Show me the money Webinar-1.txt

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Show Me The Money: Navigating Funding Sources 

Heidi Cooley-Cook 


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Kentucky Autism Training Center 

Today�s Agenda 

�House Bill 159 � coverage by insurance 
�Medicaid Waivers 
�KY IMPACT 
�IMPACT Plus 
�Hart-Supported Living Program 
�Social Security � SSI & PASS 
�Employment and the Office of Vocational 
Rehabilitation (OVR) 



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�Took effect January 1, 2011 
�Guaranteed coverage for other services 
as treatment for Autism Spectrum 
Disorders 
�Defined several terms 
�Mandated licensure for ABA 


House Bill 159 

This presentation was created from information that was obtained from secondary resources on 1/19/12 


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What�s covered? 


�Habilitative or Rehabilitative Care 
�Medical Care 
�Pharmacy Care 
�Psychiatric Care 
�Psychological Care 
�Therapeutic Care 


House Bill 159 

This presentation was created from information that was obtained from secondary resources on 1/19/12 


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What�s covered? 


�Large Group Plans 
�Enacted by 1/31/11 
�Maximum annual benefit ages 1-7=$50,000 
�Maximum monthly benefit ages 7-21=$1,000/month 
�No limits on number of visits to an autism services 
provider 
�Services may be subject to a co-pay and/or deductible 




�Individual and Small Group Plans 
�Maximum monthly benefit ages 1-21=$1,000/month 






 

House Bill 159 

This presentation was created from information that was obtained from secondary resources on 1/19/12 


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For Additional Information: 

�View webinar hosted by KATC 
�Autism and Private Insurance 
�January 19, 2012 




https://louisville.edu/education/kyautismtraining/videos 

House Bill 159 

This presentation was created from information that was obtained from secondary resources on 1/19/12 


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Types of Waivers 

�Supports for Community Living (SCL) 
�Home and Community Based (HCB) 
�Michelle P 


Medicaid Waivers 

This presentation was created from information that was obtained from secondary resources on 1/19/12 


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�Have a diagnosis of intellectual disability or 
developmental disability 


and 

�Must meet requirements for residence in an 
Intermediate Care Facility for persons with intellectual 
disabilities 


and 

�Meet other Medicaid requirements 


 

 

Eligibility Requirements 

Supports for Community Living (SCL) 

For Additional Information: http://dbhdid.ky.gov/ddid/scl.asp 

This presentation was created from information that was obtained from secondary resources on 1/19/12 


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What�s covered? 

Supports for Community Living (SCL) 

This presentation was created from information that was obtained from secondary resources on 1/19/12 

Consumer Directed Option (CDO) available 

�Adult Day Training 
�Behavior Supports 
�Case Management 
�Children�s Day Habilitation 
�Community Living Supports 
�Occupational Therapy 
�Physical Therapy 
�Psychological Services 
�Residential Supports 
�Respite 
�Speech Therapy 
�Supported Employment 



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�Currently a waiting list � apply early 
�Complete MAP 620 form 
�http://dbhdid.ky.gov/ddid/files/MAP620Form.pdf 
�Mail or Fax form to: 




The Division of Developmental & Intellectual Disabilities 

100 Fair Oaks Lane, 4W-C 

Frankfort, Kentucky 40621 

Fax: 502-564-8917 

How to Apply 

Supports for Community Living (SCL) 

This presentation was created from information that was obtained from secondary resources on 1/19/12 


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�Elderly or disabled 


and 

�Meet nursing facility level of care � without services 
would be admitted to a nursing facility 


and 

�Are financially eligible for Medicaid services 


 

 

Eligibility Requirements 

Home and Community Based (HCB) 

For Additional Information: http://chfs.ky.gov/dms/hcb.htm 

This presentation was created from information that was obtained from secondary resources on 1/19/12 


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�Assessment 
�Re-assessment 
�Case Management 
�Minor Home Adaptation 
�Adult Day Health Care 
�Homemaker 
�Personal Care 
�Attendant Care 
�Respite Care 


 

What�s covered? 

