2018-2019 IDD Waivers Renewal Children s Extensive Support (CES) - - PDF document
8/23/2018 2018-2019 IDD Waivers Renewal Children s Extensive Support (CES) Waiver Waiver Appendices A, B,& C Presented by: Dennis Roy August 23, 2018 1 Our Mission Improving health care access and outcomes for the people we serve while
’
1 August 23, 2018
Presented by: Dennis Roy
Children s Extensive Support (CES) Waiver
Waiver Appendices A, B,& C
while demonstrating sound stewardship of financial resources
2
3
During the meeting:
presentation
questions during breaks
During the engagement process:
sent to: hcbswaivers@state.co.us
please submit them to: LTSS.PublicComment@state.co.us
4
the Waiver Renewal Process & CMS required information
an HCBS waiver
application
applications illustrate the respective program
5
Council
Amendments
Transition
Management (CFCM)
6
Home and Community- Based Services Overview
7
based services to individuals who:
the community
8
to CMS
5 years
include DD, SLS, CES and CHRP
9
11
Support (CES) Waiver expires on June 30, 2019
Evidentiary Reports and
submitted 90-180 days in advance
10
Things that can change:
grammatical/technical language errors Things we cannot change:
contracts
budgetary allocations
Important Dates:
2/28/2019
around 3/1/2019
12
CMS has requirements all States must meet when administering a waiver
What are those requirements?
13
Appendix A: Waiver Administration & Operation Appendix B: Participant Access and Eligibility Appendix C: Participant Services
14
Waiver Administration and Operation
What entities are involved in the
waiver?
15
administration and operation
Also indicates how operational functions are distributed among state, local/regional and other entities
16
17
Waiver Administration and Operation (CES)
and Financing (HCPF)
18
Operated By::
Environment (CDPHE)
19
Quality Improvement (CES)
State must assure that:
The Medicaid Agency retains ultimate administrative authority and responsibility for the
by other state and local/regional non state agencies (if appropriate) and contracted entities.
How does HCPF meet the assurance?
20
Quality Improvement (CES)
State meets the assurance with 6 separate Performance Measures (PM)
The PMs in Appendix A provide CMS with the assurance that HCPF retains ultimate administrative authority over the CES waiver through the tracking and monitoring of deliverables provided by the contracted entities.
21
Who receives waiver services?
22
Participant Access and Eligibility
Evaluation/reevaluation
procedures of LOC (if any)
entrance into the waiver groups
23
24
– –
" "
Specific Target Groups (CES)
CES Serves individuals 0 17 with a Developmental Disability
Developmental Disability means a disability that is manifested before the person reaches twenty two years of age, which constitutes a substantial disability to the affected individual, and is attributable to mental retardation or related conditions which include cerebral palsy, epilepsy, autism, or other neurological conditions when such conditions result in impairment of general intellectual functioning or adaptive behavior similar to that of a person with mental retardation. (C.R.S. 27 10.5 102 11 (a), as amended).
25
Specific Target Groups (CES)
The child demonstrates a behavior or has a medical condition that requires direct human intervention, more intense than a verbal reminder, re direction or brief
hours during the day and on a weekly average of once every three hours during the night. The behavior or medical condition must be considered beyond what is typically age appropriate and due to one
26
Specific Target Groups (CES)
(A) A significant pattern of self endangering behavior(s) or medical condition which, without intervention will result in a life threatening condition/situation; or (B) A significant pattern of serious aggressive behaviors toward self, others or property; or (C) Constant vocalizations such as screaming, crying, laughing,
caregivers
Conditions shall be evidenced by written third party statements
27
participants it serves at any point in time during a waiver year
the number participants for an entire waiver year
28
(CES)
§1634 State with Miller Trust
Medicaid Eligibility Groups Served include:
29
LOC & Evaluation/Reevaluation Procedures for LOC (CES)
Community Centered Boards (CCB)
30
’
alternatives available under the waiver and provides the choice of institutional or community based services
development; and during annual re evaluation
31
Quality Improvement (CES)
32
State must assure that: The state demonstrates that it implements the processes and instrument(s) specified in its approved waiver for evaluation/reevaluating an applicant s/waiver participant s level of chare consistent with level of care provided in a hospital, NF or ICF/IID. How does HCPF meet the assurance?
Quality Improvement (CES)
33
Performance Measures (PM)
assurance that the correct assessment tools are being utilized appropriately by Case Managers
What services does the waiver
34
provider qualifications, if service may be participant-directed)
35
36
Recreational Equipment and Fees
37
Adaptations
Equipment and Supplies
For each service the state defines:
duration
38
General Service Specifications (CES)
Criminal history and / or background investigations are required for providers
39
General Service Specifications (CES)
annual service expenditures for a waiver participant
the combination of home accessibility adaptations, vehicle modifications, and assistive technology
40
Quality Improvement (CES)
State must assure that: The state demonstrates that it has designed and implemented an adequate system for assuring that all waiver services are provided by qualified providers How does HCPF meet the assurance?
41
Quality Improvement (CES)
Performance Measures (PM)
Department maintains oversight of service providers
42
43
Submit any public comments to: LTSS.PublicComment@state.co.us
September 06, 2018 1:00 pm – 3:00 pm
44
Dennis Roy HCBS Federal Policy Liaison Dennis.Royjr@state.co.us Julie Masters HCBS Federal Policy Specialist Julie.Masters@state.co.us
45
46