Habilitation Services

Transcription

1 Habilitation Services Part I Introduction to State Plan HCBS Habilitation LeAnn Moskowitz, DHS, IME June 2014

2 Habilitation Services June 2014 Training Series Part 1 Introduction to State Plan Home and Community Based Services (HCBS) Habilitation June 10 Part 2 HCBS Habilitation Services June 17 Part 3 HCBS Habilitation Services and Other Funding Sources to Support Residential and Employment Goals June 24 2

3 Objectives At the end of this training participants will understand the following: The purpose and the goals of the state plan HCBS Habilitation Program The federal requirements for the HCBS Habilitation assessment of need The HCBS Person Centered Planning requirements and process 3

4 Program Purpose To provide state plan Home and Community Based Services (HCBS) to Iowans with functional limitations typically associated with chronic mental illness. 4

5 General Parameters The program functions similar to HCBS waiver programs: A Targeted Case Manager or Integrated Health Home Coordinator completes a comprehensive functional assessment to determine each individual s needs An interdisciplinary team led by the CM or IHH plans for the services based on the identified needs and the member s personal goals The CM or IHH develops the Comprehensive Service Plan/ Treatment Plan based on the IDT service planning meeting 5

6 Funding Source(s) State and Federally funded Medicaid program: ~55.54% Federal Medical Assistance Percentage (FMAP) for FFY 15 ~ 44.46% Nonfederal paid by Medicaid (state share of costs) compared to 41.65% FFY14 6

7 State Plan HCBS -Habilitation Eligibility Must be eligible for Medicaid through an existing coverage group Household income cannot exceed 150% of Federal Poverty Level (FPL) Meet needs-based eligibility criteria as determined by a Needs-Based Evaluation Comprehensive Functional Assessment 7

8 State Plan HCBS Habilitation Eligibility Meets 1 of 2 risk factors: Has undergone or is currently undergoing psychiatric treatment more intensive than outpatient care, more than once in a lifetime (e.g., emergency services, alternative home care, partial hospitalization or inpatient hospitalization). Has a history of psychiatric illness resulting in at least one episode of continuous, professional supportive care other than hospitalization. (e.g., residential placement) 8

9 State Plan HCBS Habilitation Eligibility Meets at least 2 of 5 criteria showing a need for assistance for at least two years: Is unemployed, or employed in a sheltered setting, or have markedly limited skills and a poor work history. Requires financial assistance for out-of-hospital maintenance and may be unable to procure this assistance without help. Shows severe inability to establish or maintain a personal social support system. Requires help in basic living skills such as self-care, money management, housekeeping, cooking, or medication management. Exhibits inappropriate social behavior that results in demand for intervention. 9

10 Roles Income Maintenance Worker reviews the members application and determines financial eligibility Case Manager or Integrated Health Home Coordinator* reviews the members need for services completes a comprehensive functional assessment Iowa Medicaid Enterprise Medical Services reviews the members non financial eligibility - an assessment tool and accompanying information Providers agencies or persons enrolled/certified to provide State Plan HCBS services

11 Integrated Health Home Identifies needs through initial assessment Develops a Care Coordination Plan based on gaps in care and needs Integrates treatment plans among providers and member Responsible for monitoring of treatment plan implementation and services 11

12 Case Management Case Management When the individual is not enrolled in an integrated health home (IHH) Same functions as Targeted Case Management When a member is also accessing HCBS Waiver services, Case Management is received through Habilitation when the member does not qualify for TCM. Assists members in gaining access to needed services regardless of the funding source, and monitors services identified in the service plan 12

13 Services & Supports Services designed to assist in acquiring, retaining and improving the self-help, socialization and adaptive skills necessary to reside successfully in home and communitybased settings. Case Management (members that also receive HCBS Waiver Services) Habilitation Day Habilitation Home-Based Habilitation Prevocational Habilitation Supported Employment Habilitation 13

14 Assessment Requirements Description and history of presenting problem(s) Why Now? What is the reason for requesting services now? Mental status examination Risk assessment Review of all symptoms Allergies/medications/treatments proved unsuccessful Review of daily activities skills/supports needed/assess baseline functioning/impairments Substance use history/treatments 14

15 Assessment Requirements History of medical/mental health/substance treatments, including family history Education/learning summary/employment Status: Employment Skills : Employment supports needed to work : Enrollment with IVRS Lifestyle risk factors -home, social groups, habits Strengths/family/natural supports 15

