DODD Martin v. Strickland

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The Individual Option (IO) Waiver at a Glance

Waiver services, also known as ‘Medicaid waivers’ are programs offered by three state departments – Aging, Job and Family Services and Mental Retardation and Developmental Disabilities.

Waiver services provide certain Ohio citizens the training and support that they need in addition to the Medicaid State Plan services that they can receive. Medicaid State Plan services are often called ‘Medicaid Card’ services and include prescription medication, hospital care, physician visits and other healthcare services.

Currently, the Ohio Department of DODD offers the Level One Waiver and the IO Waiver. These waivers allow a limited number of people who meet certain conditions to stay in their own homes and receive services there and in the community instead of living in an Intermediate Care Facility for the Mentally Retarded (ICF/MR).

To receive IO waiver services, an individual must be eligible for Medicaid and have an ICF/MR Level of Care approved by the Department of Job and Family Services. Service and Support Administrators (SSAs) who work in each county board of mental retardation and developmental disabilities will assist individuals to apply for Medicaid and complete their Level of Care paperwork.

Through the service planning process, with help from the SSA and input from professionals and service providers, each individual, his/her family and advocates will determine which services are needed, how often they are needed, where they will be provided and who will provide them. The payment amounts that will be available for the IO waiver funded part of these services are based on the needs of each individual as measured by the Ohio Developmental Disabilities Profile (ODDP).The Acuity Assessment (AAI) is also used to determine a waiver budget amount if an adult needs out of home day services through the waiver.

The IO waiver provides the following services:

Adult Day Services
These non-vocational day services help an individual who is not eligible to receive educational services to be as independent and safe as possible and to be a contributing member of his/her community. These services must be provided in a non-residential place separate from the home in which the individual lives.
Environmental Accessibility Adaptations
This service includes changes to the individual’s home that help him/her to be more independent. The modifications may include widening doorways, building ramps into the home, changing bathrooms for individuals who use wheelchairs or other aids to walk, and installing special electric or plumbing changes needed to operate medical equipment.
Home Delivered Meals
Preparation and delivery of up to two meals each day, seven days per week is provided for individuals who are unable to make their own meals or get healthy meals for themselves in some other way.
Homemaker/Personal Care
Services are provided to increase the independence of the individual within his/her home or the community. Services may include:

Basic personal care and grooming such as bathing, hair care and help dressing;

Assisting the individual going to and/or using the bathroom;

Help with household chores for the individual, such as changing bed linens and doing the laundry, so the individual remains in good health and is comfortable;

Helping the individual take his/her medication or perform health-related tasks that have been delegated by the individual’s physician and a licensed nurse;

Helping the individual to prepare shopping lists, to make meals, to shop in the community for food and clothing;

Assisting the individual to go to medical appointments, to use community services, to take walks and participate in recreational activities inside and outside the home;

Cooking meals with the individual or for the individual;

Assisting the individual to get to and from work and other vocational activities;

Running errands on behalf of the individual, such as picking up medication from the drug store.

Interpreter Service
People who provide this service help the individual to communicate his/her messages and feelings and understand the messages of others.
Non-medical Transportation
This service pays for transportation needed by an individual to get to and from places where he/she receives Supported-Employment – Community, Supported Employment – Enclave, Adult Day Services and/or Vocational Habilitation waiver services.
Nutrition Service
A Nutritionist provides direction to individuals who are at risk because they a not eating the right kinds of foods to stay healthy. The service can be used to prepare a plan for healthy eating and can also be used to teach the individual, his/her family or others who help with meals.
Respite Care
Services are provided to individuals for a short period of time in an ICF/MR and/or other home licensed by the Department of MR/DD in order to give persons who care for them a break. Respite services are also available when caregivers are unable to provide care because of their illness or absence.
Social Work/Counseling
Professional help is provided to assist individuals and their families to solve problems and gain social skills that will help the individual to have a better life in the community.
Specialized Adaptive or Assistive Equipment and Supplies
Services include devices, controls, appliances, supplies and/or other equipment that an individual needs to do everyday activities or to communicate his/her needs. The waiver pays for items that are not able to be paid for through the Medicaid State Plan.
Supported Employment – Community
This service provides job coaches, supervision and training to help individuals find and keep paying community jobs at places where persons without disabilities are employed and to work side-by-side with them.
Supported Employment – Enclave
This service provides job coaches, supervision and training to help individuals who work as a team to find and keep paying jobs at one or more work sites of the ‘host’ community business.
Supported Employment – Adaptive Equipment
Payment can be made to buy or modify equipment that will be owned by an individual who is receiving Supported Employment – Community or Supported Employment – Enclave and that the individual needs to get and/or keep his/her job.
Transportation
Payment can be used to help individuals get to and from waiver services or other community services, activities or resources.
Vocational Habilitation
Day services help an individual who is not eligible to receive educational services to learn skills related to work such as being on time, finishing tasks, solving problems and getting along with others. These services must be provided in a non-residential place separate from the home in which the individual lives.

