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Frequently Asked Questions

Intellectual and Developmental Disabilities 

  
Question
Answer
Eligibility

Who is eligible to receive K plan services?​

 

Eligibility criteria will not change with the K plan. Individuals currently receiving Medicaid waiver services will continue to be eligible for K plan and waiver services.

Individuals who meet waiver criteria entering the system will also be eligible for both K plan and waiver services.

Eligibility

The K plan as submitted refers to eligible individuals having 150% of poverty level to be eligible, but Oregon has a 300% standard, are people going to lose their services?

​Centers for Medicare and Medicaid (CMS) required Oregon to indicate the 150% threshold in the K plan as a federal standard. Each state actually sets its own threshold for Medicaid eligibility, and Oregon’s is 300%. CMS is aware of this and Oregon is maintaining our 300% threshold.

Eligibility

​How does enrollment work?

​The initial determination for DD and wavier eligibility will not change. A functional needs assessment will be conducted as part of the initial and ongoing person centered planning process. The service coordinator will advise the individual and / or their representative of all available service options including Support Service brokerage.

Eligibility

Does the K plan limit eligibility?

​No, the K plan does not limit eligibility, but for these services an individual must be Medicaid eligible and meet the institutional Level of Care criteria.

Eligibility

Will the K plan reinstate services for individuals who were previously served by brokerages using general fund dollars?

​No, the K plan is a Medicaid state plan, and requires Medicaid eligibility as well as institutional level of care determination. Individuals who had been supported via general fund are not Medicaid eligible.

Eligibility

​What about families that don’t qualify for Medicaid, will they still
receive family support for children living in the family home?

​Yes, children who are eligible for DD services but are not Medicaid eligible may still access family support.

Eligibility

If there are new people coming into the system, is there a potential wait list?

​There is no waitlist. Once eligibility for services is determined and needs are identified by the functional needs assessment and addressed in the annual plan of care, services may begin when a qualified provider has been identified, and the service has been authorized by the service coordinator or personal agent.

Activities & Instrumental Activities of Daily Living

​Why does the K plan only address Activities of Daily Living and
Instrumental Activities of Daily Living?

​The K plan is based on attendant services which are identified as Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), functional skills training and health related tasks through hands on assistance, supervision, and/or cueing.
ADLs include but are not limited to assistance with bathing, personal hygiene, dressing, eating, mobility (ambulation, transferring and positioning) bowel and bladder care, stand by support, cognition, memory care and behavior supports.

IADLs are more complex activities than ADL’s. They are activities that assure a person can live as independently as possible in the community. These may include supports that assist a person to continue to productively work toward long range goals i.e. managing money, using technology, transportation to work or classes, or they may be related to maintaining independent living such as light housekeeping, laundry, meal preparation and chore services and medication management.

Other non ADL/IADL and health related services including but not limited to extended state plan services, family training, supported employment, will continue to be provided through the waivers.

Activities & Instrumental Activities of Daily Living

​What other services and supports can be obtained through the K plan?

  • ​Community transportation
  • Electronic back up systems or assistive devices (Durable medical equipment not covered by other available resources, electronic devices – to increase or maintain an individuals independence) (limited to $5000)
  • Home delivered meals (if individuals are home bound, unable to do meal prep and have no other person available to prepare meals. Meals may be provided once per day for qualifying individuals)
  • Contracted nursing services
  • Training for individuals and representatives regarding employer responsibilities – STEPs program Home Care Commission
  • Environmental modifications to assist an individual to increase or maintain independence (limited to $5000).
  • Transition costs for housing for individuals relocating from an institutional setting (Intermediate Care Facility for Individuals with Intellectual and Developmental Disabilities (ICF/IDD), Institutions for Mental Illness for those 21 and younger or 65 and older, Hospitals and Nursing facilities).

Services funded through the K plan must be identified in the individual’s functional needs assessment and documented in the annual plan of care.

Level of Care

​Will the Institutional Level of Care be the same for Developmental Disabilities and Seniors?

There is no change to current level of care requirements with the implementation of the K plan for DD or seniors and people with physical disabilities.

