Additional CCC Plus Waiver Information

Managed Care Delivery of HCBS Combination 1915 b and 1915 c waiver authorities 1915 b Waiver Allows the state to require enrollment in a managed care delivery system Must be cost-effective, efficient and consistent with the principles of the Medicaid program 1915 c Waiver Must not cost more than institutional care Ensures health and welfare protections Services follow an individualized and person-centered plan of care Waiver services will be available through a managed care approach. The state will use a combination of 1915 b and 1915 c waiver authorities, the 1915 b waiver allows the state to require managed care enrollment while the 1915 c waiver (current authority) allows the state to provide person-centered services in the community instead of an institution.

Elderly or Disabled with Consumer Direction (EDCD) Current 1915 c Waivers Elderly or Disabled with Consumer Direction (EDCD) Aging or have a physical disability Technology Assisted (Tech) Dependent on technological support and require substantial, on-going skilled nursing care Today, the EDCD waiver serves more than 30,000 individuals who are aging or have a physical disabilty and the Tech waiver serves approximately 300 individuals who require on-going skilled nursing support due to their need for technologies such as ventilators.

Combination of Existing 1915 c Waivers Combines Elderly or Disabled with Consumer Direction and Technology Assisted Waiver Expands current services to both populations Waiver becomes Commonwealth Coordinated Care Waiver Effective 7/1/2017 EDCD Waiver Tech Waiver CCC Plus Waiver The state recevied approval from CMS to combine the Tech and EDCD waivers and renamed it CCC Plus waiver. The CCC+ waiver will serve both EDCD populations (aging or have a physical disability) and the tech waiver population. With this combination, services are being expanded to both populations (AT and EM) and the waiver is effective 7/1/17.

CCC Plus Waiver Services Adult Day Health Care Personal Assistance Services Private Duty Nursing Respite care Services Facilitation Assistive Technology (AT) Environmental Modifications (EM) Personal Emergency Response System Transition Services The services offered in the waiver are as follows to anyone meeting service criteria.

CCC Plus Waiver Services AT and EM Limited to $5000 per year for each service Private Duty Nursing Must meet current Tech waiver criteria Respite Limited to 480 hours/ fiscal year Increase from 360 hours for Tech waiver AT and EM will be expanded to include EDCD population with annual limits of $5000 for each service PDN will continue to be available to those who meet the Tech waiver criteria – these are individuals who are dependent on ventilator for a portion o fthe day or require complex tracheostomy care. Respite will be 480 for all individuals- currently tech waiver has a limit of 360. This will be increased to 360 based on fiscal year.

Services will automatically continue through CCC Plus Waiver No Changes to FFS waiver processes Pre-admission screening processes unchanged Enrollment and service authorization process unchanged Current service authorizations will continue No action is required by providers Individuals currently served through either the EDCD or Tech waiver will automatically continue services through the CCC Plus Waiver. All service authorizations for the EDCD and TECH Waivers services will continue; service providers do not need to take any additional actions

CCC Plus Waiver Upcoming Medicaid Memo Emergency regulations being promulgated CCC Plus Medicaid Manual being developed Follow current Medicaid Manuals for EDCD and Tech until the new manual is posted Individuals currently served through either the EDCD or Tech waiver will automatically continue services through the CCC Plus Waiver. All service authorizations for the EDCD and TECH Waivers services will continue; service providers do not need to take any additional actions A medicaid memo will be published soon to announce this change to providers. The key take away is that no processes for FFS will change. New waiver enrollments will continue to be processed through Kepro based on the level of care ( EDCD or Tech)

VA Medicaid Behavioral Health Service Delivery Systems Fee For Service CCC Plus 2017 Jan 2018 In Patient/ Out Patient/ARTS Magellan Health Plan Community Mental Health Rehabilitation Services

Medicaid Population Waiver Services DD/ID Case Management Other Services (excluding waiver and case management) For Individuals in DD Waivers Service authorization: Provider to CSB to DBHDS for authorization   Billing: DMAS FFS pays the provider CSB/private provider provides the ID or DD case management CSB bills DMAS FFS directly CCC Plus health plans For individuals on the DD waivers wait list None CSB/private provider provides the ID or DD case management, as applicable CCC Plus Health Plans CCC Plus waiver (EDCD) while on DD wait list CCC Plus waiver services paid for by CCC Plus Health Plan CCC Plus Health Plan