|
Effective: May 1, 2010 |
|
|
03.40.15ar4 - Developmental Disabilities (DD) (Archive) |
Archived: November 1, 2011 |
Developmental Disabilities (DD) is a federally approved home and community-based services program for children and adults with mental retardation or related conditions who require the level of care provided in an Intermediate Care Facility for Persons with Mental Retardation or Related Conditions (ICF/MR).
Individuals must:
l Be eligible for Medical Assistance (MA) payment of LTC services.
l Have a documented diagnosis of developmental disabilities or a related condition.
l Be assessed through a screening process and determined to need a level of care provided in an ICF/DD.
l Make an informed choice requesting home and community-based services instead of ICF/DD services.
l Be in need of supports and services beyond those available through the standard MA benefit set according to the LTCC screening.
More information about the disability waivers can be found in the Disability Services Program Manual.
Eligibility factors and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Application Process (standard guidelines)
Follow standard MA guidelines.
Refer all applicants or their authorized representatives to the appropriate area of the county agency to obtain an LTCC screening if they have not already done so at the time they apply for MA.
Eligibility for waiver services cannot begin before an LTCC is completed, a care plan is developed, and eligibility for MA payment of LTC services has been determined.
Renewals (standard guidelines)
Follow standard MA guidelines.
The lead agency case manager determines that the person has a diagnosis of mental retardation or a related condition and requires a 24-hour plan of care. DD does not require that the person be certified disabled by the Social Security Administration (SSA) or State Medical Review Team (SMRT) . The lead agency case manager’s waiver determination takes the place of the MA disability certification.
Note: This includes people who receive MA for Employed Persons with Disabilities (MA-EPD) concurrently with DD.
The lead agency case manager will verify the following information on the Lead Agency Case Manager/Worker Communication Form (DHS-5181):
l Waiver program conversion or diversion status.
l LTCC date.
l Anticipated start date of waiver services.
Social Security Number (standard guidelines)
Follow standard MA guidelines.
Follow standard MA guidelines.
Residency (standard guidelines)
Follow standard MA guidelines.
Follow standard MA guidelines.
DD enrollees who are not eligible for the Medicare Savings Programs may be eligible for payment of Medicare premiums as cost effective insurance.
Exception: DD enrollees who are also enrolled in MA-EPD must have income at or below 200% FPG to qualify for reimbursement of Medicare Part B premiums. Part B premiums must be reimbursed for any month(s) the enrollee’s income was at or below 200% FPG back to the date of MA-EPD eligibility, regardless of the amount of the premium. No cost effective determination is needed.
Household Composition (standard guidelines)
MA eligibility is determined using a household size of one for all months in which the applicant or enrollee receives DD services.
l If the person is requesting retroactive MA for months before DD services will begin, follow standard MA household size and deeming guidelines.
l For Medicare Savings Program eligibility, follow the household size and deeming guidelines of the Medicare Savings Program.
l For MA-EPD eligibility, follow the household size and deeming guidelines of the MA-EPD program.
Eligibility Method (standard guidelines)
Use Method B for assets and income.
l Asset limit:
Only count the assets of the applicant or enrollee toward the asset limit in any month the person receives DD services. Do not deem the assets of a spouse in any month the applicant or enrollee receives DD services.
The asset limit is $3,000 (household size of one) except:
n There is no asset limit for children under 21.
n Follow the MA-EPD asset guidelines for adults who are concurrently eligible for MA-EPD.
l Transfers:
DD applicants and enrollees may transfer assets to their spouses without penalty. Asset transfers by applicants, enrollees or their spouses to others may be uncompensated, and result in a transfer penalty period during which the client is ineligible for MA payment of LTC services, including LTC services received through the DD waiver. See Transfers for more information on transfers.
l Home Equity Limit:
DD applicants and enrollees are subject to a Home Equity Limit.
l Annuities:
DD applicants and enrollees are subject to certain rules regarding annuity interests. See Annuities for more information.
Income Guidelines (standard guidelines)
Income standard is 100% FPG.
Only count the income of the applicant or enrollee in any month he or she receives DD services.
l Do not deem the income of a parent or spouse in any month the applicant or enrollee receives DD services.
l Exclude child support and RSDI payments received by or on behalf of children under age 18.
Example:
Simon is a disabled adult who is applying for MA under the DD waiver. He is also eligible for Medicare. His income meets the income standard for DD and QMB. However, when his wife’s income is deemed to him, their combined income is over the standard.
Action:
Because his wife’s income must be deemed to him under QMB program guidelines, deny QMB for Simon. However, because only his income is used to determine his MA eligibility under the DD waiver, he is under the income standard for that program. Approve DD for Simon.
Parents of children who are eligible for DD may have to pay a parental fee. See Parental Fees for information about when to refer the case to DHS for a parental fee determination.
Exception: Follow MA-EPD income guidelines for adults who are concurrently eligible for MA-EPD.
Follow standard MA guidelines.
Spenddowns/Premiums (standard guidelines)
If income is greater than 100% FPG, the person must spend down to 75% FPG. Use a monthly spenddown. Treat the cost of waiver services as a medical bill incurred on the first day of the month. The DD enrollee is responsible for payment of the spenddown amount.
Exception: If the person is concurrently eligible for MA-EPD, follow MA-EPD rules to determine the premium amount.
Covered Services (Prepaid MHCP Manual)
DD funds the following services in addition to the standard MA services:
l Day training and habilitation services, including supported employment.
l Supported living services for children.
l Supported living services for adults.
l Respite care.
l Homemaker services.
l Environmental modification.
l Case management.
l In home family supports.
l Adult day care, including bath.
l Extended personal care attendant services after regular MA coverage is exhausted.
l Personal support.
l Assistive technology.
l Caregiver and consumer training and education.
l Chore services.
l Specialist services.
l 24-hour emergency assistance.
l Consumer directed community services (CDCS).
l Housing access coordination.
l Transportation.
l Crisis respite.
l Transitional services.
l Home-delivered meals.
DD services are not available during a period of hospitalization or residence in an ICF/DD or nursing facility.
Service Delivery (Prepaid MHCP Manual)
People who are not enrolled in a managed care plan receive services through fee-for-service (FFS).
People under age 65 who are eligible for MA due to blindness as determined by the Social Security Administration (SSA) or the State Medical Review Team (SMRT) are excluded from mandatory managed care enrollment. However, people may voluntarily enroll in one of the following managed care programs:
1. Minnesota Disability Health Options for People with Physical Disabilities (MnDHO-PD) if they are:
n Ages 18-64 and are eligible for MA with or without Medicare Parts A and B.
n Certified disabled by SSA or SMRT and have a chronic physical disability that needs ongoing treatment.
n Reside in Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, or Washington counties.
2. Special Needs BasicCare (SNBC) if they are:
n Ages 18-64 and are eligible for MA with or without Medicare Parts A and B.
n Certified disabled by SSA or SMRT.
n Reside in any Minnesota county except Clearwater, Beltrami, Hubbard, or Lake of the Woods.
Note: Long-term care services, such as personal care attendant (PCA), private duty nursing (PDN), ICF/DD, county case management, and home and community-based waiver services provided under CAC continue to be paid through fee-for-service (FFS).
Not applicable.
Follow standard MA guidelines.
DD enrollees who apply for Medicare Savings Programs must meet all requirements for those programs.
Children who do not require the additional services provided by the DD waiver may be eligible under TEFRA.