Support Coordination Services and the DD Waiver

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Support Coordination Services and the DD Waiver

• Virginia Department of Medical Assistance Services

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What is Support Coordination?

• Support Coordination providers assist a consumer
  in accessing needed medical, psychiatric, social,
  educational, vocational, residential, and other
  supports essential for living in the community
  and in developing desired lifestyles
• Form of case management for the Individual and
  Family Developmental Disabilities Support (DD)
  Waiver, but is consumer-driven (team approach)

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Who Can Be A Support Coordination Provider?

• Providers must
• Have a current provider agreement with DMAS
• Be available to consumers 24 hours/day in case of
  emergencies

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Who Can Be A Support Coordination Provider Contd

• Possess a combination of disability work
  experience and knowledge, skills, and abilities
  (KSAs)as established by DMAS
• Certify via letter to DMAS that individuals who
  provide support coordination services meet the
  required KSAs and

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Support Coordinator Qualifications

• Knowledge of
• Nature and causes of developmental disabilities
• Service modalities and intervention techniques
• Different types of assessments
• Consumer and family rights
• Local community resources and service delivery
  systems

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Support Coordinator Qualifications Contd

• Knowledge of (contd)
• Types of developmental disability programs and
  services
• Effective oral, written, and interpersonal
  communication principles and techniques
• General principles of record documentation and
• Service planning process and major components of
  a service plan

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Support Coordinator Qualifications Contd

• Skills in
• Interviewing
• Negotiating with consumers and service providers
• Observing, recording, and reporting on a
  consumers functioning
• Identifying and documenting a consumers need for
  resources, services other supports

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Support Coordinator Qualifications Contd

• Skills in (contd)
• Using information from assessment, evaluations,
  observation, interviews to develop service
  plans
• Identifying services within the community and
  established service systems to meet the
  individuals needs
• Formulating, writing, and implementing
  individualized service plans to promote goal
  attainment

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Support Coordinator Qualifications Contd

• Skills in (contd)
• Coordinating the provision of services by diverse
  public and private providers
• Identifying community resources and organizations
  and coordinating resources and activities and
• Using assessment tools (e.g., level of
  functioning scale)

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Support Coordinator Qualifications Contd

• Abilities to
• Be persistent an remain objective
• Work as a team member, maintaining effective
  inter- and intra-agency working relationships
• Demonstrate a positive regard for consumers and
  their families
• Work independently, performing position duties
  under general supervision

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Support Coordinator Qualifications Contd

• Abilities to (contd)
• Communicated effectively and
• Establish and maintain ongoing, supportive
  relationships

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Team Approach Coordinating Services

• Team Approach will be the focus of providing
  services to DD waiver consumers
• Utilization of this approach will ensure the
  consumers services are coordinated, organized,
  unduplicated and provided without gaps will
  ensure health safety

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Team Approach Coordinating Services Contd

• The team approach will also provide as much
  consumer control as possible
• The team approach will use a a group of people
  (team members) who work collaboratively with the
  consumer to develop and implement his/her
  Consumer Service Plan (CSP)

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Team Approach Coordinating Services Contd

• Team members consist of
• The consumer (or consumers family/caregivers)
• Support coordinator
• Service providers and
• Any other individual who the consumer identified
  as wishing to be involved in the planning process

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Team Approach Coordinating Services Contd

• No team member (with the exception of the
  consumer) possesses any more authority than the
  others
• All team members work on behalf of the consumer

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Team Approach Coordinating Services Contd

• Support Coordinator plays critical role in this
  team approach
• Support Coordinator is team facilitator and is
  responsible for development of Consumer Service
  Plan (CSP) with consumer

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Role of Support Coordinator

• Coordinating annual reassessments for consumer
• Developing the Consumer Service Plan (CSP) with
  consumer
• Referring for medical or psychiatric assessments
  as needed
• Coordinating services and treatment planning with
  other agencies and providers

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Role of Support Coordinator Contd

• Assisting consumer directly to develop or obtain
  needed resources
• Enhancing the consumers opportunities for
  community integration
• Making collateral contacts to promote
  implementation of CSP
• Monitoring implementation of the CSP and
  community adjustment of consumer

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Role of Support Coordinator Contd

• Monitoring implementation of CSP through regular
  contacts with service providers (including site
  and home visits)
• Coordinating transfer of consumers from Medicaid
  HMO to waiver services
• Guiding the consumer as needed with
  problem-solving and decision-making
• Providing a supportive relationship

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Role of Support Coordinator Contd

• Monitoring the quality of care and
• Benefits counseling

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Who Receives Support Coordination?

