MI Choice Program Update

Report
MI Choice Program Update
HFA Regulatory Day
October 29, 2014
Elizabeth Gallagher, Manager HCBS Section, MDCH
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
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MI CHOICE PROGRAM
ELIGIBILITY
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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.
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REFERRAL TO MI CHOICE
 Persons
interested in
enrolling in
MI Choice
must work
with a
waiver
agency that
serves their
county of
residence.
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REFRRAL TO MI CHOICE
To find a local waiver agency or for
more information on the MI Choice
Waiver:
www.michigan.gov/mdch
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.”
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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.
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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
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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
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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”
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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
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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
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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.
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MI CHOICE AVAILABLE SERVICES
 Adult Day Health
 Chore Services
 Community Living
Supports
 Community Transition
Services
 Non-Medical
Transportation
 Nursing Services
 Personal Emergency
Response Systems
 Private Duty Nursing
 Counseling
 Respite
 Environmental
Accessibility Adaptations
 Specialized Medical
Equipment & Supplies
 Fiscal Intermediary
 Supports Coordination
 Goods and Services
 Training
 Home Delivered Meals
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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
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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
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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
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MI CHOICE POLICY
MI Choice Chapter in Medicaid Policy
Manual can be found at:
http://www.mdch.state.mi.us/dchmedicaid/manuals/MedicaidProviderM
anual.pdf
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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
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HOME AND COMMUNITY BASED
SETTINGS RULING
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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
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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.
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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
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SETTINGS THAT ARE NOT HCB
 Nursing Facilities
 Institution for Mental Diseases
 Intermediate Care Facility for Individuals
with Intellectual Disabilities
 Hospitals
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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
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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
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MICHIGAN TRANSITION PLANS
 MDCH is working on a statewide plan
http://www.michigan.gov/mdch/0,4612,7-1322943-334724--,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
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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
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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 8/31/2015
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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
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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
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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
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QUESTIONS?
 Elizabeth Gallagher
[email protected]
517-335-5068
 Heather Slawinski
[email protected]
517-373-0324
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