Services

Services for eligible persons with mental retardation and/or developmental disabilities may include programs listed below. The Regional Center does not directly provide these supports but rather contracts with various community agencies. All services are determined by the individual's planning team and designed for independent living and community involvement. Since services and supports are tailored to the individual's needs, you will not automatically receive all the services listed below. Due to limitations on the availability of funding, the Missouri Division of Mental Retardation (MRDD) is unable to immediately provide services to all individuals with disabilities. Persons will be served based on priority of need as defined by the utilization review process. This process was developed to ensure fairness among all consumers and families.

All costs are determined by the Standard Means Test. For individuals under age 18, the family income is considered. For adults older than 18, only their personal income is considered. For families with income less than $100,000, fees are waived.

Please click on the links below to read about available services:

ADAPTIVE BEHAVIOR EVALUATION/ASSESSMENT

This service provides systematic observation and evaluation of a consumer's skills and behavior in activities of daily living. This includes assessing the consumer's adaptive behavior, physical abilities, social skills and the ability to learn and interact within their environment. In addition to observing the consumer, this service may also include face to face interviews with the consumer, parents or caregivers. This assessment information will be the basis of making recommendations toward the development of the consumer's personal plan.

Back to top

APPLIED BEHAVIOR ANALYSIS (ABA) CONSULTATION

• Administering specialized assessments and evaluations
• Interpretation of assessments and evaluations
• Participation on a child's person-centered planning team
• Assistance to a child's person-centered planning team in determining the appropriate intensity and frequency of early intervention services
• Design of a child's individualized ABA program, including baseline and ongoing data collection methods
• Training and periodic supervision of ABA Paraprofessional Implementers
• Analysis of an individual child's progress reports
• Reassessment of a child to determine the child's progress
• Modifications to a child's ABA program design based on the child's progress
• Collaboration with parents and others in a child's life to help the child generalize skills and to successfully integrate the child into all settings (home, school, play, etc.)

Back to top

ATTENDANT SERVICES

Assistance to the client or client's family, if the client is severely physically disabled, within the home setting, focusing on personal care. Services are provided on an hourly, daily (24 hour) or overnight basis. This is not a residential service. Attendant Services is a supplemental service provided to clients who are not eligible for or who have maximized Personal Care services available from the Missouri Division of Aging. The service consists of assisting the physically disabled client and/or the family in areas of personal hygiene, housekeeping, meal preparation and other home care which allows the family to maintain the client or the client to maintain himself, in the client's own/natural home.

Back to top

AUDIOLOGICAL EVALUATION/ASSESSMENT

An evaluation of an individual to determine presence, possible cause and extent of hearing disorders and the need for corrective/adaptive treatment and devices.

Back to top

BEHAVIOR THERAPY

Behavior therapy is a service which provides systematic behavior analysis and assessment; behavior management plan development, consultation, environmental manipulation and training to and for individuals whose maladaptive behaviors are significantly disrupting their progress in habilitation, self direction or community integration and /or are threatening to require movement to a more restrictive placement. This service may also include consultation to families, other caretakers and habilitation service providers. Behavior therapy must be provided as a discrete stand-alone service, not a day-program component. The services must be prescribed in a person-centered plan and may be authorized only after a behavior therapy evaluation has been completed.

Back to top

CHOICES FOR FAMILIES

The purpose of this program is to prevent or delay out-of-home placement or to facilitate the reunion of families whose members are already in out-of-home placement. It empowers families as the primary decision makers by providing funds for their use in planning and obtaining needed items and services from providers and vendors of their choice.

Families can either pay for services and submit receipts for reimbursement, or obtain vouchers to purchase services. The vendors providing the services can then turn the vouchers in for reimbursement. The program can be used for family support services, which there may not be a contracted provider. Funds are limited and will rarely meet all the needs of any family, so it is intended to supplement other support programs and agencies under which the family is eligible for services.

Back to top

COMMUNICATION SKILLS INSTRUCTIONS

A service to train individuals with minimal language skills to use other means of communication. This includes individuals who are deaf and know neither English nor American Sign Language and do not have any other formal communication system. Under the waiver, this service is also used for individuals with multiple developmental disabilities to communicate with the people around them. Both assessment/evaluation and training are included.

