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Overview of Settlement Agreement and Release
The Department of Health (DOH) is announcing changes to the Developmental Disabilities Waiver (DDW) as a result of a court-approved settlement agreement in the Waldrop lawsuit against the State brought by Disability Rights New Mexico (DRNM) and the ARC of New Mexico NMArc. For more information read the Joint Letter from DDSD, Human Services Department (HSD), DRNM and NMArc.
''Catch – All'' Letter for Perceived Lost Services
DDSD sent a letter dated July 1, 2015 to relevant DD Waiver Participants referred to as the "Catch-All" Letter. The Catch-All letter is requesting notification of any perceived lost services. DD Waiver participants may choose to temporarily restore the service(s) that they were receiving before they were assigned to a DD Waiver Group. Read the FAQ regarding this letter and the Waldrop Instructions to Case Managers for more information.
For more information about the Waldrop Revision Budgets for Family Living Service+250 Hours of Substitute Care & Rate please read the memorandum from the Human Services Department (HSD) and the Developmental Disabilities Supports Division (DDSD) regarding the temporary Family Living Service code T2033 HB U7.
Changes to Covered Services
Director’s Release: Allowance of Three Therapy Disciplines (5/29/2015)
Clarifying change in availability of therapy services (i.e. occupational therapy, physical, therapy, and speech and language pathology) for DDW participants.
Revisions to Group H Policy and Procedure
Individuals may apply under the DOH “Group H” policy and procedure for Family Living, Supported Living or additional “day” services if the IDT can justify the clinical need for these services, regardless of the individual’s NM DDW Group assignment.
DDSD has revised the Group H policy and procedure and the DDSD Individual Support Needs Review form. Effective July 1, 2015 Group H will be referred to as “H Authorization. Refer to the Policy and Procedures for more information. All Temporary and Long Term H packets will continue to be submitted directly to your respective Regional Office. Click here for the revised DDSD individual Supports Needs Review form.
Use of NM DDW Groups
NM Department of Health does not use NM DDW Group Assignments to deny or approve any residential service model or the number of therapy disciplines on a budget request. No Service is dependent on a NM DDW Group assignment. Please read the following documents for more information:
Supports Intensity Scale® (SIS) Assessments
SIS assessments are no longer conducted for New Mexico DDW as of July 1, 2017
DDSD will be contracting with an independent third party (the “Outside Reviewer”) to provide clinical review of requested services. The DDW Participant’s case manager, and/or guardian may submit to the Outside Reviewer additional information relating to support needs. The Outside Reviewer will make a written clinical determination on whether the requested supports are needed and will recommend whether the requested annual budget should be approved. The DDW Participant, case manager and guardian (if applicable) will be provided with this written determination and notice of opportunity to request a fair hearing.
- Clinical Criteria V3 edit date June 26, 2017, effective date July 1, 2017
- Introduction to Clinical Review and Clinical/Service Criteria V2 December 2015
- Clinical Documentation Checklist
- Communication with IDT Instruction Memo (prior to annual submissions, budget revisions, RFIs, and technical denials on submissions to the TPA and/or OR)
- Guidance on Prevention of Outside Review RFIs
- Case Manager/Provider Responsibilities Regarding Supporting Clinical Documentation, RFI Communications Between Providers, and Imminent Review Process
- Frequently Asked Questions
- DD Waiver Outside Reviewer Cover Sheet V 1.2.1
- DD Waiver Outside Reviewer Cover Sheet Instructions V 1.2
- Process Flowchart
- Review Process for Adult DDW Recipients
- Service Criteria to ISP Crosswalk
- Verification of Benefits Availability
- Who is Who
- Expired Budgets for Adults on the DDW (3/24/16)