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WCHS DD Status Report


Developmental Disabilities Overview

Developmental disabilities include mental or physical conditions that occur before the age of 22 that result in substantial functional limitations and are likely to continue indefinitely. Examples of the more common conditions, which may result in a developmental disability, are mental retardation, autism, cerebral palsy, Down syndrome, etc. Many of these disabilities are considered "syndromes" because the actual causes cannot easily be identified. Mental retardation, for example, is estimated to potentially have up to 350 different causes, ranging from genetic (e.g., Trisomy 23) to environmental factors (e.g., lead poisoning). Developmental disabilities are certainly a significant challenge to those who experience the condition, but they also have significant impact on the lives of the individuals' families, schools, churches, neighborhoods and communities in general. Many persons can live, work and play in their communities – to be full participants – with those "natural supports" that we all enjoy, from our families, friends, co-workers, etc., and others require more structured service options in order to support them in learning how to manage, adjust and participate successfully in all aspects of community life.

Based upon the 2000 census figures for Wake County (653,058), there were approximately 13,061 children and adults with developmental disabilities. Of this number, half (6,531) will have mental retardation, and the remaining number will have other developmental disabilities such as cerebral palsy, autism, Down syndrome, etc. The prevalence of all DD is generally calculated at about 2% of the population, of which 1% is estimated for mild, moderate, severe and profound mental retardation (Baroff, 1991 and 2002). Recent estimates for the prevalence of autism is around 1 in 500 live births (NY Times, The News and Observer, 2002). Nationally, the dramatic increase in the incidence of autism and Autistic Spectrum Disorder has been considered at "epidemic" proportions. The prevalence of traumatic brain injury (brain injuries resultant to external trauma) is considered to be 100 per 100,000 population. Roughly 10-12% of hospitalized survivors of TBI are determined "severe" and likely eligible for services. In North Carolina, the age that the injury occurred is not a factor in determination of eligibility for DD Services, as opposed to the other conditions.

Development disabilities are a life-long issue. The prevalence of people with severe disabilities appears to be on the rise in N.C., and Wake County in particular. Advances in medical technology are helping infants, who 5-10 years ago would not have survived, survive. Many of these children, some weighing less than 26 ounces, are surviving but face a lifetime of physical and mental challenges. Many people who would have died in childhood due to significant circulatory, respiratory, alimentary and neurological disorders are living much longer but have significant physical and mental challenges. Many more people who sustain significant head injuries are surviving longer and face similar challenges.

In the not-too-distant past, families with a family member who had challenges similar to those articulated above had two choices: to cope with all the challenges, unsupported, or to place their family member in a large, State-operated institution, nursing home or rest home where services were almost exclusively custodial. Over the past 30 years or so, the choices families have has grown exponentially and include many services provided in the families' own homes, in the child's school, in their neighborhood, or at the adult client's place of employment.

Services beginning in infancy (Early Intervention) have prevented many children from needing highly specialized services later in life or have significantly lessened the need for much more expensive support services. Many of these people, historically considered non-productive members of society, have grown to adulthood, are able to live more independently, and work – in general becoming fully productive and contributing members of their communities and contributing taxpayers. Given the current state-of-the-art and best practices, the need for services certainly depends upon the level of severity of the disabling condition manifested by the individual. Some people require significant services/supports in order to live as independently as possible in their communities and others much lower levels of supports.

DD waiting list graph

The rapid population growth in Wake County also brings with it an associated growth in persons with DD or TBI. Also, with increases in medical technology, many more children with critical medical conditions survive, as do people who sustain head injuries, further increasing the consuming populations. Wake County also has an over-representative population of a number of "low-incidence" populations who are drawn to this area due to nationally and internationally recognized providers of services to those populations. In addition to this high growth rate, there have been significant decreases in service dollars with which services are purchased. With the State's reform plan calling for decreases in State-operated services and a bleak budget picture, the difficulties Wake County has in addressing the needs of its citizens will likely become more critical.

