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MI Choice Program Update HFA Regulatory Day October 29, 2014 Elizabeth Gallagher, Manager HCBS Section, MDCH.

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Presentation on theme: "MI Choice Program Update HFA Regulatory Day October 29, 2014 Elizabeth Gallagher, Manager HCBS Section, MDCH."— Presentation transcript:

1 MI Choice Program Update HFA Regulatory Day October 29, 2014 Elizabeth Gallagher, Manager HCBS Section, MDCH

2 OBJECTIVES  Learn about MI Choice Program Eligibility  Medical/Functional  Financial  Service Need  Learn about the Home and Community Based Services requirements  Basic Requirements  MI Choice time frame for compliance  Process for assessing residential and non-residential settings  Corrective Action Plans  Question and Answer Session 2

3 MI CHOICE PROGRAM ELIGIBILITY 3

4 OVERVIEW OF MI CHOICE The 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. 4

5 REFERRAL TO MI CHOICE  Persons interested in enrolling in MI Choice must work with a waiver agency that serves their county of residence. 5

6 REFRRAL TO MI CHOICE To 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.” 6

7 REFERRAL TO MI CHOICE  Contact the preferred waiver agency in the service area  Ask for an assessment of eligibility for MI Choice waiver services.  An intake specialist will conduct a pre-screen over the phone  If applicant passes the pre-screen, the specialist will schedule an in-person assessment. 7

8 WAITING LISTS  Waiting lists are managed with four priority categories as listed below in descending priority: 1.Adults aging off of Medicaid State Plan Private Duty Nursing whose services are authorized by Medicaid Program Review Division 2.Nursing Facility residents 3.Persons with active Adult Protective Services cases or Persons at imminent risk of nursing facility placement 4.All other applicants by date of inquiry 8

9 MI CHOICE ASSESSMENT  Once 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 eligibility  Will start person-centered planning  Will start development of a plan of care if likely eligible 9

10 MI CHOICE ELIGIBILITY REQUIREMENTS  Must meet nursing facility level of care (NFLOC) to demonstrate medical/functional eligibility  MI Choice waiver agents must apply the Michigan Medicaid Nursing Facility Level of Care Determination tool to persons applying for enrollment in the program  Applicants must pass through one of the seven “doors” 10

11 NFLOC DOORS 1.Activities of Daily Living (Bed Mobility, Transfers, Toilet Use, Eating) 2.Cognitive Performance 3.Physician Involvement 4.Treatments and Conditions 5.Skilled Rehabilitation Therapies 6.Behavior 7.Service Dependency 11

12 FINANCIAL ELIGIBILITY FOR MI CHOICE WAIVER  Must be eligible for Medicaid  Maximum income is 300% SSI ($2,163/mo. GROSS in calendar year 2014)  Spousal asset protections apply – but cannot divert income to the spouse  Waiver participants are considered a group of one  Waiver participants do not have a spend-down (Medicaid Deductible)  Financial Eligibility is Determined by the Department of Human Services 12

13 SERVICE NEED ELIGIBILITY  Applicant must demonstrate, through the assessment process, the need for at least one MI Choice waiver service  Waiver participants must receive at least one MI Choice service (in addition to supports coordination) on a regular basis to maintain program eligibility. 13

14 MI CHOICE AVAILABLE SERVICES  Adult Day Health  Chore Services  Community Living Supports  Community Transition Services  Counseling  Environmental Accessibility Adaptations  Fiscal Intermediary  Goods and Services  Home Delivered Meals  Non-Medical Transportation  Nursing Services  Personal Emergency Response Systems  Private Duty Nursing  Respite  Specialized Medical Equipment & Supplies  Supports Coordination  Training 14

15 SERVICES IN GROUP RESIDENCES  MI Choice CANNOT:  Pay for room and board  Duplicate services required by licensure  Duplicate “usual and customary” services provided by the residence  MI Choice CAN:  Authorize services based upon the unique needs of the individual  Authorize the additional “hands on” services and supports needed by an individual 15

