Posts Tagged ‘Medicaid Waiver’

ODP-Managed Medicaid Waivers

I am pleased to share with you that the Office of Developmental Programs (ODP) has approved BrightStar of Pittsburgh as a certified provider for its waiver consumers residing in Allegheny County.

Ok, what does it mean?

It means now BrightStar can serve the consumers who are enrolled in one of two Medicaid Waivers administered by the Office of Developmental Program (ODP). ODP offers two Waiver programs for people with intellectual disabilities/mental retardation. One is the Person/Family Directed Support (P/FDS) Waiver and the other is the Consolidated Waiver. One must meet the eligibility criteria for the Waiver and be at least 3 years old to apply.

Here is some basic information on these two waivers:

The Person/Family Directed Support (P/FDS) Waiver:

The P/FDS Waiver is known as the “small” Waiver because it has a cap of $26,000 (2011) per person each fiscal year. This funding can be used to get the support you need to participate in a wide range of activities in your community. With your Supports Coordinator, you will write an Individual Support Plan (ISP) that describes you, your life, your goals, and defines the supports and services you need to be successful. Your budget will be based on the needs identified through the planning process and in your approved Individual Support Plan (ISP). The ISP is authorized by your Administrative Entity (AE)/County. The P/FDS Waiver cannot pay for residential care in a licensed setting but it can help provide the support you need to live in your own home or your family’s home. The cost of Supports Coordination does not count against the annual cap of $26,000.

The Consolidated Waiver:

The Consolidated Waiver is sometimes referred to as the “big” Waiver, residential Waiver, or the 2176 Waiver. There is no set dollar cap on your individual budget to purchase needed supports that you could receive on this Waiver. The amount of support you receive and your budget will be based on your assessed needs, as determined through the planning process and outlined in your Individual ISP. The ISP is authorized by your AE/County. This Waiver can provide the same supports and services available in the P/FDS Waiver, but also can include out-of-home residential care in the community. With both Waivers, your plan and your supports should be updated at least once per year or any time your needs change significantly.

What services are available thru P/FDS and Consolidated Waivers?

  • Supports Coordination
  • Companion Services
  • Homemaker/Chore Services
  • Assistive Technology
  • Specialized Supplies
  • Unlicensed Home and Community Habilitation
  • Unlicensed Residential Habilitation
  • Licensed Day Habilitation
  • Supported Employment—Job Finding and Job Support
  • Transitional Work Services
  • Prevocational Work Services
  • Home Adaptations
  • Vehicle Adaptations
  • Transportation
  • Supports Broker Services
  • Physical Therapy
  • Occupational Therapy
  • Speech/Language Therapy
  • Nursing Services
  • Behavior Therapy
  • Behavioral Support
  • Visual/Mobility Therapy
  • Respite Services for the Care Giver
  • Home Finding
  • Educational Support Services

What services are not available through Consolidated Waiver but not through P/FDS Waiver?

Licensed Residential Habilitation is only available in the Consolidated Waiver. Licensed Residential Habilitation covers services provided in Community Living Arrangements (sometimes called group homes) and in licensed Life-sharing homes.

If you are already enrolled in one of these waivers and are looking for a quality provider, why not call us today? 412-561-5605 – you will get a live person 24/7.

BrightStar of Pittsburgh is proud to serve many cities and townships of Allegheny County and greater Pittsburgh area such as Pittsburgh, Bridgeville, Carnegie, Clairton, Jefferson Hills, Floreffe, Elizabeth Township, Bethel Park, Library, South Park, Mount Washington, Beechview, Dormant, South Hills, Brookline, Brentwood, Mt Lebanon, Upper St Clair, Castle Shannon, Baldwin, Pleasant Hills, South Hills Village, Whitehall, Munhall etc.

– Jana Roy RN, Director of Nursing, BrightStar of Pittsburgh

Image source: A Place for Mom

 

During this Season of Happiness, Think of D

D is twenty-two but his mental age is only fourteen. D suffers from Traumatic Brain Injury (TBI). The car crash happened just after the high school graduation. Four friends in a car – D on the passenger’s seat – another kid driving – a sharp bend on a hilly Pittsburgh road approaching fast – a split second and the driver kid is dead. D did not have his seatbelt on – his head crashed against the windshield – D’s two other friends on the back-seat are also seriously injured.

A know story, a story that repeats itself over and over on American streets everyday leaving behind bleeding bodies and mutilated minds. D spends years in hospitals and rehabs. Then last summer D comes home after being approved by the state to receive care in his mother’s home, funded by a type of Medicaid Waiver called Commcare. The waiver allows a family member to become the patient’s direct care-giver. In D’s case, his mother becomes his care-giver. State partially compensates his mother for the loss of her livelihood as she becomes tied up taking care of her son almost twenty-four-seven.

