All, we had a very informative meeting last week about Medicaid waivers in Virginia. Comprehensive minutes prepared by our fantastic SEPTA Secretary, Karen Sosnoski, appear below. Hope to see you at our April meeting!
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SEPTA MONTHLY MEETING
Thursday, March 10, 2016
Syphax Center,
2110 Washington Blvd., Arlington, VA
Board Attendance:
Katherine Harris, President
Caroline Levy, VP Membership
Linda Campanelli, VP Fundraising
Caroline Butler, Treasurer
George Buzby, Assistant Treasurer
Maria Votsch, VP of Communications
Karen Sosnoski, Secretary
Vickie Barr, APS PRC Liaison
Wendy Carria, APS Interim Director of Special Education
Katherine Harris, President—Introductions:
Katherine began the meeting by welcoming in those attending and introducing Wendy Carria and Joe Everling, the new Building Level Planning Committee BLPC rep.
joe.Everling@gmail.com Joe says he is willing to take input from members.
Katherine Harris, President—Nominating Committee and Open Positions:
We have a nominating committee to help us find parents to join us in our SEPTA team—led by former SEPTA President Chris Waddell who has tapped Caroline Levy and Linda Campanelli to help him.
Open Positions:
President-elect (to serve as President in 2017-2018 school year)
Treasurer
Assistant Treasurer
VP Fundraising
VP Programming
President (2016-2017 school year)
Filled Positions:
VP of Communications
Secretary
Caroline Butler, Current Treasurer—Report:
Reviewed Budget—July 01, 2015-June 30, 2016
Right now she has a total of 205 memberships, 30 some she hasn’t reconciled, but got membership list from Caroline Levy and will reconcile before June 30th.
The final payment of $2500 for the inclusion workshop came through yesterday.
We had our Arlington CPTA dues come back as not deposited, so she has to re-issue another check.
Katherine Harris—Upcoming Programs Report:
Unstuck and On Target—3 hour training on Executive Functioning (a healthy, functional way of being flexible and mindful.) in the spring sometime in April or May.
Members can watch Unstuck and On Target on the SEPTA website.
Caroline Levy—Membership Report:
Please join SEPTA. $10 for school year, good cause, membership covers somewhere over 200, you need to be a member to post. Look for more requests to join.
She has added a widget on the website for translation so you can read information in any language; Google will translate!
Theresa Waddell has registered our website for eScrip (using the Benefit Mobile app) so this is another way you can make a donation for regular spending.
Another feature of SEPTA is parent liaison program we share with the Parent Resource Center.
March 29th at 10 AM and 7 PM at the Parent Resource Center, Parent Liaisons will meet for training, bonding & recruitment.
Linda Campanelli—VP of Fundraising Report:
There is nothing coming up for fundraising, however she is working on a restaurant night.
There was some talk about doing a walk run and roll, however it will be for next year not this year.
Linda will be vacating the position at the end of this year. When Chris asked her to do it, she said “yes,” without having much experience. Linda says that with chunking events and the right support, you can be VP of Fundraising, overseeing events but not doing everything. She’s hoping that someone might step forward.
Cy Simonsgaard—Academic Therapist and Parent on Reading Tutoring for Teens:
Cy introduced herself as a home-schooling mom who was told that their daughter was not going to be able to read due to Sturge-Weber syndrome. Subsequently, she studied Orton-Gillingham Sounds in Syllables for five years and has become an Academic Therapist through the Atlantic Seaboard Dyslexia Education Center in Rockville, MD.
Daughter, Griffin (15) is now at a 3rd grade reading level level after three years of reading therapy and remediation.
The program Cy has used with her daughter successfully breaks reading, writing, and cursive into smaller and smaller parts and within three years her daughter age 15 is now at a third grade level.
Cy wants to take on two additional students, ages 11-17 to engage in this program from beginning to end in order to become readers.
Reading therapy would occur in one hour lessons, at a minimum 3 times a week.
Chloe Chin’s son is going through this program and has great things to say. It can take as long as three years, but it’s worth it.
