Vermont State System of Care Plan

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

Vermont

State System

of Care Plan

for

Developmental

Disabilities Services

FY 2023 – FY 2025

Three Year Plan

Effective: January 1, 2023

Technical correction May 1, 2023

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

Vermont State

System of Care Plan

for

Developmental Disabilities Services

FY 2023 – FY 2025

Three Year Plan

Effective: January 1, 2023

Developmental Disabilities Services Division

Department of Disabilities, Aging and Independent Living

Agency of Human Services

State of Vermont

This document is available online at: Vermont State System of Care Plan

(https://ddsd.vermont.gov/sites/ddsd/files/documents/SSCP_FY23-25_final.pdf)

For additional information, or to obtain copies of this document in this or

other formats,

please contact:

Developmental Disabilities Services Division

280 State Drive, HC 2 South

Waterbury, VT 05671-2030

Phone: 802-241-0304

Fax: 802-241-0410

www.ddsd.vermont.gov

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

TABLE OF CONTENTS

Page

Section One Introduction

I. Background 3

II. Guiding Documents 7

Section Two Eligibility

I. Overview 8

II. Eligibility Determination 8

III. Intake Process and Choice of Provider 9

III. Authorization of Services and Funding and Notification 14

Section Three Authorization of Services and Funding and Notifications

I. Overview 16

II. Role of Division in funding 17

III. Role of Designated Agency 19

IV. Role of Specialized Service Agency 21

V. Role of Supportive ISO 22

Section Four Available Programs and Funding Sources

I. Description of Available Programs 23

II. Special Initiatives 43

Section Five Management of Home and Community-based Services

Funding

I. Base Allocation 49

II. New Caseload Funding 50

III. Role of Funding Committees 52

IV. Guidance for Management of HCBS Funding 55

Section Six Plan Development

I. Public Input Forums 71

II. Online Survey 72

III. Division email box 72

IV. State Program Standing Committee 73

V. Quality Review 73

VI. Other information 74

VII. Public Hearings and Comments 75

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

Attachment A Link to Important Documents 77

Attachment B Moving Funds in Individualized Budgets

Overspending in Funded Areas of Support and

Authorized Funding Limits 78

Attachment C Developmental Disabilities Services Funding 80

Appropriation– FY 2023

Attachment D

Developmental Disabilities Services Needs Assessment 82

Attachment E Glossary of Terms 94

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

SECTION ONE

INTRODUCTION

Background

A. History

The closure of Brandon Training School in 1993 was a significant milestone in

the history of Vermont’s system of care for individuals with developmental

disabilities.

It marked the end of reliance on an institutional model of care and

underscored the commitment to create those supports and services necessary for

people to live with dignity, respect and independence outside of institutions.

Community-based services and supports are provided through ten Designated

Agencies and five Specialized Services Agencies (DA/SSAs) or are self or family

managed with the assistance of a Supportive Intermediary Service Organization

(Supportive ISO).

In 1996, the Vermont State Legislature embedded in law the process by which

the State continues its commitment to community-based services.

The

Developmental Disabilities Act of 1996 (DD Act) requires the Department of Disabilities,

Aging and Independent Living (DAIL), through the Developmental Disabilities

Services Division (DDSD), to adopt a plan known as the State System of Care

Plan that describes the nature, extent, allocation and timing of services that will

be provided to people with developmental disabilities and their families. The

State System of Care Plan, (from here on called the “Plan”), along with the

Developmental Disabilities Services Regulations (previously titled Regulations

Implementing the Developmental Disabilities Act of 1996 from here on called the

(

“DDS Regulations”) and the Developmental Disabilities Services Annual

Report, cover all requirements outlined in the DD Act.

In 2014, the Legislature passed Act 140 amending the DD Act. It included a new

requirement that the department adopt certain categories of the Plan through the

State rulemaking process. This means that they had to be included in the

department’s DDS Regulations

. Those categories include:

Priorities for continuation of existing programs or development of new

programs;

Criteria for receiving services or funding;

Type of services provided; and

A process for evaluating and assessing the success of programs.

The definition of developmental disability and other frequently used terms is included a glossary of terms in Attachment E.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

In 2022, the Legislature passed Act 186 which further amended the DD Act.

They removed the requirement that the above categories of the Plan be adopted

through the rulemaking process. Therefore, the Department proposed to remove

these categories from the DDS Regulations

in their next amendment, which was

happening concurrent to the development of the new Plan, and to include them

only in the Plan. This change was approved in the

DDS Regulations effective

March 1, 2023.

A draft Plan

must be submitted to the State Program Standing Committee (SPSC)

for Developmental Disabilities Services for advice and recommendations at least

60 days prior their adoption. A draft was submitted to the SPSC on 10/13/22 for

a review at the 10/20/22 SPSC monthly meeting. Once the Plan

priorities were

determined, the Commissioner of the department considered funds available to

the department in allocating resources.

Some sections of the Plan

include language that is included in the DDS

Regulations. Proposed changes to the DDS Regulations were being reviewed at

the same time as this Plan was being drafted and finalized. Because of the timing,

the draft Plan

was based upon the proposed DDS Regulations that were submitted

for review and public comment. Some changes to the proposed DDS Regulations

were made after receiving public comment and a new version was sent to the

Legislative Committee on Rules (LCAR) for review. The Department was

awaiting final review and approval of the

DDS Regulations when the Plan was

first published for an effective date of 1/1/23. Where there was language in the

Plan that overlapped with the DDS Regulations, updates to the Plan were made

to be consistent with the language in the proposed DDS Regulations that were

submitted to LCAR. See attachment A for link to the proposed DDS Regulations.

It was anticipated that some adjustments would be made to the final version of

the Plan

based on the finalized DDS Regulations when any changed language to

the DDS Regulations was referenced in the Plan. Those final adjustments to the

Plan are not subject to further review by the SPSC. This technical correction of

the Plan

reflects those updates based on the final approved DDS Regulations

which became effective on March 1, 2023. This version also fixes some of the

links in the 1.1.23 version that linked to older versions of documents. These

corrections do not change the content of the Plan.

The Plan reflects the Division’s commitment to the health, safety and well-being

of people with developmental disabilities and their families as well as to its

principles and values. The principles, which can be found

The Developmental

Disabilities Act of 1996, emphasize the Division’s commitment to maximizing

individual choice and control in designing and implementing this Plan. Act 186

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

added language to the DD Act that further emphasizes that individuals and

families need to receive full information regarding their options for services, as

well as the need to ensure that they are respected and active participants in system

change initiatives and the development of new services.

B. Creation of the Plan

Gathering information about the needs of people with developmental disabilities

in Vermont and the effectiveness of our services and supports is an ongoing

endeavor. The Plan builds on experience gained through previous plans and is

developed every three years and updated annually, as needed, with input from a

variety of individuals and organizations interested in services and supports for

people with developmental disabilities. Input was obtained by the State through

a process of gathering information from conversations with stakeholders, the

State Program Standing Committee, a dedicated email box for sending input and

comments, public forums and hearings and written comments for the

DDS

Regulations and the Plan, and an online stakeholder survey (see Section Six for

more details). Due to the Public Health Emergency related to the COVID-19

pandemic, the FY2018-FY2020 Plan was extended until 12/31/22. Also, due to

the pandemic, Local System of Care Plans were not required to be completed by

provider agencies. There was a request from stakeholders and legislators for the

Division to focus on three priority areas in developing the new Plan. These

included:

• Expanding housing options for people with developmental disabilities

• Paying parents to provide services to their children

• Services to individuals with autism spectrum disorders.

Multiple public forums were held to gather input on these 3 topics. Additional

forums were scheduled to gather input on the Plan as a whole. An online survey to

gather input into the development of the Plan was also sent to stakeholders. The

survey was added to provide an additional vehicle for providing input in light of

not completing the Local System of Care Plans. The Division also reviewed

existing information regarding the system and input gathered in other previous

forums.

The department also considered changes to the DDS Regulations

and the Plan

based upon changes in state and federal regulations, policies and agreements.

These include the rules for Home and Community-Based Services (HCBS) that

have been issued by the federal Centers for Medicare and Medicaid Services

(CMS); and the Global Commitment to Health 1115 Demonstration Waiver which

is Vermont’s agreement with CMS for operating its Medicaid program.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

One of the key groups consulted during the development of this Plan is the State

Program Standing Committee for Developmental Disabilities Services. In

accordance with the Developmental Disabilities Act, specifically 18 V.S.A. §8733,

this Governor appointed body is charged with advising DAIL on the status and

needs of people with developmental disabilities and their families and advising the

Commissioner on the development of the Plan. All these methods of input provide

the perspective of a wide range of individuals.

It should be noted that there are considerable systems changes on the near horizon

for Developmental Disabilities Services (DDS). These include the development

of a new payment model for DDS and complying with the federal HCBS rules to

separate the delivery of case management services from the delivery of other direct

services. The work to develop a new payment model has been happening for

several years, but it is not yet at the stage to recommend changes to the system.

The State has submitted a plan to the CMS to address separating case management

services from direct services by working with stakeholders to redesign the system.

This work will be happening over the next several years. Act 186 also directs the

Department to hire a Housing Specialist and form an Advisory Committee to work

on developing additional housing and support options for people with

developmental disabilities. After these planning processes have occurred, any

changes that impact the Plan will be proposed for future updates and are not

incorporated in this three-year Plan at this time. Updates to the Plan can be made

annually or sooner if needed, as long as proposed changes are submitted to the

DDS State Program Standing Committee for advice and recommendations at least

60 days prior their adoption. It is anticipated that changes to the Plan will be

required, to reflect changes in accordance with Federal requirements and/or special

initiatives as outlined herein.

C. Intention of the Plan

The Plan is intended to help people with developmental disabilities, their families,

advocates, service providers and policy makers understand how resources for

individuals with developmental disabilities and their families are managed. It lays

out criteria for determining who is eligible for developmental disabilities services

and prioritizes the use of resources. It is specifically intended to spell out how

legislatively appropriated funding will be allocated to serve individuals with

significant developmental disabilities. The Plan guides the appropriate use of this

funding to help people achieve their personal goals and to continuously improve

the system of supports for individuals with developmental disabilities within

available resources.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

This Plan does not substitute for the State of Vermont’s Medicaid State Plan. It

does not guide or direct the allocation of resources for all Medicaid State Plan

services, or other services administered by the Agency of Human Services or other

state agencies.

This three-year Plan is effective as of January 1, 2023 and will be updated on a

yearly basis, as needed. The guidance provided in the Plan reflects the expectations

for service delivery and documentation during usual operation of the program. The

Department granted some flexibilities, as outlined in the December 4, 2020 memo

to providers (DDSD_COVID_Flexibilities_FAQ_Nov_2020.pdf (vermont.gov)

)

to respond the Public Health Emergency due to COVID-19. The flexibilities will

remain in place and take precedence over the guidance in the Plan until the

Department provides notification that a flexibility has been ended. Advance notice

will be provided unless the State is directed by CMS to make an immediate change.

This includes any notices sent to providers between December 4, 2020 and January

1, 2023 regarding the ending of a specific flexibility.

Feedback on the Plan is welcome at any time.

II. Guiding Documents

The development of the Plan is guided by the Department of Disabilities, Aging

and Independent Living (DAIL) Mission Statement and Core Principles

as well as

the Principles of Service outlined in the Developmental Disabilities (DD) Act of

1996.

The DAIL Mission Statement can be found at:

DAIL Mission Statement and Core

Principles

The Principles of Service outlined in the DD Act can be found in Section 8724 of

the Developmental Disabilities Act of 1996

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

SECTION TWO

ELIGIBILITY

I. Overview

Using national prevalence rates, it is likely that roughly 16,077 of the state’s

643,077

citizens have a developmental disability as defined in the Vermont

Developmental Disabilities Act. Given the birth rate in Vermont of about 4,953

live births per year

, it is expected that approximately 124 children will be born

with a developmental disability in Vermont annually

. In FY 21, 29% of

Vermonters with a developmental disability are estimated to meet clinical

eligibility and receive DDS based on the 4,634 individuals who received services.

Not everyone with developmental disabilities needs or wants services. Most

individuals with developmental disabilities in Vermont are actively involved in

home and community life, working and living along with everyone else. Of those

who do need support, many people have only moderate needs. Those with more

intense needs usually require long term, often life-long support. Services are

determined through an individual planning process and designed to be based on

the needs and strengths of the individual, the individual’s goals and the

availability of naturally occurring supports.

In enacting the Developmental Disabilities Act, the Legislature made clear its

intention that developmental disabilities services would be provided to some, but

not all, of the state’s citizens with developmental disabilities. It gave

responsibility for defining which individuals would have priority for funding and

supports to the Division through the DDS Regulations and the Plan.

II. Eligibility Determination

Individuals with developmental disabilities who wish to receive services must

first be found eligible. There are three parts to determining eligibility.

1. Financial eligibility

National census figures obtained from the U.S. Census Bureau’s 2020 Population Estimates Program

and national prevalence rates of 1.5% for intellectual disability and 1.0% for autism spectrum

disorders.

This calculation is based on CY 20 data from the Vermont Department of Health Vital Statistics

System.

This calculation is based on prevalence rates of 1.5% for intellectual disability and 1.0% for autism

spectrum disorders, understanding that there is an overlap between the two diagnoses.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

2. Clinical eligibility

3. Funding eligibility

Financial Eligibility: In order to receive developmental disabilities services

funding, an individual must be determined by the Department of Vermont Health

Access to be financially eligible for Vermont Medicaid. (Applications for

Medicaid can be found at:

Medicaid | Department of Vermont Health Access )

Clinical Eligibility: Having a

developmental disability means to have a diagnosis

of one of the following based on a formal, professional evaluation:

• Intellectual Disability (IQ of 70 or below, or up to 75 or below when

taking into account the standard error of measurement), or

• Autism Spectrum Disorder;

and have both of the following:

• Significant deficits in adaptive function (such as, daily living skills,

communication, and/or motor development), and

• Onset of the disability prior to age 18.

Funding Eligibility: Each program and funding source has its own criteria to

access funding.

The DDS Regulations

provide more detail on clinical eligibility (Health Care

Administrative Rules (HCAR) 7.100.3), recipient criteria (HCAR 7.100.4)), and

financial requirements and responsibilities (HCAR 7.100.7)). Section Four of this

Plan describes the eligibility and access criteria as well as limitations of each

program. The clinical and financial eligibility criteria above apply to most

programs but for a few programs it is different.

III. Intake Process and Choice of Provider

Any person who believes he or she has a developmental disability or is the family

member or authorized representative of such a person may apply for services,

supports, or benefits. In addition, the guardian of the person may apply. Any

other person may refer a person who may need services, supports, or benefits. An

agency or a family member may initiate an application for a person with a

developmental disability or a family member but must obtain the consent of the

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

person or guardian to proceed with the application

DAIL has agreements with ten Designated Agencies (DA) and five Special

Services Agencies (SSA) to provide Developmental Disabilities Services. These

agreements establish their status as certified providers. There is also an agreement

with a Supportive Intermediary Service Organization (Supportive ISO) to assist

individuals and families who wish to manage their own services. An application

for Developmental Disabilities Services is filed at the DA for the geographic

region where the individual with the developmental disability lives. Any disputes

regarding which DA is the person’s responsible DA can be resolved by the DDSD

Director.

Within five (5) business days of receiving an application, the DA must complete

the application screening process. If there are extenuating circumstances that

prevent completion in five (5) business days, the agency (DA) must document

those in the individual’s record. Information should be provided both verbally and

in writing. The screening process includes all of these steps:

a. Explaining to the applicant the application process, potential service

options, how long the process takes, how and when the applicant is

notified of the decision, and the rights of applicants, including the right

to appeal decisions made in the application process;

b. Notifying the applicant of the rights of recipients in plain language,

including the procedures for filing a grievance or appeal

and their rights

as outlined in the federal CMS HCBS rules;

c. Discussing options for information and referral; and

d. Determining whether the person with a developmental disability or the

person’s family is in crisis or will be in crisis within 60 days. If the DA

determines that the person or family is facing an immediate crisis, the

DA must make a temporary or expedited decision on the application.

During the screening process, a DA must inform the person or his/her right to file

an application, have a full assessment, and be given a formal notice of decision

regarding eligibility.

At the point of initial contact with an applicant, the DA must inform the applicant

of all certified providers (DA/SSAs) in the region and the options to:

a. Receive services and supports through any certified provider (DA/SSAs)

in the region;

See HCAR 7.100.5(a) Who may apply. Link to final approved HCAR 7.100 (DDS Regulations) is

included in Attachment A.

See HCAR 7.100.9 Internal Appeals, Grievances, Notices, and State Fair Hearings.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

b. Share the management of those services with the DA or SSA; or

c. Self/family-manage their services through the Supportive ISO.

The DA shall help a recipient learn about service options, including the option of

self/family-managed services

. The option to choose designated providers

(DA/SSAs) other than the DA and to self/family-manage or share-manage

services applies only to Home and Community-Based Services described in

Section Four (G).

It is the DA’s responsibility to ensure the individual is informed of his or her

choice of all services options listed below so that the individual can make an

informed decision when choosing between and among management

options/service providers. The DA must document options discussed and

information shared as part of this process

, including a signed acknowledgement

by the applicant that they understand their options. If the applicant wants more

information about options or chooses to pursue services outside the DA, then the

DA must contact the SSA or Supportive ISO on behalf of the applicant

The DA shall provide the choices in an unbiased manner to reduce the potential

for conflict of interest

. The Designated Agency will clearly explain and provide

contact information for the applicant to learn about each of the following options.

• Agency-Managed Services: Agency-managed services are when a

Designated Agency or Specialized Service Agency (DA/SSA) manages all

services and supports provided to the individual. Even when the DA/SSA

contracts through another entity, such as a shared living provider or other

service organization that hires or contracts for support workers, the DA/SSA

remains responsible for management and quality oversight of all

developmental disabilities services.

• Shared-Managed Services: Shared-managed services are when a

Designated Agency or Specialized Services Agency (DA/SSA) manages

some, but not all, of the services and is responsible for the quality oversight

of those services, and the individual or a family member manages some of

the services. For example, a DA/SSA may provide service planning and

coordination and arrange for other services, such as home supports, while

the individual or a family member manages supports such as respite or

community supports. Shared-managed services is not defined as a DA/SSA

See HCAR 7.100.5(d) Screening.

See HCAR 7.100.5(j) Choice of Providers.

Ibid.

See HCAR 7.100.5(d) Screening.

See HCAR 7.100.5(j) Choice of Providers.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

contracting with a shared living provider and/or other service organization

who hires support workers because in those situations the DA/SSA is still

responsible for the management and quality oversight of those services.

• Self-Managed

: Self-managed services are when an individual manages

all of his or her developmental disabilities services. The individual is

responsible for hiring his or her own staff, administrative responsibilities

and quality oversight associated with receiving developmental disabilities

services funding. An individual may manage up to 12 hours per day of

In-home Family Supports or Supervised Living, but may not self-manage

Staffed Living, Group Living or Shared Living. Except for supportive

services, clinical services provided by licensed professionals, or camps that

provide respite, individuals and families may not purchase services from a

non-certified entity or organization.

• Family-Managed Services

: Family-managed services are when a family

member manages all of an individual’s developmental disabilities services.

The family member is responsible for hiring staff, administrative

responsibilities and quality oversight associated with receiving

developmental disabilities services funding. A family member may manage

up to 12 hours per day of In-home Family Supports or Supervised Living,

but may not family manage Staffed Living, Group Living or Shared Living.

Except for supportive services, clinical services provided by licensed

professionals, or camps that provide respite, individuals and families may

not purchase services from a non-certified entity or organization.

When an individual or family chooses to self/family-manage services, the

individual or family member is also responsible for ensuring that the approved

funding is used in compliance with the Plan, the DDS Regulations

and all other

relevant policies and guidelines. The Supportive Intermediary Service

Organization (Supportive ISO) must be used by individuals and family members

who self/family-manage their services to help them understand their roles and

responsibilities for self/family-management, including assuring workers are

trained, supervised and monitored, following all Division policies and guidelines

and managing funding. The DA/SSA assumes this role when services are shared-

For more information, see the Guide to Self/Family Management for a comprehensive guide for

people who are self/family-managing their developmental disabilities services funded through

Medicaid.

