Fact Sheet 2015
Initiative: Home and community-based (1915(c)) waiver whose purpose is to provide care in the community rather than in an Intermediate Care Facility for Individuals with Intellectual Disability (ICF/IID).
Targeted Population: Individuals who are 6 years of age and older who have a Developmental Disability diagnosis or a related condition and do not have a diagnosis of intellectual disability (ID) who: (1) meet the ICF/IID level of care criteria (i.e., meet two out of seven levels of functioning in order to qualify); (2) are determined to be at imminent risk of ICF/IID placement, and (3) are determined that community-based care services under the waiver are the critical services that enable the individual to remain at home rather than being placed in an ICF/IID.
Program Administration: The program is administered by DBHDS.
Eligibility: The DD Waiver provides services to participants 6 years of age and older who have a diagnosis of Developmental Disability or a related condition and do not have a diagnosis of ID. Individuals must require the level of care provided in an ICF/IID. Children who do not have a diagnosis of ID, and have received services through the ID Waiver, become ineligible for the ID Waiver when they reach the age of 6. At that time, they can be screened for eligibility for the IFDDS Waiver; if found eligible, they may transfer to the waiver prior to the age of 7 and receive an IFDDS waiver slot subject to Centers for Medicare and Medicaid Services (CMS) approval. Individuals remain on the ID waiver until a smooth transition can take place.
· Adult Companion Services – Agency-Directed and Consumer-Directed
· Assistive Technology
· Case Management (through State Plan Option)
· Crisis Stabilization
· Crisis Supervision
· Day Support - High Intensity and Regular Intensity
· Environmental Modifications
· Family/Caregiver Training
· In-home Residential Support (not group homes)
· Personal Care – Agency-Directed and Consumer-Directed
· Personal Emergency Response System (PERS)
· Prevocational Services
· Respite Care – Agency-Directed and Consumer-Directed
· Skilled Nursing – RN and LPN
· Supported Employment – Group and Individual
· Therapeutic Consultation
· Transition Services
Service Authorization: An individual is screened for this waiver by the local Virginia Department of Health. If the screening team determines the individual meets criteria, the individual is offered the choice of DD Waiver. DBHDS makes the final determination for waiver criteria and assigns the individual to the waitlist until a slot becomes available. Slot assignment is on a first come, first served basis. After enrollment and plan of care approval by DBHDS, service authorizations DD Waiver Fact Sheet Page 2 of 4 November 2015 are processed by DMAS’ service authorization contractor.
Waiting List: A waiting list exists for the DD Waiver. The waiting list is maintained on a first-come, first served basis by DBHDS. If a slot becomes vacant or when a new slot is allocated, DBHDS is responsible for assigning the slot to the next individual on the waiting list. Slots are available for individuals transferring directly from institutions via the Money Follows the Person program, in addition to the allocated slots. These individuals do not follow the waiting list process described above.
Emergency Criteria: Emergency waiver slots become available when the General Assembly allocates slots for the DD Waiver. Subject to available funding, individuals must meet at least one of the emergency criteria to be eligible for immediate access to waiver services without consideration to the length of time an individual has been waiting to access services. In the absence of waiver services, the individual would not be able to remain in his home. The criteria are: 1. The primary caregiver has a serious illness, has been hospitalized, or has died; or 2. The individual has been determined by the Department of Social Services (DSS) to have been abused or neglected and is in need of immediate waiver services; or 3. The individual demonstrates behaviors which present risk to personal or public safety; or 4. The individual presents extreme physical, emotional or financial burden at home and the family or caregiver is unable to continue to provide care. 5. The individual lives in an institutional setting and has a viable discharge plan in place.
Definitions: (12VAC30-120-700 et seq.)
"Assistive technology" means specialized medical equipment and supplies including those devices, controls, or appliances specified in the plan of care but not available under the State Plan for Medical Assistance that enable individuals to increase their abilities to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live, or that are necessary to the proper functioning of the specialized equipment.
"Case management" means services as defined in 12VAC30-50-490.
"Companion services" means nonmedical care, supervision and socialization provided to an adult (age 18 and older). The provision of companion services does not entail hands-on care. It is provided in accordance with a therapeutic goal in the plan of care and is not purely diversional in nature.
"Consumer-directed services" means personal care, companion services, and/or respite care services where the individual or his family/caregiver, as appropriate, is responsible for hiring, training, supervising, and firing of the employee or employees.
