G. Submission of the Application Packet and ISP

Once the potential participant selects a SC who agrees to work with him/her, the SC has sixty (60) calendar days to submit a completed Application Packet, including the ISP, to the RRDS.

Once the ISP is completed, the SC must review it with the applicant and asks the applicant to sign the document.

The SC must have the SC supervisor review and sign the completed Service Plan prior to submission to the RRDS for review. This provides another level of professional review identifying any inconsistencies or problems in the Service Plan which could impede the approval process. If the SC supervisor is the SC for the participant whose ISP is being submitted to the RRDS for review, the SC supervisor is not required to obtain an additional supervisory signature. In this situation, the SC supervisor must sign the Signature page of the ISP as both SC and SC Supervisor.

The SC submits the Application Packet with the ISP to the RRDS for review. In addition to the ISP, the Application Packet includes the following documents:

  • Freedom of Choice form (refer to Appendix B - form B.4) (copy) - signed by the applicant during Intake with RRDS;
  • Application for Participation form (refer to Appendix B - form B.6) (copy) - signed by the applicant during Intake with RRDS;
  • Documentation of a disability (examples: Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) award letter, Railroad retirement letter for total permanent disability or a letter from the LDSS stating the individual has been determined to have a physical disability), if under 65 years old;
  • Verification of age (examples: birth certificate, passport, drivers license);
  • Written verification from the Medicaid Eligibility Verification System (MEVS) regarding Medicaid coverage that supports community based long term care services;
  • Service Coordinator Selection form (refer to Appendix B - form B.5) (copy) - signed by the applicant and completed by RRDS;
  • Provider Selection forms- signed by the Applicant and provider;
  • A PRI and SCREEN (refer to Appendix F) completed by a certified assessor within ninety (90) days prior to the submission of the Application Packet and ISP to the RRDS;
  • Plan for Protective Oversight (PPO) (refer to Appendix C - form C.4), completed by the SC and signed by applicant;
  • Insurance, Resource and Funding Information Sheet completed by the SC and signed by the applicant;
  • Waiver Participant's Rights and Responsibilities form (refer to Appendix C - form C.5) (copy), signed by applicant during Application process; and
  • Any Description and Cost Projection form(s) (refer to Appendix C - forms C.7, C.8, C.9, and C.10) and HCSS assessment form, if applicable completed by the provider agency and submitted by the SC.

There may be instances when a delay is expected in submitting an Application Packet to the RRDS. The SC must maintain consistent and open communication with the RRDS if this is indicated. Depending on the circumstances of the delay, the RRDS may choose to grant an extension of the sixty (60) calendar day deadline. Some examples of this are: establishing a residence, unexpected hospitalization, nursing home admission, or indecisiveness on the part of the participant regarding receipt of waiver services. In addition, length of time residing in a nursing home may require a longer period of time to establish a safe discharge and set up appropriate services.

If the SC does not meet the sixty (60) calendar day time frame for submission of the ISP packet or does not meet the conditions of the approved extension period, the SC and Service Coordination agency supervisor receives written notification from the RRDS indicating that the Application Packet is past due and must be submitted within the next thirty (30) calendar days. If the SC does not comply with the thirty (30) calendar day time line, the RRDS will send the SC agency supervisor written notification stating that due to non-compliance, the agency may no longer serve that applicant. The RRDS meets with the applicant to select another Service Coordination agency.

If late submission of Application Packets becomes a repeated problem for an agency, the RRDS will notify DOH of this problem. DOH will send a Letter of Vendor Hold via certified mail to the Service Coordination agency Executive Director indicating the intent to close referrals of new participants until a written plan of action is submitted and approved by DOH. If this problem is not corrected, DOH will begin the provider disenrollment process by sending the Service Coordination agency's Executive Director a Notice of Pending Disenrollment via certified mail (refer to Section III - Becoming A Waiver Provider).