MEMO
TO: Members of the Nebraska Association of Service Providers
FROM: Kate Bolz, Executive Director
RE: Utilization of the Aged and Disabled Waiver by Developmental Disabilities Service Providers
DATE: September 18, 2015
Overview
Individuals with brain injury who have experienced their injury in adulthood often struggle to find services to regain skills needed to achieve their goals. The services needed by individuals with brain injury have characteristics in common with services provided by developmental disability services providers. As such, developmental disability service providers are positioned to fill a gap in community based service provision for individuals with brain injuries. The Aged and Disabled Waiver can provide resources for an individual with brain injury to receive services. Developmental disability service providers may provide services through the Aged and Disabled Waiver. This memo outlines:
1) the purpose of this waiver and it’s distinctions from other waivers 2) how individuals qualify for and access the waiver 3) the services provided by the waiver 4) criteria and processes for providers 5) additional resources
Comprehensive resources on the Aged and Disabled Waiver may be found here: http://dhhs.ne.gov/Pages/hcs_programs_ad-waiver.aspx
1. Purpose of the Aged and Disabled Waiver
The Aged and Disabled Waiver offers and array of services to support people in their homes. It is focused on providing services to individuals that have physically and medically disabling conditions such as stroke, active and terminal cancers, and brain injuries. Services are rehabilitative in nature to assist individuals to regain skills from prior to their injury such as assistive technology supports, home modifications, and independent skills building.
The Aged and Disabled Waiver differs from other waivers that serve adults with brain injuries.
Summary of ADULT Waivers that MAY serve individuals with Brain Injury – see details here: https://www.cms.gov/outreach-and-education/american-indian-alaska-native/aian/ltss- roadmap/resources/state-federal-relationships/1915c-Waivers-by-State.html#nebraska
1 Waiver Qualifications Services Traumatic Individuals with brain injury ages 18- Assisted living services Brain Injury 64. Waiver The Individuals with brain injury may be The Comprehensive Comprehensive served through this waiver only if they Developmental Disabilities Developmental otherwise qualify under developmental Waiver for Adults provides a Disabilities disability criteria or experienced their variety of vocational and Wavier for brain injury prior to the age of 22. residential and other services to Adults individuals who meet the developmental disability criteria.
The Nebraska Individuals with brain injury may be Day Services served through this waiver only if they The Nebraska Day Services Waiver for otherwise qualify under developmental Waiver for Adults with Adults with disability criteria or experienced their Developmental Disabilities Developmental brain injury prior to the age of 22. provides a variety of vocational Disabilities and community supports in day settings. The Aged and Individuals with needs at a nursing Provides a variety of supportive Disabled facility level of care who want to live services to help people stay in Waiver at home and are eligible for Medicaid. their homes and regain skills.
2. Individual Qualification for and Access to the Aged and Disabled Waiver Home and community-based waiver services offer eligible persons a choice between entering a Nursing Facility (NF) or receiving supportive services in their homes. Medicaid funding through the Nebraska Medical Assistance Program (NMAP) is used to fund either service option. The average cost of waiver services funded by Medicaid must not exceed the average cost to Medicaid for NF services.
Client eligibility factors - clients must: a. Be eligible for the Nebraska Medical Assistance Program (NMAP); - Medicaid eligibility relies on a variety of factors. An individual may learn about their eligibility through ACCESS Nebraska, Nebraska’s on-line and call center based eligibility system. Learn more here: https://dhhs-access-neb- menu.ne.gov/start/?tl=en b. Have participated in an assessment with a services coordinator; c. Meet the Nursing Facility (NF) level of care criteria (471 NAC 12-000); - Nursing facility level of need is defined through an assessment of medical need, risk criteria, and cognition factors. Nursing facility level of care means you have needs which require you to receive services similar to those provided to individuals who live in a nursing home. For example, you may need assistance with everyday tasks such as getting dressed, taking a bath or shower, eating, or
2 walking safely. A few examples of other areas considered are how much help you need to take medications, any memory problems or health conditions you may have and how they are managed. Persons who apply for Medicaid Waiver are assessed to see if their needs are the same as those of people who live in a nursing home. - See page 22 here: http://www.sos.ne.gov/rules-and- regs/regsearch/Rules/Health_and_Human_Services_System/Title-471/Chapter- 12.pdf Client eligibility processes: d. Clients must meet with a Service Coordinator, which has a specific role in the Aged and Disabled Waiver: - A Services Coordinator in the Aged and Disabled Waiver will help find services, work with providers, and help individuals make choices. See additional information here: http://dhhs.ne.gov/Pages/hcs_services_service- coordination.aspx - You can contact someone who can answer questions about services and eligibility in the Aged and Disabled Waiver here: http://dhhs.ne.gov/Pages/hcs_contact.aspx - Adults aged 18-64 receive Services Coordination through the Independent Living Centers in Nebraska. Contact information is found here: http://dhhs.ne.gov/Documents/IndependentLivingCenters.pdf e. Eligibility processes: - Individuals must fill out certain paperwork, including a service provider agreement and rate form with the help of the Services Coordinator - Certain services, like adult day health services, my require that the services be provided by providers with certification, other services must meet certain criteria like having first aid certification Client information and referrals: f. Referrals: - Service coordinators may provide clients a list of providers. - Individuals choose their providers and meet with providers - Clients work monthly with their service coordinator g. Resources facilitation: - Nebraska has a full time Brain Injury Resource Facilitator in Omaha and one in Lincoln. The Resource Facilitator takes calls from individuals and connects them with services and supports for their needs and following them longer term. Learn more here: http://www.biane.org/welcome.html
3. Services Provided under the Waiver Waiver services build on client/family strengths and are intended to strengthen and support informal and formal services already in place to meet the needs of the client and are not intended
3 to replace them. Waiver services utilize a self-directed services philosophy and vision that holds that each client has the right and responsibility to participate to the greatest extent possible in the development and implementation of his/her service plan. Services should improve functional adaptive skills in the home and work (community) environments, for example, teaching the individual and family how to use the brain book. Services may be a way to transition out of a rehabilitation environment as a continuation of a rehabilitation plan.
