From Waiver to Program: The Keys to Operationalizing Waivers

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From Waiver to ProgramThe Keys to
Operationalizing Waivers

• Technical Assistance to Expansion States
• March 28, 2006

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The Purpose of Operational Manuals

• To record the approved waiver standards in a
  user-friendly document
• To establish consistency in standards and
  procedures throughout implementation
• Reduce the number of questions that the state
  office needs to answer
• Assure consistency in training of program
  employees
• Provide all partners, financial management
  agencies, support brokers, participants/representa
  tives the same information

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Authority and Goals

• Provide the authority under which you operate the
  program
• Medicaid Waiver 1915 or 1115
• Medicaid State Plan (with new legislation)
• Older Americans Act Funding
• State Funds
• Identify the agency and staff who manage the
  program

• Goals
• Mission Program guidance
• Establish clear measurable standards to achieve
• Identify evaluation procedures to monitor goal
  achievement

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Eligibility

• Identify all eligibility requirements
• Willingness to participate
• Age
• Geographic area
• Disability and functional needs
• Feeder programs
• Cognitive requirements
• Use of a representative
• Programs that might make a participant ineligible

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Communications/Marketing and Enrollment

• Communications/
• Marketing
• Identify ways to inform potential participants of
  the new option
• At time of implementation
• Continuing communication
• Process to gather data on how participants
  learned of the program
• Evaluate and modify plan based on data

• Enrollment
• How interested individuals contact the program
• What information is gathered at that time
• How enrollment will be completed
• Who will complete?
• How and where?
• Forms to be used?

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Participant/Representative Responsibilities

• Identify the process to assure that enrollees
  will be successful with self-direction
• Process to follow when enrollment staff doubt an
  enrollees ability to self-direct
• Self-assessment
• Appointment of a representative
• Additional monitoring/support after enrollment

• Representative
• Situations that necessitate a
  representative
• Eligibility requirements
• Responsibilities
• Process and forms

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Budget

• Determining the amount of the budget
• Services to be converted to the budget
• Formula for calculating the budget
• Communicating the amount of the budget prior to
  enrollment
• Forms
• Calculation form
• Spending Plan or Budget
• Outline of possible uses of budget

• Development of a written spending plan
• Training on budget development
• Person-centered planning
• Acceptable expenditures within the budget
• Budget approval process
• Expected timelines

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Support Broker FMS

• Support Broker (Individual or Agency
• Procurement process
• Open enrollment of providers
• RFP
• Directly hired by participant
• Qualifications
• Responsibilities
• Clearly define the role that the SB will have
  with
• Program Administration
• Participant
• Monitoring and quality assurance
• Financial management agency

• Financial Management Agency
• Procurement Process
• Open enrollment of providers
• RFP
• Qualifications
• Responsibilities
• Payment of payroll and related reporting, tax
  payments
• Payment for other goods and services
• Sub-contracting

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Assessments Reassessment

• Who will complete?
• Who should be involved?
• Process to follow
• Frequency of reassessments
• Level of care determinations
• Service or care planning process
• Effect on the budget
• Annual budget review and update

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Closures Changes

• Conditions that will result in closure or
  disenrollment
• Unavoidable
• Voluntary
• Involuntary
• Conditions that might trigger
• Who makes the decision
• Appeal process
• Process for closing a case
• System changes
• Allowance recovery

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Directly Hired Workers

• Qualifications
• Hiring Process
• Work Agreement
• Required paperwork for FMA
• Work agreement
• Informed consent documents
• IRS Form W-4
• State Form W-4, if applicable,
• USCIS Form I-9
• IRS Notice 797

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Quality Management

• Establish measurements based on program goals
• Identify quality measures that are unique to
  participant-direction
• Assign responsibilities
• State administrative office
• Support brokers
• Financial management agencies
• Participants/Representatives

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Miscellaneous Topics

• Appeals and hearings
• Grievances
• Participant Freedom of Choice
• Privacy and release of information
• Reporting abuse, neglect, exploitation
• Retention of records

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• Summary
• Advanced planning will assure that states are
  poised and ready to begin implementation as soon
  as waivers are approved.
• Clearly stating program policies, processes, and
  procedures will help reduce problems in the
  future.
• A public process for establishing program
  operations will help divert opposition to and
  increase support of the program.
• Update manuals whenever changes occur in the
  program to assure consistency and accuracy.