Employment and Community First (ECF) CHOICESbluecare.bcbst.com/forms/Provider Information/ECF_CHOICES...• ECF CHOICES: Employment and Community First CHOICES • HCBS: Home- and

Implementation Provider Training

Employment and Community First (ECF) CHOICES

TNPEC-1370-16 February 2016 1

Agenda

• Introductions and meeting format • Day One - E2E, Fading Supports, Non-Employment

Services, Support Coordination • Day Two - Employment Services • Day Three - Dignity of Risk, Critical Incident

Management, Quality Management, Provider Readiness

• Recap and Closing

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Housekeeping items

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Acronyms

• BH: Behavioral health • DD: Developmental disabilities • ID: Intellectual disabilities • I/DD: Intellectual and developmental disabilities • DIDD: Department of Intellectual and Developmental Disabilities • ECF CHOICES: Employment and Community First CHOICES • HCBS: Home- and community-based services • ICF/IID: Intermediate care facilities for individuals with intellectual disabilities • LOC: Level of care • MCO: Managed care organization • MLTSS: Managed long term services and supports • NF: Nursing facility • PCSP: Person-centered support plan • SC: Support coordinator • TPAES: TennCare Pre Admission Evaluation System

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Meet your ECF Provider Relations teams

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Employment and Community First CHOICES

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END 2 END

Objectives: • Introduction to the managed care operations • Review high-level end to end ECF program within the

MCO process • Learn the PROS of being a contracted in-network ECF

provider • Understand the provider’s role and responsibility in

partnership with the MCO

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3 Steps To ECF Member Intake

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Member

Enrollment

Intake Screening

The beginning of the Employment and Community First program starts with an eligible member through the intake process.

ECF Member Intake

• There are three general steps: – Screening – potential members can self-screen

electronically to help determine if they meet the screening criteria and prioritization.

– Intake – helps to qualify member for prioritization for an available slot.

– Enrollment – member is approved by TennCare.

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Journey of A Contracted ECF Provider

• As a contracted/participating provider, you shall be available and willing to:

• Deliver timely services to ECF CHOICE members that select your organization to serve them.

• Assign staff who are linguistically competent in the member and/or caregiver’s primary language;

• Assign staff who can facilitate non-verbal forms of communication, including technology; and or the use of other auxiliary aids or services.

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Approved contracted providers will receive an MCO provider ID that will be used as identification of a participating provider, and for submitting claims

for reimbursement.

ECF network providers must qualify through appropriate licensure, certification and readiness by an MCO credentialing committee after a

successful site visit..

Employment Community First providers will successfully complete site visits conducted by each MCO for initial enrollment, and annually thereafter in

accordance to the services contracted for the ECF network.

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All parties, including the member, member representative (s),and each provider will sign the person-centered support plan for execution.

Services are documented on the Person-centered Support Plan including frequency, times, duration and scope of each service. Providers may be

invited to face to face meetings if requested by the member.

Members receive participating lists of ECF Providers based on counties served, services contracted, languages available.

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All services are monitored to ensure they are initiated timely and will be validated to ensure ECF services were performed as prescribed. Outcome based services will be managed through results and associated timelines.

To initiate services, providers will receive an authorization prior to facilitating the approved service. In addition to the support plan, the authorization

identifies all service details, timelines, member information.

Approved ECF services identified on the person centered- support plan must be initiated within the outlined timeframes . Services are categorized by EVV,

non-EVV and outcome-based, and non outcome based ECF services.

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Initiation of ECF Services • To initiate approved ECF services, the MCO will provide an authorization in

accordance to the member’s PCSP. You will also receive a copy of the Support Plan and be required to sign which acknowledges your commitment and obligation to the timelines, frequency and quality service to the member. For outcome based services, authorizations will be provided for billing after approval of written plans.

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ECF Support Plan Attestation

• The person-centered support plan (PCSP) is directed by the member.

• Providers will receive a copy of the PSCP and required to sign the PSCP on send signed copy to the MCO.

• PCSP will be sent via fax or e-mail. • Ensure the fax number and e-mail of the staff

member responsible is sent to the MCO.