See HCAR 7.100.6 Self/Family-Managed Services.

For more information, see the Guide to Self/Family Management for a comprehensive guide for

people who are self/family-managing their developmental disabilities services funded through

Medicaid.

See HCAR 7.100.6 Self/Family-Managed Services.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

managed. The Fiscal/Employer Agent (F/EA) must be used by employers of

record, including individuals who self/family-manage or share-manage and

shared living providers who hire workers, to assist with many of the bookkeeping

and reporting responsibilities of the employer. The F/EA also conducts

background checks for prospective employees and processes payroll for the

employer.

Services from Providers other than the Responsible DA

An applicant may choose to receive services from the DA in the county where he

or she lives or may choose to receive services from a Specialized Service Agency

(SSA), or another DA. Specialized Service Agencies are organizations that

provide a distinctive approach to services and/or services that are designed to meet

the needs of individuals with distinctive needs. There are five SSAs who provide

services in select regions around the state. The other DA/SSAs have the option to

decline to provide services in which case the individual may receive services from

their DA or choose to self-manage or family-manage their services.

The recipient or family may choose to receive services from an agency (DA/SSA)

in the state, if the agency (other DA/SSA) agrees to provide the authorized

services at or below the amount of funding authorized for the DA to provide

services.

If the recipient is not self/family-managing services, the DA shall ensure that at

least one provider within the geographic area offers the authorized services at or

below the amount of funding authorized at the DA.

If no other provider is available to provide the authorized services and the

recipient or family does not wish to self/family-manage services, the DA shall

provide the authorized services in accordance with its Provider Agreement with

DAIL. If the recipient’s needs are so specialized that no provider in the

geographic area can provide the authorized services, the DA may, with the

consent of the recipient, contract with a provider outside the geographic region

to provide some or all of the authorized services.

A recipient or family may request that an agency (DA/SSA) sub-contract with a

non-agency (non-DA/SSA) provider to provide some or all of the authorized

services, however, the decision to do so is at the discretion of the agency

(DA/SSA)

See HCAR 7.100.5(j) Choice of Provider

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

IV. Authorization of Services and Funding and Notification

The DA is responsible for verifying that the applicant has met the criteria for

financial eligibility. The DA must conduct or arrange for an assessment that will

be used to determine clinical eligibility. It is the Division’s responsibility to

determine clinical eligibility for HCBS. If an applicant has been found

financially and clinically eligible, an Individual Needs Assessment must be

completed to determine whether the applicant meets criteria to access any of the

services or funding listed in Section Four of this Plan. Individuals applying for

HCBS must participate in the needs assessment process established by the State.

Agencies must conduct or arrange for the needs assessment according to this

process.

Within 45 days of the date of the application, the DA must notify the applicant in

writing of the results of the assessment and the amount of services or funding, if

any, which the applicant will receive. If the assessment and authorization of

funding is not going to be completed within 45 days of the date of application,

the DA must notify the applicant in writing of the estimated date of completion

of the assessment and authorization of services or funding.

Failure to act in a

timely manner according to state rules is appealable. For an individual who is

authorized to receive Home and Community-Based Services, notification will

specify the amount, types and costs for these services in the form of the

individual’s Authorized Funding Limit (AFL).

Within 30 days of written notification of approval for services and/or funding,

the chosen DA/SSA will begin funded services. During this period, the DA/SSA

will work with the applicant to initiate person-centered planning and the Person’s

Story and develop an Individual Support Agreement (ISA). The DA/SSA may

begin some or all services before the 30-day timeframe depending on individual

circumstances. However, there must be a signed ISA within 30 days of the first

day of billable services

or authorized start date for HCBS. If the authorized

services are not going to start within 30 days of notification of approval, the

chosen DA/SSA will notify the applicant in writing of the estimated start date of

services. For individuals or families who choose to self/family-manage their

services, the DA will transfer the authorized funding and required records

(Transfer of Documents when Changing Providers: Guidelines for Agencies

) to

the Supportive ISO. The individual or family may then arrange to implement

services with the assistance of the Supportive ISO and F/EA.

See HCAR 7.100.5(i) Notification of Decision on Application.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

If the applicant is found ineligible for services, the DA is responsible to provide

the individual information and referrals to other services. If the applicant is found

ineligible to receive funding for some or all services, the DA will, as soon as

possible, notify the applicant and provide information to the individual about the

basis for the decision, the process for appeal and where to obtain legal assistance.

Applicants’ names will be placed on a waiting list maintained by the DA as

specified in the DDS Regulations

(HCAR 7.100.5(q). The applicant will be

informed when his or her name has been placed on the waiting list and will be

given information about the periodic review of the waiting list. (See HCAR

7.100.5(i) for more information on notification of decisions and

HCAR 8.100 on

the appeal process.)

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

SECTION THREE

FUNDING AUTHORITY AND SOURCES

I. Overview

The authority to offer and fund services for people with developmental

disabilities is outlined in the special terms and conditions of

Vermont’s Global

Commitment to Health Section 1115 Demonstration, an agreement between the

Vermont Agency of Human Services and the federal Centers for Medicare and

Medicaid Services (CMS) regarding the administration of the State’s Medicaid

program. The agreement allows for the provision of “special programs” for

individuals who would have been eligible under separate 1915 (c) waivers

previously. Developmental Disability Services is one of these special programs.

The agreement indicates that “Vermont’s specialized programs rely on person-

centered planning to develop individualized plans of care. Specialized programs

support a continuum of care from short term crisis or family support to intensive

24/7 home and community-based wraparound services. These programs include

both State Plan recognized and specialized non-State Plan services and providers

to support enrollees in home and/or community settings. The state may require:

additional provider agreements, certifications or training not found in the State

plan; specific assessment tools, level of care or other planning processes; and/or

prior authorizations to support these programs.” It provides a summary of the

services available but specifies that “complete service definitions, approved

provider types, applicant rules, prior authorizations, limitations and exclusions

can be found in Vermont statute, rule and policy.”

Below is a list of the additional Vermont statutes, rules and policies that provide

authority and guidance regarding the use of funding and service delivery for

people with developmental disabilities:

• The Vermont State System of Care Plan for Developmental Disabilities

Services, this Plan

• The Developmental Disabilities Act of 1996

• The DDS Regulations - Disability Services – Developmental Services,

• Administrative Rules on Agency Designation

• DDSD Medicaid Claim Codes and Reimbursement Rates

• Individual Support Agreement Guidelines

• Behavior Support Guidelines for Support Workers Paid with

Developmental Services Funds

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

• Guidelines for the Quality Review Process of Developmental Disabilities

Services

• Medicaid Manual for Developmental Disabilities Services

• Vermont State Medicaid regulations – Health Care Rules | Agency of

Human Services (vermont.gov)

• DDSD Encounter Data Submission Guidance

Each year, the Legislature appropriates funding for the provision of

Developmental Disabilities Services. DAIL is committed to providing high

quality, cost-effective services to support Vermonters with developmental

disabilities within the funding available and to obtain good value for funding

appropriated by the Legislature. To help achieve this goal, the Developmental

Disabilities Services Division allocates these appropriated funds to its network

of Designated Agencies and Specialized Service Agencies (DA/SSAs) as well as

the Supportive Intermediary Service Organization (Supportive ISO) on behalf of

people self/family-managing services. DAIL has Provider Agreements with all

DA/SSAs that outline the requirements for service provision and include the

amount of funding allocated for each available program and funding source.

There are separate provider standards which outline the requirements for the

Supportive ISO. The appropriation includes a base allocation used by DA/SSAs

and the Supportive ISO for individuals currently receiving services. The

appropriation may also include additional funding for individuals who are new

to services or who currently receive services and have an increase in needs. A

summary of the funding available in FY 2023 is shown in Attachment C. The

Division as well as the DA/SSAs and the Supportive ISO each have roles in the

allocation of funding to recipients.

II. Role of the Division in Funding

The Division maintains an active role in the allocation, review and approval of

developmental disabilities services funding. The Division will:

A. Prepare budget recommendations for the Administration’s review,

including analysis of emerging trends, changes in best practices, new

federal requirements, pressures, and opportunities for cost-reduction and

system-delivery improvements.

B. Allocate base funding for each program specified in each agency’s

Provider Agreement.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

C. Issue instructions for any budgetary rescissions or increases, as directed

by the Legislature. In the absence of specific instructions from the

Legislature, the Department will consult with DA/SSAs and Supportive

ISO as well as the DDS State Program Standing Committee for

recommendations regarding how to implement budgetary rescissions or

increases. Then the Department will issue instructions.

D. Provide funding guidelines and technical assistance to DA/SSAs,

Supportive ISO and local funding committees.

E. Lead the Equity and Public Safety Funding Committees (see Section

Five, III); establish operating procedures for each committee; take

recommendations from the committees; assure that each funding

proposal is in compliance with this Plan, the DDS Regulations, and all

other relevant policies and guidelines; make final funding decisions,

track funding requests for current and new recipients and monitor

caseload expenditures.

F. Verify clinical eligibility of those funded for Home and Community-

Based Services.

G. Review representative samples of individuals’ services to determine

whether the supports currently funded are of high quality, cost effective,

meet people’s needs and achieve their desired goals.

H. Review Medicaid Management Information System paid and denied

claims, and encounter data, service documentation, time records or

Electronic Medical Records (EMR) equivalent documentations to

determine adherence with state/federal rules and utilization/funding

guidelines and inform the process of working to ensure compliance.

I. Approve all Unified Service Plans. Unified Service Plans blend different

funding sources (such as developmental disabilities Home and

Community-Based Services funding, Children’s Personal Care Services

and/or Medically Complex Nursing Services

) into a unified funding

approach with one coordinated service plan for individuals with complex

and intensive medical and/or behavioral support needs.

Children’s Personal Care Services and Medically Complex Nursing Services for

children are managed by Vermont Department of Health/Children with Special Health

Needs. Medically Complex Nursing Services for adults are managed by Department

of Disabilities, Aging and Independent Living/Adult Services Division.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

J. Assist DA/SSAs to fill vacancies in group homes/residential settings that

are considered statewide resources. These are settings operated by

DA/SSAs and considered by DAIL as statewide resources available to

eligible individuals in VT. DA/SSAs must notify DDSD of a group

home/residential setting opening. The Division then sends a notice to the

statewide provider network. DA/SSAs receive referrals and consult with

DDSD staff to review viable candidates and come to a mutual agreement

as to the best match for the home. In the event that a mutual agreement

cannot be reached, the DA/SSA will make the final decision.

K. Approve increases in funding for group homes/residential settings that

are agreed upon by the provider and DDSD to be considered statewide

resources.

L. Assist DA/SSAs to negotiate and facilitate arrangements for eligible

individuals when the Department for Children and Families (DCF),

Department of Mental Health (DMH), Department of Corrections (DOC)

or other state agencies and/or organizations are contributing payment for

an individual’s Home and Community-Based Services. Provide final

funding approval in conjunction with other departments, agencies or

organizations.

M. Prior authorize requests for any out-of-home placements supported by

developmental disabilities funding for children under age 18.

N. Resolve the issue of which agency is the Designated Agency when it is

not clear which agency has the Designated Agency responsibilities for a

particular individual in accordance with DDSD guidance.

O. Manage the DDSD budget within available funding.

P. Ensure use of HCBS funds are consistent with the federal HCBS rules.

III. Role of Designated Agency

A. Verify financial eligibility.

B. Conduct or arrange for an assessment that will be used to determine clinical

eligibility.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

C. Conduct or arrange for needs assessments for all new applicants or existing

recipients, according to the process established by the Division.

D. Conduct periodic reviews of needs or new needs assessment for existing

recipients as needs change or at least annually.

E. Seek or authorize funding based upon assessed needs of individuals and

families.

F. Review service and individual budget utilization and assist individuals and

families in understanding the funding rules and management of their budget.

G. Manage base allocation by shifting funds within and across individual

budgets as needs change.

H. Follow all Division rules and guidance in requesting and managing funds as

outlined in the Provider Agreement, the Plan, the DDS Regulations and the

Medicaid Manual for Developmental Disability Services.

I. Operate a Local Funding Committee (see Section Five, III.A).

J. Submit requests for funding involving Unified Services Plans, DMH, and

DCF or other in-state or out-of-state organizations to the Division for

approval.

K. Submit requests for out-of-home placements supported by developmental

disabilities services funding for children under age 18 to the Division for

approval.

L. Notify Division of openings in group homes/residential settings that are

considered statewide resources as soon as an opening occurs.

M. Recalculate service and support costs annually and update individuals’

budgets accordingly by reallocating (known as “re-spreading”) costs across

individuals’ budgets, as appropriate.

N. Address gaps in services identified in the Local System of Care Plans with

available funds.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

IV. Role of Specialized Service Agency

A. Conduct periodic reviews of needs or new needs assessment for existing

recipients as needs change or at least annually.

B. Conduct or arrange for needs assessments for existing recipients, according

to the process established by the Division.

C. Seek or authorize funding based upon assessed needs of individuals and

families.

D. Review service and individual budget utilization and assist individuals and

families in understanding the funding rules and management of their budget.

E. Manage base allocation by shifting funds within and across individual

budgets as needs change.

F. Follow all Division rules and guidance in requesting and managing funds as

outlined in the Provider Agreement, the Plan, the DDS Regulations and the

Medicaid Manual for Developmental Disability Services.

G. Participate in the Local Funding Committee. Submit requests for increased

HCBS funding for an individual to the individual’s DA. Present on those

requests for HCBS funding at Local Funding Committee.

H. Submit requests for funding involving Unified Services Plans, DMH, and

DCF or other in-state or out-of-state organizations to the Division for

approval.

I. Submit requests for out-of-home placements supported by developmental

disabilities services funding for children under age 18 to the Division for

approval.

J. Notify Division of openings in group homes/residential settings that are

considered statewide resources as soon as an opening occurs.

K. Recalculate service and support costs annually and update individuals’

budgets accordingly by reallocating (known as “re-spreading”) costs across

individuals’ budgets, as appropriate.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

L. Address gaps in services identified in the Local System of Care Plans with

available funds.

V. Role of Supportive ISO

A. Conduct periodic reviews of needs or new needs assessment for existing

recipients as needs change or at least annually.

B. Conduct or arrange for needs assessments for existing recipients, according

to the process established by the Division.

C. Seek or authorize funding based upon assessed needs of individuals and

families.

D. Review service and individual budget utilization and assist individuals and

families in understanding the funding rules and management of their budget.

E. Follow all Division rules and guidance in requesting and managing funds as

outlined in the Provider Standards for Supportive ISO for Self/Family

Management of Developmental Disabilities Services, the Plan, the Rules and

the Medicaid Manual for Developmental Disability Services.

F. Operate a Local Funding Committee. Authorize up to $5,000 per person

annually for short-term needs from the shared funding pool in accordance

with the One-Time Funding guidelines (Section Four, I(I)). Submit requests

for increases to annualized HCBS funding to the Local Funding Committee

for review prior to submitting them to the Equity or Public Safety Funding

Committees.

G. Submit requests for funding involving Unified Services Plans, DMH, and

DCF or other in-state or out-of-state organizations to the Division for

approval.

H. Recalculate service and support costs annually and update individuals’

budgets accordingly by reallocating (known as “re-spreading”) costs across

individuals’ budgets, as appropriate.

I. When a new person transfers from a DA/SSA to self/family-management, the

Supportive ISO assists the person/family to plan how best to provide the

services using the approved budget to meet the assessed needs.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

SECTION FOUR

AVAILABLE PROGRAMS and FUNDING SOURCES

I. Description of Available Programs

Below is a description of the available programs for developmental disabilities

services. Each description includes information about the funding source, the

intent of the program, the eligibility and access criteria; limitations and process

for authorizing the services.

The Department’s programs reflect its current priorities for providing services

for Vermont residents with developmental disabilities. The availability of the

Department’s current programs, which are described below, is subject to the

limits of the funding appropriated by the Legislature on an annual basis. The

nature, extent, allocation and timing of services are addressed in this Plan, as

specified in the DD Act. Additional details, eligibility criteria, limitations and

requirements for each program are included in the current

Medicaid Manual for

Developmental Disabilities Services and in specific Division guidelines.

Programs will be continued and new programs will be developed based on annual

demographic data obtained regarding Vermont residents with developmental

disabilities, the use of existing services and programs, the identification of the

unmet needs in Vermont communities and for individual residents of Vermont,

and the reasons for any gaps in service.

(A) The Bridge Program: Care Coordination for Children with

Developmental Disabilities

The Bridge Program is an Early Periodic Screening, Diagnosis and Treatment

(EPSDT) service that provides support to families in need of care

coordination to help them access and/or coordinate medical, educational,

social or other services for their children with developmental disabilities. As

an EPSDT service, children who meet the eligibility criteria below are

entitled to receive this service and may not be placed on a waiting list.

Agencies may use Targeted Case Management funding to meet the needs of

some young adults between 18-22 when appropriate. Agencies should notify

the department if they exhaust their Bridge funding and are in need of

additional funds to serve those eligible for the Bridge Program.

See HCAR 7.100.5(g) Available Programs and Funding Sources.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

On an annual basis, the Division negotiates and approves funding allocations

for Developmental Disabilities Services Providers for the Bridge Program.

The DAs will determine clinical and financial eligibility and approve

individuals to receive this service. The Bridge Program Guidelines

provide details regarding eligibility, scope of service provision and overall

management of services.

(1) Eligibility

(a) Clinical:

Individuals who meet the criteria for developmental disability

as defined in the DDS Regulations

(b) Financial:

Vermont Medicaid eligible as determined by Department of

Vermont Health Access.

Individual must be under the age of 22. Care coordination is

available in all counties either through the Bridge Program or

through an Integrating Family Services (IFS) program

administered by the Department of Mental Health. Children

who are receiving care coordination

, case management or

service coordination from another AHS-funded source listed in

the Bridge Program Guidelines

are not eligible to receive

Bridge Program Care Coordination.

(2) Limitations

(a) Funds must be used in accordance with

Medicaid Manual for

Developmental Disabilities Services.

(b) Funds must be used in accordance with the

Bridge Program

Guidelines.

case management/care coordination rather than Targeted Case

Management, except for some young adults age 18-22 for

whom TCM is determined to be the more appropriate service.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

(B) Clinical Services-Non-HCBS

Clinical services are mental health services provided within a community

mental health or developmental disability service setting for individuals who

are not receiving HCBS funding. Services include:

• Diagnosis and Evaluation (D & E)

• individual therapy

• group therapy

• family therapy

• emergency care

• Medication and Medical Support and Consulting Services

(e.g., chemotherapy, med-check)

(1) Eligibility

(a) Clinical:

Individuals who meet the criteria for developmental disabilities as

defined in the DDS Regulations

, except for as specified in the

Medicaid Manual for initial D & E and emergency care.

(b) Financial:

Individual has a method of payment for services including:

• Private Insurance

• Medicare

• Vermont Medicaid eligible as determined by

Department of Vermont Health Access or other

arrangements specified in agency policy

Access to these services is determined by the agencies (DA/SSA)

based upon need and available resources.

(2) Limitations

(a) Funds must be used in accordance with the

Medicaid Manual for Developmental Disabilities Services.

There are exceptions to the financial eligibility criteria for initial emergency care.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

(b) An agency may not bill for these services and HCBS on the

same day.

This fund pays for dental services for adults and adaptive equipment and other

one-time ancillary services needs that individuals and families cannot meet or

are not covered by other funding sources. Requests for Special Services Funds

can be made to the Division by DA/SSAs, the Supportive ISO, individuals,

families or other interested parties.

(1) Eligibility

(a) Clinical:

Individuals who meet the criteria for developmental disability

as defined in the DDS Regulations

(b) Financial:

None.

