Collaborating with community agencies and therapists to maintain a network of service providers.
Your plan may include funded services. This funding may derive from BCFR; the Missouri Department of Mental Health, the Medicaid Home and Community Based Services Waiver (HCBS Waiver) program or other resources within the community.
In determining eligibility for the funded services listed below, Coordinators will assess the following:
- The service need is included in your individual plan
- Other funding resources have been exhausted or unavailable (private insurance, Medicaid etc)
- Service specific eligibility criteria are met
- Projected service costs are within established funding limits
- Services are prior authorized
BCFR Funded Services
Plan and service limits have been established to ensure equity in distributing agency resources to better meet the increasing number of individuals served. BCFR works collaboratively with community agencies and therapists to maintain a network of service providers to provide a wide array of services for individuals supported by BCFR.
Applied Behavior Analysis (ABA) Therapy is an evidence-based treatment approach for individuals with a diagnosis of Autism. ABA therapy helps improve socially significant behaviors including communication and social skills, memory, learning and language. These behavioral programs are developed and overseen by a Board-Certified Behavior Analyst.
This service assists with the individual’s cost for ABA Therapy services covered by health insurance. Eligible expenses for reimbursement include co-pays and deductibles. When the deductible has not been met, reimbursable costs are based on the agency established rate.
Therapy can be provided in the home or in a clinic setting. Services provided in school settings are not eligible for reimbursement.
Commercial or custom designed therapeutic devices or equipment are used to increase capacity and minimize the functional limitations associated with a developmental disability. The device or equipment is to be used by the individual with a developmental disability. The use of assistive technology or specialized equipment can decrease the need for staff attendants, thereby increasing the independence of a person with a disability and enabling the individual to live in a less restrictive environment. Examples may include Braille, video or audio-recorded directions, augmented communication technology, talking alarm clocks, hearing aids, therapy balls or mats, orthotics, door alarms, batteries for wheelchairs and hearing aids and weighted blankets, LifeLine/Angel Sense or other monitoring devices, oral motor aides, such as chewelry and vestibular system aides such as, an Astronaut board. Items not covered include, but are not limited to swimming pools, hot tubs, toys, generic exercise equipment, playground equipment (e.g. trampolines, sandboxes, swing sets), and home modification.
Generically available low-cost items for sensory processing or anxiety reduction are considered toys and not covered by this definition. Examples of items considered toys include, but are not limited to, fidget spinners, stress balls, magnetic blocks, lava lamps or other visual stimulating toys, rain sticks, sound machines, tents and Rubik’s Cube. Other items not covered by this definition include essential oil diffusers and other holistic health related items.
Assistive Technology Services directly assist an individual with a disability in the selection, acquisition, or use of an Assistive technology device. Recommendations to purchase items as a result of an Assistive Technology Services evaluation must follow the Assistive Technology Devices definition and procedure. Assistive Technology Services include:
- The evaluation of the device needs of an individual with a disability, including a functional evaluation of the individual’s customary environment
- Selecting, designing, fitting, customizing, adapting, or applying Assistive Technology Devices
- Training or technical assistance for:
- An individual with a disability and that individual’s immediate household family members
- Professionals actively providing services to the eligible individual
- Employers of an eligible individual, with the exception of those accommodations required by ADA.
Services will be provided for prevention of hearing loss and determination of need for amplification, selection, and fitting of the appropriate aide. Service may include the following, depending on individual need: Identification of auditory impairment, determination of range, nature, and degree of hearing loss and communication functions; provision of auditory training, aural rehabilitation, speech (lip) reading; listening device orientation and training.
This service is designed to help individuals demonstrating significant support needs in the areas of behavior, social, and communication skills acquire functional skills in their homes and communities and/or to prevent hospitalizations or out-of-home placements.
Behavior Intervention Specialist (BIS) services includes:
- the development of an individualized behavioral support plan that includes design of skill training and environmental modifications to address identified outcomes. The individual behavior support plan shall incorporate evidence-based practices. BCFR will not purchase services that include aversive procedures.
