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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 PEOPLE WITH INTELLECTUAL DISABILITY AND RELATED DISABILITIES

If you or a family member believes you have intellectual disability,

please call toll-free 1-800-289-7012.

This toll-free line is staffed during normal business hours; however messages can be left at any time with calls returned in the next two business days. If the applicant meets screening criteria, he/she will be provided with a list of available service coordination or early intervention (SC/EI)providers.

Click here for the Provider/Service Directory. Your selected SC/EI will begin the intake and eligibility process.

FOR PEOPLE WITH AUTISM

If you or a family member believes you have autism,

please call toll-free 1-800-289-7012.

This toll-free line is staffed during normal business hours; however messages can be left at any time with calls returned in the next two business days. If the applicant meets screening criteria, he/she will be provided with a list of available service coordination or early intervention (SC/EI)providers.

Click here for Provider/Service Directory. Your selected SC/EI will begin the intake and eligibility process.

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

If you or a family member have 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 HIGH RISK INFANTS AND TODDLERS

If your family member is 0-36 months contact

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

If your family member is 3 to 6 years old,

please call toll-free 1-800-289-7012.

If your child meets the screening criteria, you will be provided a list of available early intervention (EI) providers. Click here for a Provider/Service Directory. Your selected EI will begin the intake and eligibility process.

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After Your Initial Screening

Once you have been screened to determine if you are eligible to apply for services, a service coordinator will contact you to arrange a time to meet with you.

At that time the service coordinator will ask you or your legal guardian to sign a service agreement and will begin collecting from you information needed to determine eligibility. Determining eligibility will be easier and faster if you have all the information ready.

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

When all necessary information is gathered, the DDSN Consumer Assessment Team or the Autism Division office will review the information, and you will be notified whether or not you/your family member has been determined eligible for services.

  • – If records are available but found insufficient to determine eligibility:
    • - Further evaluation may be needed.
    • – The Service Coordinator may schedule an evaluation with an approved psychologist or the Autism Division office.
    • – The Service Coordinator will notify you of the eligibility determination upon completion.
  • – If records are not available:
    • – The Service Coordinator will immediately schedule an evaluation with an approved psychologist or the Autism Division office.
    • – The Service Coordinator will notify you of the eligibility determination upon completion.
  • – If you or your family member are not found to be eligible:
    • – The reason(s) for the denial will be given with an explanation.
    • – You will be given information on appeal procedures. If you wish to file an appeal, the Service Coordinator will assist you.
    • – The Service Coordinator will refer you to other available resources.
    • – If you have new information that might impact the eligibility determination given, the Service Coordinator will resubmit your request to the SC Department of Disabilities and Special Needs Consumer Assessment Team and/or Autism Division office for reconsideration.

Determining your eligibility for services should take no more than three (3) months. If your eligibility is not determined within this time, you should contact your Service Coordinator or the Service Coordination Supervisor. The telephone numbers for all local DSN Boards and other approved service providers can be found in the Provider/Service Directory.

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After You Become Eligible

Once eligibility for DDSN services is determined, DDSN determines the level of Service Coordination the person will receive.  For infants and toddlers eligible under BabyNet, an Early Interventionist is assigned.

DDSN provides two levels of Service Coordination:  Level I Service Coordination is provided when active, on-going assistance is needed and Level II Service Coordination is provided when intermittent assistance is needed. Please refer to DDSN Directive 700-04-DD:  Levels of Service Coordination, for more information. The Service Coordinator will inform the person which level has been assigned. If the person is assigned to Level II, they will be given contact information and asked to call the Service Coordinator with any concerns or needs they have.

If the person has been assigned to Level I Service Coordination, an in depth assessment and planning will occur.

In-Depth Assessment

A structured and comprehensive assessment will be performed by the Service Coordinator for every person assigned to Level I. The assessment includes taking a history, gathering medical, educational, social and other pertinent information from the person, family, providers, and others and identifying needs.

Developing the Person-Centered Plan

Person-Centered planning involves active participation from the person, as well as family members and those closest to the person who know him/her best. By asking questions and gathering input from the group, an effective plan can be developed which incorporates how the person’s needs can be met and goals for the future obtained. The result is an individualized plan that supports personal life choices.

One feature of Person-Centered planning that can be extremely helpful in developing an effective plan is the Circle of Support. This is a group of people chosen by the person and/or family to help develop and monitor the Person-Centered plan. They are typically family, friends, co-workers, neighbors, church members and the person’s Service Coordinator, Early Interventionist, or Qualified Intellectual Disability Professional (QIDP). They agree to meet on a regular basis and help the person identify and achieve personal aspirations and goals. Members of the Circle participate because they care about the person and want to work together to overcome obstacles and open doors to new opportunities. If someone has no family or close personal supports, the Circle may be comprised primarily of staff members who know him/her well. Using a Circle of Support is optional.

