(DD) Waiver Service Standards - New Mexico Department of Health

More documents

Recommendations

Info

CHAPTER 2 ANNUAL RESOURCE ALLOTMENTS AND SERVICE CATEGORIES I. ANNUAL RESOURCE ALLOTMENT SERVICES. The annual resource allotment service provides flexible service access, and expedites the timely provision of age appropriate services. Each individual is placed in a service category with a corresponding funding limit known as the Annual Resource Allotment (ARA). The ARA is based on an individual's age, level of care (LOC) and residential status. A. Annual Resource Allotment Service Categories include: (1) Children’s Category for individuals, ages birth – 18; (2) Young Adult Category for individuals, ages 18 – 21; (3) Young Adult Community Living Supports Category for individuals, ages 18 - 21 receiving any 24-hour residential services; (4) Adult Category for individuals, ages 22 and over; and (5) Adult Community Living Supports Category for individuals, ages 22 and over receiving any 24-hour residential services. II. SCOPE OF SERVICES FUNDED BY THE ARA. A. Annual Resource Allotment Option. Each service shall be provided in accordance with the corresponding DD Waiver standards, and applicable DDSD policies. The total budget for the selected services may not exceed the Annual Resource Allotment. The individual, in conjunction with the IDT members, may choose any or all of the following services in accordance with his or her age and residential status (ARA category): (1) Behavioral Support Consultation; (2) Community Inclusion Services (Supported Employment, Community Access and Adult Habilitation); (3) Personal Plan Facilitation; (4) Occupational Therapy (with limitations for children); (5) Physical Therapy (with limitations for children); (6) Personal Support Services (with limitations); (7) Speech Therapy (with limitations for children); (8) Goods and Services (up to $1,000.00 per year); (9) Nutritional Counseling; 18
(10) Non-Medical Transportation; (11) Respite; (12) Case Management; (13) Private Duty Nursing (with limitations for children); (14) Supplemental Dental Care; and B. Service Options Funded in addition to the ARA. (1) Environmental Modifications; (2) Community Living Supports (for individuals age 18 or older and only with prior approval from the Medicaid Utilization Review Agent); (3) Therapy Exceptions (for individuals age 21 or older); (4) Supported Employment Exceptions (for individuals age 18 or older); and (5) Tier III crisis (for individuals age 18 or older). C. Limitations and Restrictions. An exception to the ARA for additional units of therapy services and supported employment services is allowed in accordance with these Standards. Therapy exceptions in excess of 58 hours per year (or 72 hours for the first year) and Supported Employment exceptions require prior approval by DDSD. Case Management Assessment (i.e., upon initial allocation to the DD Waiver), Community Living Support Services, Outlier Services, and Environmental Modification are funded outside of the ARA. Community Living Support Services and Outlier Services require pre-approval by the Medicaid Utilization Review (NMMUR) agent. Environmental Modifications and Tier III crisis serviced require prior written approval by DDSD. The ARA may be prorated for the individuals in a non-residential ARA who change to a Community Living Supports (e.g., Supported Living, Independent Living, Family Living) during the ISP year. This adjustment will be based on the percentage of the funding used within the non-residential ARA, up to the date that Community Living Supports begin. III. CHILDREN’S CATEGORY ARA. A. General Services from the Children’s Category. Services from the children’s category are only available to individuals from birth to the age of eighteen (18). At the annual ISP meeting during the year in which the individual turns eighteen, he or she may choose to continue with services from the Children’s Category until the next regular ISP date, or he or she may choose to transition to the Young Adult Category. Individuals may use any amount of a single service, or select a variety of services to occur at different times of the year, e.g., more intensive services during school 19
Page 1 and 2: Developmental Disabilities (DD) Wai
Page 3 and 4: Developmental Disabilities (DD) Wai
Page 5 and 6: TABLE OF CONTENTS C. Adult Habilita
Page 7 and 8: TABLE OF CONTENTS V. REQUIREMENTS U
Page 9 and 10: TABLE OF CONTENTS A. Provider Agenc
Page 11 and 12: TABLE OF CONTENTS D. Consultation w
Page 13 and 14: TABLE OF CONTENTS D. Non-Medical Tr
Page 15 and 16: DOH/DDSD (Appendix A) Individual Tr
Page 17 and 18: (b) Emotional, psychological, and p
