DMHSAS Memo Series 2007-17
To: Listserv
For: Area Administrators/Human Services Area Coordinators
Aging and Disability Resource Centers
Area Agency on Aging Directors
Community Support Program (CSP) Coordinators
Comprehensive Community Services (CCS) Program
Coordinators County Departments of Aging Directors
County Departments of Community Programs Directors
County Departments of Developmental Disabilities Services
Directors County Departments of Human Services Directors
County Departments of Social Services Directors
County Long Term Support Coordinators
County Mental Health Coordinators
DLTC Administrator/Bureau Directors
DMHSAS Bureau Directors
Program Office Directors/Section Chiefs
Tribal Chairpersons/Human Services Facilitators
From: John Easterday, Administrator Division of Mental Health and
Substance Abuse Services
Subject: Community Opportunities and Recovery (COR) Waiver
Document Summary
This memo provides information about the new Community Opportunities
and Recovery (COR) Waiver and discusses the action plan needed for
counties/tribes to be considered for participation in the COR Waiver.
Contained in this memo are the highlights of the new waiver and the
Division of Mental Health and Substance Abuse Services (DMHSAS) plan for
its implementation. COR is a Medicaid Home and Community-Based Services (HCBS)
1915 (c) Waiver which has now received approval from the Centers for
Medicare and Medicaid Services (CMS). The approved implementation date is
July 1, 2007 with COR waiver enrollments expected to begin in the fall of
2007. This waiver is a relocation waiver only, no diversion slots
are available.
Background
At present there are approximately 500 eligible individuals residing in
Wisconsin nursing homes, identified as needing specialized psychiatric
rehabilitation services for their mental illness, as well as needing
nursing care services. They are adults who meet the nursing facility level
of care. Many are in county operated nursing homes and present challenges
that include behaviors that place them at risk. Numerous individuals would
prefer to reside in a community setting, but need services structured to
support their specific behavioral, physical, medical, and mental health
needs. Because communities have lacked resources and funds to meet their
needs, these individuals have remained in a nursing home setting.
In spring of 2005 Wisconsin applied to CMS for a new HCBS 1915(c)
Waiver specifically to target this population and make the choice of
community living available. COR will focus on choice, recovery, and
consumer direction with strong components of peer and advocate supports.
The goal of COR is to move people towards an independent self-reliant life
in a community setting.
COR Waiver Administration and Operations
The COR waiver will be administered by the Division of Mental Health
and Substance Abuse Services, within the Wisconsin Department of Health
and Family Services which is the State Medicaid Agency. CMS approved 50
persons for waiver services in year one of the new waiver, 150 in year two
and 250 in year three. Given that COR is new and must meet the HCBS
requirement to achieve cost neutrality, and will begin with low numbers of
participants, the Division of Mental Health & Substance Abuse Services
(DMHSAS) will directly manage the approval of persons entering the waiver.
Counties/tribes are encouraged to begin identifying potential individuals
for relocation who are the most ready and require lower cost supports.
Counties will be reimbursed for actual waiver allowable costs incurred
which are less than or equal to the approved plan specific rate for each
participant. Initially no plan will be approved for over $100/day in
waiver service costs. As the number of people served on the COR waiver
increases, we may be able to accommodate individuals who need a higher
cost plan. DMHSAS will maintain administrative oversight of the waiver,
policies, rules and regulations. Oversight is in keeping with the CMS
requirements for the Waiver and State Medicaid Agency responsibilities.
Counties/tribes will serve as the local waiver agencies and have
responsibility for their waiver operations at the local level.
Counties/tribes will not issue policies, rules, and regulations on COR
waiver program matters that differ from those issued by DHS
. The DMHSAS
COR waiver staff will establish and approve all policies affecting the COR
waiver operational and administrative functions at the state and the local
level. The county/tribe waiver agencies will provide and/or contract with
service providers to meet the assessed needs of COR waiver participants.
COR Waiver Services
The new COR waiver includes a mix of care management and recovery
focused services appropriate to support current nursing home residents who
have serious mental illness and co-occurring physical disabilities in the
community.
A comprehensive assessment of an individual's needs determines the mix
of waiver services to be provided. An individualized person centered plan
of care will be developed that includes both the mental health and
physical health community-based services considered necessary to meet the
person's unique needs. It will include a back-up plan for periods of
intense supervision and supports necessary for the individual to remain
safely in the community during a crisis situation. For those counties in
which HFS 34 part III certification is in force, it will be necessary to
reference the crisis planning and crisis stabilization service functions
that fall under the HFS 34 umbrella in the person's back-up plan.
