9 CSR 45-2.015 - Prioritizing Access to Funded Services
(1) Definitions.
(A) Community services-Supports funded and
purchased through the Department of Mental Health Purchase of Service (POS)
system with general revenue appropriations to assist individuals who have an
intellectual developmental disorder and/or developmental disabilities to live
in the community. Eligibility for MO HealthNet is not required. Community
services includes services for people with autism spectrum disorders funded
with general revenue appropriations and administered through the Autism
Projects defined at 9 CSR 45-3.060.
(B) Community Support waiver-A set of
services, not including residential services, for MO HealthNet eligible
individuals who have an intellectual developmental disorder and/or a
developmental disability who have been determined to otherwise require the
level of care provided in an ICF/DD.
(C) Comprehensive waiver-A set of services,
including residential services, for MO HealthNet-eligible individuals who have
an intellectual developmental disorder and/or a developmental disability who
have been determined to otherwise require the level of care provided in an
ICF/DD.
(D) Division-Division of
Developmental Disabilities.
(E)
Intermediate care facility for intellectual developmental disorder and/or a
developmental disability-Any facility certified under
42 CFR
440.150. These facilities are referred to as
intermediate care facilities for developmental disabilities (ICF/DD) throughout
this rule.
(F) Missouri Children
with Developmental Disabilities waiver (MOCDD)-A set of services, not including
residential services, for children under the age of eighteen (18) living with
their parents, who will qualify for MO HealthNet by qualifying for the waiver,
who have an intellectual developmental disorder and/or a developmental
disability who have been determined to otherwise require the level of care
provided in an ICF/DD.
(G)
Partnership for Hope waiver-A set of services, not including residential
services, for MO HealthNet-eligible individuals who have an intellectual
developmental disorder and/or a developmental disability who have been
determined to otherwise require the level of care provided in an ICF/DD. The
Partnership for Hope is a county-based waiver operational in any Missouri
county with a levy authorized under section
205.968, RSMo, whose board of
directors has authorized funds to support the Partnership for Hope waiver or in
any Missouri county approved by the Centers for Medicare and Medicaid Services
for inclusion in this waiver.
(H)
Prioritization of Need (PON) scoring-A process that assigns a score to the
level of need for an individual, as set forth in
9 CSR
45-2.017. PON scoring is used to determine access to
services when funding is limited and shall be applied to all individuals prior
to participation in any of the following programs:
1. Comprehensive waiver;
2. Community Support waiver;
3. Missouri Children with Developmental
Disabilities waiver (MOCDD); or
4.
Community services funded with general revenue appropriations and purchased
through the Department of Mental Health Purchase of Service (POS)
system.
(I) Waiting
list-A list of all people who have qualified for but are not currently
receiving services from the division. The waiting list shall be subdivided into
the following categories:
1. Children under
the age of eighteen who are not eligible for MO HealthNet, who have needs that
require the level of care in an ICF/DD, and who would otherwise be eligible for
the MOCDD waiver;
2. Individuals
who are eligible for MO HealthNet who have needs that require the level of care
in an ICF/DD and are otherwise eligible for the comprehensive waiver;
and
3. Individuals who are eligible
for MO HealthNet who have needs requiring the level of care in an ICF/DD, who
do not have an immediate need for residential services but have service needs
beyond the scope of the Partnership for Hope waiver; and
4. Individuals who are eligible for MO
HealthNet, who have needs requiring the level of care in an ICF/DD, whose needs
can be met safely with services in the Partnership for Hope waiver.
(2) Prioritizing Access
to State General Revenue-Funded Autism Project-Funded Services (defined at
9 CSR
45-3.060). People who are on this waiting list shall
be prioritized for access to general revenue funded services based on PON
score. When two (2) or more individuals have the same PON score, the
individual(s) who has been on the waiting list the longest time shall be given
priority.
(3) The following
sections describe how the waiting list for home and community-based waivers
will be established and managed when funding is limited and establishes the
methods used to determine which waiver is most appropriate to meet the needs of
individuals when funding becomes available.
