OAAS CCW/ADHC Transition to OCDD ROW - PowerPoint Presentation

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OAAS CCW/ADHC Transition to OCDD ROW

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Objectives

Explain why this transition is taking place.

Provide overview of the OCDD Residential Options Waiver (ROW)

Outline the Transition ProcessDefine Roles during the transition process;Affected Individuals/participantsOffice of Aging and Adult Services (OAAS) Support CoordinatorsOffice for Citizens with Developmental Disabilities (OCDD) Support CoordinatorsOCDD Local Governing Entities (LGE) Offices OAAS Regional Offices

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Where Are We

G

oing?

OAAS Participants with an SOA with OCDD will be transitioned to the ROWThere are approximately 230 CCW or ADHC participants identified that this will impactIndividuals on the Request for Services Registry (RFSR) for CCW or ADHC will be moved to a RFSR for ROWTransition process will begin in January 2016 as part of each participant’s OAAS annual planningThis change will result in greater access to services specifically designed to support the needs as persons with ID/DD.

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2 Residential Options Waiver (ROW

)

Overview4

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What is the ROW?

Residential Options Waiver (1 of 4 OCDD Waivers)

Offered to eligible individuals of all ages through OCDD

There are multiple services available that were initially designed to support individuals to move from Intermediate Care Facilities (ICF/DD) and nursing facilities into the community5

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Who is Eligible for the ROW?

Individuals from birth to end of life that meet the following eligibility criteria:

Have a Developmental Disability as defined in the DD Law

Have a Statement of Approval (SOA)Meet both financial and non-financial eligibility criteria for Home and Community Based Waiver Services (HCBS)Meet ICF/DD level of care criteriaAll other non-financial requirementsUS citizenship and Louisiana Residency

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What Services are Available?

Support Coordination (

Required Service

)Residential Services (Required Service)Must choose one of the 4 types of Residential Services in the ROW:Community Living Supports (CCW- Personal Assistance Service (PAS)/ADHC-Long Term-Personal Care Service(LT-PCS)

(May be Self – Directed)

Companion

Care

Host

Home

Shared Living

Note: ROW requires use of SC &residential support each month to maintain waiver

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Additional ROW Services

Center-Based

Respite

Vocational/Habilitation Permanent Supportive Housing ServicesNursing Professional ServicesDietician PT/OT

Speech

Social Worker

Psychological

* This is not a complete

list

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What is the ICAP?

Inventory

for Client

& Agency Planning (ICAP): a widely used assessment tool, measuring both adaptive & maladaptive behaviors & gathers additional info

Completed by the LGE

Completed

initially

and

as

needed,

R

equested

prior to the development of a ROW plan of

care

The

ICAP assessment instrument

provides:

Identification of skills

requiring assistance to allow the

individual

to live as independently as possible

information

used to identify

home & community-based support

needs

mechanism for establishing an individual’s budget in the ROW.

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Are There Limits on Budgets in the ROW?

Yes, the ROW is a Capped Waiver, where there are four (4) budget levels

Participant’s

Annual Budget is Based on ICAP Level Budget amounts change as changes occur in assessment ICAP levels

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ICAP Service Level & ROW Individual Budget Limits Correlation

ICAP

Service Score

ICAP Level

ICAP

Support Level

ROW Acuity Level

ROW Individual Budget Limit

(Based

on 7/1/2012

budget reduction LR

39;1049 &

subject

to

change)

70-90+

7,8,9

Intermittent

1

$48,087.73

40-69

4,5,6

Limited

2

S51,122.41

20-39

2,3

Extensive

3

$56,288.84

1-191Pervasive4$61,753.99

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Person Centered Discovery

Complete and/or review any required assessments

ICAP (Completed by LGE – Entry Staff)

90-L (Completed by Medical Doctor)Personal Outcomes AssessmentReview current available records and/or assessment informationSynthesize/summarize informationInterview participant & those that know him/her best to determine who they are & fill in gapsIdentify Vision & Goals for the individual

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Planning

Set Personal Goals (Based on Vision)

What opportunities exist to support achieving?

What challenges/barriers get in the way?Develop Action/Support PlanHow do we use existing opportunities?What supports are needed to move towards goals?What supports/treatment are needed to address challenges/barriers?13

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Finalization of Plan & Building Budget

What actions can the individual take independently?

What actions/supports will be provided by family, friend, others?

What connections need to be made/supported with community organizations?What other services/paid supports are accessible and will be used?Identify any areas of unmet needs & determine which ROW services will address those needs.14

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3 Transition Process

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Transition Process

OAAS will generate a list by region & POC end date of participants to be transitioned

List will be updated monthly

List will be shared with OCDD LGEs & MedicaidOAAS Area Managers will forward list to RO SupervisorsOAAS will share list with OAAS Support Coordination Agencies (SCAs)OCDD will share list with the LGEsBased on the list, OCDD

LGE office will schedule

& complete

the ICAP

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Transition Process (continued)

OCDD

will notify Statistical Resources Incorporated (SRI) to send the participant packet

SRI will send the participant packet that includes:Information regarding transition90-LFreedom of Choice (FOC) for Support Coordination AgencyIf current SC agency is also an OCDD SC agency-participant will be able to remain with that SC agency17

