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Waiver and Service Frequently Asked Questions

 

Goods & Services

Q: Can Goods and Services be used for getting a guardianship?
A: The criteria is in the definition. If the request appears to meet the criteria, the request can be reviewed by the Division for prior authorization.

Q: For a Goods & Services request, will another service need to be self-directed through PPL to utilize goods and services?
A: Yes, another direct care service such as respite, companion, or personal care must be provided to utilize goods and services.

Q: Can parents get travel reimbursement? 
A: No, parents cannot be reimbursed for any waiver services. They can receive training through Unpaid Caregiver Training, though.

Q: Can goods and services pay for a washer/dryer? Can it be used for Driver’s education for the participant?
A: The criterion is in the definition. If the request appears to meet the criteria, the request can be reviewed by the Division for prior authorization.  There is no blanket approval of one type of item for every participant.

Companion Services

Q: Can a provider bill Companion Services for an overnight stay?
A: Yes, as long as the usage falls within the IBA.

 

Q:  Will there be a limit on the number of units for Companion Service or Child Habilitation?
A:  No, limits are on the service at this time, but proper use of the service will be monitored.

Q:  Can Companion Services be used as a service for a child on the Child DD Waiver during school summer vacations, if the services are outside the home? If so, are there any childcare costs to the parents?
A:  For children age 18 and under, child habilitation services are available to help while the parents work.  The parents are responsible for the basic cost of childcare at the rate the provider charges.  Companion services are available for ages 18 and older to be used as a service on the Child DD Waiver during such times as summer vacation. 

Q:  Why are Supported Employment services now offered under the Children's Waiver, but not Day Habilitation services for the 18-20 year-olds?
A:  Companion services are available as well as other services such as Community Integrated Employment for ages 18 & older.   


Child Habilitation & Licensed Day Care issues

Q: What is the updated service definition for child habilitation?
A: You can find the new service definition document by clicking here.

Q: Is DDD going to provide a sample agreement for providers to use with parents to address the modifier they will be paying for care under child habilitation?
A: Not at this time. Local child care centers may have sample agreements available.

 

Q: Who specifically is responsible for writing goals for children’s habilitation? If providers, is DDD going to provide trainings or sample goals?
A: The team shall decide who is responsible to write them.  They should be similar to other habilitation objectives and the expectations for those are explained in the IPC instructions.

 

Q: If mom works at night and the child is with dad at night, when mom comes home at 7:00 a.m. and dad goes to work, can mom receive respite while she sleeps or does it have to be child habilitation because dad is at work?
A: If they are both working and are both primary caregivers, then respite should not be used while the caregivers are working. Child Habilitation services would be the appropriate service.

Q: Can child habilitation be used through the night if the caregiver works 3rd shift?  What would the habilitation objective be?
A: The service would probably be child habilitation, but the objective for the service when the child is awake when need to be developed to use the service.  This issue may need a specific conversation with the case manager’s Participant Support Specialist.

Q: Are parents obligated to subsidize the cost of care for their children that are 0-12? 
A:  Parents will be expected to pay the rate established by the provider for child care services.  This would be the rate that parents would pay for a normally developing child.

Q: What if the subsidized day care by DFS and the waiver portion exceeds the cost of day care? Do parents still need to pay a portion? 

A: If DFS is paying for child care and the provider is providing services for that amount, there is no need to request child habilitation services.

 

Q: Who is going to determine what is the "child care cost" now being assessed to parents for children under 12?

A:  Each provider of the child habilitation service is responsible for determining what they charge. There may be childcare assistance available through DFS for those parents who qualify.  Contact your local DFS benefits specialist for more information. 

 

Q: Are parents obligated to subsidize the cost of care for their children that are 0-12? 

A: Yes, parents will be expected to pay the wage established by the provider for child care services.  This would be the wage that parents would pay for an average developing child.  DFS has available a statewide listing of the average hourly wages for child care listed by county.  Please contact your local DFS child care licensing office for more information.

 

Q: How do you determine wages and the child habilitation fee paid by parents if a person is self-directing this service?

A: There is a wage range established with a minimum and maximum wage for this service.  The parent portion to the provider of the service is determined between the employee (provider) and the parent and the Division recommends that the two parties have a contract on the amount to be paid, but the Division may need to verify a payment is being made.

 

Q:  Can I charge for Child Habilitation for eight full hours a day?
A:  Yes, as long as it is not during other waiver services, meets the participant’s needs and the service fits the participant’s budget amount.

Q:  If a child is age 18 and his/her school has early release one day a week, what service should be used for supervision of the child?
A:  Companion Services, Residential Habilitation Training, or Supported Living


School Days & Waiver Services

Q: What about using respite before and after home schooling hours?
A: In accordance with 42 CFR §433 Subpart D, Federal Financial Participation (FFP) may not be claimed for services when another third-party (e.g., other third party health insurer or other Federal or state program) is legally liable and responsible for the provision and payment of the service.  This requirement applies to all Medicaid services, including waiver services.  The Medicaid program functions as the payer of last resort.

