Source: http://www.ct.gov/dss/lib/dss/communityservices/HCBSWaiverApplicationDraft.htm
Timestamp: 2017-03-27 20:35:19
Document Index: 37836566

Matched Legal Cases: ['§440', '§440', '§1915', '§1915', '§1915', '§1915', '§1915', '§1915', '§1915', '§17', '§17', '§435', '§1924', '§1924', '§1634']

Application for 1915(c) HCBS Waiver: Draft CT.026.04.00 - Jan 01, 2017
This is a request to renew Connecticut�s Acquired Brain Injury Waiver. The intent of the waiver is to provide an alternative to institutional care for persons with brain injuries who are at least 18 years of age.
CT ABI Waiver
Requested Approval Period:(For new waivers requesting five year approval periods, the waiver must serve individuals who are dually eligible for Medicaid and Medicare.)
Original Base Waiver Number: CT.0302
Draft ID:CT.026.04.00
The Waiver Uses NF and ABI/NF
1.-Nursing Facility As defined in 42 CFR §440.40 and 42 CFR §440.155
2.-Acquired Brain Injury Nursing Facility (ABI/NF) - A type of nursing facility that provides specialized programs for persons with acquired brain injury.
Services furnished under the provisions of §1915(a)(1)(a) of the Act and described in Appendix I Waiver(s) authorized under §1915(b) of the Act. Specify the §1915(b) waiver program and indicate whether a §1915(b) waiver application has been submitted or previously approved:
Specify the §1915(b) authorities under which this program operates (check each that applies): §1915(b)(1) (mandated enrollment to managed care) §1915(b)(2) (central broker)
Connecticut�s Acquired Brain Injury Waiver (ABI) serves persons who are at least 18 years of age with acquired brain injury who, without such services, would otherwise require placement in one of four types of institutional settings. It is designed to assist participants to relearn, improve or retain the skills needed to support community living. The waiver employs the principles of person-centered planning to develop an adequate, appropriate and cost-effective plan of care from a menu of nineteen home and community-based services to achieve personal outcomes that support the individual�s ability to live in his/her community of choice.
The Department of Social Services (DSS), as the state Medicaid Agency pursuant to Connecticut General Statutes (CGS) §17b-1, directly administers the ABI Waiver according to CGS §17b-260a. DSS assures that all individuals receiving waiver services meet the categorically and medically needy eligibility and income/asset requirements. DSS is responsible for calculating the consumer�s share of liability that can be applied to the cost of waiver services. DSS also informs individuals determined eligible to receive waiver services of their due process rights and gives them the choice of institutional or home and community based services. Care managers, in consultation with the consumer, their family and care providers (e.g., skilled nursing/ABI facility staff, primary care physicians, and neuropsychologists) develop plans of care to meet an individual�s cognitive, physical, and behavioral support needs. Plans are submitted to the department's Home and Community Based Services Unit staff for review of eligibility, service adequacy and responsiveness to the waiver participant�s needs.
DSS contracts with a fiscal agent to conduct provider recruitment; training; engage in fiscal monitoring; claims processing and reporting; and provider credentialing. Quarterly reports, at a minimum, are submitted to the Department to facilitate State oversight of the waiver program. In addition, routine quality assurance activities through staff meetings, training; case conferences, consumer record maintenance, and staff supervision are components of the Department�s oversight of the ABI waiver program. Service Delivery
ABI Waiver credentialed providers deliver services in the client�s home and community. These services are based on the team developed ABI Service plan. The providers collaborate with the consumer and other members of the team to implement strategies to support community living. These include the following:
�	Provide instruction and training in one or more areas of need to enhance the participant�s ability to live independently in their own home
�	Implement strategies to address behavioral, medical or other needs identified in the ABI Service Plan
�	Provide assistance with personal care or activities of daily living
�	Support the attainment of vocational skills
Provide training or practice in consumer skills (e.g., banking, budgeting, shopping)
Subpart E, to individuals: (a) who are not given the choice of home and community-based waiver services as an alternative to institutional level of care specified for this waiver; (b) who are denied the service(s) of their choice or the provider(s) of their choice; or (c) whose services are denied, suspended, reduced or terminated. Appendix F specifies the State's procedures to provide individuals the opportunity to request a Fair Hearing, including providing notice of action as required in 42 CFR �431.210.