Overview of the System of Services

Wake County Human Services (WCHS) Developmental Disabilities (DD) Services serves as the single portal of entry and exit for a $54 million system of services, of which 29% is administered directly by WCHS and 35% is authorized by WCHS CAP-MRDD. In Wake County, this “single portal” function consists of providing information about disabilities and services, sending and receiving applications for services, determining eligibility for services, assisting clients and families in determining service needs, maintaining and managing the DD Waiting List for services, and referral to both services provided internal to Wake County or its contract affiliates. Case management services are a significant part of DD Services and are used to assist people and their families in charting the oftentimes confusing public and private worlds of services and benefits.

DD services funding breakdown
WCHS DD Services has the role of assessing the needs of persons with developmental disabilities in the community and of ensuring efficient and effective use of public funds to meet those needs. Administration of DD Services includes the authorization of services provided by contract providers, management of a variety of categories of funding with extensive rules and regulations, and the clinical and administrative oversight and monitoring of contracts for residential, vocational, early childhood and other support services. WCHS' single-portal service maintains the waiting list for all DD services for Wake County residents, as it is the mandated point of entry and exit into publicly funded DD services.

DD Services contracts for the majority of services it funds. Internally, however, assessment, evaluation, referral, case management and limited outpatient counseling are provided, with 1,067 children and adults receiving these services during fiscal year 2001-02. Internal DD services are provided through four programs:

  1. Developmental Disability Case Management, which provides assertive outreach, case management and referral for children 3 to 17 years old and adults with developmental disabilities, other than for those served by the specialty areas listed below;
  2. Early Intervention Services, specializing in assessment, family support, service coordination and short term interventions for children 0–2 years old;
  3. Mentally Retarded/Mentally Ill (MR/MI) and Diversion Services, specializing in clinical case coordination for persons with co-occurring mental retardation and mental illness; and
  4. Community Alternatives Program – Mentally Retarded/Developmentally Disabled Services (CAP-MR/DD). A Medicaid Waiver (Title XIX) specializing in case management for persons who receive for CAP-MR/DD funding; i.e., a Medicaid-waiver program that provides community alternatives for persons who meet the special level of care criteria.

Direct services are primarily provided through for-profit and nonprofit contract providers. In fiscal year 2001-02, 43 (of 45 available) contract agencies provided services for 1,284 children and adults with developmental disabilities.  Eleven million dollars ($11 million) of State, Federal and County funds are used to fund consumer services provided by community agencies.  DD Services administers most of these funds using the DD Managed Supports System, a client-specific authorization system designed to ensure that all funding (including Medicaid-funded services) is based on consumer needs, not the service or program.

Services provided through contracted providers include but are not limited to:

  • Group living
  • Independent living supports
  • Alternative family living arrangements
  • Supported employment
  • Sheltered employment
  • Recreational/retirement supports
  • After-school/summer supports
  • Occupational, Physical and Speech Therapies
  • Personal assistance/care
  • Training in activities of daily living
  • Behavioral treatment/supports
  • Parent training
  • Specialized instruction

CAP-MR/DD funded consumers received community-based services from 32 provider agencies. (Some of these providers are both CAP-MR/DD providers and WCHS DD Services Contract Providers.) All CAP-MR/DD funded consumers receive ongoing Case Management services from WCHS DD Services. Wake County was assigned 417 CAP "slots," of which 391 consumers[1] were authorized to receive approximately $18.8 million in services during FY 2001-02; this funding is paid directly to the agencies by the CAP-MR/DD Medicaid waiver program, with the exception of an additional $3 million paid to Wake County for Case Management services.

