HFA Regulatory Day
October 29, 2014
Elizabeth Gallagher, Manager HCBS Section, MDCH

 Learn about MI Choice Program Eligibility
 Medical/Functional
 Financial
 Service Need
 Learn about the Home and Community Based Services requirements
 Basic Requirements
 MI Choice time frame for compliance
 Process for assessing residential and non-residential settings
 Corrective Action Plans
 Question and Answer Session
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The MI Choice Waiver is designed to enable the elderly and younger disabled adults (age 18 & older) to remain at home and to participate in their communities. The waiver serves approximately 14,000 adults each year.
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 Persons interested in enrolling in
MI Choice must work with a waiver agency that serves their county of residence.
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To find a local waiver agency or for more information on the MI Choice
Waiver: www.michigan.gov/mdch
 Click on “Health care coverage.”
 Click on “Services for seniors.”
 Click on “Choices for older or disabled persons who may need help caring for themselves.”
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 Contact the preferred waiver agency in the service area
 Ask for an assessment of eligibility for MI Choice waiver services.
 An intake specialist will conduct a pre-screen over the phone
 If applicant passes the pre-screen, the specialist will schedule an in-person assessment.
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 Waiting lists are managed with four priority categories as listed below in descending priority:
1.
Adults aging off of Medicaid State
Plan Private Duty Nursing whose services are authorized by Medicaid
Program Review Division
2.
Nursing Facility residents
3.
Persons with active Adult Protective
Services cases or Persons at imminent risk of nursing facility placement
4.
All other applicants by date of inquiry
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 Once an applicant is at the top of the waiting list the following happens:
 A supports coordination team comprised of a Registered Nurse (RN) and licensed Social Worker (SW) will meet with the applicant in their home to complete an assessment.
 During the assessment, the team will determine likelihood of eligibility
 Will start person-centered planning
 Will start development of a plan of care if likely eligible
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 Must meet nursing facility level of care (NFLOC) to demonstrate medical/functional eligibility
 MI Choice waiver agents must apply the Michigan Medicaid Nursing Facility
Level of Care Determination tool to persons applying for enrollment in the program
 Applicants must pass through one of the seven “doors”
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1.
Activities of Daily Living (Bed Mobility,
Transfers, Toilet Use, Eating)
2.
Cognitive Performance
3.
Physician Involvement
4.
Treatments and Conditions
5.
Skilled Rehabilitation Therapies
6.
Behavior
7.
Service Dependency
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 Must be eligible for Medicaid
 Maximum income is 300% SSI
($2,163/mo. GROSS in calendar year
2014)
 Spousal asset protections apply – but cannot divert income to the spouse
 Waiver participants are considered a group of one
 Waiver participants do not have a spend-down (Medicaid Deductible)
 Financial Eligibility is Determined by the Department of Human Services
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 Applicant must demonstrate, through the assessment process, the need for at least one MI Choice waiver service
 Waiver participants must receive at least one MI Choice service (in addition to supports coordination) on a regular basis to maintain program eligibility.
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 Adult Day Health
 Chore Services
 Community Living
Supports
 Community Transition
Services
 Counseling
 Environmental
Accessibility Adaptations
 Fiscal Intermediary
 Goods and Services
 Home Delivered Meals
 Non-Medical
Transportation
 Nursing Services
 Personal Emergency
Response Systems
 Private Duty Nursing
 Respite
 Specialized Medical
Equipment & Supplies
 Supports Coordination
 Training
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 MI Choice CANNOT:
 Pay for room and board
 Duplicate services required by licensure
 Duplicate “usual and customary” services provided by the residence
 MI Choice CAN:
 Authorize services based upon the unique needs of the individual
 Authorize the additional “hands on” services and supports needed by an individual
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 Cannot enroll before date of initial assessment by waiver agency
 Can receive all Medicaid State Plan
Services
 Cannot use both MI Choice and Home
Help program for personal care services.
 Must use MI Choice Community
Living Supports for ADL/IADL needs
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 Two Options for Service Delivery
 Traditional/Agency Based
 All workers must be employed by an agency in the waiver agency’s provider network.
 Self-Determination
 Can choose own workers
 Workers cannot be legally responsible for participant (i.e. spouse or guardian)
 Participants can use a mixture of
Traditional and Self-Determined services 17

MI Choice Chapter in Medicaid Policy
Manual can be found at: http://www.mdch.state.mi.us/dchmedicaid/manuals/MedicaidProviderM anual.pdf
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 Waiver agency must inform applicant of their right to appeal throughout the process
 If applicant put on waiting list
 If applicant does not pass telephone screen
 If applicant does not meet NFLOC
 If applicant does not meet other enrollment criteria
 If applicant requests services that are not authorized
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 Published in the Federal Register
(CMS-2249-F; CMS-2296-F) on
January 16, 2014
 Effective March 17, 2014
 Transition plan due by March 17,
2015 or sooner if updating a waiver program
 Must be fully compliant by March
17, 2019, or sooner
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To assure Medicaid-eligible persons who are part of a home and community based services program have the same access to the community in which they reside and opportunities to be a part of the community as persons who are not participants of a
Medicaid-funded program.
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 Integrated & supports full access to the community, including employment, controlling personal resources & receiving services
 The individual selects the setting
 Ensures the individual’s rights of privacy, dignity and respect and freedom from coercion & restraint
 Optimizes initiative, autonomy & independence
 Facilitates choice re: services & supports & providers
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 Nursing Facilities
 Institution for Mental Diseases
 Intermediate Care Facility for Individuals with Intellectual Disabilities
 Hospitals
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 Publicly or Privately owned facility providing inpatient treatment
 On the grounds of or next to a public institution
 Settings that separate Medicaid
HCBS recipients from other members of the community
 The state can make a case to the
Federal Government if one of these settings meets HCB requirements
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 Must also assure:
 A specific physical place that can be owned, rented or occupied under a legally enforceable agreement and individual has same legal protections as others
 Individuals have privacy in sleeping units
 Entrance doors lockable
 Choice of roommates
 Can furnish & decorate unit
 Control own schedules and activities and access to food at any time
 Have visitors at any time
 Setting is physically accessible
 Modifications to above must be documented in PCP 26

 MDCH is working on a statewide plan http://www.michigan.gov/mdch/0,4612,7-132-
2943-334724--,00.html
 MI Choice submitted a plan to CMS on
9/28/2014
 The Habilitation Supports Waiver submitted a plan to CMS on 9/30/2014
 All plans will be coordinated
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 Residential and non-residential settings
 Completed by 9/30/2015
 Conducted by MI Choice waiver agencies
 Using tools developed by CMS, but modified by
MDCH with stakeholder input
 On-site
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 Completed
 Initial Stakeholder Meetings
 Public Notice & Comment
 Revised & posted transition plan
 Post Public notice of assessment results by 7/31/2015
 Present Assessment results to stakeholders by 8/31/2015
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 By 6/30/2015
 Update policies, procedures, and contract requirements
 Add educational component to provider enrollment process
 Update provider monitoring tool
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 By 12/31/2015
 Analyze assessment data
 Notify providers of meeting or not meeting requirements
 Notify CMS if presumed settings should have exception
 Require remediation plans from providers
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 By 12/31/2016
 Offer choices to participants in settings that do not meet requirements
 Transition to setting that meets requirements
 Disenroll from MI Choice
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 Elizabeth Gallagher
GallagherE@michigan.gov
517-335-5068
 Heather Slawinski
SlawinskiH@michigan.gov
517-373-0324
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