Introduction to Waivers · 2020-06-17 · 1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org Introduction to Waivers This

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org

Introduction to Waivers

This training is called Introduction to Waivers

You will have an opportunity to learn information about NM waiver system

Through the following slides and recorded presentation,

through video clips and hearing from people and families accessing or waiting for

services in one of the waiver programs, and

Through resource materials posted along with this training module

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Welcome To Your Waiver System

We hope that the information in Introduction to Waivers

will give you a foundation to the 1915 c Home and Community Based Services

Waiver System that you are participating in.

We hope that the information in Introduction to Waivers will give you a foundation to the 1915 c Home and Community Based Services Waiver System that you are participating in.

Thank you to advocates and family members willing to share their personal stories to help

with this training.

DDSD hopes this will be a useful training and we ask that you complete an evaluation at the

end of this training to help us improve future modules.

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Learning Objectives

• What is the role of the Developmental Disabilities Support Division (DDSD) and Human Services Department in the waiver programs ?

• What NM HCBS Waivers are operated by the Developmental Disabilities Support Division (DDSD) and how do they work ?

There are two main goals to this training.

We hope that when finished with this training:

1. you will have a better understanding of the Developmental Disabilities Supports

Division and the Human Services Department in the Waiver System

2. you will have a general understanding of NM Home and Community Based Services

Waivers (HCBS waivers) that are operated by DDSD and how they work

We will talk about waiver programs in general and some specifics about DD Waiver, Mi Via

Waiver, Supports Waiver and Medically Fragile Waiver

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DDSD Mission • Person Centered Community Supports and Services

• Positive Outcomes

• Assist Individuals with Intellectual and Developmental Disabilities and their families

• Honor rights to make choices, grow and contribute to their community

DDSD stands for Developmental Disabilities Supports Division

You will hear more about DDSD as we go through the rest of the presentation

For starters, DDSD is here to make sure the waiver programs run well for people in services

and for providers.

DDSD has a mission, a purpose and goals:

To be person centered in community supports and services

To get positive outcomes for people

To help and assist individuals with Intellectual and Developmental Disabilities and

their families

And to very importantly, to honor rights of people with IDD to make choices, grow,

and contribute to their community

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Disability Rights=Civil Rights = Human Rights

• Every person has the right to make their own choices as much as possible

• Dignity of risk. Everyone has the right to make mistakes and the right to learn from them

• Every person has the right to make friendships

Let’s say a little more about rights. Disability rights are civil rights are human rights. History

has treated people with disabilities unfairly. People with IDD have sometimes had their

lives and decisions determined for them. Consider the disability rights slogan: “Nothing

about us without us.”

An intellectual disability does not mean your rights are taken away.

In the HCBS Waiver programs:

Every person has the right to make their own choices as much as possible

Every person has the right to make mistakes and the right to learn from them. This is

called Dignity of Risk

Every person has the right to make friendships.

We all have a responsibility to recognize and honor the rights of People with Disabilities

Inserted Video Interview as Available: Let’s start by listening to a waiver participant.

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What Is a Home and Community Based Services (HCBS) Waiver?

• Supports people to stay in their homes • Has an eligibility definition for participation (e.g.,

IDD or medically fragile) • Addresses needs in home and community (versus

institutional care)• Includes services in addition to medical and

behavioral health benefits available through State’s Medicaid Plan

Many states have Home and Community Based Services waiver programs.

Home and Community Based Services Waiver programs support people in their homes and

communities.

You might also hear the term 1915c waiver. This is because section 1915 c of the Social

Security Act allows states to waive certain Medicaid requirements in order to open up

more and specialized services to people in the home and community versus an institution.

In NM, there are no institutions. HCBS waiver programs are very important programs supporting inclusion and integration of people with intellectual and developmental disabilities in

their community.

Some general examples of services in NM’s HCBS waiver programs are personal care

services in a person’s home or a provider operated home, behavior support, employment

support and technology supports.