Home and Community Based (HCB) 

This presentation was created from information that was obtained from secondary resources on 1/19/12 
Consumer Directed Option (CDO) available 


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�Complete a financial application 
�Local Department for Community Based 
Services 


�Complete a physician-ordered assessment 
�Contact a home health agency or adult day 
health center 




How to Apply 

Home and Community Based (HCB) 

This presentation was created from information that was obtained from secondary resources on 1/19/12 


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�Diagnosed with a developmental or intellectual 
disability 


and 

�Require a protected environment while learning living 
skills, educational experiences, awareness of their 
environment 


and 

�Are financially eligible for Medicaid services 


 

 

Eligibility Requirements 

Michelle P 

For Additional Information: http://chfs.ky.gov/dms/mpw.htm 

This presentation was created from information that was obtained from secondary resources on 1/19/12 


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�Case Management 
�Adult Day Training 
�Supported Employment 
�Community Living 
Supports 
�Behavior Supports 
�Occupational Therapy 
�Physical Therapy 
�Speech Therapy 
�Respite 
�Homemaker Service 
�Personal Care 
�Attendant Care 
�Environmental/Minor 
Home Adaptation 
�Adult Day Health Care 


 

What�s covered? 

Michelle P 

This presentation was created from information that was obtained from secondary resources on 1/19/12 

Consumer Directed Option (CDO) available 
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�Schedule a Michelle P. Waiver assessment 
�Contact local Community Mental Health Center 
(CMHC) 
�Link on website includes contact information 






How to Apply 

Michelle P 

This presentation was created from information that was obtained from secondary resources on 1/19/12 


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�Allows waiver eligible members to choose a 
provider for their non-medical waiver services 
�Greater freedom of choice, flexibility, and control 
over their supports and services 
�Can choose to direct all or some of their non-
medical waiver services 




Why? 

Consumer Directed Option (CDO) 

This presentation was created from information that was obtained from secondary resources on 1/19/12 

For Additional Information: 

 http://chfs.ky.gov/dms/Consumer+Directed+Option.htm 


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�Under age 18 


and 

�Diagnosis of a psychiatric disorder �intellectual disability or 
other brain disorder may be present, but cannot be primary 
diagnosis 


and 

�Must be severely limited in at least 2 of the following areas: 


 

 

Eligibility Requirements 

KY IMPACT 

For Additional Information: 
http://dbhdid.ky.gov/dbh/ky%20impact.asp 
This presentation was created from information that was obtained from secondary resources on 1/19/12 
Self Care 

Interpersonal Relationships 

Family Life 

Self-direction 

Education 

 


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�Service Coordination � assists with coordination and 
service planning from 2 or more agencies at the 
same time 
�Social Services, Family Resources, Juvenile Justice, Medicaid, 
School, Physicians, other providers and a Parent Representative 


�Since no two children are alike, the services 
coordinated by IMPACT are different for each child 
�Services differ from community to community, 
depending on the resources available 


What�s covered? 

KY IMPACT 

This presentation was created from information that was obtained from secondary resources on 1/19/12 


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�You may contact the state office for Kentucky 
IMPACT, and you will be directed to the appropriate 
regional office: 
�502-564-4456 


�Contact your local Community Mental Health Center 


How to Apply 

KY IMPACT 

This presentation was created from information that was obtained from secondary resources on 1/19/12 


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�21 years old or younger 


and 

�Medicaid eligible 


and 

�At risk for immediate/extensive institutionalization or 
have a clinically significant behavioral health disorder 
other than intellectual disability, dementia, or 
personality disorder 


and 

�Disorder documented throughout a 6 month period 


 

 

Eligibility Requirements 

IMPACT PLUS 

For Additional Information: http://dbhdid.ky.gov/dbh/Impact%20Plus.asp?sub1 
This presentation was created from information that was obtained from secondary resources on 1/19/12 


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What�s covered? 
IMPACT PLUS 

This presentation was created from information that was obtained from secondary resources on 1/19/12 

