Providers are divided into two broad categories, Typical and Atypical.

Typical: A health care provider means a provider of medical or health services (as defined in section 1861(s) of the Act, 42 U.S.C. 1395x(s)), and any other person or organization who furnishes, bills, or is paid for healthcare in the normal course of business. Medical Providers are enrolled within CHAMPS and have an NPI (e.g. Institutional (Hospital, Nursing Home, etc.,) Professional (Practitioner, Prescriber, Pharmacy, Dental, etc.)).

Atypical: The Center for Medicare and Medicaid Services (CMS) defines atypical providers as providers that do not provide health care[2]. Providers who may be enrolled in CHAMPS or Bridges and do not perform medical services (e.g. Home Help, Non-Emergency Medical Transportation (NEMT), Adult Foster Care (AFC)). Atypical providers may submit HIPAA transactions, but they do not meet the HIPAA definition of a health care provider and would not receive an NPI number.

According to the Developmental Disabilities Act (Pub.L.106-402), the term developmental disability means a severe, chronic disability that:

is attributable to a mental or physical impairment or a combination of those impairments;
occurs before the individual reaches age 22;
is likely to continue indefinitely;
results in substantial functional limitations in three or more of the following areas of major life activity: (i) self care, (ii) receptive and expressive language, (iii) learning, (iv) mobility, (v) self-direction, (vi) capacity for independent living, and (vii) economic self-sufficiency; and
reflects the individual’s need for a combination and sequence of special, interdisciplinary, or generic services, individualized supports, or other forms of assistance that are of lifelong or extended duration and are individually planned and coordinated.
The term “developmental disability” can include several types of conditions including, but not limited to: autism, Down syndrome, Asperger’s syndrome, cerebral palsy, and epilepsy. Many states use different definitions for developmental disabilities based on the federal law. Oklahoma uses the federal definition and also adds that a person must have a primary diagnosis of intellectual disabilities to be qualified for developmental disabilities services.

Intellectual disabilities are generally thought to be present if an individual has an Intelligence Quotient (IQ) test score of approximately 70 or below (AAMR, 2002). Intelligence refers to a general mental capability. It involves the ability to reason, plan, solve problems, think abstractly, comprehend complex ideas, learn quickly, and learn from experience. IQ scores are determined from standardized tests given by trained professionals.

Studies have shown that somewhere between 1 percent and 3 percent of Americans have intellectual disabilities, depending on how they are counted. Based on an IQ score alone, the percentages would be closer to 3 percent.

It is difficult to pinpoint exactly how many people have intellectual disabilities. Studies alone may not identify everyone. Many parents and professionals throughout the U.S. report they are aware the label “mental retardation” can bring offense, and for this reason they avoid its use; preferring instead, “intellectual disabilities”. Many school age children receive a diagnosis of learning disability, developmental delay, behavior disorder, or autism instead of intellectual disabilities. Many adults who technically could be said to have intellectual disabilities live independent, productive lives and avoid all labels. Their success and their lack of functional limitations may mean that they are not included in studies that count the number of adults who have cognitive, intellectual or related developmental disabilities. (The Arc, 2004)

Intellectual disability is not mental illness. Intellectual disability refers to a person’s capability to think and reason. Mental illness is an emotional disturbance. There may be one occurrence or several which can develop at any time in a person’s life. Like anyone else, a person with intellectual disabilities may become emotionally disturbed or mentally ill, but they are separate conditions.

The effects of these disabilities vary considerably among people who have them, just as the range of abilities varies considerably among all people. Children may take longer to learn to speak, walk and take care of their personal needs, such as dressing or eating. People may take longer learning in school. As adults, many people will be able to lead independent lives in the community without paid support. A small percentage will have serious, lifelong limitations in functioning.

While people with intellectual disabilities learn more slowly than other people, they have many of the same hopes, fears, joys, problems, and needs that others do. They have talents and abilities that should be developed through individualized education, job training, and specialized therapies such as physical, occupational and speech therapies. Support can enhance individual functioning. Support can come from family, friends and community or from a service system such as the DHS Developmental Disabilities Services.

With early intervention as children and appropriate education, training, and supports as adults, all people with developmental disabilities can lead satisfying lives in their communities. The end result is a better, more normal life for people who have the same rights and responsibilities as anyone else.

A waiver is a funding mechanism which allows the state to offer community-based services as an alternative to institutional services. The term waiver specifically refers to two elements of home and community-based services:

First, the state applies to the Center for Medicare and Medicaid Services for a special waiver or a special allowance from the services typically included in the State Medicaid Plan. This waiver allows the state to use Medicaid funds to provide alternative community supports for a targeted population who is at risk for institutionalization.

Second, the individuals served waive the institutional services for which they are eligible in order to receive community-based supports.