Home and Community-Based Alternatives Waiver: Renewal Overview - - PowerPoint PPT Presentation

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Home and Community-Based Alternatives Waiver: Renewal Overview - - PowerPoint PPT Presentation

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Home and Community-Based Alternatives Waiver: Renewal Overview Department of Health Care Services September 17, 2020 1 Agenda Medi-Cal Home and Community-Based Services (HCBS) Overview of 1915(c) HCBS Waivers Home and

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Home and Community-Based Alternatives Waiver: Renewal Overview

Department of Health Care Services September 17, 2020

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  • Medi-Cal Home and Community-Based

Services (HCBS)

  • Overview of 1915(c) HCBS Waivers
  • Home and Community-Based Alternatives

(HCBA) Waiver

  • Changes Accomplished through the 2017

Waiver Renewal Process

  • 2022 HCBA Waiver Renewal Considerations
  • HCBA Waiver Renewal Timeline and Process
  • Stakeholder Engagement

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Agenda

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Medi-Cal HCBS

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Photo by Dominik Lange from Pexels

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  • Medicaid, known as Medi-Cal in California,

is free or low-cost health coverage for children and adults with limited income and resources

  • Medi-Cal is authorized and funded through

a federal-state partnership

  • Federal government sets minimum

standards

  • Medi-Cal delivery systems include Medi-Cal

managed care, fee-for-service, and waiver programs

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Medi-Cal

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  • Under Medi-Cal, California offers a

broad array HCBS programs and providers to eligible beneficiaries, as well as statewide Medi-Cal managed care with care coordination requirements

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DHCS Efforts for HCBS

Photo by Daniel Frank on Pexels

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  • DHCS has several initiatives planned or

underway to strengthen the availability and coordination of HCBS across the state:

– COVID Crisis Response Federal Flexibilities and Local Coordination – HCBA Waiver Renewal – CalAIM Enhanced Care Management, In-Lieu of Services, and Long-Term Care Carve-In – CalAIM transition of Coordinated Care Initiative to Dual Eligible Special Needs Plans (D-SNPs)

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HCBS Initiatives

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Overview of 1915(c) HCBS Waivers

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Photo by Karolina Grabowska on Pexels

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HCBS 1915(c) Waiver Authority

  • Under Section 1915(c) of the Social

Security Act (SSA), states have the option to submit HCBS waiver applications to the U.S. Centers for Medicare & Medicaid Services (CMS) for approval

  • HCBS waivers allow states to provide

medically-necessary services to eligible individuals in a community setting, instead

  • f in an institution

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Service authorization is based on medical necessity

  • A service is “medically necessary” or a

“medical necessity” when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain.

  • Welfare and Institutions Code 14059.5

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Medical Necessity

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Why have an HCBS waiver?

  • HCBS waivers allow states to waive one or

more of three requirements under the SSA:

– Comparability - offer services to waiver participants not provided to other Medicaid beneficiaries – Statewideness - limit the operation of a waiver to specified geographic areas of the state; and – Income and Resources for the Medically Needy

  • deem individuals eligible for Medicaid who would
  • therwise only be eligible in an institutional setting
  • All other provisions of the SSA apply

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Individuals must meet the following criteria to be eligible to enroll in an HCBS waiver:

  • Meet Medicaid eligibility requirements
  • Have care needs equal to the level

received in an institution

  • Require one or more waiver service to

remain safe in the community

  • Want to receive HCBS in the community,

instead of receiving care in an institution

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HCBS Waiver Eligibility

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HCBS Waiver Goals

  • Protect health, welfare, and safety
  • Person-centered plan of care
  • Participant choice and self-

determination

  • Institution to community diversion /

transition

  • Cost neutrality

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California’s 1915(c) HCBS Waivers

Waiver Target Population Service Area

Home and Community-Based Alternatives (HCBA) Aged, disabled, all ages Statewide

Assisted Living Waiver (ALW) Aged, disabled, 21 and over 15 Counties HCBS Waiver for Individuals with Developmental Disabilities (HCBS–DD) Individuals with Intellectual or Developmental Disabilities, all ages Statewide HIV/AIDS Medi-Cal Waiver Program (MCWP) Individuals with HIV/AIDS, all ages Statewide Multipurpose Senior Services Program (MSSP) Aged, 65 and older 46 Counties Self Determination Program (SDP) Individuals with Intellectual or Developmental Disabilities, all ages Statewide

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  • 1915(c) HCBS waivers must be

resubmitted to CMS for reauthorization every five years

  • Initial waiver terms

are approved for three years

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HCBS Waiver Renewal Timelines

Photo by Aphiwat Chuan on Pexels

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Home and Community Based Alternatives (HCBA) Waiver

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Photo by Lisa Fotios on Pexels

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  • The HCBA Waiver (formerly the Nursing Facility/Acute

Hospital (NF/AH) Waiver) was approved by CMS on May 16, 2017, with an effective period of January 1, 2017 through December 31, 2021

  • The HCBA Waiver provides care management

services to persons at risk for nursing home or institutional placement

  • A multidisciplinary team provides care management

services, coordinates waiver and State Plan services (e.g., medical, behavioral health, In-Home Supportive Services, etc.), and arranges for other long-term services and supports available in the local community

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HCBA Waiver Overview

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  • Target population:

– Full-Scope Medi-Cal – Aged or Disabled – All Ages – Nursing Facility Level of Care

  • Current enrollment (as of August 2020): 5,273

participants, and 607 applicants on waitlists

  • Maximum 8,974 slots in 2021
  • Services are provided in the home, a Congregate

Living Health Facility (CLHF), or an Intermediate Care Facilities for Individuals with Developmental Disabilities – Continuous Nursing (ICF/DD-CN)

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HCBA Population and Service Locations

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HCBA Waiver Agency Model

Who

  • Organizations with experience providing case management and

administrative functions for comparable populations

  • Non-profits, for-profits (e.g., Home Health Agencies), professional

corporations, County/City entities, etc.

