Information Guide For Navigating the System
Intake into the Developmental Services (DS) System (to register for DS Supports Coordination Services)
- You can call Westmoreland Casemanagement and Supports, Inc. directly and speak to an intake worker at (800) 353-6467
- You can register via the internet by visiting Pennsylvania website.
- The intake worker will take care of securing the information needed to determine eligibility for services and complete the initial intake. Eligibility requirements are as follows:
- IQ 70 or below
- Onset of Mental Retardation prior to the 22nd birthday
- Having below average intellectual functions along with limitations in two or more of the following areas: communication, self-care, home living, social skills, functional academics, leisure, and work.
Supports Coordinator (SC)
After eligibility is determined, a Supports Coordinator will be assigned. They will speak with you about your needs and help you plan accordingly. They will locate, coordinate, and monitor your services.
You will be offered a choice Service Preference to determine if you are interested in ICF / MR (Intermediary Care Facility for the Mentally Retarded) services or Home and Community-Based Services. You will be asked to document your choice and complete an application for MR services.
The individual will have a funding amount assigned to them based on their service needs. The SC will work with the individual’s team to develop a personal budget within their funding. The individual will have a choice of providers and services. The budget will include all OMR funded services and supports.
Monitoring varies based on the requirements of the program in which you are enrolled. Your SC will call and schedule a monitoring visit (monitoring may be a phone call if under PFDSW) to determine if you have unmet service needs, all health and safety needs are being met and you are happy with your services and supports.
Home & Community-Based Services Information System
Home & Community-Based Services Information System (HCSIS) is Pennsylvania’s statewide MR System data base. All ISPs, case notes, PUNS, HRPs, monitoring forms, IM, billing, etc. are stored in the system.
Currently individuals / family access to the system is the services and supports directory which includes information on locating services and service providers in and surrounding your county.
When there is a dispute between you and the county MH/MR Office concerning identification, evaluation or the provision of appropriate supports, you can request Mediation. In mediation, everyone agrees to work together with an impartial mediator. Mediation is through an independent mediation entity which is currently the (ODR) Office of Dispute Resolution. The address of ODR is: Office for Dispute Resolution, 6340 Flank Drive Suite 600, Harrisburg, PA 17112. Phone: 1-800-992-4334
Hearing / Appeal
This is a formal process you can use when you have a problem concerning one of the Waivers that you cannot solve with your county MH / MR Office. The first step is to have a county conference, if still no resolution, then you must complete the Fair Hearing Request Form (MR 458) given to you by your SC as part of service preference. A hearing will be held and a hearing officer will make a decision.
The practice of people with developmental disabilities making choices for themselves and having control over all aspects of their lives including the supports and services they receive. Our goal is for everyone to have “Everyday Lives.”
Targeted Service Management (TSM)
A Federal Medicaid Program that offers services to individuals with mental retardation who are eligible under the State Medical Assistance Plan. Through this program, individuals are assisted by their supports coordinators in gaining access to needed medical, social, vocational, and other services through service management. Service management consists of locating, coordinating, and monitoring necessary and appropriate services for individuals enrolled.
Health Insurance Portability and Accountability Act (HIPPA)
Passed in 1996, the act requires the development of standard transaction codes and security requirements to create a more simplified environment for processing medical claims. This act is being administered by CMS. Home and Community-Based Waiver Services are included in HIPAA legislation.