Q: What about shortened school day? Can services be used during local school district hours? What about for participants ages 18-20?
A: Participants, families, and Case Managers have until December 31 to ask the school to have an IEP meeting and figure out service arrangements for the rest of the school day.  This includes any person through the age of 21 who is still receiving school services.

Q: Can waiver services, such as respite or child habilitation, be provided when the child is sick and not in school?
A: Not if the parent is working. If the parent is working and cannot take off from work to care for their sick child, child habilitation is the appropriate service to provide the supervision needed.

Q: Can nursing be provided if the child is in shortened school day?
A: Nursing shall be funded by the school or through the Medicaid State Plan during school hours.

 Q:  Many kids have part, half or every other day for school in their Individualized Education Plan.  Can we go by this for services offered? 
A:  Parents and teams will be expected to work with their school districts on any issues concerning school hours.  Educational services must be provided for children on an IEP the same hours as all children enrolled in school.  Waiver services cannot be provided during school hours. 

Q:  If a child is being home schooled, what hours would be considered school hours?  Would it be the school districts scheduled hours?
A:  yes. School hours are defined by your local school district.

Q:  Can respite be utilized during spring break from school?
A:  Yes. Child Habilitation services would be a more appropriate service to use, though.


Therapy & Services  

Q: Can personal care be used if therapy is taking place in the home and another person is needed?
A: If the therapist needs assistance with the participant during therapy, the plan of care must justify the assistance needed and which service shall provide the assistance. Natural supports shall try to be utilized before waiver services.

If the participant is in a daily habilitation service (RH, DH, SFHH) the supervision during therapy is part of the habilitation service.  

If it is not available in a natural support, for participants ages 18 and up companion services can be used, and for participants  or child habilitation services can be used. In specific situations, personal care may be used for children under 18, if no other service can be utilized.

Q: Can the respite provider take children to Medicaid state plan therapy services?
A: If the therapist needs assistance with the participant during therapy, the plan of care must justify the assistance needed and which service shall provide the assistance. Natural supports shall try to be utilized before waiver services.  If the participant is in respite services and the respite provider is taking the child to therapy, then the respite provider has to clock in and out during the therapy session, unless the therapist submits justification for additional supervision of the child during therapy and the plan of care reflects this assistance.


Special Family Habilitation Home (SFHH)

Q:  Do I have to do the Extraordinary Care request every year with SFHH?  What if there is no response when I try to contact Department of Family Services?
A:  You do not have to do an Extraordinary Care request every year unless the Extraordinary Care decision states the case will be revisited after one year.  If you do not get a response from DFS, call the Cheyenne Department of Family Services office at (800-457-3659).

Q:  For kids in SFHH services, who is responsible for the co-pay when using Child Habilitation services during non-school days?
A:  There is not a co-pay for Child Habilitation services.  The SFHH provider is required first, to pay the basic cost for childcare at the rate that the provider charges.  Child habilitation can then be used to assist the provider with any additional supports needed due to the special needs of the child.

Q:  Under SFHH can you use respite and child habilitation?
A:  Yes, you may use respite and child habilitation as long as you are following the definition of each service. (Service definitions are posted on the Division’s website).

Q: Can we use personal care with Special Family Habilitation Home placements under the new service definitions?
A: No. For those 18 and up they can choose Residential habilitation and the provider can hire additional staff. Or if they stay with Special Family Habilitation Home, they can add companion services.

For participants under age 18 in SFHH, they can add child habilitation services to assist with the two-person needs. It cannot be personal care per CMS rules and our definition. No additional funds will be added to budgets to accommodate the change in service.

Q: Can supported living be used in conjunction with SFHH?
A: No, supported living is a similar service to residential habilitation training and cannot be used in conjunction with the service per the service definition.


Supported Living

Q: For Supported living services, are the caps “Hard Caps”?
A: If additional units exceed the cap and the IBA will be exceeded, the request goes to ECC and the cap may be exceeded if approved.  If units exceed the cap for the service but not the IBA, the Participant Support Manager may make a policy exception to approved the units above the cap for a temporary basis, not to exceed one year.  If within the IBA, both types of units can be on the same plan as long as the services do not exceed 365 days of service.  (350 daily units of SL and 2500 units of the SL 15 min units would exceed 365 days of service and would not be approved.)

Q: What if the two Supported Living services unit types are split in plan – some group, some individual unit – can they have the cap of both on the same plan?
A: If a person needs more than four hours of assistance through supported living in a day, then the daily unit shall be used to meet needs.

Q: Process if requesting supported living – Does the out of home criteria apply?
A: No, but if the request exceeds the IBA the request shall be reviewed by the ECC. The out of home criteria does not need to be met.