charting the course for waiver independence
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CHARTING THE COURSE FOR WAIVER INDEPENDENCE. Moving Cash and Counseling from the Traditional Waiver Program to the New State Plan Option. Alabama Department of Senior Services. Planning the Voyage. During Olmstead Planning, focus groups indicated strong desire to have self-direction in Alabama - PowerPoint PPT PresentationTRANSCRIPT
CHARTING THE COURSE FOR WAIVER INDEPENDENCE
Moving Cash and Counseling from the Traditional Waiver Program to the New State Plan Option
Alabama Department of Senior Services
Planning the Voyage During Olmstead Planning, focus
groups indicated strong desire to have self-direction in Alabama
Much discussion on how to accomplish Possibly combine with efforts of
other grants in Alabama – Real Choice, Medicaid Infrastructure, etc.
Application made for Cash and Counseling Project/RWJ Grant
Alabama Department of Senior Services
The Launching RWJ Grant received in 2004
Alabama was in 2nd round of grant awards Received $250,000 for assistance in start-up
Formulation of a plan Coordination with Medicaid and other state agencies on workplan
for project
Determination of need for consultant New concept for Alabama Uniqueness of program – no two states alike
Concept Paper developed Recommendation to operate program as an 1115 Research and
Development project
Alabama Department of Senior Services
Complicated Course The 1115 vs. 1915c Amendment Route
Issues with the 1915c Elderly and Disabled Waiver Concern over implementing a new concept in a large waiver Ability for one agency to test as a pilot
Rationale for the 1115 Could accomplish a small pilot program under the 1115 waiver Could carve out certain services for the program Wanted ability to give cash to participants Wanted to include Independent Living Waiver participants from the
Rehab department without having to do a separate waiver
Alabama Department of Senior Services
Leaving The Port
Workgroups formed
Concept paper submitted
1st goal to meet – achievement of budget neutrality
Alabama Department of Senior Services
Sailing Along
National Program Office (NPO) Involvement Attending Cash/Counseling meetings Participating in conference calls
Consumer Directed Module Software Project Selected as one of three states to participate Involved in selection of vendor, development of
software design, and testing
Alabama Department of Senior Services
Rough Seas Ahead Budget Neutrality
Ongoing nightmare Lengthy work sessions with
numerous state and NPO staff Took over a year to resolve
Passage of 2005 Deficit Reduction Act Potential impact for our
program
Alabama Department of Senior Services
The Calm Before the Storm 1115 Waiver submitted – 4/06
Initial questions of whether CMS would approve as an 1115 waiver because of the DRA
Numerous conversations with CMS
Were finally told by CMS that they would process as 1115
Received list of questions – 9/06
Alabama Department of Senior Services
The Storm Approaches
Waiting for word on approval
CMS conference call – 11/06 Question/Answer
clarification Told approval
forthcoming
Alabama Department of Senior Services
The Storm Hits
Received e-mail from CMS Stated proposal could not be approved as program
could be accomplished under the new state plan option of the DRA
Told to withdraw proposal and submit draft pre-print for 1915(j) or waiver would be disapproved.
Much concern - what to do? No final regulations regarding the DRA Too much work on project to just throw away
Alabama Department of Senior Services
The Sun Peaks Out
After several agonizing weeks – decision made to move forward with SPA option under the 1915(j) section
1915(j) would allow Alabama to operate program as designed under the 1115 plan
Alabama Department of Senior Services
Approaching Land
Worked closely with CMS in completion of the State Plan Amendment
Had numerous conference calls to work through the application issues
Submitted in 3/07 – almost a year after the original waiver submitted
Alabama Department of Senior Services
Docking Complete
CMS
final approval received
on
May 24, 2007!!!
Alabama Department of Senior Services
Disembarking Within a period of four months
Established Advisory Committees
Developed Operational Protocol
Developed an RFP and Selected a Financial Management Agency
Started planning for Implementation Training Enrolling clients
Alabama Department of Senior Services
Journey on Land Begins
Start Date of August 2007
1st Clients enrolled in September
Started managing budgets in November
Alabama Department of Senior Services
Trip Expectations
Goals of Program Increase access to paid personal care Increase satisfaction with services Increase overall quality of life Meet more day-to-day needs Decrease stress of families and informal
caregivers
Trip Status Extension of RWJ Grant
October 2007 - March 2008
Current Participants
Success reports Same amount of services received Money left over for special purchases/savings Purchase Examples – lift chair, air conditioner,
ceiling fan with remote, etc.
Alabama Department of Senior Services
Last Leg of the Journey
Final CMS rules/regulations
Financial impact of program
Conduction of program evaluation
Alabama Department of Senior Services
Contact Information
Alabama Department of Senior Services770 Washington Avenue RSA Plaza Suite 470
Montgomery, Alabama 36130(334) 242-5743 1-(877)-425-22431-800-AGELINE (1-800-243-5463)
Fax (334) 242-5594
Irene B. Collins, [email protected]
OrJean Stone, Division ChiefLong Term Care Programs