Network of Care for Developmental Disabilities

LARGE PRINT

	Intake Process Service Philosophy Services Programs First Steps Autism Initiatives Operating Regulations MODDRC Service Directory

Programs

Autism
Certification and Quality Enhancement
First Steps
Fiscal Intermediary Program
Guardianship in Missouri
Home & Community-Based Waiver

Autism

One of the least understood of all developmental disabilities is autism. Autism is a lifelong developmental disability that typically appears during the first three years of life, resulting from a neurological disorder that affects brain functioning which interferes with communication, learning, behavior and social development. The Division of Developmental Disabilities established Missouri’s Autism Program in 1991. The program provides support services to families and persons with autism residing in their own homes.

New developments in research and therapy have unlocked some of autism's mysteries, and with them, some of the lives affected by autism. The prevalence of autism and autism spectrum disorders is estimated to occur in as many as one in every 250 individuals or more. This equates to well over 22,000 persons in Missouri.

For additional facts about autism and to learn more about Missouri's Autism Projects, please click here.

Missouri Autism Project Registry

The Missouri Department of Mental Health is working in collaboration with the Departments of Health Psychology, Child Health, and Health Management and Informatics at the University of Missouri-Columbia to develop a Missouri Autism Project Registry. The goal of the project is to develop public policy that would enhance the system of care for children with autism spectrum disorders and their families. The Network of Care will serve as a portal for this project. To learn more, please click here.

Missouri Autism Research and Response Agenda (MARRA)

The Missouri Autism Research and Response Agenda (MARRA) is an exciting collaborative effort to develop public policy that addresses the needs of children with autism, their families, and the agencies that provide services. To learn more about MARRA, please click on the links below:

Certification and Quality Enhancement

There is an ongoing process to ensure the health and safety of persons supported by the Division, as well as to promote the outcomes in the Missouri Quality Outcomes Discussion Guide. To focus upon health and safety, the providers that received Home and Community-Based Waiver funding are evaluated and an enhancement plan is developed by the agency and the regional center to help ensure that desired outcomes are met. The state-wide quality assurance and training team works with local teams to assist providers in enhancing positive outcomes for the people supported by the Division. The long-range goal of this program is to change the way people with developmental disabilities are perceived within their communities.

The Missouri Quality Outcomes Discussion Guide describes a collection of positive outcomes identified by people with disabilities, family members and friends. The Discussion Guide is a tool designed to assist the service delivery network to put these desired concepts into practice.

First Steps

First Steps offers coordinated services and assistance to young children with special needs and their families. First Steps is designed for children, birth to age 3, who have delayed development or diagnosed conditions that are associated with developmental disabilities. First Steps is a collaborative effort of four state agencies - the Departments of Elementary and Secondary Education, Health, Mental Health, and Social Services. First Steps is supported by federal and state funds from four agencies and by other local and private agencies throughout Missouri.

To be eligible for this program, children from birth to 3 must be diagnosed as having at least a 50 percent delay in one or more areas of development: cognitive, communication, adaptive, physical (including vision and hearing), and social/emotional; or diagnosed as having a designated physical or mental condition that has a high probability of resulting in a developmental delay.

For additional information, please click here.

Fiscal Intermediary Program

When a consumer or family chooses to hire, train, supervise and schedule their own workers who are not licensed professionals, U.S. Department of Labor rules prohibit the workers from being treated as independent contractors and require the workers be treated as employees. This means the worker must have an employer. The consumer or family who wants to direct their own personal assistant services becomes the employer of record for the workers they hire. The fiscal intermediary provides all necessary payroll functions for the employer of record (the consumer or family) and acts as a liaison with various regulatory and governmental agencies.

What is a Fiscal Intermediary Program

A fiscal intermediary is an accounting or payroll office that provides payroll functions for employers that don't want to invest in managing payroll functions for their employees. Payroll involves accurately paying employees and withholding taxes, both for the employer and the employee. The amounts must be correct and taxes and insurance withheld must be directed to the right federal or state agency on a timely basis.

When are Fiscal Intermediary Services Needed?

Personal assistant services authorized to a person served by the Division of MRDD can be provided by:

workers employed by an agency,
workers who are licensed professionals (individual contractors) such as nurses, or
workers a consumer or family member hires, trains, supervises and schedules (referred to as self directed)

How are Fiscal Intermediary Services Accessed?

The consumer must be authorized personal assistant services and the planning team must document in the person's plan that the consumer's (and/or family's) choice of self directing services will not put the consumer's health and safety at risk. Services authorized for the consumer will include funding to cover the cost of fiscal intermediary services. The regional center serves as a bridge between the consumer and/or family (employer of record) and the fiscal intermediary. Individual workers maintain a time sheet and record hours worked. In addition to keeping a time sheet of time worked, the worker is responsible for documenting specific activities that were performed each day. The employer is responsible for verifying/approving time sheets for workers and sending the time sheets to the regional center according to a published schedule. The regional center forwards the time sheet information electronically to the fiscal intermediary. The fiscal intermediary processes the time sheets, generating a direct deposit to each worker's specified account, and calculating and remitting all payroll related taxes. The fiscal intermediary processes payroll twice a month.

After a family, consumer and their planning team decide that the use of a fiscal intermediary is desired the regional center service coordinator will provide assistance in completing the enrollment packet. In order to enroll in the FI program, all forms listed below must be completed and forwarded to the appropriate parties. Instructions for completing each form and a link to the forms follow:

Guardianship in Missouri

Guardianship is a legal process where an individual is appointed by the probate court to have the authority and responsibility for the personal affairs of another individual who has been adjudged to be incapacitated.