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When you are eligible for NM waiver programs, you are also eligible for the State’s Medicaid

program called Centennial Care. You will receive medical and behavioral health care benefits

through your Managed Care Organization under Centennial Care. Your Waiver Program will

be in addition to Centennial Care.

This slide has a lot of information. So, let’s review:

HCBS waivers are part of NM Medicaid Program

To participate, you must meet the eligibility definition

HCBS programs address needs in home and community (versus institutional care)

HCBS services are in addition to the medical and behavior health benefits through the State’s

Medicaid Plan, Centennial , provided through your MCO.

Let’s Listen to Waiver Participants

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What Is Centers for Medicare and Medicaid Services (CMS)?

• A federal agency within the United States Department of Health and Human Services

• Works with state governments to run Medicaid

• Must approve of the state’s waiver programs

Centers for Medicare and Medicaid Services are a part of the US Govt. CMS makes rules

that a state like NM has to follow to run a HCBS waiver program.

HCBS Waiver programs vary from state to state and many states like NM offer more than

one waiver program.

In order to received federal money to pay for the programs, the state must follow the rules

established by CMS and run the program exactly the way that CMS approved it.

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New Mexico State Agencies Administration and Operation

Administrative Agency

Medical Assistance DivisionHuman Services Department (HSD)

Operational Agency

Developmental Disabilities Supports Division (DDSD) and Division of

Health Improvement Department of Health (DOH)

Human Services Department (HSD) Oversees administration of waivers DOH‐ Developmental Disabilities Supports Division ( DDSD) implements the waivers Division of Health Improvement (DHI) part of DOH assure safety and quality of care and to improve health care services.

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Who Does What?

NM Human Services Department (HSD)/ Medical Assistance Division (MAD) is responsible for administration and oversight of the waivers.

DOH runs the day to day operations of the waivers.

HSD/ MAD is responsible for the administrative activities of the waivers. Some of the activities that HSD/MAD is responsible for are: The Waiver applications and renewals to CMS, reporting to CMS, payment of providers, and rule promulgation.The waiver applications outline to CMS, the way services under each waiver will be provided. The New Mexico Administrative Code, which is often referred to as the NMAC or the rule, is created and promulgated by HSD. The purpose of the rule is to outline the services as they are in outlined in the waiver application, in state statute. HSD is responsible for the amendments to the rules and applications as well. Both the waiver applications and the rules go through a public comment process that HSD also oversees. This provides an opportunity for the public to give the state feedback about the services under the waiver programs.

DOH/DDSD is responsible for the day to day operations of the waiver. They are responsible for activities like the waiver trainings, service standards, processing of provider applications, and providing assistance to individuals, teams, and providers to help them understand the service standards and provide quality services. Each State Agency has its own responsibilities, however both agencies work together very closely and collaboratively to ensure that all CMS requirements are met and that quality services are being provided under the waiver programs.

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Who Does What at HSD?

• Income Support Division is responsible for establishing medical and financial eligibility for the waiver participants .

Under HSD there is another division who plays a critical role in the waiver programs. This division is called the Income Support Division, or ISD. They are responsible for establishing the medical and financial eligibility for the waiver participants.

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HSD Contractors Third Party Administrator (TPA)

Determines and re-determines Level of Care (LOC) and medical eligibility Reviews and approves Individual Service Plan (ISP) and budgetPerforms utilization management

Financial Management Agent Pays service providers and tracks expenses.

HSD also has contractors who play an important role in the waiver programs.

The Third Party Assessor also referred to as the TPA is responsible for determining the Level of Care and medical eligibility for participants who are in the waiver programs. They also review the Participant’s ISP and Budget.

The Financial Management Agent, also referred to as the FMA, is the HSD/MAD contractor that helps to implement the authorized annual budget, by paying the Participants service providers while also tracking expenses.

