Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

HCBS Redesign Work Group

Orientation for members of the HCBS Waiver Redesign Work Group.
by

Tyler Deines

on 11 May 2015

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of HCBS Redesign Work Group

Medicaid: 101
Brief History of Services for People with
Intellectual & Developmental Disabilities
Colorado's Services
for Adults with Intellectual & Developmental Disabilities
Services & Supports for Coloradans with Intellectual & Developmental Disabilities
Colorado Department of Human Services
Division for Developmental Disabilities
Waiver Redesign
Workgroup

The Road Ahead
A Leader in Home & Community-Based Services
1800's
Early-Mid
1900's
Today
1980's - 90's
Tyler Deines
HCBS Waiver Administrator
tyler.deines@state.co.us
(303) 866-7441


October 29, 2013
Medicaid Governance
United States Congress
The President
Social Security Act
US Department of Health & Human Services
Code of Federal Regulations
Centers for Medicare & Medicaid Services
Colorado General Assembly
The Governor
Department of Health Care Policy & Financing
Colorado Code
of Regulations
Colorado Department of Human Services
Colorado Medical Assistance Act
Resources
Medicaid Basics
Federal Government
State Government
Medicaid Home & Community-Based Services (HCBS)
Social Security Amendments of 1965
Voluntary Federal-State Partnership
Medical Care to Low-Income Americans
Federal Medical Assistance Percentage (FMAP)
50% - 83% Depending on State's Per Capita Income
Colorado FMAP is 50%
The State Plan
Contract Between State & Federal Governments
Describes the State's Medicaid Program Administration
Assures Compliance with Federal Regulations
Mandatory Benefits
Hospital Services
Physician Services
Nursing Facility Services
Early & Periodic Screening, Diagnostic, & Treatment (EPSDT) Services
Home Health Services
Laboratory & X-Ray Services
Etc.
Optional Benefits
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/ID)
Prescription Drugs
Physical, Occupational, & Speech Therapies
Personal Care
Home & Community-Based Services
Etc.
Statutory Authorities
Service Delivery Models
Fee-For-Service
Services Delivered by Approved Provider Agencies
Unrestricted Provider Enrollment
Providers Paid a Rate for Each Service Delivered

Managed Care
Services Provided or Arranged by Managed Care Organization (MCO)
Restricted Provider Enrollment
MCOs Paid a Negotiated Monthly Rate

Participant Direction
Participants and/or Representatives Manage Service Delivery
Employer Authority
Budget Authority
§1115 Research & Demonstration Programs
Purpose: To Implement an Experiment, Pilot, or Demonstration Project Intended to Improve the Medicaid Program

Key Features:
Broad Waiver Authority
Granted at the Discretion of the Secretary
Greatest Flexibility
Rigorous & Lengthy Approval Process
Must Contain Hypothesis and Evaluation Plan
Must be Budget Neutral
State Must Demonstrate Federal Expenditures Would Not Increase
§1915(b) Managed Care Waivers
Purpose: To Deliver Services Through a Managed Care Organization

Key Features:
Does Not Expand Medicaid Eligibility
May Restrict Types of Providers for Medicaid Benefits
May Allow Local Government to Act as Broker for Managed Care Plans
May Use Savings to Provide Additional Services
May Restrict Number or Type of Providers for a Specific Service
May Exclude Populations
May Waive Comparability, Freedom of Choice, & Statewideness
Must Not Substantially Impair Access to Services
Must be Cost Effective
Average Per Person Cost May Not Exceed Comparable Fee-For-Service Cost
§1915(c) HCBS Waivers
Purpose: To Offer Home & Community-Based Services as an Alternative to Institutional Services

Key Features:
May Expand Financial Eligibility
May Waive Comparability & Statewideness
Participants Must Meet Level of Care Requirements
Must Choose from Three Major Target Populations
State May Further Define Target Populations
Must be Cost Neutral
Average Per Person Cost May Not Exceed Comparable Institutional Average Per Person Cost
May Limit Number of Participants
§1915(i) State Plan HCBS
Purpose: To Offer Home & Community-Based Services as Optional State Plan Benefits

Key Features:
May Expand Financial Eligibility
Level of Care Requirements May Apply
May Not Limit Geographically
May Target Populations
No Cost Demonstration Requirement
May Not Limit Number of Participants
§1915(j) Self-Directed Personal Assistance Services
Purpose: To Allow the Participant Direction of Personal Assistance Services

Key Features:
Does Not Expand Medicaid Eligibility
Employer & Budget Authority Required
May Limit Geographically
May Target Populations
Must be Combined with a 1915(c) Waiver or State Plan Personal Care Benefit
May Limit Number of Participants

§1915(k) Community First Choice
Purpose: To Offer Community-Based Attendant Support Services as Optional State Plan Benefits

Key Features:
Does Not Expand Medicaid Eligibility
Level of Care Requirements May Apply
May Not Limit Geographically
Limited to Services that:
Assist in Accomplishing Activities of Daily Living or Instrumental Activities of Daily Living; or
Substitute for Human Assistance
May Not Limit Number of Participants
Additional 6% FMAP
State Must Maintain or Exceed Level of Expenditure in First Fiscal Year
HCBS Waivers for Adults with Developmental Disabilities
1800's
Prior to 1800's
Family Care
Informal Institutions

