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Determining Eligibility for Services 

 

Notice: The DDSN Online Self-Serve Screening Platform is unavailable due to renovation.


Checklist for required records, if you have all the required records, they can be mailed to the SCDDSN Eligibility Division at 8301 Farrow Road, Columbia, SC 29203-3294

If you don't have records contact us tollfree at 1-800-289-7012 between 8:30-5:00 Monday through Friday.

Steps to take to determining eligibility for services links are provided below as links to specific information.




After You Become Eligible

If you are Medicaid eligible and need assistance to gain access to needed medical, social, educational, and other services, you may be eligible for Medicaid Targeted Case Management. Medicaid Targeted Case Management services can assist you by providing you with a case manger who will assess your needs, help you develop a plan to address those needs, link and refer you to needed DDSN and other services/resources, and follow-up to make sure the services are indeed addressing your needs. To request a case manager you must contact the South Carolina Department of Health and Human Services (the Medicaid Agency). The request for Medicaid Targeted Case Management services must be made online at SC DHHS Initial Electronic Referrals. If you need assistance with this request, please contact DDSN by phone at 803-898-2235 and someone will assist you.


If you are not Medicaid eligible and need assistance to gain access to needed medical, social, educational, and other services, you may be eligible for State-Funded Case Management . State-Funded Case Management services can assist you by providing you with a case manger who will assess your needs, help you develop a plan to address those needs, link and refer you to needed DDSN and other services/resources, and follow-up to make sure the services are indeed addressing your needs. To request a case manager you may contact DDSN at (803) 898-2235 and someone will assist you in obtaining a case manager.


If you are receiving either Medicaid Targeted Case Management or State Funded Case Management, you should expect your Case Manager to assess your needs, develop with you a Plan to meet those needs, offer you a choice of available providers of needed services, refer you to or link you with your chosen provider, monitor the Plan you have created to ensure it is meeting your needs and modify the Plan when modifications are needed.




Life Planning

Life Planning involves active participation from the individual, as well as his/her “circle of support” which is comprised of family members, friends, caregivers, and professionals who are closest to the individual and know him/her best. By asking questions and gathering input from the group, a life plan can be developed which expresses the individual’s personal life choices.

Through Life Planning, individuals can:

  • Explore and prioritize those things that are most important to them
  • Develop a sense/picture of how they want their lives to be
  • Explore preferences and possibilities of where and with whom they wish to live
  • Explore preferences and possibilities for how they wish to spend their time and energy and
  • Explore current/available resources and possible untapped resources

Once developed, the Life Plan can be used to guide, influence and direct the Service Plans created by service providers so that services support the person to have the life they want.

Life Planners must undergo specialized training, demonstrate competency in a variety of skills and meet other DDSN qualifications to be placed on a list of approved providers. Individuals/family members choose a Life Planner from a list which can be found on the DDSN website at http://www.ddsn.sc.gov/consumers/qpl/Pages/ListOfQualifiedLifePlanners.aspx .  There is no cost to the individual or family for this service.

Once a Life Planner has been selected, the person/family member contacts their Case Manager, Qualified Intellectual Disability Professional, or Early Interventionist to authorize and arrange the service. The Life Planner will then make contact directly with the individual or family member to finalize the meeting plans. The Case Manager, Qualified Intellectual Disability Professional or Early Interventionist is not required to attend the Life Plan meeting, but is to make every effort to participate if invited.

At the Life Plan meeting, the Life Planner will guide the individual and his/her Circle of Support through the process of planning for the individual’s immediate and long-term future.

Service Providers

In South Carolina, the individual and his/her family may choose from a list of providers qualified by DDSN to provide services.

A list of qualified service providers can be found on DDSN’s website at https://app.ddsn.sc.gov/public/directory/landing.do.  Qualified Providers are listed by county. All providers may not offer services for all disabilities or for all ages in all counties. Visit us and browse to find out if a provider offers the service you need, for the desired age group and disability, and in the location you need.

Your Case Manager may also provide you with the list of Qualified Providers. This list will include the Provider’s name, a description of the types of services they offer along with the areas of the state in which their services are offered. Individual consumers and families will then select the Provider(s) that they feel can best meet their needs within the resources assigned to them based on their level of disability.

To assure that quality services are provided, each Provider listed has been reviewed by the state to become qualified, including appropriate licensure or certification as required.

DDSN service users and families evaluate Service Providers on quality, efficiency and effectiveness, the recipient’s satisfaction with services and supports and how well they help meet the individual’s goals and produce desired results.

DDSN will continue to monitor and enforce policy and procedures. Health and safety will continue to be top priorities at all times, as well as specific outcomes and results for consumers and families.

