SW 644: Issues in Developmental DisabilitiesSW 644: Issues in Developmental Disabilities

Supports for Children with Long-Term Support NeedsSupports for Children with Long-Term Support Needs

Julie Bryda, MSSW Julie Bryda, MSSW Alice Thorson, MSSWAlice Thorson, MSSW

Department of Health Services, Department of Health Services, Bureau of Long-Term Support, Children’s SectionBureau of Long-Term Support, Children’s Section

Department of Health ServicesDepartment of Health ServicesBureau of Long-Term SupportsBureau of Long-Term Supports

Overview of Supports for Children Overview of Supports for Children with Long-Term Support Needswith Long-Term Support Needs

Funding Options for ChildrenFunding Options for Children

Medicaid cardMedicaid card

Katie Beckett ProgramKatie Beckett Program

Birth to 3 ProgramBirth to 3 Program

Family Support Program Family Support Program

CLTS waiversCLTS waivers

Eligibility ProcessEligibility Process

Functional Screen is used to determine a Functional Screen is used to determine a child’s “level of care”child’s “level of care”

Child’s disability must result in a substantial functional limitationin three or more of the following five areas:

a. Self care b. Receptive or expressive language c. Learning d. Mobility e. Self direction

Functional ScreenFunctional Screen

Determines eligibility for:Determines eligibility for: Family Support ProgramFamily Support Program Katie Beckett Program Katie Beckett Program

(MA Eligibility)(MA Eligibility) CLTS WaiversCLTS Waivers Community Options Community Options

ProgramProgram CCS ServicesCCS Services Mental Health Wrap Mental Health Wrap

Around ServicesAround Services

Does not determine for:Does not determine for: Birth to 3 ProgramBirth to 3 Program Special Education Special Education

ServicesServices Regional Children with Regional Children with

Special Health Special Health Care Needs Care Needs CentersCenters

Medicaid CardMedicaid Card

Ways to access a Medicaid card:Ways to access a Medicaid card:• Healthy Start, SSI, Badger Care, Katie Healthy Start, SSI, Badger Care, Katie

Beckett ProgramBeckett Program• Services must meet the definition of Services must meet the definition of

Medical NecessityMedical Necessity• Some services require Prior AuthorizationSome services require Prior Authorization

Which Program?Which Program?

If a child is eligible for multiple programs and If a child is eligible for multiple programs and meets multiple levels of care the county needs meets multiple levels of care the county needs to determine which target group, programs, and to determine which target group, programs, and services are most appropriate to meet the needs services are most appropriate to meet the needs of the child. The county will utilize the program of the child. The county will utilize the program most appropriate to the child’s need. most appropriate to the child’s need.

The Katie Beckett The Katie Beckett ProgramProgram

The Katie Beckett ProgramThe Katie Beckett Program

Special Medicaid eligibility for children Special Medicaid eligibility for children under 19 years old with long-term under 19 years old with long-term disabilities or complex medical needs, disabilities or complex medical needs, living at home with their familiesliving at home with their families

Must meet Level of Care for DD, PD or Must meet Level of Care for DD, PD or SEDSED

Disability determination requiredDisability determination required

The Katie Beckett ProgramThe Katie Beckett Program

Child’s income/assets within current MA Child’s income/assets within current MA guidelinesguidelines

Does not incur a cost at home to the Does not incur a cost at home to the Medicaid Program that exceeds the Medicaid Program that exceeds the potential institutional costpotential institutional cost

Approximately 5100 children currently Approximately 5100 children currently enrolledenrolled

The Family Support ProgramThe Family Support Program

The Family Support ProgramThe Family Support Program

Founded on belief that parents of children with Founded on belief that parents of children with severe disabilities know best what they needsevere disabilities know best what they need

Individual services and supports to families with a Individual services and supports to families with a child with severe disabilitieschild with severe disabilities

Offers information and help in finding services, Offers information and help in finding services, maximizing community resources, connecting maximizing community resources, connecting families with other families to strengthen natural families with other families to strengthen natural supportssupports

The Family Support The Family Support ProgramProgram

Provides flexible funding for up to Provides flexible funding for up to $3,000 per year per eligible $3,000 per year per eligible childchildCan help fill gaps of other programs by Can help fill gaps of other programs by funding needed services & goods funding needed services & goods that that can’t be obtained through other can’t be obtained through other sourcessourcesAverage FSP allocation $1,500Average FSP allocation $1,500

