State of the States in Intellectual and Developmental Disabilities

Adult Residential Care – Community-Based Residential Facilities (CBRF): A community-based residential facility (CBRF) is a residence where five (5) or more adults, not related to the operator or administrator of the facility, reside and receive care, treatment, support, supervision, and training. An individual with an intellectual disability may only reside in a CBRF that is licensed for eight (8) or fewer residents, unless that person has been determined to require No Active Treatment (NAT) for her or his intellectual disability. Services may include supportive home care, personal care, supervision, behavior and social supports, daily living skills training, transportation, and up to three hours per week of nursing care per resident. Assistive technology/communication aids: Assistive technology is an item, piece of equipment, or product system – whether acquired commercially, modified, or customized – that enables members to (1) increase their ability to perform ADLs and IADLs or control the environment in which they live and (2) access, participate, and function in their community and in competitive integrated employment. Assistive technology service is a service that directly assists a member in the selection, acquisition, or use of an assistive technology device. Assistive technology includes the following: (A) evaluation of the assistive technology needs of a member, including a functional evaluation of the impact of the provision of appropriate assistive technology and appropriate services in the customary environment of the member; (B) services consisting of purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices for the member; (C) services consisting of selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices; (D) coordination and use of necessary therapies, interventions, or services with assistive technology devices, such as therapies, interventions, or services associated with other services in the member-centered plan; (E) training or technical assistance for the member or, where appropriate, family members, guardians, advocates, or authorized representatives of the member; and (F) training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of members. Assistive Technology includes communication aids, which are devices or services needed to assist members with hearing, speech, communication, or vision impairments. These items or services assist the member to effectively communicate with others, decrease reliance on paid staff, increase personal safety, enhance independence, and improve social and emotional well-being. Communication aids include any device that addresses these objectives, such as augmentative and alternative communication systems, hearing or speech amplification devices, aids and assistive devices, interpreters, cognitive retraining aids, and the repair and/or servicing of such systems. Communication aids also include electronic technology, such as tablets, mobile devices, and related software that assists with communication, when the use provides assistance to a member who needs such assistance. Applications for mobile devices or other technology also are covered under this service when the use is primarily medical in nature or provides assistance to a member who needs such assistance. This list is intended to be illustrative and is not exhaustive. PIHPs will be permitted to purchase goods from major retailers without the retailer. PIHPs would be required to pay normal, market prices for these items. This waiver service is only provided to individuals ages 21 and over. All medically necessary Assistive Technology/Communication Aids for children under age 21 are covered in the state plan benefit pursuant to the EPSDT benefit. Transportation (specialized transportation) – community transportation: This service may not duplicate any service that is provided under another waiver service category or through the Medicaid State Plan. Excludes transportation to receive non-emergency medical services which are covered under the Medicaid State plan transportation benefit, or in the case of a self-directing member with budget authority to purchase such services, under the Other Transportation service. Excludes emergency (ambulance) medical transportation covered under the Medicaid State plan service. Transportation (specialized transportation) – other transportation: Other Transportation consists of transportation to receive non-emergency, Medicaid-covered medical services. This service may include items such as tickets, fare cards or other fare media, reimbursement of mileage expenses, or payment for services where the provider directly conveys the member and her or his attendant, if any, by common carrier or specialized medical vehicle (SMV) as appropriate to and from receiving Medicaid–covered medical services. Members eligible for this service must have decision-making authority over a budget for the purchase of such services. Such members (1) are not limited to providers in the PIHP’s network, although the PIHP must verify credentials of specialized medical vehicle providers, (2) are not required to obtain prior authorization to purchase any transportation service from a qualified provider to any Medicaid-covered medical service if the member’s budget is sufficient to pay for the service, and (3) are not required to schedule routine trips in advance if the member can obtain transport. Legally responsible persons, relatives, or legal guardians may be paid for providing this service if they meet the conditions under Appendix C-2 d & e of this waiver. Prevocational Services: Prevocational services are designed to create a path to integrated community-based employment for which an individual is compensated at or above the minimum wage but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. Prevocational services allow the member to develop general, non-job-task-specific strengths and skills that contribute to employability in paid employment in integrated, community settings. Services are expected to occur over a defined period of time as determined by the member and his or her care planning team. Services are expected to specifically involve strategies that enhance a member’s employability in integrated, community settings. Prevocational services should enable each member to attain the highest possible wage and work in the most integrated setting that is matched to the member’s interests, strengths, priorities, and abilities. Services intend to develop general skills that lead to employment, including the ability to communicate effectively and establish appropriate boundaries with supervisors, co-workers, and customers; express and understand expectations; engage in generally accepted community workplace conduct and adopt appropriate workplace dress; follow directions; attend to tasks; problem-solve; manage conflicts; and adhere to general workplace safety. Services may include mobility training. Prevocational services may be delivered in a variety of locations in the community