Individuals receiving services under the NC Innovations 1915(c) Waiver must be diagnosed with an intellectual disability (formerly classified as mental retardation) or a closely related condition that results in substantial functional limitations in three or more major life activity areas. They also must meet criteria for Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) level of care. Individuals accessing (b)(3) services must be diagnosed with an intellectual disability or a closely related condition that results in substantial functional limitations in three or more major life activity areas. For services under the 1915(b) waiver or the 1915(c) waiver, an individual must meet all criteria identified in the service definitions found in the North Carolina DMA Clinical Coverage Policies.
Waiver services offer support to facilitate opportunities for each participant to explore and enhance their quality of life by maximizing self-determination, self-advocacy, and self-sufficiency. Services are intended to support participants in living in homes of their choice, having employment or engaging in purposeful daytime activities of their choice, achieving their life goals and providing an opportunity to direct their services to the extent they choose. Waiver services are designed to provide the necessary support to keep participants in the home setting with their families.
Psychological evaluations establish diagnoses and may assist with identifying goals and intervention strategies. Psychological evaluations often include IQ testing and adaptive skills testing. When clinically appropriate, evaluations conducted by the appropriate professional may need to be explored in areas such as assistive technology, communication, feeding, and mobility. The Supports Intensity Scale (SIS®) assesses the level of support needed by an individual with intellectual disabilities or developmental disabilities to successfully accomplish life activities.
The Functional Behavior Assessment is used when an individual is experiencing challenging behaviors that interfere with the ability to function or the ability to access integrated community settings. The Functional Behavior Assessment helps the team identify the function of the behavior, positive support strategies, replacement behaviors, and reinforcement strategies. Most often the function of challenging behavior is related to trauma responses, communication difficulties, skill deficits, medical conditions, access to something desirable, attention, escape, sensory input, or pain relief. Challenging behaviors are subject to improvement when interventions reflect best practices. In addition, intervention must correspond with the function of the behavior in order for the individual to achieve optimal outcomes. It is considered best practice for assessments to include an accurate presentation of functioning levels across developmental domains and indicate preferences of the individual.
NC Innovations – 1915(c) Waiver
Individuals who seek services funded through the NC Innovations Waiver are served on a first-come, first-served basis. Individuals apply for the NC Innovations Waiver by contacting Cardinal Innovations. If the individual is determined potentially eligible for waiver , but funding is not available at the time of the referral, the individual will be placed on the Registry of Unmet Needs when all necessary documentation has been received. Individuals on the Registry of Unmet Needs are also referred to other resources while they are waiting for waiver funding.
The NC Innovations Waiver is designed to provide an array of community-based services and supports that promote choice, control, independence and community membership. These services provide a community-based alternative to institutional care for persons who require an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) level of care.
Waiver services are designed to support opportunities for participants to enhance their quality of life by assisting to maximize self-determination, self-advocacy, and self-sufficiency. Services are designed to teach and maintain skills, provide support/supervision from either paid staff or through the use of technology or modifications when appropriate, and foster community integration. Services that focus on teaching skills include In-Home Skill Building, Community Networking, Day Supports, and Supported Employment. If the individual lives in a residential setting, Residential Supports includes the skills teaching component. The service that is intended to help an individual maintain learned skills and provide supervision from a paid staff is Personal Care. If the individual lives in a residential setting, Residential Supports includes the support, supervision and skill maintenance components. Services such as Assistive Technology, Home Modification, and Vehicle Modifications provide funding for unique opportunities for support or supervision. Community Networking, Community Guide, Supported Employment, and Day Supports are designed to assist with community integration.
For planning and budgeting purposes, services fall under two categories: Base Budget Services and Non-Base Budget Services. Base Budget Services are the services that are included in the cost limit or individual budget for Cardinal Innovations participants. Non-Base Budget Services are services that do not count in the cost limit or individual budget for Cardinal Innovations participants. Non-Base Budget Services are sometimes referred to as Add-On Services. Base Budget services are the core habilitation and support services in the Innovations Waiver. Non-Base Budget services are preventative services and equipment. The total cost of Base Budget Services and Non-Base Budget Services combined cannot exceed the cost limit of $135,000 annually.
Base Budget Services include the following services:
Non-Base Budget Services include the following services:
*For all services described below, please see North Carolina DMA Clinical Coverage Policies, Behavioral Health section (http://www.ncdhhs.gov/dma/mp/) for complete service requirements.
Agency with Choice/Employer of RecordThe NC Innovations Waiver gives people with disabilities clear choice about how they receive services. The NC Innovations Waiver refers to self-directed services as
Individual and Family Directed Supports. Individuals can direct some or all of the services that are paid through the Waiver. Cardinal Innovations offers two models of Individual and Family Directed Supports.
Cardinal Innovations has developed a
Self Direction Booklet (http://www.cardinalinnovations.org/nc-innovations-waiver/individual-family) to assist members and their families choosing how they wish to direct their services.
Beginning in 2013, Cardinal Innovations partnered with Elsevier to offer the
College of Direct Support online education and training, included in the DirectCourse curricula portfolio, to Cardinal Innovation's network of Intellectual/Developmental Disability (IDD) providers across North Carolina at no cost to providers. The curriculum provides the knowledge, skills and attitudes that are nationally validated to be important for providing effective direct support. In 2015, Cardinal Innovations will be focused on expanding this program further for Mecklenburg County providers.
Non-Base Budget Services
Adjustments for Individual Circumstances
There are a number of ways to access additional funding for individuals receiving services under the NC Innovations Wavier. However, it is important to note that the waiver cost limit of $135,000 per year may not be exceeded when pursing additional funding. There are generally two different reasons to access additional funding. The first reason is for unexpected situations. An example is the need to access additional funding for respite because the caregiver is experiencing health problems and requires more relief than initially planned. The second reason is the need to access additional funding because there has been a significant change in support needs. An example is the need for additional Personal Care to provide supervision and support because the individual has recently been diagnosed with dementia and is experiencing a regression of skills.
ID/DD (b)(3) Services
Section 1915(b)(3) of the Social Security Act allows states to use savings generated from a managed care delivery system to provide additional services to eligible Medicaid recipients. These services are optional, and the services are only offered up to the amount of available funding. Cardinal Innovations Healthcare Solutions offers (b)(3) services to support individuals with intellectual disability/developmental disability, mental health, and substance abuse disorders who have Medicaid. Providers must provide all comparable services regardless of the funding source.
**For all services described below, please see North Carolina DMA Clinical Coverage Policies (http://www.ncdhhs.gov/dma/mp/) for complete service requirements.
The following services are included in the Cardinal Innovations Healthcare Solutions (b)(3) service array for individuals who have Medicaid, are diagnosed with an intellectual or developmental disability, and meet any additional entrance criteria for the specific to the service.
In 2013, a new (b)(3)
In-Home Skill Building service was approved for Medicaid members who have a documented intellectual or developmental disability, but who are not on the Innovations Waiver. The intent of the service is for the participant to acquire skills that will increase opportunities to maximize independent functioning and community integration to enhance quality of life. The service also includes a caregiver training component to help the caregiver learn how to effectively teach the participant. The service will be implemented following evidence-based practices for caregiver/parent training and teaching the skill to individuals with intellectual or developmental disabilities. Cardinal Innovations began implementing this service in 2014 and will continue implementation and monitoring in 2015.
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