Source: http://www.sharinglaw.net/elder/HCBSwaiver.htm
Timestamp: 2018-01-20 23:11:32
Document Index: 712044430

Matched Legal Cases: ['§1915', '§1915', '§1915', '§440', '§440', '§440', '§440', '§440', '§440', '§1915', '§1915', '§1915', '§1915', '§1915', '§1915', '§1915', '§1915', '§1915', '§1932', '§1915', '§1915', '§1115', '§1902', '§1902', '§1902', '§441', '§1616', '§440', '§ 440', '§441', '§441', '§441', '§431', '§1915', '§433', '§431', '§431', '§1915', '§431', '§431', '§441', '§1634', '§435', '§1931', '§435', '§1902', '§1902', '§1902', '§1902', '§435', '§435', '§435', '§435', '§435', '§435', '§435', '§435', '§435', '§435', '§435', '§435', '§435', '§435', '§435', '§435', '§441', '§435', '§435', '§1924', '§1924', '§435', '§1924', '§1924', '§435', '§435', '§1924', '§1924', '§435', '§1924', '§435', '§1924', '§1924', '§435', '§435', '§441', '§441', '§441', '§441', '§441', '§441', '§441', '§92', '§441', '§92', '§441', '§441', '§441', '§440']

Application for 1915(c) HCBS Waiver: CT.0437.R01.00 - Oct 01, 2008
Application for a §1915(c) Home and Community-Based Services Waiver
PURPOSE OF THE HCBS WAIVER PROGRAM
Main Module: Waiver
Request for a Renewal to a §1915(c) Home and Community-Based Services Waiver
1. Major Changes
Describe any significant changes to the approved waiver that are being made in this renewal application:
Character Count: out of 12000
The Department of Mental Retardation was officially changed to the Department of Developmental Services on October 1, 2007. References to official documents such as regulations, policies, procedures, or web links contained in this waiver may still be listed as DMR rather than DDS. The only immediate change in this application that impacts a current participant is the change in the name of and the provider qualifications for Supported Living and IS Hab. These service will now be named Individualized Home Supports. In addition, the service called Consultation in the existing waiver has been eliminated in this renewal application. The supports that were offered under Consultation have been separated into Nutrition and Clinical Behavioral Supports. The renewal application contains some new services as well. The new services are Adult Day Health, Live-in Caregiver, and Health Care Coordination. The renewal application also contains new funding methodologies for individual service budgets. Current authorized services will remain unchanged through this renewal application. Requests for new services by current participants received after the renewal date of this waiver will be subject to the requirements outlined in this application.
1. Request Information (1 of 3)
The State of Connecticut requests approval for a Medicaid home and community-based services (HCBS) waiver under the authority of §1915(c) of the Social Security Act (the Act).
Program Title (optional - this title will be used to locate this waiver in the finder):
Type of Request: renewal
Migration Waiver - this is an existing approved waiver
Renewal of Waiver:
Provide the information about the original waiver being renewed
Base Waiver Number:
Effective Date: (mm/dd/yy)
Waiver Number: CT.0437.R01.00
Draft ID: CT.09.01.00
Renewal Number:
Type of Waiver (select only one):
Model Waiver Regular Waiver
Proposed Effective Date: (mm/dd/yy)
1. Request Information (2 of 3)
Level(s) of Care. This waiver is requested in order to provide home and community-based waiver services to individuals who, but for the provision of such services, would require the following level(s) of care, the costs of which would be reimbursed under the approved Medicaid State plan (check each that applies):
Select applicable level of care
Hospital as defined in 42 CFR §440.10
If applicable, specify whether the State additionally limits the waiver to subcategories of the hospital level of care:
Character Count: out of 6000
Inpatient psychiatric facility for individuals age 21 and under as provided in42 CFR §440.160
Nursing Facility As defined in 42 CFR §440.40 and 42 CFR §440.155
If applicable, specify whether the State additionally limits the waiver to subcategories of the nursing facility level of care:
Institution for Mental Disease for persons with mental illnesses aged 65 and older as provided in 42 CFR §440.140
Intermediate Care Facility for the Mentally Retarded (ICF/MR) (as defined in 42 CFR §440.150)
If applicable, specify whether the State additionally limits the waiver to subcategories of the ICF/MR level of care:
1. Request Information (3 of 3)
Concurrent Operation with Other Programs. This waiver operates concurrently with another program (or programs) approved under the following authorities
Check the applicable authority or authorities:
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)
§1915(b)(3) (employ cost savings to furnish additional services)
§1915(b)(4) (selective contracting/limit number of providers)
A program operated under §1932(a) of the Act.
Specify the nature of the State Plan benefit and indicate whether the State Plan Amendment has been submitted or previously approved:
A program authorized under §1915(i) of the Act.
A program authorized under §1915(j) of the Act.
A program authorized under §1115 of the Act.
Specify the program:
2. Brief Waiver Description
Brief Waiver Description. In one page or less, briefly describe the purpose of the waiver, including its goals, objectives, organizational structure (e.g., the roles of state, local and other entities), and service delivery methods.
The Comprehensive Support Waiver provides the necessary services to support individuals who reside in licensed settings, or who reside in a personal home and require a comprehensive array of services. This waiver will operate in tandem with the IFS waiver (0426IP). This waiver provides for a broader array of supports so that individuals with more comprehensive needs, particularly in the areas of behavior or medical, can also choose a personalized package of supports necessary to remain in their own or their family home. This waiver includes traditional service-delivery and participant-directed options including employer of record and agency with choice models. The Department of Social Services (DSS) is the Single State Medicaid Agency responsible for oversight of the DDS waivers. The Department of Developmental Services is the operating authority through an executed Memorandum of Understanding between the two state departments. Both departments are cabinet level agencies. DDS operates the waiver as a state operated system with state employees delivering targeted case management services, and operational functions carried out either through a central office or through one of three state regional offices. Services are delivered through an array of private service vendors through contracts or through a fee for service system, by DDS directly, and through the use of consumer-direction with waiver participants serving as the employer of record, or through the selection of an Agency with Choice model. DDS utilizes Fiscal Intermediary organizations to support participants who choose consumer-direction and offers support brokers as part of expanded DDS case management services or through the waiver.
3. Components of the Waiver Request
The waiver application consists of the following components. Note: Item 3-E must be completed.
Waiver Administration and Operation. Appendix A specifies the administrative and operational structure of this waiver.
Participant Access and Eligibility. Appendix B specifies the target group(s) of individuals who are served in this waiver, the number of participants that the State expects to serve during each year that the waiver is in effect, applicable Medicaid eligibility and post-eligibility (if applicable) requirements, and procedures for the evaluation and reevaluation of level of care.
Participant Services. Appendix C specifies the home and community-based waiver services that are furnished through the waiver, including applicable limitations on such services.
Participant-Centered Service Planning and Delivery. Appendix D specifies the procedures and methods that the State uses to develop, implement and monitor the participant-centered service plan (of care).
Participant-Direction of Services. When the State provides for participant direction of services, Appendix E specifies the participant direction opportunities that are offered in the waiver and the supports that are available to participants who direct their services. (Select one):
Yes. This waiver provides participant direction opportunities. Appendix E is required.
No. This waiver does not provide participant direction opportunities. Appendix E is not required.
Participant Rights. Appendix F specifies how the State informs participants of their Medicaid Fair Hearing rights and other procedures to address participant grievances and complaints.
Participant Safeguards. Appendix G describes the safeguards that the State has established to assure the health and welfare of waiver participants in specified areas.
Quality Improvement Strategy. Appendix H contains the Quality Improvement Strategy for this waiver.
Financial Accountability. Appendix I describes the methods by which the State makes payments for waiver services, ensures the integrity of these payments, and complies with applicable federal requirements concerning payments and federal financial participation.
Cost-Neutrality Demonstration. Appendix J contains the State's demonstration that the waiver is cost-neutral.
4. Waiver(s) Requested
Comparability. The State requests a waiver of the requirements contained in §1902(a)(10)(B) of the Act in order to provide the services specified in Appendix C that are not otherwise available under the approved Medicaid State plan to individuals who: (a) require the level(s) of care specified in Item 1.F and (b) meet the target group criteria specified in Appendix B.
Income and Resources for the Medically Needy. Indicate whether the State requests a waiver of §1902(a)(10)(C)(i)(III) of the Act in order to use institutional income and resource rules for the medically needy (select one):
Statewideness. Indicate whether the State requests a waiver of the statewideness requirements in §1902(a)(1) of the Act (select one):
If yes, specify the waiver of statewideness that is requested (check each that applies):
Geographic Limitation. A waiver of statewideness is requested in order to furnish services under this waiver only to individuals who reside in the following geographic areas or political subdivisions of the State.
Specify the areas to which this waiver applies and, as applicable, the phase-in schedule of the waiver by geographic area:
Limited Implementation of Participant-Direction. A waiver of statewideness is requested in order to make participant-direction of services as specified in Appendix E available only to individuals who reside in the following geographic areas or political subdivisions of the State. Participants who reside in these areas may elect to direct their services as provided by the State or receive comparable services through the service delivery methods that are in effect elsewhere in the State.
Specify the areas of the State affected by this waiver and, as applicable, the phase-in schedule of the waiver by geographic area:
In accordance with 42 CFR §441.302, the State provides the following assurances to CMS:
Health & Welfare: The State assures that necessary safeguards have been taken to protect the health and welfare of persons receiving services under this waiver. These safeguards include:
As specified in Appendix C, adequate standards for all types of providers that provide services under this waiver;
Assurance that the standards of any State licensure or certification requirements specified in Appendix C are met for services or for individuals furnishing services that are provided under the waiver. The State assures that these requirements are met on the date that the services are furnished; and,
Assurance that all facilities subject to §1616(e) of the Act where home and community-based waiver services are provided comply with the applicable State standards for board and care facilities as specified in Appendix C.
Financial Accountability. The State assures financial accountability for funds expended for home and community-based services and maintains and makes available to the Department of Health and Human Services (including the Office of the Inspector General), the Comptroller General, or other designees, appropriate financial records documenting the cost of services provided under the waiver. Methods of financial accountability are specified in Appendix I.
Evaluation of Need: The State assures that it provides for an initial evaluation (and periodic reevaluations, at least annually) of the need for a level of care specified for this waiver, when there is a reasonable indication that an individual might need such services in the near future (one month or less) but for the receipt of home and community based services under this waiver. The procedures for evaluation and reevaluation of level of care are specified in Appendix B.
Choice of Alternatives: The State assures that when an individual is determined to be likely to require the level of care specified for this waiver and is in a target group specified in Appendix B, the individual (or, legal representative, if applicable) is:
Informed of any feasible alternatives under the waiver; and,
Given the choice of either institutional or home and community based waiver services. Appendix B specifies the procedures that the State employs to ensure that individuals are informed of feasible alternatives under the waiver and given the choice of institutional or home and community-based waiver services.
Average Per Capita Expenditures: The State assures that, for any year that the waiver is in effect, the average per capita expenditures under the waiver will not exceed 100 percent of the average per capita expenditures that would have been made under the Medicaid State plan for the level(s) of care specified for this waiver had the waiver not been granted. Cost-neutrality is demonstrated in Appendix J.