�After-School or Summer 
Program Service 
�Behavioral Health 
Evaluation 
�Collateral Service 
�Crisis Stabilization Service 
�Day Treatment Service 
�Group Therapy 
�Individual Therapy 
�Intensive Outpatient 
Behavioral Health Service 
�Parent-to-Parent Support 
�Partial Hospitalization 
Service 
�Targeted Case Management 
�Therapeutic Child Support 
Service 
�Therapeutic Foster Care 
Service 
�Therapeutic Group 
Residential Service 



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�Visit the Online Provider Directory 
�Select IMPACT PLUS 
�Select your city or region to narrow results 




or 

�Contact KY Department of Mental Health, 
Developmental Disabilities, and Addiction 
Services � (502) 564-5777 


How to Apply 

IMPACT PLUS 

This presentation was created from information that was obtained from secondary resources on 1/19/12 

http://dbhdid.ky.gov/ProviderDirectory/OnlineProviderDirectory.aspx 


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�Any person with a disability - 


and 

�Individual, family, or guardian is a Resident of Kentucky 


and 

�Living with a family member, independently or in a 
congregate setting 


Eligibility Requirements 

Hart-Supported Living Program 

For Additional Information: http://chfs.ky.gov/dail/HartSupportedLiving.htm 

This presentation was created from information that was obtained from secondary resources on 1/19/12 
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�Examples of one-time requests 
�Adaptive and therapeutic 
equipment 
�Home modifications 
�Vehicle modifications 
�Start-up grants � related to 
living in a house or rental 
property in the community 




 

 

What�s covered? 
Hart-Supported Living Program 

This presentation was created from information that was obtained from secondary resources on 1/19/12 

�Examples of on-going requests 
-Attendant Care/Personal 
Care/Companionship services 
-Community Resource Developer 
-Homemaker Services 
-Respite 
-Recreation/Leisure 
-Liven-In Support 
-Trainer in home management and 
independent living skills 
-Support broker or personal agent 
-Consultation 
-Transportation 
-Employment related expenses 




Not obtainable from another 
source: private insurance, 
Medicare, Medicaid or 
another program 


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�April 1 � annual deadline for submitting complete application 
�http://chfs.ky.gov/dail/HartSupportedLiving.htm 
�Select Hart-Supported Living Application in top right 
corner 
�Complete application 
�Submit application and supporting documents 
�Regional Hart-Supported Living Coordinator (listed on 
website) 






How to Apply 
Hart-Supported Living Program 

This presentation was created from information that was obtained from secondary resources on 1/19/12 


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�Meet Social Security�s definition of disability for 
children 


and 

�Income and resources fall within the eligibility 
requirements (child and family members) � until 18 


and 

�Child�s condition results in �marked and severe 
functional limitation� for at least 12 continuous months 


If a child did not qualify due to parents� earnings or 
assets � individual may want to reapply at age 18 

Eligibility Requirements 
Social Security � SSI 

For Additional Information: http://www.ssa.gov/pubs/10026.pdf 

This presentation was created from information that was obtained from secondary resources on 1/19/12 
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What�s covered? 

Social Security � SSI 

This presentation was created from information that was obtained from secondary resources on 1/19/12 
�Monthly subsidy 
�Automatically eligible for Medicaid 



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�http://www.ssa.gov/applyfordisability/child.htm 


Or 

�Call 1-800-772-1213 
�Ask for an appointment over the phone or in an 
office 




How to Apply 
Social Security � SSI 

This presentation was created from information that was obtained from secondary resources on 1/19/12 

Link to the SSI Child Disability Starter Kit � 

forms and additional info: 

http://www.ssa.gov/disability/disability_starter_kits_child_eng.htm 


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�You want to work; 
�You get SSI (for can qualify for SSI by having this plan) 
because you are disabled or blind; and 
�You have other income and/or resources to use to get a job 
or start a business 


Plan for Achieving Self-Support (PASS) 

Social Security � PASS 

For Additional Information: http://www.ssa.gov/pubs/11017.html#1 
This presentation was created from information that was obtained from secondary resources on 1/19/12 

Under SSI rules, any income that you have may reduce your SSI payment. But, if you 
have an approved plan, you can use that income to pay for the items you need to reach 
your work goal. Money set aside under this plan does not count when we decide your 
SSI payment amount. This means you may get a higher SSI payment. Also, resources 
you set aside for a plan do not count against the $2,000 per individual or $3,000 per 
couple limit. This could help you qualify for SSI. 

