THOMAS J. VILSACK, GOVERNOR DEPARTMENT OF HUMAN SERVICES
SALLY J. PEDERSON, LT. GOVERNOR KEVIN W. CONCANNON, DIRECTOR
Page 3
HCBS Elderly Waiver Case Management
INFORMATIONAL LETTER NO. 514
DATE: July 27, 2006
TO: Jim Krogman, Jim Daumueller,
Field Operation Support Unit
Lisa Roberts, Lucinda Wonderlich-Fuller
Diane Diamond, Deb Westvold, and Judy Alexander
Targeted Case Management
Department of Elder Affairs
Area Agencies on Aging
ISIS Users
FROM: Iowa Medicaid Enterprise Bureau of Long Term Care (IME)
SUBJECT: Home and Community Based Services-Case Management as an Elderly Waiver service
House File 841, the IowaCare Act, directed the Iowa Department of Human Services (DHS) to begin covering case management services under the elderly waiver. This change requires approval by the Centers for Medicare and Medicaid Services (CMS) of the United States Department of Health and Human Services to provide for inclusion of case management as a Medicaid covered service. CMS has now approved the change. The DHS has been working in collaboration with the Iowa Department of Elder Affairs (DEA) in developing the program.
Beginning October 1, 2006, Case Management will be a covered Medicaid service under the elderly waiver. The information in this informational letter will provide guidelines on the transition process between now and October 1, 2006.
Key Facts about the new process:
· There will be no change in the elderly waiver process until after October 1, 2006.
· After October 1, 2006, case management will be a covered Medicaid service under the Elderly waiver.
· Any Medicaid provider who meets the qualifications will be able to enroll and perform elderly waiver case management services.
· Interested providers will need to enroll with IME to become Medicaid case management providers. More information will be provided on how to do this at a later date.
Current Consumer Enrollment Process will remain in place until October 1, 2006:
· An individual applying for the HCBS Elderly waiver is automatically referred to a DHS Service Worker and Area Agency on Aging (AAA).
· The DHS Service Worker and/or AAA case manager contact the individual to assess the
individual and do initial paperwork.
· AAA completes the I-OASIS assessment and submits to IME Medical Services to determine level of care.
· The DHS Service Worker or AAA Case Manager develops a service plan for the individual through an interdisciplinary team process.
· The DHS Service Worker or AAA case manager enters the service plan on the Individualized Services Information System (ISIS). The DHS Service Worker approves the service plan and sends out a Notice of Decision.
Consumer Process for HCBS Elderly Waiver Enrollment AFTER October 1, 2006
· Any provider who meets the provider qualifications may provide the case management service. All providers will be required to enroll with IME in order to provide the case management service.
· An individual applying for the HCBS Elderly waiver will be given a choice of Elderly waiver case management providers. The DHS Service Worker will no longer be involved with consumers accessing the HCBS Elderly Waiver unless they are working with a case in which there are protective concerns.
· Income Maintenance Workers (IMW) will continue to be involved with the Elderly Waiver program. The IMW will inform the consumers of those entities that are enrolled to provide HCBS Elderly Waiver Case Management, therefore giving the consumer a choice. ISIS provides a list of case management entities enrolled in each county through the provider search screen.
· Once the choice is made, the HCBS Elderly waiver case manager will contact the individual to complete the initial paperwork.
· The HCBS Elderly Waiver Case Manager will assist in completing the assessment process.
· The HCBS Elderly Waiver Case Manager will develop a comprehensive service plan for the consumer through an interdisciplinary team process (which at a minimum includes the consumer/legal guardian, HCBS Elderly Waiver Case Manager and anyone else the consumer elects to attend).
· All HCBS Elderly Waiver Case Managers will be required to enroll through ISIS for a new login and password for their new roll. All current AAA’s and DHS Service Worker (only associated with the HCBS Elderly Waiver) roles will be terminated effective October 1, 2006.
· The HCBS Elderly Waiver Case Manager will enter the service plan on ISIS. The HCBS Elderly Waiver Case Manager will approve the service plan and send out the Notice of Decision.
· The HCBS Elderly Waiver Case Manager must, at a minimum, have quarterly contact with the consumer.
