What Services Does Johnny Have

What Funding Does Johnny Have?

Medicaid Funding Sources:

Ø Mental Retardation Waiver Program (MRWP waiver)

Ø Community Habilitation and Support Services Waiver Program (CHSS waiver)

State Funded Source:

Ø Grant in Aid (GIA)

Services available under the MRWP waiver program:

Ø Residential (RTS)

Ø Personal Support (PS)

Ø Day Habilitation (DH)

Ø Day Supports (DS)

Ø Supported Employment (SE)

Ø Natural Support Enhancement Services (NSE)

Ø Special Medical Supplies (SMS)

Ø Special Medical Equipment (SME)

These services are offered individually as needed and availability of funds. So an individual may only have PS, or only have DS or may have RTS and SE. It will depend on the needs of the individual. The PA will indicate which services under the MRWP the person has.

Services available under the CHSS waiver program:

This is a bundled waiver that is not a "menu" of services so all Medicaid reimbursed service needs identified on the ISP must be provided by the direct support agency. These service needs may include the following:

Ø Residential

Ø Personal Support

Ø Day Habilitation

Ø Day Supports

Ø Supported Employment

Ø Special Medical Supplies

Ø Special Medical Equipment

Services Available under Grant in Aid Funding:

Ø Family Support (FS)

Ø Autism Family Support (AFS)

Ø DD Family Support (DDFS)

These are all basically the same. The primary difference is the eligibility criteria. AFS requires the individual to a have diagnosis within the Autism spectrum. FS and DDFS requires that the individual have an MR/DD diagnosis. These services may include respite, supplies, equipment, personal support, dental services, medical care, specialized clothing, recreational/leisure activities, transportation and other services as defined by individual need.

Ø Comprehensive Day Services

Services Location of Service Delivery

Employment Services Facility or Community Based

Individual

Group (enclave, mobile crew)

Non-Employment Services Facility, Community and some

cases in the home if not RTS or

PS setting

Indirect Intervention Services Community Based

Direct non-employment services Facility or Community Based

Ø Contract Funded Residential Supports Can be provided in a home

owned or rented by the support

agency, for people living in a

home or apartment that they own

or rent themselves.

Different agencies will call these services by different names based on their internal language, however the service names listed above must be used on the Plan of Care page in the ISP.

Exclusions, Myths and Facts

Ø Individuals CANNOT be on the MRWP and CHSS waiver at the same time.

Ø People cannot receive MRWP services and receive GIA services at the same time if they are for the same thing.

Ø If there is not DMA-6 then the consumer is NOT on a waiver and the funding source would be GIA.

ISP Considerations

When recording the DD System Provided Services in Section II of the ISP you will ONLY record the applicable bulleted services listed in this document.

If it is not in this document it is not a DD System Provided service.

Exclusion chart:

If the person has this services	The person can also have this/these services	But cannot have this/these services
MRWP – RTS	MRWP DH, MRWP DS, MRWP SE, GIA Comprehensive Day Services	Any CHSS services, GIA Contract Funded Residential Services, MRWP NSE, and MRWP PS
MRWP – PS	MRWP DH, MRWP DS, MRWP SE, GIA Comprehensive Day Services	Any CHSS services, GIA Contract Funded Residential Services, MRWP NSE, and MRWP RTS
MRWP – DS	MRWP RTS, MRWP PS, MRWP NSE or GIA Contract Funded Residential Services	Any CHSS services, GIA Comprehensive Day Services, MRWP SE and MRWP DH
MRWP – DH	MRWP RTS, MRWP PS, MRWP NSE or GIA Contract Funded Residential Services	Any CHSS services, GIA Comprehensive Day Services, MRWP SE and MRWP DS
MRWP - NSE	MRWP DS, MRWP SE, MRWP DH or GIA Comprehensive Day Services	Any CHSS services, GIA Contract Funded Residential Services, MRWP RTS and MRWP PS
MRWP - SE	MRWP RTS, MRWP PS, MRWP NSE or GIA Contract Funded Residential Services	Any CHSS services, GIA Comprehensive Day Services, MRWP DH, and MRWP DS
CHSS – Residential	No additional funding	Any MRWP and Any GIA services
CHSS – Personal Support	No additional funding	Any MRWP and Any GIA services
CHSS - Day Habilitation	No additional funding	Any MRWP and Any GIA services
CHSS – Day Support	No additional funding	Any MRWP and Any GIA services
CHSS – Supported Employment	No additional funding	Any MRWP services and Any GIA services
GIA – FS, DDFS or AFS	MRWP DS, MRWP, DH, MRWP SE, GIA Comprehensive Day Services	Any CHSS services, MRWP NSE, MRWP RTS, MRWP PS
GIA – Comprehensive Day Services	MRWP RTS, MRWP PS, MRWP NSE or GIA Contract Funded Residential Services	Any CHSS services, MRWP DS, MRWP DH and MRWP SE
GIA – Contract Funded Residential Services	MRWP DS, MRWP DH, MRWP SE or GIA Comprehensive Day Services	Any CHSS services, MRWP RTS, MRWP PS and MRWP NSE