DDSN offers two types of Person-Centered planning. One is conducted by the Service Coordinator, Early Interventionist or Qualified Intellectual Disability Professional and is required for anyone receiving services through DDSN. This plan identifies existing services and supports which will benefit the individual. It is intended to be practical, positive, and realistic and based on achieving positive outcomes for the person. In addition to the support plan developed by the Service Coordinator, Early Interventionist or Qualified Intellectual Disability Professional, the individual or family member can choose to have a life plan. Through Life Planning, people 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

Life Planners may be independent (contract with DDSN) or Agency-based (work for a local board or provider organization). The role of a Life Planner is to help identify a person’s life expectations, set goals, and develop a plan of action to achieve those goals. All Life Planners must undergo specialized training, demonstrate competency in a variety of skills and meet other DDSN qualifications to be placed on an approved list of providers. Individuals and/or family members choose a Life Planner from a list of options and there is no cost to the individual or family for the service.

Persons receiving services or family members can choose a Life Planner. A list of options is provided on the website.

The person or family member can also ask the Service Coordinator, Qualified Intellectual Disability Professional or Early Interventionist to provide a list of Life Planners.  Once a Life Planner has been selected, the person/family member contacts the Service Coordinator, Qualified Intellectual Disability Professional, or Early Interventionist to authorize and arrange the service.  The Life Planner will then make contact directly with the person or family member to finalize the meeting plans. The Service Coordinator, 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 guides the person and the Circle of Support through the process of planning for the person’s immediate and long-term future. Information on identified needs, as well as knowledge of and information from the person are used to identify his or her preferences, talents, interests, and hopes for a meaningful life both now and in the future. The team helps the person identify specific goals and develop a plan of supports, activities, services and resources needed to realize specified goals. The plan includes supports that may or may not cost money.

It may be necessary for the Life Plan meeting participants to schedule additional meetings and stay in contact with one another so that the progress on the goals can be discussed and adjusted as needed.

Implementing the Person-Centered Plan

If the Service Coordinator, Early Interventionist or Qualified Intellectual Disability Professional develops the Person-Centered Plan for support services, they are responsible for monitoring the services listed on the plan. As changes occur in the individual’s life situation, the Service Coordinator, Early Interventionist or Qualified Intellectual Disability Professional updates or changes the plan as needed. If a Life Plan was conducted for the person, the Service Coordinator, Early Interventionist or Qualified Intellectual Disability Professional will receive a copy of the plan and incorporate any goals which their involvement will be needed. The person for whom the Life Plan was written or other person selected from the meeting participants will be responsible for monitoring the Life Plan. However, all involved - the person, his or her family, and Circle members-share the responsibility for implementing the plan

Choice is an essential element of the Person-Centered Plan. In South Carolina, the person and his or her family may choose from a list of qualified providers. To help people and their families, DDSN established a Provider/Service Directory that lists all organizations or agencies qualified to provide DDSN-funded services. Each organization on the Provider/Service Directory must meet all federal, state and DDSN requirements for quality and safety.

Qualified Providers are listed by county, beginning in the section titled "South Carolina Department of Disabilities and Special Needs Provider/Service Directory. All providers may not offer services for all disabilities or for all ages in all counties. Our most current update of Qualified Providers information is on the DDSN web site www.ddsn.sc.gov/. 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. For additional information about the Qualified Providers List, see the section titled "Most Asked Questions About the Qualified Providers List."

Your Service Coordinator will 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.

The Agencies or Service Providers chosen must follow the Person-Centered Plan and provide support as agreed on regarding what, how, when, and where.

Monitoring the Effectiveness of the Person-Centered Plan and Services Provided

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 person’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.

The principles of Continuous Quality Improvement will guide DDSN in determining whether services and Service Providers are meeting expectations.  The primary measure of quality will be how the person with the disability and the family view the responsiveness of the services. Service Providers will be required to design and modify supports and services to meet the expectations of the person who benefits from those services. To do this, they must continuously assess consumer satisfaction by collecting information from consumers and others, analyzing this information and making changes when needed.

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

  • meeting 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 Residential and Facility-Based Day programs must be licensed. Licensing activities occur on a regular basis, depending on the type of program. DDSN has contracted with the South Carolina Department of Health and Environmental Control (DHEC) to conduct licensing inspections. The Application to Operate will continue to be submitted to DDSN, but DHEC will complete the inspection. Upon approval, DDSN will issue the license to the Provider to operate the facility.

The primary focus of the Licensing/Certification review is to assure basic health, safety and welfare standards. Key indicators measure the following:

  • The facility’s environment promotes the consumers’ health and safety.
  • The physical plant of each facility, to include fire marshal inspections, HVAC, Water Quality, and Health and Sanitation.
  • There must be evidence of Fire Safety training and evacuation, Disaster Preparedness, First Aid supplies and other emergency items.
  • Facilities must provide documentation of continuous, coordinated health care, appropriate medical follow-up, and assistance with medications (as indicated in each consumers Plan).
  • Facilities must demonstrate understanding and application of all DDSN policies regarding Abuse/Neglect and Exploitation and Critical Incidents. Any instances of suspected abuse, neglect and/or exploitation as well as concerns relating to health and safety has resulted in appropriate action in accordance with Agency policy.

The facility review process must include an on-site review. During the course of the on-site review if substandard or noncompliant performance is found, the Provider will be expected to take immediate corrective action.

Consumer and Family Satisfaction

Consumer satisfaction surveys are conducted regularly with consumers, families and other service agencies. 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 is 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 Service Coordinator 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 person receiving services. By placing the person at the center the definition of quality is responsiveness to the person 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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