Annual Home & Community Based Waiver Conference. November 2015

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Cuthbert York
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1 Annual Home & Community Based Waiver Conference November 2015

2 Children s Waiver Program Beyond the Basics: Changes and Updates

3 Who Are We? Audrey Craft, Specialist, Federal Compliance Section, MDHHS Joan Deschamps, Specialist, Children s Home and Community Based Waivers, Retired 3

4 Who Are You? Parents? Case Managers? Supervisors? Clinical Specialists? Administrators? Provider Agencies? Other??? 4

5 Objectives Describe one way the transition of the Children s Waiver Program (CWP) from the 1915(c) waiver to the proposed 1115 waiver authority will impact the site review process. Describe three ways the Waiver Support Application (WSA) can help you manage required CWP case maintenance activities in a timely manner. Identify two things your CMHSP must do to be paid for ABA services provided to a child on the CWP who is also eligible for the Medicaid Autism Benefit 5

6 Changes to site review process with proposed move to 1115 waiver The CWP is currently on an extension while pending submission and approval of an process of applying for an 1115 waiver State is proposing fewer performance measures with a focus on health and safety 6

7 Proposed performance measures Number and percent of reviewed participants whose IPOS include services and supports that align with the individual's assessed needs. Numerator: Number of reviewed participants whose IPOS include services and supports that align with their assessed needs. Denominator: All participants whose records were reviewed. Number and percent of reviewed participants whose IPOS had adequate strategies to address their assessed health and safety risks. Numerator: Number of reviewed participants whose IPOS had adequate strategies to address their assessed health and safety risks. Denominator: all participants whose records were reviewed. 7

8 Proposed performance measures Number and percent of reviewed participants whose IPOS reflect their goals and preferences. Numerator: Number of reviewed participants whose IPOS reflect their goals and preferences. Denominator: all participants whose records were reviewed. Number and percent of IPOS for reviewed participants in which services and supports are provided as specified in the plan, including type, amount, scope, duration and frequency. Numerator: Number of IPOS for reviewed participants with services and supports provided as specified in the plan, including type, amount, scope, duration and frequency. Denominator: all IPOS for the participants whose records were reviewed. 8

9 Proposed performance measures Number and percent of participants requiring hospitalization due to injury related to the use of physical management. Numerator: Number of participants requiring hospitalization due to injury related to the use of physical management. D: all participants with reported incidents of hospitalization for injuries or medication error. Number and percent of participants requiring hospitalization due to medication error. Numerator: Number of participants requiring hospitalization due to medication error. Denominator: all participants with reported incidents of hospitalization for injuries or medication errors. 9

10 Proposed performance measures Number and percent of participants being reviewed where the BTPRC policy was followed. Numerator: Number of participants being reviewed where the BTPRC policy was followed. Denominator: Number of participants reviewed that include restrictive or intrusive interventions. MDHHS is in the process of developing performance measures to assess the settings status in getting into compliance with the HCBS final rule, person-centered planning process and requirements around conflict free case management. 10

11 Waiver Support Application (WSA) & Case Maintenance Activities Prescreen Maintenance Invitations to Apply and Application Documents Annual Re-certifications Terminations including age outs Annual Budgets Transfers (prescreens and active cases) 11

12 How to Access WSA Reports Click on Reports on the WSA menu If you have WSA security roles for the CWP only, that will be the only program available in the program dropdown list; select CWP if you have security roles for other programs The age-off, coming due and past due reports will help you plan for needed work! 12

13 How to Access WSA Reports - Con t. 13

14 Common Mistakes in WSA Not submitting terminations for age-outs Late notification of terminations due to other reasons besides aging out Not keeping prescreens up to date Submitting documentation to MDHHS but not updating the appropriate WSA tab Budgets: Not matching number of units with the actual unit measure of the code; use of yearly frequency instead of monthly ; incorrect use of code modifiers 14

15 Payment for ABA for Children on CWP (prior to 1115) Children on the CWP can pursue ABA eligibility through the Medicaid Autism Benefit. CMHSPs can evaluate eligibility for the ABA benefit and submit enrollment information via their Autism WSA user to the PIHP/MDHHS. Once eligibility is determined by MDHHS, ABA will need to be added to the IPOS. 15

16 Payment for ABA for Children on CWP IPOS must contain amount scope and duration of service of the service and the responsible professional directly supervising the service. CMHSPs bill fee for service for CWP services and PIHPs will be reimbursed for ABA if all three components required for payment are complete. 16

17 Payment for ABA for Children on CWP Three components: eligibility determined by MDHHS via the WSA, establishing an IPOS and submitted valid service encounter of H2019-U5. 17

18 Updates? 18

19 Contacts / Resources For Questions Medicaid Provider Manual-Mental Health/Substance Abuse Chapter/Children s Waiver Program (Section 14) Audrey Craft at or crafta@michigan.gov Kelli Dodson at or dodsonk@michigan.gov Children s Waiver Program User Training Manual (WSA Splash Page) 19

Subpart D Quality Assessment and Performance Improvement. Subpart D Quality Assessment and Performance Improvement

Subpart D Quality Assessment and Performance Improvement. Subpart D Quality Assessment and Performance Improvement 438.206 Availability of services (b) Delivery network (1) (b) Delivery network. The State must ensure, through its contracts, that each MCO, and each PIHP consistent with the scope of the PIHP s contracted