NEW PROCEDURES FOR AGING WAIVER APPLICATIONS …

1 NEW PROCEDURES FOR AGING WAIVER APPLICATIONS Maximus is Now the Enrollment Broker By: Dana M. Breslin, Esquire For our clients who are looking to the AGING WAIVER Program for in-home help, where do we start? What about the Husband and Wife where you need the NFCE determinations for the Snapshot Date for the Resource Assessment? These are just a few of the questions I had when I heard that Maximus was the Enrollment Broker for all of the WAIVER Programs as of April 1st. The following article sets forth what I have been advised by our Area Agency on AGING (COSA for Delaware County) as well as information which elder law attorney Leslie Wizelman learned directly from Maximus. First, if you have a married couple who are not yet ready to apply for the AGING WAIVER Program, but you want the NFCE determination, you still make the referral to the Area Agency on AGING . The AAA will continue to do the level of care determinations. For clients who are applying for WAIVER at present, contact should be made directly by calling Maximus at 1-877-550-4227.

2 If a person still calls the Area Agency on AGING , the AAA will refer them to Maximus to complete the enrollment process. Maximus will send consumers a packet via mail. Upon receipt of a completed PA-600 (the Medicaid application), Maximus will then refer them to the AAA for a Level of Care Assessment. Upon the AAA completing the Level of Care Assessment, they will e-mail a copy to Maximus and Maximus will complete the enrollment process to get the consumer enrolled in WAIVER . There are several ways anyone can make a referral to Maximus: Call 877-550-4227; Email Web Using the IRT (Information Referral Tool) Compass Application - The Project Manager at Maximus is Caryn Swartz and her email is Office number: 717-540-3115. Address: Caryn Swartz, Project Manager; Pennsylvania Independent Enrollment Broker; MAXIMUS; 6385 Flank Drive, Suite 100; Harrisburg, PA 17112. Here is link to applying online (on Maximus website): Here is a link to the Steps for WAIVER Process on Maximus website: According to the website, the exact steps to apply for WAIVER Services are as follows: Step 1 Contact the Pennsylvania Independent Enrollment Broker ( Maximus).

3 If you already have Medical Assistance, the Broker will start your WAIVER Application when you contact them. Step 2 Fill out Medical Assistance forms if you do not already have Medical Assistance. Step 3 Make sure your doctor fills out the Physician s Certification Form and HAVE YOUR FIRST IN HOME VISIT. Note: Maximius will contact your Area Agency on AGING to request the evaluation. Maximus must receive both the doctor s Certification and the finding of NFCE by the AAA within thirty (30) days after the WAIVER Application was started. Step 4 Have your second in-home visit whereby a person from Maximus will assess the client s needs and abilities to see if WAIVER services or other programs will meet client s needs. Note: After this second in-home visit Maximus will send your application to the County Assistance Office. Step 5 Send any missing information to the County Assistance Office if requested by CAO. Once the Financial Application is completed and approved or denied, the CAO will send you Notice, to the independent broker, and your chosen service coordination agency.

4 DECISION ABOUT WHETHER SOMEONE QUALIFIES WILL BE SENT TO APPLICANT WITHIN SIXTY (60) DAYS AFTER MAXIMUS STARTS THE WAIVER APPLICATION. IF APPLICANT DOES NOT GET THE DECISION WITHIN NINETY (90) DAYS, APPLICANT CAN ASK FOR A FAIR HEARING. End Result: If WAIVER application is approved, client is enrolled in home and community based WAIVER services, or if WAIVER application is denied and client disagrees, client can ask for a fair hearing. Author s question: Will your client still be alive and at home by the time the process is completed? If there are issues, you can contact the Office of Long Term Living Participant Help Line number 1-800-757-5042. Dana M Breslin is a certified elder law attorney by the National Elder Law Foundation and a fellow with the American College of Trust and Estate Counsel. She practices with the firm Pappano and Breslin in Brookhaven. She is former chair of the PBA Elder law Section and a planner for the PBI Elder Law Institute which is approaching its 19th year.

5 More importantly she has actively practiced in elder law for more years than she wishes to admit.