Louisiana Department of Health and Hospitals 628 North 4th Street, Baton Rouge, Louisiana (225) OAAS CCW/ADHC Transition to OCDD ROW 1

Objectives  Explain why this transition is taking place.  Provide overview of the OCDD Residential Options Waiver (ROW)  Outline the Transition Process  Define Roles during the transition process;  Affected Individuals/participants  Office of Aging and Adult Services (OAAS) Support Coordinators  Office for Citizens with Developmental Disabilities (OCDD) Support Coordinators  OCDD Local Governing Entities (LGE) Offices  OAAS Regional Offices 2

Where Are We Going?  OAAS Participants with an SOA with OCDD will be transitioned to the ROW  There are approximately 230 CCW or ADHC participants identified that this will impact  Individuals on the Request for Services Registry (RFSR) for CCW or ADHC will be moved to a RFSR for ROW  Transition process will begin in January 2016 as part of each participant’s OAAS annual planning  This change will result in greater access to services specifically designed to support the needs as persons with ID/DD. 3

Louisiana Department of Health and Hospitals 628 North 4th Street, Baton Rouge, Louisiana (225) Residential Options Waiver (ROW) Overview 4

What is the ROW?  Residential Options Waiver (1 of 4 OCDD Waivers)  Offered to eligible individuals of all ages through OCDD  There are multiple services available that were initially designed to support individuals to move from Intermediate Care Facilities (ICF/DD) and nursing facilities into the community 5

Who is Eligible for the ROW?  Individuals from birth to end of life that meet the following eligibility criteria:  Have a Developmental Disability as defined in the DD Law  Have a Statement of Approval (SOA)  Meet both financial and non-financial eligibility criteria for Home and Community Based Waiver Services (HCBS)  Meet ICF/DD level of care criteria  All other non-financial requirements  US citizenship and Louisiana Residency 6

What Services are Available?  Support Coordination (Required Service)  Residential Services (Required Service)  Must choose one of the 4 types of Residential Services in the ROW:  Community Living Supports (CCW- Personal Assistance Service (PAS)/ADHC-Long Term-Personal Care Service(LT-PCS) (May be Self – Directed)  Companion Care  Host Home  Shared Living Note: ROW requires use of SC &residential support each month to maintain waiver 7

Additional ROW Services Center-Based Respite Vocational/Habilitation Permanent Supportive Housing Services Nursing Professional Services  Dietician  PT/OT  Speech  Social Worker  Psychological  * This is not a complete list 8

What is the ICAP?  Inventory for Client & Agency Planning (ICAP): a widely used assessment tool, measuring both adaptive & maladaptive behaviors & gathers additional info  Completed by the LGE  Completed initially and as needed,  Requested prior to the development of a ROW plan of care  The ICAP assessment instrument provides:  Identification of skills requiring assistance to allow the individual to live as independently as possible  information used to identify home & community-based support needs  mechanism for establishing an individual’s budget in the ROW. 9

Are There Limits on Budgets in the ROW?  Yes, the ROW is a Capped Waiver, where there are four (4) budget levels  Participant’s Annual Budget is Based on ICAP Level  Budget amounts change as changes occur in assessment ICAP levels 10

ICAP Service Level & ROW Individual Budget Limits Correlation ICAP Service Score ICAP Level ICAP Support Level ROW Acuity Level ROW Individual Budget Limit (Based on 7/1/2012 budget reduction LR 39;1049 & subject to change) ,8,9Intermittent1$48, ,5,6Limited2S51, ,3Extensive3$56, Pervasive4$61,

Person Centered Discovery  Complete and/or review any required assessments  ICAP (Completed by LGE – Entry Staff)  90-L (Completed by Medical Doctor)  Personal Outcomes Assessment  Review current available records and/or assessment information  Synthesize/summarize information  Interview participant & those that know him/her best to determine who they are & fill in gaps  Identify Vision & Goals for the individual 12

Planning  Set Personal Goals (Based on Vision)  What opportunities exist to support achieving?  What challenges/barriers get in the way?  Develop Action/Support Plan  How do we use existing opportunities?  What supports are needed to move towards goals?  What supports/treatment are needed to address challenges/barriers? 13

Finalization of Plan & Building Budget  What actions can the individual take independently?  What actions/supports will be provided by family, friend, others?  What connections need to be made/supported with community organizations?  What other services/paid supports are accessible and will be used?  Identify any areas of unmet needs & determine which ROW services will address those needs. 14

Louisiana Department of Health and Hospitals 628 North 4th Street, Baton Rouge, Louisiana (225) Transition Process 15

Transition Process  OAAS will generate a list by region & POC end date of participants to be transitioned  List will be updated monthly  List will be shared with OCDD LGEs & Medicaid  OAAS Area Managers will forward list to RO Supervisors  OAAS will share list with OAAS Support Coordination Agencies (SCAs)  OCDD will share list with the LGEs  Based on the list, OCDD LGE office will schedule & complete the ICAP 16

Transition Process (continued)  OCDD will notify Statistical Resources Incorporated (SRI) to send the participant packet  SRI will send the participant packet that includes:  Information regarding transition  90-L  Freedom of Choice (FOC) for Support Coordination Agency  If current SC agency is also an OCDD SC agency-participant will be able to remain with that SC agency 17

