Reminder: Innovations Waiver changes coming Nov. 1, 2016
Publication Date: September 20, 2016
Sandhills Center is issuing a reminder to indivduals and families who receive North Carolina Innovations Waiver services that significant changes go into effect on Nov. 1, 2016.
The Medicaid-funded NC Innovations Waiver is a resource for funding services and supports for people who are at risk for institutional care in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). The waiver helps children and adults to live independently within their communities. It promotes choice, control and community integration. Those who receive the waiver must meet Medicaid eligibility criteria. Changes to the waiver are a result of a national effort to promote least-restrictive service settings for individuals with intellectual and developmental disabilities and more meaningful consumer impact on their services.
In making changes to the Innovations Waiver, the North Carolina Department of Health and Human Services (DHHS) partnered with people who receive services and their families, LME-MCOs, providers and advocacy groups. The focus of these changes is to make services more individualized and person-centered, as well as offering more choice, self-direction and flexibility.
Included in the changes are:
- New rates and service definitions for Community Living and Supports and Supported Living. It also includes Community Navigator (formerly Community Guide), a new service that promotes self-direction, self-determination and community connections.
- Community Living and Supports combines personal care, in-home skill-building and intensive in-home support services. Beginning Nov. 1, Community Living and Support will be the only waiver service that may be provided by a relative or legal guardian who resides in the member’s home. For dates of service on and after Nov. 1, Individual Community Living and Supports (T2013TF) will be reimbursed at $4.71 per 15-minute unit, and Group Community Living and Supports (T2013TFHQ) will be reimbursed at $3.10 per 15-minute unit.
- Supported Living supports people to live in homes that they own or rent. For dates of service on and after Nov. 1, Supported Living rates will be reimbursed at $153.01 per 24-hour unit for Level 1(T2033), $186.80 per 24-hour unit for Level II (T2033HI), and $220.05 per 24-hour unit for Level III (T2033TF).
- Residential supports help people to live successfully in group homes or alternative family living (AFL) settings of their choice, and to be active participants in their communities. For dates of service on and after Nov. 1, Residential Supports will be reimbursed at $113.88 per 24-hour unit for Level 1 (H2016), $156.81 for each 24-hour unit for Level II (T2014), $174.11 per 24-hour unit for Level III (T2020), and $197.32 for each 24-hour unit for Level IV (H2016HI).
- Service Definition updates, including: Home Modifications that are expanded to individualized needs; Assistive Technology that is broadened to allow for new and innovative tools; Community Transition that helps people move into their own homes; Crisis Services which involve consultation for prevention of crises and how to de-escalate situations; Respite Services that can now be used for people living in an Alternative Family Living (AFL) situation; Day Supports are now flexible where individuals can start their day in the community rather than a licensed facility.
After Nov. 1, individuals and families can choose from an array of services until the right combination of supports and services is determined. Care coordinators share information about services and rely on a planning team to make decisions. Individual budgets have been created to provide guidance for choosing services through Individualized Service Plans (ISPs). These budgets are determined by age of the member, living arrangements and the person’s assessed needs. Sandhills Center is committed to keeping individuals, families and stakeholders informed about important changes to services and funding resources. Those who have questions are urged to contact their Care Coordinator at 1-800-256-2452. For more information, visit the NC Innovations Waiver website at https://www2.ncdhhs.gov/ncinnovations/, or www.SandhillsCenter.org.
Sandhills Center is the Local Management Entity-Managed Care Organization (LME-MCO) that oversees Innovations Waiver funding for services within the nine counties of Anson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph and Richmond in central North Carolina.