part 5

[Virtual Presenter] Welcome to this presentation on the process of establishing individual budget allocations based on Algo level, age, and living arrangement. Today, we will discuss how individuals have the flexibility to use their budget allocation for community integration needs identified through person-centered planning. After completing assessments, individuals receive their overall budget allocation (O-B-A--). The O-B-A can be used to support their community integration needs with flexibility, and it is not limited to predetermined categories. Once the review is complete, individuals are notified of their O-B-A through their case managers. If desired, individual teams may request a formal review of their allocation through their case managers. During this review, teams are asked to provide supporting documentation, such as PCISPs, behavior-support plans, risk plans, and other relevant documents, to justify the need for placement in a different Algo level. This documentation will be carefully reviewed to determine the appropriate Algo level for the individual..

[Audio] The purpose of this announcement is to explain the process for allocating funds to individuals in the C-I-H Waiver program based on specific objectives. This program aims to provide funding to individuals with developmental disabilities in order to support their integration into the community. The process involves assessing each individual's Algo level, age, and living arrangement, and using this information to determine an overall budget allocation for them. The budget allocation is divided into three categories: Other/Residential Habilitation and Support (R-H-S--), Behavioral Support Services (B-M-A-N-), and Day services (D-A-Y-S-). However, individuals are allowed to use their allocated funds for other community integration needs identified through person-centered planning. Once the I-C-A-P and I-C-A-P addendum assessments are completed, individuals will be notified of their O-B-A (objective-based allocation) through their case managers. If needed, individual teams can request a formal review of their allocation in order to provide proper documentation and analysis of their Algo level. For example, an individual aged 25 or older would receive an annual O-B-A of $2620.80 for living with family, $5241.60 for living alone, and $7862.40 for living with one other or sharing R-H-S staff with one other. The B-M-A-N component would be $11025, and the days component would be $19089.50. The total allocation is based on the individual's Algo level. In summary, the objective-based allocation process for individuals in the C-I-H Waiver program ensures that each individual receives appropriate funding to support their community integration needs. This process allows for flexibility and allows individuals to customize their funding according to their specific needs..

[Audio] We are currently on the third slide of our presentation, which focuses on objective-based allocation for individuals in the C-I-H Waiver program. This slide will demonstrate how the budget allocation is determined based on an individual's living arrangement and Algo level. For individuals living with two others or sharing R-H-S staff with two others, their overall budget allocation will be divided into three categories: Other/Residential Habilitation and Support (R-H-S--), Behavioral Support Services (B-M-A-N-), and Day services (D-A-Y-S-). The amount allocated for each category will be based on the individual's Algo level and living arrangement. For instance, if an individual has an Algo level of 1 and lives with two others, they will receive an allocation of $2620.80 for the Other/RHS category, $11025.00 for the B-M-A-N category, and $24816.35 for the days category. It is important to note that individuals have the option to use their allocation in other areas to support their community integration needs, as identified through person-centered planning. Once the I-C-A-P and I-C-A-P addendum assessments are completed, individuals review the information and are notified of their O-B-A through their case managers. Thank you for your attention, and we will now move on to the next slide..

[Audio] This presentation will discuss the process for allocating funds to individuals in the C-I-H Waiver program based on their objectives. The budget allocation is determined by the individual's Algo level, age, and living arrangement. However, individuals also have the flexibility to use their allocation for other purposes related to their community integration needs, as identified through person-centered planning. Once the initial assessments, I-C-A-P and I-C-A-P addendum, are completed, individuals will be notified of their budget allocation through their case managers. If necessary, individual teams may request a formal review of their allocation to support the documentation and analysis of the individual's Algo level. Moving on to Section 6, we will now discuss the process for requesting a Long-Term Budget Request (L-T-B-R-) or a Short-Term Budget Request (S-T-B-R-) for the C-I-H Waiver program. The L-T-B-R is a set of qualifying questions, responses, and supporting documentation that is used to determine if a budget review is necessary. Adjustments to the allocation amount may also be made if there is a change in the individual's needs. The Individual Support Team (I-S-T--) may request a review of the assigned allocation through their case managers by submitting an L-T-B-R-. Before submitting the L-T-B-R-, the I-S-T must evaluate the needs of the individual receiving services and determine if a qualifying event has occurred. Qualifying events include: the individual's needs not being met through shared staffing, the individual completing their education, the Algo level being incorrect, a health or medical condition preventing the individual from attending day programs, the Wellness Coordination Health score being inaccurate and needing review, changes in the individual's behavioral conditions, significant errors in the I-C-A-P assessment, and incorrect I-C-A-P addenda (behavioral and health factors). If the I-S-T determines that the individual requires increased support after reviewing the functional assessment findings, they must provide supporting documentation to the individual's case manager to justify a review of the budget allocation. The waiver case manager must then submit the L-T-B-R to the Bureau of Disabilities Services (B-D-S--) with the necessary documentation..

