individual and family support program cindy gwinn community resource manager

DBHDSVirginia Department of

Behavioral Health andDevelopmental Services

Individual and Family Support Program

Cindy GwinnCommunity Resource Manager



The Individual and Family Support Program (ISFP)

Assists individuals with intellectual disability (ID) or developmental disabilities (DD) and their family members currently on the ID or DD Waitlist to support and maintain the continued residence of an individual in his own home or the family home.



Support Amount

Based on funding availability, DBHDS will established an annual maximum individual financial support limit of $3000.

For Fiscal Year 2012-2013:825 individuals were funded for a total of 1.9

million dollarsFiscal year 2013-2014:1000+ families are to be funded with an available

total budget of 3.2 million dollars



Basics

• Program is administrated by DBHDS.• Individuals and families can access application

directly from the DBHDS website.• They do not have to go through their Case

Manager/Support Coordinator• Case managers/support coordinators are

strongly encouraged to share the information about the IFS Program with their waitlist individuals and assist with filing out the application if an individual needs assistance.



Basics

• Individual and Family Support Program funds shall not supplant or in any way limit the availability of services provided through a Medicaid Home and Community-Based Waiver, Early and Periodic Screening, Diagnosis and Treatment (EPSDT), or similar programs.



Basics

Individuals who are on the waiting list for ID or DD Waiver and currently on the

• Elderly or Disabled with Consumer Direction, • Day Support, or • Technology Assisted Waivers May apply for funds if needed items are not

available through these waiver programs, EPSDT or Medicaid State Plan Option.



Program eligibility requirements

Eligibility is limited: • to individuals who are living in their own home or a

family members home• are on the statewide waiting list for the Intellectual

Disability (ID Waiver) Medicaid Waiver or the Individual and Family Developmental Disabilities Services (DD Waiver) Medicaid Waiver

• or to family members that are assisting those individuals and the request supports that assistance.



Covered services and supports

Services and items that may be funded through the IFSP may include:

• Professionally provided services and supports, such as respite, transportation services, behavioral consultation, and behavior management;

• Assistive technology and home modifications, goods, or products that directly support the individual;

• Temporary rental assistance or deposits;




• Fees for summer camp and other recreation services;

• Temporary assistance with utilities or deposits;• Dental or medical expenses of the individual;• Family education, information, and training




• Peer mentoring and family-to-family supports;• Emergency assistance and crisis support; or• Other direct support services as approved by

DBHDS.



Next Funding Cycle

• Applications for this program will be accepted starting September 3, 2013.

• FAX or E-mail applications will NOT be accepted.

• IF applications arrive in this manner a denial and request to resubmit via proper method letter will be sent to the applicant and application will be destroyed.



Accessing Applications

Applications can be downloaded from the DBHDS website and mailed in. Mailed applications will be sorted based on postmark date. OR

Access our web-based on-line application system that will become available September 3, 2013.

www.dbhds.virginia.gov/ODS-default.htm All updates concerning the program will also be

posted at this location.

http://www.dbhds.virginia.gov/ODS-default.htm



Application Information

Completed applications shall include the following information:

• A detailed description of the services or items for which funding is requested;

• Documentation that the requested services or items are needed to support the continued residence of the individual with ID/DD in his own or the family home and no other public funding sources are available;

• The requested funding amount and frequency of payment;



Application Information

• Written acknowledgement of participant responsibilities

• The signature of the individual (unless the individual is a minor or has a legal guardian) and financially responsible person.



Participants Responsibilities

• Individuals and Families will be required to submit supporting documentation to verify that funds have been used for the purpose stated in their application.

• Directions will be provided to families when funding is approved.

• Fulfillment of participant responsibilities is a requirement to participate in the program in future years.



Participant Responsibilities

If money is spent on non-approved items DBHDS has the legal right to:

• Stop payments for additional funding.• Deny future applications from being

funded• Garnish tax refunds or pay against the

fiscally responsible person.



Participants Responsibilities

If you are approved for one thing and your needs change by the time your receive your funds, CALL or write IFSP and request a change in approval.

Documentation must be in your file that matched what you are approved for and what you have spent on funding.



