WAIVER CASE MANAGEMENT

Case Management is another component of the waiver services.  This component’s primary goal is to ensure that the waiver participant is receiving the full range of appropriate services that our company and the community can provide and then to monitor the manner in which the services are provided.  The case manager initiates and oversees the process of assessment of the recipient’s level of care and the review of MAPS at the specified intervals for reassessment.  The case manager provides many services to accomplish the component’s primary goal. 

First, they are the facilitator of all Multi-Agency Plan of Service meetings.  Then, it is their job to maintain and observe the quality of services being provided.  They must visit each participant monthly and ask if they are satisfied with their services and what they want changed if they are not satisfied.  The case manager’s responsibility is to advocate for each waiver participant.  They make sure that each individual has the right to choose where they live and work in the community and that they receive the right outcomes from their services.  This responsibility is directly related to many of our core values and to our mission.

Many of the consumers who were new to the program learn  the responsibilities of their case manager after the first year or so.  They tell the case manager if they enjoy their program plan or if they want to change what is going on and are encouraged to do that.  They realize that if they have issues with their implementor, they can not only discuss this problem with their coordinator, but also with their case manager.  Many guardians/consumers have learned that if they need to pursue other resources for things that waiver cannot provide the case manager can research this for them.  The case management program also develops many relationships with other generic resource providers, such as mental health services or adaptive equipment providers.  The case managers are also advocating for their consumers that are in the school systems. 

More specifically case management services include responsibility for locating, coordinating and monitoring the ACS Waiver services including the following:  all proposed waiver services; other Medicaid State Plan services; needed medical, social, educational and other publicly funded services, regardless of funding source, and, informal community supports needed by recipients and their families.  According to DDS and the Medicaid regulations the intent of ACS case management services is to enable waiver recipients to receive full range of appropriate services in a planned, coordinated, efficient and effective manner.  ACS case management services consists of the following activities:  arrange for the provision of services; monitoring and review of waiver recipient’s services; facilitating intervention during crisis intervention; counseling; case planning; assessment and referral; follow-along to ensure quality of care; case reviews which focus on the recipients’s progress in meeting goals and objectives established through the MAPS; determining certification for categorical eligibility for Level IV category of eligibility for ACS waiver; and, developing and approving MAPS for Level IV category of eligibility for ACS waiver.

E-mail:
Rita Puryear

ALTERNATIVE COMMUNITY SERVICES WAIVER

The Alternative Community Services program (ACS) is a statewide program funded through Medicaid which provides services to Medicaid eligible individuals with mental retardation and/or a developmental disability.  The program provides an array of home and community based services an individual needs to avoid institutionalization.

These services are provided through Federal and State Medicaid funds.  All individuals who receive these services have been determined to be Medicaid eligible based on both a developmental disability determination and financial need.  Referrals for this service are received from Developmental Disability Services and determined eligible by DDS and Medicaid.  The program is "consumer driven" allowing the individual to select their own provider agency and participate in the selection of employees to provide direct services.  The consumer is able to select services which they believe will best meet their own needs and ideals for a quality life retaining as much independence and control in the direction of their destiny as is possible.

The program is in direct line with the mission and core values of Abilities Unlimited.  The primary goal of the program is to improve the quality of one’s life in a community setting.  By assisting one to remain living in their own home and community, the ACS waiver program promotes individual choice and direction. The services included under this program include the following: Case Management Services; Integrated Supports; Supported Employment Services; Environmental Modifications/Physical Adaptions/Personal Emergency Response Systems; Specialized Medical Supplies;  Consultation Services; and Crisis Abatement Respite Care Services. 

The services are provided under the directions of an ACS case manager and/or ACS coordinator. Each of these individuals are responsible for a separate set of services.  The ACS coordinator organizes and oversees the provision of direct care services including Integrated Supports and Supported Employment.  The coordinator hires, trains, and monitors staff to provide both the integrated supports and the supported employment services. 

E-mail:
Stephanie Gotay