waivers

[Guest guest]

This is a very long post but it should cover all of the information that you will need to start thinking about obtaining services. I am sending it to the whole list instead of privately to you so that everyone can benefit from this information. Bowen

Firstly, I would encourage you to become a member of The Arc of Georgia and encourage others to do the same- family membership is only $ 20 a year. I have attached the benefits of membership and a membership form so you can review. The address for The Arc of Georgia is :

The Arc of Georgia

1900 Century Place Suite # 360

Atlanta GA 30345

404-634-5512 Fax 404-634-9512

Executive Director, Janice Rossi

We also have a wonderful Statewide Education Committee where we work collaboratively with other agencies in GA to improve Education, transition, policy issues, adult services and much more. Please visit www.arcga.org for more information.

Another great resource is http://www./group/GA-ParentNetwork We are an online discussion group for parents in GA who have children and adolescents with disabilities. We offer assistance , support and resources for Education information, Medicaid and insurance issues, and other issues that parents of special needs children will find beneficial. This group also offers periodic trainings for parents concerning Education issues .

Beckett waiver information :

Beckett is called the Deeming waiver- call your local DFACS office to get an application. If your child has a serious medical condition ( Bipolar, ADHD and many mental health disorders are included as well as the typical health issues such as blindness, deafness, CP, etc. ) that requires chronic healthcare and you exceed the typical Social Security Medicaid income level , your child can qualify for this. It is based on his disability, not your income. This will provide many services - testing, evaluations, physical therapy, OT, speech therapy, counseling, etc. There are forms to fill out by you and the doctor. The doctor form, the DMA-6 , is not really long but make sure your doc words it in a way that is appropriate with what your child really needs. Do not think that this is for children only who need long-term institutionalization because it is not. You will need to get a current psychological if you don't have one. You will need to write a very brief treatment plan that you intend to provide in the community. These waivers provide community based services because, in most cases, it is cheaper for them to do that than the other. Some parents get outside therapies from qualified people, use their Medicaid and are still eligible for services through the school. Some schools will try to get you to provide them with your Medicaid # and they will bill Medicaid for school-based services. Note that it is illegal for school's to limit services to what Medicaid will reimburse for, many states can bill Medicaid under a program that allows for school system reimbursement. In Ga. the Medicaid program is specifically called Children's Intervention Services for Schools.

School's don't come right out & tell parents that limits are based on what Medicaid will reimburse for but that is the "hidden" practice used to determine the frequency & intensity. What many parent's don't realize is that if they give consent to the school district to use their Medicaid, it may use up the allowable units for a month or total for the year for private therapy for things like OT, PT & ST, nutrition, counseling & nursing services. You do not have to provide them with your Medicaid # but , rest assured, they will ask. If you give them your number, this will allow them to bill and take away from your child's lifetime benefits just like it would on your private insurance. Should this happen and if the school uses up all the units , you will be in trouble. If you then want to continue private therapy, who ever bills first in a month and/or year will be the party that gets reimbursed. The private therapists/providers cannot bill the parent then for the therapy/services, but many in Ga. have had to stop seeing the kids privately when this happens. Also, any services billed to your child's Medicaid will have to be written into the IEP and have been authorized by the child's doctor beforehand which is a good safeguard. Another thing to remember is that if the school does have your Medicaid billing #, let's say they provide counseling on Tuesday at school - if you have private counseling also on Tuesday and bill your Medicaid, one of these services will be denied. To find out more information about eligibility ( some of the criteria just changed ) and to download the new pediatric forms that are required for application go to:

http://www.communityhealth.state.ga.us/ click on: "New Information on TEFRA/ Beckett Forms"Georgia Medical Care Foundation (GMCF) is the contracted agency that determines deeming waiver eligibility. DFACS is only responsible for determining financial eligiblity and gathering all the information to be sent to GMCF. So, many DFACS caseworkers often know little or nothing about the deeming waiver. Levels of care are indicated below :