The goods and services requested must be related to the

person’s disability.

(2) Limitations

(a) There is a limit of $500 for any one person within a fiscal year

for non-dental expenses.

(b) Dental for adults has a maximum limit of $1,000 per person per

fiscal year.

(d) The fund shall not be used to contribute to high-cost projects,

such as extensive home modifications, purchasing of vans,

high-end adaptive equipment or orthodontic work.

(e) The fund shall not be used to pay for services covered by

Medicaid State Plan, HCBS funding, Medicare, or private

insurance.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

(f) Funds are provided based on the funds available for this

program at the Division.

(D) Employment Supports - Conversion of Community Supports Funding

The Employment Support Conversion allows for re-allocation of

Community Support funding to Employment Support funding to gain or

maintain employment. The HCBS limitations related to moving funds within

an individual’s budget do not apply to this initiative. The $5,000 threshold

for Equity/Public Safety committee funding requests is not required for these

requests.

Adults who have graduated from high school and have Community Supports

funded in their HCBS budget may transfer their Community Supports, up to

a maximum of $5,000, to receive Employment Supports in order to obtain an

employer paid job. Employment Supports to obtain employment include

Employment Assessment and Employer and Job Development.

Upon job hire, Community Support funds may be converted to Supported

Employment for Job Training and Ongoing Support to Maintain

Employment as needed. Once an adult has determined how many

Community Support hours to convert to employment, the DA/SSAs may

submit Community Support Conversion Funding Requests to Equity or

Public Safety Funding Committees for additional funding, up to $5,000, to

offset any increased cost of the Employment Support for Job Training and/or

Ongoing Support to Maintain Employment. The increased cost is the

difference in hourly rate between Community Supports and Employment

Supports.

(1) Eligibility

(a) Clinical:

Individuals who meet the criteria for developmental

disabilities as defined in the DDS Regulations

(b) Financial:

Vermont Medicaid eligible as determined by Department of

Vermont Health Access.

Individuals with HCBS funding who must have transferred

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

some or all of their existing community supports funding to

work supports.

(2) Limitations

(a) The maximum amount available to add to work supports from

this initiative for each individual is $5,000, which shall be

annualized in their individual budget.

(b) The maximum amount of Community Supports to convert for

Employment Assessment and Employer and Job Development

is $5,000.

(E) Family Managed Respite

Family Managed Respite (FMR) funding is allocated by DAs to provide

families with a break from caring for their child with a disability, up to age

21. Respite can be used as needed, either planned or in response to a crisis. It

may be used to allow the caregiver to attend to his or her own needs or the

needs of other family members. Respite may also be used to create a break

from the normal routine for the child with a disability. It is intended to

promote the health and well-being of a family by providing a temporary

break. Eligibility for FMR, determined through a needs assessment with a

Designated Agency, is defined in the Family Managed Respite Guidelines

Families are given an allocation of respite funds that they will manage.

Families are responsible for recruiting, hiring, training and supervising the

respite workers. DAs may provide assistance with these responsibilities. The

workers are paid through the Fiscal/Employer Agent (F/EA) who processes

the payroll and conducts background checks for these employees.

(1) Eligibility

(a) Clinical:

Individual with a developmental disability or eligible to receive

services from Children’s Mental Health Services.

(b) Financial:

Vermont Medicaid eligible as determined by Department of

Vermont Health Access.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

FMR is available to children up to, but not including age 21

living with their biological/adoptive families or legal guardian.

(2) Limitation

(a) Funds must be used in accordance with the

Family Managed

Respite Guidelines, including which family members can be

paid to provide respite.

(b) Funds must be used in accordance with the

Medicaid Manual for Developmental Disabilities Services.

Department and is listed on the

Family Managed Respite

Guidelines

(F) Flexible Family Funding

Flexible Family Funding (FFF) provides funding for families caring for a

family member with a developmental disability at home. Funding is provided

to eligible families of individuals with developmental disabilities to help pay

for any legal good or activity that the family chooses such as respite, assistive

technology, home modification, or individual and household needs. These

income-based funds, determined by a sliding scale, are used at the discretion

of the family. FFF is available at DAs in all counties. Families apply for FFF

through their DA, which is responsible for determining eligibility and making

allocations accordingly. Additional details are available in the

Flexible

Family Funding Guidelines.

(1) Eligibility

(a) Clinical:

Individuals who meet the criteria for developmental disability

as defined in the DDS Regulations

(b) Financial:

Income-based on sliding fee scale outlined in

Flexible Family

Funding Guidelines.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

An individual of any age who lives with their family (i.e.,

unpaid biological, adoptive and/or step-parents, adult siblings,

grandparents, aunts/uncles, nieces/nephews and legal

guardians) or an unpaid family member who lives with and

supports an individual with a developmental disability.

Individuals living independently or with their spouse or

domestic partner, and those receiving HCBS are not eligible.

(2) Limitations

(a) Applicants whose income exceeds the upper limit of the sliding

scale are not eligible.

(b) Flexible Family Funding is limited to a maximum of $1,000 per

person per year, including when using one-time dollars for FFF

and when FFF that is carried over by DAs into the next fiscal

year.

Flexible Family Funding Guidelines.

(d) Availability of these funds is limited to the amount allocated to

the DA for this program and available one-time funds.

(G) Home and Community-Based Services (HCBS)

Developmental Disabilities HCBS are long term services and supports

provided throughout the state by private, non-profit developmental

disabilities services providers, or through self/family-management, to adults

and children with developmental disabilities with the most intensive needs.

Individual HCBS service plans are based on all applicable services and

supports provided to the individual in accordance with their assessed needs.

Services and supports may include: Service Coordination, Community

Supports, Employment Supports, Respite Supports, Clinical Services,

Supportive Services, Crisis Services, Home Supports and Transportation

Services. A link to the definitions of these services is included in Attachment

A. HCBS are applied for through the local DA for new applicants. Current

recipients can request increased services or funding through their current

DA/SSA or the Supportive ISO if they are self/family-managing.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

The provision of HCBS must be consistent with federal HCBS rules. This

includes providing choice regarding living arrangements, providing supports

that are integrated in the community, and in alignment with the person’s

culture. A person’s home where these services are provided must honor and

support the person’s cultural preferences and rights to free association and

privacy. Services must be integrated in the community in a manner that does

not inhibit the person receiving services from knowing and being known by

others in the community and forming enduring relationships. HCBS must

accommodate the person’s culture and support connections to communities

of the person’s choice.

(1) Eligibility

(a) Clinical:

Individuals who meet the criteria for developmental disability

as defined in the DDS Regulations

(b) Financial:

Vermont Medicaid-eligible as determined by Department of

Vermont Health Access.

(i) Must meet all 3 of the following criteria:

1. Individual would otherwise be eligible for Intermediate

Care Facility for individuals with Developmental

Disabilities (ICF/DD) level of care;

2. The individual has an unmet need related to their

developmental disability; and

3. The individual’s unmet need meets one of the following six

funding priorities for HCBS.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

1. Health and Safety: Ongoing, direct supports and/or supervision are needed

to prevent imminent risk to the individual’s personal health or safety.

[Priority is for adults age 18 and over.]

a. “Imminent” means presently occurring or expected to occur within 45

days.

b. “Risk to the individual’s personal health and safety” means an individual

has substantial needs in one or more areas that without paid supports put

the individual at serious risk of danger, injury, or harm (as determined

through a needs assessment).

2. Public Safety: Ongoing, direct supports and/or supervision are needed to

prevent an adult who poses a risk to public safety from endangering others.

To be considered a risk to public safety, an individual must meet the Public

Safety Funding Criteria (see Section (G)(2), infra). [Priority is for adults age

18 and over.]

3. Preventing Institutionalization – Nursing Facilities: Ongoing, direct

supports and/or supervision needed to prevent or end institutionalization in

nursing facilities when deemed appropriate by Pre-Admission Screening

and Resident Review (PASRR). Services are legally mandated. [Priority is

for children and adults.]

4. Preventing Institutionalization – Psychiatric Hospitals and ICF/DD:

Ongoing, direct supports and/or supervision needed to prevent or end stays

in inpatient public or private psychiatric hospitals or end institutionalization

in an ICF/DD. [Priority is for children and adults.]

5. Employment for Transition Age Youth/Young Adults: Ongoing, direct

supports and/or supervision needed for a youth/young adult to maintain

employment. [Priority for adults age 18 through age 26 who have exited

high school.]

6. Parenting: Ongoing, direct supports and/or supervision needed for a parent

with developmental disabilities to provide training in parenting skills to help

keep a child under the age of 18 at home. Services may not substitute for

regular role and expenses of parenting. [Priority is for adults age 18 and

over.]

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

(2) Public Safety Funding Criteria

The following describes the criteria to access HCBS under the

Public Safety funding priority:

(a) Criteria for Eligibility for Public Safety Funding:

(i) For new applicants, the public safety risk must be

identified at the time of application and applicants must

meet the Public Safety Funding priority criteria below.

(ii) For individuals currently receiving services, the public

safety risk must be newly identified and recipient must

meet the Public Safety Funding priority criteria below.

(iii) The Department’s Public Safety Risk Assessment must

be completed or updated for each individual who applies

for Public Safety Funding in accordance with the

Protocols for Evaluating Less Restrictive Placements

and Supports for People with I/DD who Pose a Risk to

Public Safety.

(iv) An individual must have proposed services that reflect

offense-related specialized support needs and meet at

least one of the following criteria:

(1) Committed to the custody of the Commissioner

under Act 248 due to being dangerous to others.

Services are legally mandated.

(2) Convicted of a sexual or violent crime, has

completed their maximum sentence, and there is

evidence that the individual still poses a substantial

risk of committing a sexual or violent offense.

Examples of “evidence” may include; recent clinical

evaluations and/or recent treatment progress reports.

which indicate a continued risk to the public; recent

critical incident reports which describe risks to

public safety; and/or new criminal charges or DCF

substantiations which involve harm to a person.

Additional supporting evidence may be taken into

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

account.

(3) Substantiated by the Department or DCF for sexual

or violent abuse, neglect, or exploitation of a

vulnerable person and there is evidence that the

individual still poses a substantial risk of

committing a sexual or violent offense.

(4) In the custody of DCF for committing a sexual or

violent act that would have been a crime if committed

by an adult, now aging out of DCF custody, and there

is evidence that the individual still poses a substantial

risk of committing a sexual or violent offense.

(5) Not charged with or convicted of a crime, but the

individual’s risk assessment contains evidence that

the individual has committed an illegal act and still

poses a substantial risk of committing a sexual or

violent offense.

(6) Convicted of a crime and under supervision of the

Department of Corrections (DOC) (e.g., probation,

parole, pre-approved furlough, conditional re-entry)

and DOC is actively taking responsibility for

supervision of the individual for public safety. Public

Safety Funding only pays for supports needed

because of the individual’s developmental disability.

Offense-related specialized support needs, such as

sex offender therapy, cannot be funded by the

Department for an individual who is under the

supervision of DOC.

(b) Access Restrictions:

(i) It is not a priority to use Division funding to prevent an

individual who has been charged with or convicted of a

crime from going to or staying in jail or to prevent charges

from being filed.

(ii) Public Safety Funding shall not be used to fund services

for individuals believed to be dangerous to others but for

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

whom there is no clear evidence they pose a risk to public

safety, and who have not committed an act that is a crime

in Vermont. These individuals may be funded if the

individual meets another funding priority.

(iii) Public Safety Funding shall not be used to fund services

for individuals who have committed an offense in the past,

and:

1) Whose proposed services do not reflect any offense-

related specialized support needs, or

(2) Who do not still pose a risk to commit a sexual or

violent offense.

(3) Limitations

(a) HCBS funds must be used according to the guidance in this Plan

in Section Five, Management of Home and Community-Based

Services Funding. This section describes the availability and

limitations of HCBS funding.

(b) HCBS funds must be used in accordance with the

Medicaid Manual for Developmental Disabilities Services.

(H) Intermediate Care Facility for Individuals with Developmental

Disabilities (ICF/DD)

An ICF/DD residence provides comprehensive and individualized health

care and habilitation services to individuals, as an alternative to HCBS, to

promote their functional status and independence. There are currently no

ICF/DD facilities operating in Vermont. DAIL intends to develop a new

ICF/DD.

(1) Eligibility

(a) Clinical:

(i) Individuals who meet the criteria for developmental

disability as defined in the DDS Regulations

(ii) Individual must have significant medical needs.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

(iii) Individuals must meet nursing home level of care, as

well as ICF/DD level of care as defined by CMS.

(b) Financial:

Vermont Medicaid eligible as determined by Department of

Vermont Health Access

Access to an ICF/DD is limited to those who meet the clinical

and financial eligibility criteria.

(2) Limitations

(a) Services must be provided in accordance with Federal ICF/DD

regulations.

(b) Placement in an ICF/DD must be authorized by the Division.

service.

(I) One-Time Funding

One-time funds are generated from the new and returned caseload dollars for

the Equity and Public Safety funding pools. When new funding is approved,

100% of the annualized amount needed to support a full fiscal year of

services for the individual is committed. This assures that funds to pay for a

full fiscal year of services are built into the DA/SSA’s base budget. When

365 days of funding are not required because the individual’s newly funded

services began after the start of the fiscal year (July 1

), the unused balance

creates one-time funding.

One-time funds are used to address short term needs and cannot be used for

long term needs. The Division may use one-time funding to support specific

activities, pilot projects and special initiatives. When there are one-time funds

available, a portion of those funds shall be distributed to agencies. The

amount and timing of distribution is at the discretion of the Department. The

Department will report on the use of one-time funds distributed to DA/SSAs

and for specific activities, pilots and initiatives to the State Program Standing

Committee through the DDS Annual Report.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

Any one-time funding distributed to DA/SSAs must be allocated according

to one-time funding guidance listed in item (2) below and reported to the

Division. If there is a question about an allowable use of one-time funding,

the Division makes the final decision. One-time funds should be used only

after exploring other sources of funding such as Medicaid State Plan,

Medicare, private insurance, or other available community resources. One-

time funds are accessed through DA/SSAs and Supportive ISO. The

Supportive ISO has one-time funds generated from unused funds from

individuals’ budgets, which creates a reserved funding pool.

(1) Eligibility

(a) Clinical:

Individuals who meet the criteria for developmental disabilities

as defined in the DDS Regulations

(b) Financial:

Vermont Medicaid eligible as determined by Department of

Vermont Health Access, except when used for individuals for

Flexible Family Funding, who must meet financial eligibility

for that service.

Current recipients of DDS services or funding and individuals

who meet clinical and financial eligibility who are not current

recipients of funding to meet one of the needs listed below:

(2) Allowable Uses for One-Time Funding by Agencies (DA/SSA) and

Supportive ISO:

(a) One-time funding must be prioritized for use as Flexible Family

Funding (FFF). One-time allocations used as FFF for

individuals with developmental disabilities and families

waiting for FFF are not to exceed the FFF maximum allocation

per person per year, regardless of source.

(b) One-time allocations to address personal health or

safety or public safety issues for individuals with

developmental disabilities.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

receiving services to resolve or prevent a crisis.

(d) Assistive technology, adaptive equipment, home

modifications to make the individual’s home physically

accessible, and other special supports and services not

covered for the person under the Medicaid State Plan.

(e) Supports that may not meet funding priorities but are proactive

and short-term in nature.

(f) Transitional support to assist an adult to become more

independent in order to reduce or eliminate the need for

services.

(g) Small grants to self-advocates, families and others that promote

the Principles of Developmental Disabilities Services in the

the

Developmental Disabilities Act of 1996; for innovative

programs that increase a consumer’s ability to make informed

choices, promote independent living, and offer mentorship or

career building opportunities.

(h) Funding for people receiving developmental disabilities

services to attend a training or conference that increases

consumer ability to make informed choices, promote

independent living, offer mentorship, or career building

opportunities. One-time funds can only be used to cover the

costs of training/conference registration fee and/or

transportation costs for the individual, if needed, to attend a

training or conference.

(i) Funding to cover the cost of installing a lock that complies with

the HCBS settings rule for people in shared living homes who

are in service in FY23. In the future, the cost would be an

expectation of all new home providers.

(3) Limitations

(a) Maximum annual amount per person is $5,000 and only for

allowable uses described.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

(b) Cannot be used to pay for room and board, rent or utility

subsidies.

(J) Peer Growth and Lifelong Learning

These Department approved programs provide lifelong learning and teaching

experiences to adults with developmental disabilities and increases the

individual’s ability to become an expert in topics of interest through

supported research, inquiry, community networking and full examination of

a topic. The experience empowers individuals as role models and results in

improved confidence, self-direction, interpersonal skills, organization, and

executive functioning skills.

(1) Eligibility

(a) Clinical:

Individuals who meet the criteria for developmental disabilities

as defined in the DDS Regulations

(b) Financial:

Vermont Medicaid-eligible as determined by Department of

Vermont Health Access.

where the approved program is provided.

(2) Limitations

The Department determines the amount of funding allocated to a DA

or SSA for this program.

(K) Post-Secondary Education Initiative

The Post-Secondary Education Initiative (PSEI) is a program funded through

a combination of grants and HCBS funding that assists transition age youth

18 to 30 with developmental disabilities to engage in typical college

experiences through self-designed education plans that lead to marketable

careers in competitive employment and independent living. Supports are

arranged with the Department’s approved PSEI college support organizations

to provide academic, career and independent living skill development

through a peer mentoring model.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

(1) Eligibility

(a) Clinical:

Individuals who meet the criteria for developmental disability as defined

in the DDS Regulations

(b) Financial:

Vermont Medicaid eligible as determined by Department of Vermont

Health Access.

This program prioritizes adults under 30 who have graduated from high

school or have a GED who have been accepted for enrollment in post-

secondary programs facilitated by the PSEI support programs. If space

allows, adults 30 and older who have graduated may apply to the

program on a case-by-case basis. The individual must also have access

to resources that are needed to participate beyond what is provided by

the PSEI program.

(2) Limitations

(a) Access to the PSEI is limited to the geographic area of

partnering colleges, the capacity of the PSEI program to

support additional students and the PSEI funds available at the

DA/SSA.

(b) The individual’s existing service budget, as appropriate, must

be utilized prior to using funds from the PSEI allocations in the

Provider Agreements. Upon an individual’s completion of the

program, PSEI funding is returned to the DA/SSA for re-

allocation to new students.

college tuition.

(L) Pre-Admission Screening and Resident Review (PASRR) Specialized

Day Services

PASRR Specialized Day Services are available to individuals living in a

nursing facility and who need additional services related to their

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

developmental disability (e.g., social, behavior, communication) that are

beyond the scope of the nursing facility.

These services are prior-authorized on an individual basis by the Division.

The Division authorizes funding for those individuals who have been

determined through a PASRR evaluation to be in need of this service. If the

individual’s needs change, a request can be made to the Division for a re-

assessment. Adjustments to the individual allocation are made based on the

assessed needs.

(1) Eligibility

(a) Clinical:

Individual with a developmental disability or related condition

as defined by Federal PASRR regulations.

(b) Financial:

Vermont Medicaid eligible as determined by Department of

Vermont Health Access.

Individual over 18 years of age living in a nursing facility and

having been determined to be in need of Specialized Day

Services through PASRR evaluation.

(2) Limitations

(a) Specialized Services are limited to a maximum of 25 hours per

week.

(b) Services must be provided in accordance with

the Medicaid Manual for Developmental Disabilities Services.

(M) Projects for Transition Support

These Department approved projects prepare student-interns who are in their

last year of high school or adults up to age 30 with technical skills through

internship rotations at a host business location. The cornerstone of these

projects is immersion in a single business for the entire school year where

For individuals who are not eligible for Vermont Medicaid, the Division can assist in exploring alternative

payment arrangements.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

students learn career development skills through job coaching and direct

guidance provided by the business’ department managers. This support is

accessed through DA/SSAs with Department approved programs.