Back to top

COMMUNITY SPECIALIST SERVICES

Community specialist services include professional observation and assessment, individualized program design and implementation and consultation with caregivers, coordination with all agencies involved with the individual and monitoring and evaluation of service outcomes. This service may also, at the choice of the consumer or family, include advocating for the consumer and assisting the consumer in locating and accessing services and supports. The provider must meet QMRP qualifications and be free of any conflict of interest with other providers serving the consumer. The services of the community specialist assist the consumer and the consumer's caregivers to design and implement specialized programs to enhance self direction, independent living skills, community integration, social, leisure and recreational skills and behavior management. A community specialist with experience in person centered planning may also be selected by the consumer to facilitate the interdisciplinary planning team meeting.

Back to top

COMMUNITY TRANSITION

Transition services are one-time, set-up expenses for individuals who transition from an institution (ICF/MR or Title XIX Nursing Home) to a home, apartment, or other community-based living arrangement. This service is limited to persons who transition from a Title XIX institutional setting to the MRDD Comprehensive Waiver.

Examples of expenses that may be covered include:

• Expenses to transport furnishing and personal possessions to the new living arrangement;
• Essential furnishing expenses required to occupy and use a community domicile;
• Security deposits that are required to obtain a lease on an apartment or home that does not constitute paying for housing rent;
• Utility set-up fees or deposits for utility or service access (e.g. telephone, water, electricity, heating, trash removal);
• Health and safety assurances, such as pest eradication, allergen control or a one-time cleaning prior to occupancy.

Essential furnishings include items for an individual to establish his or her basic living arrangement, such as a bed, a table, chairs, window blinds, eating utensils, and food preparation items. Essential furnishings do not include diversional or recreational items such as televisions, cable TV access, VCR or DVD player/recorders.

Back to top

COUNSELING

This service includes goal oriented counseling to maximize strengths and reduce behavior problems and/or functional deficits which interfere with an individual's personal, familial, vocational or community adjustment. It can be provided to individuals and families when the consumer is present with the family. Counseling includes psychological testing, initial assessment, periodic outcome evaluation and coordination with family members, caretakers and other professionals in addition to direct counseling.

Back to top

COVERED ENVIRONMENTAL ACCESSIBILITY ADAPTATIONS

Adaptations may include the installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems which are necessary to accommodate the medical equipment and supplies which are necessary for the welfare of the individual, but shall exclude those adaptations or improvements to the home which are not of direct medical or remedial benefit to the waiver participant, such as carpeting, roof repair, central air conditioning, home additions solely intended to increase living space square footage, etc. All services shall be provided in accordance with applicable State or local building codes.

All adaptations must be recommended by an appropriate therapist (Occupational, Physical, Speech or Behavioral Therapist). The therapist must oversee the purchase of equipment and actual construction to ensure it meets standards for handicapped accessibility.

Back to top

CRISIS INTERVENTION

Personal, social, and behavioral challenges can result from many different causes. They are often a reaction to events or circumstances in the life or environment of the child or adult with developmental disabilities. The physical environment of the person may contribute to stresses leading to undesirable behavior. In addition, eating habits, schedules, interactions with others in the environment, frustration due to inability to communicate needs easily have been known to contribute to these challenges.

Crisis Intervention is immediate intervention available to an individual on a 24 hours basis to address these concerns which otherwise are likely to threaten the health and safety of the individual or of others and/or result in the individuals removal from his current living arrangement. Crisis Intervention may be provided in any setting and includes consultation with family members, providers, or other care takers to design and implement individualized crisis treatment plans. Areas the consultation evaluates include the physical and social environment, goals and obstacles, skills, health and daily habits, support network and opportunities available to the individual.

Crisis Intervention can respond intensively with assistance in obtaining relief, alternatives, and resources to resolve the crisis and prevent the person at risk from moving to a more restrictive setting. Crisis Intervention services are expected to be of a brief duration (4 to 8 weeks). When services of a greater duration are required, the individual should be transitioned to a more appropriate service such as counseling, behavior therapy or respite.

