Notes / 4-24-17
Agenda
· 4.2% Increase Update
· Independent Living Policy Exception
· HB0113 Military Waiver Information
· Complaint Process
· Community Integration Documentation
· Psychological and Neuropsychological Assessments
TOPICS
4.2% Increase Update for Providers and Case Managers
At the conclusion of the Wyoming Legislative Session in March, the Home and Community Based Developmental Disability Supports and Comprehensive Waivers received $5 million dollars for the biennium to increase rates across all services. The Division has created a Waiver Amendment for CMS to increase service rates using this money.
· The Acquired Brain Injury Waiver was not included in the legislation and therefore will not be part of this increase.
Updates: The Division submitted the Waiver Amendment that included the rate increase to CMS on April 11, 2017. CMS has 90 days to either approve or deny the Waiver Amendment.
The Division has created a work group that involves Division staff, staff of Conduent, EMWS, and Healthcare Financing in order to implement the 4.2% Increase. This work group has worked on system updates needed and communication plans with participants, providers and guardians. Here are some of the timelines that have been established for providers and case managers. Each Provider Support Call will elaborate on more timelines and updates:
For Plans of Care submitted into EMWS:
June 19th, 2017: ALL modifications must be approved. This includes all modifications that are in a rolled back plan.
June 26th, 2017: The Division will have all Plans of Care approved.
June 26th, 2017: Please have ALL billing up to date. This will cut down significantly on any billing issues after the rate changes are made and getting providers paid in a timely manner.
Independent Living Policy Exception
The Participant Support Specialist can assist case managers in moving participants to more independent living environments over the course of a year by submitting a policy exception request.
The policy exception, if approved, would allow the participant to return to Residential Habilitation Services within the first year without going to ECC if the transition is not successful.
During the last 6 months of the transition, the participant should begin receiving Supported Living and start receiving less supervision and more independence.
By the end of the year, it is expected that participants will transition to Supported Living.
Policy Exception Request Process:
If a case manager has a participant that wishes to move to a supported living environment, the case manager would contact the participant support specialist for that county and explain the need that justifies the request.
The PSS would complete the policy exception form explaining the request and the need for the exception.
The request is submitted through EMWS in the Supplemental Requests section.
The request is reviewed by the Division’s Participant Support Unit Manager
The Division Administrator will approve or deny the request.
The PSS will notify the CM of the decision.
A policy exception request is valid only for 1 year.
If an additional policy exception is needed past the first year the case manager would work with their PSS to see if a new policy exception is possible.
When teams begin transition planning, it is important to develop a step down process so that the participant gradually begins receiving less supervision.
HB0113 Military Waiver Information
We would like to give everyone an update on a recent legislative bill that was passed re: waiver services for dependents of Military service members. The bill goes into effect on July 1st, 2017. It will address the following scenarios:
1. Active military service members who have been assigned to serve in Wyoming can submit an application for waiver services upon receiving military orders.
2. Active Duty military service members retiring or separating from active duty military service may submit an application for waiver services in Wyoming upon receiving retirement or separation orders, provided they intend to reside in Wyoming within 18 months after retirement/separation.
3. Military service member dependents who were receiving waiver services or were on the waiting list, and left Wyoming for military reasons, shall upon their return to Wyoming be placed in the status identical to where they would be if they had not left Wyoming.
We are working on some revisions to the application process, EMWS, and developing a process for implementation. This will include a roll out plan and training for case managers. More to come later.
Complaint Process
The Division would like to remind providers that if you have a complaint that you would like to file with the Division, please do so in writing unless the complaint involves a participant who health or safety is jeopardized (Chapter 45, Section 31).
For most complaints, Chapter 45 does specify to try and resolve the complaint through “discussion and mediation between the parties.” This means that before involving the Division, please have a team meeting between parties to discuss the issue. If the complaint is not concluded, a complaint maybe filed with the Division in writing. Once the Division receives the complaint, we will ask for all documentation of any discussions regarding the complaint from all involved parties to start an investigation.
If there is an immediate or emergency issue of health and safety, do not call the Division first. Please call law enforcement, emergency services and/or the Department of Family Services. Once all law enforcement agencies are contacted, please contact the Division once health and safety is guaranteed.
Community Integration Documentation
Per the Community Integration Service Definition, “Fifty percent of service provision must address planning and participating in community integrated activities.” For documentation purposes for providers, the fifty percent is documented per month for the case managers to review during their monthly visits. We understand that there may be some months in which participants do not want to participate at the 50% minimum so some explanation can be made for these circumstances.
Psychological and Neuropsychological Assessments:
The Division has been working closely with Conduent over the past few months to design an online add process forpayment ofpsychologicalassessments. This new process will allow the Division to add one day of eligibility to MMIS so that thepsychologistmay bill Conduent directly for services. The new process will be forbothinitial and subsequentpsychologicalassessments as well as neuropsychological assessments. This process will ensure that the Division is upholding the Medicaid rule regarding payments being made directly to Medicaid Enrolledproviders.
The target implementation date for this new process isMay 1, 2017. In order to bill, thepsychologist will submit the signedassessmentreport and an invoice to the case manager. The case manager will upload theassessmentreport and email the invoice to the Participant Support Specialist (PSS). The PSS will verify receipt of the report and submit an online addto open eligibilityfor the date of the evaluation so that thepsychologistmay bill for that one day. Please refer to the process flow sheet for additional information.A bulletin will also be sent out with more information in May.
WRAP UP
Next call is on May 22 nd, 2017 (note this is the not the last Monday in May due to the Holiday on the 29th!)