Services coordination services: The services coordinator and the client together identify appropriate levels of services coordination by considering risk factors or capacity to direct their own services. a. The services coordination levels include: - Self-Directed Services Coordination - Supportive Services Coordination - Comprehensive Services Coordination - Elements in the following areas shall be considered to determine the level of services coordination both initially and as service levels change: determination of strengths, priorities, and resources, planning for services, connecting with needed services, advocacy, monitoring. Funded services: b. Some of the funded services include: - Services Coordination – provided by specially trained staff who help match your needs with services and providers, based on your preferences - In-home help, such as: home-delivered meals, cleaning, laundry, getting groceries (chore), maintaining good nutrition, personal emergency response system, special equipment to make tasks easier to perform, or modifying your home to make it easier to get around (assistive technology/home modifications) - Relief time for family caregivers (respite) - Training to increase independence in activities of daily living at home (independence skills building) - Child care so the caregiver can maintain employment (child care for children with disabilities) - Community supports like adult day services and transportation for essential activities such as medical appointments - Assisted Living services - See full detailed descriptions of services on page 28 here: http://dhhs.ne.gov/Pages/hcs_programs_ad-waiver.aspx Independent skills building vs. habilitation: c. Explanation of skills building - Independence Skills Management (ISM) is training for adults and children in activities of daily living and training to overcome or compensate for the effects of
4 physical disabilities. Training may occur in the client's home or in the community, and may be provided individually or in a group setting. The caregiver (non-Medicaid paid provider) may be included in this training to promote independence of the waiver client. The need for this service must be reflected in one or more assessment areas of the client's plan of services and supports. - Independent skill management is about skills people previously had – they may continue rehabilitation at home. Providers may look at how to break down a skill and adapt in a different way. - Training may be in self care or home management. See details here: http://dhhs.ne.gov/Pages/hcs_services_independence-skills-building.aspx#FAQs - Specific regulations may be found on page 43 here: http://www.sos.ne.gov/rules-and- regs/regsearch/Rules/Health_and_Human_Services_System/Title-480/Chapter-05.pdf
4) Criteria and Processes for Providers Expanding options for independent skills management is one clear opportunity under the A&D waiver. Individuals need support for transition into the home and providers of services under the Comprehensive Developmental Disabilities waiver are well positioned to assist.
Providers d. There is a great deal of flexibility in the choices people have in providers of services. Friends and family members and other non-professionals may fill certain roles. e. The Aged and Disabled waiver offers adult day health services through licensed nurses who also supervise activities of daily living. Adult day services also require certain additional requirements, such as providing meals and snacks. f. Providers of services under the Comprehensive Developmental Disabilities Waiver would only need to do an addendum under the Aged and Disabled Waiver. Regulatory requirements are similar and relate to administrative requirements regarding background checks, nondiscrimination, reporting of abuse and neglect, ect. g. Regulations for providers may be found on page 58 here: http://dhhs.ne.gov/Pages/hcs_programs_ad-waiver.aspx Providers will work with a "Resource Developer" to offer specific services. Resource Developers work with clients, service coordinators, independent living centers, and providers to set up services. Billing and Rates h. Rates are developed with Resource Developers. Some are negotiated and some are set. Negotiated rates will consider factors such as the care needs of the individual, the intensity of the service, and a comparison to other rates for services in the area. i. Rates: there are flexible rates for some services. Rates must be cost effective and may be contingent upon geographic area. j. Rates: there are set rates for some services like individual respite and mileage. k. DHHS reimburses monthly, providers must maintain records and submit billing.
5 Quality Assurance: l. The Nebraska Medicaid & Long Term Care Home and Community-Based Services (HCBS) Waivers Unit utilizes a Quality Improvement System to ensure the health and well-being of clients through continuous, client-focused monitoring and improvement. m. The Quality Improvement System is guided by principles, roles and functions, and processes defined by the department, more information is available here: http://dhhs.ne.gov/Pages/hcs_programs_ad-waiver.aspx
6. Resources a. The Department of Health and Human Services can serve as a resource. To ask questions related to the Aged and Disabled Wavier contact May Faith:
May Faith Program Specialist, HCBS AD Waiver Department of Health and Human Services Medicaid & Long-Term Care Ph: (402) 471-1670 Fax: (402) 471-9092 May . Faith @nebraska.gov
b. The Nebraska Brain Injury Advisory Council provides the Nebraska Traumatic Brain Injury Provider Training Manual, which is a comprehensive resource for issues related to complications of brain injury, communication styles for individuals with brain injury, screening tools, and more: http://www.braininjury.ne.gov/docs/Nebraska_Traumatic_Brain_Injury_Provider_Train ing_Manual.pdf
c. Relias Learning and College of Direct Support both offer resources to help you develop programs for independence skills building: https://reliaslearning.com/ or http://directcourseonline.com/direct-support/
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