- Return to the Community Recovery Services (CRS) Home page.
- CRS Application Frequently Asked Questions (FAQ) Webpage
In order to be eligible for CRS, is a consumer required to have an assigned case manager or be receiving case management services?
Both the approved 1915(i) SPA and the proposed §1937 CRS Benchmark Benefit Plan require that CRS certified providers (counties and tribes) commit to performing certain duties related to CRS consumers on an ongoing basis. Many of these ongoing duties are within the realm of what is commonly referred to as "Case Management", and as such must be performed by qualified staff.
The ongoing duties specifically stated in the approved 1915(i) SPA and the proposed §1937 CRS Benchmark Benefit Plan are as follows:
- Needs based evaluation and re-evaluation utilizing a person-centered approach,
- Face-to-face assessment of an individual's support needs and capabilities,
- Development of an individualized plan of care,
- Supporting the participant in the plan of care development,
- Assisting participants such that they have an informed choice of providers,
- Assuming primary responsibility for monitoring and acting upon incident reports,
- Supporting the consumer on an ongoing basis in their plan of care.
Finally, both the approved 1915(i) SPA and the proposed §1937 CRS Benchmark Benefit Plan require that CRS certified providers provide consumers with a means to request changes and/or express their satisfaction or dissatisfaction related to their services should the need arise. Such access shall be both ongoing and readily available to the consumer.
As a general rule, Medicaid members should not be asked to contribute toward thecost of a Medicaid covered service. The reimbursement that is received from Medicaid is considered paymentin full. With the exception of deductibles and co-payments as authorized in the member's benefit plan, soliciting and/or receiving payment from a Medicaid member over and above the amount reimbursed by Medicaidfor a covered service is not allowed, and carries significant penalties under federal and state Medicaid rules.Please consult the Forward Health MedicaidProvider Handbook, and DHS 104.01(12)(2)(d) "Freedom From Having to Pay the Difference Between Charges and MA Payment."
CRS requires the use of Person Centered Planning (PCP) as defined by the behavioral health model offered through Alipar, Inc. Training in this particular PCP model has been made available statewide. Terms used and defined in thismodel of PCP provide a bridge to use and define terms consistently in CRS even while Case Managers are Assessing and Planning through one or more of the State's programs, e.g., Community Support Program (CSP), Comprehensive Community Services (CCS), Home and Community Based Waiver (HCBS), or Targeted Case Management (TCM).
Recertification should occur annually during the month in which eligibility was originally determined, often referred to as the "anniversary month". Financial eligibility is key, thus we recommend that you check on financial eligibility at the beginning of the anniversary month and submit the recertification packet by the middle of the month. In this scenario, the State would use the original eligibility date, and the current year as the recertification date.
Service facilitation cannot be billed to CRS. Service facilitation can be billed to other benefits e.g., Targeted Case Management (TCM), Comprehensive Community Services (CCS) or Community Support Services (CSP). The rules applying to these MA benefits should be followed.
When making edits to the Functional Screen, make the changes as needed. Use the drop down note box of that section and enter a notation that this is an edit. Also add the date the edit is made and the date of the original Functional Screen. DO NOT CHANGE THE COMPLETION DATE OF THE FUNCTIONAL SCREEN.
If the Functional Screen shows an individual being eligible for CRS during the first year but not during the second, due to the individual having made some improvements, but the underlying issues are still there and the need for service(s) still exist, might this individual still qualify for CRS?
If this situation were to occur it is our recommendation that the screener contact Bureau staff to review the screen data and interpretation of the data. The consumer with a service in place may function better. The level of functioning may not be a long term change but a result of the support provided. On the screen the consumer?s level of functioningshould be assessed considering what the consumer would score without the service in place.
The Outcomes form will be revised in the coming months. In the meantime, to record the person?s progress toward the goal in Box 6 under the original anticipated outcome, use bolded font and begin with the word "Progress". Be sure to include the date that the progress was measured in Box 7.
In general, a person can be eligible for, and receive services from, more than one program. In the case of COP, a county could use COP funding (state revenue) to pay for the non-federal share for a CRS client. In that instance, the person could be in both programs, as long as the person met the criteria for both programs.
CMS requires that 1915i services be provided to eligible individuals across all ages (keeping in mind that the individual must need and choose the service). Wisconsin cannot set different eligibility criteria as to age.
CRS enrollees would receive only those CRS services where their comprehensive assessment determines there is a need, and where the client and care manager determine the service is the best approach to meet that need. So no, not every CRS client will receive all three services.
CRS applies to anyone who has Medicaid and is at or below 150% of the federal poverty level. People enrolled in MA HMOs or BadgerCare are eligible as long as they meet the income test.
The screening tool for children is the Children's Long Term Functional Screen.
A person can be on COP, CSP, or CCS and receive CRS services. For a service such as supported employment which could be covered under CSP or CRS, the primary concern is that it is only billed to one program. Individuals must meet CRS functional criteria. If the individual meets the MH / AODA functional screen criteria and the financial eligibility criteria, they could receive CRS services.
CRS services are provided as needed and appropriate for an individual. There is no expectation that supported employment would be provided to young children. We did not put family / parent peer support in the application. Until an amendment is done to add parent peer support to the definition, we are not able to cover it.
Assessment and planning activities are expected to be covered by Targeted case management or CSP if the individual receives CSP services.
The agency does not need a separate CRS plan (a single coordinated plan is the standard best practice), when a CCS plan or CSP plan is in place, as long as the CRS services are designated as such and include the required CRS federal and state CCS & CSP components. This also assumes that a person centered planning process was used for the CCS/CSP recovery plans.
We have provided a list of assurances to the Centers for Medicare and Medicaid Services which are detailed below regarding the independent assessment. For this program, we would need an assessment within the last year that is a comprehensive look at an individual?s current situation. An update of an old assessment does not meet this criterion.
These are the assurances provided in the Federal application regarding assessments:
There is an independent assessment of individuals determined to be eligible for the State plan HCBS benefit. The assessment is based on:
An objective face-to-face assessment with a person-centered process by an agent that is independent and qualified as defined in 42 CFR §441.568;
Consultation with the individual and if applicable, the individual?s authorized representative, and includes the opportunity for the individual to identify other persons to be consulted, such as, but not limited to, the individual?s spouse, family, guardian, and treating and consulting health and support professionals caring for the individual;
An examination of the individual?s relevant history, including findings from the independent evaluation of eligibility, medical records, an objective evaluation of functional ability, and any other records or information needed to develop the plan of care as required in 42 CFR §441.565;
An examination of the individual?s physical and mental health care and support needs, strengths and preferences, available service and housing options, and when unpaid caregivers will be relied upon to implement the plan of care, a caregiver assessment;
A determination of need for (and, if applicable, determination that service-specific additional needs-based criteria are met for), at least one State plan home and community-based service before an individual is enrolled into the State plan HCBS benefit.