Moving to the New Waivers CAPMRDD Waivers Update 1008

1
Moving to the New WaiversCAP-MR/DD Waivers
Update10-08

• Rose Burnette, Sandy Ellsworth, Cheryl Smith
• Division of Mental Health-Developmental
  Disabilities-Substance Abuse Services

2
New Waivers

• Two new waiver applications were submitted to the
  Centers for Medicaid and Medicare Services (CMS)
  on August 1, 2008
• Implementation date is November 1, 2008
• Since they are considered new waivers by CMS,
  initial approval will be for a maximum of 3 years.

3
New Waivers

• Supports Waiver-maximum annual benefit at 17,500
• Comprehensive Waiver-replacement for the current
  waiver with maximum annual benefit at 135,000

4
Objectives of the Supports Waiver and the
Comprehensive Waiver

• Enhancing the focus on person-centered planning
  and the alignment of services and supports with
  person-centered plans.

5
Objectives of the Supports Waiver and the
Comprehensive Waiver

• Modified day supports, supported employment, and
  long term vocational supports
• To ensure that participants are progressing
  towards their employment goals,
• AND have meaningful daily activities.

6
Objectives of the Supports Waiver and the
Comprehensive Waiver

• Modifying residential services to facilitate
  smaller community congregate living situations
• Facilitate living and working in the Most
  Integrated Setting and
• Improving outcome-based quality assurance
  systems.

7
Supports Waiver

• For individuals who live in their own home or
  reside with their family with some support
• and individuals who live in licensed residential
  facilities.
• Self-direction is an option in this waiver for
  individuals living in their own home or with
  their family.
• The Supports Waiver contains an annual maximum
  cost limit of 17, 500.

8
Comprehensive Waiver

• Intended for individuals who reside in their own
  home reside with their family or receive
  residential services in community congregate
  settings in the community.
• The Comprehensive Waiver contains an maximum
  annual cost limit of 135,000.

9
Moving to the New Waivers

• CORE VALUES

10
What are Core Values?

• The Core Values
• a set of ideas and norms
• established to express the foundation
• in which services are to be created, implemented
  and delivered
• to all participants of Developmental Disabilities
  and CAP-MR/DD waiver services and supports

11
What are the Core Values?

• The Core Values are
• Empowerment
• Community
• Partnership
• Integrity
• Commitment
• Quality

12
Empowerment

• Empowerment is
• a process that challenges our assumptions about
  the way things are and can be.
• challenges our basic assumptions about power,
  helping, achieving, and succeeding.
• The process which enables one to gain power,
  authority and influence over others, institutions
  or society.

13
Community

• Communities share
• intent, belief, resources, preferences, needs,
  risks,
• and a number of other conditions that may be
  present and common,
• affecting the identity of participants and their
  degree of cohesiveness.

14
Partnership

• A relationship between individuals or groups,
• characterized by mutual cooperation and
  responsibility,
• for the achievement of a specified goal.

15
Integrity  

• It is the concept of basing of one's actions on
  an internally consistent framework of principles.
  
• Integrity can be expressed as personal honesty
  acting according to one's beliefs and values at
  all times.

16
Commitment

• The means to duty or pledge to something or
  someone, the state of being bound emotionally or
  intellectually to a course of action or to
  another person or persons.
• We use this word commitment or committed to
  express why we do what we do. We must realize
  that commitment is not just a word but it is an
  action.

17
Quality

• The totality of features and characteristics of a
  product or service that bear on its ability to
  satisfy stated or implied needs.

18
Quality Measures

• Rose Burnette
• DMH/DD/SAS

19
Quality Improvement System Development

• New waiver applications required enhanced
  attention to the states quality
  improvement/management system
• Quality Improvement Strategy is evidence based
  and is a continuous Quality Improvement process

20
Quality Improvement System Development

• Quality Improvement Strategies
• Waiver Administration and operation
• Qualified Providers
• Health and Safety
• Level of Care
• Service Planning
• Financial Accountability

21
Quality Improvement System Development

• Waiver Administration and operation
• DMA-DMH-DD-SAS formal agreement
• DMA monitoring of DMH-DD-SAS compliance to
  requirements