The development of this waiver renewal included input from the ABI Waiver consumers, family members, non-waiver participants with brain injury, the Independent Living Centers, brain injury providers, DSS social work staff and the Brain Injury Association of Connecticut (BIAC). - BIAC Provider Council: Provider Comments 04/11 - BIAC Council: Advocacy Comments 05/11
- DSS Social Work Focus Group: 07/11
- BIAC Consumer Focus Groups: 05/11/2011, 05/16/2011, 05/25/2011 and 05/26/2011 - Disabilities Council: 07/11
Pursuant to Connecticut General Statutes Section 17b-260a the Commissioner of the Connecticut Department of Social Services was mandated to seek a waiver from federal law to establish a Medicaid-financed, home and community-based program for individuals with acquired brain injury.
Notice for the amendment including the transition plan was posted in the CT Law Journal on July 8th. The tribes were notified on 6/26/14. Allowance was made for a 30 day comment period prior to the public hearing. The transition plan was also posted to the DSS web site on 7/15/14. The amendment was also discussed at the quarterly meeting of the Brain Injury Advisory Committee on 7/14/14.
For this amendment (5/1/16) regarding changing care management, the department held an information forum for participants and their family members on October 1st. A presentation was also done for the ABI Waiver Advisory Committee on September 10, 2015. In addition a printed notice was published in the CT Law Journal on October 20, 2015 and published on the department's web site on October 27, 2015. The two Connecticut tribes were notified on October 8, 2015. No comments were received regarding this amendment.
A public hearing was held on December 17, 2015. The Committees of cognizance did not approve submission of the amendment. Public comment focused on the qualifications and experience of the proposed care managers.
The department made modifications to the waiver amendment and reposted notice in the CT Law Journal on February 9, 2016 and on the DSS website on February 3, 2016. A 30 day comment period was provided that ended on March 10th. Two comments were received. The first was from the Brain Injury Alliance of CT. BIAC was fully supportive of the amendment and suggests that contracting for the case management service will better serve those in the waiver.
The second comment was submitted by Dominic Cotton, a current waiver provider. The comments expressed a preference that the DSS social workers continue to provide the waiver case management.
A public hearing was held on 4/11/16 before the legislative Committees of Cognizance over the waivers. The committees supported submission of the amendment.
Print notice was published in the CT Law Journal on August 16,2016 and was also posted on the DSS website. The two CT tribes were directly notified via email.
The state assures that the settings transition plan included with this waiver amendment will be subject to any provisions or requirements included in the State's approved Statewide Transition Plan. The State will implement any required changes upon approval of the Statewide Transition Plan and will make conforming changes to its waiver when it submits the next amendment or renewal.
The state will assess the settings in which waiver applicants reside for compliance with the new rules as they apply for and are assessed for participation in the waiver. Waiver participants reside in their own homes, apartments or with family members. Under this waiver, participants may also choose to reside in provider owned homes. Prior to an individual accessing any of the services listed below the state will verify that the provider owned or controlled setting comports with CMS home and community based settings requirements through its person centered assessment process. The person centered assessment is completed to determine functional eligibility for the waiver and must be completed prior to waiver services being authorized to begin. If the social worker assesses that the setting is not compliant with the new rules, the social worker will discuss and offer the participant alternative settings that would be compliant. The applicant could choose another setting or remain in their current setting. If they stay in the setting that has been assessed not to be compliant, they would not be approved to receive services under this waiver.
Specify the unit name:Community Options Unit
DSS contracts with a non-profit fiscal intermediary that does not provide ABI Waiver Services. DSS recently issued a request for proposal for this service and this entity was again the determined the successful bidder. Provides fiduciary, training, and credentialing services. (See Items A-5 and A-6).
BIACs contract is an infrastructure grant to support organization general advocacy activates. It is not client-based contract, but BIAC has the capacity and does support participants. they provide advocacy, support groups and client support at team meetings on a self referred basis.
DSS also contracting with new providers of care management effective 5/1/16. The providers were selected as the result of a competitive procurement.
Not applicable Applicable - Local/regional non-state agencies perform waiver operational and administrative functions.
The Department of Social Services (i.e., Division of Health Services, Medical Operations and Quality Assurance) is responsible for assessing the performance of the fiscal intermediary which performs operational and administrative duties for the ABI Waiver. The FI is responsible for provider credentialing and the MMIS contractor is responsible for provider enrollment. This entity also does payroll processing for self-directed staff and claims processing to the MMIS on behalf of performing service providers and reimburses providers for services provided. They coordinate training for all provider types and conduct trainings employers/participants who choose to self-direct their staff.
The DSS Community Options unit is responsible to monitor the performance of the contracted case management providers.
