To:          Consumers, providers, case managers and stakeholders who support individuals with disabilities in Indiana

From:    Peter A. Bisbecos, DDRS Director

                Adrienne Shields, DDRS Deputy Director

                Kellie Calita, BDDS Director of Client Services

Re:         OASIS Allocations, Transition Policy, OASIS Review Committee, Budget Modification Requests, and Appeals

Date:     February 24, 2009

 

After two years of much work and collaboration with stakeholders, the Division of Disability and Rehabilitative Services (DDRS) is excited to announce that Thursday, February 19, 2009 we began to release allocations for consumers on the Developmental Disabilities (DD) and Autism (AU) Medicaid waivers with annual renewal dates in April and May. Release of allocations for new consumers identified to start on the DD or AU waivers began Friday, February 20, 2009.

 This bulletin is a continuation of our effort to communicate openly about the system changes that impact consumers, providers, and stakeholders who support individuals with disabilities. In the midst of starting the Objective Assessment System for Individual Supports (OASIS), we must also take a moment to consider the current economic situation.

 As the economic downturn in our country continues, Indiana is trying to make predictions and tough decisions to avoid the financial crises other states are experiencing.  While DDRS is committed to providing continuity of care for our existing consumers and continuing efforts to bring people off our waiting lists for waiver services, it is difficult to overstate the seriousness of the challenges we face.  Just as Indiana families and businesses are adjusting resources to deal with economic realities, so is the state.

DDRS is fortunate to be operating successfully within its budget; however, we won’t realize the full extent of our financial commitments until later in the spring.  As a result, we have had to make some important decisions regarding the transition of consumers from the annual plan service delivery system to the OASIS service delivery system.  While many consumers will experience an increase in dollars to meet their needs, others may receive less than their current budgeted amount.  To effectively manage the budgetary impact these changes will bring, DDRS has a transition plan in place for each consumer and new system supports such as the OASIS Review Committee (ORC) and Budget Modification Requests (BMR).

 The following information provides details about the roll-out of OASIS and allocations for current and new waiver recipients as well as steps we can all take to best support the individuals we serve while ensuring fiscal responsibility.

 OASIS Allocation Release

DDRS released the allocations for individuals with April and May 2009 renewals and new consumers identified to begin services beginning Thursday, February 19, 2009 and Friday February 20, 2009. Case managers will have up to ten (10) business days to share this information with consumers and guardians.

Providers listed on the current Notice of Action (NOA) will receive the allocation amounts following the ten (10) day period. This information will come via e-mail, similar to the NOA process.

Moving forward, DDRS plans to release the allocation information 100 days prior to each consumer’s annual renewal date. This begins with consumers having annual plan renewal dates June 2009 and forward.

Note to current consumers with April and May 2009 renewals:  If you have not received your allocation information from your IPMG case manager by Friday, March 6, 2009 please contact the IPMG Help Line listed at the end of this bulletin.

Transition to OASIS Allocations

The allocation amount for each consumer will be released in an individualized letter to each consumer.   The letter includes a detailed description of the transition process from the annual plan service delivery system to the OASIS service delivery system.

Current consumers are assigned one of six (6) potential transition plans based on the change in the dollar amount from their most recent annualized POC/CCB compared to their new OASIS allocation.  Consumers will have a minimum of three (3) months to a maximum of fifteen (15) months to prepare and plan for services within their OASIS allocation.

New consumers identified to start services on the DD or autism waiver will immediately use their OASIS allocation.

The chart below shows the six (6) possible transition periods from Annual Plan (AP) to the OASIS service delivery system for consumers currently on the DD and AU waivers. New consumers on the DD and AU waivers will immediately begin services in OASIS.

Current Consumers on the DD and AU Waiver
Budget Change from Annual Plan (AP) to OASIS	Transition Period
	Year 1		Year 2		Year 3 +
Increase $.01 to $20,000	6 months at 50% current AP	6 months at 50% OASIS	12 months at 100% OASIS		12 months At 100% OASIS
Increase $20,00  to $60,000	9 months at 75% current AP	3 months at 25% OASIS	12 months at100% OASIS
Increase $60,001 and greater	12 months at 100% current AP		3 months at 25% current AP	9 months at 75% OASIS
No change to a decrease -$.01 to -$20,000	3 months at 25% current AP	9 months at 75% OASIS	12 months at 100% OASIS
Decrease -$20,001 to -$60,000	6 months at 50% current AP	6 months at 50% OASIS	12 months at 100% OASIS
Decrease -$60,001 and greater	12 months at 100% current AP		12 months at 100% OASIS

If you would like to see an example of each of the transition letters, you can go online to the following link: http://www.in.gov/fssa/ddrs/2903.htm.

Using the Invoicing Tool

Beginning January 2009, providers will be required to use the current Invoicing Tool to bill for Residential Habilitation Services (RHS) for consumers when one or more consumer is served in a shared setting and is utilizing the Uniform Rate Methodology. Example: Two individuals share a setting, one is on Annual Plan and one is on Uniform Rates. Both will use the RHS Invoicing Tool. The consumer on Annual Plan will bill at the Annual Plan rates and the consumer on Uniform Rates will bill at the new rates.

