Transition to Residential Options Waiver for Participants with Developmental Disabilities
Office of Aging and Adult Services (OAAS) - Community
Choices (CCW) and Adult Day Health Care Waiver (ADHC)
Transitions to the…
Office for Citizen with Developmental Disabilities (OCDD) -
Residential Options Waiver (ROW)
1 - Objective/Purpose
Objectives
Explain why this transition is taking place.
Provide overview of the OCDD Residential Options Waiver (ROW)
Outline the Transition Process
Define Roles during the transition process;
Individuals/participants identified to transition
Office of Aging and Adult Services (OAAS) Support Coordinators
Office for Citizens with Developmental Disabilities (OCDD) Support Coordinators
OCDD Local Governing Entities (LGE) Offices
OAAS Regional Offices
Where are we going?
OAAS participants with a Statement of Approval (SOA) with OCDD and
currently receiving CCW or ADHC will be transitioned to the ROW
Approximately 230 CCW or ADHC identified participants will
impacted
Transition process will be a phased in process and based upon OAAS
plan of care expiration dates
This change will result in greater access to services specifically
designed to support the needs as persons with ID/DD.
When will transition phase be initiated?
The transitions will begin with the CCW and ADHC plans due to expire
February 2018
and moving forward
During the
90 days prior
to each participant’s OAAS annual planning
OCDD and OAAS Support Coordinators will work together to ensure
person-centered planning occurs related to the transition with a
focus on maintaining independence and continuing to live safely in
the community.
2- Residential Options Waiver (ROW)
Overview
Jeannathan Anderson, ROW Program Manager
What is the ROW?
Residential Options Waiver (1 of 4 OCDD HCBS Waivers)
Offered to eligible individuals through OCDD
There are multiple services available that were initially designed to
support individuals as transition from more restrictive environments
into the community
Who is Eligible for the ROW?
Individuals meeting 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 criteria
All other non-financial requirements
US citizenship and Louisiana Residency
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 and residential support each month to maintain waiver
Additional ROW Services
•
Center-Based Respite
•
Vocational/Habilitation
•
Permanent Supportive Housing Services
•
Nursing
•
Professional Services
Dietician
PT/OT
Speech
Social Worker
Psychological
* This is not a complete list of all ROW services
What is the Required Assessment Tool?
An Inventory for Client and Agency Planning (ICAP)
is a widely used
assessment tool which can measure both Adaptive and Maladaptive
behaviors and gathers additional information;
Completed by the LGE
I
nitially and as needed
,
Requested prior to the development of a ROW plan of care
What is the Required Assessment Tool?
The ICAP assessment instrument provides:
Identification of the skills requiring assistance to allow the individual
to live as independently as possible
information used to identify home and community-based support
needs
the primary mechanism for establishing an individual’s budget in the
ROW.
Are there Limits on Budgets in the ROW?
Yes,
ROW is a Capped Waiver
There are four (4) budget levels
Participant’s Annual Budget is Based on…
his/her ICAP Level which
must be completed prior to planning begins
Budget amounts may change as changes occur in assessment ICAP
levels
ICAP Service Level and
ROW Individual Budget Limits Correlation
ROW Planning Requirements!
Complete and/or review any required assessments
ICAP (Completed by LGE – Entry Staff)
New
90-L (Completed/Signed by Medical Doctor)
Personal Outcomes Assessment
Review current available records and/or assessment information
Identify Vision and Goals for the individual
Set Personal Goals (Based on Vision)
Develop Action/Support Plan
Identify any areas of unmet needs and determine which ROW services will
address those needs.
3 - Transition Process
Transition Process
OAAS will generate a list by region and POC end date of participants to be
transitioned.
List will be updated monthly.
This list will be shared with OCDD LGEs and Medicaid.
OAAS Area Managers will forward list to RO Managers.
OAAS will share list with OAAS Support Coordination Agencies (SCAs).
OCDD will share list with the LGEs.
Based on the list provided, the OCDD LGE office will schedule and complete the
ICAP.
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 transition,
90-L, and
Freedom of Choice (FOC) for Support Coordination Agency.
If the current SC agency is also an OCDD SC agency-the participant will be able
to remain with that SC agency.
Transition Process (cont’d)
Participant will need to return the 90-L and the FOC to SRI.
OAAS SC will
actively
assist in the completion and return of the participant packet
Follow up during monthly and face to face contacts regarding the completion of
the 90-L by the physician.
