Crisis
Applying for Crisis Waiver
Reasons to Apply
In Crisis - Crisis can resolve in 6-8 weeks but long-term mental health treatment may also be needed. Family health will determine how the crisis situation resolves by recognizing strengths and limitations, watching for signs of crisis, seeking help, and accessing resources
Client needs support
To increase independence
To minimize problem behavior
To bypass the financial cap to access medicaid
To receive insurance, to alleviate financial burden/stress with expensive medical care
To get respite (PCS - self-directed supports, SHC - agency directed supports, overnight respite etc.)
To assist with day/residential services
To access specialists (ABA, OT, PT, Speech, Medical, Dental, etc.) and receive coverages that other insurances don’t cover
Access durable medical equipments, including diapers above toilet training age
Help with necessary home modifications
…
Eligibility Checklist
PARENT/GUARDIAN EXPRESS CONCERN
INITIATE A CRISIS MEETING
Meet with a case manager or designated representative to help better understand services and crisis applications
Include parent, BCBA (if available), company representative as this can be a daunting task
DETERMINE Adverse incidence/CRISIS SITUATION: Begin documenting the crisis situation, the state will need to ensure that the crisis situation is not resolved and long-term treatment is needed. The CDDO has a frequency checklist they use, collect ABC data.
Select type: Crisis can be related to a variety of aspects of the child’s life
-risk of abuse neglect exploitation in current state
-risk of harm to self or others in current state
Select adverse incidents:
Preventable death- Any death that occurs as a direct result of the actions (or lack thereof) of any CSP provider that can be reasonably confirmed by the providers or upon medical examination
Physical abuse - Any allegation of intentionally or recklessly causing physical harm to a consumer by any other person, while receiving a CSP service.
Inappropriate sexual contact - Any allegation of intentional touching of a sexual nature, of any consumer, who does not give consent or is incapable of resisting or declining consent due to mental deficiency, or disease, or fear of retribution or hardship. In addition: Consumers receiving services in any KDADS CSP licensed or certified program who are under the age of 18 years of age cannot give consent. Any allegation of intentional touching of a sexual nature, by a provider, towards consumer is inappropriate sexual contact
Misuse of medications - The incorrect administration or mismanagement of medication, by someone providing a CSP service which results in or could result in serious injury or illness to a consumer.
Psychological abuse - A threat or menacing conduct directed toward an individual that results in or might reasonably be expected to cause emotional distress, mental distress or fear to an individual.
Neglect - The failure or omission by one’s self, caretaker or another person with a duty to supply or to provide goods or services which are reasonably necessary to ensure safety and well-being and to avoid physical or mental harm or illness.
Suicide - Death caused by self-directed injurious behavior with any intent to die as a result of the behavior.
Suicide attempt - A non-fatal self-directed potentially injurious behavior with any intent to die as a result of the behavior. A suicide attempt may or may not result in injury.
Serious injury – An unexpected occurrence involving the significant impairment of the physical condition of a consumer. Serious injury specifically includes loss of limb or function.
Elopement – The unplanned departure from an inpatient unit or facility where a consumer leaves without prior notification or permission or staff escort.
High profile event - Any situation which is likely to result in negative media coverage or involvement of the Kansas Legislators or complaints to the Governor’s office.
Natural disaster – Any closure or evacuation of a facility due to fire, storm damage or mechanical system failure that may result in major expenditures or work stoppage or any significant event affecting consumers.
Gather documents:
RECEIVE A MEDICAL DIAGNOSIS - You will need a medical diagnosis to initiate I/DD waiver services by a qualified medical provider and not an educational diagnosis
Other: Initial applications and eligibility paperwork. IEP, guardianship or power of attorney paperwork, identification cards, screening assessments etc.
