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Determining Eligibility for Services 

 

Steps to take to determining eligibility for services links are provided below as links to specific information.




Applying for Services

FOR INDIVIDUALS WHO MAY QUALIFY DUE TO AN INTELLECTUAL DISABILITY OR A RELATED DISABILITY AND AGE 3 YEARS OR OLDER

If you or a family member believes you have intellectual disability, please call toll-free 1-800-289-7012.

This toll-free line is available 24 hours a day, 7 days per week. Messages that include a contact name and phone number should be left. Calls will be returned during normal business hours within the next two business days. If the applicant meets screening criteria, he/she will be referred to DDSN’s Care Coordination Unit and assigned to a Care Coordinator.

The Care Coordinator’s primary job is to gather the information necessary for DDSN to determine if the individual is eligible for services. In addition, the Care Coordinator may provide information about services from other agencies that the individual may be eligible to receive and if desired, make referrals to those agencies on their behalf.

FOR INDIVIDUALS WHO MAY QUALIFY DUE TO AUTISM SPECTRUM DISORDER AND AGE 3 YEARS OR OLDER

If you or a family member believes you have autism spectrum disorder, please call toll-free 1-800-289-7012.

This toll-free line is available 24 hours a day, 7 days per week. Messages that include a contact name and phone number should be left. Calls will be returned during normal business hours within two business days. If the applicant meets screening criteria, he/she will be referred to DDSN’s Care Coordination Unit and assigned to a Care Coordinator.

The Care Coordinator’s primary job is to gather the information necessary for DDSN to determine if the individual is eligible for services. In addition, the Care Coordinator may provide information about services from other agencies that the individual may be eligible to receive and if desired, make referrals to those agencies on their behalf.

FOR INDIVIDUALS WITH TRAUMATIC BRAIN INJURY AND/OR SPINAL CORD INJURY (HASCI) AND SIMILAR DISABILITIES

If you or a family member has a disability resulting from traumatic brain injury or spinal cord injury or both, or a similar disability, contact HASCI Division Information & Referral (I&R) at 1-866-867-3864 (toll-free) to be screened for referral to DDSN’s HASCI division. Please refer to the HASCI section for additional information.

FOR INFANTS AND TODDLERS

If your family member is 36 months of age or younger, please contact:

First Steps/BabyNet toll-free at 1-877-621-0865.

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After Your Initial Screening

Once you have been screened to determine if you are likely eligible for DDSN services, a Care Coordinator will contact you.

The Care Coordinator will ask you or your legal guardian to sign a Service Agreement and will begin collecting information needed to determine eligibility. Determining eligibility will be easier and faster if you have and provide the information to the Care Coordinator.

The type of information needed to determine eligibility will depend on the type of disability. For example, psychological reports are required for people with intellectual disability and related disabilities, and medical reports are required for people with brain injury and spinal cord injury and similar disabilities. For more detailed information on specific disability types, please see related sections of this guide.

If you do not have the information, the Care Coordinator will ask you to give permission for DDSN to contact those necessary who have the information and obtain it from them. If needed, the Care Coordinator may schedule an evaluation with an approved psychologist or staff of DDSN’s Autism Division.

When all necessary information is gathered, it will be sent to the DDSN Consumer Assessment Team or Autism Division which will review the information to determine whether or not you/your family member is eligible for services. You will be notified of the decision and the reason(s) for the denial will be explained.

Should eligibility be denied, and you disagree with the decision, you have the right to appeal. The procedure for appealing the decision will be provided.

If you have new or additional information that might impact the eligibility decision, the information should be provided to your Care Coordinator who will forward the information to the DDSN Consumer Assessment Team or Autism Division for re-consideration.

Once the necessary information has been received, determining your eligibility for services should take no more than three (3) months. If your eligibility is not determined within this time frame, you should contact your Care Coordinator, the Care Coordination Supervisor, the Director of the Consumer Assessment Team or Autism Division.

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After You Become Eligible

If you are Medicaid eligible when you applied for DDSN services, your Care Coordinator discussed Medicaid Targeted Case Management Services with you. If interested, he/she referred you to the South Carolina Department of Health and Human Services (the Medicaid Agency) so that you could be authorized to receive these services. If authorized, staff of the Department of Health and Human Services offered you a choice of Medicaid Targeted Case Management service providers and notified the provider of their authorization. The Medicaid Targeted Case Management service provider should have assigned you to a Case Manager who has likely been in touch with you to assess your needs and develop with you a plan to meet your assessed needs. This may have happened before you were determined eligible for DDSN services. Now that you are eligible for DDSN services, your Case Manager can refer you to or link you with DDSN services that address your assessed needs, in addition to Medicaid and other services to which you have already been connected.

