Developmental Services - Support Waiver

Application Process

DHHS- Developmental Services
7/9/2007

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”

Annual Reclassification

• 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.

1. 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)
2. Have the client, or their guardian, sign a Decision Regarding Waiver Services* (commonly referred to as the Choice Letter)

3. 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
4. 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
   1. 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.
   2. 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.
   3. Include a contact name, e-mail, and phone number in case there are any questions or points of clarification needed
5. 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
   1. 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