Actual Total Expenditures: The State assures that the actual total expenditures for home and community-based waiver and other Medicaid services and its claim for FFP in expenditures for the services provided to individuals under the waiver will not, in any year of the waiver period, exceed 100 percent of the amount that would be incurred in the absence of the waiver by the State's Medicaid program for these individuals in the institutional setting(s) specified for this waiver.
Institutionalization Absent Waiver: The State assures that, absent the waiver, individuals served in the waiver would receive the appropriate type of Medicaid-funded institutional care for the level of care specified for this waiver.
Reporting: The State assures that annually it will provide CMS with information concerning the impact of the waiver on the type, amount and cost of services provided under the Medicaid State plan and on the health and welfare of waiver participants. This information will be consistent with a data collection plan designed by CMS.
Habilitation Services. The State assures that prevocational, educational, or supported employment services, or a combination of these services, if provided as habilitation services under the waiver are: (1) not otherwise available to the individual through a local educational agency under the Individuals with Disabilities Education Act (IDEA) or the Rehabilitation Act of 1973; and, (2) furnished as part of expanded habilitation services.
Services for Individuals with Chronic Mental Illness. The State assures that federal financial participation (FFP) will not be claimed in expenditures for waiver services including, but not limited to, day treatment or partial hospitalization, psychosocial rehabilitation services, and clinic services provided as home and community-based services to individuals with chronic mental illnesses if these individuals, in the absence of a waiver, would be placed in an IMD and are: (1) age 22 to 64; (2) age 65 and older and the State has not included the optional Medicaid benefit cited in 42 CFR §440.140; or (3) age 21 and under and the State has not included the optional Medicaid benefit cited in 42 CFR § 440.160.
Note: Item 6-I must be completed.
Service Plan. In accordance with 42 CFR §441.301(b)(1)(i), a participant-centered service plan (of care) is developed for each participant employing the procedures specified in Appendix D. All waiver services are furnished pursuant to the service plan. The service plan describes: (a) the waiver services that are furnished to the participant, their projected frequency and the type of provider that furnishes each service and (b) the other services (regardless of funding source, including State plan services) and informal supports that complement waiver services in meeting the needs of the participant. The service plan is subject to the approval of the Medicaid agency. Federal financial participation (FFP) is not claimed for waiver services furnished prior to the development of the service plan or for services that are not included in the service plan.
Inpatients. In accordance with 42 CFR §441.301(b)(1) (ii), waiver services are not furnished to individuals who are in-patients of a hospital, nursing facility or ICF/MR.
Room and Board. In accordance with 42 CFR §441.310(a)(2), FFP is not claimed for the cost of room and board except when: (a) provided as part of respite services in a facility approved by the State that is not a private residence or (b) claimed as a portion of the rent and food that may be reasonably attributed to an unrelated caregiver who resides in the same household as the participant, as provided in Appendix I.
Access to Services. The State does not limit or restrict participant access to waiver services except as provided in Appendix C.
Free Choice of Provider. In accordance with 42 CFR §431.151, a participant may select any willing and qualified provider to furnish waiver services included in the service plan unless the State has received approval to limit the number of providers under the provisions of §1915(b) or another provision of the Act.
FFP Limitation. In accordance with 42 CFR §433 Subpart D, FFP is not claimed for services when another third-party (e.g., another third party health insurer or other federal or state program) is legally liable and responsible for the provision and payment of the service. FFP also may not be claimed for services that are available without charge, or as free care to the community. Services will not be considered to be without charge, or free care, when (1) the provider establishes a fee schedule for each service available and (2) collects insurance information from all those served (Medicaid, and non-Medicaid), and bills other legally liable third party insurers. Alternatively, if a provider certifies that a particular legally liable third party insurer does not pay for the service(s), the provider may not generate further bills for that insurer for that annual period.
Fair Hearing: The State provides the opportunity to request a Fair Hearing under 42 CFR §431 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.
Quality Improvement. The State operates a formal, comprehensive system to ensure that the waiver meets the assurances and other requirements contained in this application. Through an ongoing process of discovery, remediation and improvement, the State assures the health and welfare of participants by monitoring: (a) level of care determinations; (b) individual plans and services delivery; (c) provider qualifications; (d) participant health and welfare; (e) financial oversight and (f) administrative oversight of the waiver. The State further assures that all problems identified through its discovery processes are addressed in an appropriate and timely manner, consistent with the severity and nature of the problem. During the period that the waiver is in effect, the State will implement the Quality Improvement Strategy specified in Appendix H.
Public Input. Describe how the State secures public input into the development of the waiver:
DDS convenes the following routine meetings where public input is provided on a routine and targeted basis: Family Forums in each of the three Regions on a quarterly basis; Provider Leadership Forums in each of the three Regions on a quarterly basis; and Provider Trades Association meetings with the Commissioner on a bi-monthly basis. Additional public input is gained through targeted information and discussion tables at meetings and events held throughout the state such as self-advocacy supported employment events, provider conferences and cultural events, through publication and solicitation of input requests through the stakeholder mailing Direct to Families; through posting on the DDS web site; through publication in the CT Law Journal; and through a legislative public hearing.
Notice to Tribal Governments. The State assures that it has notified in writing all federally-recognized Tribal Governments that maintain a primary office and/or majority population within the State of the State's intent to submit a Medicaid waiver request or renewal request to CMS at least 60 days before the anticipated submission date is provided by Presidential Executive Order 13175 of November 6, 2000. Evidence of the applicable notice is available through the Medicaid Agency.
Limited English Proficient Persons. The State assures that it provides meaningful access to waiver services by Limited English Proficient persons in accordance with: (a) Presidential Executive Order 13166 of August 11, 2000 (65 FR 50121) and (b) Department of Health and Human Services "Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons" (68 FR 47311 - August 8, 2003). Appendix B describes how the State assures meaningful access to waiver services by Limited English Proficient persons.
7. Contact Person(s)
The Medicaid agency representative with whom CMS should communicate regarding the waiver is:
Ext: TTY
If applicable, the State operating agency representative with whom CMS should communicate regarding the waiver is:
8. Authorizing Signature
This document, together with Appendices A through J, constitutes the State's request for a waiver under §1915(c) of the Social Security Act. The State assures that all materials referenced in this waiver application (including standards, licensure and certification requirements) are readily available in print or electronic form upon request to CMS through the Medicaid agency or, if applicable, from the operating agency specified in Appendix A. Any proposed changes to the waiver will be submitted by the Medicaid agency to CMS in the form of waiver amendments.
Upon approval by CMS, the waiver application serves as the State's authority to provide home and community-based waiver services to the specified target groups. The State attests that it will abide by all provisions of the approved waiver and will continuously operate the waiver in accordance with the assurances specified in Section 5 and the additional requirements specified in Section 6 of the request.
State Medicaid Director or Designee
Attachment #1: Transition Plan
Specify the transition plan for the waiver:
The Department of Mental Retardation was officially changed to the Department of Developmental Services on October 1, 2007. References to official documents such as regulations, policies, procedures, or web links contained in this waiver may still be listed as DMR rather than DDS. The only immediate change in this application that impacts a current participant is the change in the name of and the provider qualifications for Supported Living and IS Habilitation. These services have now been combined into a service named Individualized Home Supports. The transition will require changes in the MMIS system and new service authorizations for the participant’s chosen vendors. DDS will notify service vendors and participants of this change within 30 days of the waiver renewal date and provide new service authorizations. There will be no change in the amount of support that current waiver participants will receive as a result of this change. In addition, the service called Consultation in the existing waiver has been eliminated in this amendment. The supports that were offered under Consultation have been separated into Nutrition and Clinical Behavioral Supports The renewal application contains some new services as well. The new services are Adult Day Health, Live-in Caregiver, and Health Care Coordination. Participants will receive a fact sheet describing the new services at the time of his/her next Individual Planning meeting and may choose to change or add services at that time. Information regarding the new service options will be available through the DDS case manager, Regional Offices and on the DDS web site. A participant may notify DDS that he/she wishes to change service selections prior to the next scheduled meeting if desired. In those cases, DDS will schedule a team meeting within 30 days to review the new service options and develop a new Individual Plan if desired. The renewal application also contains new funding methodologies for individual service budgets. Current authorized service budgets for participants will remain unchanged by the changes to the funding methodology through this renewal application. Requests for new or additional services by current participants received after the renewal date of this waiver will be subject to the requirements outlined in this application.
Additional Needed Information (Optional)
Provide additional needed information for the waiver (optional):
Character Count: out of 60000
AppendixA: Waiver
Appendix A: Waiver Administration and Operation
State Line of Authority for Waiver Operation. Specify the state line of authority for the operation of the waiver (select one):
The waiver is operated by the State Medicaid agency.
Specify the Medicaid agency division/unit that has line authority for the operation of the waiver program (select one):
The Medical Assistance Unit.
Specify the unit name:
(Do not complete item A-2)
Another division/unit within the State Medicaid agency that is separate from the Medical Assistance Unit.
Specify the division/unit name. This includes administrations/divisions under the umbrella agency that has been identified as the Single State Medicaid Agency.
(Complete item A-2-a).
The waiver is operated by a separate agency of the State that is not a division/unit of the Medicaid agency.
Specify the division/unit name:
In accordance with 42 CFR §431.10, the Medicaid agency exercises administrative discretion in the administration and supervision of the waiver and issues policies, rules and regulations related to the waiver. The interagency agreement or memorandum of understanding that sets forth the authority and arrangements for this policy is available through the Medicaid agency to CMS upon request. (Complete item A-2-b).
Oversight of Performance.
Medicaid Director Oversight of Performance When the Waiver is Operated by another Division/Unit within the State Medicaid Agency. When the waiver is operated by another division/administration within the umbrella agency designated as the Single State Medicaid Agency. Specify (a) the functions performed by that division/administration (i.e., the Developmental Disabilities Administration within the Single State Medicaid Agency), (b) the document utilized to outline the roles and responsibilities related to waiver operation, and (c) the methods that are employed by the designated State Medicaid Director (in some instances, the head of umbrella agency) in the oversight of these activities:
As indicated in section 1 of this appendix, the waiver is not operated by another division/unit within the State Medicaid agency. Thus this section does not need to be completed.
