HCBS Waivers by mikesanye

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									     An Overview of
Home and Community-Based
     Waiver Services

                     A labama Medicaid A gency
                       Long Term Care Division
                     Rev ised: December 2007
        Home Community-Based
        Service (HCBS) Waivers

• In 1981, Congress authorized
  the waiver of certain federal
  requirements to enable a state
  to provide home and
  community-based services
  (other than room and board) to
  individuals who would otherwise
  require SNF, ICF, or ICF/MR
  services reimbursable by
  Medicaid.
                  HCBS Waivers

• The waiver programs are called 1915(c) waivers, named
  after the section of the Social Security Act that
  authorized them.

• Under 1915(c) waiver authority, states can provide
  services not usually covered by the Medicaid program,
  as long as these services are required to keep a person
  from being institutionalized .
                 HCBS Waivers

• Under HCBS Waiver programs, both the comparability
  and statewideness requirements may be waived to
  enable states to target distinct groups of recipients.




• HCBS Waiver Services can be provided only as a
  vehicle to provide an alternative to institutional care.
                  HCBS Waivers

• Initial waivers are approved for three (3) years and
  renewed every five (5) years thereafter.
        What are waiver “slots”?


• Each waiver program is
  allotted a certain number of
  “slots” to be filled by clients
  approved to receive waiver
  services within a waiver year.
          Types of waiver slots


• An active waiver slot is one in which a person is
  actively receiving waiver services and is not in a
  nursing facility.

• A pending waiver slot is one that is pending
  approval for a person to receive waiver services.
          Types of waiver slots


• A filled waiver slot is one which has a person
  currently receiving waiver services or who has
  been receiving waiver services, but had
  subsequent placement in a nursing facility, has
  moved or has requested termination from the
  waiver during the waiver year.
        More about waiver slots


• A filled slot cannot be refilled by another
  individual within the same waiver year that the
  vacancy occurred; however, the same individual
  who previously left the slot may fill the slot.
               When can a
          waiver slot be refilled?


• Although a waiver slot cannot be refilled within the same
  waiver year, available slots may be refilled in subsequent
  waiver years.
        Transfer of Waiver Slots


• If a client transfers from one waiver to another
  within the same waiver year, the slot that was
  left vacant is considered filled, and therefore may
  not be refilled by a different individual.

  For example, the client is on the MR Waiver and
  transfers to the LAHW, the MR Waiver slot cannot
  be refilled until the next waiver year.
      Medicaid Approved Home and
       Community-Based Waivers
• Elderly and Disabled (E&D)   • HIV/AIDS Waiver
  Waiver
                               • Technology Assisted (TA)
• State of Alabama               Waiver for Adults
  Independent Living (SAIL)
  Waiver

• Mentally Retarded
  (MR) Waiver

• Living At Home Waiver
     Administering State Agency


• The Alabama Medicaid
  Agency has administrative
  authority over the Home and
  Community-Based Waivers.
              Responsibilities of the
            Alabama Medicaid Agency

   To assure Centers for Medicaid and Medicare Services that:

• The Operating Agency adheres to all federal guidelines described in
   the approved waiver document;

• The health and welfare of the client is protected;

• The client has free choice of providers and waiver service workers;
• All direct service providers meet the qualifications as outlined in the
   approved waiver document; and

• The client is aware of their right to express concerns regarding
   service provision and/or direct service provider.
          Operating State Agencies
              Responsibility


• State agencies are charged with the responsibility of
  operating the home and community-based waiver
  programs.
             Responsibilities of the
              Operating Agencies
• Manage the program by focusing on
  improving care for the client;

• Protect the health and welfare of the
  client;

• Give the client free choice of providers
  and waiver service workers;

• Make sure all direct service providers
  meet the qualifications as outlined in the
  approved waiver document.
Elderly and Disabled
   (E&D) Waiver
     (Since 1982)
                   E & D Waiver


• Assists elderly and/or disabled individuals to live in the
  community who would otherwise require nursing facility
  care.
                 E & D Waiver


• Operating Agencies:
   ▪ Alabama Department of Public Health
   ▪ Alabama Department of Senior Services

