Waiver Reimagine Simplified Service Menu Office Hours - June 25th, 2021 9:00 am -10:00 am
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Waiver Reimagine Simplified Service Menu Office Hours
June 25th, 2021
9:00 am -10:00 amAgenda • Waiver Reimagine project overview and updates • Common Questions • Waiver plan and system updates • Unit based services • Residential services • Own Home • Open Q&A time • Resources
Waiver
Reimagine
project
overview
and
updates
3Vision for the future
Waiver Reimagine Introduction: Simplify programs, improve access and
increase choices
─ https://www.youtube.com/watch?v=dnUjxcxP-j0&feature=youtu.be
Waiver Reimagine will improve the disability home and community-based
waiver system so that there’s more choice and control over services, it’s
easier to understand and it’s simpler to navigate.
─ Right services at the right time
─ Access to services based on needs
─ Empowered with information and options
Waiver Reimagine does not affect eligibility for a waiver, and the same
access criteria will remain in place.
4Project Timeline
The 2019 legislature After approval from the
The 2017 legislature authorized DHS to Phase 1 Implementation legislature, DHS will
DHS developed policies,
required DHS to conduct simplify the service begins- Changes to submit plans for federal
procedures and systems
2 studies to identify menu and continue simplify the service approval to reshape the
to implement a
improvements to waiver analysis and research to menu took effect in waiver programs and
simplified services menu
programs for people with reshape the waiver January 2021 after individual budgets.
beginning January 2021.
disabilities programs and individual federal approval. Implementation will
budgets. begin in 2023 or later.
2022 and
2017 2018 2019 2020 2021
beyond
DHS conducted extensive DHS recommends
research and stakeholder DHS continued to policies to reshape the
engagement that informed conduct research and waiver programs and
the waiver reimagine extensive stakeholder implement individual
legislative report and engagement on budgets to the 2021
recommendations reshaping the waivers, legislature.
individual budgets and
self-direction
4/21/2021 5Waiver plan
and DHS
system
updates
6Excluded Time Services • Question: Will the time-excluded services list will be updated to reflect waiver- reimagine services? • Response: The Unitary Residency and Financial Responsibility statute is legislation initiated by Minnesota Counties. The Unitary Residency and Financial Responsibility statute was not revised when the legislature passed Waiver Reimagine streamline in 2019. • DHS–Disability Services Division (DSD) does not make policy decisions or determinations about Minnesota health care program eligibility and excluded time services. • Minnesota Statutes, Chapter 256G addresses Minnesota unitary residence and county lead agency financial responsibility. Excluded time services are also addressed in Minnesota Statutes, Chapter 256G. For more information, see CBSM - Minnesota Unitary Residency and Financial Responsibility Act 6/24/2021 7
Unit based
services
8Authorizing Individualized Home Supports
Question: How do I determine how much individualized home supports to
authorize for a person?
Considerations when authorizing IHS:
• the scope of the service
• the person’s assessed needs for a staff physically present or through remote support in
the covered services
• previous service authorizations as a guideline
• other services and supports that are available to the person
• remember that this is a service that is delivered in a person’s own home
6/24/2021 9Authorizing Individualized Home Supports cont.
Scope of services for individualized home supports
• A person must receive training and/or support, assistance and supervision in
at least one of the community living service categories:
• Community participation
• Health, safety and wellness
• Household management
• Adaptive Skills
6/24/2021 10Authorizing Individualized Home Supports cont.
IHS has service limitations
• IHS cannot be authorized to:
• duplicate other Minnesota state plan or waiver services
• Primarily deliver activities of daily living support
• Provide supervision during a person’s primary sleep hours
• Provide 24 hour supervision
• IHS cannot exceed 16 hours in a day
6/24/2021 11Authorizing Individualized Home Supports cont.
• Regardless of the type of IHS being provided, the case manager should use the
previous service plan and the person’s assessed needs to guide service planning to
authorize the correct amount of IHS.
• Use the Waiver Reimagine streamlined service crosswalk also as a guide to
translate previous authorizations to IHS from:
• ILS
• Personal support
• Adult companion services
• Individualized home supports
• Supported living services (own home)
• In-home family supports
6/24/2021 Optional Tagline Goes Here | mn.gov/websiteurl 12Authorizing Individualized Home Supports cont.
• What other services are available to a • What other supports are available to the
person during the day? To name a few… person during the day?
• Remote support service options
• 24 hour emergency assistance
• Can technology be used in a creative way?
• Caregiver living expenses
• Informal supports
• Chore Services
• IHS training as a way to decrease the service itself
• Day support services
• Remember: individualized home supports are
• Employment services delivered in a person’s own home or their
family home.
