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A Better Life at Home, A Better Life in Your Community

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    A Better Life at Home,

    A Better Life in Your Community

    A Guide for the

    Medicaid Home and Community Based Services Waiver for Persons with Developmental Disabilities/Mental Retardation

    ? 2005 Hawaii State Council on Developmental Disabilities

    About This Handbook

    The Hawai`i State Council on Developmental Disabilities, in collaboration with the Hawai`i State Department of Health Developmental Disabilities Division, self-advocates, and community members created this guidebook to inform individuals with developmental disabilities and their families about the Medicaid Home and Community Based Services Waiver for Persons with Developmental Disabilities/Mental Retardation (also known as “The Waiver”). It contains information about key state agencies, the

    application process, finding a provider and other community resources. The handbook is intended for use as a guide that will educate the public about some of “The Waiver‟s” main features. It includes:

    ; An introduction to “The Waiver”

    ; Personal stories of waiver recipients

    ; Eligibility criteria

    ; Individualized Service Plans (ISPs)

    ; Waiver support services

    ; How to select service providers

    ; Sample forms needed to receive waiver services

    ; Rights and responsibilities

Disclaimer: Information provided in this guide is valid as of December 2004.

    Page 2 of 80

    Table of Contents

1: Introduction to “The Waiver”

     5

    Purpose

    Personal Stories

    Key State Agencies

    2: Summary of Waiver Eligibility Requirements

     10

     How Do I Know If I‟m Eligible

     DHS Requirements

     DOH Requirements

    3: “The Waiver” Application Process

     13

     Who To Contact

     Contact Information

     Determining If “The Waiver” Is Right For You

     “The Waiver” Application

    “The Waiver” Process Flowchart

    4: The Intake Process 20

     Meeting With An Intake Worker

     The Law In Hawaii Lists The Eligibility Criteria

     What If You Don‟t Meet The Criteria

    5: The Planning Process

     25

    The Individualized Service Plan (ISP)

     The Individual Plan (IP)

    6: Select Waiver Support Services 34

     Adult Day Health (ADH)

     Consumer Directed Personal Assistance (CD PA)

     Habilitation (HAB)

     Habilitation-Supported Employment (HAB-SE)

     Personal Assistance (PA)

     Respite

     Skilled Nursing (SN)

     Specialized Environmental Accessibility Adaptations (SEAA)

     Specialized Services (SS)

     Transportation

    Page 3 of 80

    7: Select Your Service Provider(s) 38

     Sample Questions To Use in Your Selection

     Services and Provider Authorization Form (SPAF)

     List of Service Providers By Island 8: Applying for Medicaid

     44

     Eligibility Requirements

     Application

    Before You Get Started

     What If I‟m Not Eligible for Medicaid?

    9: Rights and Responsibilities

     48

     State Process

     DDD Ombudsman Office

    Provider Agency Process

     Your Responsibilities

     Understanding the Laws That Protect You 10: Resources 54

     Acronyms

     State Officials

     State Agencies

     Advocacy Agencies

     Waiver Services Provider Agencies

     Waiver Services Definitions (State Standards)

    Sample Forms

    Your Notes

    Page 4 of 80

    Introduction to “The Waiver”

    Purpose

    What is “The Waiver” and How does it work in Hawai`i?

    “Medicaid is a program designed to help states meet the costs of necessary health care for low-income and medically needy populations. Under section 1915c of the Social Security Act, states may request waivers of certain federal requirements in order to develop home and community-based services funded by Medicaid. The State, through Medicaid, may request funding for home and communitybased

    services to prevent the institutionalization of individuals with disabilities. The State‟s request is subject to approval by the Centers on Medicaid and Medicare Services (CMS).

    Individuals within the Hawai`i Department of Health (DOH) Developmental Disabilities Division (DDD) system that are eligible for Medicaid can apply for these Medicaid funded services. Needs and supports are identified through a person-centered planning process with case managers who coordinate, and assist individuals in accessing 1these services from qualified and approved providers.”

    In Hawai`i, the State has created the Home and Community Based Services for Persons with Developmental Disabilities/Mental Retardation Medicaid Waiver Program. Because CMS “waives” certain federal requirements, the program is commonly referred to as “The Waiver”.

    The State Department of Human Services (DHS) is the official Medicaid state agency. DHS works with CMS to manage the Medicaid money. DHS also determines who is eligible for Medicaid and “The Waiver”.

    The DOH DDD is responsible for managing “The Waiver”. The DOH DDD Case Management and Information Services Branch (CMISB) assigns case managers to assist individuals and families who wish to access “The Waiver”.

     1 This information was taken from the Department of Health, Developmental Disabilities Division, Case Management and Information Services Branch Information Packet for Individuals and Families (March 2001).

    Page 5 of 80

Personal Stories

    “The Waiver" has changed the lives of many people living in Hawai`i. It has helped people with developmental disabilities receive the services and support they need to remain in their communities. Throughout the handbook are stories from some of the people who receive waiver services. These individuals have agreed to share their stories so that “The Waiver” experience can be seen from different points of view.

    John

    John is a 33 year-old man who lives at home with his mother. He has been receiving waiver services for more than 10 years and currently receives Adult Day Health (ADH) and Habilitation (HAB) services. Before John began waiver services, his mother said life was dull for him. John would come home everyday from school or work and go to his room and watch television. Today, John has a full day of activity that includes working at a pizza parlor, participating in friendly basketball games, swimming, going out to movies and bowling, shopping at the mall and going to restaurants. He is busy seven days a week and eagerly gets up early every day to prepare for the day ahead. He has also made a good friend at ADH that he enjoys spending time with.