Other areas of service for individuals with Developmental Disabilities in Wake County include the Intermediate Care Facility (ICF-MR) system and services for Wake County residents living at O'Berry Center. The ICF-MR system consists of privately run five- and six-bed group homes that receive funding directly from the State's ICF-MR Medicaid program. There are 144 beds managed by five private providers in Wake County; this number has not increased over the past decade due to a State-mandated moratorium on community-based ICF-MR development. O'Berry Center serves approximately 64 Wake County residents, primarily those with severe or profound mental retardation and complex physical disabilities. WCHS DD Services' primary role with the ICF-MR system and O'Berry Center is as the Single Portal of Entry and Exit. For a limited number of homes, WCHS holds the Certificate of Need (CON) and thus is responsible for ensuring there is a qualified management company. In some cases, DD Services provides case management services for particularly complex cases in ICF-MR programs (for example, those with co-occurring mental illness).

The three major objectives of WCHS DD Services are:

  1. Improve accessibility of services;
  2. Ensure quality of services; and
  3. Efficiently administer fiscal operations.

The goals, indicators, strategies and results in these three areas are as follows:

[1] Due to a freeze imposed by the State, vacated CAP-MR/DD slots were not allowed to be reallocated to waiting consumers.

Goals, Strategies, Indicators & Results

Objective A: Improve accessibility of services.

Goals

Strategies

  1. Increase availability of services.
  2. Increase variety/continuum of services.
  3. Decrease length of wait between application and enrollment for priority consumers.
  4. Increase consumer choice of providers.
  5. Increase availability of service locations and/or transportation to meet the needs of consumers.
  6. Ensure consumer movement between service modalities as needs change.
  7. Ensure services are coordinated and collaborative.
  8. Ensure consumers receive assessment and advocacy for needed services.
  1. Provide technical assistance to provider agencies regarding effectiveness and efficiency of service provision.
  2. Encourage current and new providers to expand/add needed services in Wake County and underserved areas within the county.
  3. Increase capacity of internal case management in order to:
    1. Increase numbers of consumers enrolled and thus removed from waiting list;
    2. Advocate for needed consumer services with providers;
    3. Reduce the length of wait for services;
    4. Coordinate services; and
    5. Educate consumers regarding choice of providers.

DD funding levels

Indicators

Results

  1. Decrease waiting list service requests by 10%, through enrollment in needed services. 

Achieved: 204 (13%) of 1,547 service requests as of July 2001 were removed from the waiting list through enrollment in services during the fiscal year; however, the unduplicated number waiting increased by 5% and the service requests increased by 4% due to additions to the waiting list.

  1. Reduce the Wake County census at MR Centers by 4% (3 people).

Partially Achieved: Five people were discharged from O'Berry during the year; however, eight were admitted, resulting in a net increase of three people. Most of the admissions and discharges were due to planned short-term stays. Long-term community placements for highly disabled, medically fragile O'Berry residents remains problematic.

  1. Increase number of people receiving services, over prior year.

Achieved: 1,862 people received services, a 7% increase over the prior year (1,744). 

  1. Increase units of community-based support services (CBI/CBS and PA), over prior year.

Achieved: CBI/CBS/PA increased by 13% (17,987 hrs) over previous year. This was achieved through a planned reduction in PA and an increase in Medicaid-covered CBS.

  1. Increase number of provider agencies over prior year.

Achieved: 43 agencies provided DD Services funded by WCHS, including two new providers; 26 agencies provided Medicaid services authorized by WCHS DD Services.  32 agencies provided CAP-MRDD services; three were new during FY0102.

  1. Increase number of service locations and/or assistance with transportation.

Achieved: Funds for transportation of four clients were provided to Wake Enterprises; more clients receive support services in their home/worksite, as opposed to facility-based services.

  1. For EI children, increase the percentage of Individualized Family Service Plans (IFSPs) developed and implemented within 45 days of application.

Achieved: In FY00-01, 141 (39%) of 362 eligible referrals had their IFSP developed within 45 days; in FY01-02, 239 (60%) of 395 eligible referrals had their IFSP developed within 45 days. Services commence with IFSP development.

  1. Consumers are given a choice of service providers and understand they can change providers if dissatisfied.

Positive Results: 86% of consumers surveyed indicated that they had a choice of two or more service agencies; 95% understood that they may be able to change provider agencies if dissatisfied with their current provider.

