROLE
Act as advocate
Facilitate the individual’s access to the service system
Promote self-determination
Emphasize and promote individualism
Coordinate services with other providers
Ongoing communication
Request information
Help providers
Monitor service utilization
THE PROVIDER/DSP’S ROLE
Develop and carry out service provision based on the plan developed by the individual with his/her team
Communicate with all team members about all changes in service provision, limitations of rights, or other concerns regarding the individual
Advocate for the individual’s right to live in the most integrated – least restrictive environment
Provide for the safety of the individual with the LEAST amount of intrusion as possible
PLAN IMPLEMENTATION
Plans should reflect:
Individualism
Self-determination
Inclusion
Least restrictive environment
Quality
Safety
PLAN IMPLEMENTATION
It is important that direct support professionals are:
Flexible Remember you are working in the individual’s home
– not a group home!
Provide individualized supports to individuals Use the approach that works best for each
individual. No two people are ever exactly alike!
Direct support professionals also need to provide services according to the agency
philosophy.
RESOURCES http://www.npr.org/blogs/health/2012/05/21/153202340/katie-beckett-defied-the-odds-helped-o
ther-disabled-kids-live-longer
http://www.worksupport.com/resources/printView.cfm/376
http://parenting.blogs.nytimes.com/2012/06/06/because-of-katie-children-with-severe-disabilities
-can-live-at-home
/
http://www.ime.state.ia.us/docs/HCBSbrochure102606.pdf