The 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. 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.
Component of the Approved Waiver | Subsection(s) |
---|---|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The waiver application consists of the following components. Note: Item 3-E must be completed.
Waiver Administration and Operation. Appendix A specifies the administrative and operational structure of this waiver.
Participant Access and Eligibility. Appendix B specifies the target group(s) of individuals who are served in this waiver, the number of participants that the State expects to serve during each year that the waiver is in effect, applicable Medicaid eligibility and post-eligibility (if applicable) requirements, and procedures for the evaluation and reevaluation of level of care.
Participant Services. Appendix C specifies the home and community-based waiver services that are furnished through the waiver, including applicable limitations on such services.
Participant-Centered Service Planning and Delivery. Appendix D specifies the procedures and methods that the State uses to develop, implement and monitor the participant-centered service plan (of care).
Participant Rights. Appendix F specifies how the State informs participants of their Medicaid Fair Hearing rights and other procedures to address participant grievances and complaints.
Participant Safeguards. Appendix G describes the safeguards that the State has established to assure the health and welfare of waiver participants in specified areas.
Quality Improvement Strategy. Appendix H contains the Quality Improvement Strategy for this waiver.
Financial Accountability. Appendix I describes the methods by which the State makes payments for waiver services, ensures the integrity of these payments, and complies with applicable federal requirements concerning payments and federal financial participation.
Cost-Neutrality Demonstration. Appendix J contains the State's demonstration that the waiver is cost-neutral.
Health & Welfare: The State assures that necessary safeguards have been taken to protect the health and welfare of persons receiving services under this waiver. These safeguards include:
As specified in Appendix C, adequate standards for all types of providers that provide services under this waiver;
Assurance that the standards of any State licensure or certification requirements specified in Appendix C are met for services or for individuals furnishing services that are provided under the waiver. The State assures that these requirements are met on the date that the services are furnished; and,
Assurance that all facilities subject to §1616(e) of the Act where home and community-based waiver services are provided comply with the applicable State standards for board and care facilities as specified in Appendix C.
Financial Accountability. The State assures financial accountability for funds expended for home and community-based services and maintains and makes available to the Department of Health and Human Services (including the Office of the Inspector General), the Comptroller General, or other designees, appropriate financial records documenting the cost of services provided under the waiver. Methods of financial accountability are specified in Appendix I.
Evaluation of Need: The State assures that it provides for an initial evaluation (and periodic reevaluations, at least annually) of the need for a level of care specified for this waiver, when there is a reasonable indication that an individual might need such services in the near future (one month or less) but for the receipt of home and community-based services under this waiver. The procedures for evaluation and reevaluation of level of care are specified in Appendix B.
Choice of Alternatives: The State assures that when an individual is determined to be likely to require the level of care specified for this waiver and is in a target group specified in Appendix B, the individual (or, legal representative, if applicable) is:
Informed of any feasible alternatives under the waiver; and,
Given the choice of either institutional or home and community-based waiver services. Appendix B specifies the procedures that the State employs to ensure that individuals are informed of feasible alternatives under the waiver and given the choice of institutional or home and community-based waiver services.
Average Per Capita Expenditures: The State assures that, for any year that the waiver is in effect, the average per capita expenditures under the waiver will not exceed 100 percent of the average per capita expenditures that would have been made under the Medicaid State plan for the level(s) of care specified for this waiver had the waiver not been granted. Cost-neutrality is demonstrated in Appendix J.
Actual Total Expenditures: The State assures that the actual total expenditures for home and community-based waiver and other Medicaid services and its claim for FFP in expenditures for the services provided to individuals under the waiver will not, in any year of the waiver period, exceed 100 percent of the amount that would be incurred in the absence of the waiver by the State's Medicaid program for these individuals in the institutional setting(s) specified for this waiver.
Institutionalization Absent Waiver: The State assures that, absent the waiver, individuals served in the waiver would receive the appropriate type of Medicaid-funded institutional care for the level of care specified for this waiver.
