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Tag Archives: Waiver

Guide to Services-Day Programs

by Heather Johnson

Typically, the most urgent need families have post-graduation is some kind of safe, supervised and productive activity for their child to engage in since they are no longer attending school. Traditionally, the options for post-school-age day programs were either supported employment in the community, an activities-based day program, or a sheltered workshop. Luckily, the quality and choices offered in day programs has increased in recent years, and there are now excellent programs to choose from. Some definitions: a sheltered workshop (or prevocational program) is intended to help individuals develop skills to work in the community, usually by doing piece or factory work and being paid per completed piece. An adult day program provides supervision and opportunities to participate in cooking, art, music or other types of recreational activities. Job supports, on the other hand, provide individuals with assistance in finding, learning and maintaining employment in the community. Adult day programs are generally located in a large setting, with staff ratios typically between 1:3 to 1:15.

 


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However, the difficulty now lies in the intricacies of the CMS Final Rule. The Centers for Medicare and Medicaid Services (CMS, also known as Medical Assistance), is the national organization that provides services. CMS is changing the way services are provided in order to maximize supports and monitor the programs. The Final Rule refers to the specific mandates the federal government is now imposing on the states. The biggest change with the Final Rule is to get as many people as possible into community jobs and to de-segregate sheltered workshops. One long-term issue within the service system is the lack of genuine employment opportunities for our folks, and the push to get as many people employed in the community as possible has led to new regulations. Basically, this means that everyone must be supported in finding employment before going to a more traditional sheltered workshop or activity-based day program. As of 7/22/2015, anyone 23 years old or younger is going to be required to complete the Office of Vocational Rehabilitation process before they can attend a day program or receive job supports through a waiver. Those over 24 and already in a workshop are “grandfathered” into their placements and do not need to go through OVR unless they want to get a job or add job supports. The OVR process provides funding for an assessment of employability and 90 days of on-the-job supports, at which point the waiver could take over providing services for that person to remain employed.

Some people are not going to be successful in a community job. However, it has also been recognized that most day programs are considered segregated because they offer no opportunities for community integration. Now, day programs and sheltered workshops are required to provide individuals with some kind of community integration, whether this is volunteering in the community, having community members come into or also use the program, or other methods of exposing the individuals to opportunities beyond the facility setting. In order to attend a program like this, though, you must have a letter from OVR stating that employment is not a possibility. The full scope of the changes affecting these programs is still unknown. According to the Pennsylvania Department of Human Services, “at this point, no decisions or definitions have been made regarding adult day program settings. The transition plan states that the Department will review Pennsylvania regulations, waiver service definitions, policies, and provider standards to assure compliance with HCBS final rule.”
Some things to consider: it is usually in the best interests of the individual to complete the OVR process while still in high school. Most, but not all, high schools offer transition services which include this assessment and support, so make sure to specifically request it. Also important: if community employment is appropriate for your child, the money made impacts his or her Social Security benefits (this includes piecework in sheltered workshops!) For more information on any of these topics, feel free to contact your supports coordinator or myself.

Heather Johnson is a Supports Coordinator Supervisor at The Arc Alliance, a nonprofit organization supporting families and individuals of all ages with developmental and other disabilities. In addition to her personal experience as a family member of those with special needs, she has been working for 18 years in all areas of the special needs community. Heather is one of the guest bloggers who will periodically post information for Kokua Network members.

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A Guide to Services for Special Needs Adults – Residential Options

This is blog post is one in a series by contributing blogger Heather Johnson.

The plan for most adults with disabilities is to eventually get a place of their own in the community, and there are a couple of ways to make that happen. This blog will discuss some options and some things to consider when making residential plans.

Community Living Arrangements (or CLA’s) are what most people know as “group homes.” Group homes can be for between one to four individuals; any placement with more than four people is known under a different name. One-person homes need to be authorized by the Office of Developmental Programs (ODP) because it is important that our individuals aren’t isolated from the community; in addition, one person homes are much more expensive to fund. Because of this, one person homes are challenging to obtain through the waiver. CLAs generally have 24 hour staffing, and staff is hired by the provider agency to do things such as assist with activities of daily living, cook, provide transportation to day programs/appointments/community outings, and medication administration. The maintenance of the house (cleaning, laundry) varies depending on the functioning level and goals of the individual, but ultimately is the responsibility of the provider agency. The staff-to-client ratio varies dependent on the functioning level and need of all the individuals in the house, but is generally 1:3 or 2:4. In addition to the daily fee paid through the waiver, an individual in a CLA also has to give 72% of their social security to the provider agency for room and board fees. Any additional expenses, such as clothes, cable, money for community events, etc. are not included.

