DDS-Administered Home and Community Based Services (HCBS) Waiver
- Participating Physician Groups (PPG)
The primary goal of the Department of Developmental Services' (DDS)-administered Home and Community Based Services (HCBS) Waiver Program is to ensure consumer choice of waiver services and consumer satisfaction, and to provide safeguards necessary to ensure the health and safety of each consumer in the program. The DDS administered HCBS waiver program includes an array of services designed to support those with developmental disabilities in either a home or community-based setting as an alternative to care in a care facility for the developmentally disabled.
The DDS-administered HCBS waiver program is available to developmentally disabled persons regardless of their age. A developmental disability is defined as a disability that originates before an individual attains the age of 18, continues, or can be expected to continue indefinitely, and constitutes a substantial disability for that individual. This term includes intellectual disabilities, cerebral palsy, epilepsy and autism. This term also includes, disabling conditions found to be closely related to intellectual disability, but shall not include other handicapping conditions that are solely physical in nature.
The services provided under the HCBS waiver program for persons with developmental disabilities are not covered under Health Net's Medi-Cal contracts. Health Net's goal is to implement and maintain systems to identify members with developmental disabilities that may meet the requirements for participation in the DDS-administered HCBS waiver program and refer these members to the waiver program.
Once Health Net determines a member may meet the requirements for participation in the Department of Development Services (DDS)-administered Home and Community-Based Services (HCBS) waiver program, Health Net initiates a referral. A regional center service coordinator is assigned to coordinate the waiver services. Receipt of DDS-administered HCBS services do not require a member to be disenrolled from the plan. The primary care physician (PCP) continues to provide all medically necessary covered services and coordinates the member's care. Health Net is responsible for coordinating with the regional center care manager and the PCP in the development of the member's individual service plan and individual education plan.
If the member is currently receiving services through the DDS program, Health Net coordinates services with the PCP and regional center service coordinator.
If the member does not meet the criteria for the waiver program or if placement is unavailable, Health Net's PCP continues to manage the care and provide all covered medically necessary services to the member.
The Department of Developmental Services (DDS) has administrative responsibility for the state's five developmental centers and 21 regional centers. DDS oversees the regional centers and administers the Home and Community Based Services (HCBS) waiver program. There are four types of care settings in which specialized services may be delivered through the DDS-administered HCBS waiver program:
- Member's family home
- Local intermediate care facility (ICF), licensed as an ICF for the developmentally disabled (ICF/DD)
- Local habilitative developmental disability care facility, licensed as an ICF for the developmentally disabled-habilitative (DD-H)
- Local nursing developmental disability care facility, licensed as an ICF for the developmentally disabled-nursing (DD-N)
The regional center service coordinator is responsible for determining the DDS administered HCBS waiver setting that is best for the eligible developmental disabled member. Although the regional centers provide overall care management, they are not responsible for direct medical services. During the member's participation in the DDS-administered HCBS waiver program, a Health Net participating primary care physician (PCP) continues to provide all primary care and other medically necessary services.
Health Net's utilization management (UM) staff monitors and reviews inpatient stays to, among other things, identify members who may benefit from the Department of Developmental Services (DDS)-administered Home and Community Based Services (HCBS) waiver program. Health Net works to ensure that potentially eligible members are referred in a timely manner.
Regional center staff determines eligibility and are responsible for overall care management. Problems that arise between the regional center and Health Net or the primary care physician (PCP) are resolved by Health Net's public programs administrators. Health Net's care manager continues to coordinate and authorize all immediate health care needs for the member in collaboration with the PCP or specialty provider until the matter is resolved.
Health Net coordinates referrals to the regional center when notified of a member with a potential need for supportive care and facilitates medical records from the member's primary care physician (PCP) for the Department of Developmental Services (DDS) administered Home and Community-Based Services (HCBS) waiver program.
Regional centers are nonprofit private corporations that contract with DDS to provide or coordinate the services and supports for individuals with developmental disabilities. They have offices throughout California to provide local resources to help find and access the many services available to these individuals and their families.