Application Review

The Department will assure compliance with program regulations and policies

1. Verify that the individual is on ID or IFDDS Waiver waiting list;

2. Confirm that the services or items for which funding is being requested are eligible for funding

3.Determine that the services or items for which funding is requested are needed to support the continued residence of the individual with ID/DD in his own or the family home



Application Review

The Department shall provide a written notice to the individual or family member who submitted the application indicating the funding decision.

ApprovedPended or

Denied



Approval

Approvals - Approval notices shall include:• The services, supports, or other items for which

funding is approved;• The amount and timeframe of the financial

allocation;• The expected date that the funds should be

released; and• Documentation requirements for submitting

receipts to the Department and the date documentation shall be provided to DBHDS.



Approval

In general, receipts or other documentation to verify expenses for which IFSP funds have been requested shall be submitted to the Department within 30 days of receipt of funds OR

Upon the completion of the purchase of approved items/delivery of approved services and shall include the name of the provider of the goods/services and the individual’s name.



Approval

Applications may be approved at a reduced amount when the amount requested exceeds a reasonable amount as determined by Department staff as being necessary to purchase the services or items.



PEND

Pended Requests• When requests for IFSP funds cannot be

immediately approved due to missing information or there are questions about the application contents, DBHDS staff will “pend” the request. In that event the following procedures will be followed:

• DBHDS staff will send a letter requesting additional information to the individual or fiscally responsible family member provided on the application in order to acquire the additional information needed in order to approve the request.



PEND

• DBHDS staff will wait for the requested information from the individual or family member for up to 30 days from the date of the mailed letter.

• If the additional requested information is received, DBHDS staff will continue to process the application

• If the additional requested information is not received, DBHDS staff will deny request and send a letter following the denial procedure.



Denials

Denials - Applications shall be denied if the Department determines that:

• The service or item for which funding is requested is not eligible for funding in accordance with 12 VAC 35-230-50 (See Section V, “Covered Services and Supports,” in Guidelines.

• This program does not fund clothing, food, purchase of a vehicle or down payments for a home.



Denials

• The requesting individual or family member has not used previously received IFSP funds in accordance with the Department’s written notice approving the request or has failed to comply with IFSP policies or regulations; or

• The total annual IFSP funding appropriated by the General Assembly has been expended for the applicable fiscal year.



Denials

The request was pended and the family did not respond to request for additional information in a timely manner (i.e., 30 days);

For applications for which funding is denied or approved at a reduced amount, the Department’s notice shall state the reason or reasons why the requested services, supports, or other items were denied or approved at a reduced amount and the process for requesting the Department to reconsider its funding decision.



Requests for reconsideration

Individuals or family members who disagree with a determination of the Department may submit a written request for reconsideration to the Program Manger, Cindy Gwinn.

If the issue can not be resolved then the applicant has the right to ask for an appeal to the Commissioner, or his designee, within 30 days of the date of the written notice of denial or approval at a reduced amount.



Post Funding Review

• Utilization review of documentation or verification of funds expended may be undertaken by Department staff. Reviews may include home visits to view items purchased or services delivered.

• Funds that are not used for agreed upon services, may result in recovery of such funds by the Department and denial of all future application requests.

•



Termination of funding

Funding through the Individual and Family Support Program shall be terminated:

• when the individual is enrolled in the ID or IFDDS (DD)waiver,

• or if approved funds are used for purposes not approved by the Department in its written notice.



Quality Measures

• We look forward to hearing how these funds have assisted participants to continue to live in their community.

• A yearly satisfaction survey will be sent to each participant to assist in measuring satisfaction and effectiveness of the program.

• Outcomes will be published in the annual report and program reviews.



Assistance

Program Regulations and Sample Application can be downloaded at:

www.dbhds.virginia.gov/ODS-default.htm

http://www.dbhds.virginia.gov/ODS-default.htm



Assistance

For additional information or questions please contact:

Cindy Gwinn - IFS Program [email protected]

individual and family support program cindy gwinn community resource manager

Documents

family home

behavioral consultation

family support program

waiver programs

medicaid home

family members homeare

deposits page

dollars page