Developmental Services - Case Management Manual
Waiting List Management Protocol
September 24, 2003
Statement of Purpose:
Maine will have a consistent, fair and predictable method by which it manages the Developmental Services Waiver Waiting List.
The Developmental Services Waiver program is a Medicaid (known in Maine as "MaineCare") service. Individuals must be found to be financially eligible for MaineCare, medically eligible for these services, and eligible because there is an available slot. Eligibility for persons to receive Developmental Services Waiver services shall be prioritized on the basis of the individuals' needs. The Department of Behavioral and Developmental Services' Enterprise Information System (EIS) will identify individuals on the waiting list and their needs.
- Individuals found financially and medically eligible for Developmental Services Waiver services, will be allowed to apply for services.
- The intake worker will enter the application information on the EIS.
- As support recommendations for consumers already receiving case management services are identified, the assigned Case Manager will enter the information on the EIS.4. If there is a slot available, eligible individuals will be assigned a slot. If a slot is not available, the individuals will be asked whether they want to be placed on a waiting list. Individuals, who want to, will be placed on the waiting list.
- In order to keep information current and consumers and families informed, the Regional Office will:
a. For individuals receiving case management services through the Regional Office: keep the data in the EIS current in relationship to changing needs;
b. For individuals not receiving case management services through the Regional Office: contact consumers and/or families via mail, at least annually, to request updated information relative to previously identified needs;
c. Continue to review its current budget and other resources regarding the availability of funding for the services requested;
d. Review waiting list information generated by the EIS in each Region on a monthly basis and prepare information for the Central Office at the time of budget submission.
Routine Implementation Priorities:
Individuals on waiting lists shall be given a slot as slots become available based on the following three (3) categories of priority (Priority #1 is the top priority):
- Priority #1: By statute 22 MRSA §3473, the Department is required to provide adult protective services to persons with mental retardation who are faced with abuse, neglect, exploitation or the substantial risk of abuse, neglect or exploitation. The Department is required to respond to such situations immediately in order to assure the health and safety of the individuals. Accordingly, a certain number of slots must be reserved and available for these individuals. Historically, for the fiscal years ending June 30, 2000, 2001 and 2002 the average number of slots utilized for these Priority 1 individuals was 120. However, for any given year, the number of slots may vary, and the Department may need a greater number of slots for these Priority 1 individuals.
- Priority #2 includes individuals whose needs if not addressed within the specified time period, the potential will exist for the consumer to be in a situation with risk of physical or emotional harm or significant regression. Examples are as follows:
a. School-aged individuals receiving residential support and needing that support to continue,
b. Individuals currently placed outside the state of Maine who can be better served in Maine,
c. Adults who will graduate (or who have graduated previously) from high school have no continued supports,
d. Individuals living with a family or direct support professional(s) who may no longer be able to continue in that capacity
e. An individual whose medical or behavioral needs are creating stress on the family or current living situation,
f. An individual at risk of involvement with the criminal justice system,
g. An individual living with a family or direct support professional(s) who must work to maintain the household and who would be unable to work if some support services are not provided,
h. An individual living in unsafe or unhealthy circumstances
I. An individual ready to leave a psychiatric hospital, acute care facility, nursing home, shelter or jail and who would be unable to live in the community without services.
- Priority #3includes individuals whose needs do not place him or her at risk of physical or emotional harm or regression. An example is as follows:
a. Individuals wishing to move but are unable to do so under any other state or MaineCare program.
In the situation whereby a child and an adult have concurrently requested Home & Community–Based Waiver Services and both are being considered for a single slot3, the following process shall be utilized in order to make a final determination on which individual will be prioritized to get Developmental Services waiver services.
- Individuals must be identified as meeting Priority #2 criteria of the Waiting List Management Protocol.
- The Program Director of Developmental Services (Jane Gallivan) and the Director of Children’s Services (Joan Smyrski) will review all submitted documentation, and as necessary request a case presentation by the DHHS regional staff involved to assure that they are fully informed.
- Case presentations will include such information as, the individual’s current status and needs, a clear description of urgency in the case, and health & safety concerns.
- Clinical consultation shall be provided by DHHS Medical Director (s) if consensus between the Program Directors is not reached.
- Final determination of who shall received priority for a slot shall be reached within 10 working days of the initial request.
Critical Incident Reporting will also occur through the reportable events system. The IDS will notify the appropriate people of any event that is reported that meets the criteria of a Critical Event.