(1) Eligibility

(a) Clinical:

Individuals who meet the criteria for developmental disability

as defined in the DDS Regulations

(see exceptions below in

Access Criteria (M)(1)(C).

(b) Financial:

Vermont Medicaid eligible as determined by Department of

Vermont Health Access.

This program prioritizes students in their last year of high

school who have been determined to have developmental

disabilities. If space allows, adults under 30 who have

graduated may apply to the program on a case-by-case basis.

Those that have graduated would need to have funding

available in their HCBS budget to pay for their participation. In

addition, if space allows, students who receive special

education and do not have developmental disabilities, but do

have other challenges that are supported by an Individual

Education Plan (IEP), may apply on a case-by-case basis.

(2) Limitations

Access to these Department approved projects is limited to the

geographic area where they are provided.

(N) Public Guardianship Fund

This fund pays for small expenses directly related to the well-being of

individuals receiving public guardianship services. Access to funds is at the

discretion of the Director of the Division’s Office of Public Guardian.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

(O) Targeted Case Management for Persons with Developmental

Disabilities

Targeted Case Management (TCM) is a Medicaid State Plan service that

provides assessment, care planning, referral, and monitoring. Case

Management is provided by the agencies (DA/SSA) and designed to assist

adults to gain access to needed services. Units of service to be provided are

based upon assessed need.

(1) Eligibility

(a) Clinical:

Individuals who meet the criteria for developmental disability as

defined in the DDS Regulations

(b) Financial:

Vermont Medicaid eligible as determined by Department of Vermont

Health Access.

TCM is available for adults age 22 and over, and young adults

between 18-22 when appropriate. An agency may not bill for TCM

and HCBS, Bridge Care Coordination or other Medicaid funded case

management services on the same day.

(2) Limitations

Funds must be used in accordance with the

Medicaid Manual for Developmental Disabilities Services.

II. Special Initiatives

The Division may invest in initiatives that enhance the overall system of support

for people with developmental disabilities and their families. The Division may

use funding to support initiatives that will enhance choice and control by people

in services and increase opportunities them and their families. The timing and

amount of funding for any initiative will be identified in the Plan. For all special

initiatives, specific outcome measures will be required and results will be

reported by DDSD.

The ability to take on an initiative will depend upon

See HCAR 7.100.5(h) Special Initiatives.

See Attachment B for further guidance on Moving Funds in Individualized Budgets.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

financial resources available to the Division and staff capacity to manage

projects in collaboration with service providers, self and family advocates, and

other stakeholders. The Division’s intent is to be transparent and accountable,

and it will develop and maintain more detailed workplans that include

benchmarks and timelines for the work on these initiatives. The Division will

seek input from the DDS State Program Standing Committee regarding

prioritization and timing of these initiatives. The Division will update these

detailed workplans no less than every six months and post them on the Division

website.

Based upon stakeholder input, the Division will select initiatives that support the

following areas:

1. Increase the variety of supported living options that address the needs of

a variety of age groups, support needs, and maximizes choice and

independence.

o Leverage aspects of Act 186 to assist the Division to identify

current gaps in system related to housing options and desired

alternatives:

 The Division will work with the Vermont

Developmental Disabilities Council and Green

Mountain Self-Advocates to study statewide:

• Effective housing and residential models for

individuals with intellectual and developmental

disabilities from across the United States that align

with the CMS Settings Rules and the Principles of

Services for Vermont Developmental Disabilities

Services, and

• The number of individuals who would benefit and

choose to live in alternative housing options

o Develop a request for proposal to develop housing and

residential service pilot planning grants in at least three regions

of the State, in partnership with designated and specialized

services agencies, for individuals with developmental

disabilities and their families.

o Solicit guidance and advice from the Act 186 Steering

Committee related to the expansion of housing and residential

options for individuals with developmental disabilities and

their families, as well as their stated role as laid out in Act 186.

o Review current State rules and limitations in the Plan that may

pose barriers to innovative housing options. Seek stakeholder

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

input on possible changes to rules and limitations. Make

decisions regarding changes and initiate work to amend rules

and the Plan as needed.

o Access earmarked funding for a limited-services Residential

Program Director position. This position will lead the work:

 Related expanding housing and residential services

options for individuals with developmental disabilities,

 Assist individuals with developmental disabilities and

their families to navigate publicly and privately funded

housing and residential services options,

 Develop requests for proposals for pilot-planning grants

for different regions of the State focused on the housing

needs identified in those regions, and

 Work with the appropriate providers to implement the

selected pilots.

o Partner with stakeholders including but not limited to

individuals receiving services, family groups, providers,

related to the development and implementation of potential

housing models and options in addition to the pilot planning

grant opportunities. This includes:

 Illustrating the flexibilities inherent within the options

included in the System of Care plan.

 Exploring local, state, and federal funding options for

capital expansion and renovation.

 Determining the feasibility and sustainability of models

proposed based on compliance with state and federal

rules and regulations, and funding.

2. Develop an ICF/DD that provides nursing and supportive services for up

to six people with developmental disabilities.

3. Strengthen the direct support professional workforce through targeted

efforts in recruitment, training, supervision and mentoring, skill

development, and retention.

o Convene a stakeholder workgroup focused on exclusively DD

services

 Identify approaches for strengthening the workforce on

topics such as wages and benefits, training, and

professionalization of the workforce.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

 Leverage existing work under the DA/SSA Workforce

group as appropriate

 Provide recommendations to the Division, provider

network and State Program Standing Committee.

o With the assistance of the workgroup, research and, if

necessary, develop resources required to implement

recommendations.

o Identify and leverage local, state, and federal funds available

for this initiative.

o Ensure coordination of efforts with the Statewide workforce

workgroup.

4. Explore the option of paying parents to provide services to their adult

children using DS HCBS dollars.

o Assemble a workgroup consisting of key stakeholders,

including individuals receiving supports, families, and provider

representatives, to work with the Division to:

 Identify necessary safeguards related to oversight,

quality, accountability, and individual choice to pay

parents.

 Design administrative structure for paying parents, as

needed.

 Provide recommendations to the Division Director and

Commissioner of Disabilities, Aging and Independent

Living on whether to pay parents, and under what

conditions.

o If appropriate, the Department will seek approval from CMS.

5. Develop training resources for understanding the needs of individuals

with autism spectrum disorders and designing individualized person-

centered supports. Include people with ASD in the design and delivery of

training.

o Develop a workgroup consisting of key stakeholders, including

individuals receiving supports, and provider representatives, to

work with the Division to:

 Identify the gaps in service delivery.

 Determine areas of importance for training for direct

support professionals, clinical staff, medical

personnel, etc.,

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

 Identify best practices related to person-centered

supports.

o Identify and leverage state, local, and federal funds available for

this initiative.

6. Systemically incorporate Supported Decision Making into the service

delivery system.

o Work with the state’s Community of Practice (CoP) on Supported

Decision Making to coordinate efforts related to the development

and implementation of:

 Individual Support Agreement guidelines.

o Training for individuals, families, guardians, and the court

system.

 Guidance to providers regarding their role in Supported

Decision Making.

o Leverage the CoP to learn about Supported Decision Making

approaches in other states.

7. Explore creation of an ombuds program for DD services in partnership with

key stakeholder, including exploring a pilot grant.

o Solicit input from stakeholder groups such as individuals receiving

services and guardians, families, and providers.

o Leverage earmarked federal funding for pilot grant.

o Expand ombuds supports to include DD population to include:

 Determining a region of the state for pilot.

 Development of a monitoring visit plan.

 Development of policies and procedures.

 Creation of website, intake, and dedicated phone line.

o Explore ongoing funding and expansion of services through

Department of Disabilities, Aging and Independent Living

appropriations.

8. Conduct fiscal impact studies of making the suggested changes to expand

access to Employment Supports.

o Assess financial implications of:

 Raising the allowable age of the Employment Support

funding priority from 26 to 65.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

 Increasing the allowable number of hours per week of

employment supports funded from 25 hour per week to 30

hours per week.

o Explore resources to implement recommended changes.

o Report findings to State Program Standing Committee.

o Solicit stakeholder input, if appropriate, on priorities of potential

changes that could be implemented.

9. Develop a plain language document that outlines people’s rights described

in the DD Act and the HCBS rules, disseminate and provide training on

rights.

o Convene a stakeholder workgroup to develop the document.

o Distribute widely to stakeholders.

o Assure that providers share with all applicants and recipients.

o Work with partners (e.g., Green Mountain Self-Advocates, VT

Developmental Disabilities Council, service providers) to develop

and provide training to individuals and families on their rights.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

SECTION FIVE

MANAGEMENT of HOME and COMMUNITY-

BASED SERVICES FUNDING

I. Base Allocation

As noted previously, the Legislature appropriates the funding for DDS, including

HCBS funding. The appropriation includes a base allocation used by DA/SSAs

and the Supportive ISO for individuals currently receiving services. The

appropriation may also include additional funding for individuals who are new

to services or who currently receive services and have an increase in needs. This

funding is known as New Caseload Funding and

is allocated to the Equity and

Public Safety Fund. DA/SSAs manage their base allocations for HCBS as

follows:

Funds from the DA/SSAs and the Supportive ISO base allocation that are no

longer needed are reallocated in two ways:

1. Agencies (DA/SSA) reassign funding to individuals who meet the funding

priorities.

2. Funds are returned to the Division to be used as a statewide resource. These

funds are known as Returned Caseload Funding. See Section Five, IV.A.1

and Section Five, IV.B.5 for when funds must be returned to the Division.

The priority use of the Returned Caseload Funding is for the Equity/Public

Safety Fund for New Caseload needs.

To ensure the highest value is obtained from funding, services must be of high

quality and cost effective. To that end, the Division requires DA/SSAs to

continually reassess the use of developmental disabilities HCBS funding to

assure funding is used to:

1. Address unmet needs of individuals who apply for, or are currently

receiving, developmental disabilities services when those needs meet a

funding priority.

2. Provide services and supports using the most cost-effective option to meet

the individual’s assessed needs. Consider an individual’s strengths and

personal goals, and the prevention of a need for more costly services when

developing the plan for services and support.

3. Meet outcomes identified in Individual Support Agreements.

4. Provide services based on current Individual Needs Assessment or periodic

review. A periodic review of needs is conducted at least annually for all

individuals receiving services. The intent of this process is to reallocate

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

funding to where it is most needed. Funding is adjusted on an individual

basis so that services are reduced where they are no longer needed and

increased where there are new needs, as funds are available

Before requesting New Caseload Funding, DA/SSAs must reallocate their base

allocation funding that is no longer needed by individuals currently receiving

services. When base allocation funds are not available, DA/SSAs may request

New Caseload Funds from the Division.

The Supportive ISO must also conduct annual periodic reviews and adjust

budgets accordingly. They do not shift base allocation funding between

individuals. Base allocation funding that is not needed for ongoing needs must

be returned to the Division. Funding that continues to be needed, but is not

utilized, goes into a reserved shared funding pool. Short-term needs up to $5,000

can be accessed from the Supportive ISO from the reserved shared funding pool.

When there are increased needs for ongoing funding, the Supportive ISO may

request New Caseload Funding from the Division through the Equity/Public

Safety process.

II. New Caseload Funding

New Caseload Funding, when available, may be accessed for eligible individuals

who are new to services or existing recipients who have increased needs, who

meet a funding priority listed in Section Four (G)(1)(c)(3), when base allocation

funds are not available. The determination of meeting a funding priority is based

upon the Individual Needs Assessment and takes into consideration the specific

level of support needed, natural supports and other resources available to meet

the individual’s needs. Services and supports are then designed using the most

cost-effective option to meet the individual’s assessed needs. An individual’s

strengths and personal goals should be considered when developing the plan for

services and support. The proposed plan must be developed in accordance with

the all the rules in the Plan (Section Five, IV) and the

Medicaid Manual for

Developmental Disabilities Services and Federal HCBS Rules.

For new applicants, if the individual is found to meet a funding priority, the DA

is responsible for preparing a funding proposal requesting specific types and

amounts of service based upon the individual’s needs. The DA then presents it to

the Local Funding Committee for approval and then the appropriate Statewide

Funding Committee (Equity or Public Safety) for final review and

See Attachment B for further guidance on Moving Funds in Individualized Budgets.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

recommendation to DAIL for a final decision as described in Section Three II.E.

For individuals currently receiving services from a SSA who have new assessed

needs, the SSA prepares a funding proposal and submits it to the individual’s DA

prior to review by the Local Funding Committee. For individuals receiving

support from the Supportive ISO, the Supportive ISO prepares the funding

proposal and submits it to Supportive ISO funding committee. After review by

the Supportive ISO’s Local Funding Committee, if appropriate, proposals are

then sent to the Equity or Public Safety Funding Committee.

Funding priorities focus on an individual’s unmet needs and circumstances that

require support from the developmental disabilities services system to address.

The funding priorities are listed in Section Four (G)(1)(c)(3). Circumstances that

may result in an individual meeting a funding priority may include the loss of a

caregiver; aging caregiver or inability of caregiver to provide care due to mental

or physical limitations; caregiver unable to work without support; homelessness

of the individual; or abuse, neglect or exploitation.

Although an individual may have needs that meet more than one funding priority,

it is only necessary to meet one of the funding priorities to access funding.

However, the type and level of service may be dependent on the funding priority

or priorities the individual meets.

The Equity Funding Committee and Public Safety Funding Committee will make

funding recommendations for both new applicants and individuals with new

needs in accordance with the roles of the Equity and Public Safety funding

committees described in below. The Division makes the final decisions. The

Division will also verify that the individual is clinically eligible. When there is

conflicting information regarding clinical eligibility, the Division may request a

new assessment or review by an independent evaluator.

Division decisions will be sent to agencies as soon as possible after the funding

committee meetings. The Division will establish monthly funding targets and

will use the targets as a guide to manage the annual Caseload and Returned

Caseload funding.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

III. Role of the Funding Committees

The Local and Statewide Funding Committees for Home and Community-Based

Services and their respective roles and responsibilities are outlined below.

Funding Committee

Decision-making Authority

Local Funding Committees

Review requests to be submitted to Equity

and Public

Safety Funding Committees

Statewide Equity

Funding Committee

Review requests for New Caseload Fund and

Returned

Caseload Fund – Division

makes final decisions

Statewide Public Safety Funding

Committee

Review requests for New Caseload Fund and

Returned Caseload Funds for

those who meet

criteria under Public Safety funding priority

– Division

makes final decisions

A. Local Funding Committees

Each Designated Agency must maintain a local funding committee that meets at

least monthly and consists of staff from the Designated Agency, representatives

from local Specialized Service Agencies, people receiving services and/or family

members or guardians. Members must also include one or more individuals

representing local community resources (e.g., HireAbility, schools, Department

of Corrections, Area Agency on Aging, Department for Children and Families)

and other interested stakeholders.

The Supportive Intermediary Service Organization (Supportive ISO) for people

who choose to self/family-manage services must maintain a local funding

committee that meets on a regular basis and consists of staff from the Supportive

ISO and people receiving services and/or family members. Members must also

include one or more individuals representing local community resources (e.g.,

HireAbility, schools, Area Agencies on Aging) and other interested stakeholders.

The local funding committee will review proposals for all new funding on behalf

of individuals for whom they are the Designated Agency. The same expectations

pertain to the Supportive ISO funding committee. The committee will:

1. Confirm documentation that the individual meets clinical and financial

(Medicaid) eligibility criteria for developmental disabilities services;

2. Determine whether the individual’s needs meet a funding priority;

3. Determine if the supports and services described are needed by the

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

individual and are the most cost-effective option to meet the individual’s

assessed needs. Consider the individual’s strengths and personal goals when

making recommendations regarding the plan for services and support;

4. Ensure all other funding options and resources have been explored,

including available naturally occurring supports or unpaid supports; and,

5. Confirm that each individual funding proposal is in compliance with this

Plan, the DDS Regulations

and all other relevant policies and guidelines;

and revise the proposal as necessary prior to sending it onto the relevant

statewide funding committee.

If the committee determines that all criteria are met, the proposal is submitted to

either the Equity Funding Committee or Public Safety Funding Committee, as

appropriate, for funding consideration.

B. Equity Funding Committee

The Equity Funding Committee will follow the membership, management, and

operating procedures established by the Division. The committee consists of the

following membership.

# of

Members

Representation Selected by

Developmental Disabilities

Services Division

Developmental Disabilities

Services Division

Designated Agency and/or

pecialized Service Agency

Designated Agencies and

pecialized

Service Agencies

Individual(s) receiving

services,

family member(s) or

advocate

Recommendations from DA/SSAs,

Green

Mountain Self-Advocates,

Vermont Family Network, and other

advocacy organizations –

Division makes

final decisions

The Equity Funding Committee will confirm:

1. The individual’s needs meet a funding priority;

2. The supports and services described are needed by the individual and are

the most cost-effective option to meet the individual’s assessed needs.

Consider the individual’s strengths and personal goals when making

recommendations regarding the plan for services and support;

3. All other funding options and resources have been explored, including

available naturally occurring supports or unpaid supports; and,

4. Each individual funding proposal is in compliance with this Plan, the

DDS Regulations

and all other relevant policies and guidelines.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

The Equity Funding Committee will make recommendations to the Division

regarding the amount of service and funding to be approved for each applicant.

C. Public Safety Funding Committee

The Public Safety Funding Committee will follow the membership, management,

and operating procedures established by the Division. The committee consists of

the following membership, preferably those with knowledge and expertise in

supporting individuals who pose a public safety risk.

Number of

Members

Representation Selected by

Developmental Disabilities

Services Division

Developmental Disabilities

Services Division

Designated Agency and/or

pecialized Service Agency

Designated Agencies and

pecialized Service Agencies

Other interested individuals

(e.g., people receiving

services/family members;

Department of Corrections

staff,

public safety

professionals)

Recommendations from

DA/SSAs,

Green

Mountain Self-Advocates

and other advocacy organizations

–

Division makes final decisions

The Public Safety Funding Committee will confirm:

1. The individual’s needs meet the Public Safety funding priority,

2. The supports and services described are needed by the individual and

are the most cost-effective option to meet the individual’s assessed

needs. Consider the individual’s strengths and personal goals when

making recommendations regarding the plan for services and support;

3. All other funding options and resources have been explored, including

available naturally occurring supports or unpaid supports, when

appropriate; and,

4. Each individual funding proposal is in compliance with this Plan, the

DDS Regulations

and all other relevant policies and guidelines.

The Public Safety Funding Committee will make recommendations to the Division

regarding the amount of service and funding to be approved for each applicant.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

IV. Guidance for Management of HCBS Funding

A. Timeframes for Funding

1. New funding must be used to meet an individual’s needs and goals related to

the identified funding priority. Changes in a funded area of support must

continue to meet the needs related to the identified funding priority. For up to

one calendar year after approval of new funding, any reductions to an

individual’s budget, including both existing and new funding, up to the amount

newly funded must be returned to the Equity/Public Safety Fund. After one

calendar year, these funds are available to the DA/SSA to reallocate. For

reductions to budgets for those self/family managing, the Supportive ISO will

return the funds to Equity/Public Safety Fund.

2. An individual’s Home and Community-Based Services funding may be

suspended for up to a maximum of 6 months. If a suspension exceeds 6 months,

services must be terminated, and the funding returned to the Equity/ Public

Safety Fund. A notification of termination must be sent to the individual

informing him or her of the right of appeal, according to timeframes identified

in Health Care Administrative Rules 8.100

Internal Appeals, Grievances,

Notices, and State Fair Hearings on Medicaid Services. The same provision

applies to services approved and funded, but not implemented within 6 months

of receiving funding approval. The Division may grant additional time for

exceptional circumstances. Services must be terminated rather than suspended

when it is reasonable to conclude from available information that the individual

will not be resuming services within 6 months. Services, in whole or in part,

must be suspended for the following reasons:

 Incarceration – When an individual enters a correctional facility (pre-

or post-sentencing) and is expected to stay no more than 6 months –

all HCBS must be suspended.

