- Support Plans & Amendments
Much has changed in the Support Coordination business. Policies regarding Support Plans, Cost Plans, and Amendments have changed dramatically. See our updates, we post them as we get them. Please keep us up to date and let us know if we have missed any changes.
- Are You Current With The Changes? Are We?
Please write to WaiverInfo@aol.com if you know of any other resources.
Cost Plan Freeze
There is a cost plan freeze in effect. If you absolutely need a service, you can try to swap out services. For example, reduce your respite hours to get dental work done. The cost plan dollar amount can not be increased except in true emergency situations such as homelessness. Dental is not considered an emergency.
The Agency For Persons With Disabilities, APD, now reviews all cost plans. Maximus & APS no longer have contracts with APD.
Support Coordinators now have to send up all forms and support plan information to their local APD office.
Support Coordinators should no longer submit requests for services that DO NOT comply with the rules in the waiver handbook.
From A.P.D. Memo Dated January 9th, 2008--- "The Waiver Support Coordinator is responsible for ensuring that the individual and family or legal representative are aware of the limitations of the Developmental Disabilities Coverage and Services Limitations Handbook (a Medicaid Handbook that is in administrative rule) and advising the individual and family when any request for services is not in compliance with this rule. Requests for services that do not comply with this rule should not be submitted to the Area Office. Other service requests by the individual should be submitted to the agency by updating the support plan and completing an amendment request form. The agency maintains the specific responsibility for determining medically necessary services."
All Support Plans and Cost PLans Will be Reviewed Each Year
There is a new procedure from APD regarding support plans. Support plan reviews will no longer be randomized and only reviewed every three years. Support coordinators will need to do a full review each year.
Writing Support Plans- 101
When you write your support plan. There are some things to remember. First, this is a document that many people will read including: the person, the family, the provider, delmarva, and the person approving the service. You are writing to many audiences. It's difficult to strike the right balance. Use language that people can understand and be positive.
If you look at the support plan form, there are nine areas that you must cover: capabilities; daily activities; interactions with others; valued roles: community opportunities; issues and concerns; current supports and services; changes requested; and important relationships. You also must justify services that you are requesting.
Check your handbook to make sure services you request are allowed. Look at the limitations of services before requesting. It's helpful to quote from the handbook in order to get services approved. Make sure that each of your requested services have a goal attached to them.
"The Handbook" that everyone is talking about is the Developmental Disabilities Waiver Services Coverages and Limitations Handbook. It went into effect in May 2010. The Handbook explains each service in detail, and tells what providers how these services should be delivered
Support Plan Meetings- Some Questions To Ask
- Do you know your phone number/ address?
- Can you- stay home alone, cross a street, be safe around strangers?
- Can you use the microwave, oven, toaster?
- Do you need adaptive eating equipment?
Household Chores - Can you do dishes, sweep, organize your things, do laundry, clean bathrooms? Ambulation
- How many times have you fallen in the past year?
- Can you walk up steps, get out of bed?
- Do you use pull ups, wipes, or bed pads?
- How much help do you need in the rest room?
Hygiene - Can you brush your teeth, shave, take a shower, wash your hair, cut your nails? Dressing
- Can you tie your shoes, zip, button, put on socks?
- Do you need help picking out clean, matching clothes?
- How much would you pay for a bag of chips?
- Ask some simple math facts.
- Does your money last you until your next check?
- Can you read a book, a letter, sight words?
- Can you print your name, write a grocery list?
- If the person does not speak, ask the caregiver how they know his wants/ needs.
- Do you understand more than what people think?
- Do you ever hurt yourself, hurt others, run away, destroy property, refuse activities? How often?
- Have you ever been arrested, baker acted?
- What medications do you take? Why? Do they make you tired, gain weight, feel sick?
- Do your teeth hurt you? When was the last time you went to a dentist?
- Is it painful to walk, do chores, etc?
Sleep - Do you sleep through the night? Do you have a job?
- Do you want a job?
- Do you like your job?
Do you want to move? - Who do you want to live with? What do you want to be close to Who helps you? - How often are they available to help you?
And Most Important-
Tell Me About Yourself
- What are you good at?
- Favorite foods? Best friend? Music? Church? Favorite Animal? Movies?
Create a Weekly Service Schedule
When a person has several supports and services, make sure there are not any services overlapping or duplicated. The best way to do this, is to make a schedule.
The schedule should include the following: daily activities, time with natural supports, time needed with paid supports, and time spent alone. Also include what supports are provided in each setting. A schedule of supports and services will help prevent duplication of supports, and also provide justification needed for requesting services.
Writing goals is a very important skill for support coordinators. When you help a person write their goals, you need to keep in mind that you are trying to please many different audiences.
Delmarva wants to see that you have person centered goals. What is really important to the person? They frown upon goals like, "I want to learn how to take a bath". Delmarva also wants the goals to be positive. For example, they would prefer you say, "I want to exercise 3x per week" rather than say, "I want to lose 20 pounds".
Maximus and APS wants goals that show some kind of medical necessity. To get services approved, you must show "medical necessity". Parents often choose goals that they think are important.
A parent might say, "I want him to take a bath every day." A provider often wants you to write goals that they think they can teach the person. For example, an adult day training facility might say, "We can teach him how to cook". In many cases, none of this is really important to the person you are writing goals for.
The person might say, "I just want to have fun".
I have a few recommendations on writing goals, but I am not an expert.
1. When a person says he wants to do something, ask "Why". For example, A person might say, "I want to be a police officer". His reason for wanting to be a police officer might be any of these: likes the uniform, it looks exciting, his father is a police officer, wants to be respected. If you discover that he truly wants to be a police officer, then it needs to go on the support plan.
2. If a goal seems too difficult, suggest to the person that it would be better as a long term goal, or break it down into smaller parts. I have been to many support plan meetings and watched a person's goals be "shot down" because everyone says they are impossible.
3. Try to write goals that can be accomplished in one year. For example, "I want to learn how to write and send an email message," instead of, "I want to learn to use a computer". If a goal is too broad, the trainers tend to lose sight on their methods of training.
4. Write goals that can be measured. (Yes, I know that objectives need to be measured, and goals are simply what you want. Just trust me on this one. When you are reviewed by Delmarva, they will ask you about progress towards the goals.) If goals can not be measured, you have no way of knowing if the training is useful.
5. Know the person's current abilities. He might say, "I want to ride a bike". You then discover, he already knows how to ride a bike.
6. Encourage the person to choose new goals. Some people have the same exact goal, year after year.
7. Know who should be responsible for assisting with the goal. I've had services get denied because the school system or medicaid was responsible for providing assistance.
8. Don't lose site of the person wants. Although you have many audiences to please, remember who the support plan affects the most.