Children’s Long Term Children’s Long Term Support WaiversSupport Waivers

CLTS WaiversCLTS Waivers

There are three CLTS Waivers:There are three CLTS Waivers:Developmental Disabilities (DD)Developmental Disabilities (DD)Severe Emotional Disturbance (SED)Severe Emotional Disturbance (SED)Physical Disabilities (PD)Physical Disabilities (PD)

CLTS Waiver EligibilityCLTS Waiver Eligibility Waiver eligible level of care for appropriate target Waiver eligible level of care for appropriate target

groupgroup DD, PD, or SEDDD, PD, or SED

For state matched slots, Disability Determination For state matched slots, Disability Determination by Disability Determination Bureau (DHS)by Disability Determination Bureau (DHS)

Resides in eligible settingResides in eligible setting Meets any applicable residency requirementsMeets any applicable residency requirements Financial EligibilityFinancial Eligibility Determined to have need for waiver servicesDetermined to have need for waiver services Additional criteria for Intensive In-Home Autism Additional criteria for Intensive In-Home Autism

Treatment servicesTreatment services

CLTS Waiver FundingCLTS Waiver Funding

Different ways for a child to receive funding Different ways for a child to receive funding through the CLTS Waivers:through the CLTS Waivers:

Local match (local dollars)Local match (local dollars) Family Support ProgramFamily Support Program Community Options ProgramCommunity Options Program

State match State match

CLTS Waiver ServicesCLTS Waiver Services

Specific Services are based on Specific Services are based on individual needindividual need

Experimental or Aversive Experimental or Aversive Services will not be fundedServices will not be funded

CLTS Waiver ServicesCLTS Waiver Services Adaptive AidsAdaptive Aids Child Care & Foster Care ServicesChild Care & Foster Care Services

only supplemental costs related to meeting only supplemental costs related to meeting additional needs for the child’s disability are eligible additional needs for the child’s disability are eligible to be covered to be covered

Communication AidsCommunication Aids Consumer and Family-Directed SupportsConsumer and Family-Directed Supports Consumer Education and TrainingConsumer Education and Training Counseling and Therapeutic ResourcesCounseling and Therapeutic Resources Daily Living Skills TrainingDaily Living Skills Training Day ServicesDay Services

CLTS Waiver Services CLTS Waiver Services (continued)(continued)

Home ModificationsHome Modifications Intensive In-Home Autism Treatment ServicesIntensive In-Home Autism Treatment Services Personal Emergency Response SystemsPersonal Emergency Response Systems Respite CareRespite Care Specialized Medical and Therapeutic SuppliesSpecialized Medical and Therapeutic Supplies Specialized TransportationSpecialized Transportation Support and Service CoordinationSupport and Service Coordination Supported EmploymentSupported Employment Supportive Home CareSupportive Home Care

HISTORY OF CHILDREN’S HISTORY OF CHILDREN’S LONG TERM SUPPORT LONG TERM SUPPORT

WAIVERSWAIVERS

What is a Waiver?What is a Waiver? The Medicaid Home and Community Based Waiver The Medicaid Home and Community Based Waiver

(HCBW) programs were authorized by Congress in (HCBW) programs were authorized by Congress in 1981, and began in Wisconsin in 1983 with the 1981, and began in Wisconsin in 1983 with the Community Integration Program for the adult populationCommunity Integration Program for the adult population

The Medicaid waivers represented a significant step, The Medicaid waivers represented a significant step, taken to mitigate the Medicaid program’s institutional taken to mitigate the Medicaid program’s institutional bias that had led to the extensive development and bias that had led to the extensive development and utilization of nursing homes and Intermediate Care utilization of nursing homes and Intermediate Care Facilities for the Mentally Retarded (ICF-MR), Facilities for the Mentally Retarded (ICF-MR),

Recognizing the problem, Wisconsin had taken its own Recognizing the problem, Wisconsin had taken its own steps to reverse the trend toward institutionalization with steps to reverse the trend toward institutionalization with the creation of numerous waiver programs the creation of numerous waiver programs

HISTORY OF CLTS WaiversHISTORY OF CLTS Waivers There are three CLTS Waivers, one waiver for There are three CLTS Waivers, one waiver for

children with:children with: Developmental Disabilities (DD)Developmental Disabilities (DD) Severe Emotional Disturbance (SED)Severe Emotional Disturbance (SED) Physical Disabilities (PD)Physical Disabilities (PD)

