Overview of Services Available in the Children's Waiver Home and Community Based Services (HCBS) within Health Home and in the Early Intervention Program

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Once determined eligible for the Children´s Waiver and/or the Early Intervention Program, the following services are available based upon assessment and identified need.

Note: Although the services may be defined and provided similarly, the provider for the services may be different.

Health Home Serving Children Program Early Intervention Program
For children under 21 who meet eligibility/chronic conditions criteria and appropriateness For children under 3 years of age who have a confirmed disability or developmental delay established through a multidisciplinary evaluation (MDE). Evaluations, service coordination and therapy services are provided through the Early Intervention Program (EIP).
Health Homes provide the following Care Coordination Services: Early Intervention provides the following Service Coordination Services:
Comprehensive Care Management - Assess needs, develop care plan Initial Service Coordination - Assists the family from referral to the EIP through the eligibility determination process and if determined eligible, the development of the initial Individualized Family Service Plan (IFSP)
Care Coordination and Health Promotion - Work with children and families to identify needs, coordinate care and linkage to providers Ongoing Service Coordination - Helps families identify resources, priorities and concerns, facilitates developing individualized family service plans (IFSPs) reflecting parent-driven outcomes, helps parents identify resources to meet their child´s needs, and ensures implementation of the IFSP.
Comprehensive Transitional Care - Discharge planning, help to new programs Transition Planning - Planning for all children exiting the Early Intervention Program, either to other supports/services in the community or to the Committee on Preschool Special Education (CPSE) in the child´s local school district
Patient and Family Support - Assist with appointments and meetings Child and Family Support - Assisting with coordinating appointments and meetings
Referrals to Community and Social Supports - Link to services and resources Referrals to Community and Social Supports - Linking children and their families to services and resources
1915(c) Children´s Waiver, children who also meet Home and Community Based Services (HCBS) eligibility will be able to receive the services below based on need and assessment: Early Intervention Service Coordinators will coordinate the following services for children and families who are enrolled in the Early Intervention Program:
  Supplemental Evaluations
Services Services
Community Habilitation Applied Behavior Analysis (ABA)
Day Habilitation Assistive Technology Devices (ATD) and Services
Prevocational Services Audiology
Supported Employment Family Training
Planned and Crisis Respite Health Services
Adaptive and Assistive Equipment Medical Services
Environmental Modifications (home accessibility) Nursing Services
Vehicle Modifications Nutrition Services
Caregiver/Family Supports and Services Occupational Therapy
Community Self-Advocacy Training and Supports Physical Therapy
Non-Medical Transportation Psychological Services
Palliative care - Expressive Therapy Respite Services
Palliative care - Pain and Symptom Management Special Instruction
Palliative care - Bereavement Service Speech-Language Pathology
Palliative care - Massage Therapy Social Work Services
    Vision Services

Descriptions of Children´s Waiver Services:

Community Habilitation: Community habilitation covers services and supports related to the person´s acquisition, maintenance and enhancement of skills necessary to independently perform Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), and/or health-related tasks, which may help a person who has difficulties with skills related to: self- care, life safety, medication and health management, communication skills, mobility, community transportation skills, community integration, appropriate social behaviors, problem solving, and money management.

Day Habilitation: Assistance with acquisition, retention or improvement in self-help, socialization and adaptive skills including communication, and travel that regularly takes place in a non-residential setting, separate from the person´s private residence or other residential arrangement. Activities and environments are designed to foster the acquisition of skills, appropriate behavior, greater independence, community inclusion, relationship building, self-advocacy and informed choice.

Prevocational Services: Prevocational services are individually designed to prepare a youth (age 14 or older) to engage in paid work, volunteer work or career exploration. Prevocational services are not job-specific, but rather are geared toward facilitating success in any work environment for youth whose disabilities do not permit them access to other prevocational services.

Supported Employment: Supported employment services are individually designed to prepare youth with disabilities (age 14 or older) to engage in paid work. Supported employment services provide assistance to participants with disabilities as they perform in a work setting.

Respite: This service focuses on short-term assistance provided to children/youth regardless of disability (developmental, physical and/or behavioral) because of the absence of or need for relief of the child or the child´s family caregiver. Such services can be provided in a planned mode or delivered in a crisis situation.

Adaptive and Assistive Equipment: This service provides technological aids and devices identified within the child´s Plan of Care (POC) which enable him/her to accomplish daily living tasks that are necessary to support the health, welfare, and safety of the child.

Environmental Modifications: This service provides internal and external physical adaptations to the home or other eligible residences of the enrolled child which per the child´s plan of care (POC) are identified as necessary to support the health, welfare and safety of the child or that enable the child to function with greater independence in the home and without which the child would require institutional and/or more restrictive living setting.

Vehicle Modifications: This service provides physical adaptations to the primary vehicle of the enrolled child which per the child´s plan of care (POC) are identified as necessary to support the health, welfare and safety of the child or that enable the child to function with greater independence.

