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Leslie Paul, Manager of Economic & Employment Development of the Ohio Department of Mental Retardation and Developmental Disability

Leslie Paul is from the Ohio Department of Mental Retardation and Developmental Disability (ODMRDD), division of Community Services. She is the manager of Economic and Employment Development. She is going to explain services that can be used to assist individuals to obtain a job or learn new skills, and the process to obtain these services. The Ohio Department of Mental Retardation and Developmental Disability Acuity Assessment instrument will also be discussed. But let’s begin with some basics...

What is Medicaid?

Medicaid is a federal health insurance program allowing eligible Ohioans to receive needed health services. Services covered by Medicaid are unique to each state and eligibility is also unique to each state, and it depends on the state approved plan. Services are provided by state certified providers and each Medicaid recipient receives a Medicaid card.

What are the eligibility requirements for Medicaid?

Eligibility is determined by the individuals’ disability and age, income and assets, and the Ohio Department of Jobs and Family Services (ODJFS) determines Medicaid eligibility.

Let’s talk about Medicaid waivers...

What is a HCBS Waiver?

Well HCBS stands for Home and Community Based Waiver and allows the state to provide services beyond its state plan. In Ohio, the Ohio Department of MRDD offers Level One and Individual Options, which is also known as the IO Waiver.

Could an individual with an autism spectrum disorder receive a Home and Community Based waiver?

Yes, as long as they meet waiver eligibility. For an individual to meet waiver eligibility they must have a Medicaid Card, must meet an ICFMR level of care through an assessment completed by the local county board of MRDD, individuals enrolled on waivers mush meet Medicaid eligibility requirements every month and have a waiver re-determination done annually.

What are adult day waiver services?

Adult day waiver services became effective on 1/1/2007 and they replaced the former day habilitation services that formerly included transportation also. They’re available to individuals on IO and Level 1 waivers, and they include a discrete transportation services to get to and from Adult Day Waiver services. Now adult day waiver services include adult day supports, vocational habilitation, supported employment community and supported employment enclave.

Can you describe the adult day waiver services that are available for individuals eligible for either the level 1 or the IO waiver?

Adult day supports are non-vocational services to assure the optimal functioning of individuals who participate in these activities in a non-residential setting, and they include personal care, assessment, skill reinforcement, recreation and leisure, and delegated nursing services. Vocational habilitation services are designed to teach and reinforce work related activities, and these would include ongoing assessment, vocational assessment, assistance with social integration, training, assisting with self-medication, assistance using natural supports and community resources. Supported employment services include those in the community and in an enclave. Supported employment community refers to those services provided in an integrated work setting. Those would include job development, initial training, supervision, on-going supports and follow along. Supported employment community can also be those supports to assist and individual in self-employment. It wouldn’t be start up funds for a business, but is could help an individual with their own self-employment.

What is an example of an enclave?

An enclave would be a group of individuals, possibly going and working in an office building and they would have a supervisor and they would perform the duties together, but they would be only working with individuals with disabilities.

Is transportation included as a waiver service?

Non-medical transportation can be used by waiver enrollees to access adult day waiver services, those including vocation rehabilitation, adult day support, or supported employment enclave or community.

How do you access these services?

To access these services an individual must have an acuity assessment instrument or AAIP completed. An AAI is a standardized instrument used by Ohio to assess the relative needs and circumstances of an individual compared to other adults in non-residential settings. This is used for all individuals who receive or seek to receive HCBS funded adult day waiver services. The acuity assessment instruments measures the amount of staff time required to assist individuals with personal needs and day activities. A score is assigned and this relates to staff intensity ratio and budge limitations.

Does that mean that individuals with autism can have different levels of funding?

Yes, depending on the score the individual receives for their AAI, individuals could have different staff intensity ratios and budget limitations. The illustration here describes how the AAI is used (see Purpose of the AAI slide on the webcast), its used to assign staff intensity ratios for adult day support, vocational habilitation and supported employment enclave, it is not used to assign staff intensity ratios for supported employment community because the thought is individuals usually receive services on a one to one setting. It is used to assign cost for all four of the services.

Does the AAI determine the transportation budget limitations as well?

No, transportation has its own budget limitation and that depends on the county that the services are being provided.

How are the budget limitations for transportation determined?

First you would have to find out the cost for doing business (CODB) category for the county in which the services are going to be provided. This chart shows annual budget limitations for each (2008) cost for doing business category. You’ll see that an individual receiving services in category 1 would receive $8,990, and an individual receiving services in category 8 would receive $9,643.