The CLTS Waivers started Jan. 1, 2004The CLTS Waivers started Jan. 1, 2004 Children are eligible up to age 22 in non-Children are eligible up to age 22 in non-

Family Care Counties and age 18 in Family Family Care Counties and age 18 in Family Care CountiesCare Counties

History of CLTS WaiversHistory of CLTS Waivers 1997 CLTS Redesign1997 CLTS Redesign Review what is working well with the current Review what is working well with the current

system and the issues that need to be system and the issues that need to be addressedaddressed

Recommend Best Options about how long-term Recommend Best Options about how long-term care services for children should be designed care services for children should be designed and managedand managed

The Children’s Waivers were approved by the The Children’s Waivers were approved by the federal Centers for Medicare and Medicaid federal Centers for Medicare and Medicaid Services (CMS) under the Medicaid rules that Services (CMS) under the Medicaid rules that permit states to flexibly use Medicaid funds for permit states to flexibly use Medicaid funds for community supports and services. community supports and services.

Why CLTS Waivers?Why CLTS Waivers? Other HCBS Waivers written for adultsOther HCBS Waivers written for adults CLTS Waivers maximize match options CLTS Waivers maximize match options

for state funded programs (Family for state funded programs (Family Support Program, Community Options Support Program, Community Options Program)Program)

Flexible and family-directed Flexible and family-directed Provide services beyond what Medicaid Provide services beyond what Medicaid

fee for service can supplyfee for service can supply

County ResponsibilitiesCounty Responsibilities On September 15, 2006 the Department of Health and On September 15, 2006 the Department of Health and

Family Services (DHFS) released DDES Memo 2006-21 Family Services (DHFS) released DDES Memo 2006-21 directing the counties to implement the CLTS Waivers. directing the counties to implement the CLTS Waivers.

http://dhfs.wisconsin.gov/dsl_info/NumberedMemos/DDES/CY2006/NMemo2006-21.htm

Every county is required to implement operation of all Every county is required to implement operation of all three CLTS Waivers. The CLTS Waivers must be three CLTS Waivers. The CLTS Waivers must be operated statewide for all target groups per federal operated statewide for all target groups per federal HCBSW requirements. A county may choose to have HCBSW requirements. A county may choose to have different county departments administer different target different county departments administer different target groups for the CLTS Waivers, or may choose to contract groups for the CLTS Waivers, or may choose to contract with another county to offer services for a particular with another county to offer services for a particular target group. target group.

County ResponsibilitiesCounty Responsibilities For children from any target group whose families contact For children from any target group whose families contact

the county for long-term support services, the county must the county for long-term support services, the county must assess the child's eligibility for services under the CLTS assess the child's eligibility for services under the CLTS Waivers or other relevant programs including the Family Waivers or other relevant programs including the Family Support and Community Options Program. Support and Community Options Program.

If the child is eligible for the CLTS Waiver for any target If the child is eligible for the CLTS Waiver for any target group, but funding is not available for a slot, the county group, but funding is not available for a slot, the county must create and maintain a waiting list of those children. must create and maintain a waiting list of those children. The county agency does not need to complete a The county agency does not need to complete a comprehensive assessment until such time that funding is comprehensive assessment until such time that funding is available. This waiting list may be maintained concurrently available. This waiting list may be maintained concurrently with the Family Support or Community Options Program with the Family Support or Community Options Program wait lists. All policies regarding HCBSW waiting lists may wait lists. All policies regarding HCBSW waiting lists may be found in thebe found in the DHFS Interim HCBS Waiver Manual.

Progress to Date – Quality of Progress to Date – Quality of Children’s ServicesChildren’s Services

New methods to assure New methods to assure quality services:quality services:

Family Outcome SurveyFamily Outcome Survey Outcome-based Outcome-based

Individual Service PlansIndividual Service Plans

Number of Children Served in 2010Number of Children Served in 2010

Total of 4327 children being served Total of 4327 children being served 2262 children in state-funded slots receiving 2262 children in state-funded slots receiving

autism services (intensive and ongoing)autism services (intensive and ongoing) 1233 children in local match slots1233 children in local match slots 832 children in other state-matched slots832 children in other state-matched slots DD-2855 PD-311 SED-1161DD-2855 PD-311 SED-1161

Funding options for Funding options for Children with Mental Children with Mental

Health needsHealth needs

Funding options for Children Funding options for Children with Mental Health needswith Mental Health needs