Specific Crisis Intervention components may include the following:

• Analyzing and assessing the components of the behavior or other factors contributing to the crisis.
• Developing and writing an intervention plan which may focus on the individual and those around the individual. The purpose of the intervention is to keep all parties from harm and maintain the individual in his chosen living, working, social, and/or educational environment.
• Consulting and in some cases negotiating with those connected to the crisis in order to implement planned interventions and follow up to ensure positive outcomes from interventions or to make adjustments to interventions.

Back to top

DAY HABILITATION SERVICES, OFF-SITE - GROUP

Day habilitation is provided to enable individuals to achieve their optimal physical, emotional, sensory, and intellectual functioning. The purpose of the service is to enable and increase independent functioning, physical health and development, language and communication development, cognitive training, socialization, community integration, domestic and economic management, functional skills development (ADLs; IADLs), behavior management, responsibility and self-direction.

Services may include training families in treatment, intervention and support methodologies, and in the care and use of equipment. Day habilitation services may also include coordination and intervention with the individual, family, professionals and others involved with the individual, as needed to implement the person-centered plan.

Day habilitation services may be provided to individuals or to groups and may be provided either on site, at the day program, or off-site, in the individual's own home or community. On-site group and off-site individual settings are the norm; the other two variations are for specific and unusual situations.

Off-site training and support are intended to maximize self-determination and participation in the community; therefore this service must employ strategies which promote inclusion and self-determination, maximize the individual's participation in the experience, and address a specific functional purpose. The outcomes expected of off-site services include opportunities for repeated exposure to community life; development of social contacts, friendships, and natural support systems; increased functional independence or interdependence in areas related to community inclusion; and reduction of specialized supports due to increased independence or linkage to a system of natural supports in the community.

Back to top

ENVIRONMENTAL ACCESSIBILITY ADAPTATIONS

Those physical adaptations to the home, required by the individual's plan of care, which is necessary to ensure the health, welfare and safety of the individual, or which enable the individual to function with greater independence in the home and without which, the individual would require institutionalization.

Back to top

INCLUDED SERVICES

Supported Employment services may be provided individually or to groups of individuals and may include the following services as they directly relate to Supported Employment:

• Assessment;
• Counseling;
• Job development and placement;
• On-the-job training in work and work-related skills;
• Ongoing supervision and monitoring of the person's performance on the job; and
• Training in related skills needed to obtain and retain employment such as using community resources and public transportation.

Back to top

INDIVIDUALIZED SUPPORTED LIVING (ISL)

This is a non-facility based form of residential habilitation which provides support and training services to an individual in his or her own residence. Individualized supported living (ISL) allows individuals with even the most severe disabilities the opportunity for community living.

Individuals may live alone or with their family or may share a living arrangement with others. When living arrangements are shared, no more than three individuals with disabilities may reside together and qualify for ISL services.

Because it is neither group nor facility based, the ISL service model provides consumers maximum involvement in developing and carrying out their own service plans. Also, training and support are provided on-site in the home or in the community, thereby allowing functional skill development to occur in the real life settings where the skills will be used. The nature, amount and cost of services and supports needed to carry out each plan depend on that consumer's needs, abilities, resources and informal support systems. Therefore, ISL services and supports are individually planned and budgeted for each person served.

Back to top

IN-HOME RESPITE

This service consists of care in the individual's place of residence, at a qualified day program site, or elsewhere in the community. In Home respite is to relieve the primary care giver who may not be a formal, paid caregiver. It is not intended to substitute for day or after school care for working parents, nor take the place of day habilitation programming for adults.

Back to top

INTERPRETING

This service will be used to facilitate communication between any person and the consumer, when the consumer uses any means of communication other than spoken English. Other means of communication would include the use of sign language as well as any spoken language other than English. The outcome of this service is to provide the consumer with the means to communicate their wants and needs in order to establish eligibility for services, to develop the personal plan and to link the person with/connect to other resources.

