Employment and Community First CHOICES (Part 5)

/ April 26, 2016

By Janet Shouse

About the Author

Janet Shouse is a parent of a young adult with autism, and she is passionate about inclusion, employment of people with disabilities, medical issues related to developmental disabilities, supports and services, public policy, legislative initiatives, advocacy, and the intersection of faith and disability. She wears many hats at the Vanderbilt Kennedy Center, including one as a disability employment specialist for TennesseeWorks.

Our hope is that this weekly blog will offer information you want to know, so if you have a question you want answered about employment for people with disabilities or other mysteries of the world of work, please email me at janet.shouse@vumc.org.

This is the final installment, for now at least, of my explanations of the new Employment and Community First CHOICES waiver program. I’m wrapping up the remaining definitions for those services that the ECF CHOICES program will offer. Again, you will find some new and innovative services and supports here.

And remember, July 1, 2016, is the scheduled start date.

1. Specialized Consultation and Training – This service offers training and technical assistance in one or more specialty areas (behavior services, occupational therapy, physical therapy, speech language pathology, nutrition, orientation and mobility, or nurse education, training and delegation) to assist paid or natural or co-worker supports in supporting individuals who have long-term intervention needs, to increase the effectiveness of the specialized therapy or service. This service also is used to allow the specialists listed above to be a part of the person-centered planning team, to participate in team meetings and provide additional intensive consultation. The consultation staff and the paid support staff are both able to bill for their service time.

Activities that are covered include:

Observing the person to determine and assess functional, medical or behavioral needs.
Assessing any current interventions for effectiveness.
Developing a written, easy-to-understand intervention plan, this may include recommendations for assistive technology/equipment or workplace and community integration site modifications.
Identification of activities and outcomes to be carried out by paid and natural supports and co-workers.
Training of family caregivers or paid support personnel on how to implement the specific interventions/supports detailed in the intervention plan.
Training on how to observe, record data and monitor implementation of interventions/support strategies.
Monitoring the individual, family caregivers and/or the support personnel during the implementation of the plan.
Evaluating the activities conducted by relevant persons as detailed in the intervention plan with revision of that plan as needed to assure progress.
Participating in team meetings.
Tele-Consulting, as permitted under state law, through the use of two-way, real time-interactive audio and video to provide clinical consultation services when distance separates the expert from the individual.

Specialized Consultation Services are provided by a certified, licensed, and/or registered professional or qualified assistive technology professional.

2. Adult Dental Services – Preventive dental services, fillings, root canals, extractions, periodontics, the provision of dentures, and other dental treatments to relieve pain and infection, which have dental procedure codes listed in the current TennCare Maximum Reimbursement Rate Schedule for Dental Services for the current DIDD waivers; and intravenous sedation or other anesthesia services provided in the dentist’s office by, and billed by, the dentist or by a nurse anesthetist or anesthesiologist who meets the waiver provider qualifications.

All dental services for children enrolled in the waiver program are provided through the TennCare EPSDT program. Dental services shall not be covered for children under age 21 years, as it would duplicate TennCare/EPSDT benefits. (Here is a brief overview of EPSDT, which stands for Early Periodic Screening, Diagnosis and Treatment.)

Adult dental services shall be limited to a maximum of $5,000 per member per calendar year, and a maximum of $7,500 per member across three (3) consecutive calendar years.

3. Respite – Services provided to a person supported when unpaid caregivers are absent or need relief from routine caregiving responsibilities. Respite is limited to 30 days of service per person per calendar year (or to 216 hours per person per calendar year), depending on the needs and preferences of the individual. Respite services will be provided in settings that meet the federal home and community based services standards, which promote community involvement and inclusion, and which allow individuals to maintain their lifestyle and routines when an unpaid caregiver is absent for a period of time.

4. Supportive Home Care – This service involves the provision of services and supports in the home and community by a paid caregiver who does not live in the family home to an individual living with his or her family that directly assist the individual with activities of daily living and personal needs to insure adequate functioning in their home and maintain community living. Supportive Home Care services may be provided outside of the person’s home, if needed, with the goal of ensuring full participation and inclusion.
Services include:

Hands-on assistance with activities of daily living such as dressing/undressing, bathing, feeding, toileting, etc. This can also include preparation and cleaning of areas used during personal care activities such as the bathroom and kitchen.
Observation of the person supported to assure safety, oversight direction of the person to complete activities of daily living or instrumental activities of daily living.
Routine housecleaning and housekeeping activities performed for the person supported (and not other family members or persons living in the home), consisting of tasks that take place on a daily, weekly or other regular basis, including: washing dishes, laundry, dusting, vacuuming, meal preparation and shopping for food.