 


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What�s covered by the plan? 
Social Security � PASS 

This presentation was created from information that was obtained from secondary resources on 1/19/12 
A plan can help you set aside money for most work expenses. 
With an approved plan, you can set aside money to pay 
expenses to reach your work goal. For example, the money 
you save can be used for: 
�Transportation to and from work; 
�Tuition, books, fees and supplies needed for school or training; 
�Child care; 
�Attendant care; 
�Employment services, such as job coaching and resume writing; 
�Supplies to start a business; 
�Equipment and tools to do the job; or 
�Uniforms, special clothing and safety equipment. 



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�The plan must be in writing, and Social Security must 
approve it. To start, contact your local Social Security 
office for an application (Form SSA-545-BK) 
�Social Security must evaluate and approve your plan 


How to Apply 

Social Security � PASS 

This presentation was created from information that was obtained from secondary resources on 1/19/12 
The Center for Accessible Living in Louisville or Independence 
Place in Lexington has individuals trained to assist individuals with 
this process � WIPA � Work Incentives Planning and Assistance 

http://www.hdi.uky.edu/setp/Materials/WIPA-counties_served_Center_for_Accessible_Living_Jan_2011.pdf 


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�Must be an individual with a disability 


and 

�Must require VR services to be employed 


 

Presumed eligible if 

�Receiving SSI and/or SSDI 
�Intends to achieve employment 
�Is capable of achieving employment 


Eligibility Requirements 

Office of Vocational Rehabilitation 

For Additional Information: http://ovr.ky.gov/ 
This presentation was created from information that was obtained from secondary resources on 1/19/12 


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What�s covered? 
Office of Vocational Rehabilitation 

This presentation was created from information that was obtained from secondary resources on 1/19/12 
�See a qualified Vocational Rehabilitation Counselor 
�Individualized assessment and career exploration 
�Develop the Individualized Plan for Employment 
Services may include: 




�Reader services 
�Transition services 
�Personal assistance 
�Rehabilitation Technology 
�Supported Employment 
�Tools & equipment 
�Job placement 


�Assessment 
�Counseling and guidance 
�Referral 
�Restoration 
�Vocational training 
�Maintenance & transportation 
�Interpreter services 



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�Contact the local branch manager 
�http://ovr.ky.gov/programservices/district.htm 




or 

�Call 800-372-7172 




 

How to Apply 

Office of Vocational Rehabilitation 

This presentation was created from information that was obtained from secondary resources on 1/19/12 


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�Must be an individual with a disability 


and 

�If your disability has interfered with getting and/or 
keeping a job, you may be eligible 


 

Presumed eligible if 

�Receiving SSI and/or SSDI 
�Intends to achieve employment 
�Is capable of achieving employment 


Eligibility Requirements 
Supported Employment via OVR 

For Additional Information: http://www.ovr.ky.gov/programservices/se 
This presentation was created from information that was obtained from secondary resources on 1/19/12 


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What�s covered? 
Supported Employment via OVR 

This presentation was created from information that was obtained from secondary resources on 1/19/12 
�Assistance finding employment 
�Person-centered job selection 


�Job development services 
�Job-site training and/or ongoing follow-up and support 
�Individual Plan for Employment (IPE) 
�Person-centered employment plan 


�Long Term Support Plan 



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�Call Kentucky Office of Vocational Rehabilitation 
� 800-372-7172 or 502-564-4440 
�Specify Supported Employment 






 

How to Apply 

Supported Employment via OVR 

This presentation was created from information that was obtained from secondary resources on 1/19/12 


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Questions? 
Contact info: 
Heidi Cooley-Cook 
hacool01@louisville.edu 
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Center contact info: 
Telephone: (502) 852-2467 or 
800-334-8635 ext. 852-4631 Fax: (502) 852-7148 E-mail: katc @ louisville.edu 
https://louisville.edu/education/kyautismtraining