Objective B: Ensure service quality.

Goals

Strategies

  1. Maximize consumers' health and safety.
  2. Ensure consumer involvement in service planning.
  3. Ensure consumer rights are protected.
  4. Maximize consumers' ability to live and participate in the community.
  5. Ensure staff competency.
  6. Ensure Providers assist consumers in achieving service and personal goals.
  1. Review and respond to Incident reports that are indicative of significant issues or patterns of deficiency.
  2. Conduct consumer satisfaction surveys to solicit feedback on service quality goals.
  3. Conduct/subcontract Provider Compliance Reviews that assess compliance with safety standards, client rights procedures and staff competency requirements.
  4. Require that provider agencies develop outcomes that are indicative of consumer progress toward Service Plan and personal goals.

 

DD consumer satisfaction

Indicator B.2. Consumer Satisfaction

Indicators

Results

  1. Reduce numbers of confirmed abuse allegations and other incidents resulting in harm to consumers.

In Development: Three incidences of abuse or neglect were confirmed during FY01-02. As this data was not aggregated previously, it is unknown whether this constitutes a decrease.

  1. Consumer Satisfaction surveys indicate consumers are satisfied with services, participate in service planning, are treated with respect and have adequately trained staff.

Positive Results: 98% rated their WCHS DD Case Manager as Excellent or Good; 91% were either Satisfied or Very Satisfied with their Provider Agency; 90% indicated they had a lot of input into their service plan; 100% were satisfied or very satisfied that they are treated with respect; 98% are satisfied or very satisfied with the training of their Case Manager; 82% showed the same satisfaction with their Agency staff.

  1. At least one-third of all contract Providers receive a Contract Compliance Review and are found to be in compliance.

Achieved:11 (32.3%) of 34 contract agencies that were subject to review underwent a compliance review and were either found in compliance or made necessary corrections.  Additionally, the CAP-MR/DD program reviewed all 32 agencies that provide CAP-funded services. All agencies were either in compliance or developed a corrective action plan.

  1. Provider Agency outcomes indicate consumer success at achieving goals.

 

In Development:All agencies implemented data collection on outcomes established with WCHS DD Services. First results are due January 2003.

  1. All Providers maintain licensure when required.

Achieved: 56 facilities maintained its licensure, with the exception of one facility that let their license lapse for a few months. Upon renewal the license was made retroactive to cover the lapsed period; services were not compromised during that period.

 

Objective C: Efficiently administer fiscal operations of the DD Services system.

Goals

Strategies

 

  1. Maintain and improve an equitable system of reimbursement for Provider services
  2. Maximize service availability by
    1. Increasing Medicaid and grant revenues and
    2. Maximizing utilization of fixed revenues
  3. Improve efficiency and effectiveness of business and fiscal practices

 

  1. Review and revise service reimbursement rates, taking into consideration the cost of service provision
  2. Apply DDMSS procedures equitably across providers, including provision that Medicaid is the primary payer
  3. Monitor revenue/expenditure projections closely; revise budgets/contracts proactively to meet needs & opportunities
  4. Identify and authorize funds for vested consumers or negotiate agency funding of these individuals
  5. Apply for grants when available for services identified as gaps/insufficient
  6. Expand automation capabilities
  7. Improve reimbursement procedures
  8. Produce fiscal reporting system that supports close fiscal management

 

DD Medicaid revenues

Indicators

Results

  1. Rates are revised as necessary to be reflective of cost.

Partially Achieved: EI/CDD outpatient and evaluation services rates were increased to be more consistent with Medicaid rates ($82/hr). Other rates were not revised due to low general inflation rates, lack of resources to complete cost modeling to determine whether rates needed revision and anticipated State funding cuts.

