2OBJECTIVES Learn about MI Choice Program Eligibility Medical/FunctionalFinancialService NeedLearn about the Home and Community Based Services requirementsBasic RequirementsMI Choice time frame for complianceProcess for assessing residential and non-residential settingsCorrective Action PlansQuestion and Answer Session
4OVERVIEW OF MI CHOICEThe MI Choice Waiver is designed to enable the elderly and younger disabled adults (age 18 & older) to remain at home and to participate in their communities. The waiver serves approximately 14,000 adults each year.
5REFERRAL TO MI CHOICEPersons interested in enrolling in MI Choice must work with a waiver agency that serves their county of residence.
6REFRRAL TO MI CHOICETo find a local waiver agency or for more information on the MI Choice Waiver:Click on “Health care coverage.”Click on “Services for seniors.”Click on “Choices for older or disabled persons who may need help caring for themselves.”
7REFERRAL TO MI CHOICEContact the preferred waiver agency in the service areaAsk for an assessment of eligibility for MI Choice waiver services.An intake specialist will conduct a pre-screen over the phoneIf applicant passes the pre-screen, the specialist will schedule an in-person assessment.
8WAITING LISTSWaiting lists are managed with four priority categories as listed below in descending priority:Adults aging off of Medicaid State Plan Private Duty Nursing whose services are authorized by Medicaid Program Review DivisionNursing Facility residentsPersons with active Adult Protective Services cases or Persons at imminent risk of nursing facility placementAll other applicants by date of inquiry
9MI CHOICE ASSESSMENTOnce an applicant is at the top of the waiting list the following happens:A supports coordination team comprised of a Registered Nurse (RN) and licensed Social Worker (SW) will meet with the applicant in their home to complete an assessment.During the assessment, the team will determine likelihood of eligibilityWill start person-centered planningWill start development of a plan of care if likely eligible
10MI CHOICE ELIGIBILITY REQUIREMENTS Must meet nursing facility level of care (NFLOC) to demonstrate medical/functional eligibilityMI Choice waiver agents must apply the Michigan Medicaid Nursing Facility Level of Care Determination tool to persons applying for enrollment in the programApplicants must pass through one of the seven “doors”
11NFLOC DOORSActivities of Daily Living (Bed Mobility, Transfers, Toilet Use, Eating)Cognitive PerformancePhysician InvolvementTreatments and ConditionsSkilled Rehabilitation TherapiesBehaviorService Dependency
12FINANCIAL ELIGIBILITY FOR MI CHOICE WAIVER Must be eligible for MedicaidMaximum income is 300% SSI ($2,163/mo. GROSS in calendar year 2014)Spousal asset protections apply – but cannot divert income to the spouseWaiver participants are considered a group of oneWaiver participants do not have a spend-down (Medicaid Deductible)Financial Eligibility is Determined by the Department of Human Services
13SERVICE NEED ELIGIBILITY Applicant must demonstrate, through the assessment process, the need for at least one MI Choice waiver serviceWaiver participants must receive at least one MI Choice service (in addition to supports coordination) on a regular basis to maintain program eligibility.