22
Quality Improvement System Development

• Level of Care
• Ensuring participants meet LOC criteria
• Ensuring LOC process is completed per
  requirements
• CNR completion per required timelines and

23
Quality Improvement System Development

• Qualified Providers
• Licensure and/or certification standards
• Completion of criminal records checks
• Health Care Personnel Registry Checks
• Non-licensed AFL providers
• LME monitoring

24
Quality Improvement System Development

• Service Planning
• PCP address needs and personal outcomes
• Participant satisfaction
• Risk assessment
• PCP completion per requirements

25
Quality Improvement System Development

• Health and Welfare
• Risk assessment
• Incident Reporting
• Reports of abuse and neglect
• Review of Level II and III Incidents
• Use of restraints
• Routine dental and health care

26
Quality Improvement System Development

• Next steps
• Development of a System wide data base
• Implementation of processes
• Training

27
National Accreditation

• Requirements for CAP-MR/DD

28
National Accreditation

• Providers will have one year from the date of
  enrollment with DMA or the implementation date of
  the waiver, whichever is later, to earn National
  Accreditation.
• Requirement is based on legislation

29
Provider Endorsement and Compliance to Staff
Training/Core Competencies

• Endorsement of new services
• LME review of providers for compliance of
  additional staff training/core competencies

30
Endorsement of New Services

• Home Supports
• Long Term Vocational Service
• Crisis Respite

31
Endorsement of New Services

• Behavioral Consultant
• Revisions based on public comment
• Revision will be posted on DMA web site for
  public comment
• After the public comment period endorsement can
  be initiated and completed.

32
Endorsement of New Services

• Home Supports
• written and designed to contain the elements and
  requirements of Residential Supports.
• Home Supports is the only service that can be
  rendered by parents who live with their adult
  child.
• Currently parents may provide Home and Community
  Supports and Personal Care services to their
  adult child living in the home.

33
Endorsement of New Services

• Home Supports
• Existing providers of Residential Support
  services, who intend to provide the new service,
  Home Supports, endorsement is not required.
• Existing providers of Residential Support
  services are required to sign the attestation
  letter indicating compliance to the Home Supports
  service definition.

34
Endorsement of New Services

• Endorsement completed per the DHHS Policy and
  Procedures for Endorsement of Providers of
  Medicaid Reimbursable MH/DD/SA Services.
• Statewide enrollment, of the services provided,
  with DMA, and a signed MOA with each LME
  indicating which services they will deliver
  within the LME catchment area.

35
Modifications to Existing Service Definitions

• Modifications include additional staff
  qualifications and training/core competencies
  requirements
• Adult Day Health, Crisis Services, Day Supports,
  Home and Community Support, Personal Care,
  Residential Supports, Respite, and Supported
  Employment.

36
Modifications to Existing Service Definitions

• Providers are required to sign the Attestation
  Letter, indicating
• their understanding of the new staff
  training/core competency requirements, AND
• compliance to the added requirements prior to
  delivering the services, AND
• acknowledgement of the LMEs monitoring of
  compliance to the requirements within 60 days of
  implementation of the waivers.

37
Modifications to Existing Definitions

• Providers submit the signed Attestation letter to
  DMA Provider Services with their completed
  Addendum Application
• Copy to the LME

38
Modifications to Existing Definitions

• LMEs MUST monitor providers within 60 days of
  implementation of the waivers or provider
  delivery of the service.
• To ensure compliance to the new requirements.
• DMH-DD-SAS will verify the LME monitoring.

39
CAP-MR/DD Waivers

• Service Definitions
• October 2008

40
Opportunity
41
Opportunity

• What do people want
• Whats working
• What needs to be fixed

42
GOAL

• Develop quality services that give the
  opportunity for to
• have real lives
• have real jobs
• have real choices
• make decisions about their lives

43
Changes

• Created Two Separate Waivers
• Staff Training
• Staff Qualifications
• Services
• Added 4 new services
• Clarified Definitions
• Clarified UR Guidelines

44
Staff Training Requirements

• Added Staff Training/Competencies to all
  definitions for direct service staff
• Added Requirement for First Aid and CPR to all
  definitions for direct service staff

45
Staff Training -Competencies

• Elements for Core Values
• Elements for Person Centered Thinking
• Elements for Role/Purpose/Philosophy of Services
• Elements for Participant Rights
• Elements for Overview of Developmental
  Disabilities

46
Staff Training -Competencies

• Elements for Interaction and Communication
• Elements for Service and Documentation
• Elements for Incident/Accident and Other
  Reportable Events
• Participant Specific Competencies

47
Staff Qualifications

• Direct Care Staff, providing services, MUST have
  a High School Diploma or GED.