Reporting: The State assures that annually it will provide CMS with information concerning the impact of the waiver on the type, amount and cost of services provided under the Medicaid State plan and on the health and welfare of waiver participants. This information will be consistent with a data collection plan designed by CMS.
Habilitation Services. The State assures that prevocational, educational, or supported employment services, or a combination of these services, if provided as habilitation services under the waiver are: (1) not otherwise available to the individual through a local educational agency under the Individuals with Disabilities Education Act (IDEA) or the Rehabilitation Act of 1973; and, (2) furnished as part of expanded habilitation services.
Services for Individuals with Chronic Mental Illness. The State assures that federal financial participation (FFP) will not be claimed in expenditures for waiver services including, but not limited to, day treatment or partial hospitalization, psychosocial rehabilitation services, and clinic services provided as home and community-based services to individuals with chronic mental illnesses if these individuals, in the absence of a waiver, would be placed in an IMD and are: (1) age 22 to 64; (2) age 65 and older and the State has not included the optional Medicaid benefit cited in 42 CFR §440.140; or (3) age 21 and under and the State has not included the optional Medicaid benefit cited in 42 CFR § 440.160.
Service Plan. In accordance with 42 CFR §441.301(b)(1)(i), a participant-centered service plan (of care) is developed for each participant employing the procedures specified in Appendix D. All waiver services are furnished pursuant to the service plan. The service plan describes: (a) the waiver services that are furnished to the participant, their projected frequency and the type of provider that furnishes each service and (b) the other services (regardless of funding source, including State plan services) and informal supports that complement waiver services in meeting the needs of the participant. The service plan is subject to the approval of the Medicaid agency. Federal financial participation (FFP) is not claimed for waiver services furnished prior to the development of the service plan or for services that are not included in the service plan.
Inpatients. In accordance with 42 CFR §441.301(b)(1)(ii), waiver services are not furnished to individuals who are in-patients of a hospital, nursing facility or ICF/IID.
Room and Board. In accordance with 42 CFR §441.310(a)(2), FFP is not claimed for the cost of room and board except when: (a) provided as part of respite services in a facility approved by the State that is not a private residence or (b) claimed as a portion of the rent and food that may be reasonably attributed to an unrelated caregiver who resides in the same household as the participant, as provided in Appendix I.
Access to Services. The State does not limit or restrict participant access to waiver services except as provided in Appendix C.
Free Choice of Provider. In accordance with 42 CFR §431.151, a participant may select any willing and qualified provider to furnish waiver services included in the service plan unless the State has received approval to limit the number of providers under the provisions of §1915(b) or another provision of the Act.
FFP Limitation. In accordance with 42 CFR §433 Subpart D, FFP is not claimed for services when another third-party (e.g., another third party health insurer or other federal or state program) is legally liable and responsible for the provision and payment of the service. FFP also may not be claimed for services that are available without charge, or as free care to the community. Services will not be considered to be without charge, or free care, when (1) the provider establishes a fee schedule for each service available and (2) collects insurance information from all those served (Medicaid, and non-Medicaid), and bills other legally liable third party insurers. Alternatively, if a provider certifies that a particular legally liable third party insurer does not pay for the service(s), the provider may not generate further bills for that insurer for that annual period.
Fair Hearing: The State provides the opportunity to request a Fair Hearing under 42 CFR §431 Subpart E, to individuals: (a) who are not given the choice of home and community-based waiver services as an alternative to institutional level of care specified for this waiver; (b) who are denied the service(s) of their choice or the provider(s) of their choice; or (c) whose services are denied, suspended, reduced or terminated. Appendix F specifies the State's procedures to provide individuals the opportunity to request a Fair Hearing, including providing notice of action as required in 42 CFR §431.210.
