From Waiver to Program: The Keys to Operationalizing Waivers

1. Technical Assistance to Expansion States March 28, 2006 From Waiver to Program:The Keys to Operationalizing Waivers

2. The Purpose of Operational Manuals • To record the approved waiver standards in a user-friendly document • To establish consistency in standards and procedures throughout implementation • Reduce the number of questions that the state office needs to answer • Assure consistency in training of program employees • Provide all partners, financial management agencies, support brokers, participants/representatives the same information

3. Provide the authority under which you operate the program Medicaid Waiver – 1915 or 1115 Medicaid State Plan (with new legislation) Older Americans Act Funding State Funds Identify the agency and staff who manage the program Goals Mission – Program guidance Establish clear measurable standards to achieve Identify evaluation procedures to monitor goal achievement Authority and Goals

4. Eligibility • Identify all eligibility requirements • Willingness to participate • Age • Geographic area • Disability and functional needs • Feeder programs • Cognitive requirements • Use of a representative • Programs that might make a participant ineligible

5. Communications/ Marketing Identify ways to inform potential participants of the new option At time of implementation Continuing communication Process to gather data on how participants learned of the program Evaluate and modify plan based on data Enrollment How interested individuals contact the program What information is gathered at that time How enrollment will be completed Who will complete? How and where? Forms to be used? Communications/Marketing and Enrollment

6. Identify the process to assure that enrollees will be successful with self-direction Process to follow when enrollment staff doubt an enrollee’s ability to self-direct Self-assessment Appointment of a representative Additional monitoring/support after enrollment Representative Situations that necessitate a representative Eligibility requirements Responsibilities Process and forms Participant/Representative Responsibilities

7. Determining the amount of the budget Services to be converted to the budget Formula for calculating the budget Communicating the amount of the budget prior to enrollment Forms Calculation form Spending Plan or Budget Outline of possible uses of budget Development of a written spending plan Training on budget development Person-centered planning Acceptable expenditures within the budget Budget approval process Expected timelines Budget

8. Support Broker (Individual or Agency Procurement process Open enrollment of providers RFP Directly hired by participant Qualifications Responsibilities Clearly define the role that the SB will have with: Program Administration Participant Monitoring and quality assurance Financial management agency Financial Management Agency Procurement Process Open enrollment of providers RFP Qualifications Responsibilities Payment of payroll and related reporting, tax payments Payment for other goods and services Sub-contracting Support Broker & FMS

9. Assessments & Reassessment • Who will complete? • Who should be involved? • Process to follow • Frequency of reassessments • Level of care determinations • Service or care planning process • Effect on the budget • Annual budget review and update

10. Closures & Changes • Conditions that will result in closure or disenrollment • Unavoidable • Voluntary • Involuntary • Conditions that might trigger • Who makes the decision • Appeal process • Process for closing a case • System changes • Allowance recovery

11. Directly Hired Workers • Qualifications • Hiring Process • Work Agreement • Required paperwork for FMA • Work agreement • Informed consent documents • IRS Form W-4 • State Form W-4, if applicable, • USCIS Form I-9 • IRS Notice 797

12. Quality Management • Establish measurements based on program goals • Identify quality measures that are unique to participant-direction • Assign responsibilities • State administrative office • Support brokers • Financial management agencies • Participants/Representatives

13. Miscellaneous Topics • Appeals and hearings • Grievances • Participant Freedom of Choice • Privacy and release of information • Reporting abuse, neglect, exploitation • Retention of records

14. Summary • Advanced planning will assure that states are poised and ready to begin implementation as soon as waivers are approved. • Clearly stating program policies, processes, and procedures will help reduce problems in the future. • A public process for establishing program operations will help divert opposition to and increase support of the program. • Update manuals whenever changes occur in the program to assure consistency and accuracy.