DSS directly ensures that all waiver services must be included in a plan of care that is signed by the consumer, case manager and department prior to implementation of services. DSS has a contract with a fiscal intermediary to perform operational/administrative duties. The department assesses the performance of waiver functions, for which the contractor responsible, on an ongoing and regular basis, using diverse methods. These methods and frequency of their use are specified below:
1. Quarterly and ad hoc reports from the fiscal intermediary (All Functions)
2. Annual on-site visits to review operational and administrative functions (All Functions)
3. DSS staff attends trainings administered/approved by the fiscal intermediary to assess quality and consistency (2 times annually) (Training Function)
4. Annual on site record reviews of client records by care management agency.
5. Review of required care management agency client satisfaction surveys data
6. DSS staff attends a number of forums to gather information in each area of the state about how the Waiver is functioning. These include but are not limited to the following:
a. Brain Injury Alliance of Connecticut support group meetings (1 in each of Connecticut's 3 geographic regions). Participants: persons with brain injuries (Waiver and non-waiver) and their family members. (All Functions with an emphasis on claims payment for self-directed services, general responsiveness)
b. The Traumatic Brain Injury Advisory Committee (All Functions with an emphasis on provider recruitment, training, and credentialing)
c. Provider Council Meetings facilitated by the Brain Injury Alliance of Connecticut (BIAC) (bi-monthly). Participants: ABI Waiver Providers(All Functions with an emphasis on provider credentialing and vendor claims payment)
Attendance at each of these forums provides department staff with feedback on the performance of the FI functions. it is an open forum where consumers are encouraged to share experiences with the FI both positive and negative. We seek feedback on payroll processing, frequency and quality of training and claims payment. 7. Ongoing correspondence between the fiscal intermediary and DSS staff regarding progress on deliverables (e.g., claims processing, training schedules, numbers of credentialed providers, etc.) (All Functions)
8. A bi-annual survey of waiver participants is issued to consumers, advocates and providers to gauge the functioning of the Waiver, including its fiscal intermediary. (All Functions with an emphasis on claims payment for self-directed services, general responsiveness)
9. DSS shall facilitate an interagency advisory board established pursuant to statutory requirements consisting of consumers, waiver providers and others to study the impact of the cost cap and other matters the Board deems appropriate by February 1, 2015. (All Functions)
The aforementioned approaches aid the department in measuring, observing and seeking feedback of the contracted provider in regard to performance of assigned duties.
FunctionMedicaid AgencyContracted Entity
For each performance measure the State will use to assess compliance with the statutory assurance, complete the following. Performance measures for administrative authority should not duplicate measures found in other appendices of the waiver application.
As necessary and applicable, performance measures should focus on:
Number of background checks conducted by the fiscal intermediary in accordance with contract requirements.
Specify:Fiscal Intermediary
Responsible Party for data aggregation and analysis (check each that applies): Frequency of data aggregation and analysis(check each that applies):
Number DSS/fiscal intermediary program evaluation meetings carried out in accordance with approved Waiver.
Specify:Bi-monthly
Number and percent of provider credentialing conducted in accordance with fiscal intermediary contract.
Number and Percent of waiver participants who complete required training prior to receipt of self-directed services.
Number and Percent of waiver providers who complete required training prior to delivery of services.
The Community Options Unit staff have ongoing correspondence with the fiscal intermediary, including a monthly conference call to proactively address any issues or potential issues. Eligibility staff in the unit have ongoing correspondence with the fiscal intermediary, including a bi-weekly conference call to proactively address eligbility/claims issues. Providers will be provided with an email box that will be used solely for addressing issues with claims.
Describe the State�s method for addressing individual problems as they are discovered. Include information regarding responsible parties and GENERAL methods for problem correction. In addition, provide information on the methods used by the State to document these items. Character Count: out of 6000
Community Options Unit staff, who is assigned oversight of the contract with the fiscal intermediary is the point person for all problems that may occur. The staff member would hear and assess the problem, contact any person or department that needs to address the problem and then follow up to assure that there was resolution. The Department maintains a corrective action log regarding identified problems and related resolution.
Remediation Data Aggregation Remediation-related Data Aggregation and Analysis (including trend identification) Responsible Party(check each that applies): Frequency of data aggregation and analysis(check each that applies):
ABI Waiver applicants must be age 18 through 64. ABI waiver applicants must have sustained a brain injury and complete the eligibility assessment process prior to age 65. Participants who turn age 65 would be offered a choice to remain on the ABI Waiver, access institutional placement, or transition to the Home and Community Based Services Elder Waiver, which serves clients age 65 and over.