Comparison of Services Available in an ICF/MR, Through
The Medicaid State Plan and Through The IO Waiver

Service/Item of Cost

Provided by ICF/MR

IO Waiver Service

Medicaid Funded State Plan Service

Home Health Nursing

RN and LPN available

Delegated Nursing included in Homemaker/Personal Care

Yes

Private Duty Nursing
RN and LPN available

No

With Prior Authorization

Home Health Aide
Direct Service

Homemaker/Personal Care

Yes

Physical Therapy
Yes

No

Yes

Occupational Therapy
Yes

No

No

Psychology
Yes

No

Yes

Interpreter
Yes

Yes

No

Group or
Individual Counseling
Social Work/Licensed Counselor

Social Work/Licensed Counselor

Yes

Pharmacy Mgmt
Through State Plan

Through State Plan

Yes

Prescription Meds.
Through State Plan

Through State Plan

Yes

Respite Care
No

Yes

No

Medical/Incontinence
Supplies/ Adaptive
Equipment
Yes

Specialized medical and adaptive equipment and supplies

Yes

Crisis Intervention
As part of direct services

As part of direct services

Yes

Partial Psychiatric
Hospitalization
No

No

Yes

Community Psychiatric
Support Treatment
As part of direct services

No

Yes

Medical Case
Management
Yes

No

Yes

Service and Support Administration
From QMRP

From county mr/dd board

No

Physician’s Services
Yes

No

Yes

Environmental Accessibility Adaptations
Yes

Yes

Yes

Non-medical
Transportation

Yes

To access Adult Day Services and as a stand alone Transportation service

Yes

Day Program Services
Provider selected by the ICF/MR

Off-site Adult Day and Vocational Habilitation

No

Supported Employment
Provider selected by the ICF/MR

Yes

No

Supported Employment Adaptive Equipment
Provider selected by the ICF/MR

Yes

No

Foster Care
No

To be added as a service in 2007

No

Therapeutic Leave Days
Yes

Payment made only when waiver service is delivered

No

Room and Board
Yes

Payment for room, board and personal need items to be made from personal funds of the individual.

No

Home-Delivered Meals
Yes

Yes

No

Download Individual Option (IO) Waiver at a Glance

Service/Item of Cost	Provided by ICF/MR	IO Waiver Service	Medicaid Funded State Plan Service
Home Health Nursing	RN and LPN available	Delegated Nursing included in Homemaker/Personal Care	Yes
Private Duty Nursing	RN and LPN available	No	With Prior Authorization
Home Health Aide	Direct Service	Homemaker/Personal Care	Yes
Physical Therapy	Yes	No	Yes
Occupational Therapy	Yes	No	No
Psychology	Yes	No	Yes
Interpreter	Yes	Yes	No
Group or Individual Counseling	Social Work/Licensed Counselor	Social Work/Licensed Counselor	Yes
Pharmacy Mgmt	Through State Plan	Through State Plan	Yes
Prescription Meds.	Through State Plan	Through State Plan	Yes
Respite Care	No	Yes	No
Medical/Incontinence Supplies/ Adaptive Equipment	Yes	Specialized medical and adaptive equipment and supplies	Yes
Crisis Intervention	As part of direct services	As part of direct services	Yes
Partial Psychiatric Hospitalization	No	No	Yes
Community Psychiatric Support Treatment	As part of direct services	No	Yes
Medical Case Management	Yes	No	Yes
Service and Support Administration	From QMRP	From county mr/dd board	No
Physician’s Services	Yes	No	Yes
Environmental Accessibility Adaptations	Yes	Yes	Yes
Non-medical Transportation	Yes	To access Adult Day Services and as a stand alone Transportation service	Yes
Day Program Services	Provider selected by the ICF/MR	Off-site Adult Day and Vocational Habilitation	No
Supported Employment	Provider selected by the ICF/MR	Yes	No
Supported Employment Adaptive Equipment	Provider selected by the ICF/MR	Yes	No
Foster Care	No	To be added as a service in 2007	No
Therapeutic Leave Days	Yes	Payment made only when waiver service is delivered	No
Room and Board	Yes	Payment for room, board and personal need items to be made from personal funds of the individual.	No
Home-Delivered Meals	Yes	Yes	No

DODD Martin v. Strickland

The Individual Option (IO) Waiver at a Glance

The IO waiver provides the following services:

Comparison of Services Available in an ICF/MR, Through The Medicaid State Plan and Through The IO Waiver

Service/Item of Cost

Provided by ICF/MR

IO Waiver Service

Medicaid Funded State Plan Service

Comparison of Services Available in an ICF/MR, Through
The Medicaid State Plan and Through The IO Waiver