5. Family Caregiver Stipend in lieu of Supportive Home Care – A monthly payment to the primary family caregiver of a person supported when the person lives with the family in the family home, and the family is providing daily services and supports that would otherwise be provided by Supportive Home Care services. This service is available only in lieu of Supportive Home Care (including Personal Assistance) services. The funds may be used to make up for lost earning opportunities that are entailed in providing support to a family member with a disability and to help offset the cost of other services and supports the person needs that are not covered under this program.

For a child under 18, the Family Caregiver Stipend is limited to $500 per month. For an adult 18 or older, the Family Caregiver Stipend is limited to no more than $1,000 per month. The amount of Family Caregiver Stipend approved will be based on the needs of the individual, taking into account the supports needed for employment and community integration, and must ensure that supports needed for employment and community integration are provided first, or available to the person through other sources or as part of the supports provided by the family caregiver.

6. Family-to-Family Support – These services provide information, resources, guidance, and support from an experienced and trained parent or other family member to a family caregiver who is the primary unpaid support to a child with intellectual or developmental disabilities enrolled in ECF CHOICES. The service shall include facilitation of parent or family member “matches.”

7. Community Support Development, Organization and Navigation – This service assists individuals and families in 1) promoting a spirit of personal reliance and contribution, mutual support and community connection; 2) developing social networks and connections within local communities, and 3) emphasizes, promotes and coordinates the use of unpaid supports to address individual and family needs in addition to paid services.

Supports provided include:

Helping individuals and family caregivers to develop a network for information and mutual support from others who receive services or family caregivers.
Assisting individuals with disabilities and family caregivers with identifying and utilizing supports available from community service organizations, such as churches, schools, colleges, libraries, neighborhood associations, clubs, recreational entities, businesses and community organizations focused on exchange of services (e.g. time banks). (Here’s an article about time banking.)
Assisting individuals with disabilities and family caregivers with providing mutual support to one another (through service/support exchange), and contributions offered to others in the community.
These services are provided by a Community Navigator and reimbursed on a per person (or family) per month basis, based on specific goals and objectives as specified in the person-centered support plan.

8. Family Caregiver Education and Training – This service provides reimbursement up to $500 per year to offset the costs of educational materials, training programs, workshops and conferences that help the family caregiver to:

Understand the disability of the person supported.
Achieve greater competence and confidence in providing supports.
Develop and access community and other resources and supports.
Develop advocacy skills.
Support the person in developing self-advocacy skills.

Family Caregiver Education and Training is offered only for a family caregiver who is providing unpaid support, training, companionship, or supervision for a person participating in ECF CHOICES who is living in the family home.

9. Conservatorship and Alternatives to Conservatorship Counseling and Assistance – This service offers up to $500 in one-time consultation, education and assistance to family caregivers in understanding conservatorship and alternatives to conservatorship. These services shall be provided in a way that seeks to preserve the rights and freedoms of the individual to the maximum extent possible. This service may include assistance with completing necessary paperwork. Reimbursable services may include payment of court fees necessary to formalize an alternative to conservatorship or conservatorship.

10. Health Insurance Counseling/Forms Assistance – This service offers training and assistance to individuals enrolled in ECF CHOICES and/or their family caregiver and policy holder in understanding the benefits offered through their private or public insurance program, completing necessary forms, accessing covered benefits, and navigating appeal processes. An insurance company or its affiliate shall not be reimbursed for providing this service.

This is a time-limited service intended to develop the person and/or family caregiver’s understanding and capacity to self-manage insurance benefits. Persons choosing to receive this service must agree to complete an online assessment of its efficacy following the conclusion of the assistance.

For more in-depth explanations, time limitations and how providers are paid for services, check out the link on ECF Employment Service Definitions: http://www.tennesseeworks.org/wp-content/uploads/ECF-Employment-Service-Definitions-Handout.docx

If you have any questions, please email me at janet.shouse@vumc.org.