DSS must determine that the cost of waiver services necessary to ensure the individual�s health and safety does not exceed identified level of care annual cost limits. The ABI Waiver utilizes four levels of care, each with different spending caps and an assessment tool is used to identify those individual needs and determine level of care. This same tool is used to assess whose needs cannot be met within the cost cap. Applicants or participants whose health and safety needs cannot be reasonably assured by the formal supports, informal supports and home and community-based services within the waiver, will first be assessed to determine if a higher level of care within the waiver is applicable. If this is not possible the applicant or participant will not be enrolled or shall be disenrolled from the ABI waiver. In the event that an applicant is denied enrollment or a participants has services that are proposed to be reduced, suspended or terminated, the applicant/participant is notified via a Medicaid Notice of Action (NOA) regarding their right to a fair hearing in accordance with the rules of the Department�s Medicaid Program.
When a consumer's Level of Care (LOC) is thought to be inappropriate, the case manager reassesses that individual, with oversight by the Department's Community Options Unit staff and a neuropsychologist if appropriate to ensure that all necessary factors have been considered in assigning the care level. If the services cannot be accommodated within an appropriate LOC, it is determined that a client does not qualify for services under the ABI Waiver. If a subsequent service reduction or termination is indicated, the client receives, as noted above, a Notice of Action that sets forth the proposed denial/change. Clients are afforded the opportunity for a Fair Hearing in accordance with Departmental Medicaid Policy. Service cannot be reduced until the hearing decision is issued if a client requests a hearing within 10 days of the date of the NOA.
If a client's needs cannot be accommodated at the level of care within the 200% cost cap a team meeting is held that includes the participant and/or their representative, options are offered and if unsuccessful, verbal notice is given followed the formal written notice of action with appeal rights process is implemented.
No new participants will be added to this waiver. Anyone who was on the waiting list who has not been offered a slot on this waiver, will go into a waiting list for the states ABI waiver approved by CMS on 12/1/14.
Person's defined as qualified severely impaired individuals in section 1619b and 1905(q) of the social security act.
Use of Spousal Impoverishment Rules. Indicate whether spousal impoverishment rules are used to determine eligibility for the special home and community-based waiver group under 42 CFR �435.217: Note: For the five-year period beginning January 1, 2014, the following instructions are mandatory. The following box should be checked for all waivers that furnish waiver services to the 42 CFR §435.217 group effective at any point during this time period.
Spousal impoverishment rules under §1924 of the Act are used to determine the eligibility of individuals with a community spouse for the special home and community-based waiver group. In the case of a participant with a community spouse, the State uses spousal post-eligibility rules under §1924 of the Act. Complete Items B-5-e (if the selection for B-4-a-i is SSI State or §1634) or B-5-f (if the selection for B-4-a-i is 209b State) and Item B-5-g unless the state indicates that it also uses spousal post-eligibility rules for the time periods before January 1, 2014 or after December 31, 2018.
Not Applicable (see instructions)Note: If the State protects the maximum amount for the waiver participant, not applicable must be selected.
The department will utilize contracted case managers to complete an evaluation of the need or level(s) of care in collaboration with a neuropsychologist who is familiar with the participant. Other qualified individuals will join the interdisciplinary team as appropriate. This is done after the department's clinical staff perform a health screen, review of the neuropsychological exam and level of care determination. The case managers who conduct the initial evaluations are required to have no less than a masters degree in Social Work and be a licensed practitioner or have a Masters degree in Human Services, Counseling or Rehabilitative Counseling or be a registered nurse with no less than a bachelor's degree. The Staff must have the ability to serve multicultural, multilingual populations; and the skill set to lead and facilitate the Care Team that includes the participant’s team of providers and supporters, and reach consensus on the Service Plan. The provider agency is also required to have 5 years experience in the provision of case management service and the individual case manager is required to have at least two years experience in case management in health care or human services settings.
Neuropsychologist Qualifications: Licensure by the Connecticut Department of Public Health pursuant to Connecticut General Statutes Sections. 20-186 to 20-195 are required to serve in this role.
The Department conducts level of care assessments to evaluate and reevaluate whether an individual needs services through the waiver and the type of institutional care that the individual would otherwise require. The level of care assessment is based upon information obtained from the individual, medical reports from his or her physician(s), including a neuropsychologist, and any other clinical personnel who are familiar with the individual's case and history. The ABI Waiver allows participants to be served at 200% of LOC. If a participant meets the criteria for more than one institutional LOC, their care plan costs can be effectively met within the flexibility of the lower level. As a means to guide this level of care assessment, Connecticut Department of Social Services utilizes form W-1034 Level of Care Determination: PCA and ABI Waiver Programs in accordance with, Connecticut General Statutes17b-260a-1, Connecticut Department of Social Services pending regulations and the Connecticut Department of Social Services Acquired Brain Injury Desk Guide.