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Who is DDSD?• Administrative Services • Clinical Services • Behavior Supports • Community Inclusion• State General Funds• Litigation Management• Intake and Eligibility

• Community Programs • Systems Improvement• Provider Enrollment Unit • Office of Constituent

Support • Regional Offices

Now we are back to Department of Health –DDSD. DDSD is made up of many Bureaus and

Units where employees have special backgrounds in helping to run the waiver programs.

DDSD is here to help:

To help you as a waiver participant and your family, and

To help agencies, providers, and staff of the waiver services.

Some of DDSD Bureaus and Units are listed here. For example, Clinical Services Bureau,

Bureau of Behavior Supports, and Community Inclusion.

See the resource list posted with this training to get information about each Bureau.

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Regional Offices

• Metro• Northeast• Northwest• Southeast• SouthwestContact your Regional Office to get started on any question

The Regional Office Bureau provides assistance and guidance to individuals and people who

support them.

The Regional Office Bureau also manages contracts with the agencies who provide waiver

services.

When you have a problem, start by contacting your regional office. Contact information is

also in the resource materials for this training.

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DOH-Division of Health Improvement

• Provides compliance oversight for providers • Conducts investigations of Abuse, Neglect &

Exploitation (ANE)• Operates the Caregivers Criminal History

Screening Program (CCHSP) for criminal background checks

• Operates the Employee Abuse Registry (EAR) for background checks for substantiated cases of ANE.

Also at the Department of Health is the Division of Health Improvement. DHI has a Quality

Management Bureau that visits and looks at the paperwork for providers of DD Waiver, Mi

Via Waiver, Medically Fragile waiver. The Quality Management Bureau will survey the

Supports Waiver providers as well. Surveys are to make sure agencies provide quality

services and follow the rules.

DHI also has an Incident Management Bureau. The Incident Management Bureau conducts

investigations of Abuse, Neglect and Exploitation.

There is a caregiver’s criminal history screening program (CCHSP) which provides criminal

background checks for Caregivers. There is also an Employee Abuse Registry to help assure

that anyone who has a history Abuse, Neglect and Exploitation is not hired by any waiver

provider agency. You and your staff will also have access to a more detailed training on

Abuse neglect and Exploitation every year.

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What Are the Waivers Operated by DOH ?

• Developmental Disabilities Waiver (DDW)• Mi Via Waiver (MV)• Medically Fragile Waiver (MF) • Supports Waiver (SW)

There are four Home and Community Based Services waiver programs operated by DOH.

The DD Waiver is also known as the traditional DD Waiver. It is NM’s longest running waiver program. The DD Waiver has comprehensive supports including residential (24 hour /7 days a week supports) .

The Mi Via Waiver is newer than the DD Waiver. It is based on self‐direction which you will hear more about later in this presentation.

The Medically Fragile Waiver has eligibility criteria that includes risk of DD but primarily is related to complex medical needs.

The Supports Waiver is due to start July 1, 2020 based on Governor Michelle Lujan Grisham ‘s directions to develop a program for people who are on the waitlist for the DD Waiver.

Let’s Listen to Waiver Participants

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Waitlist

• The DD Waiver waitlist is a list of people who registered with DDSD and have been determined to meet the NMDOH definition of developmental disability.

• People are taken off the waitlist through allocations to the DD/Mi Via Waiver.

• Allocations are made by registration date when funding becomes available.

The waitlist has been growing and wait time has been a problem in NM for too long.

The waitlist is a list of people registered with DDSD who have been determined to meet the

NM DOH definition of developmental disability.

The wait time has been growing up to 13 years. People are taken off the waitlist through

allocations where they choose DD Waiver or Mi Via Waiver.

An allocation is when a slot opens up on the waiver and someone from the waitlist is given

that space. Allocations are made by registration date when funding becomes available.

