CHARTING THE COURSE FOR WAIVER INDEPENDENCE

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CHARTING THE COURSE FOR WAIVER INDEPENDENCE

• Moving Cash and Counseling from the Traditional
  Waiver Program to the New State Plan Option

Alabama Department of Senior Services
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• RWJ Grant received in 2004
• Alabama was in 2nd round of grant awards
• Received 250,000 for assistance in start-up
• Formulation of a plan
• Coordination with Medicaid and other state
  agencies on workplan for project
  
• Determination of need for consultant
• New concept for Alabama
• Uniqueness of program no two states alike
• Concept Paper developed
• Recommendation to operate program as an 1115
  Research and Development project
  

Alabama Department of Senior Services
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The 1115 vs. 1915c Amendment Route

• Issues with the 1915c Elderly and Disabled Waiver
  
  
• Concern over implementing a new concept in a
  large waiver
  
• Ability for one agency to test as a pilot
• Rationale for the 1115
• Could accomplish a small pilot program under the
  1115 waiver
  
• Could carve out certain services for the program
• Wanted ability to give cash to participants
• Wanted to include Independent Living Waiver
  participants from the Rehab department without
  having to do a separate waiver
  

Alabama Department of Senior Services
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Program Development

• National Program Office (NPO) Involvement
• Attending Cash/Counseling meetings
• Participating in conference calls
• Consumer Directed Module Software Project
• Selected as one of three states to participate
• Involved in selection of vendor, development of
  software design, and testing
  

Alabama Department of Senior Services
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What is the Consumer Direction Module (CDM)?

• The Consumer Directed Module (CDM) is a web based
  software application developed to support a new
  approach to managing personal care services for
  Medicaid beneficiaries.

Alabama Department of Senior Services
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CDM Purposes

• Makes communication among the participants,
  counselors, and state administration simple and
  efficient.
  
• Permit ongoing, timely, and efficient
  monitoring.
  
• Improve the quality of service of the program.

Alabama Department of Senior Services
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History of the CDM

• Reason Developed
• to assist the additional states that became part
  of the expansion effort for the Cash Counseling
  Program
  
• Partnerships
• Robert Wood Johnson Foundation
• US Department of Health Human Services
• The National Program Office at the Boston College
  Graduate School of Social Work
  

Alabama Department of Senior Services
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State Involvement

• Participating States for project
• Alabama
• New Mexico
• Rhode Island
• West Virginia
• CDM Steering Committee
• Comprised of State Representatives, State
  Liaison Mentors, CC National Program Office and
  Funders)
  
• Continues to meet weekly

Alabama Department of Senior Services
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• 1115 Waiver submitted 4/06
• Initial questions of whether CMS would approve as
  an 1115 waiver because of the DRA
  
• Numerous conversations with CMS
• Were finally told by CMS that they would process
  as 1115
  
• Received list of questions 9/06
• Received e-mail from CMS 12/06
• Stated proposal could not be approved as program
  could be accomplished under the new state plan
  option of the DRA
  
• Told to withdraw proposal and submit draft
  pre-print for 1915(j) or waiver would be
  disapproved.
  

Alabama Department of Senior Services
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• What to do?
• No final regulations regarding the DRA
• Too much work on project to just throw away
• After several agonizing weeks decision made to
  move forward with SPA option under the 1915(j)
  section
  
• 1915(j) would allow Alabama to operate program as
  designed under the 1115 plan
  
• Submitted State Plan Amendment - 3/07 almost a
  year after the original waiver submitted
  
• CMS final approval received on May 24, 2007!!!

Alabama Department of Senior Services
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• Start Date of August 2007
• 1st Clients enrolled in September
• Started managing budgets in November
• Extension of RWJ Grant
• October 2007 - March 2008

Alabama Department of Senior Services
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Current Participants

• 24 Enrolled completed initial paperwork
• 13 Active budgets are receiving services under
  program
  
• 2 Disenrolled
• Medical condition changed unable to manage
  budget
  
• Personal situation changed no time to manage
  budget

Alabama Department of Senior Services
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Surveys Initial Findings

• Several clients indicated too much
  paperwork/effort to manage easier to use
  traditional provider
  
• One unhappy because couldnt be paid as the
  personal representative and the employee
  
• One loved program but did not have a large enough
  budget to hire a worker to cover the weekend
  

Alabama Department of Senior Services
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Success Reports

• Same amount of services received
• Money left over for special purchases/savings
• Purchase Examples
• lift chair
• air conditioner
• ceiling fan with remote
• generator

Alabama Department of Senior Services
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Moving Forward

• Final CMS rules/regulations
• Financial impact of program
• Conduction of program evaluation

Alabama Department of Senior Services
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Contact Information

• Alabama Department of Senior Services770
  Washington Avenue
  
• RSA Plaza Suite 470Montgomery, Alabama
  36130(334) 242-5743 1-(877)-425-22431-800-AGELIN
  E (1-800-243-5463)Fax [phone]
  
• Irene B. Collins, Commissioner
• Irene.Collins_at_adss.alabama.gov
• Or
• Jean Stone, Division Chief
• Long Term Care Programs
• Jean.Stone_at_adss.alabama.gov