Counties/tribes will be required to submit a pre-enrollment packet
of initial information and a funding estimate for each individual they
wish to enroll in the COR waiver. This pre-enrollment information will be
submitted to DMHSAS COR waiver staff prior to submitting a COR waiver
applicant packet. This allows DMHSAS staff to check the cost of the card
services the person is currently using, and estimate community costs
charged to the MA card. Waiver participant approvals will be awarded on a
first-come first served basis. After the pre-enrollment packet is approved
the county/tribe local COR waiver agency can submit a COR waiver applicant
packet to DMHSAS COR waiver staff for review and approval. A COR waiver
applicant packet consists of the Long Term Care Functional Screen (LTC -
FS), financial eligibility documentation, an Individual Service Plan (ISP)
form that includes outcomes, a risk assessment form, a MA Waiver Health
form and other required documents as stated in the DHS
MA Waiver Manual.
The COR waiver is designed to work with the Comprehensive Community
Services (CCS) Program and/or the Community Support Program (CSP) and the
MA card which gives access to other state plan services. If a MA certified
CSP exists in the county, the COR waiver participant's CSP case manager is
to be the primary care manager for the COR waiver. If a MA certified CCS
exists in the county, the COR waiver participant's assigned mental health
professional from the CCS Program is to be the person's care manager for
the COR waiver. This does not prohibit care management functions being
done within the waiver unit and billed under administrative costs. COR
provides the array of services not now available under the state Medicaid
plan or under mental health plan benefits such as assistance with basic
activities of daily living and in-home and residential supports. Like
other HCBS waiver programs, MA card services are to be used before waiver
services.
COR service definitions are found in the DHS
MA Waiver Manual. The
Human Services Reporting System (HSRS) Long Term Support Module SPC/Subprogram
codes will include edits for the new COR waiver. The COR waiver services
package includes the following services:
- Care Management - supports self direction.
- Respite Care Services: Residential, Institutional, Home Based, or
Other.
- Daily Living Skills Training.
- Day Services.
- Vocational Recovery - opportunity for self direction with employer
authority.
- Environmental Accessibility Adaptations.
- Skilled Nursing.
- Transportation- opportunity for self direction with employer
authority.
- Specialized Medical Equipment and Supplies.
- Personal Emergency Response System (PERS).
- Natural Supports Training.
- Residential Services: Adult Family Home, Community-Based Residential
Facilities (CBRF), Residential Care Apartment Complexes (RCAC).
- Home Delivered Meals.
- Financial Management Services.
- Relocation Related Housing Start Up.
- Relocation Related Utilities Start Up.
- Supportive Home Care (SHC) - opportunity for self direction with
employer authority.
- Benefit Counseling.
- Consumer-Directed Supports.
- Counseling and Therapeutic Resources.
- Housing Counseling.
- Peer Advocate Supports- opportunity for self direction with employer
authority.
- Short-Term Supervision and Observation.
Self-Directed Services
Care management services will include support services when the
participant chooses to self-direct some of their waiver services. This
availability of participant direction of services with employer authority
is included in four distinct COR services. The waiver services which allow
for this opportunity include: Vocational Recovery, Transportation,
Supportive Home Care, and Peer Advocate Supports.
Employer authority allows the COR participant or their representative
to be co-employers or common law employers and to have decision-making
authority over workers who provide waiver services. This includes:
recruiting, interviewing, hiring, verifying qualifications, conducting
criminal background checks, determining duties, wages and benefits,
scheduling, orienting, supervising, evaluating, timekeeping, and
discharging. Financial management services by the local waiver agency are
mandatory and integral to participant direction. A government or
third-party entity must perform necessary financial transactions on behalf
of the waiver participant.
COR Eligibility
Following are highlights of the eligibility criteria for an individual
to be considered for the new COR waiver program:
- COR eligibility will be based on initial and continuing annual
nursing home level of care eligibility as established by the LTC FS.
- COR will require the individual to be at least 18 years of age.
- COR will require a diagnosis of serious mental illness.
- COR will require a diagnosis of a co-occurring physical health
condition with related functional deficits.
- COR will require the individual's interest in and ability to
relocate to a community placement and if appropriate, the support of
the guardian.
- COR will use the existing financial, non-financial eligibility and
the Long Term Support Functional Screen eligibility processes
currently used for the COP-Waiver.