[Audio] Ladies and gentlemen, I am here to present the process for allocating funds based on objectives for individuals in the C-I-H Waiver program. This is a crucial aspect of the program as it helps individuals achieve their community integration goals. According to the program, individuals are given a budget allocation based on their Algo level, age, and living arrangement. However, they do have the flexibility to use their funds outside of these categories to support their community integration needs, as identified through person-centered planning. After completing the I-C-A-P and I-C-A-P addendum assessments, individuals review the information and are notified of their O-B-A through their case managers. Individual teams can also request a formal review of their allocations, providing documentation and analysis of their Algo level. Now, let's move on to the objective-based allocation process for the C-I-H Waiver program. This process involves several steps to ensure fairness and transparency. Firstly, the I-S-T has identified errors in the Wellness Coordination Health score and requires documentation from a medical professional outlining any changes in condition or diagnosis, as well as anticipated duration, risk factors, and any other special considerations. Secondly, if an individual's behavioral conditions change, documentation such as a behavioral support plan, monthly reports, and incident reports are needed. Thirdly, if the I-S-T believes there are significant errors in the I-C-A-P assessment, they will review it and provide detailed notes on areas that need to be reviewed. They will also require medical and behavior documentation for updating the addendum. Lastly, if the I-S-T believes there are errors in the I-C-A-P addenda (behavioral and health factors), they will require documentation from a medical professional outlining any changes in condition or diagnosis, as well as anticipated duration, risk factors, and any other special considerations. When requested, the waiver specialist will review the L-T-B-R and supporting documentation with the B-D-S-..

[Audio] We are discussing the process for objective-based allocation of funds for individuals in the C-I-H Waiver program. We take into account an individual's Algo level, age, and living arrangement when establishing an overall budget allocation using three categories: Other/Residential Habilitation and Support (R-H-S--), Behavioral Support Services (B-M-A-N-), and Day services (D-A-Y-S-). However, individuals have the flexibility to use their allocation outside of these categories to support their community integration needs identified through person-centered planning. After completing an I-C-A-P and I-C-A-P addendum assessment, individuals will review the information and be notified of their objective-based allocation through their case managers. It is important to note that the timeline for filing a Short-Term Budget Request (S-T-B-R-) appears in the Short-Term Budget Request Timeline policy, but providers, individuals, and support teams do not have to follow this exact timeline. The process must be completed within 45 calendar days of the qualifying event, and the individual's B-D-S district office must provide an initial response within 7 calendar days of receipt. Unanticipated events, such as the loss of a housemate or employment, state substantiated abuse, neglect or exploitation, behavioral needs requiring intervention, or extraordinary health or medical needs requiring intervention, must be documented for STBRs..

[Audio] We will discuss the objective-based allocation process for individuals in the C-I-H Waiver program. As part of the program, individuals have the flexibility to use their allocation outside of the three categories of Other/Residential Habilitation and Support (R-H-S--), Behavioral Support Services (B-M-A-N-), and Day services (D-A-Y-S-), to support their community integration needs identified through person-centered planning. After completing I-C-A-P and I-C-A-P addendum assessments, individuals are notified of their O-B-A through their case managers. We will outline the process for objective-based allocation for the C-I-H Waiver program, including the documentation required for S-T-B-Rs resulting from a loss of a housemate. The documentation must demonstrate the alternative support options considered before making the submission. The residential provider or waiver case manager may submit an additional S-T-B-R with supporting documentation and ongoing status reports on a month-to-month basis, not to exceed a period of 180 days from the initial unanticipated event. An email notification is sent to providers when new S-T-B-Rs are submitted by case managers. The B-D-S responds to new S-T-B-Rs within seven business days of submission. Final decisions on S-T-B-Rs are not made until case managers respond to all inquiries from the B-D-S--. The individual or legal guardian has the right to appeal any waiver-related decision of the state within 33 calendar days of the service authorization. A service authorization is issued with the release of each state decision pertaining to a PCISP. Each service authorization contains the individual’s appeal rights, as well as instructions for filing an appeal. For further guidance, see the following B-D-S policies and procedures found on the Current D-D-R-S Policies page at in.gov/fssa/ddrs: Budget Modification Request (B-M-R--).

