Med Waiver Service Agreement Ppt

PCS benefitsudio resenter: So how does one gin eligibility for WPCS, you might be wondering. The Department, or its designee, will take effective action, as needed, to remedy a finding to promote fulfillment of the DSRIP goals. MLTSS implementation, the percentage who delivered at least one LTSS under managed care in the quarter follow MLTSS implementation, by type. The evaluation will explore and explain through developed evidence the effectiveness of the demonstration for each hypothesis, including total costs in accordance with the SRIP Tas approved by CMS. Sensitivity analyses will be conducted in order to determine the robustness of the ICERs. After approval of the mplementation Protocol, FFP will be available prospectively, not retrospectively.

The two goals listed in the following table relate to the DSRIP cardiac care projects. New Jersey population, we expect to find differences in the effect of the DSRIP program among demographic groups and we will document these differences. Activities in this stage include the piloting, testing, and replicating of chronic patient care models. Our analysis will be conductedin light of the following considerations. We have to have, you know, us, our participants, family, providers. Examination of the impact of lifting the IMD exclusion is only possible if agestratified data are available.

Evaluation Design was altered or augmented to address these changes. BDDS hear directly from the individuals and families who will be affected by these changes. This will allow estimation ofchanges in outcomes during the first demonstration period from policy changes, and additional changes in outcomes during the second demonstration period from continuation of those policy changes. Maybe we need to put out communication. Meets all financial criteria listed for a MLTSS eligible Medicaid group listed under Table Ain accordance with the Medicaid State Plan or this demonstration.

Strong evidence indicates that more can be done to help those with asthma control their symptoms. Assisted Living Services include personal care, homemaker, chore, medication oversight and administration throughout the day. It is a snapshot. Not only was this Guide made possible thanks to their previous work, but they also spent hours reviewing and editing our drafts. Medicaid Process for Children Targeted for the Medicaid Waiver.

What other rapidcycle improvement tools were used and how effective were they in supporting quality improvement? For example, an enrollee could file a grievance if he or she was treated rudely. This approach does ensure improved consistency and equity in how budgets are established for consumers. The subsidized housing provider is responsible for Environmental Accessibility Adaptations. Topics are typically related to the waiver program, or to the needs of individuals with disabilities who participate in that program. This stage includes universal metrics reported across several domains selected by the state. DSRIP Program Funding and Mechanics Protocol. If the measure result is above the highperformance threshold, the hospital will be considered a high performer for that measure. Browsers that can not handle javascript will not be able to access some features of this site.

This will provide the ability to track patients and utilization over time. The cookie for our plugin. We use cookies to ensure a smooth browsing experience. PCP has determined that receiving the services separately would subject the enrollee to unnecessary risk. Training includes instruction about treatment regimens and other services included in the service plan, use of equipment specified in the service plan, and includes updates as necessary to safely maintain the demonstration participant at home. Enrollment in MLTSS: The effective date of enrollment in MLTSS must be established by the state based on a determination that an applicant is eligible for and must begin receiving LTSS. What new community partnerships were developed? Demonstration Goal: Increase the rates of identification, initiation and engagement in treatment for OUD and other SUDs.

They want to know how to apply for services in the waivers. While some issues are not amenable to resolution through the complaint portal and may ultimately require a fair hearing, this informal complaint process is not time intensive and may result in a quick resolution. At the beginning of the demonstration period, the state must arrange with an independent party to conduct an evaluation of the demonstration to ensure that the necessary data is collected at the level of detail needed to research the approved hypotheses. MFP program, the state will continue its responsibilities for developing transitional plans of services for enrollees. Medicaid State Plan Services are delivered through the MCO. The online MI Choice Intake Guidelines is the only approved format and is only accessible to MI Choice waiver agencies. Hospitals will provide reports to the state outlining their progress, or lack of progress, in the performance measures which will be the determining factor for their receipt of DSRIP payment over the course of the year. PCP or another provider determined that receiving the services separately would subject the enrollee to unnecessary risk.

Consistent with Attachments K and L of these STCs, the evaluation documents must include a discussion of the evaluation questions and hypotheses that the state intends to test. CMS or found to not be consistent with the requirements approved by CMS. We will additionally use allpayer hospital discharge data to examine program effects on the uninsured population. In the case of a positive screen, the individual is referred for appropriate treatment services. FAQs first, to see, you know, the answer before I start rattling off something. Regularly scheduled upkeep and maintenance of a vehicle except upkeep and maintenance of themodifications. MLTSS program will be excluded from the ASO since their behavioral health care will be managed by the MCO. Questions about SMMC MMA and LTC. The claim is compared to previously paid claims. We conduct this during the last six months of the program anticipating personnel changes once the program ends and difficulty in identifying interviewees.