If you are not Medicaid eligible and your Care Coordinator has determined that you may need Case Management Services, he/she will refer you for DDSN State-Funded Case Management services. If approved, your Care Coordinator will offer you a choice of approved Case Management providers and refer you to the provider you have chosen. You will be assigned to a Case Manager who will assess your needs and develop with you a Plan to address those needs, which may include referring to or linking with DDSN services. He/she will monitor the Plan to ensure it is working (meeting your needs) and modify the Plan when needed. At the point that your need for State Funded Case Management has been addressed, State Funded Case Management will end. Should additional needs arise, the service can be requested.

If you are receiving either Medicaid Targeted Case Management or State Funded Case Management, you should expect your Case Manager to assess your needs, develop with you a Plan to meet those needs, offer you a choice of available providers of needed services, refer you to or link you with your chosen provider, monitor the Plan you have created to ensure it is meeting your needs and modify the Plan when modifications are needed.

Life Planning

Life Planning involves active participation from the individual, as well as his/her “circle of support” which is comprised of family members, friends, caregivers, and professionals who are closest to the individual and know him/her best. By asking questions and gathering input from the group, a life plan can be developed which expresses the individual’s personal life choices.

Through Life Planning, individuals can:

  • Explore and prioritize those things that are most important to them
  • Develop a sense/picture of how they want their lives to be
  • Explore preferences and possibilities of where and with whom they wish to live
  • Explore preferences and possibilities for how they wish to spend their time and energy and
  • Explore current/available resources and possible untapped resources

Once developed, the Life Plan can be used to guide, influence and direct the Service Plans created by service providers so that services support the person to have the life they want.

Life Planners must undergo specialized training, demonstrate competency in a variety of skills and meet other DDSN qualifications to be placed on a list of approved providers. Individuals/family members choose a Life Planner from a list which can be found on the DDSN website at http://www.ddsn.sc.gov/consumers/qpl/Pages/ListOfQualifiedLifePlanners.aspx .  There is no cost to the individual or family for this service.

Once a Life Planner has been selected, the person/family member contacts their Case Manager, Qualified Intellectual Disability Professional, or Early Interventionist to authorize and arrange the service. The Life Planner will then make contact directly with the individual or family member to finalize the meeting plans. The Case Manager, Qualified Intellectual Disability Professional or Early Interventionist is not required to attend the Life Plan meeting, but is to make every effort to participate if invited.

At the Life Plan meeting, the Life Planner will guide the individual and his/her Circle of Support through the process of planning for the individual’s immediate and long-term future.

Service Providers

In South Carolina, the individual and his/her family may choose from a list of providers qualified by DDSN to provide services.

A list of qualified service providers can be found on DDSN’s website at https://app.ddsn.sc.gov/public/directory/landing.do.  Qualified Providers are listed by county. All providers may not offer services for all disabilities or for all ages in all counties. Visit us and browse to find out if a provider offers the service you need, for the desired age group and disability, and in the location you need.

Your Case Manager may also provide you with the list of Qualified Providers. This list will include the Provider’s name, a description of the types of services they offer along with the areas of the state in which their services are offered. Individual consumers and families will then select the Provider(s) that they feel can best meet their needs within the resources assigned to them based on their level of disability.

To assure that quality services are provided, each Provider listed has been reviewed by the state to become qualified, including appropriate licensure or certification as required.

DDSN service users and families evaluate Service Providers on quality, efficiency and effectiveness, the recipient’s satisfaction with services and supports and how well they help meet the individual’s goals and produce desired results.

DDSN will continue to monitor and enforce policy and procedures. Health and safety will continue to be top priorities at all times, as well as specific outcomes and results for consumers and families.