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ECF CHOICES Employment Services/Supports - Outcome-Based

• Exploration - (receipt/approval of written report summarizing process and outcomes)

• Discovery (receipt/approval of written profile summarizing process, learning and recommendations for next steps)

• Situational observation and assessment (receipt/approval of written report summarizing key learnings to inform job development or self-employment plan)

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ECF CHOICES Employment Services/Supports - Outcome-Based

• Job development plan or self-employment plan

(receipt/approval of plan) • Job development or self-employment start up (when

integrated, competitive employment or self-employment begins)

• Career advancement (receipt/approval of written career objective plan)

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ECF – Outcome Based Services Service and Initiation

Timeline Service Completion

Timeline Expected service

hours Written Report

Exploration 30 days - Start Date 40 hrs. of service 14 days – last service Date

Discovery 90 days – Start Date 50 hrs. of service 14 days – last service date

Sit. Observation 30 days – Start date 12 hrs. per experience (up to 4)

10 days – last service date

Job Dev/Self Emp -Plan

30 days – Start date 1 every 3 years 30 days – last service date

Job Dev/Self Emp Start Up

After Emp. Phase -1 (2 wks.) Phase -2 (6 wks.) Phase -3 (10 wks.)

1 per every 365 days

Career Advancement

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ECF Outcome Based Services • Services are time-limited and reimbursed based on

the outcome. • Authorizations to bill for reimbursement are null and

void until a written report has been received and approved within the designated time period.

• The written reports are standardized and must include dates, activities and accomplishments according to the member’s plan.

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ECF CHOICES– Claim Submissions for Outcome-Based Services

• An authorization is required to initiate billing for these services – The provider must submit all required elements on the

TennCare approved templates. – The MCO will review and provide feedback on the

outcome with approval or request for additional information.

– Submit a CMS 1450 (UB04) claim form through the MCO’s electronic claims portal or a third party electronic claims vendor after approval and authorization received.

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ECF – Outcome Based Written Reports

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ECF CHOICES Individual Services and Supports

• Community integration support services • Community transportation • Independent living skills training • Personal assistance • Assistive technology, adaptive equipment and

supplies • Specialized consultation and training

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ECF CHOICES Individual Services and Supports

• Minor home modifications • Community living supports (CLS) and CLS – family

model • Individual education and training • Peer-to-peer support and navigation (for person

centered planning, self-direction, integrated employment/self-employment and independent community living)

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Employment and Community First CHOICES

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ECF CHOICES overview

Who is it for? • People with intellectual and other developmental disabilities who

are not currently receiving services • People in current waivers are not impacted, but can choose to move

to the new program later on

What will it offer? • Support for families caring for a person with I/DD • Supports to help people with I/DD achieve employment and independent

living goals • For people who have complex needs or need more support to live in the

community, residential and other day services to help them achieve their community living goals

• Not intended to provide 24 hour supports, except for people assessed to need them

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Fading Paid Supports and

Supporting Employment through

Non-Employment ECF Services

MORE THAN JUST A SUPPORTED EMPLOYMENT

STRATEGY & EXPECTATION

Fading Paid Supports

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Purpose of Home & Community-Based Services

• To enable people to live in their own homes and communities rather than an institution

• To provide the supports people need to overcome the impact their disability has on their ability to live independently

• To maximize independence (and interdependence with family/community/natural supports)

Purpose of Home & Community-Based Services

• Why minimize dependence on paid supports? – Not just to make our public funding go further…

– To ensure people have the highest level of dignity,

freedom, self-sufficiency….to ensure people can live like the rest of us, to the fullest extent possible

What if…

• What if Everyone in Your Life was Paid to Be There?

• What if you couldn’t do anything without the supervision and involvement of someone else?

• What if you couldn’t act on any of your ideas?

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Too Much All or Nothing in Our Approach

• Full Independence or Full Dependence

• Full Autonomy or Full Conservatorship

• Waiting List or 24/7 Services

• A Service Forever Unless Your Disability Disappears

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Supported Employment: A Model for All Services

• Match the environment and situation to the person’s interests and strengths

• Expect a service (paid supports) that results in ability to fade the paid supports over time

• If one goal of ECF is reducing people’s need for ECF services over time, would you approach the service(s) you provide any differently?

