Application for a §1915(c) Home and Community- Based ...

1 Application for a 1915(c) Home and Community- Based Services Waiver PURPOSE OF THE HCBS WAIVER PROGRAMThe Medicaid Home and Community- Based Services (HCBS) waiver program is authorized in 1915(c) of the Social Security Act. The program permits a State to furnish an array of home and community- Based services that assist Medicaid beneficiaries to live in the community and avoid institutionalization. The State has broad discretion to design its waiver program to address the needs of the waiver s target population. Waiver services complement and/or supplement the services that are available to participants through the Medicaid State plan and other federal, state and local public programs as well as the supports that families and communities provide. The Centers for Medicare & Medicaid Services (CMS) recognizes that the design and operational features of a waiver program will vary depending on the specific needs of the target population, the resources available to the State, service delivery system structure, State goals and objectives, and other factors.

2 A State has the latitude to design a waiver program that is cost-effective and employs a variety of service delivery approaches, including participant direction of services. Request for a Renewal to a 1915(c) Home and Community- Based Services Waiver 1. Major Changes Describe any significant changes to the approved waiver that are being made in this renewal Application :Summary of Significant Changes:Appendix B: Reserved capacity for MFP category has been changed to Reserved capacity for deinstitutionalization / MFPThe following changes have been made in Appendix C, Services:- Community Living and Supports: Clarification that a member can receive the community component of Community Living and Supports at the same time as Residential Supports / Supported living when an individual is accessing a non-integrated setting like summer camp. Clarification that Community Living and Supports can be provided in a Individuals living in their own homes and not with their families cannot receive Community Living and Supports.

3 The appropriate service is Supported Living or Supported Living Community Navigator Addition of language that allows for the Community Navigator to assist with QP function for individuals that have chosen the Employer of Record Self Directed option. Addition of language related tenancy Community Networking Included integrated, community- Based employment focused skill development which consists of: a. Career Exploration, b. Discovery and Career Planning, c. Participation in Workshops and Classes on Topics Related to integrated employment, d. Skill and Education-Focused Activities, e. Volunteering Opportunities (Career Focus), f. Social Networking and Skills for Social Capital to Obtain/Maintain community Based integrated employment. Expanded the accreditation bodies for vendors that only provide Community Transition Included language to support pre-transition coordination of Day Supports Added language Day Supports is typically provided in a group setting.

4 Added language that for working-age individuals (ages 16 to 62) not also working in competitive integrated employment, Day Supports shall include career and employment exploration through educational and experiential opportunities designed to identify a person s specific interests and aptitudes for paid work, including experience and skills transferable to competitive integrated employment, and also typically includes business tours, informational interviews and job shadows, related to the person s identified interests, experiences and/or skills, in order to explore potential opportunities for competitive integrated employment in the person s local area .- Financial Supports Services Added Clarifying language regarding Employer Equipment and Supplies - Residential Supports - Added language that Residential Supports levels are determined by the Individual Budget Tool and other evidence of support need.

5 The SIS Level is only one piece of evidence that may be considered. o Level 1: SIS Level Ao Level 2: SIS Level Bo Level 3: SIS Level C and Do Level 4: SIS Level E, F, and GThe results of a SIS and the IBT Base Budget are guidelines that do not constitute a binding limit that may not be exceeded on the amount of services (including the level of this service) that may be requested or authorized in a Plan of : Added clarifying language that Residential Support AFL cannot be billed on the same day as Respite for the same individual-- Supported Living Added a periodic modifier for individuals who use < 4 or less hours of Supported Living per day, added SL to the services that can be self-directed, added clarification on Supported Living Levels, added clarification of family members who can live with an individual receiving Supported Living. Added a Supported Living Transition servicePage 1 of 212 Application for 1915(c) HCBS Waiver: Draft - Jan 01, 201910/22/2018 Living and Levels:Added language that Supported Living levels are determined by the the Individual Budget Tool and other evidence of support need.