• Homemaker
• People might not want a service provider around
• Prevocational services all the time or even most of the time
6/24/2021 13Authorizing Individualized Home Supports for Children Question: For IHS services, a case manager recently declined IHS with training services for a 17 year old person, stating that there must be a diploma/GED on file for the IHS with training service to be authorized. There is language in the CBSM that the IHS with training recipient should be an adult, but nothing to indicate that a high school diploma/GED is required. How should CMs approach persons with disabilities who may not have their GED to get IHS with training (assuming best fit)? Response: For people younger than 18 who need training supports, individualized home supports with family training is the service that must be authorized per the waiver plan 6/24/2021 14
IHS and Customized Living • Question: Can IHS without training be used in addition to customized living? • Response: The federally approved waiver plan limits IHS without training and customized living to ensure not duplication of services occur. 6/24/2021 15
IHS Remote Services • Question: Is there a limitation to authorizing IHS remote? Could it be authorized for exceptional hours per day if the service planning seems to support this? • Response: Remote support is a unit-based service authorized in 15-minute units. A maximum of 730 hours can be authorized per year (i.e., 365 days), which is an average of two hours per day. • A person may use remote support in a flexible manner that meets their needs within the total yearly authorized units. • The case manager can submit an exception for delivery of greater than the average of two hours per day of remote support by completing the Remote support exception form, DHS-7759A. See the CBSM – IHS Service Amount section for more information. 6/24/2021 16
Resources
• Resources:
• CBSM individualized home supports
• CBSM Resource: Waiver Reimagine streamlined service crosswalk
6/24/2021 Optional Tagline Goes Here | mn.gov/websiteurl 17Residential
services
18ICS - Determining Financial Interests Question: How does a case manager determine financial interest in integrated community supports (ICS)? • Response: All ICS providers have a financial interest in the property. If they are providing ICS services, they have completed an assurance statement confirming they do have financial interest in the property. Providers are required to provide services that comply with the CMS waiver plan services and standards. 6/24/2021 19
ICS setting capacity • Question: How will lead agencies verify ICS settings capacity? • Response: When a setting capacity report is approved, the determination letter states the capacity. The capacity will be displayed on MNhelp.info or a case manager can request this letter from the provider. 6/24/2021 20
Collocated Settings
• Question: How are collocated settings being managed, tracked or determined as
allowable settings?
• Response: Settings operating prior to March 2017 have gone through an
attestation process up to and including on-site visit to ensure compliance with
HCBS settings rule that went into effect March 2014
• Secondary information:
• New providers and settings (e.g., providers operating after March 2017) are expected to
immediately complying with HCBS settings rule requirements including not having collocated
settings
• ICS settings are being tracked and monitored within DSD
• If you have questions or concerns regarding collocated settings or the HCBS settings rule email:
hcbs.settings@state.mn.us
6/24/2021 21DD Waiver and ICS
• Question: If a person who was on the DD waiver moved from their own
home or family home today, could they move into an ICS setting and receive
DD waiver Services until 2023?
Response: Yes, a person on the DD waiver may move into an ICS
setting when following the ICS transition plan guidance for CAC and DD
waivers. For more information, see CBSM - Integrated community supports
transition plans
6/24/2021 22Family Foster Care Question: How do we authorize services for family foster care that is not enrolled in 245D? Response: If the family wants to provide services and supports to the person, the expectation is that the family will either enroll as a 245D provider or develop a host home with a provider • Other services may support the person but the family cannot be paid to provide them. Some services may be provided in the family home (e.g., positive supports, crisis respite or in-home respite, etc.) and some services must be provided in the community (e.g., IHS w/o training) 6/24/2021 23
PCA in provider controlled settings
• Can people receive PCA when receiving services in a provider controlled
setting?
• Response:
PCA with: Same Day Same Time
Community Residential Services Duplication Duplication
Customized Living Ok same day with different Ok same time with different
providers providers
Family Residential Services Duplication Duplication
Integrated Community Supports Ok same day with different Duplication if provided
providers simultaneously but can bill the
daily rate for ICS
6/24/2021 24Own home
25Defining own home Question: What is the definition of own home? • Own home: A single-family home or multi-family home (e.g., apartment) where a person age 18 or older lives, and the person or their family owns/rents and maintains control over the individual unit, demonstrated by a lease agreement (if applicable). • This means a service provider does not own, operate or lease the home/unit or have direct or indirect financial interest in the person's housing. • For requirements, see the own home requirements section. 6/24/2021 26
Own Home - Determining financial interest, cont.
• Question: How do we know if there is direct or indirect financial interest?
• Response: There is no formal statutory or waiver definition of direct or indirect
financial interest. The case manager is responsible for asking probing questions and
making a determination on who has financial control over a setting.
• Considerations for direct interest:
• Are one of the residential services provided in this setting?
• Does the provider own, leases or tenant of the property or units (this includes master lease)?
• Considerations for indirect interests are:
• Does the provider have a financial or business relationship with the owner, lessor or tenants of the
property to provide services and supports?
• Does the provider have responsibility for upkeep, maintenance and protection of the property?