Apply for other waivers For example - In Kansas, the Autism Waiver It is through age 5 for ENTRY
1. enter through age 5
2. eligible for 3 years + 1 extension (thus, if they entered into the waiver at 5 years, 363 days they would be eligible for 5 years 363 days + 3 years = 8 years 363 day with the potential for 1 year extension to age 9 years 363 days)
3. automatically (with correct paperwork) accepted onto the I/DD waiver
REACH OUT TO MENTAL HEALTH AGENCY: Access other programs such as the SED waiver, or other services
APPLY FOR MEDICAID: You want to apply for medicaid, as programs can be helpful. For example: ABA can be accessed through EPDST program. Also having a Medicaid number will ensure a timely transition on to the waiver KDADS approves
APPLY TO THE CDDO (or state waiver medicaid department): Client meets with CDDO and completes the CDDO application along with eligibility paperwork. Forms include IDs cards, IEP, Medical (not educational) Diagnosis , guardianship paperwork (if applicable), POA, Paperwork, Health Assessment
NOTIFY THE CDDO THAT YOU ARE IN CRISIS AND/OR NEED IMMEDIATE ASSISTANCE: The CDDO won’t know the crisis situation unless you tell them. IBT had a case in which a client received the I/DD waiver simply by notifying the CDDO.
Access through
Waitlist - wait time varies
Crisis application to I/DD waiver (age 5) - some CDDOs/state waiver programs want to begin this process earlier than age 5
PRTF discharge
Military exception policy to I/DD waiver (age 5)
Transfer off another waiver (i.e. Autism Waiver)
IF YOU HAVE MEDICAID, NOTIFY THE MEDICAID TEAM THAT YOU ARE IN CRISIS - IBT had a client whose brother was on the Autism Waiver waitlist and we indicated we were going to apply for crisis, but right before his 6th birthday he was offered placement onto the waiver, not sure if this was a coincidence.
THE CDDO DETERMINES ELIGIBILITY: The CDDO has 45 days to determine eligibility.
THE CDDO COMPLETES BASIS ASSESSMENT: The CDDO will complete an initial Basis Assessment. This will determine if the client is eligible for I/DD services and tiers into services. A diagnosis itself doesn’t indicate need, the client must tier 1-5 on the state Basis assessment. A current basis is required to submit for Crisis. Note- There will be a new assessment starting in 2025.
CDDO PROVIDES TIER SCORE: Services are offered if a tier score of 1-5 is given for basis and 1-3 (tentatively) for the new assessment. This is tied to funding.
CHOOSE A REPRESENTATIVE:
TCM Targeted Case Manager paid through Medicaid
TCM private pay (sliding fee scale)
Designated Representative (some CDDO’s authorize a representative to help complete this paperwork)
INITIATE CRISIS WAIVER PROCESS
CRISIS WAIVER PROCESS
CHILD IS 5+ YRS OF Age: Crisis can be initiated at age 5. TCM services can be initiated sooner (Medicaid or private pay). If under 5, begin collecting documents and submit once the child turns 5. IBT did this and we had a smooth transition when a client turned 5.2. Some CDDOs (i.e., Riverside Resources) reported that they like to start the process earlier than 5.
CHOOSE AVENUE TO RECEIVE I/DD SERVICES: If tiered, the client will then be placed on a waitlist for services. If you wish to bypass the waitlist, you would need to submit an exception. There are ways to obtain I/DD waiver services (this will bypass parental income and allow children/adults to access paid supports/Medicaid)
Wait until the name is selected to receive funds (this could take many years): IBT had a few clients who received services based on time. One child was 12. Another 18.
Transition off of another waiver (i.e., Autism Waiver, SED waiver): IBT has had clients transition off the autism waiver (3 yrs + 4th yr exception) onto the I/DD waiver.
Submit military exemption paperwork if active duty: IBT had a client whose father was in the national guard. He deployed for 2 months and became active duty. We were able to submit for the military exemption policy. You don’t just need to be active duty 100% of the time.
Apply for the crisis waiver (most typical of clients with IBT), to immediately draw down funds - must Meet crisis waiver criteria and choose an advocate to assist with the crisis application. It may take up to 10 hours to work on this request. 1. Be at risk of abuse, neglect or exploitation in the current state or at risk of self-injurious behavior or harm to others in the current state. Identify someone to help with the application process.
A crisis situation includes on of the following
1. At risk of abuse neglect or exploitation in current state
2. At risk of self-harm or injury to self or others in current state
Transition out of a PRTF or residential facility (i.e. Lake Mary). IBT did assist a client transitioning to a PRTF to stabilize behaviors. Medicaid will push for discharge so beware.
COMPLETE ANY ADDITIONAL TCM/CRISIS PAPERWORK
If a client has current Medicaid, we ask that a TCM be identified to help with this process.