Quality Improvement. The State operates a formal, comprehensive system to ensure that the waiver meets the assurances and other requirements contained in this application. Through an ongoing process of discovery, remediation and improvement, the State assures the health and welfare of participants by monitoring: (a) level of care determinations; (b) individual plans and services delivery; (c) provider qualifications; (d) participant health and welfare; (e) financial oversight and (f) administrative oversight of the waiver. The State further assures that all problems identified through its discovery processes are addressed in an appropriate and timely manner, consistent with the severity and nature of the problem. During the period that the waiver is in effect, the State will implement the Quality Improvement Strategy specified in Appendix H.
Notice to Tribal Governments. The State assures that it has notified in writing all federally-recognized Tribal Governments that maintain a primary office and/or majority population within the State of the State's intent to submit a Medicaid waiver request or renewal request to CMS at least 60 days before the anticipated submission date is provided by Presidential Executive Order 13175 of November 6, 2000. Evidence of the applicable notice is available through the Medicaid Agency.
Limited English Proficient Persons. The State assures that it provides meaningful access to waiver services by Limited English Proficient persons in accordance with: (a) Presidential Executive Order 13166 of August 11, 2000 (65 FR 50121) and (b) Department of Health and Human Services "Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons" (68 FR 47311 - August 8, 2003). Appendix B describes how the State assures meaningful access to waiver services by Limited English Proficient persons.
State Medicaid Director or Designee
State Line of Authority for Waiver Operation. Specify the state line of authority for the operation of the waiver (select one):
Specify the Medicaid agency division/unit that has line authority for the operation of the waiver program (select one):
In accordance with 42 CFR §431.10, the Medicaid agency exercises administrative discretion in the administration and supervision of the waiver and issues policies, rules and regulations related to the waiver. The interagency agreement or memorandum of understanding that sets forth the authority and arrangements for this policy is available through the Medicaid agency to CMS upon request. (Complete item A-2-b).
Oversight of Performance.
Role of Local/Regional Non-State Entities. Indicate whether local or regional non-state entities perform waiver operational and administrative functions and, if so, specify the type of entity (Select One):
Function | Medicaid Agency | Other State Operating Agency |
---|---|---|
Participant waiver enrollment | ||
Waiver enrollment managed against approved limits | ||
Waiver expenditures managed against approved levels | ||
Level of care evaluation | ||
Review of Participant service plans | ||
Prior authorization of waiver services | ||
Utilization management | ||
Qualified provider enrollment | ||
Execution of Medicaid provider agreements | ||
Establishment of a statewide rate methodology | ||
Rules, policies, procedures and information development governing the waiver program | ||
Quality assurance and quality improvement activities |
Performance Measures
Where possible, include numerator/denominator.
For each performance measure, provide information on the aggregated data that will enable the State to analyze and assess progress toward the performance measure. In this section provide information on the method by which each source of data is analyzed statistically/deductively or inductively, how themes are identified or conclusions drawn, and how recommendations are formulated, where appropriate.
Performance Measure:
Number and percentage of DSPD reports specified in the implementation plan that were submitted to the SMA on time and in the correct format. The numerator is the number of reports submitted to the SMA by the OA in the proper format and within required time frames; the denominator is the total number of all reports submitted to the SMA by the OA.
Data Aggregation and Analysis:
|
||||||||||||||||||||||||||||||||||||
Performance Measure:
Number and percentage of documents submitted and approved by the SMA using the Document Submittal Protocol prior to implementation. The numerator is the total number of documents that were appropriately submitted by the OA; the denominator includes both the number of documents that were correctly submitted and any documents that were not correctly submitted for SMA review prior to implementation.
Data Aggregation and Analysis:
|
||||||||||||||||||||||||||||||||||||
Performance Measure:
Number and percentage of maximum allowable rates (MARs) for covered Waiver services approved by the SMA. The numerator is the total number of service codes for which the SMA has approved the payment rate prior to their use; the denominator is the total number of MARs allowed in the program.
Data Aggregation and Analysis:
|
||||||||||||||||||||||||||||||||||||
Performance Measure:
Number and percentage of participants who have been denied access to the Medicaid waiver program, who were provided timely notice of appeal rights. The numerator is the total number of participants who were denied and received a timely notice of appeal rights; the denominator includes these individuals along with those who may have been denied but did not receive a timely notice.