• Consumers who are in the community or in
  institutional settings (who are discharge ready)
  who have been determined eligible for the DD
  Waiver by the DD Waiver Screening Team

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Who Receives Support Coordination Contd

• Consumers who are in the DD Waiver must
  receive support coordination the consumer
  controls how much support coordination he/she
  needs

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How Can Individuals Be Screened for The DD Waiver?

• Beginning July 1, 2000, DMAS began receiving
  requests for screenings for the DD Waiver.
• Individuals can call DMAS at [phone] to
  receive a Request for Screening Form or download
  the form from the DMAS web site at
  www.cns.state.va.us/dmas/.

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How Can Individuals Be Screened for The DD Waiver?

• DMAS will receive and review requests
• Requests received between July 1st and August 31,
  2000 will be considered the first pool of DD
  waiver applicants

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How Can Individuals Be Screened for The DD Waiver?

• Individuals can continue to submit requests after
  August 31, 2000 to DMAS - will be first come,
  first served based on date application is
  received by DMAS
• Once the screening requests from this pool of
  applicants has been reviewed, the requests will
  be forward to the DD Waiver Screening Teams to
  conduct the screening assessment

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Who Are the DD Waiver Screening Teams?

• VDH Child Development Clinics - 11 sites located
  throughout the Commonwealth
• Blue Ridge Region - Harrisonburg, Lynchburg,
  Winchester
• Central Virginia - Petersburg
• Eastern Virginia - Newport News, Norfolk
• Northern Virginia - Arlington, Fredericksburg
• Southwest Virginia - Danville, Gale City, Roanoke

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Screening Process for DD Waiver

• The DD Waiver Screening Team will screen
  individuals to determine if they meet the level
  of care criteria with the Level of Functioning
  (LOF) Survey, which is the assessment instrument
  used to determine eligibility for ICF/MR level of
  care.

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Screening Process for DD Waiver Contd

• After DD Waiver Screening Team has determined the
  applicant is functionally eligible for DD Waiver
  service, the consumer is given choice of ICF-MR
  care or DD Waiver
• If the consumer chooses DD Waiver, the Screening
  Team will offer consumer a list of available
  Support Coordinators

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Screening Process for DD Waiver Contd

• A consumer has five calendar days to choose a
  support coordinator
• Screening team will forward screening materials
  to support coordinator within five calendar days

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Screening Process for DD Waiver Contd

• What screening materials will the support
  coordinator receive?
• A completed Level of Functioning (LOF) Survey
  (DMAS-458 form)
• A Consent Form (DMAS-20 form)
• Consumer Choice Form (DMAS-459 form)
• Service Authorization Form (DMAS-96) and
• Service Authorization letter from the Screening
  Team

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Screening Process for DD Waiver Contd

• The support coordinator will contact the consumer
  within five calendar days of receipt of the
  screening materials
• The support coordinator and the consumer will
  meet within 30 calendar days to discuss the
  consumers needs and existing supports

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Screening Process for DD Waiver Contd

• The support coordinator and consumer will develop
  an initial CSP to identify services needed and
  estimate the annual waiver cost of the CSP (using
  the DD Waiver Enrollment Form, the DMAS-453)
• If the annual waiver cost of the CSP is expected
  to exceed the average annual cost of ICF-MR care,
  the consumers CSP will be coordinated by DMAS
  health care coordinators

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Services Offered Under the DD Waiver

• Adult companion care
• Assistive Technology
• Attendant care
• Consumer-directed respite
• Crisis Stabilization
• Day Support
• Environmental Mods
• Family/Caregiver Training

• In-home residential
• Personal Care
• Personal Emergency Response System
• Respite Care
• Skilled Nursing
• Supported employment
• Therapeutic Consultation

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Screening Process for DD Waiver Contd

• The support coordinator will submit the waiver
  enrollment package to DMAS for review and
  authorization into the DD Waiver
• DMAS-96 (signed by the Screening Team)
• DD Waiver Enrollment Form (DMAS-453)
• Completed LOF
• CSP (DMAS-456)

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DD Waiver Authorization Process

• After initial implementation of the DD Waiver,
  funds will be allocated on a first come, first
  served based on the date of application
• However, first come, first served was not
  determined to be a fair method when starting up
  the waiver
• Initial 60 application period (July - August,
  2000) to give all individuals an equal chance to
  apply