48
Personal Care and Respite

• Requirement for High School Diploma or GED.
• Existing staff will have 18 months to obtain
  their High School Diploma or GED.
• All new staff must have proof of High School
  Diploma or GED upon hire/prior to delivering
  services.

49
New Services

• Home Supports
• Crisis Respite
• Behavior Consultant
• Long Term Vocational Supports

50
Participants Living with their Family

• Person Centered Planning
• Participant chooses what services/supports and
  who provides services/supports
• Choices
• Home Supports Family or Guardian of the Person
  living with the participant
• Home and Community and/or Personal Care- Person
  Not Living with Participant

51
Participants Living with their Family

• Participant can chose to receive both service
  types
• Home Support
• Home and Community- Personal Care Services
• BUT
• Not on the same day

52
Participants Living with their Family

• Example
• Participant lives with Grandma in Grandmas home.
  
• Participant chooses Grandma to provide services
  Monday, Wednesday, and Friday.
• Grandma agrees and will provide Home supports on
  those days.
• AND.

53
Participants Living with their Family

• Example, cont.
• Participant wants Acme Agency to provide services
  the remainder of the weekTuesday, Thursday,
  Saturday and Sunday.
• Acme services agrees and provides Home and
  Community Supports and/or Personal Care the other
  days the week.

54
Home Supports

• Blended service-
• Combination of Home and Community and Personal
  Care
• Daily (per diem) Service/Rate-
• Similar to Residential Supports-
• Levels I, II, III and IV

55
Home Supports

• Provided by
• Parents, Step Parents, Adoptive Parents- residing
  with the Participant
• Guardian of the Person residing with the
  Participant
• Other family members residing with the Participant

56
Home Supports

• May be used with
• Community Component of Home and Community
  Supports (4 hours per day to develop an
  individualized day program)
• Respite
• Day Supports
• Long Term Vocational Supports
• Supported Employment

57
Home Supports Grid

• Compares
• Home Supports
• Residential Supports
• Home and Community Supports
• Personal Care

58
Long Term Vocational Supports

• Provides periodic support to individuals
• 1) Who have successfully obtained a
  competitive job
• 2) No longer need Supported Employment
• 3) Who need occasional monitoring and support

59
Crisis Respite

• A short term service designed for the individual
  experiencing a crisis for which a period of
  structured support and/or programming is
  required.
• The service may be used only when the
  implementation of Crisis Services has failed to
  result in stabilization of dangerous, and
  potentially life threatening behaviors.

60
Crisis Respite

• The service is provided in a licensed facility or
  licensed private home respite setting, separate
  and apart from the individuals living
  arrangement.

61
Behavioral Consultant

• Provides consultation, support and training in
  procedures and techniques that are designed to
  decrease problem behaviors and increase positive
  replacement behaviors.

62
Behavioral Consultant

• The service is Habilitative in nature, and
  intended to assist the individual in acquiring
  and maintaining the skills necessary to live in
  their communities and avoid institutional
  placement.
• The definition is being revised and will be
  posted for public comment.

63
Definitions Clarified

• Personal Care
• Respite
• Home and Community Supports Community Component

64
Personal Care - Respite

• Enhanced Personal Care or Respite
• An individual receiving enhanced personal care
  has needs that require
• Additional skill level
• Additional training so that a higher level of
  decision can be made
• Additional supervision

65
Home and Community Supports

• Individualized Day Program

66
Community Component of Home and Community Supports

• Must be structured
• Activities must not duplicate what is provided by
  Home Supports or Residential Supports
• Limited to 4 hours /day (Community Component of
  Home and Community Supports)

67
Crisis Services

• Provides one additional staff person for the
  individual, as needed, during an acute crisis
  situation to support the individual to continue
  to participate in his/her daily routine and/or
  residential setting without interruption.
• Can be authorized for 14 days

68
Crisis Services

• Imminent institutional admission may be avoided
  while protecting the individual from harming
  themselves or others.
• Supports the implementation of the crisis
  intervention component of the formal behavior
  intervention program developed by a licensed
  psychologist under the definition of Behavior
  Consultation.