[Audio] We are currently discussing the process for objective-based allocation of funds for individuals in the C-I-H Waiver program. Based on an individual's Algo level, age, and living arrangement, an overall budget allocation is established using three categories: 1. Other/Residential Habilitation and Support (R-H-S--) 2. Behavioral Support Services (B-M-A-N-) 3. Day services (D-A-Y-S-). However, individuals have flexibility to use their allocation outside of these categories to support their community integration needs identified through person-centered planning. After assessments are completed, individuals are notified of their O-B-A through their case managers. Individual teams may request a formal review of their allocations to support documentation and analysis of their individual's Algo level. It is important to note that the O-B-A is not used with the already-capped Family Supports Waiver (F-S-W--), Traumatic Brain Injury (T-B-I--) Waiver, or Health and Wellness (H&W) Waiver. If an individual believes that their Algo level is incorrect, they may request a personal allocation review (P-A-R--) through the case manager via a L-T-B-R-. The L-T-B-R states the reason for allocation review, and the full list of acceptable reasons for allocation review is found in Section 6.5: Long-Term Budget Request and Short-Term Budget Request. If the L-T-B-R is submitted, the waiver specialist will review the L-T-B-R-, supporting documentation, and information to determine whether an individual's Algo score is supported based on the provided information. The waiver specialist will notify the waiver case manager of any changes in the Algo or allocation. If a change in the Algo score is appropriate, an updated P-C-I-S-P must be submitted at the correct allocation level so that a service authorization with appeal rights may be generated by the B-D-S and distributed to the individual through the waiver case manager. If an individual is dissatisfied with the waiver specialist's determination, they may appeal the service authorization within 33 days of the date of the notice. During the appeal, the B-D-S shall maintain the budget from the last agreed-upon budget allocation..

[Audio] We present to you a comprehensive guide on objective-based allocation of funds for individuals enrolled in the C-I-H Waiver program. Our approach to funding allocation allows individuals to utilize their allocated resources for purposes beyond the designated categories, as identified through person-centered planning. Following the completion of I-C-A-P and I-C-A-P addendum assessments, individuals are informed of their O-B-A through their case managers. If necessary, individual teams may request a formal review of their allocations to support documentation and analysis of their individual's Algo level. We have a dedicated section on the monitoring and continuation of F-S-W and C-I-H Waiver services, which covers aspects such as reevaluation of level of care, Medicaid eligibility redetermination, and annual person-centered individualized support plan development. We hope this information will be valuable in helping you understand the process for objective-based allocation of funds within the C-I-H Waiver program..

[Audio] We will discuss the process for objective-based allocation of funds for individuals in the C-I-H Waiver program. We will also discuss the monitoring and continuation of F-S-W and C-I-H Waiver services. The P-C-I-S-P is a new plan that identifies the array of services and supports, paid and unpaid from all sources that will be used to implement desired outcomes and ensure the individual’s health and welfare while the PCISP/service authorization identifies those supports and services which are funded by the waiver. The participant, case manager, and others of the participant’s choosing from the Individualized Support Team (I-S-T--) have the right and power to command and direct the entire P-C-I-S-P process, with a focus on their preferences, aspirations, and needs. This process empowers participants to create life plans and allows the individual to direct the planning and allocation of resources to meet their self-directed life goals. The annual P-C-I-S-P is developed by the participant working with their case manager a minimum of six weeks prior to the end date of each annual service plan. The P-C-I-S-P is routinely developed to cover 12 consecutive months. Although the F-S-W is already capped at $26482 annually, budgeted amounts for PCISPs developed under the C-I-H Waiver use the objective-based allocation process described in Section 6: Objective-Based Allocation. Coordination of waiver services and other services is completed by the case manager. Within 30 days of implementation of the plan, the case manager is responsible for ensuring that all identified services and supports have been implemented as identified in the PCISP. The case manager is responsible for monitoring and coordinating services on an ongoing basis and is required to record a case note for each encounter with the participant. A formal 90-day review is also completed by the case manager with the participant. The I-S-T is advised of any concerns or needs for updates that may require scheduling of additional team meetings by the case manager. Most waiver service providers are required to submit a quarterly report summarizing the level of support provided to the individual based on the identified supports and services in the PCISP/service authorization. As part of the 90-day review process, the case manager reviews these reports for consistency with the P-C-I-S-P and POC/service plan and works with providers as needed to address findings from this review. If an annual PCISP/service authorization is not submitted or cannot be approved in a timely manner, the most recently approved PCISP/service authorization is automatically converted to a new annual PCISP/service authorization. The total cost and amount of services on the “auto converted” or “default” PCISP/service authorization is determined by the cost of services and supports appearing on the most recently approved but expiring PCISP/service authorization. The auto-converted or default PCISP/service authorization ensures that there is no loss of services for the participant. The case manager is subsequently contacted and required to complete the annual person-centered planning process to update the P-C-I-S-P and service authorization as needed. Risks are assessed during the.