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Supported Employment: A Model for All Services

Fading = Reducing the need for paid supports over time

• Many strategies can be used to create opportunities for fading: – Removing Barriers to Independence from Environment – Training/Teaching – Assistive Technology (Lo and High Tech) – Engaging Existing Sources of Natural Support – Building New Sources of Natural Support

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ECF Services

• All services that are not time-limited should have a focus on fading

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Independent Living Skills Training

• Independent Living Skills Training services provide education and skill development or training to improve the person’s ability to independently perform routine daily activities and utilize community resources as specified in the person’s person-centered support plan.

• Services are instructional, focused on development of skills identified in the person-centered support plan and are not intended to provide substitute task performance.

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• Independent Living Skills Training is intended as a short-term service designed to allow a person…to acquire specific additional skills that will support his/her transition to or sustained independent community living.

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• The provider must prepare and follow a specific plan and strategy for teaching specific skills for the independent living goals identified in the person-centered support plan. Systematic instruction and other strategies used in Supported Employment Job Coaching should also be employed in this service. The provider must document monthly progress toward achieving each independent living skill identified in the person-centered support plan.

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Community Integration Support Services

• “Designed to promote maximum participation in integrated community life while facilitating meaningful relationships, friendships and social networks with persons without disabilities who share similar interests and goals for community involvement and participation.”

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• “Expected to result in the person developing and sustaining a range of…relationships; building natural supports; increasing independence…

• “For developing and sustaining a network of positive natural supports.

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• “For individuals of appropriate age (18+), fading of the service and less dependence on paid support for on-going participation in community activities and relationships is expected. Fading strategies, similar to those used in Supported Employment Job Coaching, should be utilized. Milestones for the reduction/fading of paid supports and the enhancement of natural supports must be established and monitored for this service.”

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Personal Assistance

• Includes “direction and training to individuals in the person’s social network or to his/her co-workers who choose to learn how to provide some of the Personal Assistance services.”

• What else could reduce the need for Personal Assistance?

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Other ECF Services

• Supportive Home Care – To supplement family supports for people living

with family

• Respite – “promote community involvement and inclusion

and which allow individuals to sustain their lifestyle and routines when an unpaid caregiver is absent for a period of time.”

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Community Transportation

• This service is made available when public or other no-cost community-based transportation services are not available and the person does not have access to transportation through any other means (including natural supports).

• Whenever possible, family, neighbors, co-workers, carpools or friends are utilized to provide transportation assistance without charge.

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Community Living Supports (including Family Model)

• “A continuum of support options for up to four individuals living in a home

that supports each resident’s independence and full integration into the community.”

• “Acquiring, retaining, or improving skills needed for activities of daily living…and instrumental activities of daily living.”

• “Building and maintaining interpersonal relationships with family and friends…participating fully in community life”

• Self-administering medications • Becoming aware of, and effectively using, transportation, police, fire, and

emergency help available in the community to the general public • Asserting civil and statutory rights through self-advocacy

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Fading is Possible • Use of multiple strategies helps maximize

opportunities for fading: – Removing Barriers to Independence from Environment – Training/Teaching – Assistive Technology (Lo and High Tech) – Engaging Existing Sources of Natural Support – Building New Sources of Natural Support

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Fading through Facilitation of Natural Supports

• Some natural supports will exist before you, the ECF Provider, becomes involved in someone’s life

• Most important – DO NOT SUPPLANT existing natural supports’ roles in people’s lives.

• All natural supports and their roles should be listed in PCSP


• All natural supports and their roles should be in PCSP

• Some may be missed by the Support Coordinator

• If you identify additional natural supports already involved in person’s life, inform Support Coordinator and do not supplant.


• When no natural supports exist…

• Your role can serve two purposes – Substituting for natural supports because they are not

available – Identifying and facilitating new natural supports to take

your place – DSPs will not focus on both roles unless they are trained

and supervised to do so.


• When your agency facilitates new sources of natural supports, decision must be made as to when paid supports can fade

• Your agency should have a policy for how this is done – Determination of ECF member’s and natural support’s

“willingness” and “readiness” – Consultation with the “Team” – How will your agency continue to monitor and offer

support as needed?


• your agency facilitates new sources of natural supports,

decision must be made as to when paid supports can fade • The MCO must be willing to support the transition to fade

supports – Reduced service authorization that still takes account of

the provider’s role in monitoring and offering support on as-needed basis

– Willingness to quickly re-authorize prior level of service if natural support is no longer available.

