Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 05 - Developmental Disabilities Services › Rule 016.05.17-001 - DDS Alternative Community Services Waiver (DDS ACS) Update #1-17 and Developmental Disabilities Services ACS Waiver

Current through Register Vol. 49, No. 6, June, 2024
Application for a §1915(c) Home and Community-Based
				Services Waiver
PURPOSE OF THE HCBS WAIVER PROGRAM
The Medicaid Home and Community-Based Services (HCBS) waiver
				program is authorized in §1915(c) of the Social Security Act. The program
				permits a State to furnish an array of home and community-based services that
				assist Medicaid beneficiaries to live in the community and avoid
				institutionalization. The State has broad discretion to design its waiver
				program to address the needs of the waiver's target population. Waiver services
				complement and/or supplement the services that are available to participants
				through the Medicaid State plan and other federal, state and local public
				programs as well as the supports that families and communities provide.
The Centers for Medicare & Medicaid Services (CMS)
				recognizes that the design and operational features of a waiver program will
				vary depending on the specific needs of the target population, the resources
				available to the State, service delivery system structure, State goals and
				objectives, and other factors. A State has the latitude to design a waiver
				program that is cost-effective and employs a variety of service delivery
				approaches, including participant direction of services.
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:
Appendix B - Increased by 100 the unduplicated and the
				point-in-time number of slots reserved for DCFS. Total reserved for
DCFS (for children in foster care) is 200.
Appendix C - Supportive Living - added retainer payments to
				providers for the lesser of 14 consecutive days or the number of days during
				which an individual is in an ineligible setting. Removed restriction on paying
				overtime and family working over 40
hours a week.
Appendix C - Case Management - added requirements regarding
				conflict of interest, including a stipulation that prohibits an
Organization from providing case management and any direct
				service to the same person.
Appendix C-1 added provision for case management through
				contracted provider
Appendix C5 - Added the Home and Community-Based Settings
				Transition Plan
Appendix D1 - added requirements regarding conflict of interest
				during the person-centered planning meeting, added a prohibition that
				individuals developing the PCSP are not related by blood or marriage to the
				individual or to any paid caregiver,
are not financially responsible for the individual, empowered
				to make financial or health-related decision for the individual or are
				individuals who would benefit financially from the provision of services
Appendix D - rewrote to include all requirements stated in the
				Final Rule
Appendix D1 - changed the effective term of the Interim Service
				Plan from 90 days to 60, according to guidelines in the
Technical Guide
Appendix G1 - Identified critical events as distinguished from
				reportable events
Appendix G2 - Clarified and defined each type of restraint and
				restrictive intervention, and specified when behavior plans are required
Appendix G3 - Clarified when a medication management plan must
				be in place and specified the components of the plan
Rewrote all Performance Measures to address required assurances
				and sub assurances so that they are measurable and have a direct impact on
				quality.
Application for a §1915(c) Home and Community-Based
				Services Waiver
1. Request Information (1 of 3)
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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 purpose of the ACS Waiver is to
				support individuals of all ages who have a developmental disability, meet ICF
				level of care and require waiver support services to live in the community and
				prevent institutionalization.
The goals of HCBS Waiver are to:
1) Support the person in all major life
			 activities,
2) Promote community
			 inclusion through integrated employment options and community experiences.
Support of the person includes:
1) Developing a relationship with the person
			 and maintaining direct contact,
2)
			 Determining the person's choices about their life,
3) Locating, coordinating and monitoring
			 needed developmental, medical, behavioral, social, educational and other
			 services,
4) Accessing informal
			 community supports needed by the person,
5) Development and implementation of a Person
			 Centered Service plan in coordination with an interdisciplinary team,
6) Accessing employment services and support
			 individuals in seeking and maintaining competitive employment, and
7) Integration into the life and activities
			 of the person's community.
The objectives are as follows:
1) To enhance and maintain community living
			 for all persons participating in the HCBS Waiver program,
2) To transition eligible persons who choose
			 the HCBS Waiver option from residential facilities to the community.
Under the organizational structure of the Department of Human
				Services (DHS), the Division of Medical Services (DMS) is the state Medicaid
				agency. DMS has administrative authority for the HCBS Waiver including the
				items as outlined in the Interagency Agreement (See Appendix A-2-b). The
				Division of Developmental Disabilities Services (DDS), also within DHS, is
				responsible for operation of the ACS Waiver, including the items as outlined in
				the Interagency Agreement. ACS Waiver services are delivered through private
				providers who are certified by the DDS Quality Assurance Section. The providers
				must first meet DDS certification requirements and then enroll with Medicaid as
				HCBS Waiver providers before the provider can deliver services.
ACS Waiver services are accessed through DDS Intake and
				Referral units, which include DDS Adult Intake and Referral, DDS Children's
				Services Intake and Referral, and Intermediate Care Facilities for Individuals
				with Intellectual Disabilities (ICF/IID) intake and referral staff. The intake
				and referral staff distribute the initial application, assist with completion,
				explain program options and offer choice of waiver services or ICF/IID
				services. The completed application packet is transmitted either directly or
				via the Waiver Application Unit (WAU) to the DDS Psychology Team for a
				determination of eligibility for institutional level of care services. The
				Waiver Application Unit (WAU) tracks applications once eligibility has been
				determined. The DDS
Waiver Application Unit is also responsible for assuring a
				person meets ICF/IID level of care and Medicaid income eligibility criteria
				prior to the person receiving waiver services. DDS Specialists offer choice of
				waiver providers.
Waiver services are delivered by DDS certified providers who
				have enrolled with DMS. During the DDS certification process, the providers
				identify the services they will provide, the counties they will serve and, if
				desired, the maximum number of people they will serve. Providers are permitted
				to change these criteria and may do so by contacting the DDS Certification
				Unit. However, change cannot be made if the change will adversely impact any
				persons receiving services from that provider at the time the change is
				desired.
Providers must request in writing and receive written
				permission from DDS before reducing the number of person they serve. Providers
				may reduce numbers by ceasing provision of services in a designated county or
				counties, freezing the number of persons they serve at the current number and
				reducing the number through attrition or ceasing provision of services to those
				persons they have most recently begun serving. Providers are responsible for
				continuing to provide services until transition of persons to another provider
				is complete.
All services must be delivered based on an individual
				person-centered service plan (PCSP), which is based on service needs
				assessments, has measurable goals, specific objectives, measures progress
				through data collection, and is overseen and updated by the person's case
				manager though consultation with the team, which includes the person receiving
				services.
The provider assures that the person being served and the team
				has input into the development of the PCSP, including services needed and
				desired outcomes for the person, and decisions on hiring direct care
				professionals.