• No age requirement

• 9,205 waiver slots
       Financial Eligibility Criteria


• Individuals receiving SSI and/or State Supplementation;
    Widows and Widowers under age 60;
    Widows and Widowers age 60 – 64;
    Adult children who lose supplemental security income benefits
     upon entitlement to the child’s insurance benefits based on
     disability;
Financial Eligibility Criteria…continued


• SSI related protected groups deemed to be eligible for
  SSI/Medicaid;

• Individuals who would be eligible for Medicaid in an
  institution because income from either parents or a
  spouse is not deemed available to them (referred to as
  institutional deeming).
                 Medical Criteria



• Must meet current level of care admissions criteria for
  nursing facility care.
                Covered Services


•   Case Management
•   Homemaker Services
•   Personal Care
•   Adult Day Health
•   Respite Care (Skilled and Unskilled)
•   Adult Companion Services
•   Home Delivered Meals
Mentally Retarded
  (MR) Waiver
    (Since 1981)
                    MR Waiver


• Provides Home and Community-Based Services to
  Medicaid eligible individuals who would otherwise
  require the level of care available in an Intermediate
  Care Facility for the Mentally Retarded (ICF/MR).
                     MR Waiver


• Operating Agency
    Alabama Department of Mental Health and Mental Retardation


• 3 years of age and above

• 5260 waiver slots
     Financial Eligibility Criteria

• Social Security Income (SSI) – protected
  groups deemed to be recipients of SSI

• Special home and community-based
  optional categorically needy groups whose
  income is not greater than 300% of the SSI
  federal benefit rate.
               Medical Eligibility


• Must meet current level of care admissions criteria for
  an ICF/MR (Intermediate Care Facility for the Mentally
  Retarded) Facility.
        Characteristics of Persons
         Requiring ICF/MR Care

• Intermediate care services for the mentally retarded are
  those services which are needed because of the severe,
  chronic nature of the mental impairment that results in
  substantial functional limitations in three or more of the
  following areas of life activities:
      Characteristics of Persons
  Requiring ICF/MR Care…continued
• Self Care

• Receptive and expressive language

• Learning

• Mobility

• Self Direction

• Capacity for independent living
                           Covered Services
                                                    •   Institutional Respite Care
•   Residential Habilitation Training
                                                    •   Personal Care
•   Residential Habilitation – Other Living
    Arrangement
                                                    •   Personal Care on Worksite

•   Day Habilitation – Levels 1-4                   •   Personal Care Transportation
•   Day Habilitation with Transportation – Levels   •   Environmental Accessibility
    1-4                                                 Adaptations
•   Prevocational Services                          •   Specialized Medical Equipment and
•   Supported Employment                                Supplies
•   Occupational Therapy Services
                                                    •   Skilled Nursing
•   Speech and Language Therapy
                                                    •   Assistive Technology
•   Physical Therapy
•   Behavior Therapy – Levels 1-3
                                                    •   Adult Companion Services

•   In-Home Respite Care                            •   Crisis Intervention
•   Out-of-Home Respite Care                        •   Community Specialist Services
Living At Home Waiver
      (Since 2002)
          Living At Home Waiver


• Provides Home and Community-Based Services to
  Medicaid eligible individuals who would otherwise
  require the level of care available in an Intermediate
  Care Facility for the Mentally Retarded.
          Living At Home Waiver

• Operating Agency
   ▪ Alabama Department of Mental Health and
     Mental Retardation

• 3 years of age and older

• 569 waiver slots
       Financial Eligibility Criteria


• Social Security Income (SSI) - protected groups
  deemed to be recipients of SSI.
                Medical Criteria


• Must meet current level of care admissions criteria for an
  ICF/MR (Intermediate Care Facility for the Mentally
  Retarded)
                    Covered Services

• Residential Habilitation In-Home       • Out-of-Home Respite
• Day Habilitation – Level 1-4           • Personal Care
• Day Habilitation with Transportation – • Personal Care on Worksite
  Level 1-4                              • Personal Care Transportation
• Prevocational Services                 • Environmental Accessibility
• Supported Employment                     Adaptations
• Occupational Therapy Services          • Specialized Medical Equipment and
• Speech and Language Therapy              Supplies
• Physical Therapy                       • Skilled Nursing
• Behavior Therapy – Level 1-3           • Community Specialist
• In-Home Respite                        • Crisis Intervention
State of Alabama Independent
     Living (SAIL) Waiver
         (Since 1992)
            Operating Agency



