PALLIATIVE CARE WAIVER STAKEHOLDER MEETING

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PALLIATIVE CARE WAIVER STAKEHOLDER MEETING

• California Department of Health Services
• Medi-Cal Policy Division
• 11/29/06

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OVERVIEW

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

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ROLES/RESPONSIBLITIES

• Centers for Medicare and Medicaid Services
  (federal CMS)
• CA Department of Health Services (CDHS)
• Medi-Cal Policy Division
• Waiver Analysis Section
• Childrens Medical Services (State CMS)

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California Department of Health Services (CDHS)

• Single State Medicaid Agency
• Responsible for Oversight of Medi-Cal Waivers

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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

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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

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• MEDICAID WAIVERS

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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.

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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)

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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

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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

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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

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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

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COST NEUTRALITY

• Cost to Federal Government
• With the waiver must be less than or
• equal to cost without the waiver

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COST NEUTRALITY FORMULA

• Waiver Beneficiaries Non-Waiver
  Beneficiaries
• Waiver State Plan lt Institutional
  Ancillary
• Costs Costs Costs
  Costs

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• HCBS WAIVER
• DEVELOPMENT AND
• APPLICATION PROCESS

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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

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Waiver Development

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

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Waiver Application Process

• Prepare draft application
• Obtain stakeholder input
• Obtain State approvals
• Submit final application to federal CMS

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HCBS Waiver Application Process

• 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

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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

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

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RELATED LINKS

• Federal CMS Websites
• General - http//www.cms.hhs.gov/home/medicaid.asp
  
• HCBS Waiver Application -
• http//www.cms.hhs.gov/MedicaidStWaivProgDemoPGI/0
  5_HCBSWaivers-Section1915(c).asp
• Medi-Cal Policy Institute Medicaid Waivers
  Californias Use of a Federal Option (check
  website for link)