 N

ursing Facility – When an individual enters a nursing facility and is

expected to stay no more than 6 months – all HCBS must be

suspended.

 ICF/

DD – When an individual is admitted to an ICF/DD (in state or

out of state) and is expected to stay no more than 6 months – all HCBS

must be suspended.

 P

sychiatric Hospitalization – Level 1: When an individual is admitted

to a Level 1 psychiatric bed – all HCBS must be suspended

Vermont facilities that provide Level 1 inpatient psychiatric care are the Brattleboro Retreat, Rutland

Regional Medical Center and Vermont Psychiatric Care Hospital. Note that not all “beds” used for

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

 Other Hospitalization – When an individual is temporarily

hospitalized in other than an inpatient Level 1 psychiatric bed

HCBS funding can be used to provide personal care type services.

DA/SSAs/Supportive ISO can be reimbursed for an individual’s daily

rate for home supports, service coordination and administration for up

to 30 days of hospitalization.

 Gap in Service Provision – When there is a gap in the provision of

any of an individual’s authorized HCBS that exceeds 14 days – billing

for those HCBS services that are not being delivered must be

suspended until services are resumed. Services that are provided on

an intermittent basis (service coordination, respite, individual crisis

and transportation for a van payment only), that can be expected to be

used within the fiscal year, may continue without suspension for gaps

over 14 days. Billing for shared living may continue when an

individual is temporarily away from home for no more than 30 days,

such as when visiting family, on vacation, at respite or at camp. In

most instances, a shared living provider is considered to be on-call

and may be expected to be available in the event of an emergency. It

is at the discretion of the DA/SSA to determine under what

circumstances they continue to pay a shared living provider. Services

do not need to be suspended when a person is in an agency’s local

crisis bed, an Intensive Transition Services Bed or accessing Vermont

Crisis Intervention Network (VCIN) level III statewide crisis bed)

services.

 Vi

sits outside of Vermont – When an individual leaves Vermont

temporarily but continues to need services, Home and Community-

Based Services funding may be continued for a period not to exceed

6 months

. Those services that are not being delivered during this

time must be suspended.

 Leaves Services – When an individual drops out of services without

notice and is unable to be contacted, all HCBS must be suspended.

 Ot

her circumstances – When an individual is not expected to receive

services within a 6-month period, all HCBS must be suspended.

3. An individual’s Home and Community-Based Services funding must be

terminated for the following reasons.

psychiatric care in the Brattleboro Retreat and Rutland Regional Medical Center are considered Level

Ibid.

For further information about the impact on Medicaid funding and Social Security Benefits when

leaving the State of Vermont on a temporary or permanent basis, see

Maintaining Medicaid Eligibility

when in Shared Living Out-of-State Guidelines.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

 Incarceration – When an individual’s stay in a correctional facility

exceeds, or is expected to exceed, 6 months.

 N

ursing Facility – When an individual’s stay in a nursing facility

exceeds, or is expected to exceed, 6 months.

 ICF/

DD – When an individual’s stay in an ICF/DD (in or out of state)

exceeds, or is expected to exceed, 6 months.

 Ex

tended Visit Out-of-State – When an individual’s temporary visit

out-of-state exceeds, or is expected to exceed, 6 months

 Moved Out-of-State – When an individual makes a permanent move

out-of-state. Exceptions for people who are living out-of-state for the

purposes of receiving treatment as authorized by the State, or in

shared living in a NH, MA or NY border town.

 Declines Services – When an individual voluntarily chooses to no

longer receive services.

 P

rolonged Suspension – When a suspension exceeds 6 months.

 Death – When an individual dies. Termination of funding date is the

day after the individual died.

4. The Division may conduct reviews or audits to ensure compliance with

requirements related to suspensions and terminations. Data to be used in

a review may include paid and encounter claims, utilization data from the

F/EA or agency records.

5. If an individual’s HCBS funding is terminated, including an individual

whose eligibility is based upon HCAR 7.100.4(d) of the DDS Regulation

(referring to individuals who were receiving services on July 1, 1996), the

individual retains clinical eligibility for services for up to one year, but

must reapply for funding and have needs that meet the funding priorities

in order to receive services.

6. If an individual’s HCBS funding has been terminated for more than one

year, the individual must complete the full application process, which

includes determination of clinical eligibility, financial eligibility and if

needs meet a funding priority.

7. If the start date for newly approved HCBS (in whole or in part) is delayed,

the start date for each delayed service must reflect (or, if previously

submitted to DAIL, be amended to) the actual date services were started.

For further information about the impact on Medicaid funding and Social Security

Benefits when leaving the State of Vermont on a temporary or permanent basis, see

Maintaining Medicaid Eligibility when in Shared Living Out-of-State Guidelines. See

also definition of a Vermont resident in the DDS Regulations, 7.100.2(ff) and

7.100.4(b) and Vermont Health Benefits Eligibility and Enrollment Rules §21 (part-

three-clean-scrubbed-18-062.pdf (vermont.gov) )

Ibid.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

Billing for each service must coincide with the actual start date of each

service.

8. If an individual in a licensed group living situation that is considered a

statewide resource operated by DA/SSA moves out or dies, the funding

allocated to that individual may be spread across the budgets for the

remaining people in the home for up to 30 days with prior approval from

Division. Requests to extend the funding beyond 30 days must be made to

the Equity Funding Committee or Public Safety Funding Committee and

cannot extend beyond 90 days in total. If there is more than 1 vacancy at a

time in the home, the amount of funding to be respread across the

remaining individuals is subject to the Division Director’s approval.

Administrative Guidance for Funding

1. Services and supports must be the most cost-effective option to meet the

individual’s assessed needs.

2. Funds must be used in accordance with the

DDS Regulations, the Plan and

the Medicaid Manual for the Developmental Disabilities Services and

Federal HCBS Rules.

3. Each individual receiving services must receive at least an Annual

Periodic Review of existing services by the DA/SSA providing services,

or the Supportive ISO, to assure the level of funding is consistent with

the individual’s needs. A more frequent review is required if there is a

significant change in the individual’s needs. The Periodic Review must

include an examination of the actual utilization of services in the past

year as compared to the authorized funding limit.

4. Movement of funding within an individual’s budget:

a. Moving of funds between already funded areas of support within an

individual’s budget is allowable without an updated needs

assessment.

b. Moving funding to a currently unfunded area of support is allowable

if a new needs assessment reveals a serious unmet need in that new

area (see Attachment B). However, within the first year of being

funded, movement of funds to a previously unfunded area of support

is allowable only if it continues to meet the needs related to the

originally identified funding priority (see Section Five, IV.A.1.).

5. Funds are returned as Returned Caseload Funding when an individual

has:

a. Had their services terminated (see Section Five, IV.A.3).

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

b. Moved into a group home/residential setting that is considered a

statewide resource.

c. Received new funding and there are any reductions to an individual’s

budget during the 12 months after receiving funding, including both

existing and new funding, up to the amount newly funded. Any

amount reduced that is more than the newly funded amount is retained

by the DA/SSA and is reallocated to others who have a new or

increased need.

d. Moved to self/family-management and services cost less than

Authorized Funding that was transferred from the DA/SSA.

e. Reduced budget upon periodic review when self/family

managing. Savings are returned as Returned Caseload

Funding.

6. In the event of service and/or funding allocation reductions, DA/SSAs

and Supportive ISO must inform individuals in writing of the reduction

and their rights to the Grievance and Appeal process prior to reducing

individual budgets or services as required by Health Care Administrative

Rules 8.100

Internal Appeals, Grievances, Notices, and State Fair

Hearings on Medicaid Services. Individuals, families, and guardians

must be included in the budget reduction decision-making process.

7. Costs for broad-based services, as approved by the Division, include

local and statewide crisis capacity (Vermont Crisis Intervention Network

and Intensive Transition Services) and employment program base

funding, and are spread across all individuals’ Home and Community-

Based Services budgets. These are not included in the person’s

Authorized Funding Limit.

8. Payroll taxes such as Social Security and Medicare (FICA), State

unemployment taxes (SUTA) and worker’s compensation insurance

costs must be calculated for payments to direct caregivers. DA/SSAs and

Supportive ISO may adjust for rate changes according to the

DDS

Regulations (HCAR 7.100.5(l)(2)(C)).

9. All service rates in individuals’ budgets must be set at the actual cost to

deliver or the prevailing DAIL-set rate

, whichever is lower. Services

must be billed at no more than the rate authorized by the Department.

The budgets submitted to the Department for authorization should reflect

the cost of actual services delivered except as allowable under rules noted

in Section Five IV.A.2.

DDSD Medicaid Claim Codes Reimbursement Rates

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

10. Joint funding arrangements for Home and Community-Based Services

involving other state agencies (e.g., VDH, DCF, DMH, and/or out-of-

state organizations must involve DDSD in negotiation and receipt of

funding. The Division does not contract with local schools; however,

schools may contract directly with DA/SSAs. These contracts do not

involve DDS funding and are not managed by the Division.

11. Daily respite can be used for respite provided for a 24-hour period of

which up to 8 hours of sleep time is excluded. The exclusion of payment

for sleep time must be consistent with the Federal Department of Labor

Home Care rules

regarding payment for sleep time.

12. All existing and new budgets over $300,000 shall be reviewed by the

Division annually in order to verify that the services authorized are

provided and appropriate to meet the assessed needs. Budgets over

$300,000 may be time limited and renewed based on review. Need for

review of the overall support needs, as well as timeframe, shall be

established by the Division as appropriate. If the review process does not

result in a finding that the continued level of need is verified, the Division

shall make a final decision regarding the ongoing amount of authorized

funding.

13. When utilizing shared living provider arrangements for home supports,

DA/SSAs must follow all applicable state and federal tax and labor laws.

14. HCBS funding at a DA/SSA may be converted to increase Targeted

Case Management allocations with prior approval from the Department.

This may also be done when an individual’s whole HCBS budget has

been suspended, to provide transition services for the individual when

he or she is moving back to community-based services. Providers

should access available TCM funds prior to requesting a transfer of

HCBS funds to TCM allocations.

Guidance for Requesting New Caseload Funds

1. Before requesting new funding:

a. DA/SSAs must reallocate their base allocation funding that is no

longer needed by individuals currently receiving services.

b. DA/SSA/Supportive ISO must explore all other funding options and

resources, including those noted in D.1, D.2 and D.4 below.

c. The cost of services to meet the individual’s new or increased needs

must exceed $5,000 (except those already self/family-managing and

under the employment supports conversion option described in

https://www.dol.gov/whd/homecare/sleep_time.htm

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

Section Four, I (D)).

d. For individuals who are already receiving services, the DA/SSA and

Supportive ISO must complete a new needs assessment to verify a

change in need.

2. Administration is authorized at 5% for all newly authorized funding

rather than at the DA/SSA or Supportive ISO administration rate.

3. When requesting new funding, if an individual chooses to receive

services from an agency (DA/SSA) other than the DA, or an agency

(DA/SSA) agrees to subcontract with a provider, the provider shall

submit a budget to the DA and the DA shall determine its costs to serve

the individual and shall submit the lower of the two budgets to the

funding committee. If an alternative provider is not able to provide the

services at the lower approved budget, the DA must do so at the amount

of funding authorized for the DA to provide services.

4. For new applicants who choose to self/family-manage their services,

the Designated Agency determines its costs to serve the individual, and

the individual self/family-managing works with the Supportive ISO to

plan how best to provide the services using the approved budget to meet

the assessed needs. While funds may be used flexibly, the plan must be

based upon the assessed needs as noted in A.1 above, not expand

services beyond addressing those needs. The Supportive ISO works with

the person, with input from the team, to determine reasonable rates to

provide services as noted in D.20. The number of hours of service and

hourly rates determined by the Supportive ISO become the authorized

amounts to be reflected on the person’s budget. Any savings are

returned to the Equity Fund.

5. For individuals’ already self/family-managing services who have new

needs as determined by a new needs assessment, the Supportive ISO

develops and submits proposals to the Supportive ISO funding

committee and then to the appropriate statewide funding committee.

6. When developing a proposal for an individual already receiving

funding, the DA/SSA or Supportive ISO must consider the existing

funds in all categories of the individual’s budget to determine the most

cost-effective means of meeting the individual’s needs. The

individual’s whole budget should be considered by the local and

statewide funding committees and the Division in determining the best

way to meet the individual’s new needs.

See HCAR 7.100.5(j) Choice of Provider.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

D. Limitations for Funding

1. All services that can be funded under Medicare, Medicaid State Plan

and/or private insurance must be accessed before using developmental

disabilities HCBS funding. This includes, but is not limited to,

Children’s Personal Care Services; clinical services; durable medical

equipment; nutrition; Medically Complex Nursing Services; Early

Periodic Screening, Diagnosis and Treatment; Medicaid transportation

and interpreter services when used for accessing Medicaid funded

services. Private insurance may be available for children and young

adults up to age 26. Providers must follow the established Medicaid

procedures for coordination of benefits when submitting claims for an

individual who has other insurance coverage.

2. Home and Community-Based Services funding may not duplicate or

substitute for services and supports that are the responsibility of other

publicly funded support systems. Other support systems may include

HireAbility, DCF, DOC, educational services, etc.

3. Funded services shall not duplicate or substitute for available naturally

occurring supports or unpaid supports.

4. New funding may be authorized for a time-limited period, when

appropriate, with the intention to reduce funding based on a review

of needs.

5. The maximum cost for service coordination managed through a

DA/SSA shall be published in the DDSD Medicaid Claim Codes and

Reimbursement Rates

. If actual costs are less than the published rate,

the actual cost must be used. The maximum cost for service coordination

for individuals who self/family-manage shall also be published by DAIL

in the DDSD Medicaid Claim Codes and Reimbursement Rates. When

an individual transfers from a DA/SSA to self/family-managed, the

difference between the DA/SSA’s service coordination rate and the rate

for individuals who self/family-manage is transferred to the Supportive

ISO to pay their administrative costs.

6. Funding for Vehicle Modifications for accessible transportation for an

individual living with a home provider or family member is available.

The maximum per person payment for accessible vehicles shall be

published in the DDSD Medicaid Claim Codes and Reimbursement

Rates

The cost of reimbursement for mileage is included in service

rates where appropriate. For individuals self/family or shared managing,

DDSD Medicaid Claim Codes and Reimbursement Rates

Ibid.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

a portion of the authorized rate may be used for mileage reimbursement

for employees paid through the F/EA for community and employment

supports.

7. A DA/SSA may not bill HCBS for an individual on the same day as

Clinical Services, Bridge Program, Targeted Case Management,

PASRR Specialized Day Services, Flexible Family Funding, Family

Managed Respite or ICF/DD services.

8. Home and Community-Based Services can only be billed through one

HCBS program on the same day (e.g., DDSD, Brain Injury Program,

Choices for Care, DMH). If an individual qualifies for more than one

HCBS program, the individual can be evaluated to determine the

package of supports available and then make an informed decision

about which program to choose. Where services administered by either

DMH and/or DDSD are concerned, funding from one department may

be transferred for use under one HCBS program according to the current

interdepartmental agreement between DMH and DAIL.

9. Home and Community-Based Services funding may not pay for room

and board costs, rent or utility subsidies. These costs are typically paid

for through the individual’s SSI/SSDI and other sources

. HCBS also

may not pay for the costs of vacations. Home and Community-Based

Services funding may be used, however, to cover costs incurred by a

paid caregiver to support an individual on vacation (e.g., hotel and food

expenses). HCBS funding may be used to attend camp, when going to

camp serves the function of respite. The amount of funding that can be

used is up to the typical daily rate for respite for the individual for each

day of attendance.

10. Shared living homes, including short term arrangements, must meet the

standards outlined in the Housing Safety and Accessibility Review

Process. The shared living provider, or homeowner, is responsible for

the costs to be incompliance with the housing safety standards.

11. Home Modifications

(a) Home and Community-Based Services funding may help pay for

home modifications for physical accessibility in shared living, the

family home that is the individual’s primary residence or

individual’s own home or apartment, not to exceed a $10,000 cap.

The costs of ramps, widening doorways, accessibility

modifications to bathrooms, visual fire alarm, and plexiglass

windows or alarm systems for safety may be appropriate costs to

Sources of funding other than SSI/SSDI to assist with room and board costs include Section 8

subsidies, wages, and public assistance (e.g., fuel assistance program, General Assistance vouchers,

3Squares VT).

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

reimburse.

i. Physical accessibility modifications that do not add to the value

of the home may be paid for, when necessary, using DA/SSA

base allocation, new funding, or one-time funding. Once a

modification is paid for, the additional allocation must be

deducted from the individual’s budget.

ii. Modifications that improve the value of the home that are made

to meet the physical accessibility needs of an individual may only

be funded up to 50% of the cost, not to exceed the $10,000 cap.

For example, if a new bedroom is needed to allow the individual

to live in the home, the shared living provider must pay for the

addition of the bedroom. However, additional cost to make that

bedroom accessible may be paid for with HCBS funding.

iii. Two or more bids are required when construction work is needed

to provide the modification. Funding is allocated based on the

most cost-effective bid.

iv. Home modifications that cost from $5,000 to $10,000 will be

paid on a monthly payment basis which ends if the individual

moves.

(b) HCBS funding may be used for other home modifications required

for accessibility related to an individual’s disability, including cost

effective technology that promotes safety and independence in

lieu of paid direct support

. This would be in circumstances in

which the technology substitutes for paid staff. Examples include

remote monitoring systems for the home, visual fire alarm

systems for person who is deaf, medical alert systems, etc. Costs

may be covered using DA/SSA base allocation, new funding, or

one-time funding. Once a modification is paid for, the funding

for the modification must be deducted from the individual’s

budget. Costs for systems that require an ongoing service fee may

continue to be included in the HCBS budget.

12. Funding for work supports is to maintain an employer-paid job. The

following limits apply to new funding for community supports and work

supports:

a. Community supports and work supports are limited to individuals

who are not enrolled in high school who are age 18 and older.

b. Individuals receiving work supports only: work support hours may

not exceed 25 hours per week, including transportation hours.

Developing and executing a transportation plan is part of work

See HCAR 7.100.2(v). Home Supports.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

supports. Individuals should be assisted, as needed, in learning to use

public transportation or in working out rides from natural supports,

including co-workers.

c. Individuals receiving community supports only: community support

hours may not exceed 25 hours per week (including transportation

time).

d. Individuals receiving both work supports and community supports:

may not exceed a total of 25 hours per week of community supports

and work supports (including transportation time). Individuals are

not eligible for new funding for community supports if they are

already receiving 25 hours per week of work supports.

13. Individuals who choose to self/family-manage or share-manage cannot

manage 24-hour home supports including Shared Living, Staffed

Living, Group Living.

14. Individuals may self/family-manage up to 12 hours per day of paid home

supports, specifically In-Home Family Support or Supervised Living.

However, individuals who need 24-hour home supports may receive

them from their local DA, or an SSA who agrees to serve them.

15. Developmental disabilities HCBS services funding cannot be used to:

a. Increase the availability of residential settings that provide supports

to more than four adults with developmental disabilities (age 18 and

over). Any exceptions to this limitation must be approved by the

Division and comply with HCBS setting rules.

b. Fund residential settings that provide supports to three or more

children (under the age of 18). Any exceptions to this limitation

must be approved by the Division and comply with HCBS setting

rules.

c. Fund placements in residential schools or treatment centers; or in-

state or out-of-state nursing facilities, correctional facilities,

psychiatric hospitals, or ICF/DDs.

d. Fund out-of-state placements for adults unless they pose a risk to

public safety and there are no appropriate treatment options in

Vermont and the cost is less than the cost of community-based

supports in Vermont. Involvement and approval by the Division is

required.

e. Fund sheltered workshops or enclaves (segregated work

environments within an employer’s worksite).

f. Make incentive payments, subsidies, or unrelated vocational

training expenses for Supported Employment such as the following:

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

(1) Incentive payments made to an employer to encourage or

subsidize the employer’s participation in a supported

employment program.

(2) Payments that are passed through to users of supported

employment programs.