6 The SIS Levelis only one piece of evidence that may be considered. Level One: Level A and B Level one is intended to serve persons who require minimal support to perform the activities of daily living and to remain safe and healthy. Staffing is Based on the preferences and the assessed needs of the person but typically does not require staff to be in the home or awake at night. Level Two: Levels C and D Level two is intended to serve person/s that requires moderate support to perform the activities of daily living and to remain safe and healthy. Staffing is Based on the preferences and the assessed needs of the person/s. Typically, the live-in caregiver or staff must be are onsite but not awake at night or appropriate technology may be used to ensure supervision. Level Three: Levels E, F and G Level 3: The beneficiary requires continuous supervision including awake overnight staff in order to remain safe and healthy.

7 Typically, Person/s receiving Level Three supports include arrangements in which a person/s is living in his/her own home with overnight and awake staff or appropriate technology may be used to ensure supervision as identified in the ISP. The results of a SIS and the IBT Base Budget are guidelines that do not constitute a binding limit that may not be exceeded on the amount of services (including the level of this service) that may be requested or authorized in a Plan of Specialized Consultative Services Included language that Staff must hold appropriate NC license for physical therapy, occupational therapy, speech therapy, psychology and nutrition; board certified behavior analyst MA; master s degree and expertise in augmentative communication ;state certification in assistive technology and state certification in recreation therapy or other licenses for professionals who possess experience with individuals with Intellectual / Developmental DisabilitiesAppendix H: The QI strategy was updated to reflect statewide measures in all sections have been revised through discussion with CMS around the Evidence Package citations have been reviewed and updated as for a 1915(c) Home and Community- Based Services Waiver 1.

8 Request Information (1 of 3) State of North Carolina requests approval for a Medicaid home and community- Based services (HCBS) waiver under the authority of 1915(c) of the Social Security Act (the Act). B. Program Title (optional - this title will be used to locate this waiver in the finder):North Carolina InnovationsC. Type of Request: renewal Requested Approval Period:(For new waivers requesting five year approval periods, the waiver must serve individuals who are dually eligible for Medicaid and Medicare.) 3 years 5 yearsOriginal Base Waiver Number: Draft Type of Waiver (select only one):Regular Waiver E. Proposed Effective Date: (mm/dd/yy)01/01/191. Request Information (2 of 3)F. Level(s) of Care. This waiver is requested in order to provide home and community- Based waiver services to individuals who, but for the provision of such services, would require the following level(s) of care, the costs of which would be reimbursed under the approved Medicaid State plan (check each that applies): Hospital Select applicable level of care Hospital as defined in 42 CFR If applicable, specify whether the State additionally limits the waiver to subcategories of the hospital level of care:Page 2 of 212 Application for 1915(c) HCBS Waiver.

9 Draft - Jan 01, 201910/22/2018 Inpatient psychiatric facility for individuals age 21 and under as provided in42 CFR Nursing Facility Select applicable level of care Nursing Facility as defined in 42 CFR and 42 CFR If applicable, specify whether the State additionally limits the waiver to subcategories of the nursing facility level of care: Institution for Mental Disease for persons with mental illnesses aged 65 and older as provided in 42 CFR Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) (as defined in 42 CFR ) If applicable, specify whether the State additionally limits the waiver to subcategories of the ICF/IID level of care:The NC Innovations waiver targets individuals who meet the ICF-IID eligibility criteria as defined in the State Medicaid Agency's Clinical Coverage Policy which is located on the NCDHHS Division of Medical Assistance website at Request Information (3 of 3)G.

10 Concurrent Operation with Other Programs. This waiver operates concurrently with another program (or programs) approved under the following authoritiesSelect one: Not applicable ApplicableCheck the applicable authority or authorities: Services furnished under the provisions of 1915(a)(1)(a) of the Act and described in Appendix I Waiver(s) authorized under 1915(b) of the Act. Specify the 1915(b) waiver program and indicate whether a 1915(b) waiver Application has been submitted or previously approved: This waiver operates concurrently with the NC Mental Health, Intellectual and Developmental Disabilities and Substance Abuse Services Health Plan waiver, # the 1915(b) authorities under which this program operates (check each that applies): 1915(b)(1) (mandated enrollment to managed care) 1915(b)(2) (central broker) 1915(b)(3) (employ cost savings to furnish additional services) 1915(b)(4) (selective contracting/limit number of providers) A program operated under 1932(a) of the Act.