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Department of Health and Human Services Stakeholder Engagement

Community Alternatives Program 1915(c) HCBS Waiver August 17, 2016. Department of Health and Human Services Stakeholder Engagement. Implementing an extended waiver. How to apply utilization limits in an extended waiver Waitlist

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Department of Health and Human Services Stakeholder Engagement

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  1. Community Alternatives Program 1915(c) HCBS Waiver August 17, 2016 Department of Health and Human ServicesStakeholder Engagement

  2. Implementing an extended waiver • How to apply utilization limits in an extended waiver • Waitlist • A state specifies the maximum number of unduplicated participants who will be served during each year the waiver is in effect. • The limit on the number of individuals who participate in the waiver may result in a waiting list for waiver services. Eligible applicants must be deferred until capacity becomes available as a result of turnover or the appropriation of additional funding. CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement

  3. Implementing an extended waiver • Modifications • The total cost of modifications cannot exceed the approved amount over the life (CMS approved 5 year waiver cycle) of the waiver. Participants not in the waiver for the full five years will receive the benefit prorated to 1/5 of the amount/each year of participation. • Each year of participation – 1 year from CAP effective date • 7/01/2010-6/30/2015 = $10,000 • 7/01/2011-6/30/2015 = $8,000 • 7/01/2012-6/30/2015 = $6,000 • 7/01/2013-6/30/2015 = $4,000 • 7/01/2014-6/30/2015 = $2,000 • 7/01/2015-6/30/2016 = $2,000 • 6/30/2016-new waiver is approved = $2,000 • The waiver entry year will be used to assess the amount for modifications going forward and will retro back to April 2016 CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement

  4. CAP/C waiver amendment proposal • Overview of the proposed changes and their impact • Determination of CAP nursing and nurse aide hours CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement

  5. Service provision comparison CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement • Cap Nursing • Nurse care to individuals with a skilled need that requires intervention every 2-4 hours • In-Home Care • Personal care to individuals with two or more limited to extensive Activities of Daily Living (ADLs) needs • Pediatric Nurse Aide • Personal care to individuals with two or more extensive ADLs needs that falls in the Nursing Assistant (NA) I and NA II categories • Private Duty Nursing • Nurse care to individual with a skilled need that requires intervention every 2-4 hours • Personal Care • Personal and home maintenance care to individuals with limited ADLs and Instrumental Activities of Daily Living (IADLs) needs • No comparable service

  6. Service provision comparison CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement

  7. Next Steps Meeting the needs of medically fragile children • Waiver services supplement rather than replace informal and formal supports, so how do we: • Structure needed supports within waiver guidelines and comply with the Social Security Act? • Manage care needs and maintain cost-neutral service provisions? • Use Medicaid to its fullest to optimize cost-neutral service provisions? • What supports are needed and how much? • What supports are available? • How do we leverage available supports? CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement

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