DDSN will use a combination of oversight methods to evaluate the Service Provider’s performance. They include:

  • licensing standards
  • consumer and family satisfaction
  • utilization review
  • outcome assessment
  • quality indicators
Licensing

State law requires licensing of certain programs and residential facilities. This licensing relates to the health and safety aspects of facilities and services. The law authorizes the establishment of standards for the qualifications of staff, staff ratios, fire safety, medication management, facility size and construction, storage of hazardous liquids and health maintenance. All Facility-Based Day programs and some residential facilities must be licensed. Licensing activities occur on a regular basis, depending on the type of program. DDSN contracts with a federally recognized Quality Improvement Organization to conduct licensing inspections.

Consumer and Family Satisfaction

Consumer satisfaction surveys are conducted regularly with consumers, families and other service providers. DDSN and Service Providers use this information to improve services and make them more responsive to consumers’ needs and wishes.

If a consumer and/or family are dissatisfied with services received or with a Service Provider, DDSN has established consumer concern processes and a formal appeal process to be followed when decisions or concerns cannot be resolved directly with the Provider. Ask your Case Manager for a copy of these procedures if they have not been provided to you.

Utilization Review

DDSN contracts with a federally recognized Quality Improvement Organization, to conduct periodic assessment of Service Providers by making on-site visits in its Contract Compliance Review (CCR) process. During this process, records are reviewed, consumers, staff, and family members interviewed, and observations made to make sure that services are being implemented as planned and based on the consumer’s need, that the consumer/family still wants and needs them, and that they comply with contract and/or funding requirements and best practices. In addition, the Service Provider’s administrative capabilities are reviewed annually to ensure compliance with DDSN standards, contracts, policies, and procedures.

Outcome Assessment

Historically, measures of quality were often far removed from the actual impact in the lives of the consumers of the services.  Agencies would focus on “process measures” rather than “outcome measures,” since they were often easier both to measure and to control. If the administrative and programmatic processes, protocol, procedures and paperwork were in place, then the quality of service was assumed.

Over time measures of quality shifted from “processes” to “outcomes,” but still the focus was often on what the Agency could measure and control best, and this was not the consumer. Under this model, quality was assumed by measures of service objectives written, or units of service delivered.

It has only been recently in the evolution of the nation’s long-term care system that quality measures have started to become personalized and individualized relative to specific consumers. DDSN strives to use personal outcome measures to determine how well the service and support providers are helping an individual consumer achieve personal goals. Activity in this area is based on the work of The Council on Quality and Leadership.

Personal outcome measures are often founded on goals that the individual has set for themselves in conjunction with their family and their “circle of support.” They are thought about and discussed, hopefully weighed against alternative goals and decided upon. To this degree they are objective and “matters of the head.”

On the other hand, measures of consumer satisfaction have a larger affective component; satisfaction is a “matter of the heart.” It is very possible for a consumer to have met all of his personal outcome measures, but still feel dissatisfied with his life or the services and supports that he is receiving. Thus, measures of consumer satisfaction must go hand in hand with personal outcome measures in order for an Agency to be truly consumer-focused and driven.

Personal Outcome MeasuresSM

The 21 Personal Outcome Measures focus on the outcomes of the individual receiving services. By placing the individual at the center the definition of quality is responsiveness to the individual rather than how well the organization performs. The Personal Outcome Measures are a powerful tool for evaluating quality of life and the degree to which organizations individualize supports to facilitate outcomes.

My Self

  • People are connected to natural support networks.
  • People have intimate relationships.
  • People are safe.
  • People have the best possible health.
  • People exercise rights.
  • People are treated fairly.
  • People are free from abuse and neglect.
  • People experience continuity and security.
  • People decide when to share personal information.

My World

  • People choose where and with whom they live.
  • People choose work.
  • People use their environments.
  • People live in integrated environments.
  • People interact with other members of the community.
  • People perform different social roles.
  • People choose services.

My Dreams

  • People choose personal goals.
  • People realize goals.
  • People participate in the life of the community.
  • People have friends.
  • People are respected.

©Copyright 2005, The Council on Quality and Leadership (CQL)


Quality Indicators

DDSN collects, analyzes and reports information on how well Service Providers are performing on various other quality indicators which give an indication of the health and safety of each person, dignity and respect, personal choice, participation in the community and attainment of goals. Some of the ways this information is gathered include: comprehensive Provider self-assessments; Service Coordinator oversight; peer reviews; consumer/family monitoring; local human rights committee work; staff turnover; circle of support contacts; and the quality of facilitated plans.

Information from these sources can be especially helpful to consumers and families in evaluating their plan and in selecting and evaluating individual Service Providers.


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