ConsumerDirected Services

1
Services Facilitator Training
Mental Retardation Waiver
November - December 2005
10/25/05
2
SF Duties Prior to CD Services beginning . . .

• During Initial Comprehensive home Visit . . .

• Develops with input from individual
• ISARs - Individual Service Authorization
  Request(s)

3
ISARs

• Obtain from
• DMAS website
• OMR - Community Resource Consultant
• Case Manager

4

• CD Services MUST BE Pre-authorized

Personal Assistance, Respite, Companion
5
ISAR Points To Remember . . .

• SF not Pre-authorized
• SF Start Date included on the CD Service ISAR

6
ISAR Points To Remember . . . (contd)

• One ISAR per service, using the required form
• Completed by SF
• Initially when services begin
• When hours or SF changes

7
ISAR Points To Remember . . . (contd)

• Must match ISP content
• Check type of ISAR on form
• Complete ALL blanks

8
ISAR Points To Remember . . . (contd)

• Enough narrative to justify request
• Complete hours in service on the schedule
• Start date of SF AND CD Service listed on ISAR

9
ISAR Points To Remember . . . (contd)

• End date determined by CSP unless short-term
• Dated and signed by Services Facilitator

10
SF Duties Prior to CD Services beginning . . .

• Forwards completed copy of ISAR(s) to CM

SF keeps copies
11
Case Manager will . . .

• Review ISAR for required elements
• Approve OR

ISP

• Request more information

ISP
ISAR
12
If approved, Case Manager will . . .contd

• Sign ISAR keep a copy
• Fax to assigned PA Consultant for authorization
  on or prior to requested CD service start
  date!!
• Keep fax confirmation (sent log)

13
OMR PreAuthorization Consultant will . . .

• Authorize
• Pend
• Deny
• Reduce

14
OMR PA Consultant will . . . Contd
If authorized

• Enter CD service(s) into VaMMIS (DMAS computer
  system)
• Return copy of authorized ISAR to Case Manager

15
Services Facilitator will . . .
If authorized, by OMR

• Receive a computerized DMAS PA Notice
• Check the PA Notice for errors
• Keep a current copy

16
Case Manager will . . .
Hold
If denied or pended, receive from OMR

• Status of MR Request form
• reason for pended or denial

• ISAR, if denied

17
Case Manager will . . . (contd)
If denied or pended

• Forward copy of Status of Request to SF

18
Services Facilitator will . . .
If pended

• Submit requested information to CM by specified
  deadline

19
Case Manager will . . . (contd)
If pended

• Resubmit ISAR packet to PA Consultant by
  specified deadline

20
Case Manager will . . . (contd)
If denied or reduced
Issue Right To Appeal Letter
21
Services Facilitator will . . .
Once the ISAR is approved by OMR
continue with more in-depth EMM training
22
Questions about Services Facilitation for the
Mental Retardation Waiver . . .
Can be directed to the regional OMR Community
Resource Consultant
See handout for contact information