• Alabama Department of Rehabilitation Services
          Target Population



The SAIL Waiver is approved to serve disabled
adults with specific medical diagnosis who are at
risk of being institutionalized in a nursing home.
             Target Population

                       •   Quadriplegia
                       •   Traumatic brain injury
SAIL Waiver Services •     Amyotrophic Lateral Sclerosis
are provided to, but   •   Multiple Sclerosis
not limited to persons •   Muscular Dystrophy
with the following     •   Spinal Muscular Atrophy
diagnoses:             •   Severe Cerebral Palsy
                       •   Stroke
                       •   Other substantial neurological
                           impairments, severely debilitating
                           diseases, or rare genetic diseases
                           (such as Lesch-Nyhan disease).
                 Waiver Slots



• The SAIL Waiver is approved to serve 660
  individuals.
       Financial Eligibility Criteria


• Individuals receiving SSI;

• Individuals receiving State Supplementation;

• SSI related protected groups deemed to be eligible for
  SSI/Medicaid;

• Special HCBS Waiver disabled individuals whose income is
  not greater than 300% of the SSI Federal Benefit Rate.
                  Covered Services

•   Case Management*
•   Personal Care Services
•   Environmental Accessibility Adaptations*
•   Personal Emergency Response System (Initial Set-up)
•   Personal Emergency Response System (Monthly)
•   Medical Supplies
•   Minor Assistive Technology
•   Assistive Technology
•   Evaluation for Assistive Technology*
•   Assistive Technology Repairs
•   Personal Assistance Services

*Includes Transitional Services
HIV/AIDS Waiver
  (Since 2003)
        Operating State Agency



• Alabama Department of Public Health
               Target Population


• The HIV / AIDS Waiver is designed to address the needs
  of individuals with a diagnosis of HIV, AIDS, and related
  illness who meet the nursing facility level of care criteria.
                 Waiver Slots


• The HIV/AIDS Waiver is approved to serve 150
  individuals.
      Financial Eligibility Criteria


• Individuals receiving SSI

• Disabled individuals with income up to 300% of
  the SSI income level.
           Covered Services

•   Case Management
•   Personal Care
•   Homemaker Services
•   Respite Care
•   Skilled Nursing
•   Companion Services
Technology Assisted (TA)
   Waiver for Adults
       (Since 2003)
       Operating State Agency



• Alabama Medicaid Agency
            Target Population


• Individuals who received private duty nursing
  services through the Early Periodic Screening
  Diagnostic Test (EPSDT) Program under the
  Alabama Medicaid State Plan, who will no longer
  be eligible for this service upon turning age 21
  and for whom private duty nursing services
  continues to be medically necessary based upon
  approved private duty nursing criteria .
            Waiver Slots


• The TA Waiver is approved to serve
 40 individuals.
       Financial Eligibility Criteria


• Individuals receiving SSI
• Individual receiving State Supplementation
• SSI related protected groups deemed to be eligible for
  SSI/Medicaid
• Special HCBS Waiver disabled individuals whose
  income is not greater than 300% of the SSI Federal
  Benefit Rate
• Low income families with children.
              Covered Services

•   Private Duty Nursing
•   Personal Care/Attendant Service
•   Medical Supplies
•   Assistive Technology
•   Targeted Case Management (TCM)

    TCM for the TA Waiver for Adults is under the
    Medicaid State Plan and is provided by the
    Alabama Department of Rehabilitation Services
                  HCBS Waiver Contact Information:



AIDS Waiver                          Melody Tompkins   (334 353-4383)
Technology Assisted Waiver            Melody Tompkins (334 353-4383)
State of Alabama Independent          Latonda Cunningham (334 353-4122)
Living Waiver – SAIL (formerly Homebound)
Elderly and Disabled Waiver (ADSS)   Latonda Cunningham (334 353-4122)
                            (ADPH)   Ginger Wettingfeld (334 242-5018)

Living at Home Waiver                Monica Abron       (334 242-5642)
MR Waiver                            Samantha McLeod    (334 242-5584)

								
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