MORE THAN JUST A SUPPORTED EMPLOYMENT PROVIDER’S ROLE

Supporting Pursuit of and Participation in

Employment

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HCBS Settings Rule

• Applies to ECF CHOICES from Day #1.

• Include STRONG validation of Employment First:

All HCBS Settings must “provide opportunities to seek employment and work in competitive,

integrated settings.”

All HCBS Settings must “provide opportunities to seek employment and work in competitive, integrated

settings.” • What does this mean for

providers of non-employment services in ECF?

• What should we expect these providers to do?

• What should we expect these providers will not do?

• Community Integration Support Services • Independent Living Skills Training • Personal Assistance and Supportive Home Care • Community Transportation • Community Living Supports and Community

Living Supports-Family Model • Assistive Technology, Adaptive Equipment and

Supplies and Minor Home Modifications • Peer–to-Peer Support and Navigation • Specialized Consultation and Training • Respite • Family-to-Family Support and Community

Support Development, Organization and Navigation

• Conservatorship and Alternatives to Conservatorship Counseling and Assistance and Health Insurance Counseling/Forms Assistance

• Adult Dental Services

Discussion and Questions Training Needs for Providers?

Need for ECF Policy Guidance?

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Overview of Key Non-Employment ECF

Services

Services Covered in this Overview • Community Integrated Support Services • Independent Living Skills Training • Personal Assistance • Supportive Home Care • Community Support Development, Organization and

Navigation

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Service Definition Highlights • Services which coordinate and provide supports for valued

and active participation in integrated daytime and nighttime activities that build on the person’s interests, preferences, gifts, and strengths while reflecting the person’s goals with regard to community involvement and membership.

• Participation in integrated community settings, in activities that involve persons without disabilities

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Service Definition Highlights • Promote maximum participation in integrated community life

while facilitating meaningful relationships, friendships and social networks with persons without disabilities who share similar interests and goals for community involvement and participation.

• The service is expected to result in the person developing and sustaining a range of valued, age-appropriate social roles and relationships; building natural supports; increasing independence; and experiencing meaningful community integration and inclusion.

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Service Definition Highlights: Examples • Supports to participate in formal or informal community groups,

associations; clubs, including those that are neighborhood-based; • Supports to participate in community opportunities related to the

development of hobbies or leisure/cultural interests; • Supports to promote personal health and wellness (e.g. yoga class,

walking group, etc.); • Supports to participate in adult education and postsecondary education

classes;

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Service Definition Highlights: Examples • Supports to participate in volunteer opportunities; • Supports to participate in opportunities focused on training and education

for self-determination and self-advocacy; • Supports for learning to navigate the local community, including learning

to use types of transportation available in the local area; • Supports to maintain relationships with members of the broader

community (e.g. neighbors, co-workers and other community members who do not have disabilities and who are not paid or unpaid caregivers) through natural opportunities and invitations that may occur.

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Service Definition Highlights: Skills Focus • Enable the person to increase or maintain his/her capacity for

independent participation in community life • Enable person to develop age-appropriate social roles valued

by the community by learning, practicing and applying skills necessary for full inclusion in the person’s community

• Includes skills in arranging and using public transportation for individuals aged 16 or older.

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Service Definition Highlights • Shall support and enhance, rather than supplant, an

individual’s involvement in public education, post-secondary education/training and individualized integrated employment or self-employment (or services designed to lead to these types of employment).

Note: This service can be used to support people in post-secondary education/training.

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Service Delivery Expectations • Includes an individualized combination of training and

supports • Includes personal assistance during the hours that this service

is provided, so long as PAS is not the only support being provided through this service.

• Transportation to and from the service is not included in the rate; transportation during the service (when no-cost forms of transportation are not available or not being accessed) is included in the rate.

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Service Delivery Expectations • All settings where is provided must be non-disability specific

and meet all federal standards for HCBS settings. • This service is provided separate and apart from the person’s

place of residence. • This service does not take place in licensed facilities, sheltered

workshops or any type of facility owned, leased or operated by a provider of this service.

