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Home and Community Based Services (HCBS) - Additional Updates Coming Soon


 

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Community Services is the operational unit of the Division that is responsible for overseeing services delivered directly to the individuals we support. The services delivered include Home and Community Based Services (HCBS) services and Pathways to Employment (PTE) services.

Home and Community Based Services (HCBS) Services authorized by the Division of Developmental Disabilities Services (DDDS) are listed below. The service recipient must be enrolled in the DDDS 1915 (c) Home and Community Based Lifespan waiver in order to access the services listed.

 

Day Habilitation: This service is designed to assist with increasing and maintaining independence with adaptive skills, socialization, activities of community living or daily living. Activities should include community engagement.

Community Participation: This is a highly individualized service designed to help in specific goal attainment or personal interests in one's own community. This service can only be delivered in a ratio of 1 staff to 1 service recipient (1:1) and no more than 1 staff to 2 service recipients (1:2) to ensure personal goals and interests are actively pursued. This service must be delivered in the community. It is designed to pair with other services or part-time, not as a stand-alone service.

Prevocational Services: This service is intended for those that have an interest in competitive employment in the community that need to increase or develop general "soft" skills that contribute to sustained employability. This may include learning non-job-specific skills including volunteer work opportunities or internships.

Supported Employment: This service is designed for those that want to work and/or are employed but need continued support or skills training in order to obtain employment or maintain their employment or increase their employment status, whether additional hours or higher level positions. This service can either be delivered as Individual Group Supported Employment (1 staff to 1 service recipient) or Small Group Supported Employment (1 staff to a range of service recipients that work together as a "crew").

Personal Care: This service can be self-directed, where the service-recipient and/or family identify who will provide the care or a PASA or Home Health Agency may be selected to provide the care, which can include activities of daily living such as bathing, household chores, shopping, etc., or transportation to community activities or appointments, etc.

Respite: This service is designed to give the primary caregiver(s) a break. This service can be self-directed, where the service recipient and/or family identify who will provide the care or Camp may be selected as an option; otherwise a PASA or Home Health Agency may be selected to provide this service.

Supported Living: This service can provide up to 40 hours per week of personal care to an individual in their own home or apartment, who has relatively minimal support needs but who still requires assistance to enable them to live as independently as possible in the community.

Residential Habilitation: This service is designed to assist individuals in acquiring skills related to activities of daily living, such as personal grooming and hygiene, bed making and household chores, eating and food preparation, community inclusion and social and adaptive skills necessary to enable individuals to live in the community. This service can either be provided by an agency in a neighborhood group home or apartment or by a Shared Living Provider, a single primary caregiver in their private home.

Nurse Consultation: This service is the overall coordination and monitoring of the health care needs of the service recipient. This may include assessments, oversight and monitoring of medication records, medical appointment records, etc.

Behavioral Consultation: This service provides an individually designed behavior plan and strategies to support service recipients that have significant behavioral issues. The plan is developed through a functional behavioral assessment and necessary training of the support team in order to properly implement the plan.

Community Transition: This service is available for service recipients that are either transitioning from an institutional setting to a community setting or from a provider-managed setting to their own private resident in the community. It covers an exhaustive list of one-time expenses and services in order to establish a domicile (home) in the community.

Assistive Technology: An item, piece of equipment, or product system that is used to increase, maintain, or improve functional capabilities for service recipients. Also included in this service is an evaluation of technology need, training, custom fitting, maintenance, repair, etc. This service can only cover assistive technology that is not otherwise covered by traditional State Plan Medicaid.

Specialized Medical Equipment: This service covers medical equipment and supplies which may include devices, controls, or appliances that enable the service recipient to increase their level of independence in the completion of activities of daily living that are not otherwise covered by State Plan Medicaid.

Home Modifications include physical adaptations to the private residence of the service recipient or the service recipients family (the service recipient must live with them full time to be eligible) that are necessary to ensure the health, welfare and safety of the service recipient and/or increase their level of independence in their home. This may include grab bars, widening of doors, etc.

Vehicle Modifications include adaptations or alterations to the automobile that is the service recipients primary means of transportation. Alterations or adaptations that are of general utility or maintenance are excluded from both services.

Pathways to Employment Services: The service recipient must be enrolled in the DDDS 1915 (i) State Plan Amendment (SPA) Pathways to Employment Program in order to access Pathways services.

Employment Navigation: Each service recipient will be assigned an Employment Navigator that will help develop the employment plan, help connect the service recipient to employment services, and ensure services are being delivered in accordance with the plan.

Career Exploration and Assessment: Person-centered employment planning services which helps the service recipient identify a career plan and helps identify jobs that match their interests, abilities and skills.

Supported Employment: This service is designed for those that want to work and/or are employed but need continued support or skills training in order to obtain employment or maintain their employment or increase their employment status, whether additional hours or higher level positions. This service can either be delivered in as Individual Supported Employment (1 staff to 1 service recipient) or Small Group Supported Employment (1 staff to a range of service recipients, 2-4, that work together as a "crew").

Benefits Counseling: This service provides tools to help the service recipient and/or family to understand how to have a job and still maintain necessary benefits.

Financial Coaching: This service will help the service recipient develop financial strategies identified through benefits counseling and increase the service recipients economic self-sufficiency.

Non-Medical Transportation: This service is available only when a service recipient has no other means and can only be used to gain access to employment services, activities, and resources related to employment. A Transportation Broker will arrange this service.

Personal Care: This service provides assistance with activities of daily living associated with getting ready for work or in the workplace. Services can be provided by a Home Health Agency, a Personal Assistance Services Agency (PASA), or be self-directed.

Assistive Technology: An item, piece of equipment, or product system that is used to increase, maintain, or improve functional capabilities for service recipients. Also included in this service is an evaluation of technology need, training, custom fitting, maintenance, repair, etc. This service can only cover assistive technology that is not otherwise covered by traditional State Plan Medicaid.

List of Providers

CMS 2014 Home and Community Based Services (HCBS) Settings Rule

In January 2014, CMS published a regulation in the Federal Register that further defined what kinds of services and settings can be considered "community-based" for the purpose of funding them with Medicaid funds that are specifically designated for home and community-based services. In the absence of such clear guidance in the past, states developed their own definitions of what kinds of services and settings could be funded with Medicaid HCBS funds. This resulted in wide variability services that strayed from what Congress intended when it created the first HCBS Medicaid authority in 1985. The 2014 regulation also provided much more specificity regarding CMS's expectations about the person-centered planning process and the person-centered plan itself. CMS made it clear that the service recipient drives the planning process and it is the responsibility of the entity that develops the person-centered plan to ensure that the needs and desires of the service recipient are addressed to the greatest extent possible through a combination of paid and unpaid supports. The entity responsible for developing the plan is also responsible for monitoring the delivery of services and supports under the plan and assisting the service recipient to make adjustments to the plan or the services as necessary to allow the service recipient to achieve his/her goals and lead his/her "best life".

HCBS Settings Rule published in Federal Register

CMS Guidance Materials

Delaware Statewide Transition Plan

 

School Transition Services - Coming Soon

 

Contact your Regional Community Services Office



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