- collecting and analyzing data for the effectiveness of the behavior support plan, fidelity of implementation of the behavior support plan and reliability of the data;
- adjustment or revision of the strategies identified in the behavior support plan;
- training caregivers and family members on the implementation of the behavior support plan;
- and on occasion, implementation of the behavior support plan when complicated techniques are involved or for short trial periods to determine if the plan is viable and as part of the training of the main implementers for the behavior support plan.
BIS may be used as part of an Intensive in-home program. In these situations, the BIS is responsible for the development of the behavior support plan and managing the direct implementation of the strategies and serves as a “bridge” between the program implementers and family. This service cannot be provided in school settings.
Individuals with a developmental disability who are experiencing a crisis may be eligible for Crisis Intervention services. Crisis situations include, but are not limited to, major medical procedures or illness, serious bodily injury, death of immediate caregiver or family member, suicidal attempts, rape, abuse/neglect, homelessness, marital separation or divorce, natural disasters, and severe and recurrent behavioral problems which limit efforts to minimize disabilities and/or significantly impair the caregiver/family’s ability to care for their family member with a developmental disability. The services are designed to provide intensive intervention to eligible individuals and immediate family members experiencing a crisis that adversely impacts the health, safety or welfare of the family member with a developmental disability while the individual plan team is securing additional services when the need is anticipated to continue. Services should assist the eligible individual and immediate family members through the current crisis situation by providing supports that positively impact the current living environment and address care needs, including mental health supports.
Crisis intervention services include:
- Crisis Counseling Services
- Crisis Attendant Services
- Crisis Homemaker Services
- Crisis Housing Assistance
Services are designed to assist eligible individuals and family members who are experiencing a crisis and have been approved for crisis status. Counseling services include goal-oriented counseling to maximize strengths and reduce behavior problems and/or functional deficits, which interfere with an eligible individual’s personal, familial, vocational or community adjustment. The service may be authorized for up to six months.
Time limited care for the eligible individual designed to prevent the need for out of home residential care. Services are provided on an hourly basis, but not for 24 consecutive hours. The service consists of assisting the individual in the areas of personal care, which allows the family to maintain the individual, or the individual to maintain himself in their own/natural home during a crisis.
Activities may include:
- Assisting with dietary needs, including meal preparation, clean-up and assistance with eating /feeding
- Assisting with dressing and grooming
- Assisting with bathing and personal hygiene
- Assisting with toileting and continence
- Assisting with mobility and transfer
- Assisting with advanced personal care services such as routine care related to ostomies, catheters, and bowel programs
This service may also include assisting with medication, including assisting with the self administration of medicine, applying non-prescription ointments and lotions consistent with Missouri laws governing medication administration.
Time limited assistance to the eligible individual and the individual’s family in completing general household activities. Homemaker services are primarily directed toward home management and assistance with activities of daily living on a regular basis for a person who has a multiplicity of needs and requires this assistance in order to remain in the home and to prevent unnecessary out-of-home placement. Services are provided on an hourly basis, but not for 24 consecutive hours.
Homemaker services shall include the following activities:
- Planning, preparation, and clean-up of meals
- Organizing the home environment to reduce trip hazards and allow for thorough cleaning
- Cleaning kitchen counters, cupboards, and appliances, including oven, surface burners and inside refrigerator
- Cleaning bathroom fixtures
- Laundering clothes and linens
- Washing dishes, pots, pans and utensils
- Sweeping and/or vacuuming, and mopping floors
- Bagging trash inside the home and putting it out for pick-up
- Shopping for essential items (e.g. groceries, cleaning supplies, etc.)
- Performing essential errands (e.g. picking up medication, posting mail, etc.)
Pest control assistance may be provided once determination that landlord or other assistance is not available. Competitive pricing from at least two vendors is required for pest control assistance.
Assistance to persons with developmental disabilities and their family for initial rental, utility deposits and tenant’s share of first month’s rent in Section 8 approved or public housing. Assistance limited to persons who have previously met Boone County residency requirements and are homeless, at risk of immediate homelessness or are living in substandard, unsafe, and/or unsanitary housing. This service is designed to prevent unnecessary out-of-home placement.