1) Hospital Level of Care (Services ordinarily furnished in a hospital under the direction of physician)

2) Skilled Nursing Home (Services provided on regular basis, that are health related but, do not require hospital level of car and can only be provided

through an institutional facility)

3) ICF/MR (Intermediate Care Facility for the Mentally Retarded) (Furnishes health or rehab services - the person must be receiving continuous active treatment including the acquisition of behaviors and prevention or deceleration of regression or loss of functional status. Does not include service to maintain generally independent people able to function with little supervision.)Regular Medicaid IS based on income but these waiver programs provide benefits that are not based on income. At least not YOUR income as a parent. It is based on the child's disability. Note that there have been attempts ( and still may be ) to attach premiums onto the Beckett so you will have to watch this and see how it plays out.

Intake offices for a State-based waiver- you would contact the office depending on which region you are in .

Note there is some " buzz " about restructuring of regions again so this will need to be updated and I can do that as changes occur.

Vendors Authorized to Perform Intake, Evaluation and

Level of Care Authorization for MHDDAD Regions

As of April 29, 2004

Central Region

Central Intake and Evaluation Team

Central State Hospital

Yarbrough Building, Room 3068

Milledgeville, GA 31062

Office: 478-445-7735

Fax: 478-445-7121

Emergency: Karla Brown – 478-731-4970

East Central Region

Columbus Community Services

1058 Claussen Road

Suite 108

Augusta, GA 30907

Phone: 706-736-0401

Fax: 706-736-0403

Emergency: 706-951-8372 or 678-592-4172

Metro Region

Columbus Community Services

2300 Mill Road

Suite 100

Atlanta, GA 30345

Phone: 770-938-5310 (24 hrs.)

Fax: 770-938-7815

North Region

North Intake and Evaluation Team

475 Tribble Gap Road

Suite 120

Cumming, GA 30040

Phone: 770-886-3407

Fax: 770-886-8540

Emergency: 678-852-4302

Southeast Region

Southeast Intake and Evaluation Team

Georgia Regional Hospital-Savannah

1915 Eisenhower Drive, Bldg. 1

Savannah, Georgia 31406

Office: 912-351-6609/6610

Fax: 912-356-2553

Emergency: 912-655-6088

Southwest Region

Columbus Community Services

235 Roosevelt Ave., Suite 251

Albany, GA 31701-2372

Phone: 229-435-3212

FAX: 229-435-3262

Emergency: 229-291-3587

West Central Region

*Columbus Community Services

1501 13th Street, Suite E

Columbus, GA 31901

Phone: 706-494-5929

Fax: 706-494-5931

Emergency: 706-536-1545

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Natural Supports Enhancement waiver

Administrative costs and overhead costs for MRWP Natural Support Enhancement Services (NSE) differ from provider to provider and are typically designated within the terms of the contract between the Provider and the Region. Appropriate charges for administrative and overhead costs should be based on sound standard accounting principles and procedures and typically range between 9% and 12% of billed service. The monthly administrative costs include the costs of managing the NSE services, including any home monitoring visits required by private home care regulations. Rates for respite and personal support services within a NSE budget are established in the same manner as rates for these individual services in the MRWP and include the service plus the cost of maintaining the employee providing the respite or personal support service. Hammond oversees Natural Support Services in the Office of DD and can be reached by e-mail or at (404) 657-2312 for any additional clarification needed.

The Natural Support Enhancement Services Handbook is available on the DHR website. Some revisions are currently being made to the handbook. The revised handbook will be posted to the website in the near future. If you would like, can send you a copy of the revised version when available. Please call her and just let her know that I asked you to call.

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I have also attached a file that tells what each waiver is and what supports are available under each one.

This is alot of information but, hopefully, you will be able to work through it.

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Subject: Waivers

There are three Medicaid waiver programs that have waiting lists in Georgia.

Mental Retardation Waiver Program ( or MRWP )

This is for people with MR and other developmental disabilities. To give you an

idea, as of Feb. 2004, there were 4,276 individuals waiting on the MRWP waiting

list for services such as respite, family support, supported employment, day

programs. in home personal supports, residential or a combination of the above.