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Transition Process (cont’d)

Participant will need to return the 90-L and the FOC to SRI

OAAS SC will actively assist in completion &return of participant packet

SRI will link participant to appropriate SCA after receipt of FOC & 90-L If the FOC is not received in 14 days from receipt, individual will be auto-assigned to an SC agencySRI may link without the 90-LSRI will send the link to SC agency and Medicaid

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Transition Process (cont’d)

OCDD SCA will:

Obtain ICAP score and SOA

Call the participant within 3 days of linkageMeet with participant within 7 days of linkageComplete the ROW FOCHold planning meeting within 30 days of linkageMake sure Service Provider, OAAS SC, & others identified by the participant are invited & participate in meeting

Submit POC & 148 to LGE within 35 days of linkage

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Transition Process (cont’d)

LGE Waiver staff will:

Review

the POCApprove or Return POC within 10 working days of receiving itConduct pre-cert visit with participantSend 142 & 148 to Medicaid once pre-cert visit is

completed

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Transition Process (cont’d)

Medicaid will:

Change type case and close segment

Issue decision notice 18W to LGE, participant/family, OCDD SC, OAAS, & OCDDLGE Waiver staff will:Issue 51NH (transition start date 14 days out)Initiate 2 week transition process if provider is changingNotify SRI that 18W is issued & submit appropriate documentation (budget pages, etc.)Notify OAAS State Office identified staff via email

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Transition Process (cont’d)

SRI will:

Issue, on transition date:

Prior Authorization (PA) for OCDD SCA and remove PA for OAAS SCAPA for providers changes from OAAS waivers to ROW If provider is changing, OCDD SCA will notify both providers of change date once approved POC is received from LGE22

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4 Roles

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Role of the Participant

Receive notification about transition

Ask questions

Schedule ICAPReturn SCA FOCSchedule doctor’s appointmentReturn 90-LParticipate in completion of ICAPParticipate in Discovery/Planning process24

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Role of OCDD LGE

Complete the ICAP –

Entry Staff

Share ICAP score & SOA with OCDD SC (staff TBD by DD Director)Review/Approve plan of care – Waiver StaffComplete standard initial plan of care certification process – WaiverIssue 51 NH-assure all appropriate documents are submitted to SRI51NH should be handled as other transfers are addressed (i.e., the start date should be 14 days after the 18W) -

Waiver

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Role of OCDD SC

Facilitate Discovery/Planning meetings

Request/obtain ICAP and SOA from LGE timely

Develop the Plan of CareInvite – OAAS SC, provider & others important to individual to POC meetingAssure all documents necessary for plan approval are completeConfirm with OAAS SC any open CIRs are closed prior to ROW certification Provide resources/referral as needed to address participants’ needs

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Role of OAAS SC

Serve as a resource for the OCDD SC:

Participate as a respondent in the POC meeting

Assist with explaining changes to the individualsIncluding communications sent by OAAS/OCDD State OfficeAssist with making sure participant completes & returns FOC to SRIAssist with making sure that the 90-L is completed and returned

Coordinate with OCDD SC to set up meetings

Provide copy of the assessments/plan of care

Close any existing Critical Incident Reports (CIRs)

Continue Monthly/Quarterly Requirements

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Role of the Regional Office (OAAS)

Tracking/monitoring of the transition process

Including closure of outstanding CIRs

Provide technical assistance to OAAS SCAs28

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Role of SRI

Send individual packet (90-L, FOC for SCA)

Process linkage

Send linkage to SCA and MedicaidIssues PA for OCDD SCA and removes PA for OAAS SCAIssues PA for service providers29

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Role of Medicaid

Changes type cases and closes

Issues decision notice 18W to LGE, family/individual, OCDD SC, OAAS, and OCDD

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Role of OAAS/OCDD State Office

Provide list of Individuals to be transitioned to SRI, Medicaid, and OCDD LGE offices

Develop/Send communications as necessary to individuals and stakeholders as appropriate

Track/Monitor the Transition processProvide Technical support to OCDD LGE/OAAS Regional offices31

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5 Next

Steps

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Moving Forward

OCDD will send list of participants impacted to the LGE office

ICAPs for individuals identified to transition will need to be scheduled

and completed (by timeframe)OCDD will request SRI forward Freedom of Choice (FOC) packet to identified participantsOCDD SC agency should begin discovery/planning process including requesting ICAP score/SOA from OCDD LGEOAAS SCA will assist throughout entire process

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Resources

ROW – webpage -

http://new.dhh.louisiana.gov/index.cfm/page/1875

ROW Fact Sheet - http://new.dhh.louisiana.gov/assets/docs/OCDD/waiver/ROW/ROWFactSheet110315.pdf OCDD brochure - Where to find Local Offices for ID/DD

http

://www.dhh.state.la.us/assets/docs/OCDD/publications/OCDDProgramBrochure2014.pdf

Request for Medical Eligibility Determination

 

- 90L

http://

new.dhh.louisiana.gov/assets/medicaid/hss/docs/90-LFormrev12-08.pdf

OAAS

Help Line at 1-866-758-5035

OCDD ROW Program Manager – Jeannathan H. Anderson (225) 342-5647

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Questions?

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