Developmental Disability Education includes a conference or course that is directly related to the individual’s specific developmental disability and/or specialized care needs. This service is available to an individual with a disability and the primary caregiver(s) of a person with a disability when compensation is not otherwise available from other sources. Caregivers can include relatives; caregivers employed by the individual/family including persons employed thru the Department of Mental Health’s Self-Directed Support Program or a Personal Care Attendant employed by the individual; and unpaid caregivers who provide regular care and support, such as a neighbor. The service must be pre-approved based upon the criterion that attendance will provide information that will assist the individual to minimize the effects of his/her disability or help the family/caregiver(s) make informed decisions in caring for a family member with a developmental disability, thus reducing the risk for out of home placement. Approved conference fees and lodging may be prepaid or reimbursed, however, lodging shall not exceed two nights. If an individual/family is requesting lodging assistance, efforts to identify low cost lodging options, including reduced hotel cost for training shall be included in the request. Approved, necessary, and reasonable expenses may be incurred for transportation to the conference or course, and may be reimbursed or purchased.
A Functional Behavioral Assessment (FBA) is authorized to assist the planning team in supporting individuals demonstrating significant challenges in the areas of behavior, social and communication skills impacting their ability to learn functional skills in their homes and communities and/or to prevent hospitalizations or out-of-home placements. There will be situations in which an assessment will be needed to determine if other services or if behavior services might be appropriate. Not every instance of assessment will lead to behavioral services in the person’s behavior support plan.
The scope of the assessment is determined by the provider and may include:
- Direct observation of the individual
- Gathering of information from caregivers
- Review of past behavioral and medical records
- Analysis of data collected during the assessment
- Development of an intervention plan to change the target behavior(s)
- Completion of the final report, summarizing professional opinion and recommendations.
The purpose of Home-Based Support Services (HBSS) is to prevent or delay out-of-home placement. Access to HBSS empowers families as the primary decision makers by providing funding to allow them to hire providers of their choice. Home-Based Support Services include care and supervision provided directly to eligible persons living in the community. The planning team determines the composition of the service and assures it does not duplicate, nor is duplicated by, any other service provided to the individual. Services are provided on a regular or intermittent basis by an eligible caregiver who is typically hired, trained and supervised by the family. The service may be authorized and coordinated with other in-home care services, such as nursing or personal care, but may not be delivered simultaneously with those services. HBSS cannot be provided at the same time as other BCFR funded services, such as therapeutic recreation activities and social skill groups.
When Home-Based Support Services are provided to minor children living with their parents or guardians, the services shall not supplant the cost and provision of support ordinarily provided by parents to children without disabilities, nor shall it supplant educationally related services and support that is the responsibility of local education authorities.
Home-Based Support Services do not include:
- Providing support in preschool, daycare or public school
- Completion of home-school related activities
- Services typically in lieu of day care/school for persons under the age of 11 years old
- On-call supervision
- Services typically delivered in lieu of day programs
- The caregiver’s travel time without the individual present
- Meals, mileage, entry fee and any other costs associated with providing care
Individuals are eligible for Home-Based Support Services when:
- The individual has a developmental disability and the service is directly related to the disability
- The individual has a need for care, assistance and direct supervision beyond that of a typically developing, same aged peer and
- The individual has difficulty utilizing ordinary caregiver services; such as: after school programs and daycare/preschool.
- Individuals who participate in DMH Medicaid Waiver Programs are not eligible for this service.
Individuals may be eligible for additional reimbursement of Home-based Support Services (HBSS) during the summer months (June, July, August) to supplement a plan of participation in other educational, vocational, recreational, and/or enrichment activities.
Persons may be eligible for summer teen activity assistance, if they:
- are eligible for Home-based Support Services
- are 11 to 19 years old
- are enrolled in and attending school
- continue to require intensive supervision and care due to their developmental disability
- have parents/care givers whose employment conflicts with providing supervision and summer activities.
The caregivers for eligible individuals shall provide a plan of summer educational, vocational, recreational and enrichment activities for their child. This plan should note dates and times of activities and proposed dates and times HBSS-Summer Teen Assistance would be used. The assistance may be used for interim weekday care and supervision of the child during the summer months after the end of the public-school term and prior to the beginning of the next public-school term.
