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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

Resources to learn more

Listed below are resources for you to learn more about Innovations Plus, the purpose of the program, and what it has to offer. As more resources become available, they will be posted here.

  1. Information on Innovations Plus
  2. Websites
  3. Glossary of Terms and Acronyms

Information on Innovation Plus

History of Innovations Plus

Frequently Asked Questions

PowerPoint Presentations

Videos

Printed Media

Fact Sheets or Publications on Innovations Plus

Websites

North Carolina State Agencies

LME-MCOs

Other Helpful Organizations in North Carolina

Glossary of Terms and Acronyms

Acronyms or Abbreviations

  • DHHS – Department of Health and Human Services
  • DMA – Division of Medical Assistance
  • DMH – Division of Mental Health
  • DD – Developmental Disabilities
  • I/DD – Intellectual and Developmental Disabilities
  • ICFMR – Intermediate Care Facilities for Individuals with Mental Retardation
  • PCP – Person Centered Planning
  • SIS – Supports Intensity Scale
  • LME-MCO – Local Management Entity – Managed Care Organizations
  • IBA – Individualized Budget Amount
  • ISP – Individual Support Plan
  • CAP-MR/DD – Community Alternatives Program for Persons with Mental Retardation/Developmental Disabilities
  • NC-SNAP – NC Support Needs Assessment Profile

Glossary of Key Terms

In this report, services and housing arrangements for people with intellectual and other developmental disabilities within the state are examined. Below, is a list of key terms used commonly throughout this report, as well as their meaning or definition.

Federal Definition of Intellectual and Other Developmental Disabilities

(A) The term "developmental disability" means a severe, chronic disability of an individual that:

(i) is attributable to a mental or physical impairment or combination of mental and physical impairments;

114 STAT. 1684 PUBLIC LAW 106-402-OCT. 30, 2000

(ii) is manifested before the individual attains age 22;
(iii) is likely to continue indefinitely;
(iv) results in substantial functional limitations in 3 or more of the following areas of major life activity:

(I) Self-care.
(II) Receptive and expressive language.
(III) Learning.
(IV) Mobility.
(V) Self-direction.
(VI) Capacity for independent living.
(VII) Economic self-sufficiency; and
(v) reflects the individual's need for a combination and sequence of special, interdisciplinary, or generic services, individualized supports, or other forms of assistance that are of lifelong or extended duration and are individually planned and coordinated.

(B) INFANTS AND YOUNG CHILDREN - An individual from birth to age 9, inclusive, who has a substantial developmental delay or specific congenital or acquired condition, may be considered to have a developmental disability without meeting 3 or more of the criteria described above if the individual, without services and supports, has a high probability of meeting those criteria later in life.

North Carolina Definition of Intellectual and other developmental disabilities

North Carolina General Statute 122C-3(12a) defines a developmental disability as "a severe, chronic disability of a person which:

  • is attributable to a mental or physical impairment or combination of mental and physical impairments;
  • is manifested before the person attains age 22, unless the disability is caused by traumatic head injury and is manifested after age 22;
  • is likely to continue indefinitely; results in substantial functional limitations in three or more of the following areas of major life activity:
    • self-care
    • receptive (understanding) and expressive language
    • learning mobility (ability to move)
    • self-direction (motivation)
    • the capacity for independent living
    • economic self-sufficiency
  • reflects the person's need for a combination or sequence of special, interdisciplinary, generic services, individual supports, or other forms of assistance which are of a lifelong or extended duration and are individually planned and coordinated;
  • an individual from birth to age 9, inclusive, who has a substantial developmental delay or specific congenital or acquired condition, may be considered to have a developmental disability without meeting at least three of the above 'areas of major life activities,' if the individual, without services and supports, has a high probability of meeting those criteria later in life."

Home and Community Based Services (HCBS) WAIVERS SECTION 1915(c)

States may offer a variety of services to consumers under an HCBS waiver program and the number of services that can be provided is not limited. These programs may provide a combination of both traditional medical services (i.e., dental services, skilled nursing services) as well as non-medical services (i.e. respite, case management, environmental modifications). Family members and friends may be providers of waiver services if they meet the specified provider qualifications. However, in general spouses and parents of minor children cannot be paid providers of waiver services.

Application & Approval Process

The State Medicaid agency must submit to the Center for Medicare and Medicaid Services (CMS) for review and approval an application for an HCBS waiver, and the State Medicaid Agency has the ultimate responsibility for an HCBS waiver program, although it may delegate the day-to-day operation of the program to another entity. Initial HCBS waivers are approved for a three-year period, and waivers are renewed for five-year intervals.

