Regional Resource Development Specialist (RRDS)
The RRDS is responsible for the development, management, administration, and monitoring of the NHTD waiver for the RRDC on a regional level. The RRDS promotes participant choice, ensures the delivery of high quality services, assists in the development of needed waiver services and oversees waiver cost-effectiveness.
The RRDS communicates regularly with DOH, collaborates with local government entities, service providers and advocacy groups to be an active member of the network of services and supports in the community.
The RRDS will have:
- Demonstrated expertise working with individuals with disabilities and seniors and extensive familiarity with the operation of 1915 (c) waivers and community-based services;
- Knowledge, skills, and/or abilities to assess, identify and address gaps in services;
- Excellent screening and interviewing skills;
- Excellent communication and presentation skills;
- Ability to develop and maintain collaborative relationships with regionally based stakeholders, including LDSS, other local government entities, providers, advocacy organizations and others necessary to assure a comprehensive coordinated approach to services for individuals with individuals with disabilities and seniors;
- Working knowledge of community-based resources for individuals with disabilities and/or seniors;
- Excellent problem-solving and investigating skills;
- Working knowledge of Medicaid, Medicare and/or other third party payers;
- Skill in coordinating activities, evaluating data and establishing priorities; and
- Meet all additional qualifications outlined in the RRDC contract.
Roles and Responsibilities of the RRDS
It is the responsibility of the RRDS to assist DOH in ensuring that waiver participants in New York State, who are individuals with disabilities and seniors, are able to live as independently as possible in the community. The RRDS works closely with DOH to provide data and input as needed regarding the administration of the NHTD waiver in their region.
The RRDS has the right to meet with the participant at any time or place and has the right to access all records regarding a participant's or a provider's activities related to the waiver.
RRDS responsibilities include:
1. Information, Resource and Referral
- Work closely with DOH to disseminate public information regarding the waiver's ability to meet the needs of individuals with disabilities and seniors;
- Respond to calls from individuals with disabilities and seniors, family members, advocates, professionals and others requesting information regarding waiver services;
- Provide resource information and education regarding the community-based needs of individuals with disabilities and seniors;
- Interview all prospective participants who have indicated interest in returning to the community;
- Meet with prospective waiver participants to explain the waiver philosophy and services and make a preliminary non-financial determination of appropriateness for the waiver;
- Make referrals to available resources in the community if an individual is determined not eligible for the waiver;
- Track referrals and intakes; and
- Maintain an informational database vital to the analysis of the effectiveness of the NHTD waiver.
2. Development of Community Resources
- Assess and identify regional waiver and non-waiver service capacity to meet the demands for waiver participation in the contracted area and report to DOH;
- Provide data to DOH regarding regional needs, outcomes, quality assurance and improvement and cost savings as part of quarterly reports and at other times upon request;
- Develop and implement a comprehensive outreach campaign to recruit waiver service providers;
- Promote the quality and availability of services sufficient to allow waiver participants the real opportunity of choosing providers;
- Develop strong linkages with inpatient rehabilitation units and long term care facilities to identify potential participants and to facilitate community re-entry from these institutions;
- Develop linkages with community-based health care providers to promote quality and availability of services;
- Develop and maintain relationships with existing local and state entities, including Point of Entry, advocacy groups and providers of community-based services for people with disabilities and seniors and their families;
- Maintain an open, collaborative relationship with LDSSs to understand historical information regarding the individual's prior use community based services and, coordinate and utilize Medicaid State Plan and waiver services, as well as other services that impact the health and welfare of the individual in the community (e.g. Adult Protective Services);
- Serve as a liaison between the NHTD waiver and the community by joining the Regional Task Force focusing on individuals with disabilities and seniors, or develop one if one does not exist; and
- Recommend to DOH any waiver service providers that should be surveyed and/or audited.
3. Manage Provider Enrollment and Training
- Interview potential waiver service providers using the RRDS Provider Interview form (refer to Appendix B – form B.8);
- Make provider enrollment recommendations to DOH based on factors such as the provider's understanding of the waiver philosophy, the provider's staff qualifications, the provider's established policies and procedures, participant choice and control, and the provider's ability to deliver high quality, services (refer to Section VI –Waiver Services; and
- Provide training to potential waiver service providers regarding the philosophy, policies and procedures of the waiver; participant needs; development and implementation of comprehensive waiver SPs, and standard documentation and reporting requirements
NOTE: NHTD has developed standardized trainings using the 'Training of Trainer' model for the following: Overview of NHTD waiver program; Service Coordination 101; ILST 101; and HCSS 101.
4. Interview and Preliminary Assessment of Potential Waiver Participants
- Meet with all prospective waiver participants to complete an Intake interview Initial Applicant Interview and Acknowledgement (refer to Appendix B – form B.3), explain the waiver's philosophy, goals and available services and determine if the individual is a probable candidate for the waiver;
- Offer individuals the choice of participation in the NHTD waiver and, when the individual chooses the waiver, offer him/her a choice of Service Coordination providers. Obtain signed Application for Participation form, Freedom of Choice form, and the Service Coordination Selection form (refer to Appendix B – form B.5);
- Assure each potential waiver participant receives a Level of Care (LOC) determination through the completion of the PRI and SCREEN assessment tools (refer to Appendix F);
- Verify Medicaid eligibility by collaborating with LDSS;
- Coordinate with the LDSS regarding the appropriate utilization of Medicaid State Plan and NHTD waiver services;
- Maintain contact with a potential waiver participant until a Service Coordinator (SC) is selected;
- Forward all preliminary information to the SC selected by the potential waiver participant; and
- Maintain a current list of all approved providers in their region.