69
Crisis Services

• After any crisis event it is expected that
  recommendations and changes, as needed, be made
  to the intervention program, as well as the
  crisis plan within the Person Centered Plan.

70
Services Modified

• Residential Supports
• Day Supports
• Supported Employment

71
Residential Supports 3 beds or Less

• Residential Supports can be provided in
  licensed residential settings of 3 beds or less
  including
• licensed Alternative Family Living, or
• Foster Homes, and
• unlicensed alternative family living homes
  serving one adult

72
Residential Supports 4 - 6 Beds

• Residential Supports may also be provided in
  licensed residential setting of 4 or 6 beds
• which were licensed prior to the implementation
  of the waivers and
• demonstrate a home and community character

73
Residential Supports7-15 Beds

• Participants who reside in a facility with 7-15
  beds who were participating in the CAP-MR/DD
  Waiver at the time of implementation of the
  Waiver may continue receiving Residential
  Supports in their current living arrangement if
  it is justified in the Person Centered Plan.

74
Residential Supports

• Person Centered Plan must address
• appropriateness of this placement,
• the unavailability of other appropriate
  placements
• and how this placement meets the home and
  community character.
• No other individuals receiving CAP-MR/DD services
  will be admitted to these homes except for short
  term respite.

75
Residential Supports16 or more beds

• Individuals who live in facilities with 16 or
  more beds at the time of the implementation of
  the Waiver may continue receiving Residential
  Supports in their current living arrangement
  however
• there must be a plan implemented for the
  transition of these individuals into smaller
  community based living arrangements within three
  years of the implementation of this waiver.

76
Residential Supports

• Transition plans must be developed within 6
  months of the implementation of the waiver.
• A progress report outlining activities completed
  toward transition must be accompanied with each
  Person Centered Plan and request for
  reauthorization of services.

77
Residential Supports

• After implementation of the waiver,
• No individual admitted or residing in a facility
  with 16 or more beds will be eligible to receive
  CAP waiver services.

78
Home Environment

• A home and community character is defined as a
  residence that
• Provides an environment like a home, and
• Provides full access to typical facilities in a
  home such as a kitchen with cooking facilities,
  small dining areas, and
• Provides for privacy, and

79
Home Environment

• A home and community character is defined as a
  residence where
• Individuals are supported to receive visitors at
  times convenient to the individual, AND
• There is easy access to resources and activities
  in the community.
• Participants have the opportunity to be a part of
  the neighborhood and community

80
Day Supports- modifications

• Purpose
• To assist with acquisition, retention, or
  improvement in self-help, socialization and
  adaptive skills.
• Day Supports can not be used to provide
  vocational services.

81
Supported Employment

• Supported Employment- Individual
• Pre-job training/education and development
  activities
• To prepare a participant to engage in meaningful
  work-related activities

82
Supported Employment

• May include
• career/educational counseling,
• job shadowing,
• assistance in the use of educational resources,

83
Supported Employment

• May include
• training in resume preparation, job interview
  skills, study skills
• assistance in learning skills necessary for job
  retention and
• assisting a participant to operate a
  micro-enterprise.

84
Supported Employment

• The purpose is to develop skills for competitive
  job placement.
• It is intended to be a short term service.
• Outcomes are developed that include a fading plan
  based on the individuals needs.

85
Supported Employment

• Supported Employment- Group
• Transitional Work Services consist of
• supporting participants in transition to
  integrated, competitive employment
• through work that occurs in a location other than
  a licensed facility.
• Transitional work service options include, but
  are not limited to mobile work force, work
  station in industry, affirmative industry, and
  enclave.