The mother and son somewhere carry on until a few weeks ago – when D’s mother suffers a major heart attack. The paramedics come and whisk her away to a local hospital in the middle of the night. Thanks God she is alive but the attack leaves D’s mother’s left side paralytic. Now the doctors are telling that she may have to spend months in a rehab.

What happens to D now? Who takes care of him? Who helps D to get up from bed every morning, assists him to sit on his wheel-chair and gives him something to eat?

BrightStar of Pittsburgh gets a call from a state-designated service coordinator seeking urgent help. It is one of BrightStar’s many qualified, compassionate and trained caregivers comes forward to assist D when he needs it the most.

Know it that during this season of light and happiness, we, at BrightStar of Pittsburgh, will not leave D home alone. In fact, BrightStar’s Director of Nursing, who is also a co-owner, has a date for this Christmas Eve – having a meal together with D.

If you or someone you know needs assistance this holiday season, from providing relief for a family caregiver, helping with holiday decorations and transportation to grocery shopping, meal prep and more, BrightStar of Pittsburgh’s Hire An Elf® program can help ease the stress that can overwhelm us all this time of year.

BrightStar of Pittsburgh is proud to serve many cities and townships of Allegheny County and greater Pittsburgh area such as Pittsburgh, Bridgeville, Carnegie, Clairton, Jefferson Hills, Floreffe, Elizabeth Township, Bethel Park, Library, South Park, Mount Washington, Beechview, Dormant, South Hills, Brookline, Brentwood, Mt Lebanon, Upper St Clair, Castle Shannon, Baldwin, Pleasant Hills, South Hills Village, Whitehall, Munhall etc.

Call 412-561-5605  or visit us online today to find the most caring help your loved ones need. We are open for YOU 24/7.


Medicaided? Malady of Medicaid Waivers

L is one of the one million victims of Parkinson’s disease in the United States.

A true story

L was diagnosed with the debilitating symptoms of Parkinson’s in her early forties. The diseases progressed rapidly over a decade-long period and eventually made L unable to live a normal life. Now in her early fifties, L’s legs uncontrollably shake, unable to make her walk. Her head leans forward in the middle of a conversation – it appears she is falling asleep. She can’t eat with her own hands, often forgets to take her medications.

About a year ago, L got approved to receive home care under Pennsylvania’s Medicaid’s Independence Waiver Program. Like millions of Americans, L saw lights at the end of the tunnel. L thought her life would become manageable, finally.

From a long list of approved providers, L picked an agency that is located not too far from where L lives. She selected the same agency to coordinate her services and also to provide care. Within weeks, L realized that she did a huge mistake. Some of the issues L faced:

  • The agency did not provide L any services for months saying that L’s Waiver Application might be approved BUT L’s Care Budget were still not approved.
  • After countless phone-calls to the State and to the agency, L was told her care budget was finally approved and she was eligible to receive care. L thought she was through the nightmare only to find out:
  • L’s caregiver shows up only once in a while – about half the time, neither the agency nor the caregiver informs L that the caregiver won’t come, making L wait and wait.
  • Whenever caregiver did show-up, the caregiver was spending most of her time on the phone – talking about pop music, issues with her boy-friend and what not.
  • L tried to complain against the caregiver with the agency which is also L’s Service Coordinator but the agency flatly told L that the current caregiver was only person they have and they cannot do anything about it.
  • Worst of all, the agency insisted L to sign the times sheet showing that L received full care for all her allotted hours. L complied with their demand from the fear that otherwise she would lose all her care.
  • L called the State. The State told L that she was not happy with her current agency; she had the right to change it and pick another agency from the state’s provider list. Then L called 3 other agencies – they all showed interest to take L’s business but also informed L that it would be months before the change could take place because the State first needed to approve L’s new budget plan.
  • L, in her situation, cannot live a day without care, forget months and months of waiting. L got STUCK with the agency she despised.

Then L called BrightStar of Pittsburgh. BrightStar’s Director of Nursing came in for a full assessment within 3 days after L made the 1st call. The Director of Nursing arranged a number of caregivers those are fully trained dealing with patients of Parkinson’s disease, arranged care delivery from the next day itself, without worrying about budgets and bureaucracy etc. BrightStar’s Medicaid Waiver Team (MWT) took over L’s case and worked in parallel to get L’s new budget plan approved.

