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PALLIATIVE CARE WAIVER STAKEHOLDER MEETING

PALLIATIVE CARE WAIVER STAKEHOLDER MEETING. California Department of Health Services Medi-Cal Policy Division 11/29/06. OVERVIEW. Roles/Responsibilities Home & Community-Based Services Waivers Features and Requirements Cost Neutrality Application Process. ROLES/RESPONSIBLITIES.

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PALLIATIVE CARE WAIVER STAKEHOLDER MEETING

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  1. PALLIATIVE CARE WAIVER STAKEHOLDER MEETING California Department of Health Services Medi-Cal Policy Division 11/29/06

  2. OVERVIEW • Roles/Responsibilities • Home & Community-Based Services Waivers • Features and Requirements • Cost Neutrality • Application Process

  3. ROLES/RESPONSIBLITIES • Centers for Medicare and Medicaid Services (federal CMS) • CA Department of Health Services (CDHS) • Medi-Cal Policy Division • Waiver Analysis Section • Children’s Medical Services (State CMS)

  4. California Department of Health Services (CDHS) • Single State Medicaid Agency • Responsible for Oversight of Medi-Cal Waivers

  5. Medi-Cal Policy DivisionWaiver Analysis Section • Liaison between the State and the federal CMS • Manage waiver application/renewal processes • Ensure compliance with federal requirements • Manage Interagency Agreement with other Depts

  6. Waiver Analysis SectionRole as Liaison • Advocate for the State with federal CMS • Provide technical assistance to Programs (i.e., State CMS) • State CMS will operate and monitor the Palliative Care Waiver

  7. MEDICAID WAIVERS

  8. What is a Medicaid Waiver? • Allows federal government to waive specified provisions of Medicaid law. • Allows States flexibility in administering its Medicaid program to meet healthcare needs of its populations.

  9. Types of Medicaid Waivers Section of Social Security Act 1115 – Demonstration Waivers 1915(b) – Freedom of Choice Waivers 1915(c) – Home and Community Based Services Waivers (HCBS)

  10. HCBS Waivers • Designed to offer safe and appropriate home care to individuals in lieu of care in an institution (e.g., nursing facility, hospital, etc.) • Allows State to design waiver program to address needs of target population

  11. HCBS Waivers • Allows CMS to waive following requirements: • Statewideness - allows geographic limit • Comparability - allows focus on specific population • Income and Resource Standards - allows exclusion of parental income

  12. Requirements of HCBS Waivers • Level of Care (e.g., nursing facility or hospital, etc.) • Enrollment limit or cap • Assurances (e.g., health and safety Fiscal Accountability

  13. HCBS WAIVER REQUIREMENTS • Services must be different from State Plan services (in scope amount or duration) • Individual cannot be enrolled in two HCBS waivers at the same time • Cost neutrality

  14. COST NEUTRALITY Cost to Federal Government With the waiver must be less than or equal to cost without the waiver

  15. COST NEUTRALITY FORMULA Waiver Beneficiaries Non-Waiver Beneficiaries Waiver + State Plan < Institutional + Ancillary Costs Costs Costs Costs

  16. HCBS WAIVER DEVELOPMENT AND APPLICATION PROCESS

  17. HCBS Waiver Development Process • Takes 1 year to 18 months • Consultation with federal CMS throughout process • Stakeholder input during development and comments on draft application

  18. Waiver Development • Define population, services, provider types, operational methodology • Research/resolve state/federal policy issues • Obtain data and develop cost neutrality

  19. Waiver Application Process • Prepare draft application • Obtain stakeholder input • Obtain State approvals • Submit final application to federal CMS

  20. 90-day Clock Federal CMS has 90 days to review/approve or ask questions Federal CMS Sends Questions to State - Clock stops State responds to questions Resolve more policy issues Lots of discussions with federal CMS and program New 90-day Clock starts Federal CMS has 90 days to approve or disapprove application Waiver Approved HCBS Waiver Application Process

  21. WAIVER APPROVAL • Initially approved for 3 years/renewed for 5 years • Conditions of Approval – May require • Independent Assessment • Additional Reporting Requirements • Waiver Implementation – Submit required reports

  22. Waiver Renewal Process • starts about 1 year before waiver approved

  23. RELATED LINKS Federal CMS Websites General - http://www.cms.hhs.gov/home/medicaid.asp HCBS Waiver Application - http://www.cms.hhs.gov/MedicaidStWaivProgDemoPGI/05_HCBSWaivers-Section1915(c).asp Medi-Cal Policy Institute – Medicaid Waivers: California’s Use of a Federal Option (check website for link)

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