Individuals who have a Medicaid waiver are entitled to ALL Medicaid services

that are deemed necessary. I have the current numbers as of April 2004 also if

you are interested.

The Independent Care Waiver Program ( or ICWP )

This is for people with physical disabilities or traumatic brain injury. To give

you an example, as of Feb. 2004, there were 262 people on this waiting list. I

have these current numbers also if you are interested.

The Community Care Services Waiver ( or CCSP )

Waiver for the elderly with disabling conditions and also people with severe

physical disabilities who just need some in-home support services . There are at

least an equal number of non-Medicaid eligible elderly people ( based on a 5

year average ) waiting on this list.

Two other waivers that don't have waiting lists :

Deeming Waiver ( also known as the Beckett waiver ) waives the family's

income restrictions and allows children with severe medical and / or

developmental disabilities who meet the Deeming Waiver eligibility requirements

, access to Medicaid, up to age 18. This waiver only provides eligibility for

Medicaid services- services themselves do NOT come with this waiver.

Oxygen/ Ventilator Dependent Waiver Program also known as the Model Waiver

provides services such as in home nursing, for families whose children are

leaving a hospital using oxygen or using a ventilator. The purpose of this

program is to teach families how to provide the nursing care.

Services available under each of the above

MRWP : personal supports in the home, home care, residential training and

supervision, group home, supported employment, job coaching and development,

service coordination , case management, day habilitation, service center or day

program. natural supports enhancement

CHSS : Two models. One is a Community Habilitation and Support Services

Institutional where services would include 24 hour a day care services and

service monitoring. The other is Community Habitation and Support Services in

the Community . Services include personal care services in the home or

residential placement

ICWP : personal support services based on needs

Beckett : services for children - makes child Medicaid eligible.

Respite and personal supports not based on family income.

Usually converted to a Community Care Services Program Waiver at age 18

All waiver services are SLOT BASED. That means that you must be awarded the slot

basically. Slots are awarded based on funding availability and are life-long as

funding lasts. Medicaid waiver slots are a combination of Federal funds and

State matching funds. The rates for services are set by Medicaid and do not vary

within the same waiver. However, different waivers do have different rates.

To apply for a waiver slot :

You must be on the planning list. To get on the planning list, you must call

your Regional Office to make an appt. with the Intake and CET ( Clinical

Evaluation Team ) for the region in which you live. Waiver slots are given out

based on " most in need " and recipients must be on the planning lists. You may

get on this planning list at any time in the lifetime of the consumer. This

tells the Region in which you live what needs are out there even if you are not

currently ready to receive services. Also, there are some services available

that do not require a waiver. The process is that you go through the Intake

process, you will be added to the planning list and the statement of need will

be established. If the need changes, ( i.e death, degeneration of condition,

student graduating from high school and needing adult services ), you must

notify your CET. The CET will evaluate consumer needs and, as waivers become

available, they will be offered to consumers on a " most in need " basis. Once

you have been offered a waiver slot, you will assigned a Support Coordinator

who will walk you through the rest of the process. During this process of forms,

paperwork, assessments, you can choose you provider for the services. After you

choose a provider, the Support Coordinator will continue on the case to

coordinate or monitor the services and the provider, and to serve as case manger

for the consumer making routine visits, inspections, and documentation.

Supported Employment is a comprehensive program that assists persons with

disabilities to be " supported " in their vocational career with help from

agency and staff. Staff will help with development, hiring and training. A job

coach will stay with the consumer until he is comfortable with the job and then

will check on a routine basis to prevent regression and to make needed changes.

A Supported Employment Waiver is the funding source sometimes used to pay for

this service. With this waiver, the consumer would receive a Service Coordinator

and be able to choose an agency to serve as his Supported Employment Provider.

This would include a job coach and training staff- under this waiver, working

no less than 20 hours a week should be expected.