DD Waiver Provider Training

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DD Waiver Provider Training

• Department of Medical Assistance Services
  Division of Long-Term Care and Quality Assurance
• Fall 2002

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Todays Training Goal

• To enhance the knowledge of Direct Services
  Providers in areas of service provision,
  documentation, utilization review and billing
  procedures, and to provide updates on the current
  status of the Individual and Families
  Developmental Disabilities Support Waiver

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Update Information

• Serving Lottery s up to 700
• Current Enrollment is 310
• Slots allocated for the waiver are 323
• Include your business in the Provider List for DD
  Waiver
• Kids aging out of MR waiver

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Crisis Stabilization Services
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Service Definition

• Crisis stabilization is direct intervention to
  persons with developmental disabilities who are
  experiencing serious psychiatric or behavioral
  problems, or both, that jeopardize their current
  community living situation.

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Service Definition (cont.)

• Must provide temporary intensive services and
  supports to prevent emergency psychiatric
  hospitalization, institutional placement, or
  other out-of-home placement
• Must be designed to stabilize consumers and
  strengthen current living situations so
  consumers can be maintained in community during
  and beyond crisis period.

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Service Definition (cont.)

• Services shall be designed to stabilize consumers
  and strengthen current living situations so
  consumers can be maintained in community during
  and beyond crisis period.

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Crisis Stabilization Services Shall Provide

• 1. Psychiatric, neuro-psychological,
  psychological, functional assessments, and
  stabilization
• 2. Medication management and monitoring
• 3. Behavior assessment and support and,
• 4. Intensive care coordination with other
  agencies and providers

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Crisis Stabilization Goals

• 1. Planning and delivery of services and
  supports to maintain community placement
• 2. Training of family members and other
  caregivers and service providers in positive
  behavioral supports to maintain individual in
  community and
• 3. Temporary crisis supervision to ensure safety
  of individual and others.

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Assessment of Need

• Individual must meet at least one of the
  following criteria
• Marked reduction in psychiatric, adaptive, or
  behavioral functioning
• Extreme increase in emotional distress
• Need for continuous intervention to maintain
  stability or
• Causing harm to self or others.

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Assessment of Need (cont.)

• The individual must be at risk of at least one of
  the following
• Psychiatric hospitalization
• Emergency ICF/MR placement
• Disruption of community status (living
  arrangement, day placement, or school) or
• Causing harm to self or to others

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Authorization

• A documented face to face assessment conducted by
  a qualified mental health professional must occur
  prior to authorization.
• Supporting documentation (DMAS 457) based on this
  assessment must be developed and submitted to the
  support coordinator within 72 hours for
  authorization to occur.

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Allowable Settings for Crisis Stabilization
Services

• Individuals home
• Day program
• Respite care setting

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Crisis Supervision

• May be provided as a component of this service
  only if clinical or behavioral interventions
  allowed under this service are also provided
  during the authorized period.
• If provided during the authorized period as a
  component, it is billed in hourly service units.

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Service Limitations

• Crisis stabilization may not be used for
  continuous long term care.
• Room and board and general supervision are not
  components of this service.
• Service can be provided no more than 60 days in a
  calendar year.

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Service Units

• Service is billed in hourly service units and can
  be authorized for a time period of up to 15-days.
• Actual service units per episode based on
  documented clinical needs of individual receiving
  services.

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Service Units

• Extension of services, beyond 15-day limit
  period, must be authorized following documented
  face-to-face reassessment conducted by qualified
  professional.

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Provider Documentation Requirements

• The Support Coordinator gives the provider the
  following information
• DMAS-122
• DMAS-456 and DMAS-457
• Any relevant evaluations, therapeutic consults or
  MD evaluations relevant to developing plan of care

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Provider Documentation Requirements (cont.)

• The provider must keep individual records
  including the following information
• Information provided by Support Coordinator
• Supporting documentation (DMAS 457) developed by
  provider
• Dates and times of crisis stabilization services
  and amount and type of service provided

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Provider Documentation Requirements (cont.)

• Documentation of staff qualifications must be
  maintained for review by DMAS.

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Thank You For Coming!

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