86
Supported Employment

• Mobile Work Force
• uses teams of individuals, supervised by a
  training/job supervisor,
• who conduct service activities away from an
  agency or facility.
• The provider agency contracts with an outside
  organization or business to perform maintenance,
  lawn care, janitorial services, or similar tasks
  and the individuals are paid by the provider.

87
Services for Employment

• Vocational Rehabilitation services must be
  considered prior to using waiver services.

88
Utilization Guidelines

• 1
• Direct Service Required
• (Case Management is not included)

89
Clarified Utilization Review Guidelines

• Habilitiation for Children
• No CAP-MR/DD Service Utilized in school
• No CAP-MR/DD Habilitation Services Utilized
  during the time that school is typically in
  session

90
Clarified Utilization Review Guidelines

• If the IEP indicates that the school day is less
  than the standard day, only non- habilitative
  service may be used for the remainder of the
  school day.

91
Clarified Utilization Review Guidelines

• Habilitiation for Children
• Children Home Schooled
• Home Schooling Certificate
• Dates and times of home schooling
• Home Schooling follows the same hours as the
  school

92
Clarified Utilization Review Guidelines

• Current Waiver-
• A participant enrolled in public school or are
  between 5-15 years of age can receive no more
  than 6 hours of habilitation a day when school is
  in operation according to the calendar published
  by the LEA.
• Participants who do not fall under the above
  guideline may receive 12 hours of habilitation a
  day.

93
Clarified Utilization Review Guidelines

• Habilitation Maximums
• Adults 12 hours per day
• Include habilitation portion of Home Supports and
  Residential Supports
• Children may receive 3 hours of habilitation on a
  school day and an additional 3 hours may be
  approved if clearly justified during school days.

94
Clarified Utilization Review Guidelines

• Children may receive 9 hours of habilitation
  during a non-school day. An additional 3 hours of
  habilitation may be approved if clearly
  justified.

95
Utilization Review

• Includes
• NC SNAP with justification
• Evaluations
• Initial
• Required for equipment
• Additional justification

96
Utilization Review

• Includes
• Review of Person Centered Plan
• Assurance of Health and Safety
• Client Rights Committees
• Do the services meet the needs

97
Home Supports Residential Supports

• Level 1 2 ½ - 4 ½ hours of direct service per
  day
• Level 2 4 ½ 6 ½ hours of direct service per
  day
• Level 3 6 1/2 - 9 ½ hours of direct service per
  day
• Level 4 8 ½ - 12 ½ hours of direct service per
  day

98
Home SupportsResidential Supports

• Blend of Habilitation and Personal Care
• Must include a minimum of 1 hour of habilitiation

99
Transition

• Movement to the new Waivers

100
Waiver Opportunities in NC

• If a participants cost summary is under 17,500,
  they will be entered into the Supports Waiver.
• If a participants cost summary is between 17,501
  and 135,000, they will be entered into the
  Comprehensive Waiver.

101
Waiver Transition Process
STEP 1 DMH/DD/SAS requested from
LMEs Annualized cost summary data.
STEP 2 Based on cost summary data, DMH/DD/SAS
assigned participants to either the
Comprehensive Waiver or the Supports Waiver.
STEP 3 DMH/DD/SAS provided the LMEs with
participant lists for each waiver.
STEP 6 The Case Manager will complete the Case
Manager Transition Process Check Sheet per
participant, to include waiver assignment,
waiver differences, any issues and appeal rights.
STEP 4 LMEs submit participant specific Waiver
Transition Letter to Case Manager agencies and
local DSS office, identifying participant and
waiver assignment.
STEP 5 The Case Manager will hand deliver or
mail the Waiver Transition Letter to the
participant and/or legally responsible person.
STEP 7 The Case Manager will send a copy of the
Case Manager Transition Process Check Sheet to
the LME, the participant and place original in
the participant file
STEP 9 The CAP-MR/DD participant transitions to
new waivers (new services if authorized) November
1, 2008, pending CMS approval.
Step 8 The DSS will enter the appropriate
indicator on the Medicaid card, CM-
Comprehensive and C2 Supports Waiver
102
Multi Agency Involvement with the Transition
Process

• The Division of Mental Health-Developmental
  Disabilities-Substance Abuse Services
  (DMH-DD-SAS) has had ongoing dialog with the
  Local Management Entities (LME), Division of
  Medical Assistance (DMA) and Value Options (V0)
  to develop the transition process.

