Dear Waiver Participant:
You have probably heard by now of some upcoming changes to the services available through the Mental Retardation and Related Disabilities (MR/RD) Waiver. The Department of Disabilities and Special Needs (DDSN) Commission recently approved 5 amendments to the MR/RD Waiver in an effort to address the severe budget cuts that the agency has endured. DDSN has submitted their proposal to the Centers for Medicare and Medicaid Services (CMS) for approval. DDSN has charged your service coordinator with the task of implementing these changes. The proposed implementation date for the following changes is January 1, 2010:
1. Maintain core services without change:
- Residential Habilitation, Adult Day Health with/without nursing and transportation, Day Activity, Community Services, Support Center, Career Preparation, Employment, Adult Dental, Psychological Counseling, Behavior Support, Private Vehicle Modifications, Prescription Medications, Environmental Modifications, Audiology, Vision, Institutional Respite, Assistive Technology for diapers, wipes and underpads.
2. Eliminate Therapies:
- Physical Therapy, Speech/Language Pathology, and Occupational Therapy will no longer be available through the MR/RD Waiver for adults. There is some provision for therapies for adults through State Plan Medicaid which will be addressed on a case by case basis. This will not affect the availability of therapies to children through State Plan Medicaid.
3. Eliminate daily respite which will be replaced by hourly respite:
- Daily Respite units will no longer be available through the MR/RD Waiver.
4. Place service caps on certain services:
-
Liquid Nutrition funded through the MR/RD Waiver will be capped at 2 cases per month. As always, these items must be physician ordered and supplements such as vitamins, etc. are not covered. Be aware that there are some cases where liquid nutrition is covered by State Plan Medicaid and your benefits will not change.
-
Wheelchairs will be capped at $8000.00 per chair and only one chair every 5 years may be funded through the MR/RD Waiver. As always, funding for wheelchairs through State Plan Medicaid must be exhausted prior to requesting funding through the MR/RD Waiver. **Chairs exceeding $8000.00 that are delivered after December 31, 2009 WILL NOT be covered by the MR/RD Waiver regardless of when the wheelchair was authorized by the Service Coordinator.
-
Adult Companion, Personal Care II, and Adult Attendant Care services will be capped at 28 hours per week alone or in combination. Services will be authorized in weekly increments and units cannot be “banked” across weeks. As always, Personal Care DOES NOT include supervision and aides must always be actively engaged in “hands on” care/tasks. We have been informed that “Adult” will be defined as “21 and up” for Adult Companion and Adult Attendant Care. If between the ages of 18-21, Adult Companion and Adult Attendant Care service through the MR/RD waiver will be discontinued.
-
Personal Care I services will be capped at 6 hours per week. Services will be authorized in weekly increments and units cannot be “banked” across weeks. As always, Personal Care DOES NOT include supervision and aides must always be actively engaged in “hands on” care/tasks.
-
Hourly Respite will be capped at 68 hours per month. Services must be authorized in monthly increments and units cannot be “banked” across months. ** Some exceptions to the 68 hour limit will be allowed under 3 specifically defined conditions. Exceptions will be approved by DDSN on a case by case basis. We are currently working to identify those eligible for the exception and will make every effort to get exceptions approved by DDSN before any changes go into effect.
-
LPN Nursing services will be capped at 56 hours/week. Services will be authorized in weekly increments and units cannot be “banked” across weeks.
-
RN Nursing services will be capped at 42 hours/week. Services will be authorized in weekly increments and units cannot be “banked” across weeks. **RN and LPN Nursing used in combination cannot exceed the cost of the cap for RN or LPN alone.
5. Remove personal emergency response systems (PERS) from specialized medical equipment and create a separate service.
If these changes are approved, you will need the opportunity to start making adjustments to accommodate you and your family. We know that these changes have the potential to significantly impact many of you and we want you to have ample opportunity to prepare. While the coming months will be difficult for all of us, we will work very hard to ensure as smooth a transition as possible. We are currently working to identify people who will be immediately affected by these changes. We will be contacting you to discuss these changes with you.
We will keep our agency website updated with the latest information we have related to these changes. Our website can be accessed at www.rldsn.org. Please contact us if you have any questions or concerns.
Sincerely,
Mary S. Leitner, Executive Director
Richland/Lexington Disabilities and Special Needs Board