6/24/2021 27People who need high staffing supports • Question: How can a person who has high staffing support needs live in their own home without replicating a “shift staff” or CRS model? • Response: Services delivered in a person’s home are designed to flexibly and dynamically meet a range of support needs for many people with diverse abilities. The definition of own home is described on the CBSM - Requirements for a person's own home policy page • A person is eligible to receive certain services depending on whether they live in their own home or a provider-controlled setting. The amount, duration and type of supports a person needs or receives does not determine if the setting is own-home or provider controlled. A person may have staff in their own home 24 hours a day, 7 days a week. • In a person’s home, the person directs their care, identifies where supports are needed, determines who comes into their home, and when and how their home is accessed. The person establishes rules for their home and how staff may operate within that space. 6/24/2021 28
Overnight supports in Own Home Question: Can people utilize BOTH night supervision AND 24-hour emergency assistance when it's been determined that they have a need for both an awake and overnight staff? Response: At this time, there is no formal waiver service that allows for asleep staff in a person’s own home. Additional Information: For people who currently living in their own home and receiving SLS daily, please use the guidance document service plan options for people living in their own home when transitioning from daily supported living services (SLS). Case managers should only use this resource for guidance in 2021, during the transition of own home daily supported living services (SLS) that included overnight supports. 6/24/2021 Optional Tagline Goes Here | mn.gov/websiteurl 29
Shared services in a person’s own home
Question: How do we service plan when two people or more people are sharing services?
• Response: Service plans must be based on the person’s specific needs and reflected in their
support plan
• It is not typical for a person living in their own home to receive shared staffing all day, every
day.
• Shared staffing might make sense for a few hours, multiple days a week, when each person is working
on similar activities or skill-building opportunities covered by the service.
• When creating a person’s support plan, the case manager cannot assume shared staffing will
be the primary service delivery method, with one or two staff members working with all
roommates at the same time.
• This service delivery method is similar to community residential services, which requires the home be
licensed as a community residential setting.
6/24/2021 30Transitional Lease: When a provider co-signs a lease
The person’s service provider can co-sign the lease if both of the following are
true:
• The provider does not have direct or indirect control over the property
• The property owner will not enter into an agreement with the person alone (e.g.,
because of the person's lack of rental history or a history of criminal activities).
The home is still considered the person's own home if all the requirements are
met and there is a transition plan in place.
6/24/2021 31Transitional Lease: when a provider co-signs a lease,
cont.
There must be a person-specific plan in place to transition a co-signed lease from a service provider to
the person. The transition cannot take longer than two years, unless DHS approves an extension. The
provider must share the transition plan with the person's case manager.
The provider must ensure the transition plan:
• Explains why the landlord requires a lease co-signed by the person and provider
• Addresses the assurances the landlord wants in place to enter into a lease agreement directly with
the person
• Documents activities that will occur during the two-year transition period to allow a transition to a
lease in the person’s name
• Results in a transition of the lease to the person within two years of when the person signed the
initial lease with the landlord.
6/24/2021 32Open Q&A
33Resources
34Who do I contact when I need help with… • Edits in MMIS - use the secure eForm, the Resource Center Secure Portal DHS-3754 • Provider enrollment questions - the provider should reach out to DHS Provider Enrollment through the DHS Provider Help Desk • Policy clarification question – email DSD.WaiverPolicy@state.mn.us • Rates Questions – DWRS rate mentor should email dsd.rates@state.mn.us • Exceptions questions – email dsd.fiscal@state.mn.us 6/24/2021 35
Simplified service menu policy manual updates
CBSM, RMS, resource pages and forms updated based on input received
CBSM – Requirements for a person’s own home
Resource documents:
─ CBSM – Integrated community supports transition
─ Quick reference guide on staffing hours for Integrated community supports
─ CBSM – Service options for individualized home supports
─ CBSM – Briefcase resource document: Transportation and day and employment
services
─ CBSM – Service plan options for people living in their own home when transitioning
from daily supported living services (SLS)
36Authorizing the simplified service menu
Waiver Reimagine streamline service crosswalk is a resource for Lead
Agencies and providers, includes information on existing and new HCPCS
New HCPCS and modifiers were published in December 2020 in Long-
Term Services and Supports Service Rate Limits (DHS-3945-ENG)
MHCP Billing requirements for services do not change
For more information about billing for HCBS waiver services, see DHS
Waiver and AC Resources and MN–ITS training webpage and Billing for
Waiver and Alternative Care (AC) Program
37How can you learn more?
Visit the Waiver Reimagine webpage (https://mn.gov/dhs/waiver-
reimagine/), including Waiver Reimagine FAQs
Email DHS at Waiver.Reimagine@state.mn.us with questions or input
about Waiver Reimagine
Subscribe to receive DSD e-list announcements on the Waiver Reimagine
webpage (https://mn.gov/dhs/waiver-reimagine/)
Lead agency engagement throughout 2021
Waiver Reimagine 38Thank you!
Waiver Reimagine
Waiver Reimagine Policy Team| Disability Services Division
waiver.reimagine@state.mn.us
Waiver Reimagine 39You can also read