The participant who selfdirects the personal care service may appoint a volunteer designated representative to assist with or perform employer responsibilities to the extent approved by the participant. The interim evaluation report will discuss evaluation progress and present findings to date as per the approved evaluation design. SNP population will have their behavioral health care ordinated by a behavioral health ASO. Adjusting for Patient, Provider and Geographic Factors: Our multivariate analysis will control for patient characteristics that may affect outcomes. Supported Day Services are provided as an alternative to Structure Day Program when the participant does not require continual supervision. This requires consideration of the completeness of utilization reporting in the Medicaid claims data for services where Medicare is the primary payer. The Departments of Social Services and Human Services worked collaboratively to review the final rule. The best practice is to file a written request with the Plan.

Ensuring that measures will be taken to protect the health and welfare of consumers. DDS services in certified settings. The reports will include all required elements and should not direct readers to links outside the report. New Jersey and CMS agreed to the claims lag time period. Modifier Lists are available on the applicable Waiver Procedure Code Crosswalk found on the www. Not only are you not allowed by the rules that exist r the WPCS program if you are not already enrolled, it is also impossible to be paid if you are not a part of the IHSS rogram already. The data sources and sampling methodology for assessing these outcomes; and A detailed analysis plan that describes how the effects of the demonstration are isolated from other initiatives occurring in the state. YES NO YES NO YES NO YES NO YES NO YES NO YES NO Wheelchair Lift, if applicable, is operating properly? What is the Application Process? The rformance results wbe sred with the Qualitysureittee.

This service will include nutritional supervision, health monitoring, and recreation as appropriate to the individualized care plan. We try every which way to find people. SF provides training on recruiting, interviewing and training staff, how to handle difficult situations, how to complete employment paperwork, etc. Provider Enrollment contract will not be reinstated until the application is finalized. The Supports Program provides a basic level of support services to individuals who live with family members or who live in their own homes that are not licensed to serve individuals with developmental disabilities. If they want to live in the community and they, we are able to safely serve them in the community, that is what we want to do. The default application of a six month unout to our Medicaid claims and encounter databasemay not fully capturecosts if lags in billing occur for new Medicaid providersin the expanded service continuum or due to lifting the IMD exclusion. This will allow everybody to be able to go in and print prior authorizations on demand.

As stated above, individuals may develop their CSP up to the entire dollar amount allotted to them by the state, but the county has final approval over the actual CSP. Behavioral Health for Children. Advocates should ensure that enrollees receive a legible copy of the Care Plan to review before signing. Waiver Slots, our Waiver Redesigned Status. The State implements liquidated damages on its health plans for excessive duplicate encounters and excessive denials. All residents, butparticularly these vulnerable populations, rely on the NJ hospitals to provide quality health services. If any acutecare hospitals do not participate in the DSRIPProgram, we will seek key informant interviews with representatives of those hospitals. This is probably the most important pagf this training; this is where you will find the numbers for he WPCS payroll line. The provider qualifications for the services provided are described in Table Two: Provider Qualifications below.

Help in making changes to your home so you can safely move around. SZ modifier when submitting the claim for payment. Request a copy of the case file and other relevant documents, in writing when filing the appeal and the fair hearing request. Where possible, baselines will be informed by state data, and targets will be benchmarked against performance in best practice settings. We will attempt to enumerate and represent in our interviews stakeholders representing the various categoriesof providers and consumein the state to get the fullest possible picture of how the program is affecting different groups. If the demonstration is terminated prior to the end of the demonstration period, the budget neutrality test will be based on the time period through the termination date. For demonstration phase outs prior to the expiration of the approval period, the draft Interim Evaluation Report is due to CMS on the date that will be specified in the notice of termination or suspension. Hey have Clayton and his family go and start watching all of the trainings through Tellus because you might not be using that system. Approved Medicaid provider; ii.

The ICSP uses staff from LTCOP, DOEA, and ADRCs to help enrollees understand and resolve service, coverage, and access complaints. In Florida, HCBS for adults are available under the Statewide Medicaid Managed Care system. Providers are strongly encouraged to review each semiannual cycle bulletin to prepare in advance for these threeweek cycles. AHCA determines if individuals are considered optimal and noneligible for enroll. New Jersey has contracted with Rutgers University Center for State Health Policy to complete the evaluation Plan. An individual must have a social security number or proof of having applied for one.

