1 Medicaid Updates August 28, 2013 Patrick Stephan Lori Horvath

2 FY 2014 Medicaid Priority work areas

33 Medicaid Priority initiatives Implement changes in the ICF-IID program to move towards vision outlined in white paper and budget agreement Amend IO and Level 1 waivers to incorporate policy and rate changes Develop long-term strategy for the TDD Waiver Revise the ICF Level of Care rules to consolidate our approach to ICF/IID and waivers Continue work & evaluate progress of the “Weekly Rate Pilot” and the Imagine Project

4 Waiver amendments on the horizon

55 Individual Options Waiver Awaiting CMS response for community integration add-on which would expand existing DC add on- to two years Investigate Direct Care hour limitations Nursing services in the IO Waiver Quality Incentive Payments in the IO

66 IO and Level One Rates FY 14 $5.4M to increase direct care wages Workgroup proposes increase to on-site/on- call and transportation Target date 1/1/14 dependent on Waiver amendments approval Rule timelines IT changes

7 Transitions DD Waiver

88 Transitions DD Waiver Carestar to complete PEATs for individuals with waiver start dates through 12/31/13. County boards to complete level of care for individuals with span dates 1/1/14 or later Equipment process: Alternative resources Medicaid reviews Maximum reimbursement rates

99 Transitions DD Waiver OHCW Waiver Disenrollments: What we know today

10 Transitions DD Waiver Workgroup begins 9/17/13 to develop a TDD amendment package Future of TDD in the service delivery system Phase-out plan? Service changes Provider qualifications

11 State Plan Authorizations

12 State Plan Services New authority to complete private duty nursing (PDN) acuity and determine amount of PDN to incorporate in waiver plans Trainings begin in September Additional sessions to be available in metro areas, as well as webinars No changes are being made to the process for accessing services for individuals not enrolled in waivers

13 State Plan Services State plan home health services may include incidental services (household tasks) along with hands-on assistance with personal care or health-related tasks Incidental services may not “substantially extend” the visit State/federal rules do not define the amount of time which may be spent on incidental services during a visit

14 Additional

15 Additional Level of care: Piloting by ICFs and county boards continues. Implementation expected to occur in spring/summer 2014 MSS Technical Guide has been developed and will be posted to the Medicaid tab of DODD’s website SELF Waiver: Regional support broker trainings conducted by COGs. Registration is available on DODD’s website

16 Level One Waiver reminder Amendment changes effective 9/1/13 Additional services Community respite Remote monitoring/equipment Home-delivered meals Cost cap increases from $6,000 - $7,500 over 3 years