Caregiver/Family Supports and Services: Caregiver/family supports and services enhance the child´s/youth´s ability regardless of disability (developmental, physical and/or behavioral), to function as part of a caregiver/family unit and enhance the caregiver´s/family´s ability to care for the child/youth in the home and/or community. Family is broadly defined and can include families created through birth, foster care, adoption, or a self-created unit.

Community Self-Advocacy Training and Supports: Community self-advocacy training and support provides children/youth, family, caregivers, and collateral contacts with techniques and information not generally available so that they can better respond to the needs of the participant. Community self-advocacy training and support is intended to assist the child/youth, family/caregiver, and collateral contacts in understanding and addressing the participant´s needs related to their disability(ies).

Non-Medical Transportation: Non-medical transportation services are offered, in addition to any medical transportation furnished under the 42 CFR 440.17(a) in the State Plan. Non - medical transportation services are available for individuals to access authorized HCBS and destinations that are related to a goal included on the child/youth´s Plan of Care.

Palliative care: Palliative care is specialized medical care focused on providing relief from the symptoms and stress of a chronic condition or life-threatening illness. The goal is to improve quality of life for both the child and the family. Palliative care is provided by a specially trained team of doctors, nurses, social workers and other specialists who work together with a child´s doctors to provide an extra layer of support. It is appropriate at any stage of a chronic condition or life-threatening illness and can be provided along with curative treatment.

  • Expressive Therapy: (Through art, music, and play) helps children better understand and express their reactions through creative and kinesthetic treatment.
  • Pain and Symptom Management: Relief and/or control of the child´s suffering related to their illness or condition.
  • Bereavement Service: Help for participants and their families to cope with grief related to the participant´s end-of-life experience. Bereavement counseling services are inclusive for those participants in receipt of hospice care through a hospice provider.
  • Massage Therapy: To improve muscle tone, circulation, range of motion and address physical symptoms related to their illness.

Descriptions of Early Intervention Program Services:

All Early Intervention Program services are provided in accordance with the child/family´s Individualized Family Service Plan (IFSP). Services are delivered individually or in a group. Service delivery models include individual home and community-based services and facility-based services.

Applied Behavior Analysis (ABA): The design, implementation, and evaluation of systematic environmental changes to produce socially significant change in human behavior through skill acquisition and the reduction of problematic behavior. ABA includes direct observation and measurement of behavior and the identification of functional relations between behavior and the environment. These include contextual factors such as establishing operations, antecedent stimuli, positive reinforcers, and other consequences that are used to produce the desired behavior change.

Assistive Technology/Devices: Adaptive device means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of children with disabilities. This does not include a medical device that is surgically implanted, including a cochlear implant, or the optimization (e.g., mapping), maintenance, or replacement of that device. Assistive technology is a service that directly assists a child with a disability in the selection, acquisition, or use of an assistive technology device. Assistive technology services include: the evaluation of the needs of a child with a disability, including a functional evaluation of the child in the child´s customary environment; purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices by children with disabilities; coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing education and rehabilitation plans and programs; training or technical assistance for a child with disabilities or, if appropriate, that child´s family; and, training or technical assistance for professionals, (including individuals providing early intervention services) or other individuals who provide services to, or are otherwise substantially involved in, the major life functions of individuals with disabilities.

Audiology: Identification of children with auditory impairment, using at risk criteria and appropriate audiologic screening techniques; determination of the range, nature, and degree of hearing loss and communication functions, by use of audiological evaluation procedures; referral for medical and other services necessary for the habilitation or rehabilitation of children with auditory impairment; provision of auditory training, aural rehabilitation, speech reading and listening device orientation and training, and other services; provision of services for prevention of hearing loss; and family training, counseling, home visits and parent support groups, including services provided, as appropriate, by social workers, psychologists, and other qualified personnel to assist the family of a child eligible under this part in understanding the special needs of the child and enhancing the child´s development.

Family Training: Includes family training, counseling, home visits and parent support groups, including services provided, as appropriate, by social workers, psychologists, and other qualified personnel to assist the family of a child eligible under this part in understanding the special needs of the child and enhancing the child´s development.

Health Services: Services necessary to enable a child to benefit from the other early intervention services during the time that the child is receiving other early intervention services. The term includes such services as clean intermittent catheterization, tracheostomy care, tube feeding, the changing of dressings or colostomy collection bags, and other health services; and consultation by physicians with other service providers concerning the special health care needs of eligible children that will need to be addressed in the course of providing other early intervention services.

Medical Services: Services only for diagnostic or evaluation purposes means services provided by a licensed physician to determine a child´s developmental status and need for early intervention services subject to reasonable prior approval requirements for exceptionally expensive services as prescribed by the Commissioner.

