NEW OPPORTUNITIES WAIVER (NOW) PROVIDER …

1 NEW OPPORTUNITIES WAIVER (NOW) PROVIDER manual Chapter Thirty two of the medicaid Services manual Issued March 1, 2011 Claims/authorizations for dates of service on or after October 1, 2015 must use the applicable ICD 10 diagnosis code that reflects the policy intent. References in this manual to ICD 9 diagnosis codes only apply to claims/authorizations with dates of service prior to October 1, 2015. State of Louisiana Bureau of Health Services Financing LOUISIANA medicaid PROGRAM ISSUED: 04/01/14 REPLACED: 03/01/11 CHAPTER 32: NEW OPPORTUNITIES WAIVER TABLE OF CONTENTS PAGE(S) 6 Page 1 of 6 Table of Contents NEW OPPORTUNTIES WAIVER TABLE OF CONTENTS SUBJECT SECTIONS OVERVIEW COVERED SERVICES Individual and Family Support Individual and Family Support Day Individual and Family Support Night Shared Supports Sharing Supports among Roommates Sharing Supports among Non-Roommates Transportation Place of Service Standards Service Exclusions Service Limitations Authorization for Worker to Exceed 16-Hour Service Limitation Reimbursement Center-Based Respite Transportation Standards Service Exclusions Service Limitations Reimbursement Community

2 Integration Development Shared Supports Transportation Standards Service Limitations Reimbursement Residential Habilitation Supported Independent Living Place of Service Standards Service Exclusions Service Limitations LOUISIANA medicaid PROGRAM ISSUED: 04/01/14 REPLACED: 03/01/11 CHAPTER 32: NEW OPPORTUNITIES WAIVER TABLE OF CONTENTS PAGE(S) 6 Page 2 of 6 Table of Contents Reimbursement Substitute Family Care Standards Service Exclusions Service Limitations Reimbursement Day Habilitation Transportation Place of Service Standards Service Limitations Supported Employment Types of Supported Employment Services Individual Placement or One-to-One Model Follow Along Mobile Work Crew/Enclave Transportation Place of Service Standards Service Exclusions Service Limitations Reimbursement Employment-Related Training Transportation Standards Service Exclusions Service Limitations Reimbursement Environmental

3 Accessibility Adaptations Standards Service Exclusions Service Limitations Authorization to Exceed Cap Reimbursement Specialized Medical Equipment and Supplies Standards Service Exclusions Service Limitations Authorization to Exceed Cap Personal Emergency Response Systems Standards Service Limitations LOUISIANA medicaid PROGRAM ISSUED: 04/01/14 REPLACED: 03/01/11 CHAPTER 32: NEW OPPORTUNITIES WAIVER TABLE OF CONTENTS PAGE(S) 6 Page 3 of 6 Table of Contents Reimbursement Professional Services Psychological Services Social Work Services Nutritional/Dietary Services Standards Service Exclusions Service Limitations Reimbursement Skilled Nursing Shared Supports Standards Service Exclusions Service Limitations Authorization to Exceed 12-Hour Skilled Nursing Service Cap Reimbursement One Time Transitional Expenses Standards Service Exclusions Service Limitations Housing Stabilization Transition Service and Housing Stabilization Service Housing Stabilization Transition Service Housing Stabilization Service

4 Standards Service Exclusions Service Limitations Reimbursement SELF-DIRECTION OPTION RECIPIENT REQUIREMENTS Request for Services Registry Inactive Status Verifying Request Date Level of Care Discharge Criteria RIGHTS AND RESPONSIBILITIES Freedom of Choice of Program Notification of Changes LOUISIANA medicaid PROGRAM ISSUED: 04/01/14 REPLACED: 03/01/11 CHAPTER 32: NEW OPPORTUNITIES WAIVER TABLE OF CONTENTS PAGE(S) 6 Page 4 of 6 Table of Contents Participation in Care Freedom of Choice of Support Coordination and Service Providers Voluntary Participation Compliance with Civil Rights Quality of Care Grievances/Fair Hearings Rights and Responsibilities Form SERVICE ACCESS AND AUTHORIZATION PROVIDER Selection Prior Authorization Post Authorization One Time Transitional Expenses Changes Changing Direct Service Providers Prior Authorization for New Service Providers Changing Supported Independent Living Providers Changing Support Coordination Agencies PROVIDER REQUIREMENTS Other PROVIDER Responsibilities