16 Assessment Requirements Member preferences in treatment cultural/recoverybased/evidenced-based/other -what has worked well or not well from the member perspective? -assessment at past member acceptance of treatment recommendations -review of any rights restrictions and choice of providers List of current providers List of all medications/prescribers 16

17 Assessment Requirements Identification of Interdisciplinary team members consulted for assessment completion (including member), Rights restrictions/ Plan to restore rights Legal Status Legal decision maker- Payee, Power of Attorney etc. Monthly Income/ Source: (SSI, SSDI, VA, Railroad etc.) Court Involvement 17

18 Assessment Requirements Emergency Contacts Other publicly funded (i.e. County, Veterans, SNAP, Child Care Assistance, HUD, etc.) services being accessed Veteran and Marital status 18

19 Habilitation Comprehensive Service Plan Federally required for each individual receiving State Plan HCBS Habilitation Services (1915 (i)) The IHH may call the document a Treatment Plan or Care Coordination Plan, the Centers for Medicaid and Medicare Services (CMS) refers to the document as a Comprehensive Service Plan 19

20 Habilitation Comprehensive Service Plan Must identify the services and supports the member receives from all funding sources including Medicaid, County, IVRS, Private insurance etc. Must be developed through a person-centered planning process Is established with the IDT led by the Case Manager or Integrated Health Home Coordinator. 20

21 Habilitation Comprehensive Service Plan Must be updated at least annually and when a change in the individual s circumstances or needs change significantly, and at the request of the individual. Includes people chosen by the individual Provides necessary information and support to the individual to ensure that the individual directs the process to the maximum extent possible 21

22 Habilitation Comprehensive Service Plan Is timely and occurs at times/locations of convenience to the individual Reflects cultural considerations/uses plain language Includes strategies for resolving disagreement Offers choices to the individual regarding services and supports the individual receives and from whom 22

23 Habilitation Comprehensive Service Plan Provides methods to request updates Conducted to reflect what is important to the individual to ensure delivery of services in a manner reflecting personal preferences and ensuring health and welfare Identifies the strengths, preferences, needs (clinical and support), and desired outcomes of the individual 23

24 Habilitation Comprehensive Service Plan Includes individually identified goals and preferences related to relationships, community participation, employment, income and savings, healthcare and wellness, education and others Includes risk factors and plans to minimize them Is signed by all individuals and providers responsible for its implementation and a copy of the plan must be provided to the individual and his/her representative 24

25 Service Plan Documentation Reflects individual s strengths and preferences Reflects clinical and support needs Includes observable and measureable goals and desired outcomes Identify interventions and supports needed to meet those goals with incremental action steps, as appropriate. Identify the staff people, businesses, or organizations responsible for carrying out the interventions or supports. 25

26 Service Plan Documentation Identifies for a member receiving home based habilitation: a) The member s living environment at the time of enrollment; b) The number of hours per day of on site staff supervision needed by the member; and c) The number of other members who will live with the member in the living unit. 26

27 Service Plan Documentation Reflects providers of services/supports, including unpaid supports provided voluntarily in lieu of waiver or state plan HCBS including: a) Name of the provider b) Service authorized c) Units of service authorized Includes risk factors and measures in place to minimize risk 27

28 Service Plan Documentation Includes individualized backup plans and strategies when needed Identify any health and safety issues applicable to the individual member based on information gathered before the team meeting, including a risk assessment. Identify an emergency backup support and crisis response system to address problems or issues arising when support services are interrupted or delayed or the member s needs change. Providers of applicable services shall provide for emergency backup staff. 28

29 Service Plan Documentation Includes individuals important in supporting individual Includes the names of the individuals responsible for monitoring plan Is written in plain language and understandable to the individual Documents who is responsible for monitoring the plan 29

30 Service Plan Documentation Documents the informed consent of the individual for any restrictions on the member s rights, including maintenance of personal funds and self administration of medications, the need for the restriction, and either a plan to restore those rights or written documentation that a plan is not necessary or appropriate. Any rights restrictions must be implemented in accordance with 441 IAC 77.25(4). 30

31 Service Plan Documentation Includes the signatures of all individuals and providers responsible Is distributed to the individual and others involved in plan Includes purchase/control of self-directed services Excludes unnecessary or inappropriate services and supports 31

32 Rules, Manual and Guidance Habilitation Services website: Iowa Administrative Rules Provider Manual: Informational Letters can be found at: 32

33 IME Program Contact Program Manager: LeAnn Moskowitz Dept. Of Human Services Iowa Medicaid Enterprise, Bureau of Long Term Care (515)

34 Magellan Contacts Webinars and other resources are available at: Steve Johnson, Clinical Director at