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Important Information about Developmental Disabilities Waiver Implementation
Please refer to this page for current and important updates about DD Waiver Implementation:
Updated: 5/21/2013
2012 DD Waiver Service Standards updated version April 23, 2013.
See this document for changes to the November 2012 DDW Standards
They apply as follows:
- Newly allocated individuals: at the time of their first ISP starting on or after November 1, 2012.
- Current participants: When they enter the new system by annual ISP date on or after March 1, 2013.
For the next year, DDSD will be operating a dual system of standards and rates for the DD Waiver. This dual system will remain in place through February 28, 2014. During that time current program participants will transition to the new DD Waiver services, rates and 2013 Service Standards.
Until individuals transition, their current ISP will remain in effect and their services will be provided under the 2007 DD Waiver Service Standards.
Therapy Resources
2012 Therapy Documentation Information
- 2012 Prior Authorization Therapy Criteria
Identification of therapy criteria upon which to base the Therapy Service Prior Authorization Request (TSPAR). Detailed descriptions and examples of each criterion are provided (click here ).
- Year 1 Transition
Instructions for transitioning therapies from the 2007 Standards to the 2012 Standards when one or more therapy services may require fading (click here).
COTA-PTA Calculator for TSPAR
Please note: At this time the forms in the Toolkits cannot be filled out electronically. We are currently working on this and will have upgrades that will allow for the forms to filled out electronically and have calculating fields. Please check back very soon.
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2012 Documentation Guidelines
Guidelines pertain to therapy documentation for individuals as the 2012 DD Waiver Standards are applied. Click here for the 2012 Documentation Guidelines for Therapies (link to Rules/ DDSD Guidelines). (updated 11/29/2012)
DDSD TOOLKITS Please note: At this time the forms in the Toolkits cannot be filled out electronically. We are currently working on this and will have upgrades that will allow for the forms to filled out electronically and have calculating fields. Please check back very soon.
 Adult Nursing Toolkit:(last revised: 3/22/2013)
ANS Eligibility Parameter Toolkit .
ANS Eligibility Parameter Toolkit Guidance.
ANS Prior Auth Request Form (ANSPAR).
ANS Prior Auth Request Form (ANSPAR) Instructions.
Intensive Medical Living Services:
IMLS Eligibility Parameter Toolkit.
IMLS Prior Auth Form.
IMLS Nurses Worksheet.
Agency nurse Instructions for the Prior Auth form and Worksheet.
Behavior Support Consultation: (last revised: 4/01/2013)
Behavioral Services Consultation Prior Authorization Request (BSCPAR) Instructions.
Behavioral Services Consultation Prior Authorization Request (BSCPAR) Form.
Behavioral Support Consultation (BSC) Clinical Necessity Criteria.
Resource Allocation Model for Behavioral Support Consultation.
Positive Behavior Supports Assessment Guide.
Positive Behavior Supports Plan (PBSP) Guide
Positive Behavior Supports Assessment (PBSA) Template.
Therapy Services Toolkit:(last revised: 4/3/2013)
TSPAR Instructions for Therapists..
Therapy Service Prior Authorization Request (TSPAR) Form.
Please note that the DDSD website has a link to Therapy Documentation Guidelines for the 2012 DD waiver.
DD Waiver Transition on Additional Waiver Allocations
The Department of Health has allocated additional individuals onto the Developmentally Disabled Waiver (DDW) program. Those clients can choose to receive services through the traditional DD Waiver or Mi Via Waiver program. In order to ensure a smooth transition for these clients we have developed this informational sheet as some guidance for you.
DD Waiver Implementation
DD WAIVER STANDARDS REQUIREMENT FOR PRIOR APPROVAL BY DDSD REGIONAL OFFICE PROVIDER REQUEST FORM (posted: 5/6/2013)
For any prior approval or prior authorization request (excluding the TSPAR, BSPAR and ANSPAR,) Case Manager’s must use the DD WAIVER STANDARDS REQUIREMENT FOR PRIOR APPROVAL BY DDSD REGIONAL OFFICE Provider Request Form.
This includes action/approval requests for services under the 2007 DD Waiver Service Standards and the 2012 DD Waiver Service Standards. Complete the entire form and submit with any additional attachments that may be required to your Regional Office for review. The Regional Office will respond no later than 30 days of the request on the ‘DDSD Notice of Action on Prior Approval’ section at the bottom of the form.
DD Waiver Budget Worksheet and Instructions (posted: 12/31/2012)
DDSD has issued new Budget Worksheets for services and service packages under the 2012 DD Waiver Service Standards, effective November 1, 2012. These worksheets are required for the Annual Budget and Revisions, and are to be submitted to the Medicaid Third Party Assessor, (TPA), Molina Healthcare, along with required documentation. Case Managers should ensure that they use a valid budget sheet, by downloading these sheets directly from the DDSD website regularly. Case Managers are responsible for verifying that the version date in the far upper left-hand corner is the most current.
Molina Sample Forms
Case Management Updates (updated 4/2/2013)
Case Managers are invited to review the most recent information available click here to link to the Case Managers Website. Included are the minutes for the Statewide Case Management Meeting.