A woman whose son is almost five years old and doesn’t speak asked if her son might be able to participate. Cy encouraged her to call.
Cy Simonsgaard, simonsgaards@me.com (703) 785-1482 Those interested should contact her. Also feel free to pass this information along to someone who may benefit.
Hannah Manila, Medicaid Programs Coordinator, the Endependence Center of Northern VA— Medicaid Waivers in VA:
Hannah Manila (703) 525-3268 ext. 8010, hannahm@ecnv.org March 10, 2016
Rachel Henry, works with Hannah, also present at SEPTA meeting, can be reached at Hannah’s number.
Presented on Materials by the Independence Center in consultation with DMAS and DBHDS. 75 percent of the funding to develop this product was provided by the VBPD under the federal DD and Bill of Rights Act. Contact VBPD at 800-846-4464 or go to www.vaboard.org.
Materials refer to all children up to age 21.
Material that Hannah read or skimmed for meeting participants, I’ve copied from the handouts which can be found at website above. Also check the website for details that were not covered in the meeting and not recorded here.
Medicaid is a health insurance program funded by federal and state governments.
Federal and State Roles: Centers for Medicare & Medicaid Services—Federal agency; CMS; cms.hhs.gov Department of Medical Assistance Services—State agency; DMAS; www.dmas.virginia.gov
Virginia Medicaid
General Assembly determines state funding. $7.9 billion in fiscal year 2015 (includes Federal and State funding. 50% from state funds; 50% from federal funds.
Mandated Services All States
EPSDT; Family Planning; Health Clinics; Home Health Service; Hospital Services; Lab and X-Ray; Medicare Premiums; Nurse-Midwife Services; Nurse Practitioner; Nursing Facilities; Physician Services; Transportation
Optional Services Selected by Virginia
Case Management; Home and Community Based Waivers; Home Health; Hospice; ICF-DD; Mental Health Services; Optometry; PT, OT, Speech Therapy; Podiatry; Prescribed Drugs; Prosthetics; Psychology
Institutional Placements
Hospitals; Nursing Facilities
ICFS/DD—Intermediate Care Facility for people with developmental disabilities
institutions of 4 or more beds
active treatment and rehabilitation
regulated by the federal and state governments
52 ICFs/DD in VA
4 large training centers
48 smaller ICFs.DD, ranging from 4-88 beds
Alternative Institutional Placement
Medicaid alternative institutional placement
Same criteria used for admission to institution
Nursing homes—EDCD and Tech Waivers
ICF/DD—DD and ID Waivers
Do not have to apply for or be placed in an institution
Why Home & Community Based Care Waivers?
Slow growth of Medicaid spending; People with disabilities and advocates wanted alternatives to institutions; Permit federal Medicaid funds to be used for community services by people who would otherwise be institutionalized.
Home & Community Based Care Waivers
Waivers give States the flexibility to develop and implement alternatives to institutionalization.
VA Home & Community Based Care Waivers
See State Regulations for the Waivers: http:leg1.state.va.us/000/reg/TOC12030.HTM#C0120
State Plan Medicaid Regular Medicaid:
Categorical Criteria: Disabled; 65 or older; Families with children; Pregnant Women; others
Financial Thresholds: Low income & resources; Amounts vary by group; Parent income DOES count for minor children unless in a facility or receiving a Waiver
Long-Term Care Eligibility Process:
Screening First; Financial Eligibility Second; Screening for all Waivers must be provided without any charge to the individual
Long-Term Care Medicaid HCBC Waivers, PACE & Institutions
Must need long-term care
Assessment/screening
Financial Thresholds: Monthly income limit $2,199; Resource limit $2,000 for adults; Parent income & resources do NOT count regardless of child’s age; Disability determination at age 18.
Hannah stressed that at age 18 the individual no longer falls under the child category and must apply for SSI and all waivers.
