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MEDICAID HOME & COMMUNITY-BASED SERVICES
WAIVERS MANUAL

Brain Injury Waiver (BIW)

Children's Long-Term Support (CLTS)

Community Integration Program IA (CIP IA)

Community Integration Program IB (CIP IB)

Community Integration Program II (CIP II)

Community Options Program – Waiver (COP-W)

Community Opportunities and Recovery (COR)

Memo Announcing Release of Revised Manual (PDF, 112 KB)

List of Chapters and Sections of the Revised Interim Manual
Chapter Pages
Chapter I – OVERVIEW AND ADMINISTRATION (PDF, 56 KB) I-1
1.01 Long Term Support in Wisconsin I-1
1.02 State Medicaid Waiver Authority I-2
1.03 The Medicaid Waiver Mandate I-2
1.04 Exemptions from the Mandate I-3
1.05 Registering Applicants on HSRS I-4
1.06 Medicaid Waiver Program Wait Lists I-5
   
Chapter II – WAIVER ELIGIBILITY (PDF, 136 KB) II-1
2.01 Waiver Eligibility II-1
2.02 Waiver Target Groups II-1
2.03 Waiver Services for Persons with Severe & Persistent Mental Illness II-6
2.04 Active Treatment/ No Active Treatment (NAT) Determination II-6
2.05 Medicaid Non-Financial Eligibility Requirements II-9
2.06 The Parental Payment Limit II-12
2.07 Level of Care (LOC) II-12
2.08 Eligible Living Situations II-14
2.09 Waiver Participant Moves II-16
2.10 Denial of Participation or Termination of Program Participation II-22
2.11 COP Eligibility After Waiver Program Termination II-26
   
Chapter III – FINANCIAL ELIGIBILITY (PDF, 100 KB) III-1
3.01 Medicaid Eligibility III-1
3.02 Children Applying for the Waiver –Special Considerations III-3
3.03 Medicaid Waiver Income Groups III-4
3.04 Spousal Impoverishment III-11
3.05 New Applicants Leaving an Institution III-13
3.06 Payments, Prepayments or Repayments to Medicaid III-13
3.07 Other Payments III-13
   
Chapter IV – ALLOWABLE SERVICES (PDF, 488 KB) IV-1
4.01 Introduction IV-1
4.02 Ensuring Providers are Qualified IV-1
4.03 Ensuring Access  - Provider Choice IV-4
4.04 Conflict of Interest IV-6
4.05 Provider Screening Requirements IV-8
4.06 Medicaid Waivers: General Limitations IV-12
4.07 Participant Contributions IV-14
4.08 Reserved for future use IV-14
4.09 Allowable Services Index IV-15
   
Chapter V – USE OF FUNDING IN SUBSTITUTE CARE (PDF, 104 KB) V-1
5.01 Introduction V-1
5.02 Determining Waiver Allowable Costs V-1
5.03 Ability to Pay - Room and Board V-2
5.04 Waiver Specific Requirements: CIP 1A/1B, BIW V-4
5.05 Waiver Specific Requirements: CLTS V-4
5.06 Waiver Specific Requirements: CIP II, COP-W and COR V-4
5.07 Purchasing Substitute Care Services V-13
   
Chapter VI – THE WAIVER APPLICATION PACKET (PDF, 156 KB) VI-1
6.01 Introduction: The Application VI-1
6.02 The Content of the Waiver Application Packet VI-1
6.03 Waiver Program Start Date VI-15
6.04 Medicaid Waiver Application and Approval Process VI-17
6.05 The Waiver Application Packet – Reference Guide VI-21
   
Chapter VII – RECERTIFICATION, PLAN REVIEW AND ISP UPDATE (PDF, 164 KB) VII-1
7.01 Introduction VII-1
7.02 Recertification: Program Specific Requirements VII-3
7.03 Timeliness of Recertification and Documentation VII-11
7.04 Individual Service Plan Review - Documentation VII-12
7.05 Service Plan Updates VII-13
   
Chapter VIII – PARTICIPANT RIGHTS AND APPEAL AND GRIEVANCE PROCESSES (PDF, 51 KB) VIII-1
8.01 Medicaid Waiver Applicant/Participant Rights VIII-1
8.02 Responsibility for the Notification of Rights VIII-1
8.03 Waiver Agency Actions Subject to Appeal or Grievance VIII-4
8.04 General Notice and Notification Requirements Associated with Waiver Agency Actions VIII-6
8.05 Participant Rights: Restrictive Measures VIII-7
   
Chapter IX – ASSURING THE HEALTH AND SAFETY OF MEDICAID WAIVER PARTICIPANTS (PDF, 49 KB) IX-1
9.01 Introduction IX-1
9.02 Application of this Chapter to Individuals and Agencies IX-2
9.03 Response Systems Required IX-3
9.04 Investigation / Inquiry Expectations of Waiver Agencies IX-5
9.05 Waiver Agency Response Options IX-6
9.06 Incident Prevention, Management, Resolution and Reporting IX-7

Chapter X – QUALITY ASSURANCE

NOT AVAILABLE AT THIS TIME

Chapter XI – REPORTING AND REIMBURSEMENT

Please continue to use current manual material on Reporting and Reimbursement until the revised manual material is available.

APPENDIX LIST

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Last Revised: September 28, 2011