103
Multi Agency Involvement with the Transition
Process

• The Local Management Entities provided DMH/DD/SAS
  with information, secured from case managers,
  regarding each participants current cost summary.

104
Other Agencies-

• DMH/DD/SAS notifies Division of Medical
  Assistance and the local County Department of
  Social Services of the processes and the list of
  participants for each waiver.
• DSS is responsible for Medicaid enrollment and
  processes the Medicaid Card on a monthly basis.

105
Department of Social Services

• Is responsible for Medicaid enrollment
• Has updated information regarding waiver status
  and the Medicaid status.
• Processes the Medicaid Card on a monthly basis.

106
Department of Social Services

• Comprehensive Waiver
• Medicaid card remains with same indicator code of
  CM
• Supports Waiver
• Medicaid card will have a new indicator code of
  C2

107
Division of Mental Health-Developmental
Disabilities-Substance Abuse Services

• Provides LMEs with names of participants in each
  waiver.
• Provides LMEs with process for notifying
  participants and guardian/responsible person.

108
Local Management Entities

• Submits the Waiver Transition Letters to Case
  Managers and DSS regarding the transition
  process.
• The Waiver Transition Letter is specific to each
  participant and their waiver assignment.

109
Case Managers

• Meetings with participants, guardians and
  responsible persons
• Waiver assignment
• Waiver differences
• Any Issues, and
• Appeal Rights

110
Service Specific Transition

• The Waivers

111
New Service Definitions for the Supports Waiver

• Case Manager to complete revision for -----gt

• Long Term Vocational Support
• Crisis Respite

112
Services not included in Supports Waiver

• Home Supports
• Residential Supports

113
New Service Definitions for the Comprehensive
Waiver

• Case Manager to complete revision for -----gt

• Long Term Vocational Support
• Crisis Respite
• Home Support

114
Transition

• Moving Services

115
All Plans of Care

• Case Manager, participant and Team responsible
  for
• Review Plan of Care
• Address issues with Transition
• Make necessary revisions
• If no changes in services are needed, nothing
  submitted to Value Options

116
Adding new service or changing existing services

• Complete the Plan of Care revision
• Submit complete and accurate information to Value
  Options
• If no changes in services are needed, no
  information submitted to Value Options

117
New Service Request cont

• Can not bill new services prior to November 1,
  2008 or implementation of the new waivers.
• Can not bill new services until the appropriate
  authorization is in place.

118
Completion of CNRs

• CNR(s) due November 1, 2008,
  December 1, 2008,
• January 1, 2009
• Send new Plan of Care and Revision for potential
  changes at the same time.
• If there is a delay in the implementation of the
  waivers, Value Options can make the changes in
  service orders immediately with both Plans of
  Care and Revisions.

119
Plan of Care / Person Centered Plan

• Implementation Schedule for the use of the
  uniform PCP format
• January 2009 all initial and CNRs are to be
  completed using the uniform PCP document.
• By January 2010 all plans will be on the uniform
  document.

120
Summary

• Use the current POC for current revisions
• Use the most current Cost Summary form
• Ensure all data elements are correct, and the
  mandated documentation is accurate and complete!

121
Appeals Process

• As of 10/3/08 all informal appeals have been
  completed
• All other appeals have been sent to Office of
  Administrative Hearings (OAH)
• There will be no more informal appeals
• Two Options
• Mediation
• Formal Appeal

122
CAP MR/DD Access and Eligibility Services Flow

• STEP 5E
• LME sends copies to recipients
• Mail approved MR2 with PA to
• DSS and TCM
• DSS will need MR2 and PCP to
• turn on waiver indicator

• STEP 5F
• IF Denial of ICF-MR
• Level Of Care
• 10 days to submit
• Notice of Denial

STEP 1 STR Screening, Triage Referral
STEP 2A Referral for Comprehensive Clinical
Assessment
STEP 2B Referral to TCM agency

• STEP 5D
• Murdoch Stamps Original
• MR2 Approved
• Murdoch has 5 business days
• to send to LME

