Community Alternatives Program 1915c HCBS Waiver August 17

Community Alternatives Program 1915(c) HCBS Waiver August 17, 2016 Department of Health and Human Services Stakeholder Engagement

Implementing an extended waiver • How to apply utilization limits in an extended waiver • Waitlist – A state specifies the maximum number of unduplicated participants who will be served during each year the waiver is in effect. – The limit on the number of individuals who participate in the waiver may result in a waiting list for waiver services. Eligible applicants must be deferred until capacity becomes available as a result of turnover or the appropriation of additional funding. CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement 2

Implementing an extended waiver • Modifications – The total cost of modifications cannot exceed the approved amount over the life (CMS approved 5 year waiver cycle) of the waiver. Participants not in the waiver for the full five years will receive the benefit prorated to 1/5 of the amount/each year of participation. – Each year of participation – 1 year from CAP effective date o 7/01/2010 -6/30/2015 = $10, 000 o 7/01/2011 -6/30/2015 = $8, 000 o 7/01/2012 -6/30/2015 = $6, 000 o 7/01/2013 -6/30/2015 = $4, 000 o 7/01/2014 -6/30/2015 = $2, 000 o 7/01/2015 -6/30/2016 = $2, 000 o 6/30/2016 -new waiver is approved = $2, 000 – The waiver entry year will be used to assess the amount for modifications going forward and will retro back to April 2016 CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement 3

CAP/C waiver amendment proposal • Overview of the proposed changes and their impact • Determination of CAP nursing and nurse aide hours CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement 4

Service provision comparison Waiver Services State Plan Services Cap Nursing • Cap Nursing Private Duty Nursing • Private Nursing – Nurse to individuals a Nurse care tocare individuals with awith skilled need that requires every 2 -4 need that requires intervention hours intervention every 2 -4 hours Nurse to individual with a need Nurse–care to care individual with a skilledintervention need that requires every 2 -4 hours intervention every 2 -4 hours • In-Home Care • Personal Care – Personal care to individuals with – Personal and home maintenance Personal care to individuals with two or Personal andtohome maintenance care to two or more limited to extensive care individuals with limited more limited to of extensive Activities with ADLs and Activities Daily Living (ADLs)of Daily individuals ADLs andlimited Instrumental Activities of Living needs (ADLs) needs Instrumental Activities of Daily Living (IADLs) needs – No comparable service • Pediatric Nurse Aide – Personal care to individuals with No comparable service twocare or more extensive with ADLstwo needs Personal to individuals or that falls in the Nursing Assistant more extensive ADLs needs that fall in the (NA) I and NA II categories Nursing Assistant (NA) I and NA II categories CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement 5

Service provision comparison Waiver Services Respite State Plan Services No comparable service Temporary relief for waiver beneficiary or primary caregiver Case Management Not available in North Carolina’s SPA Coordinating activities of assessing, care planning, monitoring, linking, referring and follow-up to maintain community integration and inclusion Comparable services offered through other resource agencies that provide case management • Children’s Developmental Service agencies • Department of Social Services • Private Duty Nursing agencies CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement 6

Next Steps Meeting the needs of medically fragile children • Waiver services supplement rather than replace informal and formal supports, so how do we: – Structure needed supports within waiver guidelines and comply with the Social Security Act? – Manage care needs and maintain cost-neutral service provisions? – Use Medicaid to its fullest to optimize cost-neutral service provisions? • What supports are needed and how much? • What supports are available? • How do we leverage available supports? CAP/C 1915 (c) HCBS Waiver Stakeholder Engagement 7