Data Aggregation and Analysis:
|
||||||||||||||||||||||||||||||||||||
Performance Measure:
Number and percentage of participants who have a) had a reduction/denial of a waiver service; b) been denied choice of provider if more than one was available; or c) been determined ineligible when previously receiving services; who were provided timely notice of appeal rights. Numerator = the number of compliant cases; Denominator = total number of cases with or without timely notification.
Data Aggregation and Analysis:
|
Responsible Party(check each that applies): | Frequency of data aggregation and analysis(check each that applies): |
---|---|
|
|
|
|
|
|
|
|
|
|
|
Target Group | Included | Target SubGroup | Minimum Age | Maximum Age | |
---|---|---|---|---|---|
Maximum Age Limit | No Maximum Age Limit | ||||
|
|||||
Aged | |||||
Disabled (Physical) | |||||
Disabled (Other) | |||||
|
|||||
Brain Injury | |||||
HIV/AIDS | |||||
Medically Fragile | |||||
Technology Dependent | |||||
|
|||||
Autism | |||||
Developmental Disability | |||||
Intellectual Disability | |||||
|
|||||
Mental Illness | |||||
Serious Emotional Disturbance | |||||
|
The limit specified by the State is (select one)
The cost limit specified by the State is (select one):
The dollar amount (select one)
Answers provided in Appendix B-2-a indicate that you do not need to complete this section.
Waiver Year | Unduplicated Number of Participants |
Year 1 | |
Year 2 | |
Year 3 | |
Year 4 | |
Year 5 |
Waiver Year | Maximum Number of Participants Served At Any Point During the Year |
Year 1 | |
Year 2 | |
Year 3 | |
Year 4 | |
Year 5 |
Purposes | |
---|---|
Relief of Primary Caregiver |
Appendix B: Participant Access and EligibilityB-3: Number of Individuals Served (2 of 4)
|
Select one:
Answers provided in Appendix B-3-d indicate that you do not need to complete this section.
Select one:
Check each that applies:
Select one:
Select one:
In accordance with 42 CFR §441.303(e), Appendix B-5 must be completed when the State furnishes waiver services to individuals in the special home and community-based waiver group under 42 CFR §435.217, as indicated in Appendix B-4. Post-eligibility applies only to the 42 CFR §435.217 group.
Use of Spousal Impoverishment Rules. Indicate whether spousal impoverishment rules are used to determine eligibility for the special home and community-based waiver group under 42 CFR §435.217:
In the case of a participant with a community spouse, the State elects to (select one):
Regular Post-Eligibility Treatment of Income: SSI State.
The State uses the post-eligibility rules at 42 CFR 435.726 for individuals who do not have a spouse or have a spouse who is not a community spouse as specified in §1924 of the Act. Payment for home and community-based waiver services is reduced by the amount remaining after deducting the following allowances and expenses from the waiver participant's income:
Allowance for the needs of the waiver participant (select one):
Select one:
(select one):
Allowance for the spouse only (select one):
Specify the amount of the allowance (select one):
Allowance for the family (select one):
Amounts for incurred medical or remedial care expenses not subject to payment by a third party, specified in 42 §CFR 435.726:
Select one:
Regular Post-Eligibility Treatment of Income: 209(B) State.
Answers provided in Appendix B-4 indicate that you do not need to complete this section and therefore this section is not visible.
Post-Eligibility Treatment of Income Using Spousal Impoverishment Rules
The State uses the post-eligibility rules of §1924(d) of the Act (spousal impoverishment protection) to determine the contribution of a participant with a community spouse toward the cost of home and community-based care if it determines the individual's eligibility under §1924 of the Act. There is deducted from the participant's monthly income a personal needs allowance (as specified below), a community spouse's allowance and a family allowance as specified in the State Medicaid Plan. The State must also protect amounts for incurred expenses for medical or remedial care (as specified below).