Group homes are not the only residential option. Sometimes, people will decide to open their homes up for individuals with a disability to live with them as family; this service is called Life Sharing or Family Living. The idea behind Life Sharing is that the individual will have as typical a life as possible, and be included in a family setting instead of a staffed arrangement such as a CLA. In Life Sharing, the individual is included in things like holidays and weekend excursions, and follows the schedule of the family. This service also has a daily rate paid by the waiver, and 72% of the individual’s social security goes to paying for room and board. Generally, families get paid a monthly stipend from a provider agency that covers bills, food, and household expenses (such as cleaning supplies). The family in most cases is responsible for medication administration and transportation, and the chore arrangement is agreed upon before the individual moves in. Most families agree to one year of services, but that can be shorter if the arrangement isn’t working out. However, there are individuals who have been with the same family for years. In this service, the most important thing is ensuring a good match between the family and individual. Unfortunately, parents/siblings/other family cannot be Life Sharing providers for their own family members.

Some other residential options include Reverse Life Sharing, in which a caretaker moves in with an individual in their own home, and Unlicensed Homes which only have a maximum of 30 hours of staffing per week.

All these services require a Consolidated Waiver, as the daily rate is between $100-$400 per day. There are a few other options for individuals without that waiver, such as boarding homes or low-cost apartments that can be paid for with Social Security; unfortunately, these places can be few and far between.

The future living arrangements for family members with an intellectual disability can be a hard decision to make, but your Supports Coordinator should be able to inform you of the options available to you based on individual resources.

Heather Johnson is a Supports Coordinator Supervisor at The Arc Alliance, a nonprofit organization supporting families and individuals of all ages with developmental and other disabilities. In addition to her personal experience as a family member of those with special needs, she has been working for 18 years in all areas of the special needs community. Heather is one of the guest bloggers who will periodically post information for Kokua Network members.

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A Guide to Services for Special Needs Adults–An Overview

This is blog post is one in a series by contributing blogger Heather Johnson.

Overview

Once you have your waiver, you are eligible to start receiving services. This blog series will explain and explore some of the more popular services, but before we get into specifics, here are some general things to know:

*If your waiver has a cap, you cannot go over that amount of money. This sometimes means making hard choices, such as between summer camp or respite. Also, keep in mind that if you are at the cap, you still might have to make hard choices in July when the new fiscal year begins, because services can increase in price between one year and the next. Always be prepared to have to re-evaluate your services regularly based on cost.

*Putting services in place is not a fast process. Usually it takes three to six weeks to begin services. The first thing that happens is you’ll have a meeting with your supports coordinator (SC) to discuss what the needs are and what options are available. Next, your supports coordinator will send out referral packets to provider agencies, which basically serves to give basic information about the individual to see if the provider has vacancies or a staffing match. After that has been established, you’ll either take a tour of the facility so everyone can meet each other, or have an intake meeting at home. If everyone on the team agrees, a start date will be established. The SC will then do what is called a critical revision to the individual support plan (ISP) to start the service, and submit it to the county. The county Administrative Entity (AE) requires at least ten business days to approve a service; keep that in mind when beginning services. In emergent situations this can be circumvented, but is not recommended.

*You will not get paid money from the county or federal government. Many people have the idea that they will get a lump sum of money to spend as they see fit. The process is this: once you have a service in place, the provider bills the waiver directly. There are some options for more control in terms of hiring staff or becoming an agency-with-choice provider, which are very complicated but work for some incredibly organized individuals with time to invest. For more information on PPL (a company that provides alternative service arrangements) and agency-with-choice (AWC) providers, reach out to your supports coordinator.

*Primary caregivers, in the majority of situations, cannot also be staff. Unfortunately, you can’t be paid to provide care to your child. Sometimes a family member can get hired by a provider to provide services, but rarely ever the primary caregiver.

*There are sometimes qualifications that have to be met before certain services can be provided. For example, if an individual should need nursing, a letter of medical necessity is required from the doctor as well as a denial letter from the insurance company. For job services, the person must have gone through the office of vocational rehabilitation (OVR) and obtain documentation that either the 90 days of services have been used or the person is not a good fit for OVR. The reason for this is the waiver is the payer of last resort-if there are any other possible funding streams for any service we have to attempt to go that route first.

*Consolidated waivers are incredibly scarce. It’s a lovely idea to have your adult child fly out on their own by moving into a community living arrangement (called a CLA or group home) and having a job while you still live at home and are healthy, and ideally, that would happen for everyone. Unfortunately, there just isn’t enough money to go around. Right now, some people in dire situations do not have services because funding is not available. If an individual is safe where they are, they will not be prioritized for community placement. I apologize for the harsh truth; the funding is controlled at the government level. If we as a community really want change for our adult loved ones with disabilities, we all need to get on the phone with our legislators and demand funding for Medical Assistance, it’s the only way to get the money we need.

As always, should you have questions about waiver funding you can contact your Supports Coordinator, your county Administrative Entity, or me.

Heather Johnson is a Supports Coordinator Supervisor at The Arc Alliance, a nonprofit organization supporting families and individuals of all ages with developmental and other disabilities. In addition to her personal experience as a family member of those with special needs, she has been working for 18 years in all areas of the special needs community. Heather is one of the guest bloggers who will periodically post information for Kokua Network members.

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