[Audio] Hello and welcome to the presentation on the process for objective-based allocation of funds for individuals in the C-I-H Waiver program. This presentation will provide information on how individuals with intellectual disabilities can receive the services they need to achieve their goals. In order to ensure that individuals receive the services they need, we have established a process for objective-based allocation of funds. The C-I-H Waiver program is designed to support individuals with intellectual disabilities in their community integration needs. Based on an individual's Algo level, age, and living arrangement, an overall budget allocation is established using three categories: Other/Residential Habilitation and Support (R-H-S--), Behavioral Support Services (B-M-A-N-), and Day services (D-A-Y-S-). However, individuals have flexibility to use their allocation outside of these categories to support their community integration needs identified through person-centered planning. After I-C-A-P and I-C-A-P addendum assessments are completed, individuals review the information and are notified of their O-B-A through their case managers. Individual teams may request a formal review of their allocations to support documentation and analysis of their individual's Algo level. As part of this process, we have established a monitoring and continuation of F-S-W and C-I-H Waiver services. This includes regular review of the PCISP/service authorization by the case manager and updates a minimum of every 90 calendar days with involvement of the ISt Individuals can request a change to the PCISP/service authorization at any point, and if a change is determined necessary, the individual and/or family or legal representative and I-S-T will meet to discuss the change. The actual updating of the PCISP/service authorization is completed by the case manager based on the individual and the I-S-T discussion and determination. The case manager will transmit the service authorization electronically to the state’s waiver specialist, who will review the service authorization and confirm the following: * The individual is a current Medicaid member within one of the approved Medicaid Eligibility groups. * The individual has a current ICF/IID LOC approval. * The individual's identified needs will be met, and health and safety will be assured. * The costs are consistent with the identified needs of the individual and the services to be provided. * Signatures indicate that the individual and/or guardian accepts the service authorization; has been offered choice of certified waiver service providers; and has chosen waiver services over services in an institution. The waiver specialist may request additional information from the case manager to assist in reviewing the service authorization. Thank you for your attention, and please let us know if you have any questions..

[Audio] We are welcoming you to a presentation on the process for objective-based allocation of funds for individuals in the C-I-H Waiver program. In this presentation, we will be discussing the steps involved in establishing an overall budget allocation for individuals based on their Algo level, age, and living arrangement, as well as the flexibility to use their allocation outside of these categories to support their community integration needs identified through person-centered planning. As a case manager for the C-I-H Waiver program, it is important to monitor and continue the services provided through the Service Plan Implementation and Monitoring process. This process involves face-to-face contact with the individual at least every 90 calendar days or as frequently as needed to support their needs. We review current concerns, progress and implementation of the PCISP, and conduct risk assessments to ensure the individual's needs are being met. Meetings may occur in the home of the individual or another location convenient to the individual. For individuals living in a home owned or controlled by the waiver provider, there must be at least one unannounced visit in the home each year. I-S-T meetings are now required at least semiannually, or when requested by the individual, family, B-D-S or other team members. However, face-to-face contact and team meeting requirements for individuals with high risk or health needs remain at least every 90 days or more often as determined by the ISt We use a monitoring checklist by the case manager and I-S-T to systematically review the status of the PCISP/service authorization, any behavioral support program, the individual's choice and rights, medical needs, medications, seizure management, nutritional/dining needs, incident review, staffing issues, fiscal issues, risk plans and any other issues that may be identified in regard to the satisfaction and health and welfare of the individual. The checklist is also used to verify that emergency contact information is in place in the home, including the telephone numbers for Adult Protective Services or Child Protective Services and the B-D-S Quality Assurance Services..