Allowance for the personal needs of the waiver participant
(select one):
If the allowance for the personal needs of a waiver participant with a community spouse is different from the amount used for the individual's maintenance allowance under 42 CFR §435.726 or 42 CFR §435.735, explain why this amount is reasonable to meet the individual's maintenance needs in the community.
Select one:
Amounts for incurred medical or remedial care expenses not subject to payment by a third party, specified in 42 CFR §435.726:
Select one:
Regular Post-Eligibility Treatment of Income: SSI State - 2014 through 2018.
Answers provided in Appendix B-5-a indicate the selections in B-5-b also apply to B-5-e.
Regular Post-Eligibility Treatment of Income: 209(B) State - 2014 through 2018.
Answers provided in Appendix B-4 indicate that you do not need to complete this section and therefore this section is not visible.
Post-Eligibility Treatment of Income Using Spousal Impoverishment Rules - 2014 through 2018.
The State uses the post-eligibility rules of §1924(d) of the Act (spousal impoverishment protection) to determine the contribution of a participant with a community spouse toward the cost of home and community-based care. There is deducted from the participant's monthly income a personal needs allowance (as specified below), a community spouse's allowance and a family allowance as specified in the State Medicaid Plan. The State must also protect amounts for incurred expenses for medical or remedial care (as specified below).
Reasonable Indication of Need for Services. In order for an individual to be determined to need waiver services, an individual must require: (a) the provision of at least one waiver service, as documented in the service plan, and (b) the provision of waiver services at least monthly or, if the need for services is less than monthly, the participant requires regular monthly monitoring which must be documented in the service plan. Specify the State's policies concerning the reasonable indication of the need for services:
Minimum number of services.
The state demonstrates that it implements the processes and instrument(s) specified in its approved waiver for evaluating/reevaluating an applicant's/waiver participant's level of care consistent with level of care provided in a hospital, NF or ICF/IID.
Sub-assurance: An evaluation for LOC is provided to all applicants for whom there is reasonable indication that services may be needed in the future.
Performance Measures
For each performance measure the State will use to assess compliance with the statutory assurance (or sub-assurance), complete the following. Where possible, include numerator/denominator.
For each performance measure, provide information on the aggregated data that will enable the State to analyze and assess progress toward the performance measure. In this section provide information on the method by which each source of data is analyzed statistically/deductively or inductively, how themes are identified or conclusions drawn, and how recommendations are formulated, where appropriate.
Performance Measure:
Number and percentage of new participants that have been determined to meet Intermediate Care Facility for People with Intellectual Disabilities (ICF/ID) Level of Care (LOC) prior to admission to the waiver. Numerator = the number of new participants that were determined to meet ICF/ID LOC prior to admission to the waiver; Denominator = the total number of new participants admitted to the waiver.
Data Aggregation and Analysis:
|
Sub-assurance: The levels of care of enrolled participants are reevaluated at least annually or as specified in the approved waiver.
Performance Measures
For each performance measure the State will use to assess compliance with the statutory assurance (or sub-assurance), complete the following. Where possible, include numerator/denominator.
For each performance measure, provide information on the aggregated data that will enable the State to analyze and assess progress toward the performance measure. In this section provide information on the method by which each source of data is analyzed statistically/deductively or inductively, how themes are identified or conclusions drawn, and how recommendations are formulated, where appropriate.
Sub-assurance: The processes and instruments described in the approved waiver are applied appropriately and according to the approved description to determine participant level of care.
Performance Measures
For each performance measure the State will use to assess compliance with the statutory assurance (or sub-assurance), complete the following. Where possible, include numerator/denominator.
For each performance measure, provide information on the aggregated data that will enable the State to analyze and assess progress toward the performance measure. In this section provide information on the method by which each source of data is analyzed statistically/deductively or inductively, how themes are identified or conclusions drawn, and how recommendations are formulated, where appropriate.
Performance Measure:
Number and percentage of Health Status Screenings conducted when a substantial change in health status occurs and/or at the conclusion of an inpatient stay in a medical institution to determine an ongoing need for ICF/ID LOC. Numerator = # of events in compliance; Denominator = total # of events requiring a health status change screening.
