System Transformation

In 2012, the Office for Citizens with Developmental Disabilities (OCDD) has begun a statewide System Transformation that aimed at improving access to, quality of, cost-effectiveness of and efficiency of community services for persons with developmental disabilities utilizing state plan Medicaid, waiver, EarlySteps, and state general funds services. The efforts were also geared to influence the access structures to public and private intermediate care facilities/developmental disabilities (ICF/DD).

The goals of the System Transformation initiative was to serve more persons in home and community-based services (HCBS), achieve cost effectiveness in HCBS versus institutional options, reduce institutional reliance in both private and public settings, provide access to appropriate services based upon need and increase utilization of natural and community supports versus paid supports.

System Transformation Phases:

Phase 1 - Research and Data

OCDD created several System Transformation workgroups to research the concerns that were raised by stakeholders, which included the need for increased consumer choice and control services, lifespan planning, Request for Services Registry, service array/services, Single Point of Entry/No Wrong Door, stakeholder engagement, support utilization and transformed system design, system transformation feasibility and implementation management.

Over the course of five years, OCDD engaged multiple stakeholders. The Request for Services Registry workgroup was formed to focus on ways to reduce the wait. 

Phase 2 - Request for Services Registry (RFSR) Screening Project

Information About the Request for Services Screening Initiative

Public Meeting:  The first public meeting regarding proposed changes to the Request for Services Registry was held April 28, 2015 from 10 a.m. to noon at the LDH Bienville Building in Conference Room 118. Click HERE for Announcement and HERE for Handouts

Press Release: Office for Citizens with Developmental Disabilities to Screen Individuals to Better Determine Needs

Throughout 2017, OCDD in collaboration with community partners held screenings, which were face-to-face meetings with individuals and family members who are on the RFSR waiting list. The tool known as the Screening for Urgency of Need (SUN), was designed to identify any needs a person may have, review current supports a person has and uses now, and determine the urgency of any unmet need that the person has. The screening is not a waiver offer.

SUN Scores

4 = Emergent [needs service immediately within 90 days]

3 =Urgent [needs services within 3-12 months; temporary supports may be in place but are not sustainable beyond 12 months]

2 = Critical [need supports within 1-2 years (13-24 months)]

1 = Planning [anticipate a change in the future but need is 2-5 years (25-60 months) away]

0 = None of the Above [need is more than 5 years away; need cannot be met with waiver (default choice is no unmet need is identified or anticipated in future]

A SUN was conducted on more than 9,000 individuals on the Registry and yielded the following discoveries:

99% of the people who were on the RFSR as of 06/30/2016 have been contacted or attempted to be contacted for participation in the screening. Some individuals did not participate in the screening for a variety of reasons, such as, they had moved out of the state, they were incarcerated, death in the past year, refusal to participate with request to be removed from waiting list, and unable to be located. 

More than 9,200 individuals participated in the screening to determine if they have any unmet needs, the urgency of these unmet needs, and if there are any available resources to meet these needs.     

  • 15% of the people on the waiting list have been identified to have emergent or urgent needs, meaning they are at high risk of institutionalization without waiver services in the next three months
  • 42% of the people on the waiting list have support needs identified; however, they are not in need of these services until one year or longer (critical/planning needs)
  • 43% of the people on the waiting list did not have any current unmet needs identified

Based on the screening data, it was utilized to support informed discussion of strategies for services, including request for needed waiver offers to meet the needs of individuals with urgent/emergent support needs. During fiscal year 17/18, OCDD was allocated funding by the legislature for 627 mixed waiver opportunities to address individuals who were identified as having urgent and emergent needs.

RFSR Documents:

Interim Validation Process
Telephone Script
Face-to-Face Interview
Individual Decision Form
Individual Decision Form Decline
Request for Services Registry (RFSR) Information Update

Phase 3 - Tiered Waiver System

Information About the Tiered Waiver System

OCDD's four developmental disability home and community-based waivers, New Opportunities Waiver (NOW), Residential Options Waiver (ROW), Supports Waiver, and Children's Choice Waiver have now been operationalized to a tiered waiver system of service delivery, which will allow for individuals to be supported in the most appropriate waiver. Home and community-based waiver opportunities will now be provided based on the individual's prioritized need for support, which was identified in their RFSR Screening for Urgency of Need. Instead of being first come, first served, individuals with the most emergent and urgent need for support will have priority.

The concept of a tiered waiver system was developed in conjunction with stakeholders, which included individuals on the waiting list, self-advocates, families, providers, and advocacy organizations and was approved by the Centers for Medicare & Medicaid Services (CMS).

OCDD Holds Statewide Community Meetings on Tiered Waiver System

In March and April 2018, OCDD conducted an extensive outreach and education campaign that focused on statewide community meetings, geared at informing individuals who are on the Request for Services Registry, also referred to as the waiting list about what the move to a new tiered waiver system will mean. In collaboration with community partners, two sessions were offered, a morning and an evening. The see a detailed listing of those community meetings that was provided to individuals and/or their family with information on the new tiered waiver system, please see the flier, OCDD Tiered Waiver Community Meetings

More than 689 individuals attended OCDD’s statewide tiered waiver discussions:

Region 1   | Metropolitan Human Services District (New Orleans area) - 47

Region 2   | Capital Area Human Services District (Baton Rouge area) - 80

Region 3   | South Central Louisiana Human Services Authority (Houma area) - 73

Region 4   | Acadian Area Human Services District (Lafayette area) - 140

Region 5   | Imperial Calcasieu Human Service Authority (Lake Charles area) - 50

Region 6   | Central Louisiana Human Services District (Alexandria area) - 70

Region 7   | Northwest Louisiana Human Services District (Shreveport area) -70

Region 8   | Northeast Delta Human Services Authority (Monroe area) - 33

Region 9   | Florida Parishes Human Services Authority (Hammond area) - 75

Region 10 | Jefferson Parish Human Services Authority (Metairie area) - 51

Tiered Waiver Fact Sheet

Frequently Asked Questions About OCDD's Tiered Waiver

OCDD mailed letters regarding the following:

  • Letters to individuals on the Request for Services Registry who were screened
  • Letter to individuals/families who are receiving a Children’s Choice Waiver

For additional information on the move to a new tiered waiver system, please call 1-866-517-7687 or email

OCDD Stakeholder Feedback

OCDD would like to hear your concerns and answer your questions about the system transformation efforts underway. If you have any thoughts that you would like to share, please feel fre to send them to