Community Guide Provider Training

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Coleen Oliver
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1 Community Guide Provider Training January 17, 2013 Serving Durham, Wake, Cumberland and Johnston Counties

2 What is Community Guide? Community Guide Services: provide support to individuals (and planning teams that assist them) in developing social networks and connections within the community emphasize, promote and coordinate the use of natural and unpaid supports to address the individual needs support individuals who direct their own waiver services by providing direct assistance in their participant direction responsibilities Serving Durham, Wake, Cumberland and Johnston Counties

3 Community Guide, continued Community Guide Services are intermittent and fade as community connections develop and skills increase in self-direction Formal fading plan is not required Assist and support (rather than direct and manage) the individual throughout the service delivery process Intended to enhance, not replace, existing natural and community resources

4 Purpose The purpose of this service is to: promote self-determination increase independence enhance the individual s ability to interact with and contribute to their local community link to natural supports, not replace natural supports

5 Specific Functions of Community Guide Assistance and support in forming and how to maintain natural and community supports, increasing community integration and inclusion i.e. social clubs, educational opportunities, learning to use public transportation, volunteer work, Special Olympics Assistance in locating non-medicaid supports and resources that are related to achieving support plan goals i.e. locating after-school programs; resources from Salvation Army; accessing assistance to pay for bus fare/taxi service Instruction and informal counseling, which guides the participant in problem solving and decision making Decisions with financial planning (wills and trusts, etc.); understanding guardianship Advocacy and collaborating with other individuals and organizations on behalf of the individual IEP Planning and participation; advocating for school services; locating legal resources; rights information

6 Specific Functions of Community Guide Supporting the person in preparing and participating in and implementing the support plan Assistance in locating options for renting or purchasing a personal residence, assisting with purchasing furnishings for the personal residence Informing and coordinating community resources including coordination among primary, preventative and chronic health care providers Guidance on communicating with physicians/pharmacies; how to coordinate among medical providers

7 Specific Functions of Community Guide Provide training on the Individual/Family Directed Option: Guidance with management of self-directed budget Provide information on recruiting, hiring, managing, training, evaluating, and changing support staff Assist with development of schedule and outlining staff duties Assist with understanding staff qualifications and record keeping requirements Provide ongoing info to assure participants/families understand self-direction responsibilities (i.e reporting expenditures; training) Coordinating services with the Agency with Choice

8 Entrance Criteria This service is for children and adults determined to meet the state definition of IDD The individual requires assistance to identify/ link/ develop natural and non-paid supports in addition to paid services to address the individual s needs Current support plan is required for authorization

9 Exclusions Community Guide does not duplicate MCO Care Coordination or other MCO functions. Therefore, Community Guide will not: Develop the ISP (for Innovations); monitor implementation Complete/gather evaluations Choose paid service providers Coordinate benefits

10 Exclusions The Community Guide may provide Agency with Choice services to the same participant as follows: Community Transition, Individual Goods and Services, and Primary Crisis Response The Community Guide that does not provide Agency with Choice services may only additionally provide Community Transition May only be used to provide support for Self-Direction activities as approved in the Innovations waiver A parent can not provide this service to their own child, but can provide to another child as an employee of a credentialed Community Guide network provider.

11 Staffing Requirements At a minimum; Associate Professionals (AP) and Paraprofessional level persons who meet the requirements specified for Associated Professional and Paraprofessional status according to 10 N.C.A.C. 27G 0104 may provide Community Guide. Community Guides who do not meet Qualified Professional level must be supervised by a Qualified Professional (provided according to supervision requirements set forth in 10A N.C.A.C. 27G.0204 and according to licensure or certification requirements of the appropriate discipline)

12 Service Type/Setting This is a periodic service that is reimbursed at a monthly rate, typically for a 90-day period This service may be provided in a variety of community locations, appropriate for the goal being addressed There are no caseload requirements Community Guide is Medicaid funded and not available for those with IPRS funding

13 Utilization Management Prior authorization is required for this service Service is outcome-based and goal driven The amount, duration, and frequency of the service must be included with the individuals support plan and authorized on or before the day services are to be provided. Initial authorization for services may not exceed 3 months Re-authorization Outcome identified that precipitated the referral is expected to be accomplished within 3 months, but there is flexibility based on the reauthorization request and individuals needs Billed as one unit per month at a rate of $ Hourly rate for self-direction training- TBD Will be added to Alliance benefit plan 2/1/13 as an NC Innovations and B(3) Service

14 Continued Stay-Criteria The recipient continues to meet the entrance criteria and continued need is reflected by the support plan goals The recipient continues to require this service to accomplish a goal or goals in their support plan and supports the participant in full integration within their community, AND The recipient is making reasonable, measurable progress toward meeting the goals; AND There is documentation that supports that continuation of this service will be effective in assisting the recipient in meeting support plan goals

15 Discharge Criteria The recipient has met goals identified in the support plan and no longer requires this service to maintain and assist the participant in living in a fully integrated community setting; OR The recipient no longer meets Continued Stay Criteria; OR The recipient or legally responsible person no longer wishes to receive Community Guide; OR The recipient no longer meets the state definition of IDD The recipient is no longer Medicaid eligible

16 Expected Outcomes Individuals will develop social networks and connections within their own communities. Promotion of self-determination, increase independence, and enhance the individual s ability to interact with and contribute to his/her own community. Achieve Community Guide goal (s) as determined by the individual and their planning team and documented in the support plan

17 Documentation Requirements Minimum standard is a daily full service note for each contact/intervention that meets the criteria specified in the Records Management and Documentation manual and includes the recipient s name, Medicaid identification number, date of service, purpose of contact, describes the provider s interventions including the time spent performing the interventions, effectiveness of the intervention, the signature, credentials and job title of the staff providing the service.

18 Referrals Referrals for Community Guide will be made from: I/DD Access Coordinators I/DD Care Coordinators I/DD UM Care Managers Medicaid recipients determined eligible for IDD Services may contact a Community Guide and request services directly Lead agency (i.e ADVP, PA) may provide list of Community Guide network providers and may assist with referral once individual/family chooses provider

19 Community Guide/Other Services- Lead Agency Only Community Guide Community Guide is lead, submit B(3) Support plan and NC-SNAP with Service Authorization Request (SAR) Community Guide and B(3) Respite Respite is lead, Community Guide participates in B(3) support planning with lead in order to include Community Guide goals into the plan; submits copy of B(3) support plan with SAR Community Guide and IPRS-funded service (i.e ADVP, Personal Assistance) IPRS-funded service is lead, Community Guide participates in B(3) support planning with lead in order to include Community Guide goals into the plan; submits copy of B(3) support plan with SAR Community Guide and NC Innovations Services MCO Care Coordinator is lead- develops ISP and submits SAR; Community Guide completes short-range goal(s) and keeps in record for review as needed/requested from MCO

20 Ideas for goal development Participant needs child care/after school care placement Individual is homeless and needs to secure housing Participant would like to learn to bowl and connect to others who enjoy bowling Participant would like to access volunteer opportunities Participant s family needs assistance preparing for and participating in the IEP process

21 Thank you for your time! Questions?

Innovations Waiver Update. (effective November 1, 2016)

Innovations Waiver Update. (effective November 1, 2016) Innovations Waiver Update (effective November 1, 2016) Training Overview Disclaimer How we arrived here Supports Intensity Scale (SIS) Resource Allocation Information on services-new and changed Stakeholder