[Audio] We are now moving on to Section 7: Monitoring and Continuation of F-S-W and C-I-H Waiver Services. The F-S-W and C-I-H Waiver includes a process for addressing problems related to services provided to individuals. Case managers conduct face-to-face visits with each individual at least every 90 calendar days to review and update the monitoring checklist, and obtain agreement from the I-S-T for any needed updates. Case managers investigate the quality of individual services and identify any problems related to individual services not being in place. This information is recorded on the monitoring checklist. For each identified problem, the case manager identifies the time frame and responsible person for corrective action, communicates this information to the I-S-T--, and monitors to ensure that corrective action takes place by the designated deadline. Case manager supervisors, directors or other identified executive management staff within each case management provider agency monitor each problem quarterly via a report from the state’s case management system to ensure that case managers are following up on and closing out any pending corrective actions for identified problems. At least every 90 calendar days, case managers update the individual’s P-C-I-S-P progress notes to indicate whether all providers and other team members are current and accurate in their implementation of plan activities on behalf of the individual. Any lack of compliance on the part of provider entities or other team members is noted within individual-specific case notes, flagged for follow-up and communicated to the noncompliant entity for resolution. If the individual is no longer intellectually or developmentally disabled, no longer requires home and community-based services, is no longer eligible for Medicaid services, or no longer meets ICF/IID LOC criteria, their waiver services will be terminated. If the individual is convicted, sentenced and incarcerated for more than 30 days, enters a Medicaid-funded long-term care facility for 30 days or less, engages in out of state travel that does not meet the standards for reimbursement of out of state home and community-based waiver services as defined in B-D-S policy, or is arrested and remains in jail awaiting trial, their waiver services will be interrupted. If the individual voluntarily withdraws, chooses institutional placement, remains in a Medicaid-funded long-term care facility for more than 30 days, dies, needs services so substantial that the total cost of Medicaid services for the individual would jeopardize the waiver program’s cost-effectiveness, or no longer requires home and community-based services, their waiver services will be terminated..

[Audio] Individuals enrolled in the C-I-H Waiver program have the opportunity to receive an objective-based allocation of funds based on their Algo level, age, and living arrangement. This allocation is divided into three categories: Other/Residential Habilitation and Support (R-H-S--), Behavioral Support Services (B-M-A-N-), and Day services (D-A-Y-S-). However, individuals have the option to use their allocation for other needs related to community integration as identified through person-centered planning. Once individuals have completed an assessment, they will review the information and be informed of their objective-based allocation (O-B-A--) through their case managers. If needed, individuals may request a formal review of their allocation to support documentation and analysis of their Algo level. It is important to note that waivers cannot be halted or terminated due to non-responsiveness from individuals, families, or guardians without prior approval from the Bureau of Developmental Disabilities Services (B-D-S--). In cases of waiver termination due to institutionalization or death, the termination will be entered into the system by the case manager and accepted by the state, which will then generate a service authorization. Within three calendar days of the termination being processed, the case manager must provide the individual or guardian with a copy of the service authorization, instructions for Appeal Rights as an H-C-B-S Waiver Services Recipient, and an explanation of the termination. Any other available service options will also be discussed with the individual and guardian. If an individual who has been terminated from the waiver program wishes to return within the same waiver year, they may do so without being placed on a waiting list, as long as they are still eligible. If an individual had been temporarily suspended from the program within the past 30 calendar days, they may resume the waiver program with the same Level of Care (L-O-C--) approval date and Person-Centered Individual Support Plan (P-C-I-S-P)/service authorization if their condition has not significantly changed and their needs are still being met by the PCISP/service authorization. The case manager must certify that the individual still meets the L-O-C criteria and complete a "Re-Start" Data Entry Worksheet (D-E-W--) in the Insite database, which will be electronically submitted to the D-D-R-S case management database. This information will then be reviewed by a waiver specialist and automatically transmitted..