Community Alternatives Program 1915 (c) HCBS Waiver August 4, 2016 Department of Health and Human Services Stakeholder Engagement
Communication plan • 30-60 days: –Update the DHHS/DMA website –Create a beneficiary listserv –Email stakeholders upcoming events and information • Gather emails of any stakeholder we don’t have –Communicate directly with agencies • Suggest agencies share information with families –Explore social media 2 CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement
Communication plan • 90-100 days: –Add consume interface to the e-CAP system: • Allow real-time review of CAP workflow • Report critical incidents • Submit complaints and grievances • Monitor Due Process proceedings • Enhance stakeholder and DMA to communication –Ongoing quarterly stakeholder meetings begin • 180+ days –DMA to host biannual listening sessions 3 CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement
Due process • Importance • Impact to prior approval / prior authorization process • Requests for covered and non-covered state plan and waiver services • Timeline • Appeal of adverse decision • Maintenance of services 4 CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement
Meeting the needs of medically fragile children • Waiver services suppl pplemen ent rather than repla lace informal and formal supports; How to: –Structure needed supports within waiver guidelines and and comply with the Social Security Act –Manage care needs and and maintain cost-neutral service provisions –Use Medicaid to optimize cost-neutral service provisions • What supports are needed; How many • What supports are available • How to leverage available supports 5 CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement
Service provision comparison Waiver Services State Plan Services • Cap Nursing CAP Nur Nursi sing Priv • Private Duty Nursing ivate Du Duty N Nursing – Nurse care to individuals with a – Nurse care to individual with a Nurse care to individuals with a skilled Nurse care to individuals with a skilled skilled need that requires skilled need that requires need that require intervention every 2-4 need that require intervention every 2-4 intervention every 2-4 hours intervention every 2-4 hours hours hours • In-Home Care • Personal Care In-Home C In Car are Perso sonal C Care – Personal care to individuals with – Personal and home maintenance Personal care to individuals with two or Personal and home maintenance care to two or more limited to extensive care to individuals with limited more limited to extensive Activities of Daily individuals with limited ADLs and Activities of Daily Living (ADLs) ADLs and Instrumental Activities of Living (ADLs) needs Instrumental Activities of Daily Living needs Daily Living (IADLs) needs (IADLs) needs –No comparable service • Pediatric Nurse Aide Pedia iatric N Nurse A Aid ide No c compar arable s servic ice – Personal care to individuals with two or more extensive ADLs needs Personal care to individuals with two or that falls in the Nursing Assistant more extensive ADLs needs that fall in the (NA) I and NA II categories Nursing Assistant (NA) I and NA II categories 6 CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement
Service provision comparison Waiver Services State Plan Services Respite te No c comp mparable servic ice Temporary relief for waiver beneficiary or primary caregiver Cas ase Man Manage agement No Compar arable Se Servic ice Coordinating activities of assessing, care Comparable services may be available planning, monitoring, linking, referring and through other resource agencies that follow-up to maintain community provide case management integration and inclusion • Children’s Developmental Service agencies • Department of Social Services • Private Duty Nursing agencies 7 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 8 CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement
Next meeting Should waivers be merged? • Discuss waiver issues: –Benefits –Disadvantages –Concerns • What measures are needed to ensure each group’s needs are addressed? 9 CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement
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