Back to top

OCCUPATIONAL THERAPY

Occupational therapy focuses on the functional use of the upper extremities to include areas such as dressing, eating, and cooking. The service includes evaluation, plan development, direct therapy, consultation and training of caretakers and others who work with the individual. It may also include therapeutic activities carried out by others under the direction of an OT or COTA. Examples are using adaptive equipment, proper positioning, and therapeutic exercises in a variety of settings.

Back to top

OUT-OF-HOME RESPITE

This service consists of temporary care provided outside the home in a licensed residential facility for a period of no less than 24 hours by trained, qualified personnel on an intermittent basis.

Back to top

PERSONAL ASSISTANT SERVICES: INDIVIDUAL, GROUP, AGENCY-BASED, SPECIALIZED MEDICAL/BEHAVIORAL

Personal assistant services include assistance with any activity of daily living (ADL) or instrumental activity of daily living (IADL). Assistance for ADLs include bathing, toileting, transfer and ambulation, skin care, grooming, dressing, extension of therapies and exercise, care of adaptive equipment, meal preparation, feeding and incidental household cleaning and laundry. IADLs include shopping, banking, budgeting, using public transportation, social interaction, recreation and leisure activities and assistance with IADLs includes accompaniment, coaching and minor problem-solving necessary to achieve increased independence, productivity and inclusion in the community.

Personal assistance may also include general supervision and protective oversight. The personal assistant may directly perform some activities and support the individual in learning how to perform others. The agency-based provider of personal assistance must be trained and supervised in accordance with the certification or program enrollment requirements that apply.

An individual provider of personal assistance may, if he or she falls outside the federal definition of "domestic service worker," enroll directly with the Medicaid program or with an Organized Health Care Delivery System to provide this service. Most personal assistants, however, will fall into the category of "domestic service worker," and someone will need to be that worker's employer. The state will consider such individual providers the employee of the consumer or family for whom they work, but rather than holding the consumer or family responsible for withholding taxes and performing all other required employer functions, it will contract with fiscal intermediaries to perform some or all of these functions on their behalf. The individual provider must be at least 18 years old. To the extent they desire, the consumer and his or her family/ guardian will select the personal assistant and carry out training and supervision.

Back to top

PHYSICAL THERAPY

Physical therapy is a service designed to treat physical motor dysfunction through various modalities as prescribed by a physician and following a physical motor evaluation. It is provided to individuals who demonstrate developmental, habilitative or rehabilitative needs affecting the acquisition of skills needed for adaptive functioning at the highest level of independence for that individual. This service may include clinical consultation to individuals, parents, primary caregivers or other programs. For children and youth under the age of 21, physical therapy services should be accessed through HCY.

Back to top

PRE-VOCATIONAL TRAINING

Pre-Vocational training is a service provided to individuals 16 years of age and older. The skills being trained are directly related to vocational skills required for employment in an identified sheltered or supported employment setting. Entrance and exit criteria must be developed for admission to the training program and transfer to a sheltered workshop or supported employment site. The service must be prescribed in the person-centered plan prior to authorization.

Back to top

PSYCHOLOGICAL EVALUATION

An evaluation of an individual's current psychological and intellectual functioning using standardized tests/protocols, adaptive behavior instruments, face-to-face client and family interviews and review of prior evaluations, assessment of mental health status, determination of need for guardian and whether the client presents a physical danger to self and/or others. The evaluation must be specifically prescribed in the client's personal plan.

Back to top

REGIONAL ADVISORY COUNCILS FOR DEVELOPMENTAL DISABILITIES

The regional advisory councils on developmental disabilities are private, not-for-profit organizations whose primary purpose is to advocate for improvement in the quality of life for people with developmental disabilities and their families.

Regional Councils are knowledgeable about local needs and service gaps in their region and provide a grassroots system of planning and advocating for improving the supports and services for persons with developmental disabilities.

Back to top

RESIDENTIAL HABILITATION

This service provides care, skills training in activities of daily living, home management and community integration, and supervision (protective oversight). Residential habilitation can be offered in the following types of licensed, certified or accredited Community Residential Facilities (CRF) for individuals with MRDD: group homes, residential centers and semi-independent living situations.