(A) Individuals who reside in a participating
Partnership for Hope waiver county who would otherwise require care in a ICF/DD
may be considered for enrollment in the waiver if the individual is
experiencing crisis or meets other priority criteria as outlined below in this
rule. When participation in the Partnership for Hope waiver is limited by
available funds, individuals experiencing a crisis will be served first. If
more than one (1) individual is experiencing a crisis, the individual who has
been waiting the longest will be served first. If no one is experiencing a
crisis, then individuals meeting other priority criteria will be served. If
more than one (1) individual meets priority criteria, the individual who has
been waiting the longest will be served first.
1. To be considered for access based on a
crisis, an individual must be experiencing one (1) of the following:
A. Health and safety conditions pose a
serious risk of immediate harm or death to the individual or others;
B. Loss of primary caregiver support or
change in caregiver's status to the extent the caregiver cannot meet needs of
the individual; or
C. Abuse,
neglect, or exploitation of the individual.
2. To be considered for access to the
Partnership for Hope waiver when no one in that county who is on the waiting
list is experiencing a crisis, individuals meeting the following criteria will
be served on the basis of length of time on the waiting list:
A. The individual's circumstances or
conditions necessitate substantial accommodation that cannot be reasonably
provided by the individual's primary caregiver;
B. The individual has exhausted both their
educational and Vocational Rehabilitation (VR) benefits or they are not
eligible for VR benefits and they have a need for preemployment or employment
services;
C. Individual has been
receiving supports (other than case management) from local funding for three
(3) months or more and the services are still needed and the service can be
covered by the waiver; and
D.
Individual living in a non-Medicaid funded residential care facility chooses to
transition to the community and has been determined to be capable of residing
in a less restrictive environment with access to Partnership for Hope waiver
services.
(B)
Individuals who are determined to meet emergency criteria as described in
9 CSR
45-2.017(1)(E) and who require
out-of-home residential services or for whom out-of-home residential care is
imminent, and whose needs cannot be met with services and supports other than
residential services or whose needs for services is anticipated to be in excess
of the cost limitations of other waivers shall receive priority consideration
to participate in the Comprehensive waiver.
1.
Individuals on the waiting list shall be enrolled in the Comprehensive waiver
according to the PON score, as set forth in
9 CSR
45-2.017 as funding becomes available.
2. When two (2) or more individuals have the
same PON score, the individual(s) who has been on the waiting list the longest
time shall be given priority access to the Comprehensive waiver.
3. When individuals on the waiting list are
offered and refuse waiver services a new PON assessment shall be
completed.
(C)
Individuals on the waiting list whose needs can be met without residential
services, whose needs can be met safely in the community, and whose annual
service costs is anticipated to be less than the cost limits of those waivers,
shall be prioritized for access in waivers other than the Comprehensive
waiver.
(D) Children under the age
of eighteen (18) who would otherwise require care in an ICF/DD, but who are not
otherwise eligible for MO HealthNet because of parental income and/or assets,
may be considered for participation in the MOCDD waiver, and shall be served
from the waiting list as turnover occurs based on prioritized need. When two
(2) or more individuals have the same PON score, the individual(s) who has been
on the waiting list the longest time shall be given priority. When individuals
on the waiting list are offered and refuse the service or services for which
they were placed on the waiting list, they are removed from the waiting list.
Should services be desired in the future, a new ISP and PON may be
submitted.
(4) Program
Turnover.
(A) Funds becoming available due to
participants leaving (turnover) any programs listed under subsection (1)(I)
shall first be used for individuals served in that program who have increased
needs. When these needs are met, funds that become available from turnover may
be used to enroll new individuals in the program.
(5) No individual shall receive services
under more than one (1) home and community-based waiver at the same time,
including home and community-based waivers operated by any other Missouri state
agency. Any individual who is eligible for services under more than one (1)
waiver and has priority access to services based on their score as set forth in
9 CSR 452.017, when funding is available under both programs, shall be offered
a choice of the waiver that best meets their needs, including home and
community-based waivers operated by any other Missouri state agency.
(6) An individual may receive services under
a waiver and may also receive community services funded with general revenue
appropriations and purchased through the Department of Mental Health Purchase
of Service (POS) system with approval from the division director when there is
a need that cannot be met with waiver services.
Notes
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