SRI will link the participant to the appropriate SCA after receipt of FOC and 90-L
If the FOC is not received in 14 days from receipt, the individual will be auto-
assigned to an SC agency.
SRI may link without the 90-L.
SRI will send the link to SC agency and Medicaid.
Transition Process (cont’d)
OCDD SCA will:
Obtain ICAP score and SOA,
Call the participant within 3 days of linkage,
Meet with participant within 7 days of linkage,
Complete the ROW FOC,
Hold planning meeting within 30 days of linkage, and
Make sure the Service Provider, OAAS SC, and others as identified by the
participant are invited and participate in this meeting.
Submit POC and 148 to the LGE within 35 days of linkage.
Transition Process (cont’d)
LGE Waiver staff will:
Review the POC,
Approve or return the POC within 10 working days of receiving it,
Conduct pre-cert visit with participant, and
Send 142 and 148 to Medicaid once pre-cert visit is completed.
Transition Process (cont’d)
Medicaid will:
Change type case and close segment, and
Issue decision notice 18W to LGE, participant/family, OCDD SC, OAAS, and OCDD.
LGE Waiver staff will:
Issue 51NH (transition start date 14 days out),
Initiate 2 week transition process if provider is changing,
Notify SRI that 18W is issued and submit appropriate documentation (budget
pages, etc.), and
Notify OAAS State Office identified staff via email.
Transition Process (cont’d)
SRI will issue the following on transition date:
Prior Authorization (PA) for OCDD SCA and remove PA for OAAS SCA,
PA for providers changes from OAAS waivers to ROW, and
If the provider is changing the OCDD SCA will need to notify both providers of
the change date once the approved POC is received from the LGE.
4 Roles
Role of the Participant
Receive notification about transition,
Ask questions,
Schedule ICAP and Participate in completion of ICAP,
Return SCA FOC documents to SRI
Schedule doctor’s appointment to complete 90-L,
Return 90-L to SRI or SC,
Participate in Discovery/Planning process.
Role of OCDD LGE
Complete the ICAP –
Entry Staff,
Share ICAP score and SOA with OCDD SC (staff TBD by DD Director),
Review/Approve plan of care –
Waiver Staff,
Complete standard initial plan of care certification process – Waiver,
and
Issue 51 NH-assure all appropriate documents are submitted to SRI.
51NH should be handled as other transfers are addressed (i.e., the
start date should be 14 days after the 18W) –Waiver.
Role of OCDD SC
Facilitate Discovery/Planning meetings,
Request/obtain ICAP and SOA from LGE timely,
Develop the Plan of Care,
Invite – OAAS SC, provider and others important to individual to POC
meeting,
Assure that all documents necessary for plan approval are complete,
Confirm with OAAS SC any open CIRs are closed prior to ROW
certification, and
Provide resources/referral as needed to address participants needs.
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 individuals, including communications sent
by OAAS/OCDD State Office,
Assist with making sure participant completes and returns FOC to SRI, and
Assist with making sure that the 90-L is completed and returned to SRI.
Coordinate with OCDD SC to set up meetings,
Provide copy of the assessments/plan of care,
Close any existing Critical Incident Reports (CIRs), and
Continue Monthly/Quarterly Requirements.
Role of the Regional Office (OAAS)
Tracking/monitoring of the transition process:
Ensure outstanding CIRs are closed prior to transition.
Provide technical assistance to OAAS SCAs.
Send individual packet (90-L, FOC for OCDD SCA),
Process linkage,
Send linkage to SCA and Medicaid,
Issues PA for OCDD SCA and removes PA for OAAS SCA, and
Issues PA for service providers.
Role of SRI
Role of Medicaid
Changes type cases and closes OAAS waiver,
Issues decision notice 18W to LGE, family/individual, OCDD SC, OAAS,
and OCDD regarding ROW waiver approval
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 process, and
Provide Technical support to OCDD LGE/OAAS Regional offices.
6 Next Steps
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 participants,
OCDD SC agency should begin discovery/planning process including
requesting ICAP score/SOA from OCDD LGE, and
OAAS SCA will assist throughout transition process.