Medicaid Agency Oversight of Operating Agency Performance. When the waiver is not operated by the Medicaid agency, specify the functions that are expressly delegated through a memorandum of understanding (MOU) or other written document, and indicate the frequency of review and update for that document. Specify the methods that the Medicaid agency uses to ensure that the operating agency performs its assigned waiver operational and administrative functions in accordance with waiver requirements. Also specify the frequency of Medicaid agency assessment of operating agency performance:
The Department of Social Services (DSS) and Department of Developmental Services (DDS) utilize a Memorandum of Understanding to identify assigned waiver operational and administrative functions in accordance with waiver requirements. DSS is the single state Medicaid agency responsible for the overall administration of the HCBS Waiver and assuring that federal reporting and procedural requirements are satisfied. In carrying out these responsibilities, DSS performs the following functions: 1.	Coordinates communication with federal officials concerning the waiver; Specifies and approves policies and procedures and consults with DDS in the implementation of such policies and procedures, that are necessary and appropriate for the administration and operation of the waiver in accordance with federal regulations and guidance; 2.	Monitors waiver operations for compliance with federal regulations including, but notlimited to, the areas of waiver eligibility determinations, service quality systems, plans of care, qualification of providers, and fiscal controls and accountability; 3.	Determines Medicaid eligibility for potential waiver recipients/enrollee; 4.	Establishes, in consultation and cooperation with DDS, the rates of reimbursement for services provided under the waiver; 5.	Assists with the billing process for waiver services, completes billing process and claims for FFP for such services; 6.	Prepares and submits, with assistance from DDS, all reports required by CMS or other federal agencies regarding the waiver; and, 7.	Administers the hearing process through which an individual may request a reconsideration of any decisions that affect eligibility or the denial of waiver services as provided under federal law.As the operating agency, DDS is responsible for the following components of the program: 1.	Conducts initial assessments and required re-assessments of potential waiver enrollees/recipients using uniform assessment instrument(s), documentation and procedure to establish whether an individual meets all eligibility criteria including that set forth as part of the evaluation and criteria in 42 CFR Sec. 441.302; 2.	Documents individual plans of care for waiver recipients in format(s) approved by DSS, which set forth: (1) individual service needs, (2) waiver services necessary to meet such needs, (3) the authorized service provider(s), and (4) the amount of waiver services authorized for the individual; 3.	Establishes and maintains quality assurance and improvement systems designed to assure the ongoing recruitment of qualified providers of waiver services and documents adherence to all applicable state and federal laws and regulations pertaining to health and welfare consistent with the assurance made in the approved waiver application(s); 4.	Develops and amends as necessary, training materials, activities, and initiatives sufficient to provide relevant DMR staff, waiver recipients, and potential waiver recipients, information and instruction related to participation in the waiver program; 5.	Maintains and enhances, as necessary, a billing system which: a.)Identifies the source documents that providers use to verify service delivery in accordance with individual plans of care; b.)Assures that the data elements required by CMS for Federal Financial Participation (FFP) are collected and maintained at the time of service delivery; c.)Provides computerized billing system(s) with audit capacity to identify problems and permit timely resolution; and d.)Issues complete and accurate billing information and data to DSS in accordance with the schedules mutually established by the departments; 6.	Maintains service delivery records in sufficient detail to assure that waiver services provided were authorized by individual plans of care and delivered by qualified providers in accordance with the waiver(s); 7.	Provides ongoing support and performs periodic audit and assessment of providers of waiver services; 8.	Establishes and maintains a person-centered component to the evaluation and improvement activities associated with waiver services; 9.	Establishes, maintains and documents the delivery of “case management” and “broker” services as indicated in the individual plan of care; 10.	Establishes and maintains a system that provides for continuous monitoring of the provision of waiver services to assure compliance with applicable health and welfare standards and evaluates individual outcomes and satisfaction; 11. Approves the waiver services and settings in which such services are provided; 12. Provides payment for such services from the annual budget allocation to DDS; 13. Assists DSS in establishing and maintaining rates of reimbursement for waiver services; 14. Assists DSS in the preparation of all waiver-related reports and communications with CMS; and, 15. Consults with DSS regarding all waiver-related activities and initiatives including, but not limited to, waiver applications and waiver amendments.DSS receives quarterly reports from DDS as outlined in Appendix H (Quality Management) and meets with DDS on a quarterly basis to review key operating agency activities. DSS meets with DDS on an as needed basis to review individual or systemic issues as they arise. DSS prepares the annual 372 reports.
Use of Contracted Entities. Specify whether contracted entities perform waiver operational and administrative functions on behalf of the Medicaid agency and/or the operating agency (if applicable) (select one):
Yes. Contracted entities perform waiver operational and administrative functions on behalf of the Medicaid agency and/or operating agency (if applicable).
Specify the types of contracted entities and briefly describe the functions that they perform. Complete Items A-5 and A-6.:
MMIS system operated through a contract between DSS and EDS. DDS contracts with Fiscal Intermediaries to support individuals who serve as the employer of record, and to process invoices and makes payment for services for DDS.
No. Contracted entities do not perform waiver operational and administrative functions on behalf of the Medicaid agency and/or the operating agency (if applicable).
Role of Local/Regional Non-State Entities. Indicate whether local or regional non-state entities perform waiver operational and administrative functions and, if so, specify the type of entity (Select One):
Applicable - Local/regional non-state agencies perform waiver operational and administrative functions.
Check each that applies:
Local/Regional non-state public agencies perform waiver operational and administrative functions at the local or regional level. There is an interagency agreement or memorandum of understanding between the State and these agencies that sets forth responsibilities and performance requirements for these agencies that is available through the Medicaid agency.
Specify the nature of these agencies and complete items A-5 and A-6:
Local/Regional non-governmental non-state entities conduct waiver operational and administrative functions at the local or regional level. There is a contract between the Medicaid agency and/or the operating agency (when authorized by the Medicaid agency) and each local/regional non-state entity that sets forth the responsibilities and performance requirements of the local/regional entity. The contract(s) under which private entities conduct waiver operational functions are available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
Specify the nature of these entities and complete items A-5 and A-6:
Not applicable - Local/regional non-state agencies do not perform waiver operational and administrative functions.
Responsibility for Assessment of Performance of Contracted and/or Local/Regional Non-State Entities. Specify the state agency or agencies responsible for assessing the performance of contracted and/or local/regional non-state entities in conducting waiver operational and administrative functions:
Assessment Methods and Frequency. Describe the methods that are used to assess the performance of contracted and/or local/regional non-state entities to ensure that they perform assigned waiver operational and administrative functions in accordance with waiver requirements. Also specify how frequently the performance of contracted and/or local/regional non-state entities is assessed:
1. The DDS fiscal intermediaries (V/FEA) are monitored by DDS per the terms of the contract. This includes quarterly meeting with DDS, maintenance of a complaint log by DDS, an audit of the organization as a whole by a licensed independent certified public account and submitted to the Department annually, with agreed upon procedures for the management of the DDS funds under the control of the V/FEA. 2. V/FEA is subject to audit by the Department, agents of the Department, and the State of Connecticut's Auditors of Public Accounts. Records must be made available in CT for the audit. 3. A copy of the most recent financial statement, with an opinion letter from a CPA with a CT license or by a CPA in the state the vendor performs it business in, is required as a part to the RFP proposal. 4. V/FEA must submit a cost report as requested for rate analysis.
Distribution of Waiver Operational and Administrative Functions. In the following table, specify the entity or entities that have responsibility for conducting each of the waiver operational and administrative functions listed (check each that applies):
In accordance with 42 CFR §431.10, when the Medicaid agency does not directly conduct a function, it supervises the performance of the function and establishes and/or approves policies that affect the function. All functions not performed directly by the Medicaid agency must be delegated in writing and monitored by the Medicaid Agency. Note: More than one box may be checked per item. Ensure that Medicaid is checked when the Single State Medicaid Agency (1) conducts the function directly; (2) supervises the delegated function; and/or (3) establishes and/or approves policies related to the function.
Other State Operating Agency
Participant waiver enrollment
Waiver enrollment managed against approved limits
Waiver expenditures managed against approved levels
Review of Participant service plans
Prior authorization of waiver services
Qualified provider enrollment
Execution of Medicaid provider agreements
Establishment of a statewide rate methodology
Rules, policies, procedures and information development governing the waiver program
Quality Improvement: Administrative Authority of the Single State Medicaid Agency
As a distinct component of the State’s quality improvement strategy, provide information in the following fields to detail the State’s methods for discovery and remediation.
Methods for Discovery: Administrative Authority
The Medicaid Agency retains ultimate administrative authority and responsibility for the operation of the waiver program by exercising oversight of the performance of waiver functions by other state and local/regional non-state agencies (if appropriate) and contracted entities.
For each performance measure/indicator the State will use to assess compliance with the statutory assurance complete the following. Where possible, include numerator/denominator. Each performance measure must be specific to this waiver (i.e., data presented must be waiver specific).
For each performance measure, provide information on the aggregated data that will enable the State to analyze and assess progress toward the performance measure. In this section provide information on the method by which each source of data is analyzed statistically/deductively or inductively, how themes are identified or conclusions drawn, and how recommendations are formulated, where appropriate.
DSS meets with DDS to evaluate DDS summary reports completed by the DDS Medicaid Operations Unit and Waiver Policy Unit for performance reports related to service planning and delivery, provider qualifications, safeguards, fiscal integrity and consumer satisfaction and monitor compliance with the Interagency Agreement.
Data Source (Select one):
Trends, remediation actions proposed / taken
If 'Other' is selected, specify:
Responsible Party for data collection/generation(check each that applies): Frequency of data collection/generation(check each that applies): Sampling Approach(check each that applies):
Less than 100% Review
Sub-State Entity
Describe Group:
Continuously and Ongoing
issue specific data
Responsible Party for data aggregation and analysis (check each that applies):
Frequency of data aggregation and analysis (check each that applies):
DSS conducts the Fair Hearing process and provides instruction to DDS on the implementation of utilization review criteria.
DSS conducts random record reviews per year to evaluate Level of Care and Plan of Care requirements.
Record reviews, off-site
random reviews of 10-20 records per quarter
If applicable, in the textbox below provide any necessary additional information on the strategies employed by the State to discover/identify problems/issues within the waiver program, including frequency and parties responsible.
Methods for Remediation/Fixing Individual Problems
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.
Individual participant issues requiring remediation will be referred back to the person responsible and will be corrected on an ongoing basis. Systemic issues needing remediation will be identified and discussed at the quarterly meetings with DDS and DSS staff. A plan for remediation and person(s) responsible will be developed for each item identified. Remediation strategies and progress towards correction will be reviewed and documented at the next quarterly meeting.
Remediation Data Aggregation
Remediation-related Data Aggregation and Analysis (including trend identification)
Responsible Party (check each that applies):
When the State does not have all elements of the Quality Improvement Strategy in place, provide timelines to design methods for discovery and remediation related to the assurance of Financial Accountability that are currently non-operational.
Please provide a detailed strategy for assuring Administrative Authority, the specific timeline for implementing identified strategies, and the parties responsible for its operation.
Appendix B: Waiver
Appendix B: Participant Access and Eligibility
B-1: Specification of the Waiver Target Group(s)
Target Group(s). Under the waiver of Section 1902(a)(10)(B) of the Act, the State limits waiver services to a group or subgroups of individuals. Please see the instruction manual for specifics regarding age limits. In accordance with 42 CFR §441.301(b)(6), select one waiver target group, check each of the subgroups in the selected target group that may receive services under the waiver, and specify the minimum and maximum (if any) age of individuals served in each subgroup:
Target SubGroup
Aged or Disabled, or Both - General
Disabled (Other)
Aged or Disabled, or Both - Specific Recognized Subgroups
Mental Retardation or Developmental Disability, or Both
Additional Criteria. The State further specifies its target group(s) as follows:
Mental Retardation as defined by Con Gen Stat Sec 17a-210. Also included are those determined eligible for DDS services as a result of a hearing conducted by DDS according to the Uniform Administrative Procedures Act or administrative determination of the Commissioner. Developmental Disability as a target group is limited to individuals who are developmentally disabled who currently reside in general NFs, but who have been shown, as a result of the Pre-Admission Screening and Annual Resident Review process mandated by P.L. 100-203 to require active treatment at the level of an ICF/MR. Additional Criteria to designate the target group is that the person lives in or will live in a residence licensed or certified by the Department of Developmental Services, or lives in his/her own or family home and requires a level of support not available under the DDS IFS Waiver 0426(IP) due to intensive medical, physical, and/or behavioral conditions, and/or insufficient availability of natural supports, as determined by a DDS Level of Need assessment.