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Service Delivery Models

Participant- Directed Service Delivery

Model

• Participant or designated Employer of Record in charge of hiring and onboarding staff

Agency Based Service Delivery

Model

• Freedom of Choice of provider agencies within approved provider network

All waivers require that you identify your service needs and plan how you are going to use services through a person‐centered plan that focuses on you the participant.

There are two ways that you can access the services you identify; Participant‐Directed services and Agency‐Based services.

Each waiver may offer either Participant Directed services or Agency Based services or both.

Agency Based services offers you a choice of Case Managers and a choice of provider agencies approved by the Department of Health.

Participant Directed services offer you the ability to direct your services by hiring and managing employees and providers directly. You will have an Employer of Record who will be responsible for employer and administrative functions.

Let’s take a minute to hear some experiences of individuals who are participating in a waiver.

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Waiver Programs

DD Waiver

• IDD• Agency

Based

Mi Via Waiver

• IDD• Participant

Directed

Medically Fragile

• Medically Complex and have or at risk for DD

• Agency Based

Supports Waiver

• On waitlist• Agency

based OR participant directed

Each of the four Department of Health 1915 c waivers has an eligibility requirement and offers different service models.

The DD Waiver requires that you have been determined to meet the NMDOH definition of developmental disability. This waiver offers agency‐based services.

The Mi Via Waiver requires that you have been determined to meet the NMDOH definition of developmental disability. This waiver offers participant directed services.

The Medically Fragile Waiver requires that you have been determined to have a medically complex diagnosis and that you are at risk for a developmental disability. This wavier offers agency‐based services.

The Supports Waiver requires that you are on the DD Waiver Waitlist. This waiver offers both agency‐based and participant directed services.

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Choosing and Changing Waiver Programs

When offered the Supports Waiver, the participant will remain on the Waitlist while in the Supports Waiver Program

When allocated to the traditional waiver, the participant will choose either the Mi Via (MV) or Developmental Disabilities Waiver (DDW) and change as desired

Throughout your participant in a waiver you will have opportunities to choose or change the waiver that you participate in.

When offered the Supports Waiver you have been determined to match the NMDOH definition of DD and will remain on the wait list while in the Supports Waiver Program.

When you receive a DD allocation, you will choose either the Mi Via (MV) or Developmental Disabilities Waiver (DDW) and change as desired.

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Choosing and Changing Waiver Programs

When allocated to Medically Fragile Waiver the participant must also apply for DD Waiver and, if determined eligible, will retain their registration date and stay on DD Waiver Waitlist while in the Medically Fragile Program

When allocated to Medically Fragile Waiver (MFW) it is strongly recommended that you apply for the DD Waiver. If you are determined eligible for the DD Waiver you will retain your registration date on the DD Waiver Waitlist while you participate in the Medically Fragile Program.

When you receive an allocation to the Medically Fragile Waiver you will choose between the Medically Fragile Waiver and the Mi Via Waiver.

Let’s hear from waiver particpants

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DD WaitlistMatch for services using

state IDD definition

DDW MVW (IDD Eligibility)

MVW

( Medically Fragile

Eligibility)

SW

Stay on Waitlist with original registration date

MFW Allocation

No Waitlist for MF Eligibility –may also apply for DDW

SW Supports Waiver DDW DD Waiver MVW Mi Via Waiver MFW Medically Fragile

Waiver

Can switch

Allocation within Waiver System

MFW

……………................

Let’s look at how all of the waivers are connected.

When you are on the DD Waitlist you have been determined to meet the NMDOH definition of developmental disability.

While you are the DD Waitlist you can be offered the Supports Waiver intended to provide supports while you are waiting for an allocation to the DD or Mi Via Waivers. ( 1st

Animation) If you choose to access the Supports Waiver you will remain on the waitlist with your original registration date.