Comprehensive Community Comprehensive Community Services (CCS)Services (CCS)

Children’s Long Term Support MH Children’s Long Term Support MH WaiverWaiver

Autism Treatment ServicesAutism Treatment Services Family Support ProgramFamily Support Program

CCS EligibilityCCS Eligibility

A child is screened using the same functional A child is screened using the same functional screen used for CLTS Home and Community screen used for CLTS Home and Community Based WaiversBased Waivers

Counties may limit CCS service on the eligibility Counties may limit CCS service on the eligibility of the child to receive Medicaidof the child to receive Medicaid

Additional eligibility criteria identifies functional Additional eligibility criteria identifies functional limits attributed to a diagnosed mental health or limits attributed to a diagnosed mental health or substance use conditionsubstance use condition

Family members may also be eligible for CCSFamily members may also be eligible for CCS

Comprehensive Community Comprehensive Community Services (CCS) -- HFS 36Services (CCS) -- HFS 36

Medicaid State Plan ServiceMedicaid State Plan Service Provides services and supports to eligible adults, older adults, Provides services and supports to eligible adults, older adults,

children and their familieschildren and their families Services are provided based on need for mental health and or Services are provided based on need for mental health and or

substance abuse services to eligible participantssubstance abuse services to eligible participants Available to counties as an option since 2004, 21 counties are Available to counties as an option since 2004, 21 counties are

currently certified and 8 more are completing applications using currently certified and 8 more are completing applications using technical assistance and start-up fundingtechnical assistance and start-up funding

The CCS program is not intended for treatment services for children The CCS program is not intended for treatment services for children with an autism spectrum disorder since CCS services are with an autism spectrum disorder since CCS services are considered rehabilitation services. The Center for Medicare and considered rehabilitation services. The Center for Medicare and Medicaid Services (CMS) issued a decision that autism treatment is Medicaid Services (CMS) issued a decision that autism treatment is rather a habilitation service. However if the child has another rather a habilitation service. However if the child has another mental health disorder the child may be eligible for the CCS mental health disorder the child may be eligible for the CCS program. program.

The CCS Service ArrayThe CCS Service Array

Each county chooses services from an Each county chooses services from an array to meet the needs of children and array to meet the needs of children and families in their communityfamilies in their community

Services are identified to be provided Services are identified to be provided within Assessment Domains specified by within Assessment Domains specified by the CCS rulethe CCS rule

Counties may request approval of unique Counties may request approval of unique services specific to their county programservices specific to their county program

CCS ServicesCCS Services AssessmentAssessment Recovery PlanningRecovery Planning Service FacilitationService Facilitation Communication and Communication and

Interpersonal Skills Interpersonal Skills TrainingTraining

Community Skills Community Skills Development and Development and EnhancementEnhancement

Diagnostic Evaluations Diagnostic Evaluations and Specialized and Specialized AssessmentsAssessments

Employment Related Employment Related Skill DevelopmentSkill Development

Medication ManagementMedication Management Physical Health and Physical Health and

MonitoringMonitoring Psycho-educationPsycho-education Psychosocial Rehabilitative Psychosocial Rehabilitative

Residential SupportsResidential Supports PsychotherapyPsychotherapy Recovery Education and Recovery Education and

Illness ManagementIllness Management Substance Abuse Substance Abuse

TreatmentTreatment Other: Individually tailored Other: Individually tailored

psychosocial rehabilitative psychosocial rehabilitative serviceservice

Children’s Long Term Children’s Long Term Supports Mental Supports Mental

Health WaiverHealth Waiver

CLTS MH Waiver EligibilityCLTS MH Waiver EligibilityChildren with Severe Emotional Disturbance must meet Children with Severe Emotional Disturbance must meet

all of the following criteria:all of the following criteria: Under the age of 22Under the age of 22 Emotional disability has persisted at least 6 months Emotional disability has persisted at least 6 months

except:except: If the disability has not persisted 6 months but the If the disability has not persisted 6 months but the

nature of the acute episode is such that nature of the acute episode is such that impairment in functioning is likely to be evident impairment in functioning is likely to be evident without intensive mental health treatmentwithout intensive mental health treatment

Condition expected to persist for more than one Condition expected to persist for more than one year year

Diagnosed by a psychiatrist or licensed psychologist Diagnosed by a psychiatrist or licensed psychologist using DSM-IVusing DSM-IV