Examples of the Plan of Care Page:

MRWP Residential (RTS)

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
MRWP	RTS	24/7 324 days a yr.	Acme	138.56 per day 324 units

MRWP Personal Support (PS)

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
MRWP	PS	160 days per year/5 hrs per day	Acme	122.99 per day 160 units

MRWP Day Habilitation (DH)

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
MRWP	DH	240 days per yr, 6 hrs per day/5 days per week	Acme	70.00 per day – 240 units /3.04 an hour – 5760 units

MRWP Day Supports (DS) Facility Based

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
MRWP	DS – Facility – Day Hab and Pre-Voc	60-120 hrs per month	Acme	833.33 per month/ 12 units

MRWP Day Supports (DS) Community Based

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
MRWP	DS –Community– Day Hab	30 hrs per month	Acme	833.33 per month/ 12 units

MRWP Day Supports (DS) Community Based

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
MRWP	DS –Community– Day Hab and SE	30 hrs per month	Acme	833.33 per month/ 12 units

MRWP Day Supports (DS) Combination of Facility and Community Based

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
MRWP	DS –Combo–Pre-Voc and SE	40 hrs per month	Acme	833.33 per month/ 12 units

MRWP Day Supports (DS) Combination of Facility and Community Based

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
MRWP	DS –Combo–Day Hab and Pre-Voc	40 hrs per month	Acme	833.33 per month/ 12 units

MRWP Day Supports (DS) Combination of Facility and Community Based

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
MRWP	DS –Combo–Day Hab	40 hrs per month	Acme	833.33 per month/ 12 units

MRWP Day Supports (DS) Combination of Facility and Community Based

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
MRWP	DS –Combo–Day Hab and SE	40 hrs per month	Acme	833.33 per month/ 12 units

MRWP Supported Employment (SE)

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
MRWP	SE	Example: 2 x week 4 hrs each day	Acme	1.72 per unit/3840 units per year

Natural Support Enhancement Services (NSE)

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
MRWP	NSE – Example Respite or PS	(PS) 5 days per week/4 hours per day 52 weeks a year or 8 hours of respite per month	Acme	11,907 /200units per year

Special Medical Supplies (SMS)

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
MRWP	SMS	1 box (96 indv.) of diapers per month	Acme	1,659.84 per year

MRWP Special Medical Equipment (SME)

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
MRWP	SME	Diabetes supplies (lances, etc.) 1 month	Acme	580.00 per year(dollar amount is individual specific – refer to PA for authorized amount)

CHSS Residential

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
CHSS	RTS	24/7 324 days a yr.	Acme	188.75 per day or 102.00 per day /324 units per year

CHSS Personal Support

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
CHSS	PS	160 days per year/5 hrs per day	Acme	188.75 per day or 102.00 per day/160 days per year

CHSS Day Habilitation

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
CHSS	DH	240 days per yr, 6 hrs per day/5 days per week	Acme	188.75 per day or 102.00 per day/160 days per year

CHSS Day Supports

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
CHSS	DS	240 days per yr, 6 hrs per day/5 days per week	Acme	188.75 per day or 102.00 per day/160 days per year

CHSS Supported Employment

Service Funding	Service Description	Frequency/ Schedule	Provider	Rate
CHSS	SE	Example: 2 x week 4 hrs each day	Acme	188.75 per day or 102.00 per day/160 days per year