Community Integration & Habilitation Waiver

Purpose

The Community Integration and Habilitation Waiver (CIH Waiver) program provides Medicaid HCBS to participants residing in a range of community settings as an alternative to care in an intermediate care facility for individuals with intellectual/developmental disabilities (known as an ICF/IDD) or related conditions. The CIH Waiver serves individuals with an intellectual/developmental disability or autism who have substantial functional limitations, as defined in 42 CFR 435.1010. However, entrance into services under the CIH Waiver occurs only when an applicant has been determined by the DDRS to meet priority criteria of one or more federally approved reserved waiver capacity categories, a funded slot is available, and the DDRS determines that other placement options are neither appropriate nor available.

When priority access has been deemed appropriate and a priority waiver slot in the specific reserved waiver capacity category met by the applicant remains open, participants may choose to live in their own home, family home, or community setting appropriate to their needs. Participants develop an Individualized Support Plan (ISP) using a person-centered planning process guided by IST. The IST is comprised of the participant, the participant’s Case Manager, and anyone else of the participant’s choosing, but typically family and friends. The participant with the IST selects services, chooses service providers, and develops a POC/CCB.

Goals and Objectives

The CIH Waiver accomplishes the following:

  • Provides access to meaningful and necessary home and community-based services and supports
  • Seeks to implement services and supports in a manner that respects the participant’s personal beliefs and customs
  • Ensures that services are cost-effective
  • Facilitates the participant’s involvement in the community where he or she lives and works
  • Facilitates the participant’s development of social relationships in his or her home and work communities
  • Facilitates the participant’s independent living
*Taken from Section 4.6 of the BDDS HCBS Waiver Provider Manual

Services

Community-Based Habilitation

Community-Based Habilitation Services − Individual services are services provided outside of the Participant’s home that support learning and assistance in the areas of self-care, sensory/motor development, socialization, daily living skills, communication, community living, and social skills. Community-based activities are intended to build relationships and natural supports.

Community-Transition Funding (CT)

Community Transition Services include reasonable, one-time set-up expenses for individuals who make the transition from an institution to their own home in the community and will not be reimbursable on any subsequent move.

Residential Habilitation and Support

Residential Habilitation and Support (RHS) services provide up to a full day (24- hour basis) of services and/or supports that are designed to ensure the health, safety, and welfare of the participant and assist in the acquisition, improvement, and retention of skills necessary to support participants to live successfully in their own homes. Billable either as

  • RH1O − for Level 1 with 35 hours or less per week of RHS, or
  • RH2O − for Level 2 with greater than 35 hours per week of RHS

Respite – General

Respite Care Services are services provided to participants unable to care for themselves. Respite Care services are furnished on a short-term basis in order to provide temporary relief to those unpaid persons normally providing care. Respite can be provided in the participant’s home or place of residence, in the respite caregiver’s home, in a camp setting, in a DDRS- approved day habilitation facility, or in a non-private residential setting (such as a respite home).

Transportation

Transportation Services enable waiver participants under the CIH Waiver to gain access to any non-medical community services, resources/destinations or places of employment, maintain or improve their mobility within the community, increase independence and community participation, and prevent institutionalization as specified by the ISP and POC.

Wellness Coordination – All Tiers

Wellness Coordination Services means the development, maintenance, and routine monitoring of the waiver participant’s Wellness Coordination plan and the medical services required to manage his or her health care needs.

Wellness Coordination Services extend beyond those services provided through routine doctor/health care visits required under the Medicaid State Plan and are specifically designed for participants requiring assistance of an RN or LPN to properly coordinate their medical needs:

  • Tier I – Health care needs require at least weekly* consultation/review with RN or LPN, including face-to-face visits once a month.
  • Tier II – Health care needs require at least weekly consultation/review with RN or LPN, including face-to-face visits at least twice monthly.
  • Tier III – Health care needs require at least twice weekly consultation/review with RN or LPN, including face-to-face visits once a week.