Back to top

RESPITE CARE

Respite services provide intermittent care and supervision of individuals unable to care for themselves, on a short-term basis, because of the absence or need for relief of those persons normally providing the care. This service is available as out of home or in home care.

Back to top

SERVICE APPROACHES

(1) Individual
The job coach model establishes employment opportunities for individuals with severe handicaps in local industries on a one-person/one-job basis for jobs at or above commensurate wages. A trained job coach develops the job in the industry, matches an individual to the job, trains the individual until they meet industry criteria and provides on-going follow-up support to the individual and the employer for as long as such services are required. The job coach should seek to shift reliance from him/herself to others within the work setting (natural supports).

(2) Group
A supported employment enclave maintains many of the benefits of integrated employment while providing the continuous on-going support required by some individuals for long-term success. Small groups of workers, of not more than eight, with severe disabilities are employed in an industrialized setting managed by a specially trained supervisor. With the enclave payment for work performed is commensurate with pay to others within the host company doing the same type and amount of work. Persons with disabilities work alongside others doing the same work, although limited work abilities and behavioral needs may require that workers be situated in proximity of each other to enhance training and supervision. Workers with handicaps receive the same benefits as others in the company with respect to such procedures as working hours, lunch and break times and performance evaluations.

As with the enclave model, the mobile crew provides the opportunity for continuous, on-going support while offering integrated employment. A small crew or set of crews have one supervisor and not more than eight per crew perform work in regular industry. Typically, the workers in a mobile crew perform service operations for organizations, businesses, and individual community members.

Back to top

SPECIALIZED MEDICAL EQUIPMENT AND SUPPLIES

Specialized medical equipment and supplies specified in the plan of care, which enable individuals to increase their abilities to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live and without which, the individual would require institutionalization. Items reimbursed shall be in addition to any medical equipment and supplies furnished under the Medicaid State plan and shall exclude those items which are not of direct medical or remedial benefit to the individual.

Covered items include devices, controls, or appliances that increase a person's ability to perform activities of daily living, items necessary for life support, ancillary supplies and equipment necessary to the proper functioning of such items, and durable and non-durable medical equipment not available under the Medicaid State Plan.

Back to top

SPEECH/LANGUAGE EVALUATION

Evaluation to determine the presence, possible cause, extent and corrective/ adaptive treatment of developmental communication disorders, including dysfunction in oral motor, receptive/expressive language, articulation, rhythm of speech, etc. An oral peripheral examination should also be completed, as well as a voice evaluation. Auditory screening may also be authorized.

Back to top

SPEECH THERAPY

Speech therapy is provided for individuals who have speech, language or hearing problems. The individual's need for therapy must be determined in a speech/language evaluation conducted by a certified audiologist or a state certified speech therapist. Services must be required in the plan of care and prescribed by a physician.

Speech therapy provides treatment for these and other disorders:

Delayed speech, stuttering, spastic speech, aphasic disorders and hearing disabilities requiring specialized auditory training, lip reading, signing or use of a hearing aid. Services may include consultation provided to families, other caretakers and habilitation service providers.

Back to top

SUPPORTED EMPLOYMENT

Supported employment is competitive work in an integrated work setting with on-going support services for individuals with severe disabilities for whom competitive employment either has never been possible or has been interrupted as a result of the disability. The service must be based on a supported employment assessment and must be prescribed in a person centered plan. In the context of supported employment, competitive work is defined as a full or half-time job, for which the individual is paid in accordance with the Fair Labor Standards Act. An integrated work setting is one in which workers with disabilities are, to the greatest extent possible, integrated with persons who do not have disabilities. Ongoing support consists of continuous or periodic job skill training provided at least twice monthly at the work site to enable the individual to perform the work.

Back to top

TRANSPORTATION

This service is designed to help individuals travel about their communities as necessary to access services, activities, and resources specified by their plan of care. This service shall not supplant publicly funded transportation nor shall it replace emergency medical transportation. A variety of modes of transportation may be provided, depending on the needs of the individual and availability of services.

Back to top