Level of Care Criteria:
1. Category I (NF) - The individual is considered to require care in a nursing facility (NF) if he or she resides in such a facility, or has impaired cognition and, due to physical or cognitive deficits, requires physical assistance, supervision or cueing with two or more activities of daily living. Activities of daily living (ADLs) include eating, bathing, dressing, toileting and transfers.
2. Category II (ABI/NF) - The individual is considered to require care in an acquired brain injury nursing facility (ABI/NF) if he or she resides in such a facility, or has impaired cognition, impaired behavior requiring daily supervision or cueing, and a mental illness which manifested itself before the brain injury occurred and requires physical assistance, supervision or cueing with two or more activities of daily living. Activities of daily living (ADLs) include eating, bathing, dressing, toileting and transfers. Persons who did not have a premorbid mental illness would not qualify for this level of care and would be evaluated for other levels of care. 3. Category III (ICF/IID) - The individual is considered to require care in an intermediate care facility for individuals with intellectual disabilities (ICF/IID) if he or she resides in such a facility, or has impaired cognition, an acquired brain injury that occurred before the age of 22 and, due to physical deficits, requires physical assistance, with two or more ADLs.
4. Category IV (CDH) - The individual is considered to require care in a chronic disease hospital (CDH) if he or she resides in such a facility, or has impaired cognition, impaired behavior and, due to physical or cognitive deficits, requires physical assistance, supervision or cueing with two or more ADLs.
In the event that an individual who meets the level of care requirements for more than one institutional level, such individual shall be served at the lower level of care.
For the purposes of determining level of care, a Department of Social Services clinical staff make an initial determination of the level of care of each applicant. Information gathered for the evaluation/reevaluation of care is derived from face to face interviews and includes a thorough evaluation of the client�s individual circumstances and a neuropsychological evaluation/review. The level of care determination form (W-1034) is used to summarize this information and confirm level of care. The case manager's face to face assessment confirms or recommends modification of the department's level of care assignment. The reassessment process requires a case manager to do an annual review of each applicant and the completion of the W-1034.
Reevaluations (reassessments) are conducted by the contracted care manager. DSS utilizes an electronic data base that tracks reassessment due dates and completion of those reviews. The system generates reports of overdue reassessments. Compliance with the reassessment process is verified during the on site reviews that will be conducted of each case management providers
Written copies of the care plan evaluations and reevaluation documents are maintained by the Department of Social Services in its electronic data base. This is done to conform with 42 CFR 441.303(c)(3) and 45 CFR 74.53. The DSS case management database also retains an electronic record of the performance of evaluations and reevaluations. As a back-up the fiscal intermediary maintains copies of approved care plans.
Number and percentage of participants who received an initial level of care determination indicating need for institutional level of care prior to receipt of waiver services.
Number and percentage of participants� initial (or annual, or both) LOC determinations forms/instruments that were completed as required by the state.
If 'Other' is selected, specify:Compiled report completed by Fiscal Intermediary that provides a timeliness assessment of submitted LOC determination forms forwarded by State Medicaid Agency.
Number and percentage of participants who received an annual level of care determination within 12 months of initial determination or previous level of care determination.
Specify:As needed
Number and percentage of participants whose LOC determiantions were made by a case manager.
Data Source (Select one):Program logs
Number and percent of participants� LOC determinations (initial and annual)were made on the state's approved forms/instruments.
The case manager will re-assess a client if it appears that they require a different level of care. If it is determined that a level of care is either too high or too low, the service plan is adjusted and a Notice of Action is sent to the client. The consumer is afforded full access to the Medicaid appeals process, which is administered by the DSS office of Legal Counsel, Regulations, and Fair Hearings.
Individual concerns regarding the health and safety of clients is reported to DSS HCBS staff. The Waiver manager determines whether DSS' Quality Assurance division or clinical staff investigates the basis of the complaint/referral. Once an investigation is completed HCBS or QA staff consults with the Waiver Manager who makes determination if corrective action is pursued. For health and welfare matters the case managers monitor in collaboration with department clinical staff monitor until a satisfactory resolution is achieved. Any final recommendations are made in consultation with the manager. QA staff monitors non-health and safety complaints until satisfactory resolution is obtained.
At the time of screening for eligibility to participate in this waiver, the case manager informs the potential participant of his or her option of receiving services in a long-term care institution or through this waiver. The individual is also advised of his/her right to a Fair Hearing. This is documented on the (form W-1035) �Freedom of Choice/Fair Hearing Notification�. This form is maintained by the case manager in the participant�s case file.
