Participant and Recovery Coach review 2 year historical spending on Behavioral Healthcare (doesn't include inpatient and crisis spending) Spending Plan to Support / Recovery Plan Established Within the individual budget, participant and Recovery Coach establish a spending plan to support the Recovery Plan Freedom Funds Any savings in use of in-plan services can be used to purchase non-traditional services. Care Manager at BH-MCO must authorize all expenditures Table 2 provides a comparison of the self-directed models currently available in Pennsylvania. Table 2: Comparison of SDC Options in Pennsylvania ID Waivers Attendant Care OBRA, CRIF (P/FDS and and Aging COMMCARE, Consolidated) Independence Target Ages 3+ with Attendant Care: OBRA: 18-59 Delaware County Population intellectual Physical disability severe physical HealthChoices disability and ages 18-59 developmental adults and ICF/ID Level of Nursing Facility disability requiring transition age Care level of care ICF/ORC Level of with a SMI, Care 18 to 65 years of Aging: Age 60+ age, with 295 or Need Nursing Commcare: 21+ 296 DSM IV-R Facility level of care TBI and Nursing diagnoses. Facility level of care Utilization of Independence: Medicaid mental physical health and/or drug disability or alcohol services Nursing Facility at least once every of care 3 months over the last 2 years Legally competent to manage own affairs Consenting to treatment and evaluation
Participant and Recovery Coach review 2 year historical spending on Behavioral Healthcare (doesn't include inpatient and crisis spending) Spending Plan to Support / Recovery Plan Established Within the individual budget, participant and Recovery Coach establish a spending plan to support the Recovery Plan Freedom Funds Any savings in use of in-plan services can be used to purchase non-traditional services. Care Manager at BH-MCO must authorize all expenditures Table 2 provides a comparison of the self-directed models currently available in Pennsylvania. Table 2: Comparison of SDC Options in Pennsylvania ID Waivers (P/FDS and Consolidated) Attendant Care and Aging OBRA, COMMCARE, Independence CRIF Target Population Ages 3+ with intellectual disability and ICF/ID Level of Care Attendant Care: Physical disability ages 18-59 Nursing Facility level of care Aging: Age 60+ Need Nursing Facility level of care OBRA: 18-59 severe physical developmental disability requiring ICF/ORC Level of Care Commcare: 21+ TBI and Nursing Facility level of care Independence: physical disability Nursing Facility of care Delaware County HealthChoices adults and transition age with a SMI, 18 to 65 years of age, with 295 or 296 DSM IV-R diagnoses. Utilization of Medicaid mental health and/or drug or alcohol services at least once every 3 months over the last 2 years Legally competent to manage own affairs Consenting to treatment and evaluation
SDC_BH_System_PA_2015.docx