Prior to seeking guardianship for an individual it is important to understand the implication of guardianship and the long term affects that guardianship has on an individual’s life. When an individual is declared incapacitated, s/he looses many rights which you and I take for granted such as the right to vote, to obtain a drivers license, to consent or object to medical care or to enter into contracts like marriage or home ownership. Individuals may not get to decide where they live, who they live with, where they may go in the community or how their money is spent. These decisions are ones that define us as human beings and determine our quality of life. If we are to promote independence, dignity and freedom of choice among persons with disabilities than guardianship should be an action of last resort. There are other reasons to avoid guardianship as well: attorneys, hearings and evaluations can be expensive. Courts often do not follow the law in promoting partial guardianships as it is easier for the court to inflict full guardianship on someone even when this is unnecessary. Guardianships are also very difficult to modify or terminate.

Prior to considering guardianship as a way to ensure someone’s health and safety the following alternatives should be considered:

Designation of an advocate for care and medical treatment.
Improved person centered planning that identifies risks and ways to reduce risks, and describes backup plans etc.
Money Management Alternatives

Bill Payer programs
Representative Payees
Dual signature checking accounts

Power of Attorney- a written document which give someone legal authority to act on an individual’s behalf in specified matters.
Trusts
Conservatorship (Maybe limited): When a person is appointed by the court to make financial decisions for the individual.
Advance Directives

Durable Power of Attorney – a written document that appoints someone to act as an agent in making health care decisions when the individual can not.
Living Wills

The Missouri statutes recognize that individuals may be partially incapacitated, that is perfectly able to make decisions in one area of life, while needing significant support in another. For example, an individual may be able to handle small amounts of money, dress herself and cook simple meals but may be unable to properly take medication or understand what happens at doctor’s visits. If it is determined by those who know and care about the person that the ONLY alternative is guardianship, than limited guardianship should ALWAYS be considered first. With limited guardianship, the individual retains certain legal rights and freedoms that may directly impact quality of life. For more information, go to Missouri Protection & Advocacy Services.

The Guardianship Process:

Legal guardianship is a great responsibility and wonderful opportunity to make a difference in someone else's life. A person can legally assume guardianship over a child, or an adult who is not physically or mentally able to care for himself. Regardless of the biological relationship, people generally file for guardianship in the best interest of caring for another person. However, when there isn't another person willing to assume the responsibility of guardianship Public Administrators are elected official within each county who can be appointed by the court to carry out the duties of guardianship.

There is a process in the Probate Court System in Missouri that makes guardianship appointments, whether it is a Public Administrator or another person. There is a process in place that must be completed to become someone's guardian. The process involves filing papers in court, participating in a court investigation, and attending a court hearing to decide the rights to legal guardianship for a person. Each step of this process is taken to ensure that the guardian will provide a better life for the person for whom they take responsibility. Guardians may be appointed on a limited basis or for just one area, i.e. medical decision.

Case Managers will provide information and/or assistance to an individual or family to seek guardianship for another person.

To help you perform your duties properly, described below are the general duties and obligations of a guardian and conservator.

If you have been appointed guardian, you have charge of the respondent's person and respondent is known as a ward. If you have been appointed conservator, you have charge of the respondent's property and respondent is known as a protectee. If you have been appointed both guardian and conservator, you have charge of both respondent's person and property and respondent is known as both a ward and a protectee. Your authority as guardian and conservator may be limited by the order appointing you. Consult your attorney as to the extent of your authority.
As guardian, you have the duty to take charge of the person of the ward and to provide for the ward's care, treatment, habilitation, education, support and maintenance; and the powers and duties shall include (a) assuring that the ward resides in the best and least restrictive setting reasonably available; (b) assuring that the ward receives medical care and other services that are needed; (c) promoting and protecting the care, comfort, safety, health and welfare of the ward; and (d) providing required consents on behalf of the ward. You will be required to file a personal status report annually concerning the care, welfare and placement of your ward.
As conservator, you must take possession of your protectee's property to the extent authorized by the court. The property, income and bank accounts should be kept separate from your own funds in your name as conservator for the protectee. You must invest the protectee's funds according to law and you are personally liable for imprudent or unauthorized investments. You may only spend the protectee's funds for purposes authorized by statue or court order. You may apply for an order of continuing supports and maintenance authorizing you to spend a budgeted sum each month for the protectee. You will be required to file an annual accounting (called a settlement) showing in detail all receipts and expenditures occurring during the preceding year. Each entry must be explained and each expenditure must be authorized by statue or court order. You may not sell, trade, lease, mortgage, transfer or discard your protectee's property without court approval, even though the protectee is your child or other relative.
In the event the ward or protectee dies or you or the ward or protectee move from one address to another, you have the duty to notify the court in writing of such death or new address as soon as possible.
If you fail to perform any of your duties as guardian or conservator, you are liable for any loss or damage sustained by the ward or protectee by reason of your failure. You are under the duty, at all times, to act in the best interests of your ward or protectee to avoid conflicts of interest which impair your ability to act.
In certain cases, expenses of bond and other costs may be saved by placing funds in restricted deposits and/or securing waiver of filing the annual settlement. Consult your attorney.
With court approval, a conservator may use the protectee's funds to pay for your attorney's services. If only limited funds or public assistance (SSI) is available, you may qualify for free legal aid.

Home & Community-Based Waiver

The waiver is used as the primary source of funding for people who live in the community but need residential services.

In July 2003, the Division of Developmental Disabilities sought and received approval for the Sarah Jian Lopez Medicaid Waiver. This waiver allows access to funding for appropriate care and support for children with developmental disabilities so they may continue living at home with their families.

Sarah Jian Lopez Waiver