5 Support Coordination Providers Direct Service PROVIDER Responsibilities Individualized Service Plan Back-up Planning Emergency Evacuation Planning Residential Habilitation Supported Independent Living PROVIDER Responsibilities Day Habilitation PROVIDER Responsibilities Supported Employment PROVIDER Responsibilities Employment Related Training PROVIDER Responsibilities Professional Services Psychological PROVIDER Responsibilities Skilled Nursing Services PROVIDER Responsibilities STAFFING REQUIREMENTS Individualized and Family Support Residential Habilitation Supported Independent Living Substitute Family Care LOUISIANA medicaid PROGRAM ISSUED: 04/01/14 REPLACED: 03/01/11 CHAPTER 32.

6 NEW OPPORTUNITIES WAIVER TABLE OF CONTENTS PAGE(S) 6 Page 5 of 6 Table of Contents RECORD KEEPING Components of Record Keeping Confidentiality and Protection of Records Review by State and Federal Agencies Retention of Records Administrative and Personnel Files Recipient Records Organization of Records, Record Entries and Corrections Components of Recipient Records Service Documentation Service Logs Progress Notes Progress Summary Discharge Summary for Transfers and Closures Individualized Documentation Schedule of Required Documentation REIMBURSEMENT PROGRAM MONITORING On-Site Reviews Administrative Review Interviews Personnel Record Review Recipient Record Review PROVIDER Staff Interviews Monitoring Report Corrective Action Report Informal Dispute Resolution (Optional)

7 Fraud and Abuse Quality Management INCIDENTS, ACCIDENTS AND COMPLAINTS Internal Complaint Policy Complaint Disclosure Statement Definition of Related Terms Regarding Incidents and Complaints DEVELOPMENTAL DISABILITY LAW APPENDIX A LOUISIANA medicaid PROGRAM ISSUED: 04/01/14 REPLACED: 03/01/11 CHAPTER 32: NEW OPPORTUNITIES WAIVER TABLE OF CONTENTS PAGE(S) 6 Page 6 of 6 Table of Contents GLOSSARY APPENDIX B CONTACT INFORMATION APPENDIX C FORMS APPENDIX D BILLING CODES APPENDIX E CLAIMS FILING APPENDIX F LOUISIANA medicaid PROGRAM ISSUED: 08/25/16 REPLACED: 03/01/11 CHAPTER 32: NEW OPPORTUNITIES WAIVER SECTION.

8 OVERVIEW PAGE(S) 2 Page 1 of 2 Section OVERVIEW The New OPPORTUNITIES WAIVER (NOW) program is a medicaid WAIVER designed to provide home and community-based supports and services to recipients with developmental disabilities who require the level of care of an intermediate care facility for people with intellectual disabilities (ICF/ID). This WAIVER is operated by the Office for Citizens with Developmental Disabilities (OCDD) under the authorization of the Bureau of Health Services Financing (BHSF). Both OCDD and BHSF are agencies within the Louisiana Department of Health (LDH).

9 The objectives of the NOW program are to offer an alternative to institutionalization and promote independence and community inclusion for recipients through the provision of services. The NOW program utilizes the principles of self-determination as a foundation for supports and services and to supplement the family and/or community supports that are available to maintain the recipient in the community. The NOW program includes an array of services such as residential supports, respite, community integration and development, employment-related supports, habilitation, environmental modifications and specialized equipment, professional services, as well as other services.

10 The NOW program also includes a self-direction option which allows recipients or their authorized representative to act as the employer in the delivery of their designated self-directed services. This option provides recipients with maximum flexibility and control over their supports and services. NOW services should not be viewed as a lifetime entitlement or a fixed annual allocation. The average recipient s expenditures for all WAIVER services shall not exceed the average medicaid expenditures for ICF/ID services. Recipients have the choice of available support coordination and service PROVIDER agencies and are able to select enrolled qualified agencies through the freedom of choice process.