14MI CHOICE AVAILABLE SERVICES Adult Day HealthChore ServicesCommunity Living SupportsCommunity Transition ServicesCounselingEnvironmental Accessibility AdaptationsFiscal IntermediaryGoods and ServicesHome Delivered MealsNon-Medical TransportationNursing ServicesPersonal Emergency Response SystemsPrivate Duty NursingRespiteSpecialized Medical Equipment & SuppliesSupports CoordinationTraining
15SERVICES IN GROUP RESIDENCES MI Choice CANNOT:Pay for room and boardDuplicate services required by licensureDuplicate “usual and customary” services provided by the residenceMI Choice CAN:Authorize services based upon the unique needs of the individualAuthorize the additional “hands on” services and supports needed by an individual
16MI CHOICE ENROLLMENTCannot enroll before date of initial assessment by waiver agencyCan receive all Medicaid State Plan ServicesCannot use both MI Choice and Home Help program for personal care services.Must use MI Choice Community Living Supports for ADL/IADL needs
17MI CHOICE ENROLLMENT Two Options for Service Delivery Traditional/Agency BasedAll workers must be employed by an agency in the waiver agency’s provider network.Self-DeterminationCan choose own workersWorkers cannot be legally responsible for participant (i.e. spouse or guardian)Participants can use a mixture of Traditional and Self-Determined services
18MI CHOICE POLICYMI Choice Chapter in Medicaid Policy Manual can be found at:medicaid/manuals/MedicaidProviderM anual.pdf
19APPLICANT’S RIGHT TO APPEAL Waiver agency must inform applicant of their right to appeal throughout the processIf applicant put on waiting listIf applicant does not pass telephone screenIf applicant does not meet NFLOCIf applicant does not meet other enrollment criteriaIf applicant requests services that are not authorized
21HCB SETTINGS RULINGPublished in the Federal Register (CMS-2249-F; CMS-2296-F) on January 16, 2014Effective March 17, 2014Transition plan due by March 17, or sooner if updating a waiver programMust be fully compliant by March 17, 2019, or sooner
22FEDERAL INTENT OF THE RULING To assure Medicaid-eligible persons who are part of a home and community based services program have the same access to the community in which they reside and opportunities to be a part of the community as persons who are not participants of a Medicaid-funded program.
23REQUIRED QUALITIESIntegrated & supports full access to the community, including employment, controlling personal resources & receiving servicesThe individual selects the settingEnsures the individual’s rights of privacy, dignity and respect and freedom from coercion & restraintOptimizes initiative, autonomy & independenceFacilitates choice re: services & supports & providers
24SETTINGS THAT ARE NOT HCB Nursing FacilitiesInstitution for Mental DiseasesIntermediate Care Facility for Individuals with Intellectual DisabilitiesHospitals
25SETTINGS PRESUMED NOT HCB Publicly or Privately owned facility providing inpatient treatmentOn the grounds of or next to a public institutionSettings that separate Medicaid HCBS recipients from other members of the communityThe state can make a case to the Federal Government if one of these settings meets HCB requirements
26PROVIDER OWNED SETTINGS Must also assure:A specific physical place that can be owned, rented or occupied under a legally enforceable agreement and individual has same legal protections as othersIndividuals have privacy in sleeping unitsEntrance doors lockableChoice of roommatesCan furnish & decorate unitControl own schedules and activities and access to food at any timeHave visitors at any timeSetting is physically accessibleModifications to above must be documented in PCP
27MICHIGAN TRANSITION PLANS MDCH is working on a statewide plan,00.htmlMI Choice submitted a plan to CMS on 9/28/2014The Habilitation Supports Waiver submitted a plan to CMS on 9/30/2014All plans will be coordinated
28MI CHOICE PLAN: ASSESSMENT Residential and non-residential settingsCompleted by 9/30/2015Conducted by MI Choice waiver agenciesUsing tools developed by CMS, but modified by MDCH with stakeholder inputOn-site
29MI CHOICE PLAN: OUTREACH & ENGAGEMENT CompletedInitial Stakeholder MeetingsPublic Notice & CommentRevised & posted transition planPost Public notice of assessment results by 7/31/2015Present Assessment results to stakeholders by 8/31/2015
30MI CHOICE PLAN: REMEDIATION By 6/30/2015Update policies, procedures, and contract requirementsAdd educational component to provider enrollment processUpdate provider monitoring tool
31MI CHOICE PLAN: REMEDIATION By 12/31/2015Analyze assessment dataNotify providers of meeting or not meeting requirementsNotify CMS if presumed settings should have exceptionRequire remediation plans from providers
32MI CHOICE PLAN: REMEDIATION By 12/31/2016Offer choices to participants in settings that do not meet requirementsTransition to setting that meets requirementsDisenroll from MI Choice
33QUESTIONS? Elizabeth Gallagher GallagherE@michigan.gov 517-335-5068 Heather Slawinski