Establish a crisis team to assist with the paperwork and who will be leading the paperwork
Designate timeline (ideally, we would want to submit for crisis in 30 days)
COMPLETE HIPAA RELEASE OF INFO DOCUMENTS
KDADS
CDDO
DCF
TCM agency
Medical teams
School
Other
INITIATE A CRISIS MEETING
Crisis Team Members present - Parent/Guardian, TCM/Representative, BCBA/Autism Specialist, TCM from outside agency if applicable - please note concurrent billing, two TCMs cannot bill for the same service at the same time.
Determine who will lead the crisis request
Review process
Timeline
COMPILE PAPERWORK: Compile the folllowing paperwork and send to TCM/representative in a timely manner
Community reference letters of support , exhaust natural supports, to strengthen application (see example). These letters do not need to be long.
Parent or Guardian Letter - must report if their the parent/guardian has natural support assistance (must exhaust natural supports before paid supports)
Natural Support Letters - letters of support from neighbors or relatives
TCM / Representative Letter - briefly describes cover crisis state
ABA Letters - From behavior analysis or BCBA, treatment team (BCBAs, BT, SHC)
School Letters - principle, teachers, SPED teacher, para, SLP, OT, PT etc
Medical Team Letters - (specialists, primary care doctor, medical necessity letters, private therapies)
Mental Health Agency letter - Exhaust mental health agency - Letter from the Mental Health agency that states I/DD waiver best suits client needs to work on core deficits of autism. This is needed as you must bypass all other waivers including the SED waiver!!! The letter can simply say that the client needs assistance with core deficits of autism. Even clients with limited verbal ability needed to be screened by the mental health agency to bypass the SED waiver.
DCF Letter (as applicable) - Any Documented contact with DCF, Police or Family Crisis Response Helplines: 833-441-2240 - in certain cases, EMS, law enforcement, and/or the mobile crisis response units that have assisted (i.e. mental health respite agency)
Medicaid Note - Apply for Medicaid and get a denial letter - we need to exhaust regular avenues for Medicaid - in other words we need a medicaid number to indicate that you don’t qualify for other medicaid services) - Exhaust other insurance benefits
Community Involvement Letters - includes letters from the community expressing need. May include letters from church, volunteer organizations, sports teams, scouts, YMCA, etc
ADDITIONAL DOCUMENTS
Eligibility paperwork and state assessment (CDDO/waiver department likely has this after completion)
CDDO justification to crisis form
CDDO documents PCSP/Needs Assessment
CDDO document MR12 form indicating what other members of the household are doing/when
Support letters (see above)
IEP and school documents (i.e. ABC log, progress reports, incident reports, email communication logs)
Health Assessment - KANBEHEALTHY (if possible)
Behavior plan (Intensity of crisis situation, ABC data, assessments, ™ notes, BIP, etc.) If you don’t have a BIP - Parsons Dual Diagnosis Outreach Team (if behavior plan is not available) can assist
IBP Plan of care (ABA treatment plan) if applicable
Other plans such as a counselor plan (may build crisis plan, define roles for family members, natural support members, and other professionals, goals)
Exhaustive resource list in the area (waitlists, agencies that cannot assist)
ER documents (if applicable): Letters of support by emergency rooms, nurses and physicians. Report family structure, communication patterns, past and current relationships, the strength of marital relationships, and parental experiences. Nurses should provide patient-centered planning, helping patients understand the perception and impact of the problem (risk of self-harm, coping skills, and skills tried to cope with conflict), offering financial, social, and community resources, possible intervention strategies to help return to previous levels of functioning while referring to appropriate mental health service providers. Examine social relationships including who is living in the household, extended family members, friendships, trusted people, community or other activities, financial resources, transportation needs, and occupations (Parsons, 2003).
Follow-up Plans (if available) (outpatient or inpatient services) - Follow plans: Work with a counselor to build a crisis plan, define roles for family members, natural support members, and other professionals, Create person-centered planning, support coordination, transition planning, and apply for the crisis waiver
Police documents
Any Mandated Reporting documents -Kansas Protection Reporting Center - 800-922-5330, DCF
DCF case findings (if applicable)
Other
Compile Crisis Packet and Submit to CDDO (or waiver department)
Compile
Submit to local review board
Submit to state review board
References:
Myers, d. (1995). Eliminating the battering of women by men: some considerations for behavior analysis. 28. 493-507.
Parsons, C. (2003). Caring for adolescents and families in crisis. The Nursing Clinics of North America. 38:1. 111-122