Fees for summer school, meals, mileage, costs associated with leisure recreational activities and any other costs associated with providing care cannot be paid for by the agency. The caregiver’s travel time without the individual present is not covered as part of this definition. HBSS Summer Teen Assistance cannot be provided at the same time as other BCFR funded services, such as therapeutic recreation activities and social skill groups.
This service provides physical adaptations to the home or vehicle, identified in the individual’s support plan, which enable the individual to function with greater independence in the home and community and/or provide modifications to assist caregivers in meeting the service recipients’ care needs.
- Priority is given to those modifications and adaptations which are necessary to ensure the health, welfare, and safety of the individual.
- Service recipients or guardian must state their intention to continue residency in the modified location to receive the benefit of the proposed home modification.
- Service recipients who are eligible for and participate in a Medicaid Waiver program for persons with developmental disabilities will utilize this resource for environmental accessibility adaptations.
This service consists of facilitating communication between a service recipient and/or his family and agency staff by communicating in the primary language of the individual or family, including American Sign Language (ASL). Language interpretation services may be used for individual plan meetings and for on-going communication with the Support Coordinator and the individual and/or family for the purpose of coordinating and monitoring services, including periodic contacts and eligibility assessments.
Language Interpretation Services may be requested for short term use to facilitate initial communication between the individual and their family and a service provider or community agency for the purpose of linking to needed services; when no other options are available. BCFR funded language interpretation services are not provided for school-based meetings, legal situations or medical care.
This service may also be used for translation of BCFR materials such as the individual’s annual plan.
These services are intended to help eligible persons to build skills for life and work in the community. The services are delivered by the agency’s Life & Work Connections program depending upon its capacity. Waiting lists may exist.
Services include skills training and support to adults living on their own; also transition age youth and adults who aspire to live on their own. Staff members help link participants with resources and connections in the community that help them build social capital and access natural supports. Staff support individuals in mapping self-determined trajectories to achieve their goals.
Through Transition Network, staff members teach classes in various community locations including schools, aimed at helping people transition to greater independence and productivity.
Pre-employment and employment services are offered to transition age youth. Staff members provide support in work skills development. Participants receive hands on experience on Life & Work Connections, Inc. work crews, while learning work habits portable to any job – punctuality, accountability and team work. Some learning is classroom-based.
Staff help individuals find and keep jobs – including teens and adults who are not eligible for Supported Employment services through the Division of Vocational Rehabilitation (VR) but who are work ready. Support may include interest/skills assessments, job exploration, help with interviewing, connection to natural supports, advocacy, consultation with employers, benefits planning, and arranging transportation.
The services are delivered by the agency’s Life & Work Connections program depending upon its capacity. Waiting lists may exist. If a waiting list exists, priority for admission is given individuals at risk for abuse, neglect, exploitation or out-of-home placement.
A mental health evaluation may be needed to assess one or more of the following: an individual’s intellectual functioning; mental health status; the need for guardianship; if the individual is a physical danger to self and/or others.
Services and supports not included in other service definitions which may be provided to an eligible individual with a developmental disability to minimize the functional limitations of the individual and increase their abilities. Requests will be reviewed on an individual basis and cannot exceed the established service limits.
Items used by typically developing peers or non-adapted common household items are not covered under Miscellaneous Individual Supports. Services and supports not covered include, but are not limited to, medications, vitamins, non-adapted clothing, shoes, hygiene supplies, furniture and household items. Materials such as videos and books relating to developmental disabilities may be available for loan through a cooperative agreement with the Daniel Boone Regional Library.
Nutrition Services includes:
- Conducting individual assessments including: nutritional history and dietary intake; anthropometric, biochemical, and clinical variables; feeding skills and feeding problems; and food habits and food preferences.
- Following the assessment, the provider develops an individual plans to address nutritional needs; making referrals to appropriate community resources to carry out nutrition goals, provides caregiver training and monitors implementation of the nutrition plan and achievement of desired goals.
Services include face-to-face assessments and on-going consultations in person, by phone or by electronic participation.