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Caps/Limitations • This service is not available to all ECF members. If you get a

referral/authorization, you can assume the ECF member is eligible. • Those receiving CLS or CLS-Family Model cannot get this service because

these supports are included in the CLS or CLS-Family Model service. • Working-age ECF Members cannot get this service unless they:

– Are working in (or pursuing) individual integrated employment – Have agreed to and completed an Employment Informed Choice

Process including the Exploration service.

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Caps/Limitations • There are limits on the number of hours per week a person

can receive this service • Depends on what other services are in a person’s Plan • Also depends on whether the person is working in individual

integrated employment (and how many hours per week the person is working)

• MCO responsible for following these limits – if you receive authorization, you should assume the rules are being followed

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Caps/Limitations • Payment for registration, materials and supplies for

participation in classes, conferences and similar types of activities, or club/association dues can be covered, but cannot exceed $500 per year for children under age 21 or $1,000 per year for adults age 21 and older.

• These costs are not included in the rates paid to the providers of Community Integration Support Services and must be prior approved before being incurred.

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Reimbursement • 15 minute unit • 1:1 staffing ratio $5.50/15 minutes

$22/hour/person • 1:2 staffing ratio $3.75/15 minutes

$15/hour/person DSP Qualifications • Standard qualifications for all DSPs. • Meet the Personal Assistance DSP qualifications if providing

PA.

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Independent Living Skills Training Service Definition Highlights • Provide education and skill development or training to

improve the person’s ability to independently perform routine daily activities and utilize community resources as specified in the person’s person-centered support plan.

• Services are instructional, focused on development of skills identified in the person-centered support plan and are not intended to provide substitute task performance.

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Independent Living Skills Training Daily living skills training may include only education and skill development related to: • Personal hygiene; • Food and meal preparation; • Home upkeep/maintenance; • Money management; • Accessing and using community resources; • Community mobility; • Parenting; • Computer use; and • Driving evaluation and lessons

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Independent Living Skills Training Service Delivery Expectations • Intended as a short-term service designed to allow a person

to acquire specific additional skills that will support his/her transition to or sustained independent community living.

• Individuals receiving Independent Living Skills Training must have specific independent-living goals in their person-centered support plan that Independent Living Skills Training is specifically designed to support.

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Independent Living Skills Training Service Delivery Expectations • The provider must prepare and follow a specific plan and

strategy for teaching specific skills for the independent living goals identified in the person-centered support plan.

• Systematic instruction and other strategies used in Supported Employment Job Coaching should also be employed in this service.

• The provider must document monthly progress toward achieving each independent living skill identified in the person-centered support plan.

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Independent Living Skills Training Service Delivery Expectations • This service will typically originate from the person’s home

and take place in the person’s home and their home community.

• Providers of this service should meet people in these natural environments to provide this service rather than maintaining a separate service location.

• Transportation during the service (when no-cost forms of transportation are not available or not being accessed) is included in the rate paid for the service.

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Independent Living Skills Training Caps/Limitations • This service is not available to all ECF members. If you get a

referral/authorization, you can assume the ECF member is eligible. • Those receiving CLS or CLS-Family Model cannot get this service because

these supports are included in the CLS or CLS-Family Model service. • Working-age ECF Members cannot get this service unless they:

– Are working in (or pursuing) individual integrated employment – Have agreed to and completed an Employment Informed Choice

Process including the Exploration service.

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Independent Living Skills Training Reimbursement • 15 minute unit • 1:1 staffing ratio $5.50/15 minutes

$22/hour/person

DSP Qualifications • Standard qualifications for all DSPs. • Meet the Personal Assistance DSP qualifications if providing

PA.

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Personal Assistance Service Definition Highlights • A range of services and supports designed to assist an

individual with a disability to perform activities and instrumental activities of daily living at the person’s own home, on the job or in the community that the individual would typically do for themselves if he/she did not have a disability. Personal Assistance services may be provided outside of the person’s home as long as the outcomes are consistent with the supports defined in the person-centered support plan with the goal of ensuring full participation and inclusion.

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Personal Assistance Personal Assistance services may be used to: • Support the person at home in getting ready for work and/or

community participation; • Support the person in getting to work and/or community

participation opportunities; and • Support the person in the workplace and/or in the broader

community.

Can’t get at same time you are receiving another service that includes PAS in the definition for that service.

