Medicaid Waivers

As part of an on-going effort to share information on quality, CMS has offered a series of letters and progress reports. This eighth letter discusses and a new resource: <i>Risk Management and Quality in HCBS: Individual Risk Planning and Prevention, System-Wide Quality Improvement</i>. The letter address the interrelated steps for Successful risk management for individuals in HCBS waivers.

Recognizing that states are engaging in risk planning for HCBS waiver participants, CMS requested this report that explores the topic of effective individual risk management. Potential risk falls into three general categories: health, behavioral and personal safety risks. The project selected 11 states to determine: how programs are addressing risk for participants, identify risk management themes and emerging issues, identify any state tools or policies that can be useful to other states.

This website is the site for the Maine Quality Choices grant. Maine’s Work Group for Community-Based Living includes a broad array of consumer and state representatives from five departments (Transportation, Labor, Education, Human Services, and Behavioral and Developmental Services). The website offers information on the Work Group, Accessing Services, Community Living, Data Integration, Person-Centered Services, Quality Improvement, Workforce and a Project Index.

This report reviews the initiatives of five states and highlights ongoing efforts to create a more balanced financing and delivery system. A table summarizes the home and community-based services system in each of the states. The case studies suggest at least five key issues for other states, Area Agencies on Aging, providers and consumers that are interested in reform. This report is one of 5 in a series called Case Studies from the Aging Network: Health and Social Support Systems Integration.

A brochure on the Arkansas Ombudsman program for home and community based services addresses participants rights and their choice in receiving services for long term care. Includes contact information on the Web and the toll free telephone number to contact the Arkansas Division of Aging and Adult Services.

The Indiana Waiver Services is a new unit created in Jan ‘04, to consolidate the management and operation of Indiana’s eight HCBS Waivers. Attached are documents that provide a program overview. The Services Unit Summary describes the program; the Priority Diversion Guidelines details the individual criteria for priority diversion; the Waiver Services Organizational Chart provides a pictorial overview; and the Hoosiers at Home Press Release announces the programs goals.

This November 2004 issue brief on Premium Assistance, a strategy in which a state uses public funds (e.g.,Medicaid dollars) to pay for a portion of the cost of private coverage (usually employer-sponsored insurance). Current use of premium assistance by states is minimal; only about one-third operate such programs, and recent reports indicate that enrollment in these programs is modest in most of these states. Nonetheless, state interest remains high due to the potential benefits.

The New Freedom Initiative, announced in February 2001, called for a comprehensive assessment of federal policies, programs, statutes, and regulations to identify barriers that impede community living for disabled individuals—and for recommended solutions. In October 2004 CMS awarded an additional $30 million in Real Choice Systems Change Grants—this money in addition to the 188 grants for over $158 million between fiscal years 2001-03. This report highlights accomplishments of those programs.

The purpose of The Protocol is to provide the CMS Regional Office staff responsible for reviewing 1915(c) waiver programs, i.e., the state Medicaid Home and Community Based Services (HCBS) waiver programs, with standardized and comprehensive procedures for assessing the quality of care and services provided through these programs. This Protocol was developed for reviews of all waivers and all waiver target groups.

When Medicaid was first enacted, payment for long-term services was made solely to institutions such as nursing homes. Medicaid now pays for a comprehensive range of home & community services that provide alternatives to institutional care. Medicaid is a flexible program but it is also a complex program. It is no surprise that there are a host of questions about what is allowable under Medicaid law and regulation. This Primer on Medicaid Home and Community Services serves as a reference guide.