How

  • DHCS developed a Solicitation for Application (SFA) process to identify

qualified entities

  • DHCS entered into contracts with selected entities to delegate HCBA

Waiver Agency responsibilities

When

  • DHCS implemented the Waiver Agency model effective August 1, 2018
  • DHCS conducted training and readiness review functions for selected

Waiver Agencies prior to implementation, and continues to provide training and technical support

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Changes Accomplished through the 2017 Waiver Renewal Process

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Photo by Engin Akyurt on Pexels

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Key Changes in 2017

  • Waiver name
  • Waiver capacity
  • Reserve capacity and waitlist criteria
  • Level of Care (LOC) consolidation
  • Case Management Acuity Assessment
  • Shift to an Organized Health Care

Delivery System (OHCDS) model

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New Name for Waiver

Nursing Facility/Acute Hospital (NF/AH) Transition and Diversion Waiver 1/1/2012 – 12/31/2016 Home and Community-Based Alternatives (HCBA) Waiver 1/1/2017 – 12/31/2021

Previous Waiver New Waiver

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Waiver Capacity

NF/AH Waiver

Max enrollment per waiver year by LOC With a max capacity of 3,964 in 2016

HCBA Waiver

Max enrollment per waiver year by point in time With a max capacity of 8,974 in 2021

Previous Waiver New Waiver

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Reserved Capacity

NF/AH Waiver

By LOC

HCBA Waiver

Individuals residing in a facility for 90+ days, individuals transitioning from similar HCBS programs, or youth under the age of 21

Previous Waiver New Waiver

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Consolidated LOC

NF/AH Waiver

9 LOC

HCBA Waiver

3 LOC

NF-A/B NF-Subacute Acute Hospital

Previous Waiver New Waiver

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Case Management Acuity

NF/AH Waiver

N/A

HCBA Waiver

Case Management Acuity: the amount

  • f case manage-

ment an individual requires to remain safe at home

Previous Waiver New Waiver

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Administrative Model

NF/AH Waiver

State-operated wavier model with DHCS Nurse Evaluators providing administrative case management

HCBA Waiver

Approved as an OHCDS model with contracted

  • rganizations

responsible for waiver admin- istration at the local level

Previous Waiver New Waiver

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2022 HCBA Waiver Renewal Considerations

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Photo by Emre Kuz on Pexels

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Proposed Goals for HCBA Waiver Renewal

  • Expand what works well
  • Address elements that

present challenges

  • Safeguard participant

health and safety

  • Reinforce participant

choice

  • Improve access

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Photo by You X Ventures on Unsplash

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  • What is working well in the current HCBA

Waiver?

  • What are opportunities for improvements

in the HCBA Waiver renewal?

  • What other factors should DHCS consider

in the HCBA Waiver renewal process?

  • How can DHCS improve its overall HCBS

strategy?

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DHCS Requested Feedback from Stakeholders

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HCBA Waiver Renewal Timeline and Process

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Define Goals Engage Public Plan Do Measure Act

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  • September 2020: Overview Webinar
  • October 2020 - January 2021: Technical

workgroup meetings

  • January 2021: Workgroup renewal

recommendations due to DHCS

  • Spring 2021: DHCS prepares new/revised waiver

content

  • Summer 2021: Updated waiver posted for a 30

day public comment period

  • Fall 2021: DHCS incorporates stakeholder

feedback and submits waiver renewal to CMS

  • January 1, 2022: Start date of new waiver term

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HCBA Waiver Renewal Timeline

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Stakeholder Engagement

DHCS is committed to a robust public engagement process to help ensure the waiver continues to meet the needs of the eligible population.

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Photo by Dylan Gillis on Unsplash

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  • There will be multiple opportunities to submit

feedback to DHCS during the waiver renewal process:

– After today’s presentation – After each of the three technical workgroup meetings

  • Submit feedback no later than one week after

today’s presentation and each technical workgroup meeting to ensure your questions and comments can be considered by the following workgroup

  • Send feedback to HCBAlternatives@dhcs.ca.gov

inbox, using the HCBA Waiver Renewal Public Feedback form available on the DHCS website

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Opportunities for Public Feedback

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HCBA Waiver Renewal Technical Workgroup

  • Participants
  • HCBS waiver providers
  • HCBA Waiver Agencies
  • Advocates
  • Other interested stakeholders

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  • To apply for the HCBA Waiver Renewal

Technical Workgroup, stakeholders must submit a Statement of Interest, using the form available on DHCS’ website, to the HCBAlternatives@dhcs.ca.gov inbox by September 25, 2020.

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Next Steps

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Stakeholder Questions and Comments

Pexels Public Domain

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For More Information

  • https://www.dhcs.ca.gov/

DHCS

  • https://www.dhcs.ca.gov/services/ltc/Pages/Home-and-

Community-Based-(HCB)-Alternatives-Waiver.aspx

HCBA

  • https://www.dhcs.ca.gov/services/ltc/Pages/HCBA-

Waiver-Renewal.aspx

Waiver Renewal

Please submit questions about the HCBA Waiver renewal to: HCBAlternatives@dhcs.ca.gov

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