Acquired Brain Injury (ABI) Medicaid Waiver 10th Annual Life Conference 1/24/2008 Medicaid Facts - There are currently 150,000 people in Delaware receiving Medicaid. - 5,104 served under Long Term Care - Nursing Home- 2700 - Out of State Rehab- 10 - Disabled Kids- 1022 - AIDS Waiver- 488 - Developmental Disabilities Services Waiver- 789 - Elderly and Disabled Wavier- 935 - Assisted Living Waiver- 228 - Acquired Brain Injury Waiver- 50 Why Do We Have Waivers? - To provide services that are not covered under the Medicaid State Plan - To waiver the requirement that the services be provided in a institution. - To maximize service dollars by getting the 50% Medicaid federal match Why Are We Starting an ABI Waiver? - The ABI waiver will offer enhanced services and community support to individuals (adults 18 years of age or older) with physical, cognitive and/or behavioral symptoms, which require supervised and/or supportive care. Who Runs the ABI Waiver? - Division of Medicaid and Medical Assistance - Oversight - Funding - Division of Services for Aging and Adults with Physical Disabilities - Administration Targeted Population Definition - Enhanced waiver services are available to individuals with an Acquired Brain Injury (ABI). An ABI is an injury to the brain which is not hereditary, congenital, degenerative, or induced by birth trauma. Individuals must meet nursing facility level of care standards established by the State's preadmission screening process for the Assisted Living and Elderly and Disabled Waiver. - Individuals must also meet the following medical necessity criteria in order to be considered for the enhanced ABI Services: - Diagnosis of an acquired brain injury (Diagnosis based on ICD-9 Codes developed by the Center for Disease Control and Prevention - reviewed and updated by Delaware Medicaid medical consultants on a periodic basis) - Exhibit medical, emotional, behavioral, and/or cognitive deficits resulting from their brain injury; and - Have a rating of at least 5 but no greater than 8 on the Rancho Los Amigos Level of Cognitive Functioning Scale. Waiver Services • Case Management - Outsourced through Medicaid provider contracts - Mandatory to receive other ABI Wavier Services - Assessment - Care plan development and updates - Onsite meetings with clients at least monthly - Coordination of state plan services, waiver services, other state agency services and community services. • Assisted Living • Adult Day Services - Level I or Basic Adult Day Services (aka Adult Day Care) encompasses both health and social services needed to ensure the optimal functioning of the participant. - Level II or Enhanced ABI Adult Day Services is intended to provide a Supplemental Service Rate or additional reimbursement for the additional staff time needed to care for participants who demonstrate ongoing behavioral patterns and/or ADL dependencies which increase the amount of staff time needed to care for those participants. • Day Habilitation - Day Habilitation service is the assistance with the acquisition, retention, or improvement in self-help, socialization and adaptive skills that take place in a non-residential setting separate from the participant's private residence or other residential living arrangement. Activities and environments are designed to foster the acquisition of skills, appropriate behavior, greater independence, and personal choice. • Cognitive Services - Multidisciplinary Assessment and consultation to determine the participant's level of functioning and service needs. This Cognitive Services component includes neuropsychological consultation and assessments, functional assessment and the development and implementation of a structured behavioral intervention plan. -Behavioral Therapies include remediation, programming, counseling and therapeutic services for participants and their families which have the goal of decreasing or modifying the participant's significant maladaptive behaviors or cognitive disorders that are not covered under the Medicaid State Plan. • Personal Care -A range of assistance to enable waiver participants who live in the community (outside AL facilities) to accomplish tasks that they would normally do for themselves if they did not have a disability. • Respite Care Services -Respite Care Services are provided to Waiver participants who live in the community (outside AL facilities), who are unable to care for themselves. In home respite care is furnished on a short-term basis because of the absence or need for relief of those persons who normally provide care for the participant. • Personal Emergency Response System -Personal Emergency Response Systems (PERS) is an electronic device that enables waiver participants who live in the community (outside AL facilities) to secure help in an emergency. Duration of the Waiver - CMS approved the ABI Waiver effective 12/1/2007. - The wavier is approved for 3 years. - The waiver year runs 12/12007- 11/31/2008 - Year 1- 50 slots - Year 2- 60 slots - Year 3- 70 slots Implementation - Provider Recruitment - Provider Enrollment - Opening Clients - Quality Assurance Strategies Referrals - DSAAPD New Castle County Newark 302-453-3820 TTY 453-3837 - DSAAPD Kent and Sussex Counties Milford 302-424-7310 TTY 422-1415 - DSAAPD Toll Free 1800-223-9074 Question/Answer Lisa Bond Planning Supervisor Division of Services for Aging and Adultswith Physical Disabilities 302-255-9358 lisa.bond@state.de.us www.dhss.delaware.gov/dsaapd