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)
Memo Announcing Release of Revised Manual (PDF,
112 KB)
List of Chapters and Sections of the Revised Interim Manual
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Chapter
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Pages
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Chapter I OVERVIEW AND ADMINISTRATION (PDF,
56 KB)
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I-1
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1.01 Long Term Support in Wisconsin
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I-1
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1.02 State Medicaid Waiver Authority
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I-2
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1.03 The Medicaid Waiver Mandate
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I-2
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1.04 Exemptions from the Mandate
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I-3
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1.05 Registering Applicants on HSRS
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I-4
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1.06 Medicaid Waiver Program Wait Lists
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I-5
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Chapter II WAIVER ELIGIBILITY (PDF,
136 KB)
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II-1
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2.01 Waiver Eligibility
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II-1
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2.02 Waiver Target Groups
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II-1
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2.03 Waiver Services for Persons with Severe & Persistent Mental Illness
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II-6
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2.04 Active Treatment/ No Active Treatment (NAT) Determination
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II-6
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2.05 Medicaid Non-Financial Eligibility Requirements
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II-9
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2.06 The Parental Payment Limit
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II-12
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2.07 Level of Care (LOC)
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II-12
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2.08 Eligible Living Situations
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II-13
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2.09 Waiver Participant Moves
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II-15
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2.10 Denial of Participation or Termination of Program Participation
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II-22
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2.11 COP Eligibility After Waiver Program
Termination
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II-26
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Chapter III FINANCIAL ELIGIBILITY (PDF,
100 KB)
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III-1
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3.01 Medicaid Eligibility
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III-1
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3.02 Children Applying for the Waiver Special Considerations
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III-3
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3.03 Medicaid Waiver Income Groups
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III-4
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3.04 Spousal Impoverishment
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III-11
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3.05 New Applicants Leaving an Institution
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III-13
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3.06 Payments, Prepayments or Repayments to Medicaid
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III-13
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3.07 Other Payments
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III-13
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Chapter IV ALLOWABLE SERVICES (PDF,
488 KB)
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IV-1
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4.01 Introduction
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IV-1
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4.02 Ensuring Providers are Qualified
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IV-1
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4.03 Ensuring Access - Provider
Choice
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IV-4
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4.04 Conflict of Interest
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IV-6
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4.05 Provider Screening Requirements
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IV-8
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4.06 Medicaid Waivers: General Limitations
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IV-12
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4.07 Participant Contributions
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IV-14
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4.08 Reserved for future use
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IV-14
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4.09 Allowable Services Index
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IV-15
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Chapter V USE OF FUNDING IN SUBSTITUTE CARE (PDF,
104 KB)
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V-1
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5.01 Introduction
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V-1
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5.02 Determining Waiver Allowable Costs
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V-1
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5.03 Ability to Pay - Room and Board
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V-2
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5.04 Waiver Specific Requirements: CIP 1A/1B, BIW
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V-4
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5.05 Waiver Specific Requirements:
CLTS
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V-4
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5.06 Waiver Specific Requirements:
CIP II, COP-W and COR
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V-4
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5.07 Purchasing Substitute Care Services
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V-13
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Chapter VI THE WAIVER APPLICATION PACKET (PDF,
156 KB)
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VI-1
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6.01 Introduction: The Application
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VI-1
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6.02 The Content of the Waiver Application Packet
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VI-1
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6.03 Waiver Program Start Date
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VI-15
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6.04 Medicaid Waiver Application and Approval Process
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VI-17
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6.05 The Waiver Application Packet
Reference Guide
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VI-21
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Chapter VII RECERTIFICATION, PLAN
REVIEW AND ISP UPDATE (PDF, 164 KB)
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VII-1
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7.01 Introduction
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VII-1
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7.02 Recertification: Program
Specific Requirements
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VII-3
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7.03 Timeliness of Recertification
and Documentation
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VII-11
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7.04 Individual Service Plan Review
- Documentation
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VII-12
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7.05 Service Plan Updates
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VII-13
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Chapter VIII PARTICIPANT RIGHTS
AND APPEAL AND GRIEVANCE PROCESSES (PDF, 51 KB)
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VIII-1
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8.01 Medicaid Waiver Applicant/Participant Rights
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VIII-1
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8.02 Responsibility for the Notification of Rights
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VIII-1
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8.03 Waiver Agency Actions Subject to
Appeal or Grievance
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VIII-4
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8.04 General Notice and Notification
Requirements Associated with Waiver Agency Actions
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VIII-6
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8.05 Participant Rights: Restrictive
Measures
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VIII-7
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Chapter IX ASSURING THE HEALTH AND
SAFETY OF MEDICAID WAIVER PARTICIPANTS (PDF, 49 KB)
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IX-1
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9.01 Introduction
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IX-1
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9.02 Application of this Chapter to
Individuals and Agencies
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IX-2
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9.03 Response Systems Required
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IX-3
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9.04 Investigation / Inquiry
Expectations of Waiver Agencies
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IX-5
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9.05 Waiver Agency Response Options
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IX-6
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9.06 Incident Prevention, Management,
Resolution and Reporting
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IX-7
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Chapter X QUALITY ASSURANCE
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- NOT AVAILABLE AT THIS TIME
Chapter XI REPORTING AND REIMBURSEMENT
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- 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: July 12, 2010 |
