2018-2019 Waiver Renewal Children s Habilitation Residential - - PowerPoint PPT Presentation
2018-2019 Waiver Renewal Children s Habilitation Residential Program (CHRP) Presented by: Sarah Hoerle December 2018 1 Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of
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December 2018
Presented by: Sarah Hoerle
Children’ s Habilitation Residential Program (CHRP)
while demonstrating sound stewardship of financial resources
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During the meeting:
until breaks in the presentation.
participants. During the engagement process:
process can be sent to: hcbswaivers@ state.co.us
waiver(s), please submit them to: ltss.publiccomment@ state.co.us
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takeholders of the Waiver Renewal Process
the CHRP waiver application
CHRP waiver for this renewal
takeholder feedback
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Major Changes to the CHRP Waiver
the Department.
Management Agencies (specifically Community Centered Boards- CCBs).
stabilized.
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Home and Community- Based Services Overview
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HCBS waiver authority permits the state to
to individuals on the CHRP waiver who:
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determined to have a developmental disability
placement in an Intermediate Care Facility of Individuals with Intellectual Disabilities
Waiver Application Process
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tates must submit initial waiver application to the Centers for Medicare and Medicaid
every 5 years
by June 30, 2019
residential Program (CHRP) Waiver expires on June 30, 2019
tate must respond to Evidentiary Reports and
Guidance
submitted at least 90 days in advance of expiration
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S cope
Things that can change:
technical language errors
Things we cannot change:
authorized by legislation
cause a fiscal impact
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Important Dates:
2/ 28/ 2019
before 3/ 31/ 2019
The Centers for Medicare and Medicaid Services (CMS) has several requirements States must meet when administering a waiver
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Appendix A: Waiver Administration & Operation Appendix B: Participant Access and Eligibility Appendix C: Participant Services
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Appendix D: Participant-Centered Planning and Service Delivery Appendix E: Participant Direction
Appendix F: Participant Rights
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Appendix J: Cost Neutrality Demonstration
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Appendix I: Financial Accountability Appendix H: Systems Improvement Appendix G: Participant Safeguards
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W ai aiver r Adm inist rat rat ion
an and Operat rat ion
The S tate agency responsibilities for day to day administration and operation of the waiver and contracted
entities with
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Waiver Administration and Operation
a separate state agency: The Colorado Department of Human S ervices, Division of Child Welfare S ervices
tate will update this to the S tate Medicaid Agency per HB 18-1328
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Currently there are no contracted entities that perform waiver operational and administrative functions on behalf
At renewal we will:
provide targeted case management services
for monitoring/ licensing of residential services
services
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agencies, the County Departments of Human/ S
clients enrolled in the CHRP waiver.
state entities, the Community Center Board’ s (CCB), will perform waiver operational and administrative functions for clients enrolled in the CHRP waiver.
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performance of County Departments of Human/ S
ervices in conducting waiver
, under the oversight of HCPF.
performance of the Community Centered Boards (CCB) in conducting waiver operational and administrative functions.
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Currently, methods to assess performance of Contracted non-state entities include:
administrator for all enrollments
agencies is provided by the DHS waiver administrator.
review all plans of correction and necessary remediations.
waiver administrator.
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At renewal, the CHRP waiver will be updated to include:
investigated
requirements
files
Payment Review contractor
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Operational and Administrative Functions
Currently the assessment of performance of contracted non-state entities is DHS , under the
Human/ S
ervices in conducting waiver
At renewal, HCPF will be responsible for the assessment of performance for Community Centered Boards (CCB).
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HCPF will update the Performance Measures in Appendix A to provide CMS with the assurance that HCPF retains ultimate administrative authority over the CHRP waiver through the tracking and monitoring of deliverables provided by the contracted entities.