Eligibility

How can one assessment tool assess the needs of individuals with a wide range of need and service settings?

The tool addresses the individual’s needs in any setting. Like current assessment tools, needs at all levels are captured for individuals. Federal regulation requires states to have a single tool that assesses the needs of the population served.  

Case Management

How will Service Coordinators and Personal Agents be able to add new duties with current caseloads and no new FTE?

As the new state plan design is implemented with stakeholders, the tools are, and will continue to be examined for efficiency. K state plan approval will also enable ODDS to obtain additional resources for training, technical assistance and quality assurance.  As these are in place, along with improved functionality in other ODDS technology, case management tasks will be more efficient. Repurposing some roles and services will also provide increased support to case managers.

Case Management

Why are children receiving in home services excluded from the brokerage as a case management option?

Oregon statute defines brokerage services as supporting adults. Adding children to the brokerage requires a statutory change.  The Support Services Waiver is only offered to individuals aged 18 and older who reside in their own or family home.

Level of Care

If initial LOC is done at the CDDP, does a new one need to be done if individual is referred to the brokerage?

No, the initial Level of Care would transfer to the brokerage.

Level of Care

Why can’t the brokerage do the initial LOC?

Eligibility begins at the CDDP, as will initial choice counseling. The initial LOC (on new form pending full roll out) requires eligibility specialist signature. Personal Agents are qualified to conduct an initial LOC, however, in order to maximize the state’s access to federal funds, enrollment to a waiver needs to happen as quickly as possible – which will be prior to entry to a brokerage.  The CM activity occurring at a CDDP can only be matched with federal funds if the individual is enrolled to a waiver, thus the CDDP does the LOC. 

Level of Care

What is the process if an individual disagrees with the LOC assessment?

The new tool does not change how LOC is determined, it just makes more explicit to CMS how we are arriving at the LOC determination more discreetly. Individuals will have appeal rights, and the Department is working on process and expects to have that completed within the next 60 days.

Choice Counseling
Does choice counseling only happen at initial case management assignment?
 

No. Choice is to be offered initially and at least annually as part of the person centered planning process. 

The type of Choice Counseling that occurs in conjunction with the initial determination of level of care as described above need not occur annually.  Every individual has those choices available to them year round and may request changes at any time.  Minimally, annually, the PA/SC should discuss the individual’s satisfaction with existing services and include options to make changes to the extent the individual is not satisfied.

Functional Needs Assessment

​Is the brokerage having to start doing these in July?

Individuals receiving waiver services whose plan renewal dates occur between July 1st thru August 30, 2013, will not have a functional needs assessment as part of their plan renewal; however an FNAT must be conducted for these individuals no later than June 30, 2014. 

Effective September 1, 2013, all individuals newly enrolled or renewing an annual plan will have an FNAT completed as part of the person centered planning process. FNAT results will not result in change of rates or current services levels for July 1 thru September 30, 2013.

 Effective October 1, 2013, FNAT results will contribute to the ISP/annual plan development by establishing a service level for meeting support needs of individuals receiving in home supports. Other existing rate setting tools will continue to be used (SIS/SNAP) until further notice.


Functional Needs Assessment

Will there be a character count feature displaying the current count as you type?

Not currently. The Microsoft Excel “counter” only calculates after the cell has been “entered”, which does not resolve the issue. ODDS will continue to research alternatives.

Functional Needs Assessment

​Does there need to be a goal in every section?

No. It is anticipated that most individuals will have some goals, but would not necessarily have a goal for every topic area. All of us, regardless of disability, have many areas of our life where opportunities for improvement exist, however it is not reasonable to expect any person to want to work on every aspect of their life. In the rare event that no goals are expressed in the entirety of the assessment, it would be reasonable to review potential goals at the end of the assessment.

 It is important to note that the assessor’s role if to ask the individual whether there are potential goals within each section that he/she wants to discuss during service planning. The FNAT is not the tool for establishing goals, rather identifying potential goals for the individual to determine whether to include in the development of his or her ISP. While the assessor should not limit types of goals recorded, it is recommended that assessors encourage individuals to consider whether they have a desire to increase their independence in the specific activity being addressed.

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