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DD Waiver Authorization Process Contd

• Two funding levels
• Consumer Service Plans with annual waiver service
  costs up to 25,000
• Consumer Service Plans with annual waiver service
  costs over 25,000 (if CSP costs more than
  average annual cost of Intermediate Care Facility
  for the Mentally Retarded, the consumer will
  receive support coordination from DMAS staff)
• Costs do not include non-waiver Medicaid services

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Assuring Waiver Cost- Effectiveness
55 of Funding
40 of Funding
5 of Funding
CSP up to 25,000
CSP More than 25,000
Emergencies
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Emergency Criteria for DD Waiver

• 1. The primary caregiver has a serious illness,
  has been hospitalized, or has died
• 2. The individual has been determined by the DSS
  to have been abused or neglected and is in need
  of immediate Waiver services
• 3. The individual has behaviors which present
  risk to personal or public safety OR
• 4. The individual presents extreme physical,
  emotional, or financial burden at home and the
  family or caregiver is unable to continue to
  provide care.

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DD Waiver Funding

• If more consumers are eligible than funding is
  available to serve them, consumers will be chosen
  by lottery and a number assigned
• Individuals will be served in numerical order,
  beginning with 1. DMAS will serve as many as
  possible with available funds - those not
  initially served will be placed on a waiting list

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DD Waiver Authorization Process Contd

• If DMAS determines the consumer is not eligible
  for waiver services, DMAS will notify the
  consumer and support coordinator in writing and
  provide appeal rights to the consumer
• If the consumer is eligible for DD Waiver
  services but there is no funding, DMAS will
  notify the consumer and support coordinator in
  writing and provide the consumer with appeal
  rights

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DD Waiver Authorization Process Contd

• Once DMAS authorizes the consumer for DD Waiver
  services, the consumer and support coordinator
  will contact service providers within 60 calendar
  days to complete the CSP and supporting
  documentation and initiate services
• All DD Waiver services (with the exception of
  crisis stabilization) must be prior authorized by
  DMAS

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DD Waiver Authorization Process Contd

• If services are not initiated within 60 days, the
  support coordinator must submit a statement to
  DMAS demonstrating why more time is needed to
  initiate services. DMAS has the authority to
  approve or deny this request in 30 day extensions
• Support coordinator signs off on all CSP and
  supporting documentation contacts DMAS for any
  prior authorizations or revisions to CSP

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Consumer Service Plan (CSP)

• Must be developed for each consumer receiving DD
  Waiver Services
• It organizes and describes the services and
  supports necessary for meeting a consumers goals
  desires for community living
• Individualized approach should be taken when
  completing this with the consumer or consumers
  family

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CSP Contd

• Support Coordinator, consumer, and service
  providers meet to identify and discuss consumers
  needs
• From this, and through consensus, consumers
  goals and objectives are identified
• Each provider documents these goals in supporting
  documentation that is maintained with the CSP

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CSP Contd

• The consumer, support coordinator, and service
  providers sign off on the CSP when an agreed-upon
  plan is developed
• CSP contains
• Social assessment or consumer profiles
• Primary goals or outcomes of consumer
• Supporting documentation and
• Documentation of agreement by persons
  participating in development implementation of
  CSP

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CSP Contd

• Once CSP and supporting documentation are
  developed, the support coordinator is responsible
  for monitoring the implementation of CSP
• Service quality and consumer satisfaction is a
  shared responsibility accomplished through
  effective and consistent communication with
  consumer, support coordinator and service
  providers

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Social Assessment/Consumer Profile

• Used to help determine consumers need for
  services and supports and the outcomes desired
  from the services
• Basis of development of CSP

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Social Assessment/Consumer Profile Contd

• Looks at the following areas
• Physical or mental health, personal safety, and
  behavior issues
• Financial, insurance, transportation, and other
  resources
• Home and daily living
• Education and vocation
• Leisure and recreation

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Social Assessment/Consumer Profile Contd

• Relationships and social supports
• Legal issues and guardianship and
• Consumer empowerment, advocacy and volunteerism

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CSP Contd

• Support coordinator must review CSP at a minimum
  of every three months to determine if service
  goals are being met and whether any modifications
  to the CSP are necessary

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CSP Contd

• The coordinator must take necessary actions and
  document the results in the consumers record if
  there is evidence that
• Consumer or family/caregiver are dissatisfied
  with services
• The consumers health and safety are at risk
• Services are not delivered as described in the
  CSP

