MI Choice Program Update
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Transcript MI Choice Program Update
MI Choice Program Update
HFA Regulatory Day
October 29, 2014
Elizabeth Gallagher, Manager HCBS Section, MDCH
OBJECTIVES
Learn about MI Choice Program Eligibility
Medical/Functional
Financial
Service Need
Learn about the Home and Community Based Services
requirements
Basic Requirements
MI Choice time frame for compliance
Process for assessing residential and non-residential
settings
Corrective Action Plans
Question and Answer Session
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MI CHOICE PROGRAM
ELIGIBILITY
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OVERVIEW OF MI CHOICE
The MI Choice Waiver is designed to
enable the elderly and younger disabled
adults (age 18 & older) to remain at
home and to participate in their
communities. The waiver serves
approximately 14,000 adults each year.
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REFERRAL TO MI CHOICE
Persons
interested in
enrolling in
MI Choice
must work
with a
waiver
agency that
serves their
county of
residence.
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REFRRAL TO MI CHOICE
To find a local waiver agency or for
more information on the MI Choice
Waiver:
www.michigan.gov/mdch
Click on “Health care coverage.”
Click on “Services for seniors.”
Click on “Choices for older or
disabled persons who may need
help caring for themselves.”
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REFERRAL TO MI CHOICE
Contact the preferred
waiver agency in the
service area
Ask for an assessment of
eligibility for MI Choice
waiver services.
An intake specialist will
conduct a pre-screen over
the phone
If applicant passes the
pre-screen, the specialist
will schedule an in-person
assessment.
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WAITING LISTS
Waiting lists are managed with
four priority categories as listed
below in descending priority:
1. Adults aging off of Medicaid State
Plan Private Duty Nursing whose
services are authorized by Medicaid
Program Review Division
2. Nursing Facility residents
3. Persons with active Adult Protective
Services cases or Persons at
imminent risk of nursing facility
placement
4. All other applicants by date of
inquiry
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MI CHOICE ASSESSMENT
Once an applicant is at the top
of the waiting list the following
happens:
A supports coordination team
comprised of a Registered Nurse (RN)
and licensed Social Worker (SW) will
meet with the applicant in their home
to complete an assessment.
During the assessment, the team will
determine likelihood of eligibility
Will start person-centered planning
Will start development of a plan of
care if likely eligible
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MI CHOICE ELIGIBILITY REQUIREMENTS
Must meet nursing facility level of
care (NFLOC) to demonstrate
medical/functional eligibility
MI Choice waiver agents must apply
the Michigan Medicaid Nursing Facility
Level of Care Determination tool to
persons applying for enrollment in the
program
Applicants must pass through one of
the seven “doors”
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NFLOC DOORS
1. Activities of Daily Living (Bed Mobility,
Transfers, Toilet Use, Eating)
2. Cognitive Performance
3. Physician Involvement
4. Treatments and Conditions
5. Skilled Rehabilitation Therapies
6. Behavior
7. Service Dependency
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FINANCIAL ELIGIBILITY FOR MI CHOICE
WAIVER
Must be eligible for Medicaid
Maximum income is 300% SSI
($2,163/mo. GROSS in calendar year
2014)
Spousal asset protections apply –
but cannot divert income to the
spouse
Waiver participants are considered a
group of one
Waiver participants do not have a
spend-down (Medicaid Deductible)
Financial Eligibility is Determined by
the Department of Human Services
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SERVICE NEED ELIGIBILITY
Applicant must demonstrate, through
the assessment process, the need for
at least one MI Choice waiver
service
Waiver participants must receive at
least one MI Choice service (in
addition to supports coordination) on
a regular basis to maintain program
eligibility.
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MI CHOICE AVAILABLE SERVICES
Adult Day Health
Chore Services
Community Living
Supports
Community Transition
Services
Non-Medical
Transportation
Nursing Services
Personal Emergency
Response Systems
Private Duty Nursing
Counseling
Respite
Environmental
Accessibility Adaptations
Specialized Medical
Equipment & Supplies
Fiscal Intermediary
Supports Coordination
Goods and Services
Training
Home Delivered Meals
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SERVICES IN GROUP RESIDENCES
MI Choice CANNOT:
Pay for room and board
Duplicate services required by
licensure
Duplicate “usual and customary”
services provided by the residence
MI Choice CAN:
Authorize services based upon the
unique needs of the individual
Authorize the additional “hands on”
services and supports needed by an
individual
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MI CHOICE ENROLLMENT
Cannot enroll before date of initial
assessment by waiver agency
Can receive all Medicaid State Plan
Services
Cannot use both MI Choice and Home
Help program for personal care
services.