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Part art icipan ant Access an and Eligibilit y
Target group(s) and Medicaid eligibility groups, Level of Care (LOC) & Evaluation procedures, Freedom of Choice, and the Application Process for entrance into the waiver
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Currently CHRP serves individuals 0 – 20 with a Developmental Disability. At renewal, we will update the definition of intellectual and developmental disability to read:
"Int ellect ual and development al disabilit y" means a disabilit y t hat manifest s before t he person reaches t went y-t wo years of age, t hat const it ut es a subst ant ial disabilit y t o t he affect ed person, and t hat is at t ribut able t o an int ellect ual and development al disabilit y or relat ed condit ions, including Prader-Willi syndrome, cerebral palsy, epilepsy, aut ism, or ot her neurological condit ions when t he condit ion or condit ions result in impairment of general int ellect ual funct ioning or adapt ive behavior similar t o t hat of a person wit h an int ellect ual and development al disabilit y. Unless
found at C.R.S . 25.5-10-202
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Selection of Entrants into the Waiver
Children/ youth age birth (0) through twenty (20) who have a determination of developmental disability by a Community Centered Board. As well as; meet the level of care criteria for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) as defined in 42 CFR §440.150, and have with extraordinary support needs as defined in 10 CCR 2505-10 8.500, and are at risk
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Medicaid Eligibility Group
§1634 State with Miller Trust
Medicaid Eligibility Groups Served include: S S I recipients
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LOC & Evaluation/Reevaluation Procedures for LOC
Currently, evaluations and reevaluations are performed by County Departments of Human/ S
ervices. At renewal, evaluations and reevaluations will be preformed by Community Centered Boards (CCB). This section also will include the updates for:
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HCPF will update the performance measures in Appendix B to provide CMS with the assurance that the correct assessment tools are being utilized appropriately by Case Managers.
Human/ S
ervices caseworker and/ or liaison provide the parent/ guardian with an explanation
the feasible alternatives available under the waiver and provides the choice of institutional or community based services.
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Summarizes services provided in the waiver and describes scope, provider qualifications, coverage policies and limitations (if any)
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Current S ervices:
ervices
ervices
upported Community Connections
Proposed S ervices:
ervices
upported Community Connections
upport S ervices (new)
upport S ervices (new)
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For each service the state defines:
duration
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General Service Specifications
Criminal history and/ or background investigations are required for providers This will be updated to include information for non-child welfare
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General Service Specifications
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HCPF will updat e performance measures in Appendix C t o provide CMS wit h t he assurance t hat t he Depart ment maint ains
How are participant needs identified and addressed during the service plan development process?
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Participant-Centered Planning and Service Delivery
Participant-centered service plan development and
implementations and monitoring of the service plan
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Responsibility for Service Plan Development
Currently, the CHRP waiver has Case Manager Qualifications as identified in Volume 7. At renewal, the CHRP waiver will be updated to remove the counties and include CMA requirements. These include:
S population, in a private or public agency may substitute for the required education on a year for year
basis
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Supporting the Participant in Service Plan Development
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Each CCB is contractually obligated to provide information to participants about:
Service Plan Development Process
following responsibilities when implementing the person-centered support plan:
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Risk Assessment and Mitigation
at other options.
evaluating different options for an assessment tool.
January 2019 to discuss the determination made upon completion of evaluation.
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Risk Assessment and Mitigation
HCBS
Planning (ICAP), until the new Long-Term S ervices and S upports (LTS S ) standardized assessment is implemented.
and S trengths (CANS ) assessment until the LTS S standardized assessment is implemented. This option would include evaluating if and how the CANS assessment could be incorporated with the new tool.
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Informed Choice of Providers
Participant is provided a statewide list of qualified providers
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Process for Making Service Plan Subject to the Approval of the Medicaid Agency
ervice Plans
(ULTC 100.2)
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Service Plan Implementation and Monitoring
CMs are responsible for monitoring the implementation of the service plan and the health and welfare of the participant.
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Monitoring Safeguards
Department is in the process of implementing Conflict Free Case Management (CFCM) by 2022
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HCPF will update performance measures in Appendix D to provide CMS with the assurance that the participant support plan are meeting their needs and services are delivered according to the support plan
How are participant rights protected?
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Participant Rights
Appendix F Addresses
Participant rights to request a fair hearing
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Opportunity to Request a Fair Hearing
Participants are notified of adverse action through issuance of a written form entitled the Long Term Care Waiver Program Notice of Action (LTC 803 Form)
right to a fair hearing upon enrollment in the waiver and when the CCB anticipates an adverse action will be taken.