Who completes the AAI?

Well the service and support administrator (SSA) is responsible to insure that all information on the assessment is correct . There will be a variety of informants that provide information to the SSA to insure that they have the most reliable information. Informants can be a variety of people, but it would be those knowing the individual best.

Do informants include parents or guardians?

Yes, it would include parents or guardians, it could be people at a work setting, school personnel. I think when an individual has not received adult day waiver services in the past, you’re going to be getting informants that might not be the typical, it would be more the guardians or from the schools.

What areas are covered in the sections of the AAI?

The first section deals with identifying information and an individual schedule. And then there’s nine scored elements, these include task training, expressive communication, mobility, clothing assistance, bathroom assistance, eating assistance, community integration, supervision, and medical needs.

How is the AAI scored?

From the scored elements, you would just take the corresponding score for each response given in those areas and add them together. There’s a total of 55 points that an individual could have. The table provided (AAI Scores table on webcast) demonstrates how the scores relate to an individuals group and staff intensity ratio. For example, an individual who scores in group A would have and acuity assessment score between an 8 and 22 and would have a staff intensity ratio of 1 to 12. While an individual who scores in group C, would have a score between a 35 and a 55 and have a staff intensity ratio of 1 to 3.

Does this mean an individual with a score associated with group C will receive more funding?

If you look at the next chart (budget limitations on webcast) you’ll see that group C will have a larger annual budget limitation and that would be between $28,380 and $30,420. Individuals falling in the group A range would only have a budget limitation of $9,480 to $10,140. These funds would cover adult day waiver services, including adult day support, vocational habilitation, and supported employment. And like I said before, it would not be used for transportation.

Once the individual has received a score and a corresponding budget, who can provide those needed services?

I think it’s important to remember that individuals have free choice of provider, and this would relate to adult day waiver services and transportation. And also that providers have to be certified for that service through the Ohio Department of MRDD. You can find certified providers on our website at: odmrdd.state.oh.us

Does the AAI need to be completed more than once?

The AAI does not have to be completed annually, but it can be reviewed at any time at the request of the individual or at the discretion of the SSA with the individual’s knowledge.

What if an individual requires a greater staff intensity ratio or budget limitation?

An administrative review can be completed, this would be sent to the Ohio Department of MRDD for final approval and could assign a staff intensity ratio or annul budget limitation that exceeds the group resulting from administration of the AAI. If an individual already fall into the C group, then they cannot have an administrative review complete, you cannot have a higher group than a C, and there is no administrative review for transportation services.

How does one initiate the administrated review process?

An individual would want to talk to their service and support administrator about the need for a greater staff intensity ratio or budget limitation, or it could discussed by the team at their ISP meeting.

What if an individual does not agree with the administration of the AAI?

Recipients at any time can challenge the administration of the assessment, appeal the scoring of the assessment, or appeal the type, amount, scope and duration of services included or excluded from the ISP, and this Due Process can be found on our website under rules, and it would be rule 5123:2-9-19.

Would the AAI ever be completed for an individual that is not on a Medicaid Waiver?

Individuals who are not on a waiver might have an AAI completed if they are receiving services along with individuals who are on a waiver. You must determine the staff intensity ratio for individual who are receiving services with those on a waiver, although the rules specifies that it does not have to be an AAI, it could be another assessment to determine staff intensity ratio, but we do recommend that an AAI is completed.

The needs of an individual with an autism spectrum disorder may change from day to day. Will the acuity assessment capture these changing needs?

If the AAI is scored correctly, then an individual who needs support at different levels at different times during the day, or on different days, should be able to have that support by scoring each of these elements at the highest support needed.

When scoring the nine elements of the AAI are you scoring the individual’s ability level or are you scoring what kind of support they might need?

You’re scoring the amount of staff time that’s required in each of these areas. So for instance, if an individual is independent using the restroom, they wouldn’t need assistance with the actual act of using the restroom, but because of behavioral reasons need to have a staff present at all times, you would score it at a higher level because of that staff assistance.

Will the AAI identify the need for social supports that may be necessary for those individuals with high functioning autism?

The AAI measures staff need, so if an individuals needs would require more staff time, then it would capture those services that are needed.

Can you explain expressive communication as related to the AAI?

Expressive communication assesses the staff time it takes to understand the wants and needs of an individual, and I think it’s important to remember that even if an individual is understood by one person very well, but to the majority of individuals they are not understood, then it must be scored at a higher level.

For more information about the items discussed in this webcast, go to the ODMRDD website at: www.odmrdd.state.oh.us