The online instructions for Creating a Site indicate that a provider must enter the service planner hours for a consumer as they appear on the ISP service planner.  However, this will only work for consumers who have transitioned onto OASIS.  Consumers still on Annual Plan may not have a service planner which indicates their current services.  Providers do have flexibility to enter Non-OASIS housemates without the benefit of a service planner.  As each housemate comes onto an OASIS service plan, the provider will want to update their site(s) on the Invoicing Tool to reflect the accurate service planner hours.

Additionally, providers do have the ability to change the underlying site information each time they bill.  This is allowed; however, if a provider continually changes the underlying site information regarding the service planner, they may exhaust a consumers POC/CCB/NOA prior authorization before the period is over.

The invoicing tool is available online at: https://ddrsprovider.fssa.in.gov/BDDS/.

OASIS Review Committee

A consumer or support team may feel that the allocation amount is not enough to support the health and welfare needs of the individual. The support team should contact the IPMG case manager to request a review by the OASIS Review Committee (ORC).  The IPMG case manager will complete the OASIS review request within the INSITE system.

The ORC is assigned to review an allocation, inputs used to build the allocation, and any collateral information provided by the consumer’s support team.  This committee will report its findings and recommend actions to be taken, if any, to adjust the allocation amount. The committee and the process have been created consumers and support teams have the opportunity to review their situation prior to filing a formal appeal.

Events to request an OASIS review

• Life Changing Events:
• Death, institutionalization or long-term incapacitation of a primary caregiver
• Primary Caregiver is age 80 or older
• Transition from Crisis Management Services and unable to return to original setting
• A young adult who is currently on the waiver and is terminating their secondary education

·         Needs have changed and individual is unable to purchase services to meet current needs

• ICAP assessments did not accurately reflect the individual’s current situation/ability

Members of ORC include:

·         BDDS Director of Client Services

·         BDDS Field Services Director(s)

·         DDRS Case Management Liaison

·         BDDS Waiver Unit Supervisor

·         OMPP Representative

·         BQIS Representative

·         BDDS Ombudsman

The process for accessing ORC is explained in individualized consumer allocation and transition letters. If you have additional questions about ORC, you should contact Kellie Calita, Director of Client Services with the Bureau of Developmental Disabilities Services (BDDS) by E-mail at kellie.calita@fssa.IN.gov.

Please note: If you attended a previous OASIS presentation or have reviewed materials on the OASIS web pages, you may have noticed that we used the word ‘mediation’ rather than ‘OASIS Review Committee’ or ‘ORC’. Because the word mediation implies a legal process, the name change was made to reinforce that this review is an informal, but important step in our internal processes to help DDRS/BDDS best support the individuals we serve.

Appeals

Each consumer has the right to appeal an approved or denied plan of care.  These rights and the process for filing an appeal are fully disclosed on the Notice of Action (NOA).  The appeal process has not changed.

Budget Modifications Requests for Qualifying and Life Changing Events

During the course of the waiver plan year, a consumer may experience circumstances where the support team may need to seek a Budget Modification Request (BMR). The support team should contact the IPMG case manager to request a BMR. The IPMG case manager will complete the BMR within the INSITE system. A BMR is available for the unanticipated, short-term situations listed below.

Events to request a Budget Modification Request

• Life Changing Events:

o   Death, institutionalization or long-term incapacitation of a primary caregiver

o   Primary Caregiver is age 80 or older

o   Transition from Crisis Management Services and unable to return to original setting

o   A young adult who is currently on the waiver and is terminating their secondary education

• Loss of housemate
• State intervention for behavioral needs
• State intervention for health or medical needs
• State intervention for substantiated abuse, neglect, or exploitation

Please note: Additional funds from an approved BMR are meant as a supplement to meet the immediate needs of the consumer.  Each initial event may be approved for up to ninety (90) days. If short term support is still required, additional BMR’s may be submitted each month, not to exceed 180 days from the initial event.

Sharing Staff and Resources

Due to the recent events affecting the economy of the State of Indiana, it is very important for consumers and providers to seek and discover ways to share resources.  The State of Indiana is requesting that consumers, families, providers, advocates and other stakeholders seek innovative ways to manage their resources by seeking alternatives that are respectful, reasonable, and responsible such as:

·         Shared staffing

·         Shared living arrangements

·         Electronic Monitoring Systems/Technology Services

·         Assistive/Adaptive Technology

Questions or Concerns

We will continue to communicate information about the OASIS service delivery system. In addition, we plan to include frequently asked questions in a future bulletin. The following resources are available to assist you:

Questions or concerns regarding the OASIS initiative:

OASIS-ICAP Help Lines: (317) 234-5222 or 1-888-527-0008

Email: OASIS-ICAPHelp@fssa.in.gov

Website: www.ddrs.IN.gov

Mailing address:              MS-26: DDRS/OASIS ICAP-Help

402 W. Washington St., W451

Indianapolis, IN 46204

Questions or concerns regarding your allocation, contact
your case manager or the IPMG Help Line:

IPMG Toll Free Phone: 1-866-672-4764, extension 261

Website:  www.gotoipmg.com

Though the economic climate has changed in recent months, the values we share have not. We will continue to be transparent, responsive and accountable. Working together, we can accomplish a lot to bring about the changes our system needs and improve the quality of life for Hoosiers with disabilities.

Thank you.

 

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