Transition of Individuals Affected by Maximum Age Limitation. When there is a maximum age limit that applies to individuals who may be served in the waiver, describe the transition planning procedures that are undertaken on behalf of participants affected by the age limit (select one):
Not applicable. There is no maximum age limit
The following transition planning procedures are employed for participants who will reach the waiver's maximum age limit.
B-2: Individual Cost Limit (1 of 2)
Individual Cost Limit. The following individual cost limit applies when determining whether to deny home and community-based services or entrance to the waiver to an otherwise eligible individual (select one) Please note that a State may have only ONE individual cost limit for the purposes of determining eligibility for the waiver:
No Cost Limit. The State does not apply an individual cost limit. Do not complete Item B-2-b or item B-2-c.
Cost Limit in Excess of Institutional Costs. The State refuses entrance to the waiver to any otherwise eligible individual when the State reasonably expects that the cost of the home and community-based services furnished to that individual would exceed the cost of a level of care specified for the waiver up to an amount specified by the State. Complete Items B-2-b and B-2-c.
The limit specified by the State is (select one)
A level higher than 100% of the institutional average.
Specify the percentage:
Institutional Cost Limit. Pursuant to 42 CFR 441.301(a)(3), the State refuses entrance to the waiver to any otherwise eligible individual when the State reasonably expects that the cost of the home and community-based services furnished to that individual would exceed 100% of the cost of the level of care specified for the waiver. Complete Items B-2-b and B-2-c.
Cost Limit Lower Than Institutional Costs. The State refuses entrance to the waiver to any otherwise qualified individual when the State reasonably expects that the cost of home and community-based services furnished to that individual would exceed the following amount specified by the State that is less than the cost of a level of care specified for the waiver.
Specify the basis of the limit, including evidence that the limit is sufficient to assure the health and welfare of waiver participants. Complete Items B-2-b and B-2-c.
The cost limit specified by the State is (select one):
The following dollar amount:
Specify dollar amount:
The dollar amount (select one)
Is adjusted each year that the waiver is in effect by applying the following formula:
Specify the formula:
May be adjusted during the period the waiver is in effect. The State will submit a waiver amendment to CMS to adjust the dollar amount.
The following percentage that is less than 100% of the institutional average:
Specify percent:
B-2: Individual Cost Limit (2 of 2)
Method of Implementation of the Individual Cost Limit. When an individual cost limit is specified in Item B-2-a, specify the procedures that are followed to determine in advance of waiver entrance that the individual's health and welfare can be assured within the cost limit:
The team submits a request for services to the Regional Planning and Allocation Team. Based on the findings of the LON Assessment, the PRAT notifies the team of the funding allocations. The team initiates the Individual Planning process in advance of enrollment in a DDS waiver. If the team determines that the initial allocation is insufficient to meet the individual’s needs, the team submits a request for utilization review to the PRAT for consideration. The PRAT determines if a higher funding amount is justified. If approved, the participant will complete enrollment in the Comprehensive waiver and the Individual Plan is processed for service authorizations to initiate services. If the PRAT does not approve the higher funding request, the individual is provided opportunity to informally negotiate a resolution and is simultaneously notified of his/her fair hearing rights as a result of being denied enrollment in the DDS Comprehensive waiver.
Participant Safeguards. When the State specifies an individual cost limit in Item B-2-a and there is a change in the participant's condition or circumstances post-entrance to the waiver that requires the provision of services in an amount that exceeds the cost limit in order to assure the participant's health and welfare, the State has established the following safeguards to avoid an adverse impact on the participant (check each that applies):
The participant is referred to another waiver that can accommodate the individual's needs.
Additional services in excess of the individual cost limit may be authorized.
Specify the procedures for authorizing additional services, including the amount that may be authorized:
The case manager submits to the PRAT a request for additional services/funding and an updated Level of Need Assessment supporting the request. The PRAT may authorize funding up to the amount associated with the participant’s newly determined Level of Need.
Other safeguard(s)
B-3: Number of Individuals Served (1 of 4)
Unduplicated Number of Participants. The following table specifies the maximum number of unduplicated participants who are served in each year that the waiver is in effect. The State will submit a waiver amendment to CMS to modify the number of participants specified for any year(s), including when a modification is necessary due to legislative appropriation or another reason. The number of unduplicated participants specified in this table is basis for the cost-neutrality calculations in Appendix J:
Table: B-3-a
Waiver Year Unduplicated Number of Participants
Year 4 (renewal only)
Year 5 (renewal only)
Limitation on the Number of Participants Served at Any Point in Time. Consistent with the unduplicated number of participants specified in Item B-3-a, the State may limit to a lesser number the number of participants who will be served at any point in time during a waiver year. Indicate whether the State limits the number of participants in this way: (select one):
The State does not limit the number of participants that it serves at any point in time during a waiver year.
The State limits the number of participants that it serves at any point in time during a waiver year.
The limit that applies to each year of the waiver period is specified in the following table:
Table: B-3-b
Waiver Year Maximum Number of Participants Served At Any Point During the Year
B-3: Number of Individuals Served (2 of 4)
Reserved Waiver Capacity. The State may reserve a portion of the participant capacity of the waiver for specified purposes (e.g., provide for the community transition of institutionalized persons or furnish waiver services to individuals experiencing a crisis) subject to CMS review and approval. The State (select one):
Not applicable. The state does not reserve capacity.
The State reserves capacity for the following purpose(s).
B-3: Number of Individuals Served (3 of 4)
Scheduled Phase-In or Phase-Out. Within a waiver year, the State may make the number of participants who are served subject to a phase-in or phase-out schedule (select one):
The waiver is not subject to a phase-in or a phase-out schedule.
The waiver is subject to a phase-in or phase-out schedule that is included in Attachment #1 to Appendix B-3. This schedule constitutes an intra-year limitation on the number of participants who are served in the waiver.
Allocation of Waiver Capacity.
Waiver capacity is allocated/managed on a statewide basis.
Waiver capacity is allocated to local/regional non-state entities.
Specify: (a) the entities to which waiver capacity is allocated; (b) the methodology that is used to allocate capacity and how often the methodology is reevaluated; and, (c) policies for the reallocation of unused capacity among local/regional non-state entities:
Selection of Entrants to the Waiver. Specify the policies that apply to the selection of individuals for entrance to the waiver:
The State DDS uses a priority system to select individuals for entrance to the DDS waivers. The DDS utilizes a Priority Checklist that incorporates findings from the Level of Needs Assessment and Risk Screening Tool and collects findings on additional questions pertaining to individual and caregiver status. The system assigns the individual to one of three categories, either an Emergency, a Priority 1 or a Planning status as a result of the screening tools. Those identified as an Emergency require services immediately and are given first priority to the appropriate waiver program when slots are available. The Priority 1 group are those individuals identified as needing services within one year. Those with elderly caregivers (age 65 and above) are given priority within the Priority 1 sub-set. Other than individuals with emergency status and those with elderly caregivers, applicants with a Priority 1 status are managed on a first come, first served basis. Individuals who are dissatisfied with their priority assignment (E, P1, or Planning) may request in writing to the Commissioner of DDS a Fair Hearing pursuant to sub-section (e), section 17a-210, C.G.S., and/or, may initiate an informal dispute resolution process, Programmatic Administrative Review (PAR) set forth in DMR Policy 7 (1986). Individuals who request a PAR may also request a Fair Hearing at any time.
B-3: Number of Individuals Served - Attachment #1 (4 of 4)
Answers provided in Appendix B-3-d indicate that you do not need to complete this section.
B-4: Eligibility Groups Served in the Waiver
State Classification. The State is a (select one):
§1634 State
SSI Criteria State
209(b) State
Miller Trust State.
Indicate whether the State is a Miller Trust State (select one):
Medicaid Eligibility Groups Served in the Waiver. Individuals who receive services under this waiver are eligible under the following eligibility groups contained in the State plan. The State applies all applicable federal financial participation limits under the plan. Check all that apply:
Eligibility Groups Served in the Waiver (excluding the special home and community-based waiver group under 42 CFR §435.217)
Low income families with children as provided in §1931 of the Act
Aged, blind or disabled in 209(b) states who are eligible under 42 CFR §435.121
Optional State supplement recipients
Optional categorically needy aged and/or disabled individuals who have income at:
100% of the Federal poverty level (FPL)
% of FPL, which is lower than 100% of FPL.
Specify percentage:
Working individuals with disabilities who buy into Medicaid (BBA working disabled group as provided in §1902(a)(10)(A)(ii)(XIII)) of the Act)
Working individuals with disabilities who buy into Medicaid (TWWIIA Basic Coverage Group as provided in §1902(a)(10)(A)(ii)(XV) of the Act)
Working individuals with disabilities who buy into Medicaid (TWWIIA Medical Improvement Coverage Group as provided in §1902(a)(10)(A)(ii)(XVI) of the Act)
Disabled individuals age 18 or younger who would require an institutional level of care (TEFRA 134 eligibility group as provided in §1902(e)(3) of the Act)
Medically needy in 209(b) States (42 CFR §435.330)
Medically needy in 1634 States and SSI Criteria States (42 CFR §435.320, §435.322 and §435.324)
Other specified groups (include only statutory/regulatory reference to reflect the additional groups in the State plan that may receive services under this waiver)
Persons defined as qualified severely impaired individuals in section 1619(b) and 1905(q) of the Social Security Act.
Special home and community-based waiver group under 42 CFR §435.217) Note: When the special home and community-based waiver group under 42 CFR §435.217 is included, Appendix B-5 must be completed
No. The State does not furnish waiver services to individuals in the special home and community-based waiver group under 42 CFR §435.217. Appendix B-5 is not submitted.
Yes. The State furnishes waiver services to individuals in the special home and community-based waiver group under 42 CFR §435.217.
Select one and complete Appendix B-5.
All individuals in the special home and community-based waiver group under 42 CFR §435.217
Only the following groups of individuals in the special home and community-based waiver group under 42 CFR §435.217
A special income level equal to:
300% of the SSI Federal Benefit Rate (FBR)
A percentage of FBR, which is lower than 300% (42 CFR §435.236)
A dollar amount which is lower than 300%.
Aged, blind and disabled individuals who meet requirements that are more restrictive than the SSI program (42 CFR §435.121)
Medically needy without spenddown in States which also provide Medicaid to recipients of SSI (42 CFR §435.320, §435.322 and §435.324)
Medically needy without spend down in 209(b) States (42 CFR §435.330)
Aged and disabled individuals who have income at:
% of FPL, which is lower than 100%.
Specify percentage amount:
B-5: Post-Eligibility Treatment of Income (1 of 4)
In accordance with 42 CFR §441.303(e), Appendix B-5 must be completed when the State furnishes waiver services to individuals in the special home and community-based waiver group under 42 CFR §435.217, as indicated in Appendix B-4. Post-eligibility applies only to the 42 CFR §435.217 group. A State that uses spousal impoverishment rules under §1924 of the Act to determine the eligibility of individuals with a community spouse may elect to use spousal post-eligibility rules under §1924 of the Act to protect a personal needs allowance for a participant with a community spouse.