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/ROWFactSheet111015.pdf
Where to find OCDD Local Governing Entity’s Office near you!
http://new.dhh.louisiana.gov/index.cfm/page/134/n/137
REQUEST FOR MEDICAL ELIGIBILITY DETERMINATION - 90L
http://new.dhh.louisiana.gov/assets/docs/OCDD/waiver/NOW/90LFormRev6117Fillable.pdf
Resources (cont’d)
OAAS Help Line at 1-866-758-5035
OCDD ROW Program Manager – Jeannathan H. Anderson (225) 342-5647
This content outlines the transition process from Community Choices and Adult Day Health Care programs to the Residential Options Waiver for participants with developmental disabilities in Louisiana. It explains the objectives, timeline, and roles involved in the transition. The Residential Options Waiver will provide greater access to services tailored to the specific needs of individuals with intellectual and developmental disabilities.
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Office of Aging and Adult Services (OAAS) - Community Choices (CCW) and Adult Day Health Care Waiver (ADHC) Transitions to the Office for Citizen with Developmental Disabilities (OCDD) - Residential Options Waiver (ROW) Louisiana Department of Health Office for Citizens with Developmental Disabilities 628 North 4th Street, Baton Rouge, Louisiana 70802 (225) 342-0095
Objectives Explain why this transition is taking place. Provide overview of the OCDD Residential Options Waiver (ROW) Outline the Transition Process Define Roles during the transition process; Individuals/participants identified to transition Office of Aging and Adult Services (OAAS) Support Coordinators Office for Citizens with Developmental Disabilities (OCDD) Support Coordinators OCDD Local Governing Entities (LGE) Offices OAAS Regional Offices
Where are we going? OAAS participants with a Statement of Approval (SOA) with OCDD and currently receiving CCW or ADHC will be transitioned to the ROW Approximately 230 CCW or ADHC identified participants will impacted Transition process will be a phased in process and based upon OAAS plan of care expiration dates This change will result in greater access to services specifically designed to support the needs as persons with ID/DD.
When will transition phase be initiated? The transitions will begin with the CCW and ADHC plans due to expire February 2018 and moving forward During the 90 days prior to each participant s OAAS annual planning OCDD and OAAS Support Coordinators will work together to ensure person-centered planning occurs related to the transition with a focus on maintaining independence and continuing to live safely in the community.
2- Residential Options Waiver (ROW) Overview Jeannathan Anderson, ROW Program Manager
What is the ROW? Residential Options Waiver (1 of 4 OCDD HCBS Waivers) Offered to eligible individuals through OCDD There are multiple services available that were initially designed to support individuals as transition from more restrictive environments into the community
Who is Eligible for the ROW? Individuals meeting 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 criteria All other non-financial requirements US citizenship and Louisiana Residency
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 and residential support each month to maintain waiver
Additional ROW Services Center-Based Respite Vocational/Habilitation Permanent Supportive Housing Services Nursing Professional Services Dietician PT/OT Speech Social Worker Psychological * This is not a complete list of all ROW services
What is the Required Assessment Tool? An Inventory for Client and Agency Planning (ICAP) is a widely used assessment tool which can measure both Adaptive and Maladaptive behaviors and gathers additional information; Completed by the LGE Initially and as needed, Requested prior to the development of a ROW plan of care
What is the Required Assessment Tool? The ICAP assessment instrument provides: Identification of the skills requiring assistance to allow the individual to live as independently as possible information used to identify home and community-based support needs the primary mechanism for establishing an individual s budget in the ROW.
Are there Limits on Budgets in the ROW? Yes, ROW is a Capped Waiver There are four (4) budget levels Participant s Annual Budget is Based on his/her ICAP Level which must be completed prior to planning begins Budget amounts may change as changes occur in assessment ICAP levels
ICAP Service Level and ROW Individual Budget Limits Correlation
ROW Planning Requirements! Complete and/or review any required assessments ICAP (Completed by LGE Entry Staff) New 90-L (Completed/Signed by Medical Doctor) Personal Outcomes Assessment Review current available records and/or assessment information Identify Vision and Goals for the individual Set Personal Goals (Based on Vision) Develop Action/Support Plan Identify any areas of unmet needs and determine which ROW services will address those needs.
Transition Process OAAS will generate a list by region and POC end date of participants to be transitioned. List will be updated monthly. This list will be shared with OCDD LGEs and Medicaid. OAAS Area Managers will forward list to RO Managers. OAAS will share list with OAAS Support Coordination Agencies (SCAs). OCDD will share list with the LGEs. Based on the list provided, the OCDD LGE office will schedule and complete the ICAP.
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 transition, 90-L, and Freedom of Choice (FOC) for Support Coordination Agency. If the current SC agency is also an OCDD SC agency-the participant will be able to remain with that SC agency.