Establishment of Formal Institutions
First Attempts at Intervention
Built on Model of Segregation & Rehabilitation

Legal Protections & Entitlements

Creation of the Arcs

Early Intervention Leads to Fewer Childhood Diagnoses

Research Refutes False Claims of Causation
Early - Middle 1900's
Deinstitutionalization Movement
Medicaid Home & Community-Based Services Waivers
Community Group & Residential Supports

Additional Legal Protections & Entitlements
Americans with Disabilities Act
Supreme Court Olmstead Ruling
1980's - 1990's
Today
Continued Focus on Community Living & Deinstitutionalization
Money Follows the Person

Person-Centered Thinking

Self Determination

Supports & Opportunities for Self Sufficiency, Building Relationships, & Greater Control of Life Circumstances
Code of Federal Regulations
http://www.gpo.gov/fdsys/browse/collectionCfr.action?collectionCode=CFR

Colorado Department of Human Services - Division for Developmental Disabilities
http://www.colorado.gov/cdhs/ddd

Colorado Department of Health Care Policy & Financing
http://www.colorado.gov/hcpf

The Colorado State Plan
http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1197969486289

Explore Medicaid Benefits
http://www.colorado.gov/cs/Satellite?c=Page&childpagename=HCPF%2FHCPFLayout&cid=1251647237611&pagename=HCPFWrapper

Long-Term Supports & Services
http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1197969485604

History of Intellectual Disability
http://www.cirrie.buffalo.edu/encyclopedia/en/pdf/history_of_intellectual_disability.pdf

Medicaid: A Primer
http://www.kff.org/medicaid/issue-brief/medicaid-a-primer/

Medicaid.gov
http://www.medicaid.gov/

Social Security Act - Title XIX
http://www.ssa.gov/OP_Home/ssact/title19/1900.htm

Understanding Medicaid Home & Community Services: A Primer
http://www.aspe.hhs.gov/daltcp/reports/2010/primer10.pdf
Non-Medicaid Supports & Services
State-Funded Supported Living Services (State SLS)
Provides services for adults who are not eligible for Medicaid and who either can live independently with limited supports or who, if they need extensive support, are getting that support from other sources, such as their family

Family Support Services
Provides support for families who have a member with a developmental disability or delay with costs that are beyond those normally experienced by other families

Family Support Loan Program
Provides access to short-term low interest rate loans in order to obtain family support services, which help to maintain a dependent family member with a developmental disability in the home

Service Delivery
Home & Community-Based Services for Persons with Developmental Disabilities (HCBS -DD)
Purpose:
To provide services and/or supports to individuals with developmental disabilities who are in need of services and supports 24 hours a day that will allow them to live safely and participate in the community

Target Population:
Intermediate Care Facilities for Individuals with Intellectual Disability (ICF/ID) Level of Care
18 Years & Older with a Developmental Disability

Services:
Day Habilitation
Prevocational Services
Residential Habilitation
Supported Employment
Dental Services
Vision Services
Behavioral Services
Non-Medical Transportation
Specialized Medical Equipment & Supplies
Home & Community-Based Services -
Supported Living Services (HCBS-SLS)
Purpose:
To provide a variety of services to adults with developmental disabilities who are able to live independently with limited paid supports or who also receive extensive supports from other sources. HCBS-SLS participants live in their own homes or in family homes

Target Population:
Intermediate Care Facilities for Individuals with Intellectual Disability (ICF/ID) Level of Care
18 Years & Older with a Developmental Disability

Services:
Day Habilitation
Homemaker Services
Personal Care
Prevocational Services
Respite Care
Supported Employment
Dental Services
Vision Services
Behavioral Services
Home Accessibility Adaptations
Mentorship
Non-Medical Transportation
Personal Emergency Response Systems
Professional Services
Specialized Medical Equipment & Supplies
Vehicle Modifications
Fee-For-Service Providers
Program Approved Service Agencies (PASAs)

Community Centered Boards (CCBs)
Single Entry Point Functions
Level of Care Determination
Verification of Target Criteria
Targeted Case Management
Service Planning and Coordination
Fee-For-Service Provider
Drivers for Change
Inflexibility
System Centered
Lack of Choice & Control

Limitations
Delivery Options
Service Definitions
Plan Restraints

Access
Forced Choice
Overly Restrictive
Inadequate
Office of Community Living
Established by Executive Order
Department of Health Care Policy & Financing

Better Align Service & Supports
Reduce Complication & Fragmentation

Prepare Long-Term Services & Supports for the Future
Our Charge
Community Living Advisory Group Recommendation
Explore Redesigned HCBS Waiver
Services Based Upon Participant Needs & Preferences
Principles:
Freedom of Choice
Participant Authority Over Services & Supports
Support to Organize Resources
Health & Safety Assurances
Opportunities for Contribution
Responsible Use of Public Dollars


Community Living Advisory Group
Established by Executive Order
Ensure responsiveness, flexibility, accountability, and self-directed services and & supports for all eligible persons
Final Recommendations to Governor September 30, 2014

Subcommittees
Care Coordination
Entry Point & Eligibility
Regulatory Subcommittee
Waiver Simplification
House Bill 13-1314
Creates the Division for Intellectual & Developmental Disabilities
Within Office of Community Living

March 2014 - Administrative Authority for DDD-Operated Programs Transfers to Department of Health Care Policy & Financing
Full transcript