Physical Disabilities Waiver (PDW) Administrative Case Management Program

SHCN

Description:

The Physical Disabilities Waiver provides home and community-based services to a limited number of individuals with serious and complex medical needs who have reached the age of 21 and are no longer eligible to receive these services through the HCY program.  The waiver provides a cost effective alternative to placement in an intermediate care facility (ICF-MR).

Eligibility:

The participant must:

Be a Missouri resident
Be age 21 and over
Be enrolled in MO HealthNet
Have a federally-matched MO HealthNet eligibility code
Require medical care equivalent to the level of care received in an intermediate care facility
Not be receiving services from another state waiver program
Have participated or been eligible for private duty nursing through the HCY Program

Service Coordination:

• Assisting recipients/families in identifying and accessing medically necessary services
• Establishing a medical home
• Connecting families with appropriate community resources
• Meeting with the recipient and family on an ongoing basis to plan, promote, assist and assure the implementation of services

Service (Case) Planning:

Developing an interdisciplinary plan for coordination of the required medical services.

Service Identification:

Following assessment and service planning, the SHCN service coordinator will identify the type, amount, intensity, and duration of services required to meet the case plan goals. The SHCN Service Coordinator/HCY Facilitator will identify potential service providers from which the family may choose.

Prior Authorization:

• Private duty nursing
• Advanced personal care aide
• Personal care aide
• Supplies and equipment

Service Monitoring:

Service coordinators monitor services through regular home visits and assessments, medical records, and care plan review.