Transition Process (contd) Participant will need to return the 90-L and the FOC to SRI. OAAS SC will actively assist in the completion and return of the participant packet Follow up during monthly and face to face contacts regarding the completion of the 90-L by the physician. SRI will link the participant to the appropriate SCA after receipt of FOC and 90-L If the FOC is not received in 14 days from receipt, the individual will be auto- assigned to an SC agency. SRI may link without the 90-L. SRI will send the link to SC agency and Medicaid.
Transition Process (contd) OCDD SCA will: Obtain ICAP score and SOA, Call the participant within 3 days of linkage, Meet with participant within 7 days of linkage, Complete the ROW FOC, Hold planning meeting within 30 days of linkage, and Make sure the Service Provider, OAAS SC, and others as identified by the participant are invited and participate in this meeting. Submit POC and 148 to the LGE within 35 days of linkage.
Transition Process (contd) LGE Waiver staff will: Review the POC, Approve or return the POC within 10 working days of receiving it, Conduct pre-cert visit with participant, and Send 142 and 148 to Medicaid once pre-cert visit is completed.
Transition Process (contd) Medicaid will: Change type case and close segment, and Issue decision notice 18W to LGE, participant/family, OCDD SC, OAAS, and OCDD. LGE Waiver staff will: Issue 51NH (transition start date 14 days out), Initiate 2 week transition process if provider is changing, Notify SRI that 18W is issued and submit appropriate documentation (budget pages, etc.), and Notify OAAS State Office identified staff via email.
Transition Process (contd) SRI will issue the following on transition date: Prior Authorization (PA) for OCDD SCA and remove PA for OAAS SCA, PA for providers changes from OAAS waivers to ROW, and If the provider is changing the OCDD SCA will need to notify both providers of the change date once the approved POC is received from the LGE.
Role of the Participant Receive notification about transition, Ask questions, Schedule ICAP and Participate in completion of ICAP, Return SCA FOC documents to SRI Schedule doctor s appointment to complete 90-L, Return 90-L to SRI or SC, Participate in Discovery/Planning process.
Role of OCDD LGE Complete the ICAP Entry Staff, Share ICAP score and SOA with OCDD SC (staff TBD by DD Director), Review/Approve plan of care Waiver Staff, Complete standard initial plan of care certification process Waiver, and Issue 51 NH-assure all appropriate documents are submitted to SRI. 51NH should be handled as other transfers are addressed (i.e., the start date should be 14 days after the 18W) Waiver.
Role of OCDD SC Facilitate Discovery/Planning meetings, Request/obtain ICAP and SOA from LGE timely, Develop the Plan of Care, Invite OAAS SC, provider and others important to individual to POC meeting, Assure that all documents necessary for plan approval are complete, Confirm with OAAS SC any open CIRs are closed prior to ROW certification, and Provide resources/referral as needed to address participants needs.
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 individuals, including communications sent by OAAS/OCDD State Office, Assist with making sure participant completes and returns FOC to SRI, and Assist with making sure that the 90-L is completed and returned to SRI. Coordinate with OCDD SC to set up meetings, Provide copy of the assessments/plan of care, Close any existing Critical Incident Reports (CIRs), and Continue Monthly/Quarterly Requirements.
Role of the Regional Office (OAAS) Tracking/monitoring of the transition process: Ensure outstanding CIRs are closed prior to transition. Provide technical assistance to OAAS SCAs.
Role of SRI Send individual packet (90-L, FOC for OCDD SCA), Process linkage, Send linkage to SCA and Medicaid, Issues PA for OCDD SCA and removes PA for OAAS SCA, and Issues PA for service providers.
Role of Medicaid Changes type cases and closes OAAS waiver, Issues decision notice 18W to LGE, family/individual, OCDD SC, OAAS, and OCDD regarding ROW waiver approval
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 process, and Provide Technical support to OCDD LGE/OAAS Regional offices.
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 participants, OCDD SC agency should begin discovery/planning process including requesting ICAP score/SOA from OCDD LGE, and OAAS SCA will assist throughout transition process.
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/ROWFactSheet111015.pdf Where to find OCDD Local Governing Entity s Office near you! http://new.dhh.louisiana.gov/index.cfm/page/134/n/137 REQUEST FOR MEDICAL ELIGIBILITY DETERMINATION - 90L http://new.dhh.louisiana.gov/assets/docs/OCDD/waiver/NOW/90LFormRev6117Fillable.pdf
Resources (contd) OAAS Help Line at 1-866-758-5035 OCDD ROW Program Manager Jeannathan H. Anderson (225) 342-5647
