213

The terminology used in this Waiver has been updated to make the term intellectual disability synonymous with (and preferable to) the term mental retardation. The diagnostic requirements outlined in 213 A. 1. & 2. do not reflect that change.

215 B. 2. b.

If the DBHDS approved assessment (the AAIDD-SIS) is the only tool to be used and replaces the functional assessments currently in use; it will be difficult to demonstrate “a need for each specific services” as required. The SIS should be one of the instruments used, but providers should not be limited in their use of other more appropriate instruments.

215 D. 5.

This should be revised to read “The case manager must obtain an updated DMAS 225, designate and inform a collector of patient pay when applicable and forward a copy of the updated DMAS-225 form to all service providers and the consumer-directed fiscal agent if applicable.” See other comments below.

223 D. 2. d.

This language should be modified to match the language in 225 B. 7. to indicate that compensation will not be permitted for services “effective the date that the criminal record check confirms . . . “

223 D. 7. a.

229 F. 3. a.

233 D. 10. a.

237 D. 3. a.

241 D. 4. a.

247 D. 2. a.

These references to the assessment instrument (the AAIDD-SIS) which is scheduled to be complete triennially, should include the following language “A copy of the DBHDS-approved assessment, or documentation of the provider’s attempts to obtain a copy . . . “

223 D. 7. g.

229 F. 3. h.

233 D. 10. h.

237 D. 3. i.

241 D. 4. e.

245 D. 4. h.

247 D. 2. f.

249 D. 5.

Unlike the DMAS 122, the DMAS 225 is not completed on an annual basis; it may not be possible for the provider to know when a new DMAS 225 has been completed and, therefore, they could neither have the “most recent” nor know to request the “most recent.”   This will place an undue burden on the providers to document information they have no way to know and may place a provider at risk of monetary penalty in the event of an audit.

223 D. 7. g.

229 F. 3. h.

233 D. 10. h.

237 D. 3. i.

241 D. 4. e.

245 D. 4. h.

247 D. 2. f.

249 D. 5.

The DMAS 225 does not convey the patient pay amount and, therefore, does not contain any information useful or relevant to the provider; it should not be required to be contained in the provider’s records, but should be maintained in the Case Manager’s record.

229 F. 3. c. & d.

If the word “type” refers to the types of service described in 229 C. then documentation of the “individual’s response to . . . as agreed to in the Plan for Supports” should be sufficient to show that the type of service was that as approved in the prior authorization request. Requesting this as a separate item may place a provider at risk of monetary penalty in the event of an audit.

233 D. 7. a. (2)

While I do not object to the intent, documentation of the skill to read and write English may be lacking in a hiring package as it is generally considered discriminatory to apply this standard to only select applicants. The lack of documentation to this specific point may place a provider at risk of monetary penalty in the event of an audit.

241 B. 3.

247 B. 3.

Add the following phrase “Providers must participate as requested in the completion . . . “ to the first sentence and then add “Documentation must be maintained in the Case Management record of attempts to schedule the participation and the results.”

241 D. 4. d.

Because of the allowance for average daily billing; the phrase “the amount of time in services” should be deleted. Attendance recorded on a daily basis mat not satisfy that requirement and may place a provider at risk of monetary penalty in the event of an audit.