  1. Medicaid services and revenues increase over previous year.

Achieved:There was a 32% increase in Medicaid revenues over the previous year, with Provider Agencies seeing a 72% increase. WCHS CAP-MRDD Medicaid waiver experienced a 6% decrease due to the State-imposed freeze on filling vacant slots.

  1. Grant revenues increase over previous year.

Achieved:Early Intervention Services was awarded a total of $380,984 in grants for an Autism Project, Prescribed Pediatric Childcare, First in Families program and Neonatal Intensive Care Unit services, a 24% increase over the previous year's grants.

  1. Additional vested consumers are funded or alternative funding removes them from "unfunded vested client" list.

Not Achieved: Due to budget uncertainties and the State budget crisis, funds were not able to be committed for this ongoing expense.

  1. 95% of provider payments are made within contracted timeline, when accurately submitted.

In Development: Unable to determine due to incomplete information regarding accuracy of billing. Tracking data has been improved for FY02-03.

  1. The DD Services budget is expended within +/-5 % of allocation.

Not Achieved:DD Services expended all but 7% of its budget ($526,913), excluding MR/MI, CAP-MR/DD and certain grants where funding is only available for specified individuals/services. Services (and thus expenditures) were curtailed midway through the year due to anticipated budget cuts and the Wake County hiring freeze. 64% of the unexpended funds were funds authorized and encumbered, but were unexpended due to Contract Providers' staffing difficulties.

Discussion
During fiscal year 2001-02, DD Services made significant progress toward its goals, including increases in numbers of clients served, increases in Medicaid revenues, accomplishing targeted numbers of persons on the waiting list enrolled in services and consumer satisfaction. The DD Managed Support System underwent some refinement, but continued to work well as a system for administering the DD Services budget.

These accomplishments occurred despite a very difficult fiscal situation. The State government underwent a budget crisis, and for more than half the year there were threats of midyear allocation reductions to help balance the State budget. The County also had budget woes, partially due to the slowing economy and partly due to reductions in State funds, resulting in the County freezing vacant positions and denying requests for additional positions. These highly publicized budget problems affected contract providers, as the anticipation of potential budget cuts resulted in positions being left vacant. WCHS DD Services was unable to hire vacant and requested case managers to carry out the stated strategy of increasing case management services, for the purposes of decreasing the waiting list, consumer advocacy and coordination.

Additionally, CAP-MR/DD slots were frozen by the State, resulting in fewer admissions to the CAP program, since new consumers could not use vacated slots.

WCHS' total number of children and adults waiting list for DD services remains the largest the State – 886 children and adults as of July 2002. When viewed as a rate per 100,000, WCHS still ranks very high, having the second largest number in the State (136 persons waiting per 100,000 residents). Given years of vigorous population growth in Wake County and the State's system of basing allocations on the previous year's funding level, funding for Wake has lagged behind the growth in need. The State's per capita funding of WCHS DD Services is 33rd out of 38 Area Programs. Wake received an average of $15.90 per capita from the State, when the State's average per capita funding is $20.91. It would take an additional $3.25 million to increase Wake's funding to the statewide average per capita funding level (see Attachment).