DDSN will use a combination of oversight methods to evaluate the Service Provider’s performance. They include:

  • licensing standards
  • consumer and family satisfaction
  • utilization review
  • outcome assessment
  • quality indicators

Licensing

State law requires licensing of certain programs and residential facilities. This licensing relates to the health and safety aspects of facilities and services. The law authorizes the establishment of standards for the qualifications of staff, staff ratios, fire safety, medication management, facility size and construction, storage of hazardous liquids and health maintenance. All Facility-Based Day programs and some residential facilities must be licensed. Licensing activities occur on a regular basis, depending on the type of program. DDSN contracts with a federally recognized Quality Improvement Organization to conduct licensing inspections.

Consumer and Family Satisfaction

Consumer satisfaction surveys are conducted regularly with consumers, families and other service providers. DDSN and Service Providers use this information to improve services and make them more responsive to consumers’ needs and wishes.

If a consumer and/or family are dissatisfied with services received or with a Service Provider, DDSN has established consumer concern processes and a formal appeal process to be followed when decisions or concerns cannot be resolved directly with the Provider. Ask your Case Manager for a copy of these procedures if they have not been provided to you.

Utilization Review

DDSN contracts with a federally recognized Quality Improvement Organization, to conduct periodic assessment of Service Providers by making on-site visits in its Contract Compliance Review (CCR) process. During this process, records are reviewed, consumers, staff, and family members interviewed, and observations made to make sure that services are being implemented as planned and based on the consumer’s need, that the consumer/family still wants and needs them, and that they comply with contract and/or funding requirements and best practices. In addition, the Service Provider’s administrative capabilities are reviewed annually to ensure compliance with DDSN standards, contracts, policies, and procedures.

Outcome Assessment

Historically, measures of quality were often far removed from the actual impact in the lives of the consumers of the services.  Agencies would focus on “process measures” rather than “outcome measures,” since they were often easier both to measure and to control. If the administrative and programmatic processes, protocol, procedures and paperwork were in place, then the quality of service was assumed.

Over time measures of quality shifted from “processes” to “outcomes,” but still the focus was often on what the Agency could measure and control best, and this was not the consumer. Under this model, quality was assumed by measures of service objectives written, or units of service delivered.

It has only been recently in the evolution of the nation’s long-term care system that quality measures have started to become personalized and individualized relative to specific consumers. DDSN strives to use personal outcome measures to determine how well the service and support providers are helping an individual consumer achieve personal goals. Activity in this area is based on the work of The Council on Quality and Leadership.

Personal outcome measures are often founded on goals that the individual has set for themselves in conjunction with their family and their “circle of support.” They are thought about and discussed, hopefully weighed against alternative goals and decided upon. To this degree they are objective and “matters of the head.”

On the other hand, measures of consumer satisfaction have a larger affective component; satisfaction is a “matter of the heart.” It is very possible for a consumer to have met all of his personal outcome measures, but still feel dissatisfied with his life or the services and supports that he is receiving. Thus, measures of consumer satisfaction must go hand in hand with personal outcome measures in order for an Agency to be truly consumer-focused and driven.

Personal Outcome MeasuresSM

The 21 Personal Outcome Measures focus on the outcomes of the individual receiving services. By placing the individual at the center the definition of quality is responsiveness to the individual rather than how well the organization performs. The Personal Outcome Measures are a powerful tool for evaluating quality of life and the degree to which organizations individualize supports to facilitate outcomes.

MY SELF

  • People are connected to natural support networks.
  • People have intimate relationships.
  • People are safe.
  • People have the best possible health.
  • People exercise rights.
  • People are treated fairly.
  • People are free from abuse and neglect.
  • People experience continuity and security.
  • People decide when to share personal information.

MY WORLD

  • People choose where and with whom they live.
  • People choose work.
  • People use their environments.
  • People live in integrated environments.
  • People interact with other members of the community.
  • People perform different social roles.
  • People choose services.

MY DREAMS

  • People choose personal goals.
  • People realize goals.
  • People participate in the life of the community.
  • People have friends.
  • People are respected.
©Copyright 2005, The Council on Quality and Leadership (CQL)


Quality Indicators

DDSN collects, analyzes and reports information on how well Service Providers are performing on various other quality indicators which give an indication of the health and safety of each person, dignity and respect, personal choice, participation in the community and attainment of goals. Some of the ways this information is gathered include: comprehensive Provider self-assessments; Service Coordinator oversight; peer reviews; consumer/family monitoring; local human rights committee work; staff turnover; circle of support contacts; and the quality of facilitated plans.

Information from these sources can be especially helpful to consumers and families in evaluating their plan and in selecting and evaluating individual Service Providers.


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