Long Term Care Division

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Long Term Care Division. Alabama Medicaid Agency Long Term Care Division Outreach and Education Unit February 2004. P R E S E N T S An Overview Of Home and Community Based Waiver Services. What Is A Waiver?. - PowerPoint PPT Presentation

Text of Long Term Care Division

  • Long Term Care DivisionAlabama Medicaid AgencyLong Term Care DivisionOutreach and Education UnitFebruary 2004

  • P R E S E N T S

    An Overview Of

    Home and Community Based Waiver Services

  • What Is A Waiver?

    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.

  • Home and 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 state wideness 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.

  • Distribution of Slots

    Waiver slot distribution will be determined by the Alabama Medicaid Agency.

  • 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 is considered filled and therefore may not be refilled by a different individual.

  • Medicaid Approved Home and Community Based WaiversElderly and Disabled (E&D) Waiver

    Mental Retardation/ Developmentally Disability (MRDD) Waiver

    Living at Home Waiver

    State of Alabama Independent Living (SAIL) WaiverSpecialty Care Assisted Living Facility (SCALF) Waiver

    Technology Assisted (TA) Waiver for Adults

    HIV/AIDS Waiver

  • Administering State Agency

    The Alabama Medicaid Agency has administrative authority over the Home and Community Based Waivers.

  • Responsibilities of the Alabama Medicaid Agency

    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

    State agencies are charged with the responsibility of operating the home and community based waiver programs and vary by each particular waiver.

  • 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

  • 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

    7500 waiver slots

  • Financial Eligibility Criteria

    Individuals receiving SSI and/or State Supplementation;

    Widows and Widowers under age 60;

    Widows and Widowers age 60 64;

  • Financial Eligibility Criteriacontinued

    Adult children who lose supplemental security income benefits upon entitlement to the childs insurance benefits based on disability;

    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 ManagementHomemaker ServicesPersonal Care ServicesAdult Day Health ServicesRespite Care (Skilled and Unskilled)Adult Companion ServicesHome Delivered Meals

  • Mental RetardationDevelopmentally Disability (MRDD) Waiver

  • MRDD 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)

  • MRDD Waiver

    Operating AgencyAlabama Department of Mental Health and Mental Retardation

    No age requirement

    5200 waiver slots

  • Financial Eligibility Criteria

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

    TANF - (Temporary Assistance to Needy Families) low income families with children

    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)

  • 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 Carecontinued

    Self Care Receptive and expressive language

    Learning

    Mobility

    Self Direction

    Capacity for independent living

  • Covered Services

    Residential Habilitation TrainingResidential Habilitation Other Living ArrangementDay HabilitationPrevocational ServicesSupported EmploymentOccupational Therapy ServicesSpeech and Language TherapyPhysical Therapy

    Behavior ManagementCompanion ServicesRespite CarePersonal CareEnvironmental Accessibility AdaptationsMedical SuppliesSkilled NursingAssistive Technology

  • Living At Home Waiver

  • 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

    Waiver SlotsYear 1 204Year 2 326Year 3 - 449

  • 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 ServicesResidential Habilitation TrainingDay HabilitationPrevocational ServicesSupported EmploymentOccupational TherapySpeech and Language TherapyPhysical TherapyBehavior Therapy

    Respite CarePersonal Care ServicesPersonal Care TransportationEnvironmental Accessibility AdaptationsSpecialized Medical Equipment and SuppliesSkilled NursingCommunity SpecialistCrisis Intervention

  • State of Alabama Independent Living (SAIL) Waiver(formerly Homebound Waiver)

  • SAIL Waiver

    Serves disabled adults with specific medical diagnoses who are at risk of being institutionalized in a nursing home

  • SAIL Waiver

    Operating Agency Alabama Department of Rehabilitation Services

    18 years of age or older

    550 waiver slots

  • Financial Eligibility Criteria

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

    TANF-(Temporary Assistance to Needy Families) low income families with children

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