Department of Health and Human Services Stakeholder Engagement Community Alternatives Program 1915(c) HCBS Waiver August 17, 2016 Department of Health and Human Services Stakeholder Engagement
Implementing an extended waiver How to apply utilization limits in an extended waiver Waitlist A state specifies the maximum number of unduplicated participants who will be served during each year the waiver is in effect. The limit on the number of individuals who participate in the waiver may result in a waiting list for waiver services. Eligible applicants must be deferred until capacity becomes available as a result of turnover or the appropriation of additional funding. CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement
Implementing an extended waiver Modifications The total cost of modifications cannot exceed the approved amount over the life (CMS approved 5 year waiver cycle) of the waiver. Participants not in the waiver for the full five years will receive the benefit prorated to 1/5 of the amount/each year of participation. Each year of participation – 1 year from CAP effective date 7/01/2010-6/30/2015 = $10,000 7/01/2011-6/30/2015 = $8,000 7/01/2012-6/30/2015 = $6,000 7/01/2013-6/30/2015 = $4,000 7/01/2014-6/30/2015 = $2,000 7/01/2015-6/30/2016 = $2,000 6/30/2016-new waiver is approved = $2,000 The waiver entry year will be used to assess the amount for modifications going forward and will retro back to April 2016 CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement
CAP/C waiver amendment proposal Overview of the proposed changes and their impact Determination of CAP nursing and nurse aide hours CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement
Service provision comparison Waiver Services State Plan Services Cap Nursing Private Duty Nursing Nurse care to individuals with a skilled need that requires intervention every 2-4 hours Nurse care to individual with a skilled need that requires intervention every 2-4 hours In-Home Care Personal Care Personal care to individuals with two or more limited to extensive Activities of Daily Living (ADLs) needs Personal and home maintenance care to individuals with limited ADLs and Instrumental Activities of Daily Living (IADLs) needs Pediatric Nurse Aide No comparable service Personal care to individuals with two or more extensive ADLs needs that fall in the Nursing Assistant (NA) I and NA II categories Cap Nursing Nurse care to individuals with a skilled need that requires intervention every 2-4 hours In-Home Care Personal care to individuals with two or more limited to extensive Activities of Daily Living (ADLs) needs Pediatric Nurse Aide Personal care to individuals with two or more extensive ADLs needs that falls in the Nursing Assistant (NA) I and NA II categories Private Duty Nursing Nurse care to individual with a skilled need that requires intervention every 2-4 hours Personal Care Personal and home maintenance care to individuals with limited ADLs and Instrumental Activities of Daily Living (IADLs) needs No comparable service CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement
Service provision comparison Waiver Services State Plan Services Respite No comparable service Temporary relief for waiver beneficiary or primary caregiver Case Management Not available in North Carolina’s SPA Coordinating activities of assessing, care planning, monitoring, linking, referring and follow-up to maintain community integration and inclusion Comparable services offered through other resource agencies that provide case management Children’s Developmental Service agencies Department of Social Services Private Duty Nursing agencies CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement
Next Steps Meeting the needs of medically fragile children Waiver services supplement rather than replace informal and formal supports, so how do we: Structure needed supports within waiver guidelines and comply with the Social Security Act? Manage care needs and maintain cost-neutral service provisions? Use Medicaid to its fullest to optimize cost-neutral service provisions? What supports are needed and how much? What supports are available? How do we leverage available supports? CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement