Operations Memorandum - Waivers
OPS980304

3/5/98
SUBJECT: Medical Assistance Waiver Programs
(Reference: Medical Assistance Eligibility Handbook, Chapter 389 Waivers)
TO: Executive Directors
FROM: Sherri Z. Heller, Deputy Secretary, Office of Income Maintenance

PURPOSE

To clarify instructions for processing applications and redeterminations for the various waiver programs.

To authorize implementation of the Waiver for Infants, Toddlers and Families.

To authorize the expansion of the Pennsylvania Department of Aging (PDA) Waiver to additional counties.

BACKGROUND/DISCUSSION

As Medical Assistance (MA) waivers are implemented, procedures are developed by the program office with responsibility for the waiver. For example, the Community Based Service Waiver was developed by the Office of Mental Retardation, the Attendant Care Waiver by the Office of Social Programs, and the PDA Waiver by the Department of Aging. Consequently, the procedures have not previously been exactly the same for the various waivers. In addition, some of the waivers are not available Statewide and some are being implemented in stages with plans for expansion.

Attached is a chart which standardizes the application and redetermination process for the various waivers. This chart has been reviewed with all of the program offices that administer the various waivers and the information has been distributed Statewide to providers of waiver services. The application and redetermination processes outlined in the Nursing Care Handbook (NCH), Chapters 404 and 476 (Pilot 10/07, Revised 1/98), are to be used for all waiver programs.

The biggest change for providers is that they do not need to send annual medical documentation to the CAO. The providers will complete medical reviews according to the requirements of the program office for the waiver. Providers will not keep track of MA redetermination schedules. CAOs will complete reviews as needed on a case-by-case basis, according to the case circumstances. Local arrangements can be made with providers who help the client to complete partial or complete redeterminations. The minimum requirement is a complete redetermination once every three years. The requirements for partial and complete redeterminations are specified in the Pilot Handbook pages, Chapter 476.

The attached chart also indicates that MA recipients do not need to complete application forms when entering a waiver program. The CAO should review the case circumstances and make a determination of eligibility and may complete a redetermination, but an application is not required. CAO staff need to discuss this expedited process with all providers of waiver services to establish a method by which the provider can determine whether a waiver candidate is already MA-eligible. This will avoid unnecessary application forms and repeated documentation of information already in the case record or on the Income Eligibility Verification System. Many CAOs have already established such a process.

Central program office staff require that the local waiver providers have a Notice of Eligibility (either from the Client Information System or a PA/FA 162) in their files which advises the client of eligibility for the specific waiver. CAOs need to also enter the appropriate facility code with the start date of the waiver program.

AUTHORIZATION OF NEW WAIVERS

The Office of Mental Retardation has been authorized to begin a waiver program in selected counties for Infants, Toddlers and Families beginning March 1, 1998. An Operations Memorandum will be issued with additional instructions.

The PDA has been authorized to expand the PDA waiver to the following counties: Luzerne, Wyoming, Northampton, Beaver, Cameron, Elk, McKean. CAOs should use the special waiver resource and income limits in Medical Assistance Eligibility Handbook (MAEH), Chapter 389, Appendices A and B for cases identified by the Area Agency for Aging staff as meeting requirements to participate in the waiver program.

NEXT STEPS

1. Review the information in this memorandum with all IMCWs who handle waiver cases.

2. Meet locally with providers of waiver services to discuss information and establish local procedures.

3. Call Carole Rebert at 717-772-0732 if you have questions.

4. Retain this memorandum until information is added to the MAEH and NCH.


LONG TERM CARE WAIVERS

WAIVER APPLICATION REDETERMINATION CLIENT LIABILITY
AIDS SSI = Not needed
MA = Not needed
3 years or as scheduled by CAO according to case circumstances No PPL
Michael Dallas
(18 cases)
SSI = Automatic
MA = Automatic
3 years or as scheduled by CAO according to case circumstances No PPL
Consolidated MR (AKA Home and Community Services or 2176)
(10,400 cases)
SSI = Automatic
MA = Expedited
3 years or as scheduled by CAO according to case circumstances PPL
OSP/OBRA
(100 cases)
SSI = Automatic
MA = Expedited
3 years or as scheduled by CAO according to case circumstances No PPL
OSP/Independence
(Max 56 in 97-98)
(Max 60 in 98-99)
SSI = Automatic
MA = Expedited
3 years or as scheduled by CAO according to case circumstances No PPL
Attendant Care
(1,400 cases)
SSI = Automatic
MA = Expedited
3 years or as scheduled by CAO according to case circumstances No PPL
PDA
(1,500 cases)
SSI = Automatic
MA = Expedited
3 years or as scheduled by CAO according to case circumstances No PPL
Infants, Toddlers, and Families Start 3/98 SSI = Automatic
MA = Expedited
None
(Participants age 0-3 only)
No PPL
LTCCAP
Start 3/98
SSI = Automatic
MA = Expedited
3 years or as scheduled by CAO according to case circumstances No PPL

At initial application for waiver service, the CAO will obtain documentation of medical eligibility. No further documentation of medical information is required unless there is a change. If medical need for service changes, the waiver provider will forward information to the CAO. The CAO will initiate and complete financial reviews at least every three years. The CAO will periodically complete partial redeterminations of specific income or resource information according to case circumstances. A form and interview may not be necessary.