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Additional Dispute Resolution Process
A waiver participant may utilize the additional process to dispute the specific actions taken by the Community Centered Board (CCB) or other qualified provider
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Additional Dispute Resolution Process
participant at least 15 days prior in writing
to participant to informally negotiate
impartial decision maker
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Department Review of the Dispute Decision
decision
Resolution process at PASA agencies through its Inter Agency Agreement with the Department of Public Health and Environment (DPHE)
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Operation of Grievance/ Complaint System
The Department is responsible for
for this process are located at 10 CCR 2505-10
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Participant Safeguards
How does the state monitor the delivery of waiver services?
Safeguards to assure the health and welfare of waiver participants and describes how to respond to critical events or incidents.
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Response to Critical Events
Who is required to report critical events or incidents?
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What is considered a critical incident?
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24 hour period:
Exploitation
property
Issues
Displacement
Participant Training and Education
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CMA provides information about mistreatment, abuse, neglect and exploitation to the participants, guardians, involved family members and Authorized Representatives at initial enrollment and annually thereafter.
Responsibility for Review and Response
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CCBs monitor services (e.g., incident reports, anecdotal data, interview, etc.) and are required to identify and report all critical incidents HCPF identifies incidents of non-compliance through Program Quality on-site surveys, stakeholder complaints and review of the critical incident reporting system
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A personal restraint is to be used only during periods of crisis or emergency for the child, when the child is a danger to him/ herself and/ or others, the child is beyond control, and when all other means to control and de-escalate the crisis or emergency has failed.
Personal restraint is an age appropriate physical intervention by a staff member of a facility in an emergency situation to limit, restrict, or control the dangerous behavior of a child by means of physically holding the child.
State oversight is the responsibility of the Department of Health Care Policy and Financing.
Use of Restrictive Interventions
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State oversight is the responsibility of the Department of Health Care Policy and Financing. Whenever possible, positive behavioral interventions such as a calming tool (e.g. blankets, brushes) are used to avoid restraints.
The use of a mechanical restraint, including, but not limited to, the use of handcuffs, shackles, straight j ackets, posey vests, ankle and wrist restraints, craig beds, vail beds, hospital cribs, and chest restraints is prohibited, except as otherwise allowed under Article 27-10, C.R.S .
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S tate Law Title 27-10.5-115 (5) C.R.S . prohibits the use of seclusion.
Medication Management and Administration
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State oversight is the responsibility of the Department of Health Care Policy and Financing.
Service Providers are responsible for
management and follow-up
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HCPF will update performance measures in Appendix G to provide CMS with the assurance that the State is monitoring the Health and Welfare of the DD and SLS waiver participants
What is the Quality Improvement Strategy (QIS)?
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Systems Improvement
CMS Technical Guide States:
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“ Quality Improvement is a critical operational feature that an organization employs to continually determine whether it operates in accordance with the approved design of its program, meets statutory and regulatory assurances and requirements, achieves desired
improvement”
Appendices:
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System Improvements & System Design Changes
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How does the state maintain financial accountability in the waiver?
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Financial Accountability
Appendix I Addresses
Financial elements of waiver operations such as payment methods, rates, billings and claims.
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Financial Integrity
Information S ystem (MMIS )
Post Payment review (PPR) contractor
reviews and medical record reviews
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Rates Claims & Billing
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and do not vary based upon tier levels such as professional services and supported community connection. Other services are reimbursed on a tiered fee-for-service rate.
from the Inventory for Client and Agency Planning (ICAP).
Payments to providers are made through the MMIS
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HCPF will update the performance measures in Appendix I to provide CMS with the assurance that the State is monitoring waiver finances.
Does the waiver meet statutory cost-neutrality requirements?
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Cost Neutrality Demonstration
Home & Community Based S ervices Factors:
will receive services through a waiver within a year
tay – Average span, in days, that an individual utilizes waiver services
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Home & Community Based S ervices Factors:
Medicaid cost for HCBS services for individuals in the waiver program
Medicaid cost for all other services provided to individuals in the waiver program
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Institutional S ervices Factors:
Medicaid cost for hospital, NF, or ICF care that would be incurred for individuals served in the waiver, were the waiver not granted.
Medicaid cost for all services other than those included in factor G for individuals served in the waiver, were the waiver not granted.
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Demonstration of Cost- Neutrality Formula
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S ubmit any public comments to: ltss.publiccomment@ state.co.us
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Justine Miracle 303-866-5919 Justine.Miracle@ state.co.us Michele Craig 303-866-5147 Michele.Craig@ state.co.us
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