In this session, Brian Norton, Director of Assistive Technology at INDATA Project Easterseals Crossroads, discusses the core services provided by INDATA. Private Duty Nursing must be a covered service only for those beneficiaries enrolled in MLTSS and the DDD Supports Plus PDN program operated by DDD. Clinical experts are physicians, physician assistants, nurse practitioners, and registered nurses. The UPP aows foterewards to spitals that mt omprove their iversarfoce metrics. Provider contracts must reflect the requirements of this system. Services that are rehabilitative in nature are only provided when the limits of speech therapy services under the approved state plan areexhausted. Claims submitted outside of Santrax may be submitted using spanned dates. HCBS are not considered an entitlement through the Medicaid state plan waiver application, meaning the state is only authorized to provide HCBS to a set number of eligible individuals based on available funding.

In addition, any notice of adverse benefit determination should include instructions on how, where, and when to file an appeal. The ITG wbe termd thrgh the uof chmark daor statewide benchmark data whichever results in a higher ITG for the rformance metrics. Division of Vocational Rehabilitation Services, these services must be exhausted before Career Planning can be offered to the demonstration participant. The AV fometric be summed determine the T f the stage. Primary care and Urgent Care appointments will be provided at least equal to those offered to the Medicaid feeforservice participants. If you wish to download it, please recommend it to your friends in any social system.

An enrollee can also request that a choice counselor meet with him or her at home. If you have questions about policy. Documentthetimeshortlyafteryoudelivertheservice Youshouldnotbe prepanngdocumentationwhenaskedforsurveyor auditor. If there is a cookie. This stage is all pay for reporting. The DAAA utilizes the MDCH Waitlist policy for removing individuals from the Waitlist.

Such an estimation strategy is able to identify changes in outcomes that are due to program impact and distinct from secular trends. Waiver and the amendment request. Have you had an updated address? Total billed to Medicaid for year The individual budget planning is comprehensive and is not specific to just those items and services covered by Medicaid. Service Limits: This service is available to demonstration participants in accordance with the DDD Supports Program Policies and Procedure manuals, and as authorized in their Service Plan. The state must submit a statement accompanying the BN Monitoring Tool, which certifies the accuracy of this information. We will work with the Department of Health to obtain approval to extend this arrangement for the DSRIP evaluation. SUD Evaluation Design Technical Assistance Document. Consultative Supports are intended to address the behavioral symptoms often related to the diagnosis of ASD through the teaching of adaptive skills provided by the Consultative Supports staff.

Resource Development that regional centers must have a Board approved policy specifying the circumstances under which the regional center will issue requests for proposal to address a service need. ST, morning units of OT, and afternoon units of CRT. These links, and others, between themilestones and goals are shown in the following driver diagram. MLTSS when submitting the claim for payment. Appeals for any semiannual measures may be adjudicated as part of the yearappeal process. The selected service chosen must be the most cost effective means of transportation that the individual is reasonably able to access. Over the course of the program, the number of hospitals in the comparison group may increase if somehospitals decide to discontinue participation in the program. Supplemental Security Income Eligibility.

NJFCservices, taking into account any limitations on coverage. So like one family had reached out and said, well, but we have a lake house that is two counties over. Service Limits: These services are only available when prescribed by an appropriate health care professional. Rate of potentially avoidable inpatient hospitalizations reflecting inadequate level of ambulatory care. SUD program under this demonstration.

For services of shorter duration, authorization must be supported by PCP prescription. And so like personal care or CLS, adult day training. Is this the size requested by the cookie? Describe the population groups impacted by the demonstration. It also included detailed descriptions of the services to be offered, the case management process for developing a care plan, and other procedures designed to ensure that due process is protected. Respite services are not to be authorized due to the absence of those persons who would normally provide paid care for the participant. This includes knowingly making false entry of a material fact in any book, report, or statement of any person.

MLTSS Cognitive Rehabilitation Therapy. The following projectsstrive to ensure more immediate symptomatic treatment for withdrawal and a pathway to long term treatment and recovery. We love getting out and talking to people. But if you will complete the evaluation at the end of this webinar, we would really appreciate it. Increase access to Naloxone Implement care management benefit and link patients with community services and supports throughout the continuum of care, especially following inpatient and residential stays. The State Medicaid Agency must exercise oversight of all delegated functions to operating agencies, MCOs and any other contracted entities.

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