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Personal Assistance Covered Personal Assistance services also include the following:

– Support, supervision and engaging participation with eating, toileting, personal hygiene and grooming, and other activities of daily living as appropriate and needed to sustain community living, except when provided as a component of another covered service the person is receiving at that time; and

– Direction and training to individuals in the person’s social network or to his/her co-workers who choose to learn how to provide some of the Personal Assistance services.

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Personal Assistance Caps/Limitations • This service is available to ECF Groups 5 and 6 only • There are limits on the number of hours per week a person

can receive this service. • If you get a referral/authorization, you can assume the ECF

member is eligible.

An MCO may authorize services in excess of the limit as a cost-effective alternative to institutional placement or other covered benefits.

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Personal Assistance Reimbursement • 15 minute unit • Individualized service $5.08/15 minutes

$20.32/hour/person

DSP Qualifications • Standard qualifications for all DSPs.

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Supportive Home Care Service Definition Highlights • Essentially, personal assistance for people living with family. • Provision of services and supports in the home and

community to an individual living with his or her family • Directly assist the individual with activities of daily living and

personal needs to insure adequate functioning in their home and maintain community living.

• Person delivering service cannot live in the family home

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Supportive Home Care Services include:

• Hands-on assistance with activities of daily living such as

dressing/undressing, bathing, feeding, toileting, assistance with ambulation (including the use of a walker, cane, etc.), care of hair and care of teeth or dentures. This can also include preparation and cleaning of areas used during personal care activities such as the bathroom and kitchen.

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Supportive Home Care Services include:

• Observation of the person supported to assure safety;

• Oversight and assistance (including providing directions) to

the person to complete activities of daily living or instrumental activities of daily living.

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Supportive Home Care Services include: • Routine housecleaning and housekeeping activities performed

for/with the person supported (not for other family members or persons living in the home, as applicable), 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 and similar activities.

• Necessary cleaning of vehicles, wheelchairs and other adaptive equipment and home modifications such as ramps.

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Supportive Home Care Caps/Limitations • This service is available to ECF Group 4 only • Authorized in same manner as Personal Assistance • No limits on the number of hours per week a person can

receive this • If you get a referral/authorization, you can assume the ECF

member is eligible.

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Supportive Home Care Reimbursement • 15 minute unit • Individualized service $5.08/15 minutes

$20.32/hour/person

DSP Qualifications • Standard qualifications for all DSPs.

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Community Support: Development; Organization and Navigation

Service Definition Highlights: • Assists individuals and families in

1) Developing social networks and connections within local communities

2) Identifying and coordinating the use of unpaid supports to address individual and family needs (service emphasizes and promotes the use of unpaid supports)

3) Increasing personal reliance, community contribution, community connections and mutually supportive relationships;

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Supports provided include assisting ECF members and family caregivers to:

• Provide mutual support to one another • Develop a network for getting information and support,

when needed, from others who receive services or family caregivers of individuals with intellectual/developmental disabilities;

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Supports provided include assisting ECF members and family caregivers to:

• Identify and utilize 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);

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Reimbursement: • What you provide needs to be based on specific goals and

objectives specified in the individual’s PCSP • $100 per member per month • Best to think about this payment as similar to a membership

fee. • Be able to describe what you offer/provide to those who

“join” • Develop something for MCOs to provide to ECF members

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Reimbursement: • $100 per member per month as “membership fee” • Sit down with (or survey) people to find out what they would

most want • Develop business plan to determine how many people you

need to have as “members” to cover your costs • Consider seeking foundation support for start-up costs

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What you might offer each month:

• A combination of information, connections, events, group and 1:1 opportunities that are made available – Virtual – In-person

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Tailor to Different Types of Members

• Older members with Aging Parents & Older Siblings

• Young people and young parents/families

Start with one group if you feel more knowledgeable and better able to address the needs of one group rather than both.

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What you might offer each month: • Virtual platform for your “members” to connect to each other

– Private Facebook page you host • Regular updates on important

information/resources/opportunities • Planning/coordinating opportunities to connect in-person (in

various local areas) • Support of peer matching based on what people have to offer

and need

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What you might offer each month: • Support for ECF members and family caregivers to find and

join groups that relate to their interests, reduce their isolation and increase their connections with others in their communities.

• Support for ECF members and family caregivers to make plans and arrangements to participate in community opportunities.