and are not limited to fixed-site facilities. Some examples of community sites include the library, job center, banks, or businesses. Prevocational services, regardless of how and where they are delivered, are expected to help people make reasonable and continued progress toward participation in at least part-time, integrated employment. Prevocational services are not considered outcomes; competitive employment and supported employment are considered successful outcomes of prevocational services. The optimal outcome of the provision of prevocational services is permanent integrated employment at or above the minimum wage in the community. Prevocational services may not duplicate services that are provided as part of an Individualized Plan for Employment (IPE), under the Rehabilitation Act of 1973, as amended, or as part of an Individualized Education Plan (IEP), under the Individuals with Disabilities Education Act (IDEA). The contracted provider of pre-vocational services must complete a six-month progress report and service plan document for the interdisciplinary care management team (IDT). The purpose is to ensure and document that prevocational services are assisting the member in progressing toward a goal of at least part-time, integrated employment. Timely completion of this document is required for the IDT to consider reauthorization of prevocational services. Participation in prevocational services is not a prerequisite for individual or small group supported employment services provided under the waiver. Members who receive prevocational services may also receive educational, supported employment, and/or day services. A member-center plan may include two or more types of nonresidential services. However, different types of non-residential services may not be billed for the same period of time. Members participating in prevocational services shall be compensated in accordance with applicable Federal and State laws and regulations. Transportation may be provided between the member’s residence and the site of the prevocational services or between prevocational service sites – in cases where the member receives prevocational services in more than one place – as a component part of prevocational services or under specialized (community) transportation but not both. All providers of transportation shall ensure that the provider qualifications for specialized (community) transportation are met. If the transportation is provided by the prevocational services provider, the cost of this transportation is included in the rate paid to the provider. Personal care provided to a member during the receipt of prevocational services may be included in the reimbursement paid to the prevocational services provider, or it may be covered and reimbursed under another waiver service so long as there is no duplication of payment. Skilled Nursing Services RN/LPN: Skilled nursing is “professional nursing” as defined in Wisconsin’s Nurse Practice Act, Wis. Stat. Ch. 441. Nursing services are medically necessary, skilled nursing services that may only be provided safely and effectively by an advanced practice nurse, a registered nurse, or a licensed practical nurse who is working under the supervision of a registered nurse. Nursing students may provide allowable nursing services. The nursing services provided must be within the scope of the Wisconsin Nurse Practice Act, consistent with the member-centered plan, authorized by the PIHP, and not otherwise available to the member under the Medicaid state plan or through Medicare. However, the lack of coverage under the State plan or through Medicare does not preclude the coverage of skilled nursing as a waiver service when services are within the scope of the Wisconsin Nurse Practice Act. This waiver service is only provided to individuals ages 21 and over. All medically necessary Skilled Nursing Services RN/LPN services for children under age 21 are covered in the state plan benefit pursuant to the EPSDT benefit. Under the Wisconsin Nurse Practice Act, professional nursing includes any of the following: Professional skilled nursing means the observation or care of the ill, injured, or infirm, or for the maintenance of health or prevention of illness of others, that requires substantial nursing skill, knowledge, training, or application of nursing principles based on biological, physical, and social sciences. Professional skilled nursing includes any of the following: (a) The observation and recording of symptoms and reactions; (b) The execution of procedures and techniques in the treatment of the sick under the general or special supervision or direction of a physician, podiatrist licensed under Wis. Stat. Ch. 448, dentist licensed under Wis. Stat. Ch. 447, or optometrist licensed under Wis. Stat. Ch. 449, or under an order of a person who is licensed to practice medicine, podiatry, dentistry, or optometry in another state if the person making the order prepared the order after examining the patient in that other state and directs that the order be carried out in this state. (c) The execution of general nursing procedures and techniques. (d) The supervision of a patient and the supervision and direction of licensed practical nurses and less skilled assistants in accordance with Wis. Stat. Ch. 441. Nursing services may include periodic assessment of the member’s medical condition when the condition requires a skilled nurse to identify and evaluate the need for medical intervention or monitor and/or modify the medical treatment services provided by non-professional care providers. Services may also include regular, ongoing monitoring of a member’s fragile or complex medical condition as well as the monitoring of a member who has a history of non-adherence with medication or other medical treatment needs. Delegation of nursing tasks to less skilled personnel shall be in accordance with Wis. Stat. Ch. 441, Wis. Admin. Code Ch. N 6, and the Wisconsin Nurses Association’s Guidelines for Registered Nurse Delegation to Unlicensed Assistive Personnel. These services are provided when nursing services identified as needed in a plan of care and furnished under the approved State plan limits are exhausted or when the nursing services are not covered under the Medicaid State Plan. For members enrolled in Medicare, this excludes services that are available through the Medicare program except for payment of Medicare cost share.

Remove requirement to complete a six month progress report to reauthorize service.

N/A

Allow all home and community-based waiver services to be provided in temporary settings including hotels, shelters, schools, churches, and isolation facilities. Residential Services (CBRF): Permit community-based residential facilities (CBRFs) with greater than 8 beds to provide services to individuals with IDD who do not have a NAT (no active treatment) designation.

Temporarily provide home and community-based waiver services in out of state settings. Providers must have a provider agreement with the SMA, and payment must be made directly to the provider.