• STEP 6 TCM
• Submit PCP to UR vendor
• 30 days from MR2 signature
• READY FOR SERVICES

• STEP 3 TCM
• MA Eligibility, if applicable
• 8 Hrs Unmanaged (MA) Begins
• CTCM Submitted
• Referral To LME if waiver
• services requested
• READY FOR SERVICES

• STEP 5C
• LME Mails Original MR2 to
• Murdoch
• LME has 5 business
• Days to submit MR2 (original)

• STEP 7
• CAP-MR/DD Waiver
• Services Rendered
• LME/TCM has 120 days to
• Implement services upon slot
• Allocation

• STEP 4 LME
• Prioritization Tool Completed
• Request Slot (based on
• availability of funding)
• MR2 completed
• Referral to Murdoch for LOC

• STEP 5B
• Murdoch completes
• LOC
• LME has 5 business
• Days to submit MR2
• (Copy) to Murdoch

STEP 5A TCM follows up with local DSS for MA
(CAP) Eligibility
123
Risk Assessment

• Tool and Instructions

124
Risk Identification

• All risks are not bad!
• Life events affect everyone differently.
• Not all crisis are behavioral in nature.
• Growth-Maturity comes from taking risks.
• Identifying and addressing risks are the key to
  crisis prevention.

125
Types of choices their consequences

• Trivial - Do you want the blue or black pen?
• Minor, reversible consequences - You spent your
  money on a CD, so you dont have any for a
  movie.
• Minor, irreversible - You ate the Twinkie, so
  you cant get your money back because you changed
  your mind.
• Major, reversible Marriage.
• Major, irreversible Unprotected sex resulting
  in HIV/Aids.

126
Risk Identification

• Risk Identification Tool identifies potential
  risk and asks for the reason why this is a risk
  for this person.
• Use of the Tool creates a risk assessment.

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Risk Identification Tool

• Identifies issues in the following areas
• Situational
• Environmental
• Behavioral
• Medical
• Financial
• Review of incidents from the incident
  reporting system

128
Risk Identification Tool

• A means to discuss risk as it relates to the
  participant
• Reviews risk from all view points
• Different environments
• Different activities
• Allows opportunities to reduce, or eliminate
  risks.
• Identifies potential crisis

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Risk Assessment

• The Risk Assessment created using information
  attained using the Risk Identification Tool is
  considered during the development of the Person
  Centered Plan.
• Supports, strategies and goals will be developed
  based on information learned from the Risk
  Assessment.

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Health, Safety and Risk
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Health, Safety and Risk

• A question of balance.
• Balance implies that the person gets more of
  what is important to him or her as a unique
  individual and that issues of health or safety
  are effectively addressed within the context of
  how the person wants to live. (Smull)
• Supporting choice while not promoting harm.

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Prioritization

• Prioritization Tool,
• Process
• And
• Instructions

133
Prioritization Tool

• The waiver application requires states to specify
  how individuals will be identified to receive
  waiver funding and to assure statewideness.
• The CAP-MR/DD Waiver Services Prioritization Tool
  is used to assess the intensity of need of
  individuals requesting CAP-MR/DD Waiver funding.

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Crisis is Defined As

• Homelessness or pending imminent homelessness
  with no viable housing alternative.
• Requiring protection from confirmed abuse,
  neglect, or exploitation.

135
Crisis Is Defined As

• At significant risk of serious physical harm in
  current environment.
• At significant risk of causing serious physical
  harm to others in current environment.

136
Crisis Is Defined As

• Caregivers unable to provide adequate care due to
  caregivers significantly impaired health.

137
Prioritization Tool

• The tool has six sections covering the areas of
  need
• Habilitation Support
• Medical and Related Support
• Personal Care and Adaptive Equipment
• Array of Current Supports and Services
• Risk of Institutionalization
• Length of time waiting for CAP-MR/DD waiver
  funding

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Prioritization Tool

• The LME completes the tool by interviewing family
  or another person who is very familiar with the
  individual.
• Information is updated
• When additional funding is available
• When the needs of the individual change

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Thank you!

• www.ncdhhs.gov/mhddsas/
• Questions???