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To ensure success: • Need to do Community Mapping of areas where members live • Searchable databases will be critical part of this service

– Searchable members’ database (with member profiles that members can enter/modify or you can assist with this) –

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Sources to Consult • LOV-Dane (Dane County, Wisconsin Project) www.lovdane.org

• Vanderbilt Kennedy Center

This should not have a political “bent” to it – although people you connect may choose to do this outside of your involvement.

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http://www.lovdane.org/


DSP Qualifications: • These services are to be provided by a “Community

Navigator” • People with community organizing experience

(informal/formal) will likely be good at this role. • Additional training, beyond basic DSP qualifications, will be

required

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ECF CHOICES Support Coordination

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ECF CHOICES Support Coordination

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Support Coordination

• In ECF CHOICES, support coordination is the responsibility of the MCO

• Each ECF CHOICES member is assigned a Support Coordinator • Support Coordinators:

– Assist in Referral Management, through the intake process – Conduct person-centered needs assessment to develop the

Person Centered Support Plan (PCSP) – Provide information about preferred providers – Support the person in identifying and meeting goals for

integrated employment & community membership – Act as a resource to providers to identify paid & unpaid supports

available to the person

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Objectives: • Understand the role of the Support Coordinator and

the importance of collaboration • Learn about the Referral and Intake Process • Learn about the process of developing the Person

Centered Support Plan, Provider Selection and initiation of services

• Understand the providers role and responsibility in understanding the PCSP

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ECF CHOICES Referrals

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1-Screening

2- Intake

3- Enrollment

Screening TennCare Self-Screening Tool: • On-line application to collect basic information to

assist in determining the applicant’s likelihood for meeting target criteria and priority enrollment categories

• Applicants who need assistance or who do not utilize the self-screening tool, a telephonic screening will be conducted utilizing the same electronic tool

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Intake

• For applicants who are currently enrolled in Medicaid and are Amerigroup or Blue Care members, their MCO will conduct intake

• For applicants who are not currently enrolled in Medicaid OR who are currently enrolled with United Healthcare, DIDD will conduct intake

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Enrollment Intake Coordinator will complete the Enrollment Packet: • Documentation that support the applicant’s Level of Care

(PAE) • Documentation that supports ID/DD diagnosis • ECF CHOICES Member Education Completed Enrollment Packet will be submitted to TennCare for final eligibility and enrollment determination

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ECF CHOICES- NEW MEMBERS

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Support Coordination for new members

• Upon enrollment, the Support Coordinator has 10 business days to: – Conduct a face to face visit; – Initiate a comprehensive needs assessment to

ensure needs are identified and addressed; – Conduct a caregiver assessment; – Develop an initial PCSP; and – Initiate and authorize ECF CHOICES services

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Initial PCSP • The initial PCPS will identify ECF CHOICES HCBS that are needed by

the member on an interim basis while the comprehensive PCSP is developed. – Including employment services, if needed immediately in order

to maintain current employment for the member. • ECF CHOICES HCBS identified in the initial PCSP will be authorized

for no more than thirty (30) calendar days, pending development of the PCSP which shall identify ongoing ECF CHOICES HCBS needed.

• The Support Coordinator is responsible for ensuring a seamless transition from ECF CHOICES HCBS in the initial plan of care to ECF CHOICES HCBS in the PCSP, with no gaps in care.

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Provider Responsibility in Initial PCSP

• Provide electronic signature confirming receipt of PCSP • Communicate frequently with the Support Coordinator

and member to ensure expectations for service delivery and timeframes are clear • Authorizations in initial PCSP will be no greater than

30 days • Partner with the Support Coordinator in the

development of the Comprehensive PCSP and ensuring no gaps in care

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Person-Centered Support Plan

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Person-centered support plan

The partnership between the Support Coordinator and Provider is critical to

ensuring the success of the PCSP

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Person-centered support plan

• The PCSP is the product of the completed person-centered planning process and assessments.

• It is a comprehensive plan that includes individually identified employment, community living and health and wellness goals.

• It identifies all of the LTSS and natural supports necessary to achieve individually identified employment and other outcomes in the most integrated community setting possible.

• The PCSP is the plan of care.

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• The plan describes person’s current status, the person’s desired future status, and supports needed to achieve goals.

