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Transition of Waiver Services to Managed Care and the New State Plan Amendment

LeadingAge New York met with the Department of Health (DOH) last week on two issues. We continued the discussion on transitioning the two 1915(c) waivers, Traumatic Brain Injury (TBI) and Nursing Home Transition and Diversion (NHTD) to managed care. In addition, the discussion included the Centers for Medicare and Medicaid Services (CMS) recent approval of the Community First Choice Option (CFCO) State Plan.

On Dec. 30, 2013, DOH submitted for CMS approval a Medicaid state plan amendment (SPA) #13-35 for consumer-directed, person-centered home and community based attendant services and supports through the CFCO. As we previously reported, the CFCO is a federal option under the Affordable Care Act that allows states to provide consumer-controlled personal attendant services and supports in their state plan. CFCO provides additional Federal Medicaid Assistance Percentage (FMAP) of six percent to states who apply to expand and enhance state plan home and community-based services and supports. New York is one of 10 states to apply for this SPA and the additional six percent FMAP will be used to support NYS’s Olmstead agenda. To be eligible for services under this option, individuals must be assessed as requiring an institutional level of care and be capable of directing their own services directly or through a representative. Services must be related to an individual’s need for assistance with activities of daily living, instrumental activities of daily living, and/or health related tasks. Services may also include assistance with transitioning from institutional to community- based settings.

New York's CFCO SPA covers a range of services: personal care, consumer-directed personal care, home health care, home and community support services, community habilitation, home maintenance (chore service), community transportation, and congregate/home delivered meals. Services also include functional skills training, coaching and prompting the individual to accomplish the ADL, IADL and health-related skills. In addition, the State has opted to offer the optional services of assistive/adaptive devices, home modifications, and transitional services including moving expenses and those to establish a home. Some of these services are currently only available to individuals participating in waivers.

The recent CFCO SPA can be found here and has been approved effective July 2015.

The second part of the DOH meeting continued the crosswalk of proposed NHTD/TBI waiver services that could be included in a managed care benefit package. The Oct. 23rd meeting minutes set the stage for this discussion. It has been determined that there won’t be a two tiered approach with waiver services, the services will be available for all plan members not just existing waiver service participants.

We will continue to keep members posted on additional information and implementation activities as they become available.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871