Provider Enrollment Process Effective October 1, 2006:
Case Management will be added to the HCBS Elderly Waiver Program as a service. Any agencies or individuals may enroll as a HCBS Elderly Waiver Case Management provider if they meet one of the following criteria:
Ø An Agency that meets Iowa Administrative Code (IAC) 441.24 for case management (must submit a copy of their certification).
Ø An Agency that meets Iowa Administrative Code (IAC) 321.21 for case management (must submit a letter from the Department of Elder Affairs that they meet the requirements to provide case management).
Ø An individual that meets Iowa Administrative Code (IAC) 441.24 for case management or Iowa Administrative code 331.21 for case management services (must submit a copy of a letter from the Department of Elder Affairs, or a copy of their certificate that they are qualified to provide case management).
Ø An Agency or individual certified through either CARF, CCO the Council or JCAHO to provide case management (must submit a copy of their letter of certification or accreditation).
Ø An amendment has been submitted to CMS to add the following provider type:
Meets the standards in the Iowa Administrative Code 641.80 for case management services (must submit a letter from the Department of Public Health that they meet the requirements to provide Case Management).
The new Medicaid waiver provider application will be on the Iowa Medicaid Enterprise website at http://www.ime.state.ia.us/Providers/Enrollment.html in July or August 2006.
Service workers who are currently involved in HCBS Elderly Waiver cases will need to work in cooperation with the HCBS Elderly Waiver Case Manager to ensure a smooth transition.
HCBS Elderly Waiver Case Management services may be reimbursed for services provided on a monthly basis. The reimbursement is based on a fee schedule methodology with a unit upper payment limit of $70.00 per person per month. Unlike Targeted Case Management, there is no limit on the HCBS Elderly Waiver Case Manager’s caseload number.
MYTHS and FACTS
MYTH
/FACT
Adding the HCBS Elderly Waiver Case Management Service will require the reduction or deletion of services if by adding this service the monthly service amount exceeds the monthly cap of $1052. / Adding the HCBS Elderly Waiver Case Management service will not reduce or delete any services received through the Elderly Waiver. If the individual is at the monthly cap of $1052 the $70 will be allowed to go over the cap. The $70.00 per month maximum will still be within the cost neutrality for CMS.MYTH
/FACT
The Area Agencies on Aging will be the only provider entity qualified to provide HCBS Elderly Waiver Case Management. / Any agency or individual who meets the HCBS Elderly Case Management criteria will be enrolled to provide this service. The Elderly waiver consumer will have a choice of any qualified provider. All providers will need to enroll with IME to provide the service.Someone other than the HCBS Elderly Waiver Case Manager may enter HCBS Elderly Waiver service plans in the Individualized Services Information System (ISIS). / ISIS is an electronic system, which is password protected and requires unique log in identification for workers to have access to the system and to work on behalf of the Medicaid consumer. The system was built to have the person attached to that role/responsibility have the access to the system and the consumer’s information. This ensures both the Iowa Department of Human Services and CMS the confidentiality of HIPAA requirements. Therefore, HIPAA does not allow a clerical person, case manager supervisor, etc. to enter in information on any consumer, it must be the individual assigned as the Elderly Waiver Case Manager.
An HCBS Elderly Waiver Case Manager will have access to all elderly waiver consumers on ISIS. / Elderly Waiver Case Managers will only be able to view those consumers who have been assigned to their workload. This again assures confidentiality as required by CMS/HIPAA requirements.
An agency that is providing services to an HCBS Elderly Wavier consumer may also provide the HCBS Elderly Waiver Case Management Service. / CMS will not allow an enrolled agency to provide both case management and a service as it creates a conflict of interest. If an agency of services elects to provide case management, they must demonstrate that a “firewall” (legal separation of business and conflict of interest policies) is established to assure that no conflict of interest exists.
Area Agencies on Aging will receive less funding because of the addition of HCBS Elderly Waiver Case Management. / The Iowa Legislature appropriated $1.3 million for HCBS Elderly Waiver Case Management, which is expected to be matched by $2.6 million federal funding. This equals a $4.9 million expansion of funding for the HCBS Elderly Waiver Case Management Service.