16 MI CHOICE ENROLLMENT  Cannot enroll before date of initial assessment by waiver agency  Can receive all Medicaid State Plan Services  Cannot use both MI Choice and Home Help program for personal care services.  Must use MI Choice Community Living Supports for ADL/IADL needs 16

17 MI CHOICE ENROLLMENT  Two Options for Service Delivery  Traditional/Agency Based  All workers must be employed by an agency in the waiver agency’s provider network.  Self-Determination  Can choose own workers  Workers cannot be legally responsible for participant (i.e. spouse or guardian)  Participants can use a mixture of Traditional and Self-Determined services 17

18 MI CHOICE POLICY MI Choice Chapter in Medicaid Policy Manual can be found at: medicaid/manuals/MedicaidProviderM anual.pdf 18

19 APPLICANT’S RIGHT TO APPEAL  Waiver agency must inform applicant of their right to appeal throughout the process  If applicant put on waiting list  If applicant does not pass telephone screen  If applicant does not meet NFLOC  If applicant does not meet other enrollment criteria  If applicant requests services that are not authorized 19

20 HOME AND COMMUNITY BASED SETTINGS RULING 20

21 HCB SETTINGS RULING  Published in the Federal Register (CMS-2249-F; CMS-2296-F) on January 16, 2014  Effective March 17, 2014  Transition plan due by March 17, 2015 or sooner if updating a waiver program  Must be fully compliant by March 17, 2019, or sooner 21

22 FEDERAL 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. 22

23 REQUIRED QUALITIES  Integrated & supports full access to the community, including employment, controlling personal resources & receiving services  The individual selects the setting  Ensures the individual’s rights of privacy, dignity and respect and freedom from coercion & restraint  Optimizes initiative, autonomy & independence  Facilitates choice re: services & supports & providers 23

24 SETTINGS THAT ARE NOT HCB  Nursing Facilities  Institution for Mental Diseases  Intermediate Care Facility for Individuals with Intellectual Disabilities  Hospitals 24

25 SETTINGS PRESUMED NOT HCB  Publicly or Privately owned facility providing inpatient treatment  On the grounds of or next to a public institution  Settings that separate Medicaid HCBS recipients from other members of the community  The state can make a case to the Federal Government if one of these settings meets HCB requirements 25

26 PROVIDER 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 others  Individuals have privacy in sleeping units  Entrance doors lockable  Choice of roommates  Can furnish & decorate unit  Control own schedules and activities and access to food at any time  Have visitors at any time  Setting is physically accessible  Modifications to above must be documented in PCP 26

27 MICHIGAN TRANSITION PLANS  MDCH is working on a statewide plan ,00.html  MI Choice submitted a plan to CMS on 9/28/2014  The Habilitation Supports Waiver submitted a plan to CMS on 9/30/2014  All plans will be coordinated 27

28 MI CHOICE PLAN: ASSESSMENT  Residential and non-residential settings  Completed by 9/30/2015  Conducted by MI Choice waiver agencies  Using tools developed by CMS, but modified by MDCH with stakeholder input  On-site 28

29 MI CHOICE PLAN: OUTREACH & ENGAGEMENT  Completed  Initial Stakeholder Meetings  Public Notice & Comment  Revised & posted transition plan  Post Public notice of assessment results by 7/31/2015  Present Assessment results to stakeholders by 8/31/

30 MI CHOICE PLAN: REMEDIATION  By 6/30/2015  Update policies, procedures, and contract requirements  Add educational component to provider enrollment process  Update provider monitoring tool 30

31 MI CHOICE PLAN: REMEDIATION  By 12/31/2015  Analyze assessment data  Notify providers of meeting or not meeting requirements  Notify CMS if presumed settings should have exception  Require remediation plans from providers 31

32 MI CHOICE PLAN: REMEDIATION  By 12/31/2016  Offer choices to participants in settings that do not meet requirements  Transition to setting that meets requirements  Disenroll from MI Choice 32

33 QUESTIONS?  Elizabeth Gallagher  Heather Slawinski


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