Must use MI Choice Community
Living Supports for ADL/IADL needs
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MI CHOICE ENROLLMENT
Two Options for Service Delivery
Traditional/Agency Based
All workers must be employed by an
agency in the waiver agency’s provider
network.
Self-Determination
Can choose own workers
Workers cannot be legally responsible
for participant (i.e. spouse or
guardian)
Participants can use a mixture of
Traditional and Self-Determined
services
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MI CHOICE POLICY
MI Choice Chapter in Medicaid Policy
Manual can be found at:
http://www.mdch.state.mi.us/dchmedicaid/manuals/MedicaidProviderM
anual.pdf
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APPLICANT’S RIGHT TO APPEAL
Waiver agency must inform
applicant of their right to appeal
throughout the process
If applicant put on waiting list
If applicant does not pass telephone
screen
If applicant does not meet NFLOC
If applicant does not meet other
enrollment criteria
If applicant requests services that
are not authorized
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HOME AND COMMUNITY BASED
SETTINGS RULING
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HCB SETTINGS RULING
Published in the Federal Register
(CMS-2249-F; CMS-2296-F) on
January 16, 2014
Effective March 17, 2014
Transition plan due by March 17,
2015 or sooner if updating a
waiver program
Must be fully compliant by March
17, 2019, or sooner
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FEDERAL INTENT OF THE RULING
To assure Medicaid-eligible persons who are
part of a home and community based
services program have the same access to
the community in which they reside and
opportunities to be a part of the community
as persons who are not participants of a
Medicaid-funded program.
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REQUIRED QUALITIES
Integrated & supports full access to the
community, including employment, controlling
personal resources & receiving services
The individual selects the setting
Ensures the individual’s rights of privacy, dignity
and respect and freedom from coercion &
restraint
Optimizes initiative, autonomy & independence
Facilitates choice re: services & supports &
providers
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SETTINGS THAT ARE NOT HCB
Nursing Facilities
Institution for Mental Diseases
Intermediate Care Facility for Individuals
with Intellectual Disabilities
Hospitals
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SETTINGS PRESUMED NOT HCB
Publicly or Privately owned facility
providing inpatient treatment
On the grounds of or next to a
public institution
Settings that separate Medicaid
HCBS recipients from other
members of the community
The state can make a case to the
Federal Government if one of these
settings meets HCB requirements
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PROVIDER OWNED SETTINGS
Must also assure:
A specific physical place that can be owned, rented
or occupied under a legally enforceable agreement
and individual has same legal protections as others
Individuals have privacy in sleeping units
Entrance doors lockable
Choice of roommates
Can furnish & decorate unit
Control own schedules and activities and access to
food at any time
Have visitors at any time
Setting is physically accessible
Modifications to above must be documented in PCP
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MICHIGAN TRANSITION PLANS
MDCH is working on a statewide plan
http://www.michigan.gov/mdch/0,4612,7-1322943-334724--,00.html
MI Choice submitted a plan to CMS on
9/28/2014
The Habilitation Supports Waiver
submitted a plan to CMS on 9/30/2014
All plans will be coordinated
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MI CHOICE PLAN: ASSESSMENT
Residential and non-residential settings
Completed by 9/30/2015
Conducted by MI Choice waiver agencies
Using tools developed by CMS, but modified by
MDCH with stakeholder input
On-site
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MI CHOICE PLAN:
OUTREACH & ENGAGEMENT
Completed
Initial Stakeholder Meetings
Public Notice & Comment
Revised & posted transition plan
Post Public notice of assessment results
by 7/31/2015
Present Assessment results to
stakeholders by 8/31/2015
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MI CHOICE PLAN: REMEDIATION
By 6/30/2015
Update policies, procedures, and contract
requirements
Add educational component to provider
enrollment process
Update provider monitoring tool
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MI CHOICE PLAN: REMEDIATION
By 12/31/2015
Analyze assessment data
Notify providers of meeting or not meeting
requirements
Notify CMS if presumed settings should have
exception
Require remediation plans from providers
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MI CHOICE PLAN: REMEDIATION
By 12/31/2016
Offer choices to participants in settings that do not
meet requirements
Transition to setting that meets requirements
Disenroll from MI Choice
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QUESTIONS?
Elizabeth Gallagher
[email protected]
517-335-5068
Heather Slawinski
[email protected]
517-373-0324
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