When you are on offered an allocation from the DD Waitlist, this can be from the Supports Waiver (2nd animation) or from the Waitlist(3rd Animation), you will choose between the DD Waiver and the Mi Via Waiver. (4th animation)

The Medically Fragile Waiver does not have a waitlist. Once you have been determined eligible (5th and 6th)) you will choose between the Medically Fragile Waiver and the Mi Via Waiver. Medically Fragile Waiver participants are strongly encouraged to apply to the DD Waiver Waitlist while they are accessing Medically Fragile Services.

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What Are the Basic Parts to HCBS Waivers?

All waivers have similar elements that may look different depending on the waiver you are participating in.

We will review some of the basic parts of waiver programs in the next few slides.

So, Lets review some of the basic parts of the various waiver programs in the next few slides.

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HCBS Waivers - Waiver Services

All waivers provide:• A selection of services• What is covered by the service • Access to choice of qualified providers or

employees • Some training or licensing requirement

All waivers provide a choice of services. The waiver that you choose will have a list of services that are associated with that waiver. Please note: All waivers require that services are defined and provided by qualified providers.

All waivers provide what is covered by the service, that is there will be a description of what is included in the service chosen.

All waivers give access to choice of qualified providers or employees. So based on your needs you will have choices of what services you use and who provides those services to you.

And finally all waivers have training or licensing requirements, such as First Aide, Abuse, Neglect, Exploitation training, etc. Some waivers require licensing requirements for providers. For example Therapists have to have a license to provide services.

Let’s listen to waiver participants

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HCBS Waivers - Services

You must use benefits available from other sources prior to using the waiver like:

• Medicaid State Plan• Early and Periodic, Screening, Diagnosis

and Treatment (EPSDT)• Division of Vocational Rehabilitation

Please note that Waivers are the payor of last resort. Waiver Services cannot duplicate or take place of other Medicaid benefits.

Medicaid State Plan which is Centennial Care – these are your medical and behavior benefits through Medicaid

EPSDT is for children under 21 and can include preventative check‐ups, diagnostic testing, services such as therapies and personal care.

DVR : Assists people with disabilities to obtain and retain employment. DVR provides information and referral services as well as access to Assistive Technology that supports independence.

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HCBS Waivers -Service Planning and Delivery

The plan is the foundation for:

• The type, amount and frequency of services• Health and safety for the participant • Personal vision, goals, choices and preferences in

home and community life• Quality Assurance

.

All waivers require service planning through a person‐centered plan.

The type, amount and frequency of servicesHealth and safety for the participant Personal vision, goals, choices and preferences in home and community lifeQuality Assurance All of these things will be identified and decided through the person‐centered planning process.

Once service planning is complete and you have an approved individual plan your services will begin based on the service delivery method you have chosen (such as agency‐based or participant directed), Please note; All waivers are required to be monitored by the state.

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HCBS Waivers -Service Planning and Delivery

All waiver programs require a written plan that must be:• Developed through person centered planning• Planned with who the person wants involved • Followed by the paid providers, vendors or

employees • Monitored• Revised when needed

All waivers require service planning through a person‐centered plan.

Please remember: Each Waiver Uses different terms for the plan, case manger and provider. See Resource document 15 for a snapshot

Person‐centered planning is driven by the waiver participant and must reflect what is important to the participant to allow delivery of services based upon preferences and to ensure health and welfare

Plans Identify the strengths, preferences, needs and desired outcomes of the individual

Plans also Includes strategies for solving disagreements

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Person-Centered PlanningEmployment First

• Supported Employment Activities are a planning priority for all working age adults.

• Employment should be the first consideration.

• If someone does not choose employment, the decision should be based on informed choice.

Employment First is an initiative of DDSD and considered during the Person‐Centered Planning Process in all waivers that offer employment supports.

Informed Choice is when a person makes a decision based on a solid understanding of all available options and consequences of how that choice impacts his or her life.

Informed choice often takes into account a person’s experience or limited experience and offers them the opportunity to participate in activities that support making an informed choice about employment. Individuals can gain experience through volunteering, community‐based assessments or trial work opportunities.