All materials pertaining to a specific waiver participant, is maintained in their individual file. The signed �Freedom of Choice/Hearing Notification� form and other documents are maintained by the social worker in the participant�s case file.
Potential and active waiver participants with limited fluency in English must have access to services without undue hardship. The DSS Request for Waiver Services (W-1130) is available in Spanish. Case managers are required to make arrangements to provide interpretation or translation services for potential and active waiver participants who need them. This is accomplished through the use of bilingual staff and/or purchasing/contracting for interpreters. Non-English speaking waiver applicants/participants may bring an interpreter of their choice with them to DSS, provider and planning meetings. They cannot, however, be required to bring their own interpreter. No person can be denied access on the basis of English proficiency.
ABI Group Day
01 Case Management
02 Round-the-Clock Services
03 Supported Employment
04 Day Services
06 Home Delivered Meals
07 Rent and Food Expenses for Live-In Caregiver
08 Home-Based Services
09 Caregiver Support
10 Other Mental Health and Behavioral Services
11 Other Health and Therapeutic Services
12 Services Supporting Self-Direction
13 Participant Training
14 Equipment, Technology, and Modifications
15 Non-Medical Transportation
16 Community Transition Services
Homemaker services consist of general household activities, including meal preparation and routine household chores. Homemaker services are provided by the Department only when the individual regularly responsible for these activities is temporarily absent from the home or unable to manage the home and care for him/herself or others in the home; or, when the waiver participant is unable to (re)learn such skills or does not choose to perform these tasks. Homemaker services may not be provided by a member of the participant�s family.
A member of the consumer�s family or the conservator or their family may not provide these services.
Private household employee
Homemaker service providers are not licensed or regulated.
A homemaker provider shall:
�	be at least 18 years of age
�	follow instructions given by the consumer or the consumer�s conservator
�	be able to report changes in the consumer�s condition or needs
�	have the ability or skills necessary to meet the consumer�s needs as delineated in the service plan
�	demonstrate ability to implement cognitive and behavioral strategies
At start of services
Services that provide learning and work experiences, including volunteer work, where the individual can develop general, non-job-task-specific strengths and skills that contribute to employability in paid employment in integrated community settings. Services are expected to occur over a defined period of time and with specific outcomes to be achieved, as determined by the individual and his/her service and supports planning team through an ongoing person-centered planning process. Services are delivered in a participant's home or in a fully integrated work setting based on the participant's needs and preferences. Services are not delivered in facility based, congregate or sheltered work settings where individuals are supervised for the primary purpose of producing goods or performing services.
Individuals receiving prevocational services must have employment-related goals in their person-centered services and supports plan; the general habilitation activities must be designed to support such employment goals. Competitive, integrated employment in the community for which an individual is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities is considered to be the optimal outcome of prevocational services. Prevocational services should enable each individual to attain the highest level of work in the most integrated setting and with the job matched to the individual's interests, strengths, priorities, abilities, and capabilities, while following applicable federal wage guidelines. Services are intended to develop and teach general skills. Examples include, but are not limited to: ability to communicate effectively with supervisors, co-workers and customers; generally accepted community workplace conduct and dress; ability to follow directions; ability to attend to tasks; workplace problem solving skills and strategies; general workplace safety and mobility training.
40 hours per week. This service will be limited to two years than may be extended up to a maximum of four years if the participant is demonstrating progress toward achieving their employment goal.
Some waiver participants have been receiving this service for 10, 12 and 14 years. Upon approval of the amendment, each participant's plan will be reviewed as part of their annual reassessment process. The department may approve an additional 2 years of service up to a maximum of an additional four years beyond the services received through December 1, 2015. The determination will be made as part of the ongoing evaluation of the person centered plan and based on whether there is demonstrated progress being made toward vocational goals. Annual redeterminations of eligibility for such services. Once services are discontinued, the participant would be evaluated for other services as part of the person centered planning process. The most likely services to replace the prevocational service would be ABI Group Day or Independent Living Skills Training.
Vocational Agency Provider
Service Name: Pre-Vocational Service
Commission on Accreditation of Rehabilitation Facilities (CARF)- Employment Services, or
Meet the State of CT Standard to provide vocational rehabilitation services for the Bureau of Rehabilitative Services, Department of Developmental Services or the Department of Mental Health and Addiction Services. This shal include: A Director of Vocational Services has Commission on Rehabilitation Counselor certification and a minimum of two years experience (experience is defined as a minimum of 1000 documented service hours per year) in providing community based vocational services to persons with disabilities. OR The Director of Vocational Services has a Bachelor�s degree in a relevant area and a minimum of five years experience (experience is defined as a minimum of 1000 documented service hours per year) in providing community based vocational services to persons with disabilities.