Revised Individual Service Plan:
DD Waiver Budget Worksheets (1/1/2013)
Worksheets (updated: 4/22/2013; posted to web 5/8/2013)
These files contain formulas within the worksheets that may make windows give you alerts. The suggested way of downloading these documents is to "Save As" in a location on your desktop or other place where you want to keep it. Then from that location attempt to open the document. The first error message may tell you that the file has been saved in a different format than specified by the file extension. Go ahead and select "Yes." This should allow you to open up the file and it should work properly. DDSD is working to fix this issue. Download times will vary.
Policy
Updated: 4/29/2013
The purpose of this policy is for the Department of Health (DOH), Developmental Disabilities Supports Division, (DDSD) to provide a stipend for individuals who are non-ambulatory and receiving Supported Living services through the New Mexico Home and Community Based Medicaid Developmental Disabilities Waiver (DDW) program.
The purpose of this policy is to allow one full Individual Service Plan (ISP) year for individuals assigned to NM DD Waiver Group A or B receiving services through the New Mexico Home and Community Based Medicaid Waiver (DDW) program to transition out of twenty-four (24) hour residential services into models of service that provide intermittent support consistent with the individual’s assessed need.
- New Mexico Developmental Disabilities Waiver Group H Policy(Effective Date: January 1, 2013)
The purpose of this policy is to establish criteria for the Department of Health (DOH) employees to follow when reviewing requests for temporary or long term assignment to NM DDW Group H for eligible participants of the Developmental Disabilities Medicaid Waiver (DDW) program.
- Use of the Supports Intensity Scale® Assessment (SIS) Policy(Effective Date: December 20, 2012)
The Purpose of this policy is to use a valid assessment tool to identify the support needs for all adult individuals receiving services through the New Mexico Home and Community Based Medicaid Waiver (DDW) program. The Support Intensity Scale® (SIS) assessment, published by the American Association on Intellectual and Developmental Disabilities (AAIDD) has been chosen by New Mexico to fulfill this purpose.
Procedures
Updated: 4/29/2013
This procedure establishes a process for:
a. Providing information to adults eligible for the DDW about the SIS assessments process; and
b. Scheduling the SIS assessment for eligible adults served through the New Mexico Home and Community based Medicaid Waiver (DDW) Program.
This procedure establishes a process for conducting SIS assessments to determine the support needs of individuals served through the New Mexico Home and Community Based Medicaid Waiver (DDW) Program.
This procedure establishes a process for determining the New Mexico (NM DD Waiver Group) assignment and notification process for eligible individuals served through the New Mexico Home and Community Based Medicaid Waiver (DDW) Program.
This procedure establishes a process for determining the need for additional staff support for eligible adults who receive Supported Living services. Information provided from the Supports Intensity Scale® (SIS) assessment, conducted in accordance with 8.134.5.NMAC, is the basis for determining whether an adult receiving Supported Living services through the New Mexico Home and Community Based Medicaid Developmental Disabilities Waiver (DDW) Program requires an increased level of staffing in order to assist with transfers and other activities of daily living.
This procedure establishes a process for transitioning eligible adults assigned to a NM DD Waiver Group A or B from 24 hour residential services to more independent living supports such as Customized In-Home Supports. Individuals will have up to a full ISP year to transition into models of service that provide intermittent support consistent with the individual’s assessed need.
This procedure establishes a process for assigning certain individuals to New Mexico Developmental Disabilities Waiver Group H for purposes of resource allocation within the Developmental Disabilities (DD) Waiver.
Director's Release
Updated: 5/21/2013
SIS Reassessment Requests for New Allocations
For individuals allocated to the DD Waiver between April 1, 2012 and May 9, 2013, reassessments may be requested without prior authorization from DDSD within certain timeframes. For new allocations and transfers to the DD Waiver on May 10, 2013 and after, prior authorization for reassessments is required.
Areas affected by the new DDW Standards (link to Rules/ Director's Releases) (issue date: 10/30/2012)
This Director’s Release clarifies issues related to the DD Waiver Standards, effective 11/1/12
Consumer Records (link to Rules/ Director's Releases) Oct 29 2012 update (issue date: 10/29/2012)
The purpose of this policy is to establish provider requirements for documentation in the Individual Case File for individuals receiving services through the Developmental Disabilities Home and Community Base Waiver (Developmental Disabilities Waiver or DD Waiver), while at the same time minimizing the transmission of documents from one entity to another.
NEW DEVELOPMENTAL DISABILITIES WAIVER SERVICES FEE SCHEDULE: This supplement replaces the State of New Mexico Medical Assistance Program Manual Supplement #12-07 dated June 27, 2012. The Medical Assistance Division of the Human Services Department has concluded its comment period for the new DDW provider fee schedule; the final fee schedule is attached. The new fee schedule and service packages will become effective for services provided to DDW eligible recipients on November 1, 2012 (click here). Also see: www.hsd.state.nm.us/mad
Announcement about implementation dates:
Updated: 8/24/2012
- DD Waiver Implementation: extension of the implementation timeline Click here.
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