Gaps/Unmet Needs

  • During the past fiscal year, 1,135 new service requests added to the DD waiting list for services. As of July 2002, there are 886 individuals waiting for services, of which 62% receive no services.
  • The population of persons with developmental disabilities who are aging or at retirement age continues to grow. Although service dollars have been redirected to address this need, there are not enough resources to meet the increasing demand.
  • There is a lack of inclusive services for children in need of after-school care. For working parents finding after-school care for their disabled child with their typically developing peers is almost non-existent. Inclusion in non-school-related activities is very beneficial to the social/emotional development of children with disabilities.
  • The lack of available and affordable transportation relates directly to access to services and limits choice of services to consumers and their families.
  • Existing community-based leisure and recreational activities for persons with DD are not adequate to meet the demand.
  • The service capability for persons who are medically fragile is inadequate to meet the needs of this growing population. Many have to be referred to State MR Centers for services.
  • Limited availability of providers for persons with mild MR and co-occurring severe behavioral/ psychiatric disorders.
  • Limited availability of affordable housing for persons with disabilities and of limited economic means.
  • Internal (WCHS) case management capacity. WCHS needs to be able to provide case management to all eligible children and adults with DD, including both those waiting for services and those who may be receiving services through contracted or other private providers. There are almost 300 children and adults currently waiting for case management services.
  • Wake County has the highest per capita rate of persons with autism or Autism Spectrum Disorders in the State. The provider network of services dedicated to this population is inadequate to meet the needs of this population.
  • The lack of a local psychiatric unit/hospital creates significant issues for persons with MR/MI needing access to psychiatric inpatient care.
  • Early Intervention Services has recognized several gaps/needs:
  • The Special Needs Assessment completed in the spring of 2001 indicated parents primary concern was the long wait for services. The current waiting list indicates there are 60 children waiting for Child Development Specialist services. There are an additional 20 children waiting for occupational, physical or speech therapy services because of a lack of insurance coverage or Medicaid to pay for this needed service.
  • Insurance coverage has moved to a rehabilitative philosophy rather than a philosophy of habilitation. The result has been insurance coverage for specialized therapies (occupational therapy, speech therapy and physical therapy) are limited in the number of visits and payment. This has been a significant change in the last five years and early intervention and families have become the payer of many of these services.
  • Funding for Early Intervention over the last eight years has increased less than 5%, while the need for service has increased by 145%.

Emerging Issues

  • MH/DD/SA State-wide reform efforts
  • Early Intervention reform efforts
  • Downsizing and closure of Regional MR centers
  • Ongoing moratorium on community-based ICF/MR development.
  • Downsizing of State psychiatric hospitals
  • Lack of appropriate psychiatric diversion sites
  • Freezing of CAP/MR "slots"
  • Inadequate capacity of community-based providers to meet the needs of Wake County citizens with DD
  • Inadequate State funding to purchase non-Medicaid funded services for Wake County citizens with DD
  • Over-representation of "low incident" disability populations (i.e. autism, Asperger's syndrome, etc.) in Wake County.
  • Inadequate provider network to address mental health needs of Wake County clients with DD.
  • Inadequate transportation resources
  • Inadequate housing options
  • Inadequate medical/dental resources to address the needs of persons with DD in Wake County
  • Inadequate service capacity in all areas (i.e., residential, vocational, supports, etc.) for survivors of traumatic brain injury (TBI)
  • Due to changes in Medicaid and insurance coverage for outpatient treatment (occupational therapy, speech therapy and physical therapy), needed services may not be covered by these funding sources. This puts the burden of payment on families and state and county funds. For the most part, private insurance covers only rehabilitation (when the skill was lost) rather than habilitation (when the skill has not yet been learned), and if they cover habilitation, it is very limited. This greatly impacts young children, because developmentally they are at the age where they are just acquiring the skill. For example a child with cerebral palsy may need assistance learning how to walk at 12–15 months. Medicaid Prior Approval went into effect October 1, 2002, so at this time the impact is virtually unknown. It is known that some denials of service have occurred. Contract providers have had to set up new structures and in some cases added additional staff in order to track the approvals/denials to ensure payment for services.
  • The impact of the Early Intervention services reorganization by the State is unknown. Early Intervention Re-design goes into effect in July 2004 and will move lead agency roles from WCHS to a new entity – Children's Developmental Services Agency. A key component of the new design is contracting for services, which is already done by WCHS; however, the impact of the planned shift in funding and lead agency duties on the community and families is unknown. Planning for this transition will begin in January 2003.
  • The increase in the Latino and other non-English populations has increased the need for interpreters and translation funds. IDEA requires that certain aspects of Early Intervention services be provided in the family's native language. Recruiting qualified staff who speak another language has been very difficult. Currently, in the Early Intervention System (including WCHS and Contract Providers) there are two staff who speak Spanish. 

