Medicaid Home and Community-Based Services

For use by children's long-term support (CLTS) waiver agencies.

The Community Options Program (COP) and Community Integration Program (CIP) ended on June 30, 2018. References in the waiver manual to COP and CIP no longer apply to adults.

List of Chapters and Sections of the Revised Interim Manual

Chapter I – Overview and Administration (PDF) I-1
1.01 Long-Term Support in Wisconsin (PDF) I-1
1.02 State Medicaid Waiver Authority (PDF) I-2
1.03 The Medicaid Waiver Mandate (PDF) I-2
1.04 Exemptions from the Mandate (PDF) I-3
1.05 Registering Applicants on HSRS (PDF) I-4
1.06 Medicaid Waiver Program Wait Lists (PDF) I-5
   
Chapter II – Waiver Eligibility (PDF) II-1
2.01 Waiver Eligibility (PDF) II-1
2.02 Waiver Target Groups (PDF) II-1
2.03 Waiver Services for Persons with Severe & Persistent Mental Illness (PDF) II-6
2.04 Active Treatment/ No Active Treatment (NAT) Determination (PDF) II-6
2.05 Medicaid Non-Financial Eligibility Requirements (PDF) II-9
2.06 The Parental Payment Limit (PDF) II-12
2.07 Level of Care (LOC) (PDF) II-12
2.08 Eligible Living Situations (PDF) II-14
2.09 Waiver Participant Moves (PDF) II-16
2.10 Denial of Participation or Termination of Program Participation (PDF) II-22
2.11 COP Eligibility After Waiver Program Termination (PDF) II-26
   
Chapter III – Financial Eligibility (PDF) III-1
3.01 Medicaid Eligibility (PDF) III-1
3.02 Children Applying for the Waiver – Special Considerations (PDF) III-3
3.03 Medicaid Waiver Income Groups (PDF) III-4
3.04 Spousal Impoverishment (PDF) III-11
3.05 New Applicants Leaving an Institution (PDF) III-13
3.06 Payments, Prepayments or Repayments to Medicaid (PDF) III-13
3.07 Other Payments (PDF) III-13
   
Chapter IV – Allowable Services (PDF) IV-1
4.01 Introduction (PDF) IV-1
4.02 Ensuring Providers are Qualified (PDF) IV-1
4.03 Ensuring Access  - Provider Choice (PDF) IV-4
4.04 Conflict of Interest (PDF) IV-6
4.05 Provider Screening Requirements (PDF) IV-8
4.06 Medicaid Waivers: General Limitations (PDF) IV-12
4.07 Participant Contributions (PDF) IV-14
4.08 Reserved for future use (PDF) IV-14
4.09 Allowable Services Index (PDF) IV-15
   
Chapter V – Use of Funding in Substitute Care (PDF) V-1
5.01 Introduction (PDF) V-1
5.02 Determining Waiver Allowable Costs (PDF) V-1
5.03 Ability to Pay - Room and Board (PDF) V-2
5.04 Waiver Specific Requirements: CIP 1A/1B (PDF) V-4
5.05 Waiver Specific Requirements: CLTS (PDF) V-4
5.06 Waiver Specific Requirements: CIP II, COP-W, and COR (PDF) V-4
5.07 Purchasing Substitute Care Services (PDF) V-13
   
Chapter VI – The Waiver Application Packet (PDF) VI-1
6.01 Introduction: The Application (PDF) VI-1
6.02 The Content of the Waiver Application Packet (PDF) VI-1
6.03 Waiver Program Start Date (PDF) VI-15
6.04 Medicaid Waiver Application and Approval Process (PDF) VI-17
6.05 The Waiver Application Packet – Reference Guide (PDF) VI-21
   
Chapter VII – Recertification, Plan Review, and ISP Update (PDF) VII-1
7.01 Introduction (PDF) VII-1
7.02 Recertification: Program Specific Requirements (PDF) VII-3
7.03 Timeliness of Recertification and Documentation (PDF) VII-11
7.04 Individual Service Plan Review - Documentation (PDF) VII-12
7.05 Service Plan Updates (PDF) VII-13
   
Chapter VIII – Participant Rights and Appeal and Grievance Processes (PDF) VIII-1
8.01 Medicaid Waiver Applicant/Participant Rights (PDF) VIII-1
8.02 Responsibility for the Notification of Rights (PDF) VIII-1
8.03 Waiver Agency Actions Subject to Appeal or Grievance (PDF) VIII-4
8.04 General Notice and Notification Requirements Associated with Waiver Agency Actions (PDF) VIII-6
8.05 Participant Rights: Restrictive Measures (PDF) VIII-7
   
Chapter IX – Assuring the Health and Safety of Medicaid Waiver Participants (PDF) IX-1
9.01 Introduction (PDF) IX-1
9.02 Application of this Chapter to Individuals and Agencies (PDF) IX-2
9.03 Response Systems Required (PDF) IX-3
9.04 Investigation / Inquiry Expectations of Waiver Agencies (PDF) IX-5
9.05 Waiver Agency Response Options (PDF) IX-6
9.06 Incident Prevention, Management, Resolution, and Reporting (PDF) 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: August 31, 2018