CLTS MH Waiver Eligibility CLTS MH Waiver Eligibility (continued)(continued)

Impairment in two or more of the following capacities Impairment in two or more of the following capacities Self careSelf care Community involvementCommunity involvement Social relationshipsSocial relationships Family relationships Family relationships School or workSchool or work

Impairment is such that the child is at risk of Impairment is such that the child is at risk of hospitalizationhospitalization The child is receiving services from two or more of the The child is receiving services from two or more of the

following service systems:following service systems: Juvenile justice, Juvenile justice, Child protective servicesChild protective services Social servicesSocial services

Or one system only if the intensity of treatment needed is Or one system only if the intensity of treatment needed is three hours or more of MH servicesthree hours or more of MH services

CLTS MH Waiver services CLTS MH Waiver services Adaptive AidsAdaptive Aids Child Care & Foster Care ServicesChild Care & Foster Care Services

only supplemental costs related to meeting only supplemental costs related to meeting additional needs for the child’s disability additional needs for the child’s disability are eligible to be covered are eligible to be covered

Communication AidsCommunication Aids Consumer and Family-Directed SupportsConsumer and Family-Directed Supports Consumer Education and TrainingConsumer Education and Training Counseling and Therapeutic ResourcesCounseling and Therapeutic Resources Daily Living Skills TrainingDaily Living Skills Training Day ServicesDay Services

CLTS MH Waiver Services CLTS MH Waiver Services (continued)(continued)

Home ModificationsHome Modifications Intensive In-Home Autism Treatment ServicesIntensive In-Home Autism Treatment Services Personal Emergency Response SystemsPersonal Emergency Response Systems Respite CareRespite Care Specialized Medical and Therapeutic Specialized Medical and Therapeutic

SuppliesSupplies Specialized TransportationSpecialized Transportation Support and Service CoordinationSupport and Service Coordination Supported EmploymentSupported Employment Supportive Home CareSupportive Home Care

CLTS MH Waiver ServicesCLTS MH Waiver Services

Specific Services are based Specific Services are based on individual needon individual need

Experimental or Aversive Experimental or Aversive Services will not be fundedServices will not be funded

Autism ServicesAutism Services A unique component of the CLTS Waivers A unique component of the CLTS Waivers

is the state funded autism services is the state funded autism services provided to children with autism, provided to children with autism, Asperger’s, or Pervasive Developmental Asperger’s, or Pervasive Developmental Disorders-not otherwise specified (PDD-Disorders-not otherwise specified (PDD-NOS). NOS).

Children referred for this funding must Children referred for this funding must meet specific criteria.meet specific criteria.

Criteria for State-funded Autism ServicesCriteria for State-funded Autism Services

Verified DSM IV Axis I diagnosis of one of the three Verified DSM IV Axis I diagnosis of one of the three disorders within the Autism Spectrum Disorders disorders within the Autism Spectrum Disorders CategoryCategory

One year commitment from family to participate in the One year commitment from family to participate in the intensive services intensive services

Qualified provider ready to start serving childQualified provider ready to start serving child Child must be under 8 years of age prior to be added to Child must be under 8 years of age prior to be added to

the state wait listthe state wait list Child has not already received 3 years of intensive in-Child has not already received 3 years of intensive in-

home autism from any funding sourcehome autism from any funding source Child meets level of care for DD or SEDChild meets level of care for DD or SED Child has been determined disabled by DDBChild has been determined disabled by DDB Child has been a WI resident for at least the last 6 Child has been a WI resident for at least the last 6

mos.mos.

Resources:Resources: CLTS Waiver Manual weblink:CLTS Waiver Manual weblink:

http://dhfs.wisconsin.gov/bdds/waivermanual/index.htm Appendix E has all the CLTS Waiver forms, policies and Appendix E has all the CLTS Waiver forms, policies and

proceduresprocedures Chapter IV has all the services offered through the CLTS WaiversChapter IV has all the services offered through the CLTS Waivers

CLTS Council weblink:CLTS Council weblink: http://dhfs.wisconsin.gov/bdds/clts/council/index.htm

Autism Council weblink:Autism Council weblink: http://dhfs.wisconsin.gov/bdds/clts/autism/council/index.htm

CLTS Functional Screen weblink:CLTS Functional Screen weblink: http://dhfs.wisconsin.gov/LTCare/FunctionalScreen/

See Transcript for Biographical InformationSee Transcript for Biographical Information