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 (select one):
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 elects to (select one):
Use spousal post-eligibility rules under §1924 of the Act.
(Complete Item B-5-c (209b State) and Item B-5-d)
Use regular post-eligibility rules under 42 CFR §435.726 (SSI State) or under §435.735 (209b State)
(Complete Item B-5-c (209b State) . Do not complete Item B-5-d)
Spousal impoverishment rules under §1924 of the Act are not used to determine eligibility of individuals with a community spouse for the special home and community-based waiver group. The State uses regular post-eligibility rules for individuals with a community spouse.
B-5: Post-Eligibility Treatment of Income (2 of 4)
Regular Post-Eligibility Treatment of Income: SSI State.
Answers provided in Appendix B-4 indicate that you do not need to complete this section and therefore this section is not visible.
B-5: Post-Eligibility Treatment of Income (3 of 4)
Regular Post-Eligibility Treatment of Income: 209(B) State.
The State uses more restrictive eligibility requirements than SSI and uses the post-eligibility rules at 42 CFR 435.735 for individuals who do not have a spouse or have a spouse who is not a community spouse as specified in §1924 of the Act. Payment for home and community-based waiver services is reduced by the amount remaining after deducting the following amounts and expenses from the waiver participant's income:
Allowance for the needs of the waiver participant (select one):
The following standard included under the State plan
The following standard under 42 CFR §435.121
Optional State supplement standard
The special income level for institutionalized persons
A percentage of the FBR, which is less than 300%
A dollar amount which is less than 300%.
A percentage of the Federal poverty level
Other standard included under the State Plan
Character Count: out of 36000
The following dollar amount
Specify dollar amount: If this amount changes, this item will be revised.
The following formula is used to determine the needs allowance:
Allowance for the spouse only (select one):
The state provides an allowance for a spouse who does not meet the definition of a community spouse in §1924 of the Act. Describe the circumstances under which this allowance is provided:
Specify the amount of the allowance (select one):
The amount is determined using the following formula:
Allowance for the family (select one):
Not Applicable (see instructions)
AFDC need standard
Specify dollar amount: The amount specified cannot exceed the higher of the need standard for a family of the same size used to determine eligibility under the State's approved AFDC plan or the medically needy income standard established under 42 CFR §435.811 for a family of the same size. If this amount changes, this item will be revised.
Amounts for incurred medical or remedial care expenses not subject to payment by a third party, specified in 42 §CFR 435.726:
Health insurance premiums, deductibles and co-insurance charges
Necessary medical or remedial care expenses recognized under State law but not covered under the State's Medicaid plan, subject to reasonable limits that the State may establish on the amounts of these expenses.
Not Applicable (see instructions) Note: If the State protects the maximum amount for the waiver participant, not applicable must be selected.
The State does not establish reasonable limits.
The State establishes the following reasonable limits
B-5: Post-Eligibility Treatment of Income (4 of 4)
Post-Eligibility Treatment of Income Using Spousal Impoverishment Rules
The State uses the post-eligibility rules of §1924(d) of the Act (spousal impoverishment protection) to determine the contribution of a participant with a community spouse toward the cost of home and community-based care if it determines the individual's eligibility under §1924 of the Act. There is deducted from the participant’s monthly income a personal needs allowance (as specified below), a community spouse's allowance and a family allowance as specified in the State Medicaid Plan.. The State must also protect amounts for incurred expenses for medical or remedial care (as specified below).
Allowance for the personal needs of the waiver participant
Specify dollar amount: If this amount changes, this item will be revised
Specify formula:
Character Count: out of 4000
If the allowance for the personal needs of a waiver participant with a community spouse is different from the amount used for the individual's maintenance allowance under 42 CFR §435.726 or 42 CFR §435.735, explain why this amount is reasonable to meet the individual's maintenance needs in the community.
Allowance is different.
The State uses the same reasonable limits as are used for regular (non-spousal) post-eligibility.
B-6: Evaluation/Reevaluation of Level of Care
As specified in 42 CFR §441.302(c), the State provides for an evaluation (and periodic reevaluations) of the need for the level(s) of care specified for this waiver, when there is a reasonable indication that an individual may need such services in the near future (one month or less), but for the availability of home and community-based waiver services.
Reasonable Indication of Need for Services. In order for an individual to be determined to need waiver services, an individual must require: (a) the provision of at least one waiver service, as documented in the service plan, and (b) the provision of waiver services at least monthly or, if the need for services is less than monthly, the participant requires regular monthly monitoring which must be documented in the service plan. Specify the State's policies concerning the reasonable indication of the need for services:
Minimum number of services.
The minimum number of waiver services (one or more) that an individual must require in order to be determined to need waiver services is:
Frequency of services. The State requires (select one):
The provision of waiver services at least monthly
Monthly monitoring of the individual when services are furnished on a less than monthly basis
If the State also requires a minimum frequency for the provision of waiver services other than monthly (e.g., quarterly), specify the frequency:
Responsibility for Performing Evaluations and Reevaluations. Level of care evaluations and reevaluations are performed (select one):
Directly by the Medicaid agency
By the operating agency specified in Appendix A
By an entity under contract with the Medicaid agency.
Specify the entity:
Qualifications of Individuals Performing Initial Evaluation: Per 42 CFR §441.303(c)(1), specify the educational/professional qualifications of individuals who perform the initial evaluation of level of care for waiver applicants:
Case managers or CM Supervisors who meet QMRP standards.
Level of Care Criteria. Fully specify the level of care criteria that are used to evaluate and reevaluate whether an individual needs services through the waiver and that serve as the basis of the State's level of care instrument/tool. Specify the level of care instrument/tool that is employed. State laws, regulations, and policies concerning level of care criteria and the level of care instrument/tool are available to CMS upon request through the Medicaid agency or the operating agency (if applicable), including the instrument/tool utilized.
DDS Form 219 10/1/05 version is used to document that indiviual meets the Level of Care Criteria listed below. This determination/redetermination is made through a planning and support team process based on comprehensive professional assessments, including the DDS Level of Need assessment; evaluations; and/or reports that are on file in the Client Record or another identified location. There is reasonable indication that the person, but for the provision of waiver services would require placement in an ICF/MR. The person requires assistance due to one or more of the following: 1. Has a physical or medical disability requiring substantial and/or routine assistance as well as habilitative support in performing self-care and daily activities. 2. Has a deficit in self-care and daily living skills requiring habilitative training. 3. Has a maladaptive social and/or interpersonal patterns to the exent that he/she is incapable of conducting self-care or activities of daily living without habilitative training.
Level of Care Instrument(s). Per 42 CFR §441.303(c)(2), indicate whether the instrument/tool used to evaluate level of care for the waiver differs from the instrument/tool used to evaluate institutional level of care (select one):
The same instrument is used in determining the level of care for the waiver and for institutional care under the State Plan.
A different instrument is used to determine the level of care for the waiver than for institutional care under the State plan.
Describe how and why this instrument differs from the form used to evaluate institutional level of care and explain how the outcome of the determination is reliable, valid, and fully comparable.
Process for Level of Care Evaluation/Reevaluation: Per 42 CFR §441.303(c)(1), describe the process for evaluating waiver applicants for their need for the level of care under the waiver. If the reevaluation process differs from the evaluation process, describe the differences:
Reevaluation Schedule. Per 42 CFR §441.303(c)(4), reevaluations of the level of care required by a participant are conducted no less frequently than annually according to the following schedule (select one):
Specify the other schedule:
Qualifications of Individuals Who Perform Reevaluations. Specify the qualifications of individuals who perform reevaluations (select one):
The qualifications of individuals who perform reevaluations are the same as individuals who perform initial evaluations.
The qualifications are different.
Specify the qualifications:
Procedures to Ensure Timely Reevaluations. Per 42 CFR §441.303(c)(4), specify the procedures that the State employs to ensure timely reevaluations of level of care (specify):
The CT automated consumer information system (CAMRIS) maintains the date of the last Individual Annual Plan review. The Level of Care determination is completed at the time of each review. The case manager and case manager supervisor use this system as a tickler system.
Maintenance of Evaluation/Reevaluation Records. Per 42 CFR §441.303(c)(3), the State assures that written and/or electronically retrievable documentation of all evaluations and reevaluations are maintained for a minimum period of 3 years as required in 45 CFR §92.42. Specify the location(s) where records of evaluations and reevaluations of level of care are maintained:
All evaluations and re-evaluations are available in the DDS case management record. The initial evaluations are also maintained in the individual’s DSS records.
Appendix B: Evaluation/Reevaluation of Level of Care
Quality Improvement: Level of Care
Methods for Discovery: Level of Care Assurance/Sub-assurances
Sub-Assurances:
Sub-assurance: An evaluation for LOC is provided to all applicants for whom there is reasonable indication that services may be needed in the future.
The DDS Medicaid Operations Unit verifies that all newly enrolled individuals have a completed Level of Care determination, and that each one makes a choice between ICF/MR and waiver services.
Record reviews, on-site
Sub-assurance: The levels of care of enrolled participants are reevaluated at least annually or as specified in the approved waiver.
DDS Central Office and regional supervisory staff conduct record audits to ensure that LOC determinations are reevaluated annually.
95% or 400 participants quarterly
15 record audits in each of the three regions per quarter
Sub-assurance: The processes and instruments described in the approved waiver are applied appropriately and according to the approved description to determine participant level of care.
The DSS representative assigned to DDS reviews all new applications to verify that DDS follows policies and procedures regarding Level of Care determinations.
The CO Medicaid Operations Unit notifies the Regional Case Management Supervisor of findings from individual initial enrollment reviews and record audits. Corrective actions are completed in the Regional Offices and reported back to the CO Medicaid Operations Unit. The Case Manager Supervisor ensures remediation of any individual or case manager specific issues identified in the LOC determination review.
B-7: Freedom of Choice
Freedom of Choice. As provided in 42 CFR §441.302(d), when an individual is determined to be likely to require a level of care for this waiver, the individual or his or her legal representative is:
informed of any feasible alternatives under the waiver; and
given the choice of either institutional or home and community-based services.
Procedures. Specify the State's procedures for informing eligible individuals (or their legal representatives) of the feasible alternatives available under the waiver and allowing these individuals to choose either institutional or waiver services. Identify the form(s) that are employed to document freedom of choice. The form or forms are available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
Individuals seeking services from DDS are notified of the alternatives available under the waiver and are informed of their option to choose institutional or waiver services by the DDS case manager. This decision is documented on Form 222, Service Selection Form. The State provides individuals with the HCBS waiver Fact Sheet, and with the Guide to Understanding the DDS HCBS Waivers for Individuals and Families at the annual planning meeting, and both are available on the DDS web site
Maintenance of Forms. Per 45 CFR §92.42, written copies or electronically retrievable facsimiles of Freedom of Choice forms are maintained for a minimum of three years. Specify the locations where copies of these forms are maintained.
DDS case management record and DSS record.