Nursing Services: An assessment of health status for the purpose of providing nursing care, including the identification of patterns of human response to actual or potential health problems, provision of nursing care to prevent health problems, restore and improve functioning, and promote optimal health and development. Administration of medications, treatments, and regimens prescribed by a licensed physician.

Nutrition Services: Conducting individual assessments in nutritional history and dietary intake; anthropometric, biochemical, and clinical variables; feeding skills and feeding problems; and, food habits and food preferences; developing and monitoring appropriate plans to address the nutritional needs of eligible children; and making referrals to appropriate community resources to carry out nutrition goals.

Occupational Therapy: Includes services to address the functional needs of a child related to adaptive development, adaptive behavior and play, and sensory, motor, and postural development. These services are designed to improve the child´s functional ability to perform tasks in home, school, and community settings, and include: identification, assessment, and intervention; adaptation of the environment, and selection, design and fabrication of assistive and orthotic devices to facilitate development and promote the acquisition of functional skills; and prevention or minimization of the impact of initial or future impairment, delay in development, or loss of functional ability.

Physical Therapy: Includes services to address the promotion of sensorimotor function through enhancement of musculoskeletal status, neurobehavioral organization, perceptual and motor development, cardiopulmonary status and effective environmental adaptation. These services include: screening, evaluation, and assessment of infants and toddlers to identify movement dysfunction; obtaining, interpreting, and integrating information appropriate to program planning, to prevent, alleviate, or compensate for movement dysfunction and related functional problems; and providing individual and group services or treatment to prevent, alleviate , or compensate for movement dysfunction and related functional problems.

Psychological Services: Administering psychological and developmental tests, and other assessment procedures; interpreting assessment results; obtaining, integrating, and interpreting information about child behavior and child and family conditions related to learning, mental health, and development; and planning and managing a program of psychological services, including psychological counseling for children and parents, family counseling, consultation on child development, parent training, and education programs.

Respite Services: The provision of respite services for an eligible child and family shall be determined based on the individual needs of the child and family, and with consideration given to the following criteria: severity of child´s disability and needs; potential risk of out-of-home placement for the child if respite services are not provided; lack of access to informal support systems (e.g., extended family, supportive friends, community supports, etc.); lack of access to other sources of respite (e.g., Family Support Services under the auspices of the Office of People with Developmental Disabilities and respite provided through other state early intervention service agencies), due to barriers such as waiting lists, remote/inaccessible location of services, etc. presence of factors known to increase family stress (e.g., family size, presence of another child or family member with a disability, etc.); and, the perceived and expressed level of need for respite services by parent.

Special Instruction: The design of learning environments and activities that promote the child´s acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction; curriculum planning, including the planned interaction of personnel, materials, and time and space, that leads to achieving the outcomes in the child´s individualized family service plan; providing families and any primary caregivers (e.g., child care providers) with information, skills, and support related to enhancing the skill development of the child; and working with the child to enhance the child´s development.

Speech-Language Pathology: Identification of children with communicative or oropharyngeal disorders and delays in development of communication skills, including the diagnosis and appraisal of specific disorders and delays in those skills; referral for medical or other professional services necessary for the habilitation or rehabilitation of children with communicative or oropharyngeal disorders and delays in development of communication skills; and provision of services for the habilitation, rehabilitation, or prevention of communicative or oropharyngeal disorders and delays in development of communication skills.

Supplemental Evaluations: Supplemental evaluations shall include supplemental physician or non-physician evaluations and shall be provided upon the recommendation of the multi- disciplinary team conducting the core evaluation and agreement of the child´s parent. A supplemental evaluation may also be provided in conjunction with the core evaluation by a specialist trained in the area of the child´s suspected delay or disability who is present during the core evaluation and who provides an in-depth assessment of the child´s strengths and needs in such area. Supplemental evaluations provided subsequent to the child´s Individualized Family Service Plan (IFSP) must be required by and performed in accordance with the IFSP.

Social Work Services: Making home visits to evaluate a child´s living conditions and patterns of parent-child interaction; preparing a social/emotional developmental assessment of the child within the family context; providing individual and family-group counseling with parents and other family members, and appropriate social skill building activities with the child and parents; working with those problems in a child´s and family´s living situation (home, community, and any center where early intervention services are provided) that affect the child´s maximum utilization of early intervention services; and identifying, mobilizing, and coordinating community resources and services to enable the child and family to receive maximum benefit from early intervention services.

Transportation: Transportation and related costs includes the cost of travel (e.g., mileage or travel by taxi, common carrier, or other means) and other costs (e.g., tolls and parking expenses) that are necessary to enable an eligible child and the child´s family to receive early intervention services.

Vision Services: Evaluation and assessment of visual functioning, including the diagnosis and appraisal of specific visual disorders, delays, and abilities; referral for medical or other professional services necessary for the habilitation or rehabilitation of visual functioning disorders, or both; and communication skills training, orientation and mobility training for all environments, visual training, independent living skills training, and additional training necessary to activate visual motor abilities.