At start of services or re-accreditation (every two years).
Services provided to persons unable to care for themselves, and furnished on a short-term basis only in the individual�s home or place of residence, when person performing such services is absent or in need of relief.
Commission on Accreditation of Rehabilitation Facilities (CARF) � Community Support Services,
Employ staff who:
�	are at least 18 years of age
�	demonstrate the ability to maintain a safe and healthy living environment
�	demonstrate knowledge of basic first aid
�	demonstrate knowledge of response to fire and emergency situations
�	demonstrate ability to function as a member of an interdisciplinary team.
�	Must be capable of performing all functions of the primary caregiver in their absence.
Must have completed an approved training program(s) concerning acquired brain injury and person-centered planning, given by a state agency, the state�s fiduciary, community providers, Brain Injury Association of CT, or an Independent Living Center.
At start of services or at re-accrediation for CARF Providers
OR meet the qualifications for Independent Living Skills Training and Development.
At start of services or at re-accreditation for CARF Providers
Supported Employment -Individual Employment Support services are the ongoing supports to participants who, because of their disabilities, need intensive on-going support to obtain and maintain an individual job in competitive or customized employment, or self-employment, in an integrated work setting in the general workforce for which an individual is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. The outcome of this service is sustained paid employment at or above the minimum wage in an integrated setting in the general workforce, in a job that meets personal and career goals.
Supported employment services can be provided through many different service models. Some of these models can include evidence-based supported employment for individuals with mental illness, or customized employment for individuals with significant disabilities. States may define other models of individualized supported employment that promote community inclusion and integrated employment.
Supported employment individual employment supports may also include support to establish or maintain self-employment, including home-based self-employment. Supported employment services are individualized and may include any combination of the following services: vocational/job-related discovery or assessment, person-centered employment planning, job placement, job development, negotiation with prospective employers, job analysis, job carving, training and systematic instruction, job coaching, benefits support, training and planning, transportation (Transportation to and from the individual�s residence and a day habilitation site is included in the rate paid to the provider), asset development and career advancement services, and other workplace support services including services not specifically related to job skill training that enable the waiver participant to be successful in integrating into the job setting.
Documentation is maintained that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the IDEA (20 U.S.C. 1401 et seq.).
Federal financial participation is not claimed for incentive payments, subsidies, or
unrelated vocational training expenses such as the following:
1. Incentive payments made to an employer to encourage or subsidize the employer's
participation in supported employment; or
Commission on Accreditation of Rehabilitation Facilities (CARF) � Employment Services
At start of services or at recertification
Services and supports that lead to the acquisition, improvement and/or retention of skills and abilities to prepare an individual for health and wellness, self-care or for work and/or community participation, or support meaningful socialization, leisure activities. This service is provided by a qualified provider in a facility-based program or appropriate community locations. Transportation to and from home is not included as part of this waiver service.
Community Integration Agency Provider
Employment Services/Supports Agency Provider
Rehabilitation Hospital Outpatient Department
Service Name: ABI Group Day
CARF certification in brain injury and/or Community Support, or
JCAHO accreditation for Behavioral Health Care
Employee staff who:
�	are at least 18 years old
�	have a minimum of a Bachelor�s Degree and one year�s experience providing services to individuals with brain injuries in the community, and complete training program(s) concerning acquired brain injury and person-centered planning, given by a state agency, the fiduciary, community providers, Brain Injury Association of CT, or Independent Living Center, or have a high school diploma and two years experience providing services to individuals with brain injuries in the community and completed training program(s) concerning acquired brain injury and person-centered planning, given by a state agency, broker agency, community providers, Brain Injury Association of CT, or Independent Living Center
�	demonstrate ability to function as a member of an interdisciplinary team
�	have documented experience implementing cognitive/Behavioral interventions developed by a clinician and utilized in community settings
�	or, meet qualifications for Cognitive/Behavioral Programs
At start of services and at recertification/re-accreditation (Every two years)
Commission on Accredidation of Rehabilitation Facilities (CARF) -Employment Services
Meet the State of CT Standard to provide vocational rehabilitation services for the Bureau of Rehabilitative Services, Department of Developmental Services or the Department of Mental Health and Addiction Services.
At start of services or at recertification (Every two years)
Services needed to maintain the consumer�s home in a clean, sanitary and safe condition. This service includes heavy household chores, such as washing floors, windows, walls, and moving heavy items of furniture in order to provide safe access and egress.
