Eight years since the original twenty four OBRA waiver Pilot Program recipients started their services in 2000; ALAW has now become a Supports Coordinator for recipients of the OBRA waiver beginning in November 2008.  ALAW presently provides services in Bucks, Chester, Delaware, Lehigh, Montgomery, Northampton, and Philadelphia counties; if you live in another county and are interested in ALAW providing Supports Coordination in your county please contact us.

The Pilot Program has induced many changes, growing pains, and learning experiences for ALAW, both as a non-profit corporation, and as an organization of people whose core is comprised of parents of, and adult children with ASD who are part of the Pilot Program.

We have found through our personal experiences with Supports Coordination that there are few choices of service providers, and most services were not up to par with what we expect from Supports Coordination services; and none were specifically geared toward adults with autism/ASD. These experiences and frustrations with Supports Coordination service providers led us to the decision that ALAW would make Supports Coordination services a new focus.

ALAW began conceptualizing parent-like Supports Coordination services from its very beginning; the parents who formed ALAW wanted to feel secure that their adult children’s services that were now finally in place would continue life-long.

This requires truly person-centered and consumer and family directed services; that the ‘consumer’ (waiver recipient) themselves, as well as their families & caregivers are involved in a significant way in developing their own needed plans for services, service providers and every aspect of their lives. This high level of involvement also requires flexibility and the consumer setting their own plans and schedules for their own Supports Coordination services.

ALAW as Supports Coordinators actually let consumers ‘own’ the Supports Coordination service hours they are allocated and use those hours as they see fit.

Some examples:

OBRA waiver recipient/consumer Q is allocated 4 hrs Supports Coordination per month. Consumer Q decides he wants one 2 (two) hour visit and two half hour visits per month, as he likes to check -in with his Supports Coordinator often; but July, August and December he only wants one visit per month, as he enjoys travelling with his family.

Consumer V is also allocated 4hrs Supports Coordination per month but prefers weekly phone calls and a visit every three months.

ALAW also sets the internal limit of twenty (20) consumers for each Supports Coordinator, although the State allows up to thirty five (35) consumers as one Supports Coordinators’ caseload. We feel that this is necessary to ensure the high levels of both quality and flexibility necessary for outstanding Supports Coordination Services.

Included below is cut and paste from the OBRA waiver Supports Coordination service description for your information.

[cut and paste below: information taken from the OBRA waiver online:]

Supports Coordination Agency duties:

Ensure participant choice by providing information to ensure participants make fully informed decisions. 

• Assist participants in gaining access to needed waiver and other Medicaid state plan services, as well as needed medical, social, educational and other services, regardless of the funding source.
• Work with and at the direction of the participant whenever possible to identify, coordinate, and facilitate waiver services.
• Provide advocacy for services from local resources, and coordinate services to achieve maximum participant input and support.
• Provide ongoing monthly monitoring of the provision of services included in the participant’s ISP, and any risk agreements negotiated by the participant to assure the health and welfare of the participant.
• Initiate and oversee the process of reevaluation of the participant’s level of care and the review of ISP.
• Ensure that each participant has a comprehensive ISP.

The Supports Coordination Agency assures that all eligible participants are given a choice of service providers during the enrollment process and before services begin and at anytime during the year when a participant requests a change of providers. A Waiver Services Provider Choice form (Appendix B-7, Attachment #2, Participant Access and Eligibility) is completed by all applicants/participants of Waiver services. 

• A disclosure statement is included in the Waiver Services Provider Choice form which fully informs the participant that the enrollment/supports coordination agency may also be a service provider of service.

The entities responsible for ISP implementation and monitoring are the Supports Coordinator, Supports Coordination Agency, the grantee, the BHCBS and the Office of Medical Assistance Program’s (OMAP) Bureau of Long Term Care Waiver Monitoring Unit.

Supports Coordinator implements and monitors the ISP as follows:

• Ensure participant choice by providing information to ensure participants make fully informed decisions.
• Assists participants in gaining access to needed waiver and other Medicaid state plan services, as well as needed medical, social, educational and other services, regardless of the funding source
• Works with and at the direction of the participant whenever possible to identify, coordinate, and facilitate waiver services.
• Performs advocacy for services from local resources, and coordination of services to achieve maximum participant input and support.
• Performs ongoing monthly monitoring of the provision of services included in the participant’s ISP. Reviews back-up plans, and risk agreements negotiated by the participant to assure the health and welfare of the participant.
• The above monitoring includes personal face to face contact at minimum of once per quarter, or at an interval agreed upon by the participant and team to assure provision of services and health and welfare of the participant. Frequency of contact is documented in the ISP.
• Initiates the process of reevaluation of the participant’s level of care and the review of ISP.
• Ensures that each participant has a comprehensive ISP that meets the identified needs of the participant and that services are implemented as indicated on the ISP. The Supports Coordinator Supervisor completes periodic reviews of the monitoring documentation completed by the Supports Coordinator’s.
• Copies of the incident report must also be faxed or e-mailed within three (3) days to the Supports Coordination Agency and other related providers responsible for monitoring of the participant’s ISP.
• Within one month prior to the anniversary of the participant’s initial certification of level of care to receive waiver services, the Supports Coordinator will meet with the participant in their home to reassess the participant’s need for OBRA waiver services. The Supports Coordinator will be alerted to the anniversary certification date through Home and Community Services Information System (HCSIS).
• At reevaluation, the supports coordination agency team in conjunction with the participant will reassess the Individual Service Plan (ISP).
• In addition, the Supports Coordinator will verify the participant’s back-up system to assure the participant’s health and welfare. All verifications will be noted on the participant’s ISP.
• The Supports Coordinator along with the Physician, Physician’s assistant or Certified Nurse Practitioner completes an MA- 51 for recertification.
• After the level of care recertification is completed, the Supports Coordinator performs a general update transaction in HCSIS, which generates alerts to, and requires the review and approval of, their supervisor, the grantee, and BHCBS program staff.
• The Supports Coordinator is required to review the certification of a participant at any time during the year when the participant’s circumstances change.