(3) Payments for vocational training that are not directly related to

individuals’ supported employment program.

g. Fund settings that are not consistent with the federal HCBS Rules.

16. For requests for new funding for clinical and supportive services the

follow limits apply:

(i) The maximum number of visits for psychiatry is four per year for

those individuals who are stable on their medications and up to a

maximum of 12 per year for those who are not stable on

medications.

(ii) The maximum number of visits for individual, group or family

therapy is 48 visits per year or a total of 96 visits per year for

those needing a combination of those therapies.

(iii) The maximum number of visits for behavioral support,

assessment, planning and consultation is 96 visits per year.

(iv) All other supportive services are limited to 48 visits per year or

a total of 96 visits per year for those needing a combination of

supportive services (not including behavior consultation).

If a needs assessment justifies additional services, one-time or internal

DA/SSA or Supportive ISO funds may be utilized to increase visits

beyond these limits. When requesting new caseload funding, exceptions

beyond these limits for psychiatry and individual, group or family

therapy will be considered when the DA/SSA or Supportive ISO provides

written documentation from the treating clinician that additional services

are necessary.

17. Facilitated Communication shall only be funded when it is used

consistent with the DDSD Facilitated Communication Guidelines

18. Behavior Support, Assessment, Planning and Consultation shall only be

funded when it is used consistent with the DDSD

Behavior Support

Guidelines. HCBS funding cannot be used for behavior interventions that

restrict an individual’s basic human rights and their rights guaranteed by

the DD Act.

19. The maximum amount of funding for the Parenting funding priority listed

in Section Four (G)(1)(c)(3) is $10,000 per person per year.

20. When authorizing hourly rates for services for workers who are paid

through the F/EA, the lowest rate must be at least the minimum hourly

wage negotiated through the Collective Bargaining Agreement for those

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

workers (or VT minimum wage, if higher), plus employer taxes. The

rates should be based upon the level of support needed by the individual.

DDSD approves rates for new requests to Equity and Public Safety

Funding committees. The DA/SSA or Supportive ISO determines the

authorized rates for existing recipients. While there is no established

maximum rate for services paid through the F/EA, DDSD provides a

benchmark rate to the F/EA above which the F/EA is required to check

in with the DA/SSA or Supportive ISO to verify that the hourly rate is

reasonable and needed for the individual. The F/EA will pay the rate

authorized by the DA/SSA or Supportive ISO or at or below the

benchmark as directed by the employer.

E. Guidance for Transfers between DA/SSA/Supportive ISO or

Methods of Management

1. If the individual decides to move to a different DA/SSA or method of

management (self/family or shared management or home provider hiring

workers) within a calendar year from receiving new funding, savings

must be returned to the appropriate caseload fund (Equity and Public

Safety). After one calendar year, if services cost less to meet an

individual’s assessed needs when transferring to a new DA/SSA or the

Supportive ISO, the savings should be reallocated through internal

adjustments by the new DA/SSA or returned to the Equity Fund by the

Supportive ISO for those who are self/family-managing. After one

calendar year, for those moving to a new method of management within

the same DA/SSA, savings should be reallocated through internal

adjustments.

2. When a person chooses to change from having agency hired staff to

hiring his/her own workers to deliver a specific service, the person’s

authorized hours of that service should remain the same. The agency

works with the person and the team to determine the new hourly rate for

the service as noted above in D.20. Any savings are returned to the

agency for internal adjustments. This applies to agency and shared-

management arrangements. See C.4 above for the process for self/family

management.

3. If a person transfers from the Supportive ISO to a DA/SSA, a periodic

review should be done by the DA/SSA to determine current needs. If the

cost of services is greater at a DA/SSA, the rates may be adjusted through

internal adjustments or requests for additional funding can be made to

the Equity or Public Safety Fund committees when the amount exceeds

$5,000.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

4. If at any time a recipient chooses or consents to receive some or all

authorized services or supports from a different agency (DA/SSA or

Supportive ISO), the agency (DA/SSA or Supportive ISO) currently

serving the recipient shall promptly transfer the individual’s authorized

funding limit to the agency (DA/SSA or Supportive ISO) selected

according to the procedures outlined in Division guidelines.

This

includes the administration amount specified in division policy. Funding

for local and state crisis services, employment program base and

statewide communication resources (through Howard Center and

Washington County Mental Health) are not transferred.

5. When an individual chooses to transfer to another agency (DA/SSA) or

to self/family-manage, the receiving agency (DA/SSA) or Supportive

ISO must fully inform the recipient and the individual’s designated

representative, if applicable, prior to the transfer, of the impact on the

amount of services that can be provided within the approved budget

based upon the agency (DA/SSA) or Supportive ISO’s costs for services.

6. When a person transfers to another DA/SSA or the Supportive ISO, the

budget is prorated for the days remaining in the FY, regardless of the

amount of service utilized for the FY. If there is an allocation to the

F/EA, the receiving organization will send prorated allocations, based on

the new approved budget, to the F/EA.

7. Any disputes about the amount of funding to be transferred will be

resolved by the director of the Division.

F. Managing Home and Community-Based

Services Funding if There

are Insufficient Funds

The Developmental Disabilities Act provides the authority for the

Commissioner to consider funds available to the Department in allocating

resources. In the event of fiscal pressures (e.g., an appropriation less than

projected need, rescission), the Commissioner may adjust funding

allocations to DA/SSAs and Supportive ISO. The Department may reduce

DA/SSAs and Supportive ISO base allocations. The Division will issue

instructions and provide guidance regarding any reductions. If services are

reduced, individuals and guardians will be provided with notice of the right

to appeal

the reduction.

See HCAR 7.100.5(j)Choice of Provider.

Ibid.

See HCAR 8.100 Internal Appeals, Grievances, Notices, and State Fair Hearings.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

Any proposed change that relates to the nature, extent, allocation, and

timing of services for the prioritized programs will be sent to the State

Program Standing Committee for advice and recommendations 60 days

prior to implementing the change. The proposed change will be presented

at the earliest scheduled full committee meeting.

G. Waiting List

A person with a developmental disability whose application for Home and

Community-Based Services, Flexible Family Funding or Family Managed

Respite is denied must be added to a waiting list maintained by the

Designated Agency.

The Designated Agency must notify individuals when they have been

placed on a waiting list and review needs of all people on the waiting list,

as indicated below, to see if the individual meets a funding priority, and if

so, to submit a funding proposal and/or refer the individual to other

resources and services. A review of the needs of all individuals on the

waiting list must occur:

1. When there are changes in the funding priorities or funds available;

2. When notified of significant changes in the individual’s life

situation.

Each Designated Agency must submit waiting list data according to

instructions established by the Division. The waiting list for Flexible

Family Funding and Family Managed Respite are reviewed by the Division

annually. Information regarding the utilization of each DA’s allocation and

waiting lists for the FFF and FMR programs is used in determining the

following fiscal year allocations.

Information regarding waiting lists will be included in the DDSD annual

report and will be reviewed annually by the DDS State Program Standing

Committee.

See HCAR 7.100.5(q) Waiting List.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

SECTION SIX

PLAN DEVELOPMENT

This section highlights the contributors to the Plan. Preparation of the State System

of Care Plan typically includes the following:

1. Review of local system of care plans from DAs,

2. Input received from public forums and hearings,

3. Discussion and input from the State Program Standing Committee for

Developmental Disabilities Services,

4. Analysis of trends in the quality review process and satisfaction surveys,

5. Review of adherence to the principles of service in Developmental

Disabilities Act of 1996 as reported in the DDS Annual Report, and

6. Review of ongoing input and feedback provided to the Department by various

stakeholders (individuals, families, providers, advocacy organizations, etc.)

over the past several years.

Due to COVID 19 pandemic related extenuating circumstances and workforce crisis

in the system, there were some changes to the typical method of developing the Plan.

The Division did not require agencies to develop local system of care plans to

contribute to the development of this Plan. Because the local system of care plans

were not being done, the Division created an on-line survey that was disseminated

widely to seek input from stakeholders across the state. In addition, the Division held

seventeen stakeholder specific and general forums to seek input on the development

of the Plan.

Until recently, the Division contracted for satisfaction surveys conducted using the

National Core Indicators In-Person Survey. The Department put the survey on hold to

respond to other priorities during the pandemic. The last survey completed was in

2018-19. This data is unlikely to reflect the current level of satisfaction with services

which have been significantly impacted by the pandemic and workforce challenges.

Therefore, satisfaction survey information was not considered in the development of

this Plan.

For this renewal of the Plan, the following sources of input and information were

gathered and reviewed:

1. Input received from public forums,

2. Input received from an online survey,

3. Input received via Division email box set up for stakeholder input on Plan,

4. Discussion and input from the State Program Standing Committee for

Developmental Disabilities Services,

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

5. Analysis of trends in the quality review process,

6. Review of adherence to the principles of service in Developmental Disabilities

Act of 1996 as reported in the DDS Annual Report,

7. Review of ongoing input and feedback provided to the Department by various

stakeholders (individuals, families, providers, advocacy organizations, etc.)

over the past several years,

8. Review of input from the DDS Innovation Think Tank – 2018, and

9. Public comments on draft Plan.

A draft of the Plan was developed considering sources of input in 1-8 above. The final

Plan incorporates changes made in response to public comments on the draft.

More information regarding each of these sources of input is included below.

I. Public Input Forums

Prior to developing a draft Plan, the Division held a series of forums to seek

stakeholder input on the development of the Plan. General forums were held to seek

input on the entire plan. In addition, there was a request from stakeholders and

legislators for the Division to focus on three priority areas in developing the new Plan.

These included:

A. Expanding housing options for people with developmental disabilities

B. Exploring options to allow for paying parents to provide services to their

children

C. Services to individuals with autism spectrum disorders.

Between late spring and early fall of 2022, DDSD held 17 forums to obtain

stakeholder feedback and input. In response to input from the State Program Standing

Committee, advocates, and families regarding the composition and structure of public

forums, the State held specific targeted forums to create safe spaces for individuals to

express their thoughts, make comments and ask questions. DDSD met with:

• Provider Agencies/Vermont Care Partners,

• Members of the Developmental Disabilities Services State Program Standing

Committee,

• Green Mountain Self-Advocates,

• Vermont Developmental Disabilities Council,

• Vermont Family Network and other family members,

• The Vermont Developmental Disabilities Housing Initiative,

• The Vermont Communication Task Force,

• Guardianship and Supported Decision Making Group and

• People who are Deaf or Hard of Hearing.

The result is a collection of ideas, concerns, and recommendations from many

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

different voices. DDSD staff compiled all the comments shared at these forums, as

well as through the online survey, the Division email box and the State Program

Standing Committee. Central themes that emerged from all the input were

summarized. A link to the summaries of the input provided is included in Appendix

II. Online Survey

DDSD posted an online survey to the DAIL website to gather input on the

development of the Plan on August 1, 2022. The link to the survey was sent to key

stakeholder groups with the request to disseminate it to people who may have been

interested in responding. People were asked to provide input on:

• what was working well in the system,

• what was not working well

• recommendations for improvements and changes in the system

• changes to any rules or limitations in the current Plan

• what is needed to help people live in a home of their choice

• what would they like to see changed or improved to supports for adults

with autism spectrum disorders

• what specific rules or safeguards should there be if parents were able to

be paid with Medicaid funds to care for their children with

developmental disabilities

The survey was open until August 18, 2022. 237 people responded to the on-line

survey. The responses were compiled with the input from the public forums and are

incorporated into the summaries of major themes. Links to the summaries are

included in Appendix A.

III. Division email box set up for stakeholder input on Plan

The Division set up an email box for stakeholders to provide input and comments on

either the Plan or the DDS Regulations

which are being renewed and updated

concurrently. The email address to send input or comments to the Division was shared

at all public forums and hearings. It was also posted on the DDSD website. The input

provided via that mailbox was compiled with the input from the public forums and is

incorporated into the summaries of major themes. Links to the summaries are included

in Appendix A.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

IV. State Program Standing Committee for Developmental Disabilities

Services

The State Program Standing Committee (SPSC) for Developmental Disabilities

Services is the advisory board to the Division regarding the DDS system. The SPSC

provided input into the development of the Plan at their August 18, 2022 meeting.

This input was compiled with the input from the public forums and is incorporated

into the summaries of major themes. Links to the summaries are included in Appendix

The SPSC reviewed the draft Plan on October 20, 2022 at their regularly scheduled

meeting. The minutes from that meeting

reflect the input provided. This meeting was

one of the two public hearings held on the draft.

V. Quality Reviews

The Division’s Quality Management Reviewers conduct bi-annual on-site reviews to

assess the quality of services provided by DA/SSAs and services that are self/ family-

managed. Due to the COVID-19 pandemic, the bi-annual onsite review process was

suspended for two months from mid-March to mid-May 2020. This suspension of the

review process along with safety protocols to prevent the spread of COVID-19

required the Quality Management Review team to make some changes to the review

process itself. The decision was made to restart the review cycle performing the

interviews with individuals receiving services, family/guardians, shared living

providers, direct support staff and service coordinators virtually via video calls.

Additionally, the sample size was reduced back to the previous 10% of individuals

receiving HCBS funded supports in order to accommodate the reduced staffing at the

provider agencies while maintaining the ability of the review team to gather the

required information and fulfill its oversight responsibilities. Two, two-year review

cycles occurred since the last update of the Plan, first from July 2018 through June

2020 with a total of services for 382 individuals being reviewed. The second review

cycle was from July 2020 through June 2022, with a total of services for 347

individuals being reviewed. The lower total number of individuals whose services

were reviewed is a result of returning the sample size in general back to 10%. The

goal going forward is to return it to a minimum of 15% of individuals receiving HCBS

funded services with the next review cycle as well as a return to face to face, in person

interviews.

Areas of Strength – The following trends were noted as areas of strength during these

review cycles:

 Creative opportunities for individuals to remain safe while being connected to their

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

peers through on-line video classes, group meetings/interactions with individuals

wearing masks and other protective equipment and maintaining social distancing,

etc.

 Communication among the individual’s team members.

 Individualized supports across all funded areas.

 Knowledgeable and well-trained service coordination staff.

 Successful, creative employment supports – individualized to meet needs and

increased support for consumer businesses and self-employment.

 People experiencing post-secondary education opportunities at local colleges and

universities.

 Well trained direct service staff, including shared living providers.

 Positive family supports.

 Individuals supported to make healthy meal choices & exercise regularly.

 Clinical supports available and used as appropriate.

Areas of Importance to Improve the Quality of Services – The majority of

DA/SSAs had no areas of importance noted during this review cycle. Of those that

did have areas identified, the following trends were noted. Agencies have submitted

plans of correction to address these areas.

 Service Coordinator training to ensure consistency in quality and depth of Individual

Support Agreements, person centered planning processes, and following the Health

& Wellness Guidelines and Needs Assessment & use of services to identify needs and

allocate funds to meet these needs across individuals.

 Special Care Procedure training, monitoring and support.

 Recognizing the need for, developing, writing, implementing and monitoring

comprehensive Behavior Support Plans.

 Need to establish or expand availability of clinical and therapy supports.

 Lack of consistency and thoroughness in the ISA documents (e.g., no clear method

for documenting or tracking progress toward accomplishing the outcomes).

VI. Review of other existing information

The Division also reviewed other existing information and input provided since the

development of the last Plan. This included reviews of:

• Adherence to the principles of service in Developmental Disabilities Act of

1996 as reported in the DDS Annual Report

 Ongoing input and feedback provided to the Department by various

stakeholders (individuals, families, providers, advocacy organizations, etc.)

over the past several years.

 Input and recommendations from the DDS Innovation Think Tank – 2018

(Retreat_Summary_of_Key_Topics.pdf (vermont.gov)

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 - Technical Correction May 1, 2023

VII. Public Hearings and Comments

The draft Plan , notice of public hearings, including the teleconference links to join the

hearings, and request for comments was posted on the DAIL website on October 13,

2022. The request for comment was also sent to key stakeholder groups. A public hearing

on the DRAFT Developmental Disabilities Service State System of Care Plan was held

on October 20, 2022, from 10:00 a.m.-12:30 p.m. during the State Program Standing

Committee meeting. All comments were recorded. A second public hearing was held

on October 26, 2022, from 4:00-6:00 pm. The public hearings were conducted via

teleconference. Stakeholders were invited to send written comments via email or regular

mail to the Department.

All comments were reviewed and considered prior to finalizing the Plan. Any changes

made in response to comments have been incorporated into the final version.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

ATTACHMENTS

[Page intentionally left blank.]

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

ATTACHMENT A

LINKS TO IMPORTANT DOCUMENTS

Developmental Disabilities Services Codes and Definitions for Home and

Community-based Services

(DDSD_Service_Definitions.pdf (vermont.gov)

)

Summary of Input from System of Care Plan forums

Proposed Changes to the Vermont State System of Care Plan (SOCP) for

DDS | Developmental Disabilities Services Division

Proposed Changes to Regulations Implementing the DD Act of 1996 now referred

to as the DDS Regulations or HCAR 7.100 Disability Services- Developmental

Services

Disability Services - Developmental Services Rules Sent to Legislative

Committee on Rules for Approval | Disabilities Aging and Independent

Living (vermont.gov)

Final Approved Developmental Disabilities Services Regulations or HCAR

7.100 Disability Services- Developmental Services

DDS Regulations

Act 186 – An act amending the Developmental Disabilities Act

ATTACHMENT B

OVING FUNDS IN INDIVIDUALIZED BUDGETS

Applies to ALL

Self-Managed / Family-Managed / Shared-Managed/ Agency-Managed

Services and Supports

Moving funds between funded areas of support is allowable without an updated needs assessment. A move to an unfunded area is allowable if a new needs assessment

reveals a serious unmet need in that area. Only individuals and/or their guardians and the agency may make decisions to move funds between funded areas. Home

providers

or other employers may not move funds. Moving funds requires a team decision. In all cases the agency or Supportive ISO must be notified of the decision.

Moving

funds must comply with the DDS State System of Care Plan.

Applies to

Self-Managed and

Family-Managed Services

The individual/family:

 Makes the decision to move funds within

funded areas of support with his or her team

 Notifies the Supportive ISO prior to

implementing any change

 Is responsible for any overspending in the

funded areas of support/authorized

funding limits

 Must personally pay their employee(s) or other

bills if the overall authorized funding limit

is exceeded

The Supportive ISO:

 May or may not be part of the team

 Notifies the Fiscal/Employer Agent of any

changes in the budget/authorized funding

limits

 May determine the individual or family cannot

manage services if overspending is repeated

The Fiscal/Employer Agent:

 Will enforce the limits on funded areas of

support/authorized funding limits

 Will not pay the employee(s) or bills if overall

authorized funding limit is exceeded

Applies to

Shared-Managed Services

The individual/family:

 With the agency, discuss moving funds;

come to agreement prior to moving the

funds between funded areas of support

and before implementing any change

 Is responsible for any over-spending in

the funded areas for those services that

they manage

The Agency:

 Notifies the Fiscal/Employer Agent of

any changes in the budget

 Is responsible for any overspending in the

funded areas it manages

 May determine the individual/family

cannot manage services if overspending

is repeated

The Fiscal/Employer Agent:

 Will enforce the limits on funded areas of

support and the authorized funding limits

 Will not pay the employee(s) or bills

if overall authorized funding limit

is exceeded

Applies to

Agency-Managed

Services

The individual/family:

 Is involved in the team decision

about moving funds between

funded areas of support

The Agency:

 Manages the individualized budget

and is responsible for any

overspending in funded areas of

support/ authorized funding limits.