Next Steps
One major objective for the 2002-2003 fiscal year is to implement the NCDMHDDSA's Integrated Payment and Reporting System (IPRS) for drawing down State, Federal and Medicaid funding. Implementation of this system will require significant administrative staff resources.

Efforts to increase WCHS DD Service's internal Case Management capacity that were thwarted by budget woes during FY01-02 will be resurrected during FY02-03. The objectives of reducing the waiting list, increasing service coordination and consumer education and advocacy remain prominent.

In its evolving role as assuror of services, DD Services will be designing and implementing an in-depth monitoring and evaluation process for all Contract Provider services. This will include, but not be limited to triennial audits of all fiscal, administrative and service delivery procedures and outcomes.

There are currently seven vested clients receiving residential services from contract provider agencies without funding from DD Services. To build capacity for expansion, DD Services will work to provide funding for these consumers.

In the 2002-2003 year, DD Services required contract providers to establish and submit to WCHS their outcomes for services. The agencies will collect data relative to these outcomes and submit it in January and June to DD Services for review. Outcome data will be reviewed for use in improving service coordination, service quality and staff training.

The two overriding issues facing WCHS DD Services for FY2002-03 continue to be the gross under-funding of services by the State and the resulting large size of the waiting list. Without an influx of funding and an opportunity to expand the network of service providers, children and adults in Wake County with developmental disabilities will continue to wait months and years for basic services, where only those with major or impending crises become the priority for next available services.

This Report Prepared by: Patricia B. Coleman, Ph.D., of Human Services Management Consultants, and WCHS DD Service Directors Jeff Hildreth, Linda Lang, Patti Beardsley, Suzanne Goerger, Glenda Reed, & Jenny Hamm. Completed 12/20/02.

DD Waiting List Ranking and Division Funding, Per Capita
DD waiting list rank
Attachment
Overview of DD Managed Supports System

In July 1999, WCHS DD Services revised its method of funding Contract Providers and implemented a method called the Developmental Disabilities Managed Supports System (DDMSS) for most of its funding. 

DD Managed Support System Guiding Principles:

  1. Funding is based on consumer needs, not the service or program.
  2. A Unified Service Plan and informed choice are required.
  3. There is a consumer-specific authorization process, by which WCHS DD Services authorizes the provision of services that are either funded directly by WCHS or via WCHS' Medicaid provider number.
  4. A standardized rate structure is used that takes into consideration cost of service, market salaries, accepted standards of productivity and staff:client ratios and administrative overhead; it is standardized across Contract Providers for the same service.

Clinical Philosophy of Service Provision

Decisions regarding the authorization of consumers to receive services take into consideration the following factors:

  • Medical and Habilitative Necessity – Services must be medically and habilitatively necessary.
  • Clinical or Habilitative Appropriateness, Least Restrictive/Intensive Manner – Services will be rendered at the most clinically/habilitatively appropriate level of care in the least restrictive, least intensive manner.
  • Demonstrated Need – Services will be provided where there are demonstrated needs as identified through accepted and standardized assessment, history and prescribed eligibility determination instrumentation and requirements.
  • Consumer- and Family-Centered – Access to services will be responsive and timely, using consumer- and family-centered models. The models will use collaborative planning efforts between consumers/families, case managers and contract providers in defining assets and needs, establishing goals/objectives and outcomes, and identifying the most appropriate services. The end result of this process is a Unified Service Plan.
  • Achievement/Restoration – Services will be aimed at providing rehabilitative care in order to assist consumers in achieving their maximum level of independence or in restoring consumers to a previous level of functioning.
  • Safety and Well-Being – Services will be provided in the least restrictive, most community-based environment possible, while maintaining the safety and well being of the consumer.
  • Service Outcomes – At a general level, services should result in increased independence in functioning, improved adaptive ability and increased quality of life. If services are to be a continuation of previous years and little/no progress has been made, either a new approach should be reflected in the justification, or there should be a justification of a "maintenance" of level of service.