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CSP Contd

• Necessary actions include, but are not limited
  to
• Requesting a corrective plan of action from the
  service provider
• Reporting the information to the appropriate
  licensing, certifying or approving agency
• Informing the consumer of other providers of the
  service in question and

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CSP Contd

• Informing the consumer his eligibility may be in
  jeopardy of he continues to receive services from
  a provider who cannot ensure health and safety
• If abuse or neglect is suspected, the support
  coordinator is required to inform the local
  Department of Social Services Child Protective
  Services or Adult Protective Services units

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DMAS 122 Form

• When consumer is initially approved for Waiver
  services, the support coordinator must submit to
  the local DSS a DMAS-122 form and a copy of the
  completed DMAS-96 form
• DMAS 122 confirms a consumers financial
  eligibility for DD Waiver services and informs
  the coordinator of any patient pay requirements

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DMAS 122 Contd

• Only DSS can determine a consumers financial
  eligibility for Medicaid
• The support coordinator is responsible for
  coordinating the consumers patient pay
• The patient pay is deducted the service provider
  who provides the most services as outlined in the
  CSP

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DMAS 122 Contd

• If services are started prior to receiving a
  completed DMAS-122, the provider is at risk of
  not being reimbursed for the services provided
  because the consumers eligibility has not been
  fully determined

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DMAS 122 Contd

• When does a DMAS 122 need to be revised and sent
  to DSS and DMAS?
• Whenever a consumer is enrolled into the DD
  Waiver
• Whenever a consumers income changes and
• When a consumer receives no DD Waiver services
  for more than 30 days

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Support Coordination

• Support Coordinators must -
• conduct a minimum of one face to face contact
  every 90 days
• To observe consumers status
• Verify services are being provided as described
  in the CSP and supporting documentation
• To assess the consumers satisfaction with
  services and
• To determine any unmet needs or changes needed to
  the CSP

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Support Coordination

• Support Coordinators must (contd)-
• contact the consumer or the family, service
  providers, or other organizations on the
  consumers behalf to bill for the month
• contact must be meaningful (monitor service
  delivery, investigating a complaint, etc.)
• DMAS will evaluate the consumers continued
  eligibility and need for DD Waiver Services every
  12 months

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Support Coordination

• Support Coordination services may not duplicate
  any other Medicaid or Waiver service
• Support Coordinators CANNOT be service providers
  in the DD Waiver

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Service Units and Service Limitations

• A unit of service is equal to one month of
  service
• Billing may begin with the first face-to-face
  contact
• Bill can be submitted only for months in which at
  least one meaningful direct or consumer-related
  contact, activity, or communication occurs and is
  documented

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Service Units and Service Limitations

• Support Coordination services may be billed for
  Medicaid-eligible institutionalized consumers
  during the 60 calendar days preceding discharge
  for consumers who are discharge ready
• If additional time is needed to necessitate
  discharge, prior authorization is required by
  DMAS for 30 day intervals
• This service may not duplicate institutional
  discharge planning services

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Provider Documentation Requirements

• A Consumer Service Plan (DMAS-456) - including
  other service supporting documentation
• Supporting documentation stating what support
  coordination services will be provided (DMAS-457)
• Ongoing (signed date) documentation indicating
  when support coordination was rendered

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Provider Documentation Requirements Contd

• Documentation that supporting documentation is
  reviewed by the support coordinator, service
  provider and consumer every 6 months and as
  needed
• All relevant communication with providers,
  consumer, DMAS and other state agencies, or other
  related parties

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Provider Documentation Requirements Contd

• A copy of the new or revised CSP must be
  developed within 365 days of the effective date
  of the previous CSP
• Maintenance of the consumers LOF if medical or
  psychiatric assessments needed, support
  coordinator makes referral

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Provider Documentation Requirements Contd

• Maintaining consumer documentation for a period
  of five years
• Written documentation that consumers had a choice
  of service providers when DD Waiver services were
  initiated

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Provider Documentation Requirements Contd

• Keeping most recent copies of
• DMAS-20 (Consent form)
• DMAS-122 (Patient Information Form)
• CSP
• Supporting Documentation for Waiver Services

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Billing Code for Support Coordination

• Y0055 - Support Coordination (for DD Waiver
  only)
• 175.40 per unit

• Additional billing information to be shared in
  afternoon training

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Thank You For Coming!

• We look forward to partnering with you to provide
  Support Coordination to our DD Waiver
  beneficiaries
• Any Questions? Please Ask