What's New in the Habilitation Supports Waiver?

1
What's New in the Habilitation Supports Waiver?

• Presented by
• Jill Kemp Deb Ziegler

2
Changes in the HSW

• Separate capitation payments for HSW
• Amendment approval from CMS opens new enrollments
  again (with limits)
• Closer DCH oversight of enrollments,
  recertifications, and disenrollments

3
How Is the HSW Enrollment File for Payment
Generated?

• DCH uses the HSW enrollment data provided by the
  PIHPs on the disk submitted by the 15th of each
  month.
• Enrollment data incorporated into Master HSW
  database.
• End Month HSW Enrollee List transmitted to
  Department of Information Technology (DIT)

4
How Is the HSW Enrollment File for Payment
Generated? (Contd)

• DIT verifies Medicaid Eligibility and Processes
  HSW Enrollment File which posted on DEG
• HSW Payments paid 2nd Wednesday of the month
• HSW Enrollment files 5089/834(5093)
• Available on DEG 7 business days before payment
  (Monday)

5
How Is the HSW Enrollment File for Payment
Generated? (Contd)

• These are prospective payments, which affects
  retro-eligible HSW enrollees.
• If a HSW enrollee does not have Medicaid
  eligibility on the day the list is checked for
  eligibility, payment will not be issued for that
  month.
• However each month, DCH checks to see if the
  person became eligible. If so, the beneficiary
  will be added to the HSW Enrollee List to
  initiate retroactive payment.

6
When Can We Expect Retroactive Payments or
Recoveries to Begin?

• Retroactive payments and recoveries will begin
  with the June payment.
• These recoveries will only be for people paid for
  who were not eligible or enrolled in the program.
• HSW Enrollment file posted on DEG on or before
  May 31

7
What If We See a Discrepancy In the Payment?

• First, check to see if the HSW enrollee had
  Medicaid eligibility for the month in question.
• Second, check your HSW database to make sure a
  status change to Disenrolled or Inactive had
  not been entered in error.
• Finally, fax a list of the Medicaid ID numbers,
  Recipient Names, and the months in question to
  Jill Kemp at 517/335-6856.

8
When Will Recoveries for Lack of Encounter Data
Begin?

• DCH expects to begin checking encounter data
  against the HSW enrollment file later this
  summer, looking back to January.
• Remember, each HSW enrollee must receive at least
  one HSW service per month.
• All encounter data for the month must be entered
  no later than 90 days, regardless of whether the
  claim has been adjudicated.

9
What Should Supports Coordinators Monitor?

• It is important for supports coordinators to be
  very aware of when their HSW enrollees annual
  FIA paperwork is due.
• This helps to avoid unnecessary loss of Medicaid
  eligibility due to a lack of paperwork being
  filed on time.

10
When Can We Begin Enrolling People in the HSW?

• The amendment requesting additional slots, while
  staying within our annual appropriation, has been
  approved.
• The number of new enrollments per PIHP will be
  managed by DCH.
• Priority enrollments will go first to people
  exiting Mt. Pleasant Center and the Childrens
  Waiver Program.

11
When Can We Begin Enrolling People in the HSW?
(contd)

• Packets may be submitted to Deb Ziegler.
• The packets need to include the information
  specified in the Patrick Barrie memo dated in
  November, 2003.
• Reminder If no slots are available, you must
  still assure that the person receives the needed
  services, using b and b-3 services.

12
Other Changes

• Recertification forms must be submitted to DCH
  with the monthly disk.
• Disenrollments must now be reviewed by DCH

13
Technical Assistance

• If you have questions about the HSW
• For payment database questions, call Jill Kemp
  at 517/373-3863 or e-mail at Kempjil_at_michigan.gov
• For program questions (enrollments, services),
  call Deb Ziegler at 517/241-3044 or
  Zieglerd_at_michigan.gov