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DDES Memo Series 2005-18
ACTION MEMO

October 12, 2005

TO: 
Area Administrators/Human Services Area Coordinators
County Departments of Community Program Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
County LTS/COP Coordinators
County Developmental Disabilities Services Coordinators
DDES Bureau Directors
DDES Section Chiefs
County/Tribal Aging Directors
Tribal Chairpersons/Human Services Facilitators

FROM:
Sinikka Santala
Administrator

RE: Medicaid Waiver Services Termination Date    

Document Summary

Effective January 1, 2006, the termination date of Medicaid waiver services will be consistent with the termination of Medicaid waiver eligibility. This memo describes the process used by the Long Term Support Agencies and Economic Support Agencies to implement the policy change.

The purpose of this memo is to align termination of Medicaid waiver services with the termination of Medicaid waiver eligibility to be in compliance with Centers for Medicare and Medicaid Services requirements.

Background.

Currently, when an individual eligible for and receiving Medicaid waiver services loses eligibility, the Long Term Support Agency (LTSA) terminates services by issuing a manual 10-day notice. The Medicaid waiver services end 10 days from the date the notice was issued. However, the Medicaid waiver eligibility is terminated in CARES by the Income Maintenance Agency (IMA) using adverse action logic, resulting in eligibility being extended beyond the date the services are actually ending.

Medicaid waiver services are subject to the same termination rules that apply to any service under the Medicaid State Plan. To this end, the termination date of Medicaid waiver services must be aligned with the termination date of Medicaid waiver eligibility.[1]  The change will affect the processing of fewer than 200 Medicaid waiver participants who lose waiver eligibility statewide per year.

Exceptions: Individuals on Medicaid due to SSI, SSI-E, 1619 or Katie Beckett eligibility are not always entered in CARES. Termination for these programs is handled by the Social Security Administration, except for Katie Beckett cases, which are handled by the Bureau of Long-Term Support, Children Services Section. LTSA shall continue issuing 10-day termination notices when SSI, 1619 or Katie Beckett eligibility ends, just as they currently do.

New Termination Process of Waiver Services effective January 1, 2006.

Under the new process, termination of Medicaid waiver services will coincide with termination of Medicaid waiver eligibility. When reported changes relate to issues such as income, assets, divestments, permanent institutionalization, etc., the Economic Support Staff (ESS) determines if and how Medicaid waiver eligibility is affected. When reported changes relate to level of care, need for waiver services, non-payment of cost-shares, etc., the care manager (CM) will determine if Medicaid waiver eligibility is affected.

In all cases, the sequence is as follows:

1a) Waiver participant notifies ESS of a change that could affect eligibility.

ESS runs eligibility in CARES. If eligibility for waiver is impacted, ESS generates an "Interagency Notification Termination of Medicaid Waiver Eligibility for a Community Waiver Participant" (Form HCF 10142 - See Attachment # 1) and forwards it to the CM. If termination is not warranted, ESS will not issue a notice.

OR

1b) Care Manager notifies ESS of a change that could affect eligibility.

The CM will first complete and deliver an Interagency Notification Termination of Community Waiver Participation (Form DDE 2637 - See Attachment # 2) to ESS, to inform ESS of the possible reason for termination of waiver services. It is important for CM to complete and deliver this notice to ESS promptly (prior to adverse action whenever feasible). The sooner a change is reported to ESS, the earlier it can be entered in CARES, and, when applicable, a Medicaid waiver eligibility termination date will be generated.

ESS runs eligibility in CARES. If eligibility for waiver is impacted, ESS generates an "Interagency Notification Termination of Medicaid Waiver Eligibility for a Community Waiver Participant" (Form HCF 10142) and forwards it to the CM. If termination is not warranted, ESS will not issue a notice.

2) CM or participant has notified ESS of a participant's change in eligibility criteria, and CM receives Form HCF 10142 from ESS.

The CM will issue a Notification of Waiver Program Termination (Form DDE 2638 - See Attachment # 3) to the participant, using as the effective date of termination for waiver services the same termination date noted by ESS on Form HCF 10142.

3) CM or participant has notified ESS of a participant's change in eligibility criteria, and CM does not receive Form HCF 10142 from ESS.

CM should always follow up with ESS to ascertain disposition of the case. If termination is not required, a case note will be entered in the case file documenting the conversation with ESS. If termination is required, CM will proceed as outlined in # 3.

4) ESS and CM will continue to send two separate termination notices to the participant.

The termination dates for waiver services and termination for Medicaid waiver eligibility on these two notices will coincide. ESS will continue to screen waiver participants for Medicaid eligibility under other Medicaid subprograms.

Action Required:  Effective January 1, 2006, LTSA must use the Medicaid waiver eligibility end date as the termination date for Medicaid waiver services, using the process described above.

REGIONAL OFFICE CONTACT: 
Human Services Area Coordinators-Adult Services

CENTRAL OFFICE CONTACT: 
Rita Cairns
Bureau of Long-Term Support
P. O. Box 7851
Madison, WI 53707-7851
608-266-6891
CairnRI@wisconsin.gov

MEMO WEB SITE: 
http://www.dhs.wisconsin.gov/partners/local.htm

 

Attachments:

1) Form HCF-10142 (PDF, 16 KB) - Interagency Notification of Termination of Medicaid Waiver Program Eligibility for a Community Waiver Participant. (Issued by ESA to LTSA)

2) Form DDE-2637 (PDF, 9 KB) - Interagency Notification Termination of Community Waiver Participation. (Issued by LTSA to ESA)

3) Form DDE-2638 (Word Fillable, 48 KB) or Form DDE- 2638 (PDF, 31 KB) - Notification of Waiver Program Termination (issued by LTSA to Community Waiver Participant).

4) Flow Chart (PDF, 12 KB) Aligning Termination of Medicaid Waiver Services with Termination of Medicaid Waiver Eligibility.


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