 Does not use the

Fiscal/Employer Agent for

their employees

OVERSPENDING IN FUNDED AREAS OF SUPPORT

AUTHORIZED FUNDING LIMITS

Applies to Self-Managed / Family-Managed and Shared-Managed Services and Supports

If an individual or family exceeds the money available in a funded area of support, but there are still funds in another funded area of support, Employer of

Record can direct the Fiscal/Employer Agent (F/EA)

to pay the worker for that payroll period only. The F/EA will not continue to pay workers, unless

directed by the agency or Supportive ISO. The team must address the issue before the next payroll

period. The agency or Supportive ISO must notify the

F/EA of any changes in the budget before the next payroll period. Otherwise, timesheet and

requests for non-payroll payments will not be processed by the

Fiscal/Employer Agent. Also, the F/EA will not process timesheets or requests for non-payroll

payments that exceed the overall authorized funding limits

for “goods” and services.

Applies to

Self-Managed and Family-Managed Services

Applies to Shared-Managed Services

The Employer of Record:

 Notifies the Supportive ISO how to address the issue of overspending in a

funded area of support and the necessary changes

to existing funded areas of

support to process the submitted timesheets or non-payroll requests

 Is responsible for personally paying their employee and other bills if

the

overall authorized funding limit is exceeded

The Supportive ISO:



Discusses how the issue will be addressed with the Employer of Record.

The

Supportive ISO may make contact if the Employer of Record does not

contact

them.

 Notifies the Fiscal/Employer Agent of the new changes in the funded areas of

support

 Is not responsible for any overspending caused by the Employer of Record

 May determine the Employer of Record cannot manage services if

overspending is repeated

The Fiscal/Employer Agent:



Enforces spending limits in each funded area of support

 Provides bi-weekly Employer Spending Reports, which notify

employers of remaining balances in funded areas of support

 Pays the worker as directed, only after the employer works with the SISO to

transfer unspent funds in another funded area of support

 Will not pay the worker if the funded area of support is exceeded

The Employer of Record:

• Is notified of spending throughout the fiscal year by the Fiscal/Employer Agent

through bi-weekly Employer Spending Reports



The team decides how to address the issue and whether any money can be

shifted between funded areas of support when overspending occurs

 Is responsible for the services they manage

 Is personally responsible for paying their employee and other bills if

funding

cannot be moved or if overall authorized funding limit is exceeded

The agency:



Discusses how the issue will be addressed with the Employer of Record.

The agency may make contact if the Employer of Record does not

contact

them.

 Notifies the Fiscal/Employer Agent of the new changes in the funded areas of

support

 Is not responsible for overspending by the Employer of Record

 Is responsible for any overspending in the area it manages

 May determine the Employer of Record cannot manage services if

overspending is repeated

The Fiscal/Employer Agent:



Enforces spending limits in each funded area of support

 Provides bi-weekly Employer Spending Reports, which notify

employers of remaining balances in funded areas of support

 Pays the worker as directed, only after the Employer of Record

works with the agency to transfer unspent funds in another funded

area

of support

 Will not pay the worker if the overall authorized funding limit is exceeded

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023- Technical Correction May 1, 2023

ATTACHMENT C

EVELOPMENTAL DISABILITIES SERVICES

FUNDING APPROPRIATION FOR HCBS – FY 2023

New Caseload Projected Need $14,680,391

(341 individuals (includes high school graduates) x $43,051 avg

x 1% COLA)

Minus Returned Caseload Estimate (7,658.127)

(3 year average)

Public Safety/Act 248 896,714

(13 individuals x $68,978 average x 1% COLA)

TOTAL FY ‘23 ESTIMATED NEW CASELOAD

NEED

7,918,978

• Annualization of FY22 CBA increase $1,051,929

• FY23 CBA increase $1,896,917

• 8% DS/SSA rate increase $22,493,138

TOTAL DDS APPROPRIATION - AS PASSED FY 23

$282,169,830

[Page intentionally left blank.]

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

TTACHMENT D

Vermont Council of

Developmental and Mental Health Services

NEEDS ASSESSMENT

Name:

D.O.B.:

Recorder (name & title):

Date:

Informant(s) (name(s) & relationship to consumer):

Supports requested:

Housing & Home Supports: Supports related to current or needed living

arrangements.

Community Supports: Supports related to being an included and contributing

member of the community such as volunteer, recreational, and self-advocacy activities,

board member responsibilities, establishing/maintaining friendships.

Work Supports: Supports related to obtaining or maintaining employment.

Service Planning & Coordination: Supports related to coordination and monitoring

of services.

Respite Care: Supports to give breaks to caregivers in order to maintain living

situation/placement.

Crisis Supports: Supports that aid in the prevention of crisis and that assist people

in crisis situations.

Clinical Interventions: Supports needed to meet therapeutic needs such as

individual and group therapy, occupational therapy, physical therapy, speech and

language therapy, consultation, psychiatric, and team training.

Transportation: Specialized transportation:

Other: Please specify:

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

NEEDS ASSESSMENT

COMMUNICATION: Level of support needed to express wants and needs and to

understand ideas from others (e.g., verbal prompts, cueing, communication devices,

gesture dictionaries, sign language, interpreters).

Description of Support:

What are other resources for these supports (including natural supports)?

What will happen if these supports are not put in place?

Levels of Support:

None. No support

Minimal. Some support

Moderate. Ongoing support and/or uses alternative means of communication and/or requires

interpreter

Significant. Uses maximum level of support to understand communication or be understood

Current Level of Support Level of Support Needed

At Home: Select Level Select Level

At Work: Select Level Select Level

In Community: Select Level Select Level

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

NEEDS ASSESSMENT

SELF-CARE: Level of support needed to complete self-care tasks such as bathing,

dressing, toileting, eating, etc.

Description of Support:

What are other resources for these supports (including natural supports)?

What will happen if these supports are not put in place?

Levels of Support:

None. No assistance

Minimal. Monitoring and periodic support

Moderate. Some physical assistance and/or verbal prompting

Significant. Total physical assistance to complete most tasks

Current Level of Support Level of Support Needed

At Home: Select Level Select Level

At Work: Select Level Select Level

In Community: Select Level Select Level

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

NEEDS ASSESSMENT

INDEPENDENT LIVING: Level of support needed to complete independent living tasks

such as home care, budgeting, cooking, etc.

Description of Support:

What are other resources for these supports (including natural supports)?

What will happen if these supports are not put in place?

Levels of Support:

None. No assistance

Minimal. Monitoring and periodic support

Moderate. Some physical assistance and/or verbal prompting

Significant. Total physical assistance to complete most tasks

Current Level of Support Level of Support Needed

At Home: Select Level Select Level

At Work: Select Level Select Level

In Community: Select Level Select Level

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

NEEDS ASSESSMENT

WORK: Level of support needed to obtain or maintain employment.

Description of Support:

What are other resources for these supports (including natural supports)?

What will happen if these supports are not put in place?

Levels of Support:

None. No assistance

Minimal. Monitoring and periodic support

Moderate. Some assistance and/or verbal prompting

Significant. Total assistance to complete most tasks

Current Level of Support Level of Support Needed

Job development:

On-the-job support

Select Level Select Level

& supervision:

Select Level

Job follow-up: Select Level Select Level

Transportation: Select Level Select Level

Supports related

to being safe:

Select Level

Accessibility

issues/adaptations:

Select Level

Communication: Select Level Select Level

Legal concerns: Select Level Select Level

Health/physical

needs:

Select Level

Personal care needs: Select Level Select Level

Psychological/emotional/

behavioral: Select Level Select Level

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

NEEDS ASSESSMENT

RESPITE: Level of support needed to give breaks to caregivers in order to maintain

living situation/placement.

Description of Support:

What are other resources for these supports (including natural supports)?

What will happen if these supports are not put in place?

Levels of Support:

None. No respite

Minimal. Occasional respite

Moderate. Consistent ongoing respite

Significant. Regular, frequent respite

Current Level of Support Level of Support Needed

At Home: Select Level Select Level

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

NEEDS ASSESSMENT

PARENTING: Level of support needed to provide training in parenting skills to help

keep a child under 18 at home.

Description of Support:

What are other resources for these supports (including natural supports)?

What will happen if these supports are not put in place?

Levels of Support:

None. No assistance

Minimal. Monitoring and periodic support

Moderate. Regular intervention and support

Significant. Intense intervention and support

Current Level of Support Level of Support Needed

At Home: Select Level Select Level

In Community: Select Level Select Level

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

NEEDS ASSESSMENT

HEALTH CARE/MEDICAL/MOBILITY: Level of support needed in the following areas:

taking medications; making and getting to medical/dental appointments; using special

equipment such as a wheelchair, Hoyer lift, etc.; addressing chronic medical conditions

such as diabetes, seizures, etc.; addressing special care procedures such as tube

feedings, colostomy bag, etc.

Description of Support:

What are other resources for these supports (including natural supports)?

What will happen if these supports are not put in place?

Levels of Support:

None. No assistance

Minimal. Monitoring or periodic support / Routine health care; stable

conditions Moderate. Ongoing assistance / Serious and/or multiple conditions

Significant. Total assistance / Substantial health issues

Current Level of Support Level of Support Needed

Taking medication:

Making medical/

Select Level Select Level

dental appointments:

Select Level

Getting to medical/

dental appointments:

Select Level

Using specialized

equipment such as

wheelchair, Hoyer lift, etc.:

Select Level

Chronic medical

conditions such as

diabetes, seizures, etc.:

Select Level

Special care procedures such

as tube feedings,

colostomy bag, etc.: Select Level Select Level

Other: Select Level Select Level

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

NEEDS ASSESSMENT

SLEEPING: Level of support needed as a result of sleep disruption during the night.

Description of Support:

What are other resources for these supports (including natural supports)?

What will happen if these supports are not put in place?

Levels of Support:

None. No intervention

Minimal. Occasional assistance; monitoring of medium or short duration

Moderate. Frequent assistance; monitoring of extended duration on an episodic basis

Significant. Nightly assistance of long duration

Current Level of Support Level of Support Needed

At Home: Select Level Select Level

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

NEEDS ASSESSMENT

BEHAVIORAL/MENTAL HEALTH: Level of support/supervision needed throughout the

day to manage emotions and/or behavior.

Description of Support:

What are other resources for these supports (including natural supports)?

What will happen if these supports are not put in place?

Levels of Support:

None. No assistance

Minimal. Periodic or ongoing intervention

Moderate. Planned support and skilled intervention and/or 24-hour support and/or monitoring

Significant. Extensive skilled intervention and/or 24-hour supervision in close proximity

Current Level of Support Level of Support Needed

At Home: Select Level Select Level

At Work: Select Level Select Level

In Community: Select Level Select Level

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

NEEDS ASSESSMENT

CLINICAL: Level of support needed to meet therapeutic needs.

Description of Support:

What are other resources for these supports (including natural supports)?

What will happen if these supports are not put in place?

Levels of Support:

None. No support

Minimal. Infrequent intervention

Moderate. Ongoing intervention

Significant. Intervention more than once a week

Current Level of Support Level of Support Needed

Psychotherapy:

Psychiatry:

Select Level

Occupational Therapy: Select Level Select Level

Physical Therapy: Select Level Select Level

Speech Therapy: Select Level Select Level

Communication: Select Level Select Level

Behavior Consult/Support:

Offender Treatment:

Select Level

Other: Select Level Select Level

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

NEEDS ASSESSMENT

Additional Comments:

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

ATTACHMENT E

LOSSARY OF TERMS

Below is a glossary of terms used in the DDS State System of Care Plan

Terms in red are also found in the Disabilities Services – Developmental

Services Rules, mostly in the definition section (HCAR 7.100.2)

PL means plain language version of definition

Link to more information is included when appropriate

Act 248: a law that authorizes a VT State criminal court to civilly commit a

person with an intellectual disability who is a continuous risk of significant harm

to others, into the custody of the Commissioner of the Department of

Disabilities, Aging, and Independent Living (DAIL).

PL: a law that allows the state to have legal custody of people with intellectual

disabilities who are at risk of causing serious harm to others.

https://ddsd.vermont.gov/sites/ddsd/files/documents/Act_248_Info.pdf

Administrative Rules on Agency Designation: rules and qualifications that

agencies must follow and demonstrate in order to be designated by the

Department to provide services for individuals with developmental disabilities.

PL: rules agencies must follow in order to receive funding from the Department

to provide services to people with developmental disabilities.

https://ddsd.vermont.gov/sites/ddsd/files/documents/administrative-rules-on-

agency-designation.pdf

Adult: means a person who is age eighteen or older. The term includes people

who are age eighteen or older who attend school.

PL: a person who is 18 years old or older, even if they are in school.

Advisory groups: a group of individuals who advise the State on policy,

projects, and special initiatives.

PL: a group of people who speak up and give their thoughts, ideas, and advice to

the State about services.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

Agency: means the responsible designated agency or specialized service agency

(DA/SSA).

PL: the organization that the Department provides funding to and who is

responsible for providing services for people with developmental disabilities. It

could be a Designated Agency, also called a DA or a Specialized Agency, also

called an SSA.

Agency Designation: process by which agencies are reviewed by the State on a

multi-year cycle to assure that agencies meet the standards to be designated

within the geographic areas identified by the Commissioner.

PL: a review that the State does to check and make sure that the agency is able

to meet the needs of people in their community.

https://ddsd.vermont.gov/sites/ddsd/files/documents/administrative-rules-on-

agency-designation.pdf

Annual Periodic Review: means an annual review of an individual’s support

needs to assure the individual's budget reflects current needs, strengths, and

progress towards personal goals.

PL: a review of the amount of support needed by a person who is currently

receiving services. This is done once each year with the person.

Annual Report: means the Developmental Disabilities Services Annual Report

that highlights the work provided to individuals with developmental disabilities

and their families in Vermont. It also reviews the extent to which the system is

meeting their needs.

PL: a report that comes out each year that talks about services provided to

people with developmental disabilities and their families in Vermont and how

well services are meeting people’s needs.

https://ddsd.vermont.gov/annual-report-dds

Appeal: means a request for an internal review (see HCAR 8.100) of an adverse

benefit determination (see HCAR 1.101) by the Department or designated

agency or specialized service agency.

PL: if a person or their authorized representative disagrees with a decision

regarding their services, they can request that the Department or the agency that

made the decision review that decision. Some of the decisions that can be

appealed include:

• Denial of a service that was asked for

• Denial of the amount of service that was asked for

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

• Denial of the type of service that was asked for

• Denial of who can provide the services

• Decisions to reduce, put on hold or end services

• Not getting approved services in a timely manner

11.101-hcar-definitions-adopted-rule.pdf (vermont.gov), hcar-8.100-ga-adopted-

rule-7.6.18.pdf (vermont.gov)

Applicant: means a person who files a written application for services, supports

or benefits in accordance with HCAR 7.100.5. If the applicant is a guardian or

family member or a designated agency, the term "applicant" also includes the

person with a developmental disability.

PL: means the person that fills out an application for services or the person who

is applying for services.

Authorized Funding Limit (AFL): means all funding related to an individual’s

home and community-based services budget, including the administration

amount available to transfer (as specified in division policy), but does not

include: funding for state and local crisis services, employment program base

and statewide communication resources.

PL: The amount of money in a person’s individual service budget that they can

use to pay for their supports. An AFL is based on the person’s needs assessment

and is reviewed each year. The AFL says how much money is available in each

category of service such as Community Supports, Respite, Home Supports, etc.

Authorized Representative: means an individual or organization, either

appointed, by an applicant or beneficiary, or authorized under State or other

applicable law, to act on behalf of the applicant or beneficiary in assisting with

the application and renewal of eligibility, the internal appeal, grievance, or State

fair hearing processes, and in all other matters with the Department, as permitted

under 42 CFR § 435.923. Unless otherwise stated in law, the authorized

representative has the same rights and responsibilities as the applicant or

beneficiary in obtaining a benefit determination and in dealing with the internal

appeal, grievance, and State fair hearing processes.

PL: means a person who is given permission by the person with a developmental

disability or appointed by the State to help with applications, appeals, grievances

or other issues regarding services.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

Budgetary Recissions: means reductions to the budgets provided by the State to

agencies to provide services to individuals. These reductions usually result in

reductions to individual’s service budgets.

PL: When the State does not have enough money to fund agencies, they may cut

the agencies’ budgets and then the agencies may cut individual budgets for

people in services.

Caregiver: means a person who provides support and care to a person with

developmental disabilities in their day-to-day life. A caregiver may be paid or

unpaid.

PL: NA

Centers for Medicare and Medicaid Services: (CMS) federal agency that

works with state governments to provide health insurance and related services to

individuals who qualify based on specific criteria.

PL: Also called CMS. CMS is a federal agency that works with the State to

provide Medicaid services.

Home - Centers for Medicare & Medicaid Services | CMS

Certification: means the process by which the Department determines whether a

provider meets minimum standards for receiving funds administered by the

Department to provide services or supports to people with developmental

disabilities.

PL: means the process the State uses to make sure agencies are qualified to

provide services.

See HCAR 7.100.11 7.100 final-clean.ddact-regulations-10-01-2017.pdf (vermont.gov)

Certified provider: means an agency that has as one of its primary purposes to

deliver services and supports for people who have developmental disabilities and

that currently is certified by the Department of Disabilities, Aging and

Independent Living in accordance with HCAR 7.100.11.

PL: means a designated agency, specialized agency, or other organization that

the State has determined to meet what is required to provide services to people

with developmental disabilities.

See HCAR 7.100.11 7.100 final-clean.ddact-regulations-10-01-2017.pdf (vermont.gov)

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

Collective Bargaining Agreement (CBA): A CBA is generally a negotiated

agreement between an employer and a union representing employees regarding

conditions of employment such as wages, benefits, hours, etc. As referenced in

this document it refers to the CBA between the State of VT and the union

representing independent direct support workers who provide services to people

with disabilities.

PL: The agreement between the State and the union for workers who are hired

by people in services, their families or shared living providers regarding their

wages and benefits.

Commissioner: means the Commissioner of the Department of Disabilities,

Aging, and Independent Living (DAIL).

PL: The Commissioner is the person appointed by the Governor of VT to run the

Department.

Conflict of Interest: a real or seeming incompatibility between the private

interests and the official responsibilities of a person in trust. The CMS rule (42

CFR 441.301 (c)(1)) requires that Home and Community-Based Services

(HCBS) programs use a person-centered planning process which includes ways

to solve conflict or disagreement and that the guidelines around conflict of

interest are clear to everyone in the process. The rule also requires that providers

of HCBS, or those who have an interest in or are employed by a provider of

HCBS may not provide case management to or develop the person-centered

service plan for people receiving services.

PL: Conflict of Interest in this document mostly refers to a federal rule that says

the agency who provides a person’s case management services cannot also

provide the rest of the person’s Home and Community-Based Services.

hcbs-cfcm-summary-3.26.19.pdf (vermont.gov)

Day: day means calendar day, not working day, unless otherwise specified.

PL: calendar day means each of the 7 days of the week. Working day usually

means Monday to Friday, not including holidays.

Department of Children and Families (DCF): a department within Vermont's

Agency of Human Services that provides supports and services for children and

families.

PL: NA

Vermont Department for Children and Families (DCF) | Department for Children and Families

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

Department of Mental Health (DMH): a department within the Agency of

Human Services that provides supports and services to Vermonters in the area of

mental health.

PL: NA

https://mentalhealth.vermont.gov/about-us

Department of Corrections (DOC): a department within the Agency of Human

Services that provides services to support safe communities through leadership in

crime prevention, reparations, addressing needs of crime victims, ensuring

offender accountability for criminal acts, and managing risk posed by offenders.

PL: A department that provides services to people who have been victims of a

crime or who have committed a crime.

https://doc.vermont.gov/about-us

Department: (DAIL) means the Department of Disabilities, Aging and

Independent Living.

PL: the department within the Agency of Human Services that provides services

and supports for people with disabilities. The Developmental Disabilities

Services Division (DDSD) is a division within DAIL.

Home Page | Disabilities Aging and Independent Living (vermont.gov)

Designated Agency: (DA) means an agency designated by the Department,

pursuant to 18 V.S.A. § 8907, and the regulations implementing that law, to

oversee, provide and ensure the delivery of services and/or service authorizations

for eligible individuals with developmental disabilities in an identified

geographic area of the state. The requirements for being a DA are explained in

the Department’s Administrative Rules on Agency Designation.