B-8: Access to Services by Limited English Proficiency Persons
Access to Services by Limited English Proficient Persons. Specify the methods that the State uses to provide meaningful access to the waiver by Limited English Proficient persons in accordance with the Department of Health and Human Services "Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons" (68 FR 47311 - August 8, 2003):
The State DDS prepares HCBS waiver informational materials in English and Spanish and posts both to the DDS web site. Additionally, the DDS utilizes a Language Line service to ensure that all individuals who call the DDS at the Central Office or Regional locations will have language interpreter service immediately upon the call. DDS policy states that language interpretation service will be provided free of charge at all intake, formal planning meetings, hearings or informal dispute resolution process sessions. Once enrolled in an HCBS waiver, interpreter services are also included as a covered waiver service for other purposes as detailed in the plan.
Appendix C: Waiver
Appendix C: Participant Services
C-1: Summary of Services Covered (1 of 2)
Waiver Services Summary. List the services that are furnished under the waiver in the following table. If case management is not a service under the waiver, complete items C-1-b and C-1-c:
Statutory Service Adult Day Health
Statutory Service Community Training Homes (CTH) and Community Living Arrangements (CLA)
Statutory Service Group Day Supports
Statutory Service Live-in Caregiver (42 CFR §441.303(f)(8))
Statutory Service Respite
Statutory Service Supported Employment
Supports for Participant Direction Independent Support Broker (formerly Family and Individual Consultation and Support)
Other Service Adult Companion
Other Service Assisted Living
Other Service Clinical Behavioral Support Services (formerly Consultation)
Other Service Environmental Modifications
Other Service Health Care Coordination
Other Service Individual Goods and Services
Other Service Individualized Day Supports
Other Service Individualized Home Supports (formerly Supported Living and IS Habilitation)
Other Service Interpreter
Other Service Nutrition (formerly Consultative Services)
Other Service Personal Emergency Response System (PERS)
Other Service Personal Support
Other Service Specialized Medical Equipment and Supplies
Other Service Transportation
Other Service Vehicle Modifications
C-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
Statutory Service Extended State Plan Service Supports for Participant Direction Other Service
Case Management Homemaker Home Health Aide Personal Care Adult Day Health Habilitation Residential Habilitation Day Habilitation Prevocational Services Supported Employment Education Respite Day Treatment Partial Hospitalization Psychosocial Rehabilitation Clinic Services Live-in Caregiver (42 CFR §441.303(f)(8))
Alternate Service Title (if any):
Complete this part for a renewal application or a new waiver that replaces an existing waiver. Select one :
Service is included in approved waiver. There is no change in service specifications.
Service is included in approved waiver. The service specifications have been modified.
Service is not included in the approved waiver.
Adult day health services are provided through a community-based program designed to meet the needs of cognitively and physically impaired adults through a structure, comprehensive program that provides a variety of health, social and related support services including, but not limited to, socialization, supervision and monitoring, personal care and nutrition in a protective setting during any part of a day. There are two different models of adult day health services: the social model and the medical model. Both models shall include the minimum requirements described in Section 17b-342-2(b)(2) of the DSS regulations. In order to qualify as a medical model, adult day health services shall also meet the requirements described in Section 17b-342-2(b)(3) of the DSS regulations. May not be provided at the same time as Group Day, Individualized Day Supports, Supported Employment, Respite, Individualized Home Supports, Adult Companion, or Personal Support.
Service Delivery Method (check each that applies):
Participant-directed as specified in Appendix E
Provider managed
Specify whether the service may be provided by (check each that applies):
Provider Specifications:
Provider Type Title
Agency Private Agency
C-1/C-3: Provider Specifications for Service
Service Type: Statutory Service
Service Name: Adult Day Health
License (specify):
Certificate (specify):
Other Standard (specify):
Provider must meet the requirements of Section 17b-342-2(b)(2) of the DSS regulations. Providers of the medical model of Adult Day Health must also meet the requirements of Section 17b-342-2(b)(3) of the DSS regulations The agency must ensure that all employees meet the following qualifications: Prior to Employment ·18 yrs of age ·criminal background check ·registry check ·have ability to communicate effectively with the individual/family ·have ability to complete record keeping as required by the employer Prior to being alone with the Individual: ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; client rights and confidentiality; handling fire and other emergencies; prevention of sexual abuse; knowledge of approved and prohibited physical management techniques ·demonstrate competence/knowledge in topics required to safely support the individual as described in the Individual Plan ·demonstrate competence, skills, abilities, education and/or experience necessary to achieve the specific training outcomes as described in the Individual Plan ·ability to participate as a member of the circle if requested by the individual ·demonstrate understanding of Person Centered Planning ·Medication Administration* * if required by the individual supported
Verification of Provider Qualifications
Entity Responsible for Verification:
DDS or DSS
Frequency of Verification:
Initial and every 2 years thereafter.
Community Training Homes (CTH) and Community Living Arrangements (CLA)
Assist with the acquisition, improvement and /or retention of skills and provide necessary support to achieve personal outcomes that enhance an individual’s ability to live in their community as specified in their Individual Plan. This service is specifically designed to result in learned outcomes, but can also include elements of personal support that occur naturally during the course of the day. Examples of the type of support that may occur in these settings include: ·Provision of instruction and training in one or more need areas to enhance the individual’s ability to access and use the community; ·Implement strategies to address behavioral, medical or other needs identified in the Individual Plan; ·Implement all therapeutic recommendations including Speech, O.T., P.T., and assist in following special diets and other therapeutic routines; ·Mobility training; ·Adaptive communication training; ·Training or practice in basic consumer skills such as shopping or banking; and, ·Assisting the individual with all personal care activities. Provision of these services is limited to licensed private CLAs, certified DDS CLAs and licensed CTH settings. Payments for services in these settings do not include room and board, the cost of facility maintenance, upkeep or improvement. Community Living Arrangements are an all inclusive residential support model and cannot be used in combination with Individualized Home Supports, Personal Support or Adult Companion services. Community Training Homes provide residential habilitation services and cannot be used in combination with Individualized Home Supports or Personal Support. Not included in the payment for services in CLAs or CTHs is an average of 30 hours per week when it is expected that participants will be receiving Group Day Supports, Individualized Day Supports, Supported Employment, or Adult Day Health services.
Individual Community Training Home Provider
Agency Private agencies or DDS
Service Name: Community Training Homes (CTH) and Community Living Arrangements (CLA)
Community Training Home Provider
Licensed by DDS to be a Community Training Home
Prior to being licensed the Community Training Home operator must have the following qualifications: ·18 yrs of age ·criminal background check ·registry check ·have ability to communicate effectively with the individual/family ·have ability to complete record keeping as required Prior to being alone with the Individual the CTH provider must: ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; client rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse, knowledge of approved and prohibited physical management techniques ·demonstrate competence/knowledge in topics required to safely support the individual as described in the Individual Plan ·demonstrate competence, skills, abilities, education and/or experience necessary to achieve the specific training outcomes as described in the Individual Plan ·ability to participate as a member of the circle if requested by the individualdemonstrate understanding of Person Centered Planning
Private agencies or DDS
Private providers licensed to operate Community Living Arrangements
DDS operated CLAs are certified
The agency operating the Community Living Arrangements ensures that all employees meet the following qualifications prior to employment: ·18 yrs of age ·criminal background check ·registry check ·have ability to communicate effectively with the individual/family ·have ability to complete record keeping as required by the employer The agency operating the Community Living Arrangements ensures that all employees meet the following qualifications prior to being alone with the Individual: ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; client rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse, knowledge of approved and prohibited physical management techniques ·demonstrate competence/knowledge in topics required to safely support the individual as described in the Individual Plan ·demonstrate competence, skills, abilities, education and/or experience necessary to achieve the specific training outcomes as described in the Individual Plan ·ability to participate as a member of the circle if requested by the individual ·demonstrate understanding of Person Centered Planning·	Medication Administration* * if required by the individual supported
Initial and every 2 years certification thereafter.
Group Day Supports
Services and supports leading to the acquisition, improvement and/or retention of skills and abilities to prepare an individual for work and/or community participation, or support meaningful socialization, leisure and retirement 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. This service may not be provided at the same time as Individualized Day Supports, Supported Employment, Respite, Personal Support, Individualized Home Supports, or Adult Companion.
This service is limited to no more than 8 hours per day.
Agency Private Agency or DDS
Service Name: Group Day Supports
Private Agency or DDS
The agency ensures that employees meet the following qualifications prior to employment: ·18 yrs of age ·criminal background check ·registry check ·have ability to communicate effectively with the individual/family ·have ability to complete record keeping as required by the employer The agency ensures that employees meet the following qualifications prior to being alone with the Individual: ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; client rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse, knowledge of approved and prohibited physical management techniques ·demonstrate competence/knowledge in topics required to safely support the individual as described in the Individual Plan ·demonstrate competence, skills, abilities, education and/or experience necessary to achieve the specific training outcomes as described in the Individual Plan ·ability to participate as a member of the circle if requested by the individual ·demonstrate understanding of Person Centered Planning ·Medication Administration* * if required by the individual supported
DDS Central Office
The payment for the additional costs of rent and food that can be reasonably attributed to an unrelated live-in personal caregiver who resides in the same household as the waiver participant. The reimbursement for the increased rental costs will be based on the DDS Rent Subsidy Guidelines and will follow the limits established in those guidelines for rental costs. The reimbursement for food costs will be based on the USDA Moderate Food Plan Cost averages. Payment will not be made when the participant lives in the caregiver’s home or in a residence that is owned or leased by the provider of Medicaid services.
Individual Individuals hired by Participants who Self Direct
Agency DDS Private Agency
Service Name: Live-in Caregiver (42 CFR §441.303(f)(8))
Individuals hired by Participants who Self Direct
The FI ensures that the live-in caregiver meets the following qualifications prior to employment: ·18 yrs of age ·criminal background check ·registry check ·have ability to communicate effectively with the individual/family The FI ensures that the live-in caregiver meets the following qualifications prior to being alone with the Individual: ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; client rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse, knowledge of approved and prohibited physical management techniques ·demonstrate competence/knowledge in topics required safely support the individual as described in the Individual Plan ·ability to participate as a member of the team if requested by the individual
FI and DDS
FI Prior to employment DDS Annual sample of consumer directed persons
DDS Private Agency
The agency ensures that the caregiver meets the following qualifications: ·21 yrs of age ·criminal background check ·registry check ·have ability to communicate effectively with the individual ·have ability to complete record keeping as required by the employer The agency ensures that the caregiver meets the following qualifications prior to being alone with the Individual: ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; client rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse, knowledge of approved and prohibited physical management techniques ·demonstrate competence/knowledge in topics required to safely support the individual as described in the Individual Plan ·ability to participate as a member of the circle if requested by the individual
Services provided to individuals unable to care for themselves; furnished on a short-term basis because of the absence or need for relief of those persons normally providing the care. FFP will not be claimed for the cost of room and board except when provided as part of respite care furnished in a facility approved by the State that is not a private residence. Respite care will be provided in the following location(s): Individual's home or place of residence; DDS certified respite care facility; DDS operated respite care facility; DDS certified residential camp program. Respite services may not be provided at the same time as Group Day, Individualized Day, Supported Employment, Personal Support, Adult Companion, or Individualized Home Supports.
Respite may be provided for up to 30 consecutive days. Respite services beyond 30 consecutive days will require approval from DDS.