Screening
Pre-Admission Screening Teams of the Department of Health & Department of Social Services or Hospitals
Alzheimer’s Waiver
EDCD (Elderly or Community Disabled Waiver) Waiver
Tech Waiver
Community Services Board
ID Waiver and Day Support Waiver
Department of Health Local Clinics/Child Development Clinics
DD Waiver
Uniform Assessment Instrument (UAI)
Used for nursing home placement and Alzheimer’s, EDCD and Tech Waivers
Assess social, physical health and functional abilities
Hannah provided a pre-admission screening assessment pamphlet.
Criteria for Nursing Home and Alternative Waivers
Functional Needs Category: Combination of—Activities of daily living; Behavior and orientation; Mobility; Joint motion; Medication administration.
Nursing or Medical Needs Category
Risk of Placement in a Nursing Facility
Hannah added that the Nursing or Medical Needs Category is a non-exclusive list, including not being able to self-evaluate.
Risk of placement in a nursing facility refers to imminent risk: if you weren’t there, would your child be at risk of being placed in a nursing facility? Don’t automatically say “no.” Saying “yes” doesn’t mean your child will be placed in a nursing facility now.
Question (Chris Waddell) Related to Criteria for Placement in a Nursing Facility: If someone has an EDCD waiver and they need to be placed in a nursing facility, would they be able to apply for one?
Answer (Hannah): Absolutely; sometimes they can’t be picky about which facility though.
Hannah stresses you need to be honest about the risks, painting a picture of the child on the worst day so they’ll get the help they need: wandering, seizures, kind breakdown—a more detailed account of criteria can be found in the pre-admissions criteria packet.
Elderly or Disabled with Consumer Direction (EDCD) Waiver
Individuals seeking Waiver services are eligible if disabled or 65 or older; must meet nursing home criteria; screening is conducted by the Preadmission Screening Team using the UAI.
Question re. Service Provider Rates (George Buzby): We’re given money for a service provider, however it isn’t at a good rate. Who decides this?
Answer (Hannah): DMAS. It is low, $11.70 per hour, however you are not allowed to supplement that Medicaid rate—to do so is considered Medicaid fraud. You can hire and pay a person to do non Medicaid duties, but it must be in writing and must be outside the plan of care.
Chris Waddell elaborated: If a person works Medicaid hours 3-7. then during that time they get the Medicaid rate. If they work other hours, they can have client rates, but you can’t bill Medicaid during that time.
EDCD Waiver Services
Adult Day Health Care; Personal Care Services (Consumer Directed or Agency); Personal Emergency Response System (PERS); Respite (CD, Agency or Skilled).
Hannah notes that for Respite Services, there has to be an unpaid caregiver identified.
For people transitioning from a nursing facility: Assistive Technology; Environmental Modifications; Transition Services; Transition Coordination.
Technology Assisted Waiver
Individual may be eligible if they need both a medical device to compensate for the loss of a vital body function and substantial ongoing skilled nursing care; DMAS reviews individual’s policy for private duty nursing benefits; Case management provided by DMAS.
Tech Waiver Services: (See www.vaboard.org).
Level of Functioning (LOF) (See www.vaboard.org).
Intellectual Disability (ID) Waiver:
Diagnosis of ID or be under the age of 6 and at developmental risk
Children using the ID Waiver without a diagnosis of ID at the age of 6, possible transfer to DD waiver.
Waitlist—8,167 (4,943 urgent, 3.244 nonurgent.)
Hannah clarified that children on the waitlist who do not have a diagnosis of ID at age 6 need to get screened for a DD waiver. If they do have an ID diagnosis, they can stay on the waitlist.
Rachel Henry explained that kids in VA can’t be diagnosed with ID before the age of 6.
One meeting participant complained that her son went through the PIE program and Childfind but no one gave them this info about waivers until he turned six. She said he could have been on the waitlist earlier if she had been given guidance. Another meeting participant said that they’re in a similar situation. His son has an ID, but they got none of this information through the school.
Katherine Harris has been told that APS sometimes gives out info about medicaid waivers at IEP meetings.
Another woman complained that 5-6 social workers have come to their house, their child is 15 but they only found out about the EDCD waiver through hockey cool cats parents.