PL: the agency responsible for making sure that needed developmental services

are available in specific areas of the state. People go to the DA to apply for

services. The DA provides direct supports to people as well as makes referrals to

other agencies.

Vermont Laws,

https://ddsd.vermont.gov/sites/ddsd/files/documents/administrative-rules-on-

agency-designation.pdf

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

100

Developmental Disability: means an intellectual disability or an autism

spectrum disorder which occurred before age 18 and which results in significant

deficits in adaptive behavior that manifested before age 18 (See HCAR 7.100.3).

Temporary deficits in cognitive functioning or adaptive behavior as the result of

severe emotional disturbance before age 18 are not a developmental disability.

The onset after age 18 of impaired intellectual or adaptive functioning due to

drugs, accident, disease, emotional disturbance, or other causes is not a

developmental disability.

PL: means a person who has been diagnosed with either an intellectual disability

or an autism spectrum disorder, who also needs support around day-to-day tasks

and their disability started prior to age 18.

See HCAR 7.100.3 for specifics on determining that a person has a

developmental disability.

Direct Care/Direct Support: work, care, or support that is provided directly to

an individual with a developmental disability.

PL: NA

Developmental Disabilities Services Division (DDSD): is a Division of the

Department of Disabilities Aging and Independent Living that oversees services

to individuals with developmental disabilities and their families.

PL: See definition of Division below.

Home Page | Developmental Disabilities Services Division (vermont.gov)

Direct support professional (DSP): someone who works directly with

individuals with developmental disabilities to provide assistance and support for

individuals to access the community, employment, and other services.

PL: Person who provides direct support to individuals with developmental

disabilities so they can be as independent as possible and participate in their

communities. Also called staff.

Division: means the Developmental Disabilities Services Division (DDSD)

within the Department.

PL: DDSD is a Division within DAIL. DDSD provides funding for agencies to

provide services for people with developmental disabilities. They also develop

the rules for how services should be provided and oversee the agencies providing

services. Sometimes people call the Division “the State” because the Division is

part of the State government.

Home Page | Developmental Disabilities Services Division (vermont.gov)

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

101

Department of Vermont Health Access: (DVHA) a department within the

Agency of Human Services that is responsible for administering the Vermont

Medicaid health insurance program and Vermont’s state-based insurance

marketplace.

PL: The department at the State that oversees Medicaid services for Vermonters.

https://dvha.vermont.gov/

Early, Periodic, Diagnosis and Treatment (EPSDT): a Medicaid benefit that

provides comprehensive and preventative health care services for children under

age 21 who are enrolled in Medicaid.

PL: Medicaid services for children who are under age 21

https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-

diagnostic-and-treatment/index.html

Employer of record: (EOR) The organization or person who hires, trains and

supervises employees. This includes setting wages for employees and being the

one who signs employees’ timesheets.

PL: NA

Equity Fund/Equity Funding Committee: The Equity Fund is funding made

available by the Legislature to address the needs of current recipients with new

needs or people newly applying for DDS Home and Community-Based Services.

The Equity Funding Committee reviews requests and makes recommendations to

the Division regarding authorizing funding from the Equity Fund.

PL: NA

https://ddsd.vermont.gov/boards-committees/equity-committee

Family: means a group of individuals that includes a person with a

developmental disability and that is related by blood, marriage, or adoption or

that considers itself a family based upon the bonds of affection, which means

enduring ties that do not depend upon the existence of an economic relationship.

PL: family related by blood includes people such as parent, grandparent, sister,

brother, aunt or uncle. Being related by marriage would include people such as a

husband or wife, or husbands or wives of people related by blood. Being related

by adoption would include the person being adopted or other relatives who were

adopted. Family also includes people the person considers to be family.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

102

Federal HCBS rules: regulations from the Centers for Medicare and Medicaid

Services (CMS) that support enhanced quality in HCBS programs, outlines

person centered planning practices, separate case management from delivery of

direct services, and that ensure individuals receiving services and supports that:

• Are integrated in, and support full access to the greater community;

• Ensure individual rights of privacy, dignity, and respect, and freedom from

coercion and restraint;

• Optimize individual autonomy and independence in making life choices;

and

• Facilitate choice regarding services and who provides them

PL: the federal regulations that the State and agencies must follow in providing

Home and Community-Based Services (HCBS). They include:

• Person must be at the center of planning their services

• Service must be in and support access to the community

• Ensure people’s rights for privacy, dignity, respect

• Support people in making choices about their life

• Separating case management from delivery of other services

Click on this link for more information on the federal HCBS rule: § 441.530

Fee for service: means services that are billed for individually.

PL: The majority of developmental disability services (HCBS) in VT are paid

for in a monthly bundle that includes multiple categories of services such as

Home Supports, Employment Supports, Respite, Clinical Services, etc.

Fee for service is when each service is paid for separately. Some services that

are paid for by fee for service in DDS include Targeted Case Management,

Individual Therapy, Family Managed Respite.

Fiscal/Employer Agent: means an organization that is: 1) qualified under

Internal Revenue Service rules to pay taxes and provide payroll services for

employers as a fiscal agent; and 2) under contract with the Department to handle

payroll duties for recipients or families who choose to self/family manage or

share-manage services.

PL: means an organization that takes of care payroll and taxes for services

provided by the independent direct support workers who are hired by individuals

in service, family members or shared living providers. Currently, ARIS is the

Fiscal/Employer Agent for those workers.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

103

Funding Priorities: A list of situations delineated in the State System of Care

Plan that a person must meet in order for the Division to authorize use of the

Equity or Public Safety funds for Home and Community-Based Services.

Funding priorities specify how the Division will allocate its limited caseload

funds.

PL: The Division has a limited amount of money to meet the needs of people

who are currently in services but have new needs or people newly applying for

services. The funding priorities help the Division decide who can receive that

funding.

See Section Four G(1)(c)(3) of this document for the funding priorities.

Global Commitment to Health 1115 Waiver: is the agreement that the state of

Vermont has with the federal Centers for Medicare and Medicaid Services

(CMS) regarding how VT operates its Medicaid program. The agreement

includes all of the Medicaid funded developmental disabilities services. It

provides flexibilities to strengthen the overall Vermont's health care system.

PL: The agreement that the State of Vermont has with the federal government

regarding how it operates its Medicaid program. Most of the developmental

disabilities services are funded by Medicaid under this agreement.

https://humanservices.vermont.gov/about-us/medicaid-administration/global-

commitment-health-1115-waiver/1115-waiver-documents

Goods: means tangible merchandise or supplies.

PL: Goods are things that can be bought.

Guardian: A guardian is a person with the legal responsibility to protect the

well-being and rights of another. A guardian is a person appointed by the court to

make certain legal decisions for the person, when they have been determined to

be unable to do so for themself due to their disability.

PL: A person appointed by the court to supervise and protect the interests of

another person who is found not able to make decisions on their own. A

guardian may be a family member or friend or a public guardian.

https://ddsd.vermont.gov/sites/ddsd/files/documents/OPG%20handbook%20Apri

l%202016.pdf

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

104

HireAbility Vermont: previously called VocRehab, a network of employment

and job skills specialists and counselors who assist Vermonters with disabilities

to find employment and expand career paths.

PL: A division within DAIL that helps people find jobs and supports them to be

successful and independent with their jobs. Hireability used to be called Voc

Rehab.

https://www.hireabilityvt.com/

Home and Community Based Services (HCBS): means an array of long-term

services developed to support individuals to live and participate in their home

and community rather than in an institutional setting, consistent with Centers for

Medicare and Medicaid Services (CMS) federal HCBS Rules.

PL: Services that are provided to people with developmental disabilities to help

them live in and be part of their community. HCBS services can help a person in

their home, work and community. Providers of HCBS must follow all the federal

rules when providing services.

See Section Four G in this document for more information on the DDS HCBS

program. Click on this link for more information on the federal HCBS rule:

§ 441.530

Intermediate Care Facility for Individuals with Developmental Disabilities:

(ICF/DD) is a residence that provides comprehensive and individualized health

care and habilitation services to individuals, as an alternative to HCBS, to

promote their functional status and independence.

PL: Facilities that provide care for people with developmental disabilities who

have specialized needs, such as unique medical care needs. Vermont had one

ICF/DD that served people with high medical needs, but it closed. The Division

is planning to open a new ICF/DD.

The requirements for operating an ICF/DD can be found at: (eCFR :: 42 CFR

Part 483 Subpart– -- Conditions of Participation for Intermediate Care Facilities

for Individuals with Intellectual Disabilities).

Individual: means a young child, a school-age child or an adult with a

developmental disability.

PL: A person who meets the eligibility criteria in the DDS Rules for having a

developmental disability.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

105

Individual Support Agreement: means the agreement between an individual

and an agency or Supportive Intermediary Service Organization that describes

the plan of services and supports.

PL: An agreement between the person, the person’s guardian (if there is one),

and the agency that describes the person's supports and services. Every person

who receives DDS Medicaid services must have an ISA. The ISA includes how

the person wishes to be supported, what will be different in the person’s life

because of services, and what the person and the agency’s responsibilities are.

https://ddsd.vermont.gov/sites/ddsd/files/documents/ISA_Guidelines.pdf

Internal adjustments: the movement of funds in a person's individual service

budget from one service category to another or moving funds no longer needed

by one person to another person’s budget within the same agency.

PL: Means moving funds from one area of a person’s budget to another. For

example, a person has community supports but they get a job. Money from their

community supports can be moved to employment supports. It can also mean

moving money between people’s budgets within the same agency. If a service is

no longer needed, the money for that service can be moved to another person’s

budget who has increased needs.

Information about moving funds within a person’s budget is included in

Appendix B in this document. More information regarding internal adjustments

can be found in:

https://ddsd.vermont.gov/sites/ddsd/files/documents/DDS_HCBS_Spreadsheet_

Manual_FY 23_DA_SSA_FINAL.pdf

Intellectual Disability: (1) “Intellectual disability” means significantly sub-

average cognitive functioning that is at least two standard deviations below the

mean for a similar age normative comparison group. On most tests, this is

documented by a full-scale score of 70 or below, or up to 75 or below when

taking into account the standard error of measurement, on an appropriate norm-

referenced standardized test of intelligence and resulting in significant deficits in

adaptive behavior manifested before age 18.

(2) “Intellectual disability” includes severe cognitive deficits which result from

brain injury or disease if the injury or disease resulted in deficits in adaptive

functioning before age 18. A person with a diagnosis of “learning impairment”

has intellectual disability if the person meets the criteria for determining

“intellectual disability” outlined in HCAR 7.100.3(e).

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

106

PL: An intellectual disability is one that develops in childhood and affects a

person’s ability to learn new information or skills and the ability to function in

day-to-day life. The disability could be mild or severe.

Local Funding Committee: is a committee operated by the local Designated

Agency or Supportive ISO in order to review requests for funding for people

receiving Home and Community-Based Services (HCBS) who have new needs

or for people newly applying for HCBS.

PL: NA

See Section Five III(A) for more information about the role of Local Funding

Committees.

Local System of Care Plan: plans submitted by all designated agencies under

contract with the Division that covers a three-year period. The plan assists in

guiding the development of local services, including identifying priority areas of

support, gaps in services and use of resources.

PL: Agencies ask people in services and their families, as well as other

stakeholders and partners in the community about how well their services are

meeting the needs of people with developmental disabilities in their region. This

helps to know what is working well or not working well so they can make a plan

to improve if needed. The information from all the agencies’ local systems of

care plans is used by the Division when developing the State System of Care

Plan.

Medicaid Management Information System (MMIS): system used to process

Medicaid claims and obtain information on utilization and eligibility for

Medicaid members.

PL: An online system where agencies send their bills and information about

what Medicaid services have been provided to people. The State can review the

information in the system to see how much service is being provided to people.

Medicaid Manual for DDSD: a manual that provides guidance to provider

agencies, the Supportive ISO, and the Fiscal/Employer Agent regarding eligible

Medicaid service activity, procedures for billing and documentation

requirements.

PL: a manual that explains Medicaid insurance benefits for developmental

disabilities services. The manual tells agencies how to bill for services and

explains the rules for using Medicaid funding.

https://ddsd.vermont.gov/sites/ddsd/files/documents/dds-medicaid-procedures.pdf

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

107

Natural supports: unpaid relationships and personal associations that occur in

the everyday life of a person, including but not limited to: family relationships,

friendships, community, fellowship, etc.

PL: means the people, communities, or organizations in someone’s life that

provides support. Examples of natural supports include family members, friends,

or church groups. These people are not paid to provide support to the person.

Needs Assessment: a tool that is used to measure the level of need and support

an individual with a developmental disability requires in a variety of areas of

daily functioning.

PL: An assessment that is done when a person first applies for developmental

services to see what kinds of support they need. The assessment is done each

year to check and see if there are new or changed needs.

Network: means providers enrolled in the Vermont Medicaid program who are

designated by the Commissioner to provide or arrange developmental disabilities

services and who provide services on an ongoing basis to recipients.

PL: means the designated and specialized service agencies who the Department

says can receiving funding to provide services to people with developmental

disabilities.

Non-certified entity: a person, company, agency that is not certified by the

Department to provide developmental disabilities services. (See definition of

“certified provider” above.)

PL: NA

Pre-Admission Screening and Resident Review (PASRR): a federal

requirement to help ensure that individuals are not inappropriately placed in

nursing homes for long term care. PASRR requires that all applicants are

screened for serious mental illness and/or intellectual disability, are offered the

most appropriate setting for their needs, and provide all applicants the services

they need in those settings.

PL: a process for review of people who have a developmental disability and are

at risk of being placed in a nursing home.

Preadmission Screening and Resident Review | Medicaid

Periodic review: See Annual Periodic Review above.

PL: NA

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

108

Person-centered planning/person-centered plan (PCP): a process by which a

person's supports and services are selected and that is directed by the person who

is receiving services. PCP approach identifies strengths, goals, medical needs,

support services, and desired outcomes.

PL: means that the person who is receiving services is at the center of and an

active participant in the creation of their plan or ISA.

Prior authorization: a process where prior approval by a physician, health care

provider, insurer or the State is required before a service can occur and be paid

for.

PL: When a doctor, health care provider, insurance company or the State must

approve a service before it can happen and be paid for.

Provider: means a person, facility, institution, partnership, or corporation

licensed, certified or authorized by law to provide health care service to a

recipient during that individual’s medical care, treatment or confinement. A

provider cannot be reimbursed by Medicaid unless they are enrolled with

Medicaid; however, a provider may enroll to serve only a specific recipient. A

shared living provider, employee of a shared living provider, or an individual or

family that self/family-manages services is not a provider for purposes of these

regulations.

PL: Means the agency that is providing developmental disabilities services.

Other examples of providers are doctors, hospitals, dentists, speech and language

therapists.

Provider Agreements: means agreements the State has with developmental

disabilities service providers that outline the conditions and requirements for the

services provided.

PL: An agreement the state has with agencies that outlines the rules they must

follow in order to provide services.

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

109

Public Safety Funding Committee: a committee that reviews requests and

makes recommendations to the Division regarding authorizing HCBS funding

allocated by the Legislature to specifically address public safety issues posed by

adults with developmental disabilities.

PL: a committee that makes recommendation to the Division about funding for

people who have needs related to public safety. For example, a person who has

committed a violent crime and has a developmental disability may be eligible for

public safety funding.

https://ddsd.vermont.gov/boards-committees/public-safety-committee

Qualified Developmental Disabilities Professional: (QDDP) means a person

who meets the Department's qualifications as specified in the Department policy

for education, knowledge, training and experience in supporting people with

developmental disabilities and their families.

PL: A person who has certain training and experience in providing

developmental disabilities services. It is required that each person have a QDDP

on their team to develop, review and monitor their plan for services (ISA).

Qualified Developmental Disability Professional (QDDP) | Developmental Disabilities Services Division

(vermont.gov)

Recipient: means a person who meets the criteria contained in HCAR 7.100, and

who has been authorized to receive funding or services, or a family that has been

approved to receive funding or services under criteria specified in HCAR 7.100.

PL: means a person with a developmental disability or their family who is

approved to receive funding or services.

Self/Family Managed: services means the recipient or his or her family plans,

establishes, coordinates, maintains, and monitors all developmental disabilities

services and manages the recipient’s budget within federal and state guidelines.

PL: When an individual or family member chooses to manage all of their

services. This means that the person or family member has the responsibility of

hiring staff and overseeing the funding and other parts of their services. The

Supportive ISO and the Fiscal/Employer Agent provide support for self/family

management of services, but a provider agency is not involved.

Self and Family Management | Developmental Disabilities Services Division (vermont.gov)

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

110

Service: means a benefit:

1) covered under the 115(a) Global Commitment to Health waiver as set out in

the Special Terms and Conditions approved by the Centers for Medicare and

Medicaid Services (CMS),

2) included in the State Medicaid plan if required by CMS,

3) authorized by state rule or law, or

4) identified in the intergovernmental agreement (IGA) between the Office of

Vermont Health Access and Agency (DVHA) and the Agency of Human

Services (AHS), or DVHA and the Agency of Education for the administration

and operation of the Global Commitment to Health Section 1115 Demonstration.

PL: means the assistance or help a person receives when they are approved for

developmental disabilities services. Examples of services include: community

support, work support, case management, and respite.

Shared Management of Services: means that the recipient or his or her family

manages some but not all Medicaid-funded developmental disabilities services,

and an agency manages the remaining services.

PL: When an individual or family member chooses to manage some, but not all,

of their services. For example, the agency may provide service coordination and

home supports, but the person may choose to manage community and work

supports. The Fiscal/Employer Agent provides payroll services for people share

managing their services.

Specialized Service Agency: (SSA) means an agency designated by the

Department that meets criteria for contracting with the Department as an SSA, as

described in the Department’s Administrative Rules on Agency Designation, and

that contracts with the Department to provide services to individuals with

developmental disabilities.

PL: An agency similar to a designated agency that provides supports and

services to people with developmental disabilities. The SSA does not do intake

but takes referrals from other agencies. Unlike designated agencies, an SSA can

say no to serving someone if they do not have the capacity to serve them.

Vermont Laws,

https://ddsd.vermont.gov/sites/ddsd/files/documents/administrative-rules-on-

agency-designation.pdf

Vermont State System of Care Plan for Developmental Disabilities Services

Effective January 1, 2023 – Technical Correction May 1, 2023

111

Stakeholders: individuals or groups that have an interest in the decisions or

activities of an organization.

PL: A group of people that have interest in the decisions and activities of the

State or provider agencies. Stakeholders in DDS include people receiving

services, family members, people who work at the State, people who work at

agencies, people who work for other organizations with an interest in services for

people with developmental disabilities.

State Plan: Vermont's plan for providing services to those who are eligible for

Medicaid.

PL: The State Plan includes what Medicaid benefits are available to people who

qualify and the rules around those benefits.

State Program Standing Committee: committee that advises the

Developmental Disabilities Services Division (DDSD) on the performance of the

DDS system, evaluation of quality and responsiveness of services, development

of the State System of Care Plan, department policy, and complaints grievances

and appeals and agency designation. Made up of 15 members, majority of whom

are disclosed service recipients.

PL: A committee of stakeholders that advises the State about developmental

disabilities services.

DS State Program Standing Committee | Developmental Disabilities Services Division (vermont.gov)

Supported decision making: (SDM) Supported decision-making (SDM) is a

term used to describe a series of relationships, practices, arrangements, and

agreements designed to assist an individual with a disability to make and

communicate to others decisions about their life.

PL: a process that supports individuals with disabilities to make choices about

their lives with support from a trusted person or team of people they choose.

Supported Decision Making (SDM) | Developmental Disabilities Services Division (vermont.gov)

Supportive Intermediary Service Organization: (Supportive ISO) means an

organization under contract with the Department to provide support to

individuals and families to learn and understand the responsibilities of

self/family-managed services.

PL: An organization that helps people who are self or family managing their

services. Transition II is currently the Supportive ISO under an agreement the

State.