Evaluation of a person to determine the presence, cause and extent of movement delays or challenges related to an individual’s developmental disability which interfere with activities of daily living and community participation. The evaluation may be sought to identify the need for therapeutic intervention, equipment or equipment modification, services, supplies or devices, and may also include consultation with physicians, if any, involved in the individual’s care.
Service is provided to address the functional needs of an individual related to adaptive development and recreation, sensory, motor, and postural development. These services are designed to improve the individual’s functional ability to perform tasks in their home, and community settings including employment. Individual therapy is designed to prevent or minimize delays in development, or loss of functional ability. Training or technical assistance regarding treatment or use of adaptive equipment may be provided for:
- an individual with a disability and their caregiver
- professionals actively providing services to the
- eligible individual
employers of eligible individuals
Evaluation of a person to determine the presence, cause and extent of movement delays or challenges related to an individual’s developmental disability that interfere with activities of daily living and community participation. Evaluation may also be sought to identify the need for therapeutic intervention, equipment or equipment modification, services, supplies or devices, and may also include consultation with physician(s) involved in the individual’s care.
Physical Therapy is provided to improve movement, function, strength, and range of motion related to an individual’s developmental disability that interferes with activities of daily living and community participation. Therapy may be provided on a one-to-one basis or in a consultative mode. One-to-one therapy is for individuals who require intervention to maintain health, prevent further movement loss, or enhance physical skills. Training or technical assistance regarding treatment or use of adaptive equipment may be provided for:
- an individual with a disability and their caregiver
- professionals actively providing services to the eligible individual
- employers of eligible individuals
Positive Behavior Support services are designed to assist individuals with developmental disabilities to develop positive interaction skills for success in the individual’s home and community. Individualized strategies should emphasize learning new skills, offer choice, promote community participation, be culturally appropriate, and include modifying environments, as needed. BCFR will not purchase services that include aversive procedures.
Examples of how this service may be used include, but are not limited to:
- Assisting the person served and their caregivers in developing and implementing a morning routine for success in arriving to school or work on time
- Teaching skills and/or strategies to reduce anxiety in new situations
- Assisting parents in implementing strategies, including incorporating door alarms in the home environment to reduce their child leaving the home, without permission.
The provider must submit an initial assessment with recommendations on the proposed treatment plan to promote more positive interactions and behaviors, clarify expectations and establish positive expectations or rules, improve recognition of desirable behaviors and reduce problematic interactions.
Provider activities covered by this service include:
- Coaching and monitoring of caregivers on implementation of strategies
- Modeling desired interactions
- Developing skill training(s)
- Revising strategies based on an evaluation of identified outcomes.
This service is not to be provided for development or implementation of behavior support strategies or a functional behavioral assessment as these services require licensure as a behavior analyst, psychologist, counselor or social worker with specialized training in behavior analysis.
Social Skills Group experiences are designed to assist individuals with developmental disabilities to develop social communication and interaction skills for success in community settings, employment and in the individual’s home.
Strategies to increase targeted social skills may include interactive activities, role play, modeling and rehearsal. Examples of targeted outcomes include but are not limited to:
- work related communication skills; including interviewing skills and interacting with co-workers
- social language skills to build communication and peer relationships
There is an expectation that the service is provided in a group setting as it is not only a more effective means to deliver the service but also a more efficient and cost effective treatment than individual service.
This service includes fees for Social Skills Group programs specifically designed for persons with developmental disabilities that meet identified goals and needs of the participant. Fees for community or generic programs that provide small group experiences, such as play groups, clubs, or programs that provide movement and music activities or costs of materials and supplies are not included under this definition. Agency or Home and Community-based Waiver funded supports cannot be accessed at the same time the individual is participating in a Social Skills Group experience funded by the agency.
Evaluation to determine presence, cause, extent and corrective/adaptive treatment of developmental communication disorders, including receptive/expressive language, articulation and rhythm of speech. An oral peripheral examination may also be completed.
Service designed to treat disorders of speech, language, and hearing identified by a Speech/Language Evaluation and to enhance adaptive communication.