Wendy Carria said that the expectation is that there’s a school social worker talking to the family about needs and concerns during the eligibility process. She said she’ll reiterate this with the social workers who should be the ones connecting people with resources.
Wendy Carria also said she’d follow up on individual cases.
Katherine Harris said she’d reach out to the PIE program about this issue.
Screenings for the ID waiver are conducted by CSB
Level of Functioning used for screening
Participant question: Is there an IQ criteria for ID that exists? Answer: Under a score of 70 plus or minus 5.
ID Waiver Services:
Adult companion (consumer directed and agency)
Assistive technology ($5,000 per year max)
Crisis stabilization
Day support and Prevocational services
Environmental modifications ($5,00 max a year)
Personal emergency response system (PERS)
Personal assistance services (consumer directed and agency)
Residential support (individual’s home or congregate)
Respite care (consumer directed and agency)
Skilled nursing
Supported employment
Therapeutic consultation
Transition Services ($5,000 lifetime max)
ID Waiver Waiting Lists, Urgent and Non-urgent: www.vaboard.org. for details
Linda C. asked for a summary. Hannah: the parent and case manager need to look up the criteria and that the case manager should be helping to monitor this.
ID Waiver Urgent Criteria :www.vaboard.org.
Day Support Waiver: www.vaboard.org.
Individual and Family Developmental Disabilities Support (DD) Waiver
6 years of age or older and have DD; no diagnosis of ID; wait list—2.245 people; Level of functioning survey used for screening.
Screening request
www.dmas.virginia.gov/Content_pgs/lts-screen.aspx
DD Waiver Services: www.vaboard.org.
The DD and ID waivers have virtually the same services, so they’re redesigning to combine these waivers.
DD Waiver Emergency Criteria: www.vaboard.org.
Waiting Lists: www.vaboard.org.
EDCD Waiver While on Wait List: www.vaboard.org.
Meeting participant asked if there is any re-assessing of original screening while you’re on the waitlist. Hannah answered that when the slot opens up, that’s when they reassess. Each year that your child is on the waiting list, you can apply for up to $1,000 in family support.
Planning for Services:
Who will participate in your meeting
Prepare list of needed supports & services
Collect documentation including vocational evaluations; IEPs, school evaluations; medical documentation
Accessing Providers: www.vaboard.org.
Note that there can be a shortage of some providers in VA
Medicaid Benefits: www.vaboard.org.
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Medicaid benefits for children under the age of 21: www.vaboard.org.
Wendy Carria adds that EPSDT also provides for personal in-school attendant in private schools for students who have needs for a skilled nurse.
Hannah adds that it does not cover services that are experimental. Call EPSDT department with questions.
Special Needs Trusts:
Maintain assets for future needs
Protects from disqualifying for public benefits
Participant question: does this mean if the child is too inherit too much $ they get thrown out of their Medicaid eligibility less they have a special needs trust? Answer: Yes.
www.commonwealthcommunitytrust.org www.thearcofnovatrust.org
Anyone with a physical or mental disability is eligible for a special needs trust
HIPP Health Insurance Premium Payment—available to children who have Medicaid and also primary insurance.
Call 800-432-5924 and see www.vaboard.org.for details
Medicaid Appeals: www.vaboard.org.
Know that if you don’t agree with any decision that’s made, you have a right to appeal.
Always leave a paper trail.
American Disabilities Act: www.vaboard.org.
Supreme Court Ruling: www.olmsteadVA.com
Dept. of Justice Settlement agreement: www.dbhds.virginia.gov/individuals-and-families/developmental-disabilities/doj-settlement-agreement
Future Changes
Significant modifications to DD, Day Support and ID Waivers
Changes anticipated to begin summer 2016
Funding will have to be approved by VA legislature
Waiver Regulations
VaWaivers-subscribe@yahoogroups.com
One meeting participant highly recommended the website above as an awesome resource.
For more on proposed changes, see: www.vaboard.org.
Hannah said there will be more of an individualized budget to support individuals in work and communities. More flexible, evolving services.
Meeting Adjourned.
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