"Crisis stabilization" means direct intervention for persons with related conditions who are experiencing serious psychiatric or behavioral challenges, or both, that jeopardize their current community living situation. This service must provide temporary intensive services and supports that avert emergency psychiatric hospitalization or institutional placement or prevent other out-of-home placement. This service shall be designed to stabilize individuals and strengthen the current living situations so that individuals may be maintained in the community during and beyond the crisis period.
"Day support" means training in intellectual, sensory, motor, and affective social DD Waiver Fact Sheet Page 3 of 4 November 2015 development including awareness skills, sensory stimulation, use of appropriate behaviors and social skills, learning and problem solving, communication and self care, physical development, services and support activities. These services take place outside of the individual's home/residence.
"Environmental modifications" means physical adaptations to a house, place of residence, primary vehicle or work site, when the work site modification exceeds reasonable accommodation requirements of the Americans with Disabilities Act, necessary to ensure individuals' health and safety or enable functioning with greater independence when the adaptation is not being used to bring a substandard dwelling up to minimum habitation standards and is of direct medical or remedial benefit to individuals.
"Family/caregiver training" means training and counseling services provided to families or caregivers of individuals receiving services in the IFDDS Waiver.
"In-home residential support services" means support provided primarily in the individual's home, which includes training, assistance, and specialized supervision to enable the individual to maintain or improve his health; assisting in performing individual care tasks; training in activities of daily living; training and use of community resources; providing life skills training; and adapting behavior to community and home-like environments.
"Personal care services" means long-term maintenance or support services necessary to enable individuals to remain in or return to the community rather than enter an Intermediate Care Facility for the Mentally Retarded. Personal care services include assistance with activities of daily living, instrumental activities of daily living, access to the community, medication or other medical needs, and monitoring health status and physical condition. This does not include skilled nursing services with the exception of skilled nursing tasks that may be delegated in accordance with 18VAC90-20-420 through 18VAC90-20-460 and Act (§ 54.1-3000 et seq. of The Code of Virginia).
"Personal emergency response system (PERS)" is an electronic device that enables certain individuals to secure help in an emergency. PERS services are limited to those individuals who live alone or are alone for significant parts of the day and who have no regular caregiver for extended periods of time, and who would otherwise require extensive routine supervision.
“Prevocational services” are services aimed at preparing an individual for paid or unpaid employment, but are not job-task oriented. Prevocational services are provided for individuals who are not expected to be able to join the general work force without supports or to participate in a transitional, sheltered workshop within one year of beginning waiver services (excluding supported employment services or programs). Activities included in this service are not primarily directed at teaching specific job skills but at underlying rehabilitative goals such as accepting supervision, attendance, task completion, problem solving and safety.
"Respite care" means services provided for unpaid caregivers of eligible individuals who are unable to care for themselves and are provided on an episodic or routine basis because of the absence of or need for relief of those unpaid persons who routinely provide the care.
"Skilled nursing services" means nursing services (i) listed in the plan of care that do not meet home health criteria, (ii) required to prevent institutionalization, (iii) not otherwise available under the State Plan for Medical Assistance, (iv) provided within the scope of the state's Nursing Act (§ 54.1-3000 et seq. of The Code of Virginia) and Drug Control Act DD Waiver Fact Sheet Page 4 of 4 November 2015 (§54.1-3400 et seq. of The Code of Virginia), and (v) provided by a registered professional nurse or by a licensed practical nurse under the supervision of a registered nurse who is licensed to practice in the state. Skilled nursing services are to be used to provide training, consultation, nurse delegation as appropriate and oversight of direct care staff as appropriate.
"Supported employment" means work in settings in which persons without disabilities are typically employed. It includes training in specific skills related to paid employment and provision of ongoing or intermittent assistance and specialized supervision to enable an individual to maintain paid employment.
"Therapeutic consultation" means consultation provided by members of psychology, social work, rehabilitation engineering, behavioral analysis, speech therapy, occupational therapy, psychiatry, psychiatric clinical nursing, therapeutic recreation, or physical therapy or behavior consultation to assist individuals, parents, family members, in-home residential support, day support and any other providers of support services in implementing a plan of care.
"Transition services" means set-up expenses for individuals who are transitioning from an institution or licensed or certified provider-operated living arrangement to a living arrangement in a private residence where the person is directly responsible for his or her own living expenses.
Quality Management Review: DMAS conducts quality management reviews of the services provided and interview individuals for all providers providing services in this waiver to ensure the health and safety of all individuals. Level of functioning reviews are performed at least annually.