- COR is a relocation waiver only and does not include individuals
seeking diversion from nursing home placement.
- On the effective date that a Family Care b/c waiver becomes
available in a county, the COR waiver will become unavailable for new
people. New people would enroll in Family Care when they are ready to
transition from the nursing home to the community. Individuals already
enrolled in the COR waiver will be transitioned into Family Care as
part of the MCO's transition plan. Family Care is expected to continue
to provide the necessary services for the individual to remain in the
community, and the waiver allocation will be factored into the
capitation rates for that FC agency.
The Division of Healthcare Financing (DHCF) Bureau of Eligibility
Management (BEM) issued Operations Memo No. 07-30 on June 38, 2007
outlining the process IM agencies should follow for processing cases for
persons being considered for or enrolled in the COR waiver. The Long Term
Care Functional Screen has also been edited to allow for the new COR
waiver to be a selection.
COR Waiver Process Models
Because the COR waiver will relocate persons from a nursing home who
have serious mental illness, it will require that local long-term care and
mental health units work together to develop, achieve and maintain the
person's relocation. COR will also require that these units work closely
with county economic support units regarding financial eligibility.
Memorandums of Understanding (MOUs) will be required between all of these
units/agencies (MH, LTC and ES) and will need to spell out roles &
responsibilities. The MOU should address which unit has the lead role in
working with nursing home staff, consumers, guardians and providers. In
some geographical areas, the Aging and Disability Resource Centers (ADRC)
role will need to be developed if they are to do the Long Term Care
Functional Screen for this population to determine COR eligibility. A copy
of the MOU's will need to be submitted to DMHSAS COR staff prior to the
approval of any COR enrollments for the county/tribe.
Attached to this Action Memo is a flowchart of the COR waiver process
models counties/tribes will use for implementing the new waiver. The chart
addresses the waiver activities of eligibility, the waiver application
packet, arranging/sustaining services and on-going waiver administration.
It also includes the elements that will need to be addressed in each MOU
developed between the collaborating agencies. Please refer to it in
completing the Action portion below.
ACTION SUMMARY STATEMENT:
This Memo outlines a process for counties/tribes to follow if they are
interested in participating in the new COR waiver program. Counties/tribes
need to complete and submit a written description responding to each of
the items below on how you will implement the new COR waiver program
before submitting any potential COR participant pre-enrollment packets.
- Describe the process model the county/tribe will use to operate the
COR waiver.
- Explain how the mental health, long-term care and economic support
units will collaborate.
- Give details about how the county/tribe will achieve cross-training
of the mental health and long-term care units.
- Describe who will oversee daily operations of the COR waiver at the
county/tribe level.
- Explain how the county/tribe will staff the COR waiver operations
and meet data reporting requirements.
- Explain your staffing caseload size requirement, how you will ensure
you can adequately support this population in the community and an
estimate of the potential COR participants you predict may want to
enroll for the first year of the waiver.
- Provide what percentage of a full-time equivalent (FTE) will be
allocated to the waiver, if staff have other duties.
- Describe who will monitor the waiver provider agencies compliance
with the HCBS CMS assurances and COR policies and procedures in the
DHS
MA Waivers Manual. Include the monitoring techniques and data
that will be used to accomplish this monitoring.
- In those geographical areas where an ADRC exists, describe their
role in the COR waiver enrollment process.
- In those counties where HFS 34 part III certification is in force,
describe how collaboration with the crisis response system will occur
for COR participants.
- Provide county/tribe staff contact information.
Send your written description to:
Betty Blessinger, Relocation Waiver Consultant
Division of Mental Health and Substance Abuse Services
P.O. Box 7851
Madison, WI 53707-7851
DMHSAS COR specific training for state, county, providers and other
interested parties will occur after counties/tribes are identified for
participation in the new waiver and prior to their submitting any waiver
participant pre-enrollment packets.
REGIONAL OFFICE CONTACT: Area Administrators
CENTRAL OFFICE CONTACT: Betty Blessinger
Relocation Waiver Consultant
Division of Mental Health and Substance Abuse Services
1 West Wilson Street, room 850
P.O. Box 7851 Madison, WI 53707-7851
Telephone: (608) 261-9316
Fax: (608) 267-7793
E-mail: blessel@wisconsin.gov
MEMO WEB SITE: http://www.dhs.wisconsin.gov/dsl_info/
Attachment: COR Waiver Process Model (PDF,
13 KB)
Return to Numbered Memos Index |