5. Review of All Service Plans
- Review all completed Application Packets, including the Initial Service Plan (refer to Appendix C – form C.1) submitted by the SC to determine initial appropriateness for participation in the waiver;
- Review all SPs (Initial, Revised and Addendum) for completeness focusing on the needs and goals of the waiver participant, the ability of waiver services to support the health and welfare of the participant in the community, the timely provision of services, participant rights and choices, and the efficiency and cost effectiveness of the Plan;
- Complete the RRDS Service Plan Review form and determine whether the Plan, Application Packet, or subsequent RSP or Addenda is approved or disapproved. If needed, provide a written evaluation of the review to the SC indicating any necessary revisions or additions needed to the SP or Application packet;
- Forward all SPs over $300/day along with the appropriate RRDS review form to the QMS for review and recommendations;
- Track time elapsed from receipt of referral through setting up Intake appointment, and conducting of Intake;
- Track time elapsed from applicant's selection of Service Coordination agency/Coordinator through distribution of Notice of Decision (NOD);
- Track timeliness of submission of all SPs and follow up as needed to assure compliance; and
- Send notification to the SC of late submission of SPs using the appropriate Late Notice (refer to Appendix B – forms B.13 and B.14).
6. Administer Notice of Decisions (NOD)
- Provide the potential waiver participant with information regarding NODs and his/her rights regarding Informal Conferences and Fair Hearings during the initial interview process;
- Notify participants of his/her program status through utilization of the standard DOH NOD forms as outlined in the Program Manual;
- Provide each applicant/participant an appropriate NOD. Forward a copy to all entities listed on the NOD form (refer to Appendix B – forms NOD.1 to NOD.9);
- Maintain open communication with DOH regarding NODs that lead to an Informal Conference or Fair Hearing process and all discontinuation notices issued by LDSS due to loss of Medicaid coverage;
- Attend Informal Conferences and Fair Hearings as a representative of the NHTD Waiver program (refer to Section II – Becoming a Waiver Participant); and
- Keep DOH informed of any concerns affecting the status of the Fair Hearing process.
7. Maintain Regional Budgets
- Review all SPs in their region to ensure that the targeted aggregate average cost for all waiver participants does not exceed that of serving such individuals in an institutional setting without prior consent from DOH;
- Maintain information and data regarding the annual cost for each waiver participant;
- Maintain information and data regarding the average aggregate cost for all participants in their region; and
- Track and report expenditures to maintain regional cost neutrality.
8. Incident Reporting
- Meet responsibilities described in the Incident Reporting policy and procedure (refer to Section X – Incident Reporting Policy and Complaint Procedure);
- Support the efforts of the QMS in determining whether a Serious Reportable Incident (SRI) should be closed or whether further action is needed through collaborative discussion and prompt response to requests from QMS for consultation; and
- Assure that the SC has made needed changes to SPs as a result of SRI outcomes are implemented timely and effectively.
9. Technical Assistance to Participants, Family Members and Others
- Be available to participants, family members/informal supports and legal guardians to answer questions and address concerns regarding the NHTD waiver;
- Support a participant's right to be the decision-maker regarding life goals, activities, services and providers; and
- Provide information, regarding the NHTD waiver program to meet the needs of individuals with disabilities and/or seniors, their family members/informal supports and the community in their region.
10. Technical Assistance to Providers
- Attend Team Meetings as appropriate or upon request of Participant, SC or Team, (refer to Section V – The Service Plan);
- Provide training and technical assistance to waiver service providers on all aspects of the waiver program, including the needs of waiver participants, development and implementation of comprehensive waiver SPs, and standard documentation and reporting requirements;
- Conduct scheduled provider meetings 8-10 times per year in the region to review waiver policies and updates, and provide waiver-related training; and
- Provide on-going technical assistance and receive feedback from providers regarding the policy and procedures of the waiver.
11. Technical Assistance to QMS, Other RRDS, Community Agencies and the State
- Attend and participate in Regional Forums set up by the QMS;
- Provide cross training and technical assistance and share areas of expertise with RRDCs in other regions and the QMSs as needed; and
- Provide information and assistance to the State and community agencies.
12. Develop and Submit Reports to DOH
- Prepare and submit quarterly and annual reports on behalf of the RRDC summarizing services provided and progress made toward contractual obligations and detailing the use of grant funds for a full range of program activities undertaken. Reports are sent to DOH and to the regional QMS;
- Work closely with DOH to provide information, records and statistical and narrative reports regarding regional needs, outcomes, quality assurance and improvement and cost savings;
- Communicate regularly with DOH, including attending meetings, to review policies affecting the waiver and to receive ongoing technical assistance through phone calls and e-mails;
- Attend quarterly RRDS meetings in Albany and other meetings upon the request of DOH;
- Make recommendations, based on experience with waiver activities and ongoing administration of the program to DOH for improvements to NHTD waiver policies and procedures; and
- Assess quality of services in the region and report findings to DOH.