October 2024 Edition

Learning Corner

Dive into training and tips to enhance your understanding and skills as an EOR!

Understanding Assistive Technology, Enabling Technology, and Self-Directed Goods

Understanding the different types of items available to waiver recipients can make a significant difference in enhancing independence and quality of life. In this section, we’ll explore three key categories: Assistive Technology, Enabling Technology, and Self-Directed Goods. Each of these plays a unique role in supporting recipients. Let’s dive into what each category offers and how they can be utilized to meet various needs.

Assistive Technology: This includes any item, piece of equipment, or product used to increase, maintain, or improve the functional capabilities of recipients. Examples include hearing aids, indoor sensory swings, overhead lifts, and wheelchair scales.

• If you need an item that is essential for health, safety, or improving access and mobility, it can be obtained through Assistive Technology.

Enabling Technology: This includes equipment, products, engineered solutions, devices, software, or items that support a person’s increased independence in the home, employment site, or community. Examples include tablets, wearables, computer applications, and personal emergency response systems.

• For items that help increase, gain, or maintain independence and are available through the traditional waiver but not covered by Medicaid, Medicare, or private insurance, Enabling Technology can be used.

Self-Directed Goods: These are incidental, non-routine items that promote a person’s self-care, daily living, adaptive functioning, exercise, recreation, and leisure skills needed to reside successfully in the community. Examples include outdoor adaptive swings, adapted bikes, sensory toys, and fitness items.

• If an item is for exercise, entertainment, or recreation and isn’t available through the traditional waiver or covered by Medicaid, Medicare, or private insurance, you can use Self-Directed Services.

Justification, including a letter of recommendation and a proposal or invoice, must be provided to request approval for each item within all programs.

If you have any questions or need assistance, please reach out to your Case Manager (CM).

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SDS Spotlight

Stay informed about the latest developments and changes in Self-Directed Services.

Exciting Updates From DDS and Acumen!

We have some great news to share! DDS has received approval from the Centers for Medicare and Medicaid (CMS) for a rate increase, effective October 1, 2024.

What’s Changing?

• In-Home Supports Waivers (IHSW): The annual financial limit for these waivers will increase by 25%! This means the new annual limit is $36,143 for adults and $24,104 for children.
  Services are provided based on need, not on available funding. However, the increase allows the team to justify additional necessary supports, which can include goods, services, or Self-Directed Habilitation Training Specialist (HTS) staff.
  
  
• New Rate Sheet: Click here to access the new “Show Me the Money” rate sheet. If you choose to increase the pay rate for your HTS staff, you can find all the options there.
  
  
• 90-Day FAC Code: Acumen has revamped their training program for new EORs. The new training format is simpler and no longer requires billing the 90-day FAC code.

Important Details for HTS Rate Increase:

• The rate increases were approved on October 1, but the EOR needs to go through the SDS rate increase process. The new rates for staff will go into effect based on when the process is completed and the new authorization begins.
  
  
• Pay increases for SD HTS staff will not be retroactive to October 1.
  
  
• It’s up to the EOR to decide if they want to increase the pay rate for their HTS staff. This isn’t mandatory, but it can be done at any time during the Plan of Care (POC) period. We recommend submitting any rate increase requests during the planning process for a smooth transition.

If you have multiple staff with different pay rates, please let your CM and Acumen Agent know which staff you want to increase the rate for.

Stay Up-to-Date

Be the first to hear about upcoming events and opportunities.

You’re Invited!

We’re excited to announce an upcoming educational webinar hosted by Acumen, where you can learn all about the new vendor payment process. This informative session will be held on two different days in November, giving you the flexibility to choose the date that best fits your schedule.

Webinar Dates:

•  Option 1: November 2 at 10 AM
•  Option 2: November 6 at 12 PM and 6 PM

We encourage you to attend and take advantage of this learning experience. Register using this link.teams.microsoft.com

Meeting ID: 260 418 604 289 
Passcode: BWoXj2 

*Clicking this link will take you directly to the meeting.

Community Connect

Let's foster peer connections and build a supportive network by sharing success stories in our community!

Meet Joe Wingbermuehle: Our Resource Development Program Manager 

Joe Wingbermuehle has been our dedicated Resource Development Program Manager for three years. He handles all requests related to Assistive Technology, Enabling Technology, and Vehicle and Architectural Modifications. We had a chat with Joe to get some insights into his role and the processes involved!

Q: Are there any items that can be requested through the Resource Development Request (RDQ) process without a SoonerCare denial?

A: Yes, there are! Some examples include orthotics for adults, hearing aids, wheelchair scales, overhead lifts, and vehicle and architectural modifications. 

Q: What documentation does the Resource Development Unit team need to review a request and issue an authorization? 

A: We need a professional recommendation from a Medicaid-approved therapist. The Individual Plan (IP) must have a completed addendum with justification for the request and team approval. For architectural modifications or ceiling lifts, we need homeowner information and a one-year lease, plus a statement that the waiver recipient plans to live in the home for at least five years. 

For a wheelchair scale, we require a signed physician’s order stating the frequency of weights, a nutritional risk assessment showing moderate or high risk, and an assessment from a physical or occupational therapist stating that the individual cannot stand or pivot transfer, even with assistance. 

For an Alternative Augmented Communication Device (AAC), we need a justification from a speech therapist for the device and the speech app, as well as a speech therapist on the team to monitor and implement the program after procurement.

Q: If an item is denied through the RDQ process, can it be requested through Self-Directed Services?

A: No, items that can be requested through the RDQ process cannot be funded through SDS. If an item cannot be authorized, we provide a DDS-4 with the policy supporting the decision. The service recipient or guardian has the right to appeal the decision. 

If an RDQ is submitted for an item that has never been covered through the RDQ process but might be covered by SDS, we forward the request to the SDS team. The SDS team will then reach out to the case manager to guide them on submitting the request through SDS. Examples of such items include sensory toys, exercise equipment, outdoor swings, strollers, or specialized equipment for extracurricular activities.

Q: How soon before the Plan of Care (POC) ends should a request be submitted?

A: RDQs can take up to 60 days to process. However, sometimes there are factors beyond our control that can cause delays, such as material availability, shipping issues, or homeowner authorization. It’s best to submit requests as early as possible. 

Q: Can a duplicate, upgraded, or backup item be requested if Medicaid has already provided one?

A: No, the waiver cannot cover items available from another funding source. Additionally, waiver funds cannot be used to repair items not funded by the waiver. 

Building Together

You asked, we answered! Here you will find responses to your most commonly asked questions and helpful information to streamline the EOR process.

Q: What should I do if an item we need is covered by Medicaid, Medicare, or private insurance?

A: If an item is covered by Medicaid, Medicare, or private insurance, the request should be submitted by the therapist or family to the insurance provider.

Q: What do I do if I need to request adaptive equipment, home or vehicle modifications, or assistive technology for health and safety?

A: All adaptive equipment for health and safety, modifications to the home or vehicle, and assistive technology must be requested through the Resource Development Unit (RDU) team first for consideration. Reach out to your CM to get the process started!

Q: What types of items or equipment will the SDS and RDU Teams consider funding?

A: The SDS Team will consider funding items or equipment used for exercise, entertainment, and recreation. The RDU Team will consider funding items or equipment used for critical health, safety, and increased independence.

Q: Are there any items that DDS will NOT purchase?

A: Yes, DDS will not purchase items that are restrictive in nature, such as cameras in private areas, door locks, and enclosed/confined beds.

Do you have more questions about Self-Directed Services?

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