Chore services are provided only when neither the individual, nor anyone else in the household, is capable of performing or financially providing for them, or where no other third party is capable for their provision. ABI Waiver funds shall not be used if the service may be provided free of charge through friends, relatives, caregiver or community agencies. In the case of rental property, any service that is the responsibility of the landlord or his or her designee shall not be paid from ABI waiver funds; a copy of the lease agreement shall be reviewed before this service is authorized.
Private or non-profit agencies
Self employed private provider
Service Name: Chore
Chore service providers are not licensed or regulated. Services shall not be provided by any person who is a relative of the participant, is the participant�s conservator, or is a member of the conservator�s family.
A chore service provider shall:
Be at least 18 years of age and be able to physically perform the service required.
Be able to follow instructions given by the consumer or the consumer�s conservator.
Be able to report changes in the consumer�s condition or needs.
Have the ability or skills necessary to meet the consumer�s needs as delineated in the service plan.
At start of service and every 2 years
At start of services and recertification every 2 years
Individual interventions designed to increase an individual's cognitive and behavioral capabilities and to further the individual's adjustment to successful community engagement including:
- Comprehensive assessment of cognitive strengths and liabilities, quality of adjustment and behavioral functioning
- Development and implementation of cognitive and behavioral strategies
- Development of a structured cognitive/behavioral intervention plan
- Ongoing or periodic consultation with the waiver participant, support system and providers concerning cognitive and behavioral strategies and interventions specified in the cognitive/ behavioral intervention plan
- Ongoing or periodic assistance with training of the waiver participant, support system and providers concerning cognitive behavior strategies and interventions
- Periodic reassessment and revision as needed, of the cognitive/behavioral intervention plan.
This service is performed within the context of the individual’s person-centered team, in concert with the case manager. Cognitive/behavioral programs may be provided in the individual’s home or in the community in order to reinforce the training in a real-life situation.
The service will be delivered utilizing two procedure codes, one for in person face to face visits that include the participant, providers and/or supporters. A quarterly, in person meeting with the waiver participant is required for this service.
The second procedure code is for non face-to-face service that includes development of the cognitive behavioral plan and phone or other types of interactions with participants, providers or supporters.
Rehabilitation Hospital (Outpatient Department)
Brain Injury Services Community Agency
Service Name: Cognitive Behavioral Programs
At beginning of services and recertification (every two years).
State of CT General Statutes Section 20-408.
At least three year�s experience in cognitive/behavioral programming for people with a brain injury, delivered in community settings.
State of CT General Statutes Section 20-74a
Allied Community Resources, Inc
State of CT DPH Chap.383B, Section 20-188-1 Sec. 20-188-2 and Sec. 20-188-3.
Certification in Special Education CT General Statutes Sec. 10-145d-538 and Sec. 10-145d-539.
Ph.D. in Education with concentration in cognitive strategy development and remediation and/or post-doctoral experience in providing such services.
State of CT General Statutes Section 20-66
State of CT Dept. of Health Services (DPH) Section 20-188-1
Post-doctoral study or clinical supervision in neuropsychology
At beginning of services and recertification (Every two years)
CARF certification in Brain Injury, or JCAHO, or Accreditation for Behavioral Health Care, or
Employ neuro-psychologists, educational psychologists, psychologists, occupational therapists, speech therapists or physical therapists that meet the standards of individual providers.
This service provides supervised living in the consumer�s residence that provides up to 24-hour support services, including overnight supervision, for up to three individuals with acquired brain injury. Services are provided in the residence or in the community and include supervision of and assistance with: self-care; medication management; communication and interpersonal skills; socialization; sensory/motor skills; mobility; community transportation skills; problem-solving skills; money management and ability to maintain a household. Assessment and training services are not provided under this component.
The CLSS provider must develop a plan that demonstrates its ability to work with the individual and to provide services that are consistent with the therapeutic goals of his or her overall service plan. When the individual chooses, or improves his or her ability to live more independently, the CLSS provider will work with the individual and the DSS Social Worker to develop and implement a plan to transition the individual to greater independence in the community.
CLSS participants are not precluded from attending or participating in other community-based services if these are determined by the individual and the DSS Social Worker to be of potential benefit in providing the individual with skills and training needed to achieve independence.
No ABI funds will be spent on the room and board component of CLSS services.
This service is purchased by the day or half (12-hour) day. If the individual is involved in other service plan activities that consistently involve being away from the CLSS for a significant period of time, more than six hours per day, this service shall be paid on a half-day basis.