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Employment First

• Access to competitive integrated employment will enable the person to engage in community life, control personal resources and receive services in the community.

• Preference to community and natural supports is given to assist individuals to attain their employment goals and desired outcomes

DDSD adopted the Employment First Policy in 2016 to establish procedures for supporting working age adults to have valued employment opportunities as the preferred service in New Mexico.

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HCBS Waivers -Participant Rights

All waiver programs have specific stated participant rights and ways for participants to dispute decisions that have been made. • Opportunity for Fair Hearing• Additional dispute resolution mechanism• State grievance/complaint system

All people have rights, with or without a waiver, and regardless of which waiver they may participate in.

Our HCBS waivers are set up to ensure people retain those rights and we have things in place for waiver participants to dispute any decisions that have been made that they don’t agree with.

Opportunity for Fair HearingAdditional dispute resolution mechanismState grievance/complaint system

An example of when someone might request a fair hearing would be if a service request on someone’s budget is denied. People will receive written notification with instructions when they have a right to a fair hearing.

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Rights and the CMS Final RuleThe Final Rule is designed to improve available HCBS programs by:

Allowing participants to have maximum control over their lives and day-to-day decision making

Ensuring the quality of HCBS

Providing protections to participants

Enabling participants the opportunity to receive services in the most integrated setting appropriate

Maximizing opportunities for individuals to have full access to the benefits of community living

In 2014 CMS issued the Final Rule for home and community‐based services. All states have until 2022 to fully comply with this federal legislation.

The Final Rule is designed to improve the quality of HCBS by ensuring that people have:

1. Maximum control over their lives and decision making2. Providing protections such as lease agreements3. Allow people to receive services in the most integrated settings, and 4. Promote full access to the benefits of community living

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Important Rights Supported in CMS Final Rule

• Have visitors• Have friendships and romantic relationships• Have food when you want in your home• Be respected and staff should not talk about

you as if you were not there • Make decisions about your health• Choose your providers and change them if

you’re not happy with them

• :

Some examples of rights that are outlined in the final rule are probably things most people take for granted. There is a reason these have been highlighted for people with IDD.

The final rule supports things like…Having visitors, making informed decisions about your health, having romantic relationships and having food when you want it in your home

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Important Rights Supported in CMS Final Rule

Choose where you live and choose your roommate

Privacy, respect and dignity Decorate your room the way you

want Have access to all areas of your

home Have freedom and support to

control your schedule

More examples of rights outlined in the final rule includePeople being in control of their own schedules, having privacy and having access to every part of their home

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HCBS Waivers -Participant Safeguards

Your waiver has:• Training and education on Abuse, Neglect,

Exploitation• Response to critical incidents or event• Rules about use of restraints and restrictions • Medication Management and Administration

In addition to the work we are doing to assure compliance with the final rule, the waivers have safeguards built in for all participants.

Abuse, Neglect and Exploitation education, training and reporting requirements

Response to critical incidents

Rules that prohibit restraints and restrictions, and

Medication management and administration

These safeguards are written into the waivers, as applicable and are approved by CMS.

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HCBS Waivers -Participant Safeguards

During delivery of services, Waiver Programs must have protections against : • Limiting a person’s movement, access to other

individuals, locations or activities• Restricting a participant’s rights • Using aversive/uncomfortable technique to

change behavior• Restraint.

Additional safeguards for waiver participants include protections against:Limiting movement

Limiting access to other people and locations

Restricting rights

Restraints and using uncomfortable techniques to address or even change people’s behaviors. The next slide captures what is allowed and what is not.

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HCBS Waivers -Protections Against Restraints and Restrictions

MVW, MFW, SW

•Not Allowed•Monitoring is required

DDW

•Allowance for health and safety only

•Human Rights Committee with a person with IDD on the committee must approve every three months

•Monitoring is required

In the DD Waiver, there is a Human Rights Committee. The Human Rights Committee must review and approve any recommendations for restraints or restrictions.