Program Requirements

Within the parameters of broad Federal guidelines, States have the flexibility to develop HCBS waiver programs designed to meet the specific needs of targeted populations. Federal requirements for states choosing to implement an HCBS waiver program include:

  • Demonstrating that providing waiver services to a target population is no more costly overall than the cost of services these individuals would receive in an institution.
  • Ensuring that measures will be taken to protect the health and welfare of consumers.
  • Providing adequate and reasonable provider standards to meet the needs of the target population.

Ensuring that services are provided in accordance with a plan of care.

States have the discretion to choose the number of consumers to serve in a HCBS waiver program. Once approved by CMS, a state is held to the number of persons estimated in its application, but has the flexibility to serve greater or fewer numbers of consumers by submitting an amendment to CMS for approval.

Intermediate Care Facility For Persons With Mental Retardation1 (ICF/MR)

(1905(d) of the SSA)

An institution (or distinct part thereof) for the mentally retarded or persons with related conditions if —

  1. the primary purpose of such institution (or distinct part thereof) is to provide health or rehabilitative services to mentally retarded individuals and the institution meets such standards as may be prescribed by the Secretary;
  2. the mentally retarded individual with respect to whom a request for payment is made under a plan approved under this title is receiving active treatment under such a program; and
  3. in the case of a public institution, the State or political subdivision responsible for the operation of such institution has agreed that the non-Federal expenditures in any calendar quarter prior to January 1,1975, with respect to services furnished to patients in such institution (or distinct part thereof) in the State will not, because of payments made under this title, be reduced below the average amount expended for such services in such institution in the four quarters immediately preceding the quarter in which the State in which such institution is located elected to make such services available under its plan approved under this title.
  4. Institution for persons with mental retardation means an institution (or distinct part of an institution) that: 1. Is primarily for the diagnosis, treatment, or rehabilitation of the mentally retarded or persons with related conditions; and 2. Provides, in a protected residential setting, ongoing evaluation, planning, 24-hour supervision, coordination, and integration of health or rehabilitative services to help each individual function at his greatest ability. (42 CFR 435.1009)

Community integration, used with respect to individuals with developmental disabilities, means exercising the equal right of individuals with developmental disabilities to access and use the same community resources as are used by and available to other individuals. Public Law 106-402-OCT. 30, 2000 114 STAT. 1686 (17)

Inclusion means the acceptance and encouragement of the presence and participation of individuals with developmental disabilities, by individuals without disabilities, in social, educational, work, and community activities, that enables individuals with developmental disabilities to: (a) have friendships and relationships with individuals and families of their own choice; (b) live in homes close to community resources, with regular contact with individuals without disabilities in their communities; (c) enjoy full access to and active participation in the same community activities and types of employment as individuals without disabilities; and (d) take full advantage of their integration into the same community resources as individuals without disabilities, living, learning, working, and enjoying life in regular contact with individuals without disabilities. Public Law 106-402-OCT. 30, 2000 114 STAT. 1685 (15)

Supported employment services means services that enable individuals with developmental disabilities to perform competitive work in integrated work settings, in the case of individuals with developmental disabilities: (a) for whom competitive employment has not traditionally occurred or for whom competitive employment has been interrupted or intermittent as a result of significant disabilities; and (b) who, because of the nature and severity of their disabilities, need intensive supported employment services or extended services in order to perform such work. The Developmental Disabilities Assistance and Bill of Rights Act of 2000 Public Law 106-402-OCT. 30, 2000 114 STAT. 1688 (30)

Self-determination refers to activities that result in individuals with developmental disabilities, with appropriate assistance, having: (a) the ability and opportunity to communicate and make personal decisions; (b) the ability and opportunity to communicate choices and exercise control over the type and intensity of services, supports, and other assistance the individuals receive; (c) the authority to control resources to obtain needed services, supports, and other assistance; (d) opportunities to participate in, and contribute to, their communities; and (e) support, including financial support, to advocate for themselves and others, to develop leadership skills, through training in self-advocacy, to participate in coalitions, to educate policy makers, and to play a role in the development of public policies that affect individuals with developmental disabilities. The Developmental Disabilities Assistance and Bill of Rights Act of 2000 Public Law 106-402-OCT. 30, 2000 114 STAT. 1687 (27)

  1. This term, Intermediate Care Facilities for the Mentally Retarded is a federal Medicaid term. North Carolina, while operating facilities under this definition, refers to these facilities as Intermediate Care Facilities for the Developmentally Disabled (ICFs/DD). This report uses the terminology ICF/DD in place of ICF/MR.

 

January 8, 2013