• The plan is not used to determine funding level, but rather is a description of the person’s support needs and individually identified goals.

• The plan is expected to change and evolve to meet the person’s needs and to respond to the person’s changing support needs timely.

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Person-centered support plan (cont.)

Person Centered Support Plan (PCSP)

• Refer to handout

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• Face sheet • Demographics • Employment • Education • Relationships and community

integration • Communication • Decision-making/rights • HCBS settings • Personal funds management

• Physical and behavioral health • Medical information • Preventative care • Equipment needs • Action plan/goals • Natural supports and other non-

ECF services • Service plan • Related assessments

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Person-centered support plan The PCSP includes:

Provider responsibility in PCSP • Providing electronic signature acknowledging receipt of PCSP • Utilizing the PCSP to ensure they are providing services in

accordance with the PCSP and training staff to the meet the individual needs of the person supported.

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Provider responsibility in PCSP • Communicating to the SC any time there is a significant

change in circumstances; including but not limited to: – Change of residence or primary caregiver or loss of essential social supports; – Significant change in physical or behavioral health and/or functional status – Hospitalization – Loss of mobility – An event that significantly increases the perceived risk to a member – Member has been referred to APS or DCS, as applicable because of abuse

neglect or exploitation (Critical Incident Training will occur on day 2) – Loss of employment or change in employment status

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ECF CHOICES support coordination provider selection

• SCs are responsible for providing information to the person or the person that helps them make decisions about providers and will include information about preferred providers.

• SCs will assist the person in identifying providers that are linguistically competent in the person’s primary spoken language or in sign language, or other forms of communication including assistive devices.

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ECF CHOICES Support Coordination Minimum contacts • ECF CHOICES Group 4 (Essential Family Supports)

– Quarterly, with semi-annual face-to-face • ECF CHOICES Group 5 (Essential Supports for Employment and Independent

Living) – Monthly, with quarterly face-to-face

• ECF CHOICES Group 6 (Comprehensive Supports for Employment and Community Living) – Low to moderate need; no exceptional medical/behavioral needs

• Monthly, with bimonthly (every other month) face-to-face – Low to moderate need; exceptional medical or behavioral needs

• Monthly face-to-face – High need; with or without exceptional medical or behavioral needs

• Monthly face-to-face

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SUPPORT COORDINATION AND EMPLOYMENT

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Support coordination and employment • SCs have been trained to support individuals in identifying

and meeting their integrated employment goals including: – How to address employment with members at all stages,

including use of motivational interviewing and coordinating efforts with partners

– Employment services available (how to authorize/monitor); other systems that can help (how to help member access/monitor member’s experience)

– Partnering with VR to ensure the member is progressing through every stage in the process of obtaining employment

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Employment Informed Choice Employment Informed Choice Process must be

completed by the Support Coordinator for all working age members (ages 16 to 62) who are eligible for, and

want to receive, Community Integration Support Services and/or Independent Living Skills Training services when the member is not engaged in or

pursuing integrated employment Providers and Support Coordinators will partner to assist the member in making an informed decision related to seeking

employment.

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ECF CHOICES PROVIDER REFERRALS

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ECF CHOICES Provider Referral Process

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Telephonic Referral

Provider Confirmation

Authorization & PCSP

Signature

ECF Service Referral • Support Coordinators will make a telephonic

referral – Best Practice: Provider sends staff to meet the

member to allow the member the opportunity to participate in staff selection

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Provider Confirmation Providers will confirm their ability to train staff on the member’s PCSP and initiate the service within the timeframe communicated by the SC

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PCSP • All providers will receive a copy of the PCSP • PCSP should be used to develop training

specific to the person supported • Providers should review the PCSP and provide

an electronic confirmation – For services in EVV, this electronic confirmation

will take place in the EVV system – For other services, this will take place via email

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Pre-Authorizations & Authorizations

Prior to providing the services, providers will receive an authorization or pre-authorization communicating their approval to provide he service.

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Pre-Authorizations & Authorizations

• Each MCO will have their own processes for authorizations.

• You will be trained on each MCO’s process prior to going live on July 1st

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Documents

Employment and Community First (ECF) CHOICESbluecare.bcbst.com/forms/Provider Information/ECF_CHOICES...• ECF CHOICES: Employment and Community First CHOICES • HCBS: Home- and