Page 19 and 20: AD. AE. IDEA. means Individuals wit
Page 21 and 22: includes a functional assessment of
Page 23 and 24: CHAPTER 1 INTRODUCTION These standa
Page 25 and 26: (2) On the day a Provider Agency is
Page 27 and 28: provided to the receiving agency wh
Page 29 and 30: G. Transportation. Provider agencie
Page 31 and 32: equires delivery by licensed or cer
Page 33 and 34: F. Sanitation. When services are pr
Page 35 and 36: (6) Report required personnel train
Page 37 and 38: implemented, and return the plan to
Page 39: (g) Reduction in term of the agency
Page 43 and 44: (4) Physical Therapy (limited and w
Page 45 and 46: (l) Non-Medical Transportation; (m)
Page 47 and 48: (3) Service Options in Addition to
Page 49 and 50: age 22 or older who are receiving D
Page 51 and 52: CHAPTER 3 BEHAVIORAL SUPPORT CONSUL
Page 53 and 54: (2) Guide the IDT members in assess
Page 55 and 56: B. Behavioral Support Consultation
Page 57 and 58: (4) All Behavioral Support Consulta
Page 59 and 60: (d) Functional evaluations/assessme
Page 61 and 62: the training is not offered by DDSD
Page 63 and 64: K. Inform the individual of his or
Page 65 and 66: (2) A new history and physical; (3)
Page 67 and 68: of the Case Manager and all IDT mem
Page 69 and 70: (b) A change from a less restrictiv
Page 71 and 72: (b) Case Management Provider Agenci
Page 73 and 74: for at least 30 hours per week of p
Page 75 and 76: (c) Bachelor’s or Master’s degr
Page 77 and 78: its designee and will include the n
Page 79 and 80: (2) Services furnished to an indivi
Page 81 and 82: (6) Identification of barriers to i
Page 83 and 84: (4) Volunteer time in the community
Page 85 and 86: conservator, physician’s name(s)
Page 87 and 88: (2) Whenever possible, direct suppo
Page 89 and 90: (9) Job coaching; (10) Situational
Page 91 and 92:
(6) Individuals are not excluded fr
Page 93 and 94:
Individual Supported Employment, a
Page 95 and 96:
E. Reimbursement. (g) Assess barrie
Page 97 and 98:
service are determined by the indiv
Page 99 and 100:
(6) Community Access Coaching is al
Page 101 and 102:
(10) The individual is provided opp
Page 103 and 104:
(p) Implement recommendations from
Page 105 and 106:
The Adult Habilitation Service Prov
Page 107 and 108:
(25) Development of increased indep
Page 109 and 110:
XV. PROVIDER AGENCY STAFF QUALIFICA
Page 111 and 112:
CHAPTER 6 COMMUNITY LIVING SERVICES
Page 113 and 114:
(4) Internal service coordination.
Page 115 and 116:
(a) Documentation of determination
Page 117 and 118:
(b) That each individual with a sco
Page 119 and 120:
individual’s home and an updated
Page 121 and 122:
G. IDT Coordination. (1) Appropriat
Page 123 and 124:
J. Qualification for Agency Supervi
Page 125 and 126:
(a) At a maximum of two (2) individ
Page 127 and 128:
(2) Up to 1000 hours of substitute
Page 129 and 130:
(15) Handrails, grab-bars, door han
Page 131 and 132:
(5) Written verification that the c
Page 133 and 134:
Funding for adaptations is availabl
Page 135 and 136:
of a work uniform for an employed i
Page 137 and 138:
CHAPTER 9 OUTLIER SERVICES I. OUTLI
Page 139 and 140:
Necessity Outlier services, the ind
Page 141 and 142:
(b) The billable unit for Outlier A
Page 143 and 144:
III. PERSONAL PLAN FACILITATION REQ
Page 145 and 146:
CHAPTER 11 PERSONAL SUPPORT SERVICE
Page 147 and 148:
(4) Personal Support Services may n
Page 149 and 150:
CHAPTER 12 RESPITE SERVICES I. RESP
Page 151 and 152:
(c) Direct Support Staff are requir
Page 153 and 154:
B. Eligibility for Medicaid DD Waiv
Page 155 and 156:
(b) Therapy Provider Agencies shall
Page 157 and 158:
D. Integrating Therapy Strategies i
Page 159 and 160:
(f) An Occupational Therapy Aide/Te
Page 161 and 162:
(3) Designing, building or preparin
Page 163 and 164:
(12) Providing other non-administra
Page 165 and 166:
(2) Collaborative therapy services
Page 167 and 168:
F. Training Family/Support Staff. (
Page 169 and 170:
(b) Relevant background information
Page 171 and 172:
listed in the ISP. The therapy inte
Page 173 and 174:
L. Discontinuation of Services Repo
Page 175 and 176:
(c) Caregiver training and consulta
Page 177 and 178:
(3) In the first year of service or
Page 179 and 180:
G. Attend IDT meetings. H. The Tier
Page 181 and 182:
E. Reimbursement. (e) Required DDSD
Page 183 and 184:
R. Skin care; S. Weight management;
Page 185 and 186:
CHAPTER 16 NUTRITIONAL COUNSELING S
Page 187 and 188:
CHAPTER 17 NON-MEDICAL TRANSPORTATI
Page 189 and 190:
support the planning process. This
Page 191 and 192:
CHAPTER 18 SUPPLEMENTAL DENTAL CARE
show all

(DD) Waiver Service Standards - New Mexico Department of Health

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?