    John‟s mother said that the services have really helped both John and her to have an active life that is free from much of the worry and stress that formerly was a daily part of her life. “The Waiver” services have also relieved much of the financial strain as well. Prior to receiving waiver services, John‟s mother had to pay someone to provide supervision for John while she attended to her job or other responsibilities.

    Both John and his mother feel good about waiver services and feel the process to get into “The Waiver” was well worth it.

    Page 6 of 80

Key State Agencies

    There are several key State of Hawai`i agencies involved in providing waiver services. This section will help you learn about their roles and responsibilities.

The Hawai`i State Council on Developmental Disabilities

    The mission of the Hawai`i State Council on Developmental Disabilities (DD Council) is to support people with developmental disabilities to control their own destiny and determine the quality of life they desire. The DD Council is a body comprised of individuals appointed by the governor. Sixty percent of the DD Council is made up of individuals with developmental disabilities and family members of persons with developmental disabilities. The remaining members represent state and private agencies and the community at-large.

    The Hawai`i DD Council was established in state law by Act 198, Session Laws of Hawai`i, 1975. The DD Council (according to Hawai`i Revised Statutes, Section 333E) develops, prepares, and adopts the State plan, which "shall guide the development and delivery of all services to individuals with developmental disabilities." The State plan shall include "establishment of goals and priorities of the State in meeting the needs of individuals with developmental disabilities, including the recommendation of priorities for the distribution of public funds for comprehensive services to individuals with developmental disabilities within the State and other matters deemed necessary to achieve independence, productivity, integration, inclusion, and self-2determination of individuals with developmental disabilities."

    The federal Developmental Disabilities Assistance and Bill of Rights Act of 2000 (P.L. 106402) defines the purpose of State Councils on

    Developmental Disabilities as engaging in "advocacy, capacity building, and systemic change activities..." that "contribute to a coordinated, consumer- and family-centered, consumer- and family-directed, comprehensive system that includes needed community services, individualized supports, and other forms of assistance that promote self-determination for individuals with developmental disabilities and their families."

     2 This information was taken from the Hawai`i State Council on Developmental Disabilities website at http://www.hiddc.org.

    Page 7 of 80

    For more information on the Hawai`i DD Council, visit the website available at: http://www.hiddc.org.

Department of Health

    The mission of the Department of Health (DOH) is to protect and 3 improve the health and environment for all people in Hawai`i.For more information on the DOH, visit the website available at: http://www.hawaii.gov/health.html.

Developmental Disabilities Division

    The mission of the DOH‟s Developmental Disabilities Division (DDD) is to assure that there is a state system of supports and services for persons with developmental disabilities or mental retardation (DD/MR), which includes principles of self-determination and incorporates individualized funding, person-centered planning and community 4services.”

    For more information on the DDD, visit the website available at: http://www.hawaii.gov/health/disability-

    services/developmental/index.html.

Case Management and Information Services Branch

    The mission of the DDD‟s Case Management and Information Services Branch (CMISB) states that, “The CMISB is dedicated to the support of persons with mental retardation and developmental disabilities to 5choose and achieve their individual goals.” The case managers that

    work for this branch will help you to access the services you need. For more information on the CMISB, visit the website available at: http://www.cmisb.org/about.htm.

Department of Human Services

     3 This information was taken from the Department of Health website available at http://www.hawaii.gov/health.html.

     4 This information was taken from the Developmental Disabilities Division website, available at http://www.hawaii.gov/health/disability-

    services/developmental/index.html.

     5 This information was taken from the Case Management and Information Services Branch website available at http://www.cmisb.org/about.htm.

    Page 8 of 80

    The Department of Human Services (DHS) is the State Medicaid agency. You will work with DHS when applying for Medicaid. DHS administers “The Waiver” program “for persons with developmental disabilities and mental retardation who would otherwise receive such services in an Intermediate Care Facility for persons with mental 6 retardation (ICF/MR).”

    “The goal of this program is to reduce and prevent unnecessary

    institutionalization by providing home and community-based services at a cost less than or equal to institutional care.”

    The DHS motto for “The Waiver” is “Independence”, “Dignity”, and “Choice”.

    For more information on the DHS Medicaid Waiver DD/MR Program, visit the website available at:

    http://www.state.hi.us/dhs/DDMR%20%207-03.pdf.

     6 This information was taken from the Department of Human Services Medicaid Waiver for Individuals with DD/MR Program website available at: http://www.state.hi.us/dhs/DDMR%20%207-03.pdf.

    Page 9 of 80

    Summary of Waiver Eligibility Requirements How Do I Know If I’m Eligible?

    The Department of Human Services (DHS) and the Department of Health (DOH) each play a role in determining eligibility. You may start the application and eligibility process by:

    1. Applying for Medicaid with DHS; and

    2. Applying for services with DOH, Developmental Disabilities

    Division (DDD), Case Management and Information Services

    Branch (CMISB).

    You do not need to wait for the determination from one department to begin the process with the other.

DHS Eligibility Requirements

    Admission to the program requires a referral from a DOH DDD CMISB Case Manager (CM). This program serves people of all ages. The person must:

    ; Be eligible for Medicaid;

    ; Be assessed as needing Intermediate Care Facility-Mentally

    Retarded (ICF/MR) Level of Care; and

    ; Choose to receive home and community-based services as an

    alternative to institutional placement.

DOH Eligibility Requirements

    The following must be completed/provided:

    ; Application for DOH DDD services;

    ; Application for waiver services; and

    ; Evaluations to determine ICF/MR Level of Care:

    Page 10 of 80

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