Individual Individuals hired by Particpants who Self Direct
Agency DDS Respite Center or Private Respite Facility
Service Name: Respite
Individuals hired by Particpants who Self Direct
Out of home respite homes must meet all requirements under CT General Statute 17a-218 and State Administrative Code 17a-218-1 to 17a-218-17
The FI will verify that the respite provider meets the following qualifications prior to employment: ·18 yrs of age ·criminal background check ·registry check ·have ability to communicate effectively with the individual/family ·have ability to complete record keeping as required by the employer Prior to being alone with the Individual: ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; client rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse, knowledge of approved and prohibited physical management techniques ·demonstrate competence/knowledge in topics required to safely support the individual as described in the Individual Plan ·demonstrate competence/knowledge in positive behavioral programming, working with individuals who experience moderate to severe psychological and psychiatric behavioral health needs and ability to properly implement behavioral support plans* ·Medication Administration* * if required by the individual supported
DDS Respite Center or Private Respite Facility
Facilities and/or entities and individuals certified in accordance with subsection (d) of Section 17a-218, the regulations promulgated there under, or otherwise certified as a “qualified provider” of respite services by DDS and Reg. Conn. Agencies-DMR Sections 17a-218-8 through 17a-218-17 (The “Respite Regs”) The agency ensures that emloyees meet the following qualifications: Prior to Employment ·18 yrs of age ·criminal background check ·registry check ·have ability to communicate effectively with the individual/family ·have ability to complete record keeping as required by the employer Prior to being alone with the Individual: ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; client rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse, knowledge of approved and prohibited physical management techniques ·demonstrate competence/knowledge in topics required to safely support the individual as described in the Individual Plan ·demonstrate competence/knowledge in positive behavioral programming, working with individuals who experience moderate to severe psychological and psychiatric behavioral health needs and ability to properly implement behavioral support plans* ·Medication Administration* * if required by the individual supported
Supported Employment consists of intensive, ongoing supports that enable participants, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who because of their disabilities, need supports to perform in a regular work setting. Supported employment may include assisting the participant to locate a job or develop a job on behalf of the participant. Supported employment is conducted in a variety of settings, particularly work sites where persons without disabilities are employed. Supported Employment includes activities needed to sustain paid work by participants, including supervision and training. When supported employment services are provided at a work site where persons without disabilities are employed, payment is made only for adaptations, supervision and training required by participants receiving waiver services as a result of their disabilities but does not include payment for supervisory activities rendered as a normal part of the business setting. Supported employment does not include sheltered work or similar types of vocational services furnished in specialized facilities. Supported employment services may be furnished to participants who are paid at a rate more than minimum wage, provided that the participant requires supported employment services in order to sustain employment. Supported employment services may be furnished by a co-worker or other sob-site personnel provided that the services which are furnished are not part of the normal duties of the co-worker or other personnel and those individuals meet the pertinent qualifications for providers of the service. Supported employment may include services and supports that assist the participant in achieving self-employment through the operation of a business. However, Medicaid funds may not be used to defray the expenses associated with starting up or operating a business. FFP will not be 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 a supported employment program; 2. Payments that are passed through to users of supported employment programs; 3. Payments for vocational training that is not directly related to a participant's supported employment. Supported employment services furnished under the waiver are not available under a program funded by either program funded by either the Rehabilitation Act of 1973 or P.L. 94-142. May not be provided at the same time as Group Day Supports, Individualized Day Supports, Individualized Home Supports, Respite, Personal Support, or Adult Companion.
This service is limited to no more than 8 hours per day or 40 hours per week.
Agency Private agency or DDS operated
Service Name: Supported Employment
The Fiscal Intermediary ensures that employees meet the following qualifications: Prior to Employment: ·21 years of age ·criminal background check ·registry check ·have ability to communicate effectively with the individual/family ·have ability to complete record keeping as required by the employer Prior to being alone with the individual: ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; human rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse. ·demonstrate competence/knowledge in topics required to safely support the individual as described in the Individual Plan ·demonstrate competence, skills, abilities, education and/or experience necessary to achieve the specific outcomes as described in the IP ·ability to participate as a member of the circle if requested by the individual ·Medication Administration* * if required by the individual supported
Private agency or DDS operated
The agency ensures that employees meet the following qualifications: Prior to Employment ·21 years of age ·criminal background check ·registry check ·have ability to communicate effectively with the individual/family ·have ability to complete record keeping as required by the employer Prior to being alone with the individual ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; human rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse. ·demonstrate competence, skills, abilities, education and/or experience necessary to achieve the specific outcomes as described in the IP ·ability to participate as a member of the circle if requested by the individual ·Medication Administration* * if required by the individual supported
The waiver provides for participant direction of services as specified in Appendix E. Indicate whether the waiver includes the following supports or other supports for participant direction.
Support for Participant Direction:
Information and Assistance in Support of Participant Direction Financial Management Services Other Supports for Participant Direction
Independent Support Broker (formerly Family and Individual Consultation and Support)
Support and Consultation provided to individuals and/or their families to assist them in directing their own plan of individual support. This service is limited to those who direct their own supports. The services included are: ·Assistance with developing a natural community support network ·Assistance with managing the Individual Budget ·Support with and training on how to hire, manage and train staff ·Accessing community activities and services, including helping the individual and family with day to day coordination of needed services. ·Assistance with negotiating rates and reimbursements. ·Developing an emergency back up plan ·Self advocacy training and support
Individual Individual Hired by Participants who Self Direct
Service Type: Supports for Participant Direction
Service Name: Independent Support Broker (formerly Family and Individual Consultation and Support)
The agency ensures that employees meet the following qualifications prior to employment: ·21 yrs of age ·criminal background check ·registry check ·demonstrated ability, experience and/or education to assist the individual and/or family in the specific areas of support as described by the circle in the Individual Plan. ·Five years experience in working with people with mental retardation involving participation in an interdisciplinary team process and the development, review and/or implementation of elements in an individual’s plan of care. ·One year of the General Experience must have involved supervision of direct care staff in OR responsibility for developing, implementing and evaluating individualized supports for people with mental retardation in the areas of behavior, education or rehabilitation. Substitutions Allowed: College training in programs related to supporting people with disabilities (social service, education, psychology, rehabilitation etc.) may be substituted for the General Experience on the basis of fifteen (15) semester hours equaling one-half (1/2) year of experience to a maximum of four (4) years. ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; human rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse, knowledge of approved and prohibited physical management techniques ·demonstrate understanding of the role of the service, of advocacy, person-centered planning, and community services ·demonstrate understanding of individual budgets and DDS fiscal management policies
Individual Hired by Participants who Self Direct
The FI will ensure that the individual meets the following qualifications prior to employment: ·21 yrs of age ·criminal background check ·registry check ·demonstrated ability, experience and/or education to assist the individual and/or family in the specific areas of support as described by the circle in the Individual Plan. ·Five years experience in working with people with mental retardation involving participation in an interdisciplinary team process and the development, review and/or implementation of elements in an individual’s plan of care. ·One year of the General Experience must have involved supervision of direct care staff in OR responsibility for developing, implementing and evaluating individualized supports for people with mental retardation in the areas of behavior, education or rehabilitation. Substitutions Allowed: College training in programs related to supporting people with disabilities (social service, education, psychology, rehabilitation etc.) may be substituted for the General Experience on the basis of fifteen (15) semester hours equaling one-half (1/2) year of experience to a maximum of four (4) years. ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; human rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse, knowledge of approved and prohibited physical management techniques ·demonstrate understanding of the role of the service, of advocacy, person-centered planning, and community services ·demonstrate understanding of individual budgets and DDS fiscal management policies
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
Non-medical care, supervision and socialization provided to an adult. Services may include assistance with meals and basic activities of daily living incidental to the support and supervision of the individual. This service is provided to carry out personal outcomes identified in the individual plan that supports an individual to successfully live in his/her own home. This service does not entail hands-on nursing care, except as permitted under the Nurse Practice Act (CGS 20-101). May not be provided at the same time as Individualized Day Supports, Group Day Supports, Supported Employment, Respite, Individualized Home Support, and/or Residential Habilitation (CLA).
Service Name: Adult Companion
The agency ensures that employees meet the following qualifications prior to employment ·18 yrs of age ·criminal background check ·registry check ·have ability to communicate effectively with the individual/family ·have ability to complete record keeping as required by the employer Prior to being alone with the Individual: ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; client rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse, knowledge of approved and prohibited physical management techniques ·demonstrate competence/knowledge in topics required to safely support the individual as described in the Individual Plan ·Medication Administration* * if required by the individual supported
Initial and every 2 years thereafter
The FI will verify that the employee mets the following qualifications prior to employment: ·18 yrs of age ·criminal background check ·registry check ·have ability to communicate effectively with the individual/family ·have ability to complete record keeping as required by the employer Prior to being alone with the Individual: ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; client rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse, knowledge of approved and prohibited physical management techniques ·demonstrate competence/knowledge in topics required to safely support the individual as described in the Individual Plan ·Medication Administration* * if required by the individual supported
FI Prior to employment DDS Annual sample of consumer directed persons.
Personal care and services, homemaker, chore, attendant care, companion services, medication oversight(to the extent permitted under State law), therapeutic social and recreational programming, provided in a home-like environment in a licensed (where applicable) community care facility, provided to residents of the facility. This service includes 24 hour on site response staff to meet scheduled or unpredictable needs in a way that promotes maximum dignity and independence, and to provide supervision, safety and security. Other individuals or agencies may also furnish care directly, or under arrangement with the community care facility, but the care provided by these other entities supplements that provided by the community care facility and does not supplant it.Personalized care is furnished to individuals who reside in their own living units (which may include dually occupied units when both occupants consent to the arrangement) which may or may not include kitchenette and/or living rooms and which contain bedrooms and toilet facilities. The consumer has a right to privacy. Living units may be locked at the discretion of the consumer, except when a physician or mental health professional has certified in writing that the consumer is sufficiently cognitively impaired as to be a danger to self or others if given the opportunity to lock the door. (This requirement does not apply where it conflicts with fire code.) Each living unit is separate and distinct from each other The facility must have a central dining room, living room or parlor, and common activity center(s) (which may also serve as living rooms or dining rooms). The consumer retains the right to assume risk, tempered only by the individual’s ability to assume responsibility for that risk. Care must be furnished in a way that fosters independence of each consumer to facilitate aging in place. Routines of care provision and service delivery must be consumer-driven to the maximum extent possible, and treat each person with dignity and respect. Assisted Living services may also include home health care, medication administration, intermittent skilled nursing services, and transportation specified in the Individual Plan. This is an all inclusive support model and cannot be used in combination with Personal Support or Adult Companion services.
Agency Licensed Assisted Living Provider
Service Name: Assisted Living
Licensed Assisted Living Provider
ALSA License from the Department of Public Health, Public Health Code 19-13-D105
Clinical Behavioral Support Services (formerly Consultation)
Clinical and therapeutic services which are not covered by the Medicaid State Plan, necessary to improve the individual’s independence and inclusion in their community. This service is available to individuals who have intellectual disabilities and demonstrate an emotional, behavioral or mental health issue that results in the functional impairment of the individual and substantially interferes with or limits functioning at home or in the community. Professional clinical service to include: 1) Assess and evaluate the behavioral and clinical need(s); 2) Develop a behavioral support plan that includes intervention techniques as well as teaching strategies for increasing new adaptive positive behaviors, and decreasing challenging behaviors addressing these needs in the individual’s natural environments; 3) Provide training to the individual’s family and the support providers in appropriate implementation of the behavioral support plan and associated documentation; and, 4) Evaluate the effectiveness of the behavioral support plan by monitoring the plan on a monthly basis, and by meeting with the team one month after the implementation of the behavior plan, and in future three month intervals. The service will include any changes to the plan when necessary and the professional(s) shall be available to the team for questions and consultation. The professional(s) shall make recommendations to the Individual Support Team and Case Manager for referrals to community physicians and other clinical professionals that support the recommendations of the assessment findings as appropriate. Use of this service requires the preparation of a formal comprehensive assessment and submission of any restrictive behavioral support program to the DDS Program Review Committee for approval prior to implementation.