Any approved recommendation must be closely monitored, reviewed and is ONLY allowed for health and safety purposes.

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HCBS Waivers-Systems Improvement

The state has a system for continuous quality improvement including discovery and remediation.

• State may audit files• State requires training• State may sanction providers

The state engages in continuous quality improvement activities for all of its HCBS waivers.Some of these activities include:

Discovery

Auditing

Training and

Remediation.

These activities are required by CMS and performance and quality improvement activities are reported to CMS routinely.

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Quality Management Bureau

A QMB team conducts surveys of provider’s services to:• determine if they are following the standards,

rules and statutes• ensure the health, safety and welfare of

individuals receiving services

The Quality Management Bureau of the Department of Health conducts surveys of providers to make sure they are following waiver standards, rules and statutes, which are in place to ensure the health, safety and welfare of the people in services, who, of course, are our top priority.

Compliance surveys are conducted at regular frequencies with agencies that have a provider agreement with DDSD, which are all DD Waiver providers, all Medically Fragile Waiver providers, Mi Via Consultants and soon the providers in the Supports Waiver.

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HCBS Waivers-Financial Accountability

• Making sure the services that have been paid for have been provided to you

• Making sure that the services provided are the services that are approved

1915 c waivers are paid with state money that is matched by federal money.

All waivers are required to maintain financial accountability measures.

What this means is we have an obligation and a responsibility to:

1. Make sure people receive the services that were paid for, and

2. Make sure services people received are the same services that were approved on

their budget

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HCBS Waivers-Financial Accountability

Anyone that participates in a waiver should be aware of their responsibility to make sure that there is no fraud, waste and abuse of money or funds.

You can fight fraud and abuse with the 3Rs: Record, Review, Report

We all have a shared responsibility to make sure there is no fraud, waste or abuse of money or funds.

It is important to Protect the public resources that fund the Medicaid programs

Fraud is intentional, when some acts to benefit unfairly from Medicaid program. Waste and abuse can occur even if not on purpose

You can fight fraud, waste and abuse with the 3Rs: Record, Review, Report,

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Examples of Fraud and Abuse

• Medicaid is billed for services you never received

• Medicaid paid for equipment you never got or that was returned

• Documents are changed to gain a higher payment

• When providers do things that result in unnecessary costs

Most individuals and organizations with Medicaid are honest

However any one can commit fraud or abuse

You can fight fraud and abuse with the 3Rs: Record, Review, Report

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HCBS Waivers-Cost Neutrality

The average cost per person under the waiver must be less than the average cost would have been in institutional care.

The state must maintain cost neutrality, which means that the average cost per person on the waiver must be less than the average cost would be for institutional care.

Without cost neutrality, the state wouldn’t be allowed to continue to operate the waivers.

This is reported on and monitored by CMS.

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Developmental Disabilities Support Division (DDSD)

Support people with intellectual and developmental disabilities to live the lives they prefer in their communities

.

DDSD’s mission is to :Support people with intellectual and developmental disabilities to live the lives they prefer in their communities

We are committed to supporting people with IDD and designing programs and supports to meet their needs.

We strive to have people with IDD, advocates and families at the table providing input when making policy decisions.

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Waiver Programs Recap

• DD Waiver, Mi Via Waiver, Supports Waiver and Medically Fragile

• Supplement Medicaid benefits • Support life in home and community

We hope you get the most out of your waiver program to live out your goals and choices in your home and community.

To Wrap Up :

The 4 Waivers Operated by Department of Health are : DD Waiver, Mi Via Waiver, Supports Waiver and Medically Fragile Waiver

They Supplement regular Medicaid benefits

And the Waiver programs are to help you live the life you want in your home and community.

There is a comparison Table available as one of the resources available with this presentation.

We hope this presentation helps to understand this complex waiver system that can be confusing at times. The DDSD is here to help participants and providers navigate the system

Thank you for your participation. Please complete an evaluation.

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