What BrightStar of Pittsburgh could not do was to completely heal L from the mortal grip of Parkinson’s disease — for which is, still, there is no known cure. But what BrightStar could do was to make L’s life manageable – provide her with the care she deserved.

If you are in a similar situation or you know someone who is in a situation like L’s – Call us today. We will do everything in our capacity to make the person’s life a little better. That’s the BrightStar Promise.

BrightStar of Pittsburgh is proud to serve many cities and townships of Allegheny County and greater Pittsburgh area such as Pittsburgh, Bridgeville, Carnegie, Clairton, Jefferson Hills, Floreffe, Elizabeth Township, Bethel Park, Library, South Park, Mount Washington, Beechview, Dormant, South Hills, Brookline, Brentwood, Mt Lebanon, Upper St Clair, Castle Shannon, Baldwin, Pleasant Hills, South Hills Village, Whitehall, Munhall etc.

Medicaid Waiver – What Is It?

If you have heard of Medicaid but not Medicaid Waiver – you are not the only one. Many of us never heard of Medicaid Waivers.

What is it?

Do you know someone who does NOT need 24/7 skilled care in a nursing home set-up but needs some amount of care in home? The care requirement may range from a couple of hours to 8-10 hours every day or a few times a week. The person may need assistance with transportation to get around – to live a normal life in the community. The type of assistance may vary from daily living (bathing, meal preparation, light house-keeping etc.) to skilled nursing (weekly visit by a registered nurse). May be the person is currently and primarily taken care by a companion or a family member who needs occasional break. Taking care of someone day-in and day-out could be daunting. The Medicaid Waiver is the answer to these questions.

Dilemma of dealing with the government
Many are daunted by the government bureaucracy even before they get involved. Just to make the matter further complicated, Medicaid Waivers come in many flavors and varieties. For example – Aging Waiver for persons above 60, Independence Waiver for persons with debilitating disabilities, CommCare Waivers for younger persons with Diagnosis of traumatic brain injury (TBI), OBRA Waiver for persons with developmental physical disabilities. It is not the end – there is more – some are managed by the counties, others are directly managed by the State Department of Health. The State’s department of health has many divisions such as Office of Long Term Loving (OLTL), Office of Developmental Program (ODP), just to name a few. For some categories of waivers, the enrollment is managed by an Independent Enrollment Broker (IEB) – in case of Pennsylvania, it is Maximus, other are enrolled by the county.

We can help

We, at BrightStar of Pittsburgh, did the due diligence and essential research for you. We have assembled a team of ‘smart’ people with advanced degrees such as MBA, RN/BSN and Master Degrees in order to untangle the knot of Medicaid Waivers. Our Medicaid Waiver Team (MWT) is available 24/7 to take your call and guide you through the process.
You may be already in the process of getting approved or just thinking of applying – or perhaps already approved and trying to find a dependable and knowledgeable agency who can provide you or loved one the best quality service. We, at BrightStar of Pittsburgh, have put in place a system and resources to take care of your needs, based on where you are in the process. Some of the services we provide:

  • Guidance and advise to consumers who are in the beginning phase – just thinking of applying for Medicaid Waiver (we provide this service completely free of charge)
  • Assisting consumers who are already approved but needs help formulating an Individualized Service Plan (free again)
  • Post approval, professional service coordination (paid by the state)
  • Providing Assistance with Daily Living (ADL) and Personal Assistance Service (PAS) – (paid by the state)
  • Non-medical transportation – (paid by the state)
  • RN/LPN skilled services – (paid by the state)
  • And much more…

Do you have to wait for months before get any service?

Not really. The State generally pays for the services from the date of approval (in some cases from date of application). So if you are approved, you can start getting services right away. It may take months before your ISP or budget plan is approved. You pay us now at state-mandated rate for the services we provide until your ISP or budget plan gets approved. Once your budget is approved and when state pays us in arrear – WE WILL REFUND YOUR MONEY- 100% - Guaranteed!

Good enough? Call us today – let’s work together make your or loved one’s life a little better. That’s our promise.

BrightStar of Pittsburgh is proud to serve many cities and townships of Allegheny County and greater Pittsburgh area such as Pittsburgh, Bridgeville, Carnegie, Clairton, Jefferson Hills, Floreffe, Elizabeth Township, Bethel Park, Library, South Park, Mount Washington, Beechview, Dormant, South Hills, Brookline, Brentwood, Mt Lebanon, Upper St Clair, Castle Shannon, Baldwin, Pleasant Hills, South Hills Village, Whitehall, Munhall etc.