Home and Community-Based Services (HCBS) Waivers

Developmental Disability Services in
Nebraska – Now & In the Future
For adults and children with
intellectual and related
developmental disabilities
Division of Developmental Disabilities
Eligibility for DD Services
DD Services are voluntary – they are not an
entitlement like educational services
Anyone can request eligibility determination
through their local DD office
Follows statutory definition of
developmental disability in accordance with
the Developmental Disabilities Services Act
(DDSA) § 83-1201 to § 83-1226
Eligibility (continued)
§ 83-1205. Developmental disability, defined.
Developmental disability shall mean:
1. Mental retardation; or
2. A severe, chronic disability other than mental
retardation or mental illness which:
Is attributable to a mental or physical
impairment other than a mental or physical
impairment caused solely by mental illness;
Is manifested before the age of twenty-two
Is likely to continue indefinitely; and
Eligibility (continued)
Results in:
In the case of a person under three years
of age, at least one developmental delay;
In the case of a person three years of age
or older, a substantial limitation in three
or more of the following areas of major
life activity, as appropriate for the
person's age:
(A) Self-care; (B) Receptive and expressive
language development and use; (C) Learning; (D)
Mobility; (E) Self-direction; (F) Capacity for
independent living; and (G) Economic self4
Eligibility (continued)
Once eligibility is determined, a date of need is
Individuals are put on the registry (aka the waiting
list) until funding is available or they meet the
criteria to become a ‘priority’ for emergency
If the individual is over age of 21 and has
graduated from a Nebraska high school on or
before September 6, 1993, ‘day’ services are
automatically funded according to § 83-1216
Home and Community Based Services
(HCBS) Waivers
1915 (c) Waivers are DDD’s policy documents,
they define the services which allow Nebraska to
collect federal matching dollars
A HCBS Waiver is a waiver from institutional care.
To be eligible to be on a Waiver, an individual has
to meet ICF/MR level of care requirements
ICF/MR level of care and DD eligibility are NOT the
same, so some individuals may have state only
funded services
Regardless of funding source, all DD services are
the same
DDD Currently Manages Five Waivers
Adult Day (DDAD)
Adult Residential (DDAR)
Assisted Day – prevocational workshops and some
Assisted = All the time
Supported Day
Supported = Some of the time
Supported Employment
Assisted residential
Supported residential
Adult Comprehensive (DDAC)
Community Supports Program (CSP)
For Children and their Families
Adult Day, Residential & Comprehensive
Offers a combination of specialized services
Residential habilitation services
Day habilitation services
Traditional group homes or extended family homes
(continuous support), intermittent in-home support.
Vocational planning, integrated community
employment, workstations, prevocational
Respite for families
Team behavioral consultation
Community Supports Program
Offers non-specialized supports provided by
independent providers, people hired by the
individual and their family – job coaches,
companions, and housekeepers that are your
neighbors, college students, friends, etc.
Community living and day supports
Respite for families
Assistive technology and supports
Home modifications
Vehicle modifications
Community Living and Day Supports
Supports to access the community
Supports to maintain or obtain employment—not in
specialized provider-operated settings
Supports to access services and opportunities in community
Supports to assist the individual to develop self-advocacy
Supports to assist the individual in identifying and sustaining
a personal support network of family, friends, and associates
Household activities necessary to maintain person’s home
living environment on a day to day basis
Home maintenance activities (personal living space)
Assistance with hygiene, bathing, eating, dressing, grooming,
toileting, menstrual care, transferring, or basic first aid
DDD’s Focus on Employment
In April 2010, DDD got approval from CMS to
amend current adult waivers to redefine
supported day and supported employment
New services included:
Vocational Planning
Integrated Community Employment (ICE)
DDD’s Focus on Employment (continued)
Focus on community integration, activities
and job experiences in the community
Provides graduates with more options to live
and work in their community
Funds more job training activities
Allows for in home job searching activities
Allows for home-based businesses
A Sneak Peak…
The adult day, residential and comprehensive
waivers expire on 12/31/2010
Renewals were submitted to CMS in September
Our current five waivers will become three
waivers upon approval of the renewals
Individual Budgets with a menu of services
Individuals will have more flexibility and options
Will be implemented January 1, 2011
Individualized Budget Amounts
Separately authorized monthly allocated
amounts for day and residential services will
be converted into one annual amount for
participants to choose the services that meet
their goals and preferences
Individuals can budget their year and flex the
amount they spend from month to month
A Menu of Services
The 4 adult waivers will become two by:
Adding community support (non-specialized)
services to all adult waivers, eliminating annual
cap on CSP services as well as the cap on rate for
Transitioning CSP participants to the
comprehensive waiver and residential waiver
participants to the comprehensive waiver
Terminating CSP and DDAR waivers
A Menu of Services (continued)
Adding more specialized services to the two
adult waivers
Retirement services
Medical risk services
Behavioral risk services
Going from four service definitions to
nineteen – most already exist but were
grouped together in either assisted or
supported services
Tricia Mason, Administrator
Community-Based Services
Division of Developmental Disabilities
Department of Health and Human Services
[email protected]

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