This service is limited to $2,500 per year unless additional services in a plan year are authorized via the Prior Approval process.
Individual Professional Counselor
Individual Behavior Specialist
Service Name: Clinical Behavioral Support Services (formerly Consultation)
Licensed by the American Psychological Association and meets requirements of Connecticut General Statutes Chapter 383
Criminal background check if requested by the participant. Registry check if requested by the participant. Providers of this service to children must have 3 years of experience in working with children and adolescents with intellectual disabilities.
FI Prior to Employment for consumer directed services DDS Annual verification of ongoing licensure.
Meets the requirements of Connecticut General Statutes Chapter 383 c
FI Prior to employment for consumer directed service DDS Annual verification of ongoing licensure
Psychologist must be licensed by the American Psychological Association and meet the requirements of Connecticut General Statutes Chapter 383 Professional Counselor must meet the requirements of Connecticut General Statutes Chapter 383 c
The agency must ensure that employees meet the following qualifications: Psychologist, Professional Counselor and Behavior Specialist are required to have Criminal background check if requested by the participant. Registry check if requested by the participant. In addition, providers of this service to children must have 3 years of experience in working with children and adolescents with intellectual disabilities. Behavior Specialist Only-- Masters degree in psychology, special education, applied behavior analysis, or other related field and course work in human behavior. One year experience working with people with intellectual disabilities. Criminal background check if requested by the participant. Registry check if requested by the participant. -or- Bachelor’s degree in psychology, special education or other related field and review and approval by either the Autism Services Clinical Review Panel or the DDS Clinical Review Panel. One year experience working with people with intellectual disabilities. Criminal background check if requested by the participant. Registry check if requested by the participant.
Initially and every two years thereafter.
Masters degree in psychology, special education, applied behavior analysis, or other related field andcourse work in human behavior.One year experience working with people with intellectual disabilities.Criminal background check if requested by the participant.Registry check if requested by the participant. -or- Bachelor’s degree in psychology, special education or other related field and review and approval by either the Autism Services Clinical Review Panel or the DDS Clinical Review Panel. One year experience working with people with intellectual disabilities.Criminal background check if requested by the participant. Registry check if requested by the participant. Providers of this service to children must have 3 years of experience in working with children and adolescents with intellectual disabilities.
FI Prior to employment for consumer directed service DDS Annual sample of consumer directed persons
Those physical adaptations to the private residence of participant or the participant's family, required by the individual's plan of care, which are necessary to ensure the health, welfare and safety of the individual, or which enable the individual to function with greater independence in the home, and without which, the individual would require institutionalization. Such adaptations may include the installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems which are necessary to accommodate the medical equipment and supplies which are necessary for the welfare of the individual. Excluded are those adaptations or improvements to the home that are of general utility, and are not of direct medical or remedial benefit to the individual, such as carpeting, roof repair, central air conditioning, etc. Also excluded are those modifications which would normally be considered the responsibility of the landlord. Adaptations which add to the total square footage of the home are excluded from this benefit. All services shall be provided in accordance with applicable State or local building codes. Home accessibility modifications may not be furnished to adapt living arrangements that are owned or leased by providers of waiver services.
Maximum benefit over the term of the waiver (5 years) shall not exceed $15,000
Individual Private Contractors
Service Name: Environmental Modifications
Licensed in State of CT for specific service to be rendered, i.e. electrical, plumbing, general contractor.
NFPA Life Safety CodeState Building Code
FI Initial DDS Annual sample of consumer directed participants.
Assessment, education and assistance provided by a registered nurse to those waiver participants with identified health risks living in their own homes with less than 24 hour supports, and who, as a result of their intellectual disability, have limited ability to identify changes in their health status or to manage their complex medical conditions. These participants have medical needs that require more healthcare coordination than is available through their primary healthcare providers to assure their health, safety and well-being. This service will ensure that there is communication between primary care physicians, medical specialists, and behavioral health practitioners, and will provide a resource person to communicate to consumers and direct support staff (if utilized by the participant) and train them to follow through on medical recommendations. The RN Healthcare Coordinator will complete a comprehensive nursing assessment on each participant and develop an integrated healthcare management plan for the participant and his/her support staff (if utilized by the participant) to implement. This service shall provide the clinical and technical guidance necessary to support the participant in managing complex health care services and supports to improve health outcomes and prevent admission to a nursing facility. Support provided includes, but is not limited to, the following: train/retrain staff (if utilized by the participant) on interventions, monitor the effectiveness of interventions, coordinate specialists, evaluate treatment recommendations, review lab results, monitor, coordinate tests/results, and review diets. This service is only available to individuals with identified health risks who receive less than 24 hour supports in their own home. The RN Healthcare Coordinator does not provide skilled nursing services that are available under the Medicaid State plan.
Individual Registered Nurse
Service Name: Health Care Coordination
Registered Nurse who meets the requirements of CGS Chapter 368a Department of Public Health
Criminal background check if requested by the participant. Registry check if requested by the participant.
Services, equipment or supplies that will provide direct benefit to the individual and support specific outcomes identified in the Individual Plan. The service, equipment or supply must either reduce the reliance of the individual on other paid supports, be directly related to the health and/or safety of the individual in his/her home or in the community, be habilitative in nature and contribute to a therapeutic goal, enhance the individual’s ability to be integrated into the community, or provide resources to expand self-advocacy skills and knowledge, and, the individual has no other funds to purchase the described goods or services. DDS Cost Standards are a set of guidelines which are used to ensure applies consistent criteria with respect to the appropriateness of the services or items to be approved in this service definition and their cost. Experimental and prohibited treatments are excluded. This service is only available for individuals who self-direct their own supports, and must be pre-approved by DDS and follow DDS Cost Standards. DDS applies consistent guidelines in respect to the appropriateness of the services or items to be approved in this service definition. This service may not duplicate any Medicaid State Plan service.Direct supports under this service may not be provided at the same time as Individualized Day Supports, Group Day, Supported Employment, Respite, Individualized Home Supports, Adult Companion, or Personal Support.
Individual Participant directed Individual
Agency Private agency or Private Vendor
Service Name: Individual Goods and Services
Participant directed Individual
Meets any applicable state regulations for the typr of supply or service as described in the Individual Plan approved by DDS. If the participant is purchasing direct support the FI will ensure that the person hired meets the following qualifications prior to employment:	·18 yrs of age ·criminal background check ·registry check ·have ability to communicate effectively with the individual/family ·have ability to complete record keeping as required by the employer Prior to being alone with the Individual: ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; client rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse, knowledge of approved and prohibited physical management techniques ·demonstrate competence/knowledge in topics required to safely support the individual as described in the Individual Plan ·demonstrate competence, skills, abilities, education and/or experience necessary to achieve the specific training outcomes as described in the Individual Plan ·ability to participate as a member of the circle if requested by the individual ·demonstrate understanding of Person Centered Planning ·Medication Administration* * if required by the individual supported
Private agency or Private Vendor
Meets any applicable stae regulations for the typr of supply or service as described in the Individual Plan approved by DDS. If the participant is purchasing direct supports the agency will ensure that employees meet the following qualifications prior to employment: ·18 yrs of age·	criminal background check ·registry check ·have ability to communicate effectively with the individual/family ·have ability to complete record keeping as required by the employer Prior to being alone with the Individual: ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; client rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse, knowledge of approved and prohibited physical management techniques ·demonstrate competence/knowledge in topics required to safely support the individual as described in the Individual Plan ·demonstrate competence, skills, abilities, education and/or experience necessary to achieve the specific training outcomes as described in the Individual Plan ·ability to participate as a member of the circle if requested by the individual ·demonstrate understanding of Person Centered Planning ·Medication Administration* * if required by the individual supported
Individualized Day Supports
Services and supports provided to individuals tailored to their specific personal outcomes related to the acquisition, improvement and/or retention of skills and abilities to prepare and support an individual for work and/or community participation and/or meaningful retirement activities, or for an individual who has their own business, and could not do so without this direct support. This service eminates from the participant's home and is not delivered in or from a facility-based program. May not be provided at the same time as Group Day, Supported Employment, Respite, Personal Support, Adult Companion, Individualized Home Supports.
Service Name: Individualized Day Supports
The agency ensures that employees meet the following qualifications: Prior to Employment: ·18 yrs of age ·criminal background check ·registry check ·have ability to communicate effectively with the individual/family ·have ability to complete record keeping as required by the employer Prior to being alone with the Individual: ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; client rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse, knowledge of approved and prohibited physical management techniques ·demonstrate competence/knowledge in topics required to safely support the individual as described in the Individual Plan ·demonstrate competence, skills, abilities, education and/or experience necessary to achieve the specific training outcomes as described in the Individual Plan ·ability to participate as a member of the circle if requested by the individual ·demonstrate understanding of Person Centered Planning ·Medication Administration* * if required by the individual supported
The FI ensures that employeew meet the following qualifications: Prior to Employment: ·18 yrs of age ·criminal background check ·registry check ·have ability to communicate effectively with the individual/family ·have ability to complete record keeping as required by the employer Prior to being alone with the Individual: ·demonstrate competence in knowledge of DDS policies and procedures: abuse/neglect; incident reporting; client rights and confidentiality; handling fire and other emergencies, prevention of sexual abuse, knowledge of approved and prohibited physical management techniques ·demonstrate competence/knowledge in topics required to safely support the individual as described in the Individual Plan ·demonstrate competence, skills, abilities, education and/or experience necessary to achieve the specific training outcomes as described in the Individual Plan ·ability to participate as a member of the team if requested by the individual ·demonstrate understanding of Person Centered Planning ·Medication Administration* * if required by the individual supported
Individualized Home Supports (formerly Supported Living and IS Habilitation)
The services formerly called Supported Living and IS Habilitation have been renamed Individualized Home Supports. There is not change in the service definitions. This service provides assistance with the acquisition, improvement and/or retention of skills and provides necessary support to achieve personal outcomes that enhance an individual’s ability to live in their community as specified in the Individual Plan. This service includes a combination of habilitative and personal support activities as they would naturally occur during the course of a day. This service is not available for use in licensed settings. The service may be delivered in a personal home (one’s own or family home) and in the community. Payments for Individualized Home Support do not include room and board. May not be provided at the same time as Group Day, Individualized Day, Supported Employment, Respite, Personal Support, or Adult Companion. and/or Individualized Goods and Services.
Service Name: Individualized Home Supports (formerly Supported Living and IS Habilitation)
The FI will ensure that employees meet the following qualifications: Prior to Emplyment: ·18 yrs of age ·criminal background check &