Developmental Services - Support Waiver
DHHS- Developmental Services
Prerequisites for Participants
- Must be at least 18 years old.
- Must be eligible for Adult Developmental Services (Intake completed)
- Must have an Individual Support Coordinator or Community Case Manager
- Must agree to a minimum of support to include planning, application/reclassification of the waiver program, and a minimum of two visits a year to the applicable site (community program, work site/or provider of work services) provided by the ISC or CCM.
- Must be Maine Care Eligible (assurance from ISC or CCM)
Responsibilities of ISC/CCM
Step 1: Planning
- Needs and services to be provided by Support Waiver must be identified in plan; identify both service needed and frequency/amount of service
- Action plan must identify ISC/CCM as responsible person for classification process
- ISC/CCM signature on plan is indication that they acknowledge and agree with the recommended services and units or cost included in the plan and other supporting documentation; cover sheet as noted above, written estimate for environmental accessibility adaptations, etc.
Step 2: Choice Letter
- ISC/CCM must provide explanation to participant and/or guardian and have signed either at or after the planning meeting
Step 3: BMS-99
- Must be completed within EIS
- Electronic signature is acceptable and hard copy not required
Step 4: Submission of Material for eligibility & level of care determination
- Copies of the plan and the Choice Letter are sent to the Support Waiver Manager.
- NOTE: They should not be sent until the BMS-99 is complete in EIS.
- Send PCP and Choice Letter to:
Ron Bridges, Support Waiver Manager
175 Lancaster Street
Portland, ME 04401
Responsibilities of Support Waiver Manager
1. Determination of eligibility/level of care
Based on the three documents noted above, the Support Waiver Manager makes a decision on eligibility
- If determined eligible, appropriate notification is sent electronically back to the ISC/CCM and the appropriate regional Resource Coordinator is copied.
- If consumer is determined eligible:
1. Appropriate notification is sent electronically back to the ISC/CCM
2. Written notification will be sent to Consumer or Guardian stating eligible or ineligible for waiver. Grievance materials will be included.
2. Authorization for Services
- The Support Waiver office transfers the appropriate information into an authorization format within EIS and the result is a “Summary of Authorized Services”
- Follows essentially the same process
- Essential for uninterrupted funding
- Annual planning dates remain unchanged
How To Send In an Eligibility Determination for Section 21 & Section 29 Services
Follow these steps if the Waiver program you are applying for is closed to new admissions and you are requesting a spot on that program’s waitlist for your client.
- Hold a team meeting – discuss the client’s need for Section 21 Comprehensive Waiver services or Section 29 Support Waiver services; recommend specific Section 21 or Section 29 Waiver services; and document the team’s decision and proposal for Waiver services in the Person-Centered Plan (commonly referred to as the Plan document)
- Have the client, or their guardian, sign a Decision Regarding Waiver Services* (commonly referred to as the Choice Letter)
- Complete and save the Section 21 DS Comprehensive HCB Waiver Assessment or the Section 29 DS Support HCB Waiver Assessment (commonly referred to as the BMS-99) in EIS
- Mail the Plan and Choice Letter (signed on or after the plan date) to the Central Office Waiver Manager - Marquardt Building 2nd Floor, 11 State House Station, Augusta Maine 04333 – for review and determination
- Send other documents and information that will help with the eligibility determination– i.e. current psychological assessment, current behavior plan, OT/PT evaluation, IEP recommendation, etc.
- If under section 21 the team is concerned for the persons health and safety and is recommending priority 1 wait list, it is recommended that the waiver eligibility funding request form be fill out.
- Include a contact name, e-mail, and phone number in case there are any questions or points of clarification needed
- The Central Office Waiver Manager will assign the eligible applicant to the appropriate waiting list, based upon criteria in Section 21.03-5 and Section 29.03-04
- The Waiver Manager will inform the client, or their guardian, as to the outcome of their eligibility determination for Waiver services, including their wait list status, in writing