Transition Process (cont’d)  Participant will need to return the 90-L and the FOC to SRI  OAAS SC will actively assist in completion &return of participant packet  SRI will link participant to appropriate SCA after receipt of FOC & 90-L  If the FOC is not received in 14 days from receipt, individual will be auto-assigned to an SC agency  SRI may link without the 90-L  SRI will send the link to SC agency and Medicaid 18

Transition Process (cont’d)  OCDD SCA will:  Obtain ICAP score and SOA  Call the participant within 3 days of linkage  Meet with participant within 7 days of linkage  Complete the ROW FOC  Hold planning meeting within 30 days of linkage  Make sure Service Provider, OAAS SC, & others identified by the participant are invited & participate in meeting  Submit POC & 148 to LGE within 35 days of linkage 19

Transition Process (cont’d)  LGE Waiver staff will:  Review the POC  Approve or Return POC within 10 working days of receiving it  Conduct pre-cert visit with participant  Send 142 & 148 to Medicaid once pre-cert visit is completed 20

Transition Process (cont’d)  Medicaid will:  Change type case and close segment  Issue decision notice 18W to LGE, participant/family, OCDD SC, OAAS, & OCDD  LGE Waiver staff will:  Issue 51NH (transition start date 14 days out)  Initiate 2 week transition process if provider is changing  Notify SRI that 18W is issued & submit appropriate documentation (budget pages, etc.)  Notify OAAS State Office identified staff via 21

Transition Process (cont’d)  SRI will:  Issue, on transition date:  Prior Authorization (PA) for OCDD SCA and remove PA for OAAS SCA  PA for providers changes from OAAS waivers to ROW  If provider is changing, OCDD SCA will notify both providers of change date once approved POC is received from LGE 22

Louisiana Department of Health and Hospitals 628 North 4th Street, Baton Rouge, Louisiana (225) Roles 23

Role of the Participant  Receive notification about transition  Ask questions  Schedule ICAP  Return SCA FOC  Schedule doctor’s appointment  Return 90-L  Participate in completion of ICAP  Participate in Discovery/Planning process 24

Role of OCDD LGE  Complete the ICAP – Entry Staff  Share ICAP score & SOA with OCDD SC (staff TBD by DD Director)  Review/Approve plan of care – Waiver Staff  Complete standard initial plan of care certification process – Waiver  Issue 51 NH-assure all appropriate documents are submitted to SRI  51NH should be handled as other transfers are addressed (i.e., the start date should be 14 days after the 18W) -Waiver 25

Role of OCDD SC  Facilitate Discovery/Planning meetings  Request/obtain ICAP and SOA from LGE timely  Develop the Plan of Care  Invite – OAAS SC, provider & others important to individual to POC meeting  Assure all documents necessary for plan approval are complete  Confirm with OAAS SC any open CIRs are closed prior to ROW certification  Provide resources/referral as needed to address participants’ needs 26

Role of OAAS SC  Serve as a resource for the OCDD SC:  Participate as a respondent in the POC meeting  Assist with explaining changes to the individuals  Including communications sent by OAAS/OCDD State Office  Assist with making sure participant completes & returns FOC to SRI  Assist with making sure that the 90-L is completed and returned  Coordinate with OCDD SC to set up meetings  Provide copy of the assessments/plan of care  Close any existing Critical Incident Reports (CIRs)  Continue Monthly/Quarterly Requirements 27

Role of the Regional Office (OAAS)  Tracking/monitoring of the transition process  Including closure of outstanding CIRs  Provide technical assistance to OAAS SCAs 28

Role of SRI  Send individual packet (90-L, FOC for SCA)  Process linkage  Send linkage to SCA and Medicaid  Issues PA for OCDD SCA and removes PA for OAAS SCA  Issues PA for service providers 29

Role of Medicaid  Changes type cases and closes  Issues decision notice 18W to LGE, family/individual, OCDD SC, OAAS, and OCDD 30

Role of OAAS/OCDD State Office  Provide list of Individuals to be transitioned to SRI, Medicaid, and OCDD LGE offices  Develop/Send communications as necessary to individuals and stakeholders as appropriate  Track/Monitor the Transition process  Provide Technical support to OCDD LGE/OAAS Regional offices 31

Louisiana Department of Health and Hospitals 628 North 4th Street, Baton Rouge, Louisiana (225) Next Steps 32

Moving Forward  OCDD will send list of participants impacted to the LGE office  ICAPs for individuals identified to transition will need to be scheduled and completed (by timeframe)  OCDD will request SRI forward Freedom of Choice (FOC) packet to identified participants  OCDD SC agency should begin discovery/planning process including requesting ICAP score/SOA from OCDD LGE  OAAS SCA will assist throughout entire process 33

Resources  ROW – webpage -  ROW Fact Sheet  OCDD brochure - Where to find Local Offices for ID/DD  Request for Medical Eligibility Determination - 90L OAAS Help Line at OCDD ROW Program Manager – Jeannathan H. Anderson (225)

Questions ? 35