Data Aggregation and Analysis:
|
||||||||||||||||||||||||||||||||||||
Performance Measure:
When indicated by a Health Status Screening resulting from an inpatient stay/health change due to functional limitations, # & % of participant reevaluations of LOC and/or supports received ensuring eligibility requirements and ongoing needs can be met by the waiver. Numerator=# of reevaluations correctly conducted;Denominator=# of Health Status Screenings demonstrating a reevaluation is necessary.
Data Aggregation and Analysis:
|
||||||||||||||||||||||||||||||||||||
Performance Measure:
Number and percentage of Level of Care (LOC) initial evaluations and reevaluations conducted by a Qualified Intellectual Disability Professional (QIDP) certified by DSPD. The numerator is the number of LOC initial evaluations and reevaluations which were performed by a QIDP certified by DSPD; the denominator is the total number of LOC initial evaluations and reevaluations performed and reviewed.
Data Aggregation and Analysis:
|
||||||||||||||||||||||||||||||||||||
Performance Measure:
Number and percentage of Level of Care (LOC) determinations documented in USTEPS. The numerator is the number of LOC determinations reviewed and then documented in USTEPS; the denominator is the total number of LOC determinations reviewed.
Data Aggregation and Analysis:
|
||||||||||||||||||||||||||||||||||||
Performance Measure:
Number and percentage of 927 forms, Home and Community-Based Waiver Referrals, on which the effective date of the applicant’s Medicaid eligibility determination and effective date of the applicant’s Level of Care eligibility determination are documented. The numerator = # of 927 forms reviewed and correctly completed;the denominator = the total # of applicants for whom a 927 form was reviewed.
Data Aggregation and Analysis:
|
Responsible Party(check each that applies): | Frequency of data aggregation and analysis(check each that applies): |
---|---|
|
|
|
|
|
|
|
|
|
|
|
Service Type | Service | ||
---|---|---|---|
Statutory Service | Day Supports | ||
Statutory Service | Homemaker | ||
Statutory Service | Personal Care | ||
Statutory Service | Residential Habilitation | ||
Statutory Service | Respite Care - Intensive | ||
Statutory Service | Supported Employment | ||
Statutory Service | Waiver Support Coordination | ||
Supports for Participant Direction | Financial Management Services | ||
Other Service | Behavior Consultation I | ||
Other Service | Behavior Consultation II | ||
Other Service | Behavior Consultation III | ||
Other Service | Chore Services | ||
Other Service | Companion Services | ||
Other Service | Environmental Adaptations | ||
Other Service | Extended Living Supports | ||
Other Service | Family and Individual Training and Preparation Services | ||
Other Service | Family Training and Preparation Services | ||
Other Service | Living Start-Up Costs | ||
Other Service | Massage Therapy | ||
Other Service | Personal Budget Assistance | ||
Other Service | Personal Emergency Response System | ||
Other Service | Professional Medication Monitoring | ||
Other Service | Respite Care - Routine Group | ||
Other Service | Respite Care - Routine | ||
Other Service | Respite Care - Session | ||
Other Service | Service Animal | ||
Other Service | Specialized Medical Equipment/Supplies/Assistive Technology - Monthly Fee | ||
Other Service | Specialized Medical Equipment/Supplies/Assistive Technology - Purchase | ||
Other Service | Supported Living | ||
Other Service | Transportation Services (non-medical) |
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
The waiver provides for participant direction of services as specified in Appendix E. Indicate whether the waiver includes the following supports or other supports for participant direction.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|
|||||||||||||||||||||
Appendix C: Participant ServicesC-1/C-3: Service Specification
State laws, regulations and policies referenced in the specification are readily available to CMS upon request through the Medicaid agency or the operating agency (if applicable).
As provided in 42 CFR §440.180(b)(9), the State requests the authority to provide the following additional service not specified in statute.
HCBS Taxonomy:
Service Delivery Method (check each that applies): Specify whether the service may be provided by (check each that applies):
|