Therapy may be provided on a one-to-one basis or in a consultative mode. Training or technical assistance regarding treatment or use of adaptive equipment may be provided for:
- An individual with a disability and their caregiver
- Professionals actively providing services to the eligible individual
- Employees of eligible individuals
Therapeutic recreation programs enable persons with developmental disabilities to develop their capacity, performance and relationships with other persons. There is an expectation that the service is provided in a group setting. Therapeutic Recreation services include fees for recreation programs specifically designed and adapted for persons with developmental disabilities that meet identified psychosocial and physical motor needs of the participant. Examples would include activities such as Special Olympics, therapeutic horseback riding, adaptive swimming lessons, and camps for persons with developmental disabilities. Fees for community or generic recreational programs, fitness club memberships, personal training or costs of materials and supplies are not included under this definition. Therapeutic Recreation is not intended and shall not be used to pay for accommodations required through the Americans with Disabilities Act.
Agency or Home and Community-based Waiver funded supports cannot be accessed at the same time the individual is participating in a therapeutic recreation experience funded by the Agency.
Toileting supplies are those used by persons for incontinence due to their developmental disability. Supplies available through this service include diapers or disposable briefs for persons five-years old and older, suppositories and fiber supplements when used as part of a bowel program for persons with physical disabilities, adult toileting wipes, bed chux, and catheter supplies.
Specialized door-to-door transportation will be limited to low-income individuals who have a developmental disability and are unable to access public transportation or para-transit services and do not have transportation of their own. The eligible individual must be an active MO Healthnet (Medicaid) recipient.
Transportation is available for verifiable vocational and day programs, employment, therapies, community resource access activities identified in the Individual Plan, support groups, counseling, therapeutic recreation, independent living skills training, evaluations and planning meetings with the individual’s team. This service cannot be a substitute for non-emergency medical transportation covered by MO Health Net. Health related appointments such as lab work and medical equipment fittings may be covered if not covered by non-emergency medical transportation.
This service is limited to low-income individuals who have a developmental disability and includes authorization for purchased or reimbursed Half-Fare Bus Passes, Paratransit or to subsidize other means of transportation. Persons/families both residing outside the city limits and within the city limits may apply for mileage reimbursement not to exceed established budgetary guidelines. The eligible individual must be an active MOHealthNet recipient.
Transportation is available for verifiable vocational and day programs, employment, therapies, community resource access activities identified in the Individual Plan, support groups, counseling, therapeutic recreation, independent living skills training, evaluations, and planning meetings with the individual’s team. This service cannot be a substitute for non-emergency medical transportation covered by MO Health Net. Health related appointments such as lab work and medical equipment fittings may be covered if not covered by non-emergency medical transportation.
An individual is eligible for reimbursed transportation when:
- the service recipient or primary caregiver(s) agrees to and abides by the rules and conditions for participation in the reimbursed program.
Vocational Transition Services may be authorized for short-term assistance in school-to-work and other transitional employment experiences. Vocational Transition Services enable service recipients to increase their work capacity and improve their performance and relationships with others in work settings. Services include face-to-face job mentoring, consultation, supervision and problem solving with the employee or employer on a short-term basis as the service recipient adjusts to employment.
Autism is a complex neurobiological disorder which can affect communication, development, and social behavior. The Department of Mental Health has established Autism Projects throughout the state to support individuals with Autism Spectrum Disorder. In Boone County, this is the Central Missouri Autism Project (CMAP) with EasterSeals Midwest being the sole provider of services.
Individuals served by BCFR must have a primary diagnosis of Autism Spectrum Disorder verified through the Department of Mental Health to be referred for CMAP services.
For additional information on Autism Project services see the Office Of Autism Services or EasterSeals Midwest.
The Missouri Department of Mental Health currently administers four Home and Community Based Services Waivers. These include the Comprehensive Waiver, Missouri Children with Developmental Disabilities Waiver, Community Support Waiver and the Partnership for Hope Waiver.
Not all individuals served by BCFR will qualify for a Medicaid waiver. These are specialized programs which require additional eligibility beyond those for general admission to BCFR.
For additional information please speak with your Coordinator.