Medicaid Waiver. Generally, a waiver of existing law authorized under Section 1115(a), 1115A, or 1915 of the Social Security Act.
Medicaid Waiver. Generally, a waiver of existing law authorized under Section 1115(a), 1115A, or 1915 of the Social Security Act. A Section 1115(a) waiver is also referred to as a demonstration.
Medicaid Waiver refers to the two (2) North Carolina Medicaid Section 1915(c) Home and Community-Based Services (HCBS) waivers: the North Carolina Innovations waiver for individuals with Intellectual and Developmental Disabilities (I/DD) and the (Traumatic Brain Injury (TBI) waiver for individuals with a TBI in limited geographies. The Innovations and TBI waivers provide a community-based alternative to institutional care for PIHP’s Members who meet medical necessity for an institutional level of care.
Medicaid Waiver. The State intends to align as many aspects of the three programs as possible, while acknowledging that some differences will continue to exist. The two existing programs, Safe at Home (a Title IV-E child welfare program) and the Bureau of Behavioral Health’s (BBH) Children’s Mental Health Wraparound, currently serve different populations and use different provider networks, though some providers are providers of both currently operating programs. Regarding the third Wraparound program, with the 1915(c) waiver in near-final negotiation with Centers for Medicare & Medicaid Services (CMS), some initial provider network development has occurred for the 1915(c), with additional work planned to commence once the waiver is finalized. The 1915(c) Wraparound program may share some providers with the existing programs as well.
Medicaid Waiver. ■ Proposed Regulations ❑ The Department issued draft regulations for the Home and Community Based Services, Title 480 in 2016. ❑ Nebraska Health Care Association submitted comments. ❑ The proposed regulations provided definition for “Resident Service Agreement.” ❑ No action yet.
Medicaid Waiver. ❑ The regulation states:
Medicaid Waiver. Generally, a waiver of existing law authorized under Section 1115(a), 1115A, or 1915 of the Social Security Act. A Section 1115(a) waiver is also referred to as a demonstration. Medicare – Title XVIII of the Social Security Act, the Federal health insurance program for people age 65 or older, people under 65 with certain disabilities, and people with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). Medicare Waiver – Generally, a waiver of existing law authorized under Section 1115A of the Opt Out – A process by which an eligible individual can choose not to participate in the Demonstration. Passive Enrollment – An enrollment process through which an eligible individual is enrolled by the State (or its vendor) into an MMP, when not affirmatively electing one, following a minimum 60-day advance notification that includes the plan selection and the opportunity to select a different MMP, if applicable; make another enrollment decision; or opt out of the Demonstration prior to the effective date.
Medicaid Waiver. Generally, a waiver of existing law authorized under Section 1115(a), 1115A, or 1915 of the Social Security Act. A Section 1115(a) waiver is also referred to as a demonstration. Medicare – Title XVIII of the Social Security Act, the Federal health insurance program for people age 65 or older, people under 65 with certain disabilities, and people with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). Medicare Waiver – Generally, a waiver of existing law authorized under Section 1115A of the Social Security Act. New York State Department of Health (NYSDOH) – The agency responsible for administering the Medicaid program in the State of New York and the terms of this Demonstration in collaboration with OPWDD. New York State Office of Mental Health (OMH) – The agency responsible for operating psychiatric centers across the State and regulating, certifying, and overseeing more than 4,500 programs, which are operated by local governments and nonprofit agencies. These programs include various inpatient and outpatient programs, emergency, community support, residential and family care programs. New York State Office of Temporary and Disability Assistance (OTDA) – The agency responsible for conducting State Medicaid fair hearings and supervising programs that provide assistance and support to eligible families and individuals. New York State Office of the Medicaid Inspector General – The agency responsible for enhancing the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices within the Medicaid program and recovering improperly expended Medicaid funds while promoting high quality patient care. New York State Office for People with Developmental Disabilities (OPWDD) – The agency responsible for all services defined as OPWDD Services (see definition below) for persons with developmental disabilities and for collaborating with the NYSDOH and CMS on the administration of the FIDA-IDD Demonstration. Nursing Facility Clinically Eligible – A standard of eligibility for care in a nursing facility, based on an individual’s care needs and functional, cognitive, and medical status as determined upon completion of the NYSDOH/OPWDD Approved Assessment Tool.
Medicaid Waiver. Generally, a waiver of existing law authorized under Section 1115(a), 1115A, or 1915 of the Social Security Act as approved by the Secretary of Health and Human Services or his/her designee. Medicare Waiver – Generally, a waiver of existing law authorized under Section 1115A of the Social Security Act. Minimum Data Set (MDS) – Part of the federally-mandated process for assessing individuals receiving care in certified skilled nursing facilities in order to record their overall health status regardless of payer source. The process provides a comprehensive assessment of individuals’ current health conditions, treatments, abilities, and plans for discharge. The MDS is administered to all residents upon admission, quarterly, yearly, and whenever there is a significant change in an individual’s condition. Section Q is the part of the MDS designed to explore meaningful opportunities for nursing facility residents to return to community settings. Beginning October 1, 2010, all Medicare and Medicaid certified nursing facilities were required to use the MDS 3.0. Money Follows the Person (MFP) – A Demonstration project designed to create a system of LTSS that better enables individuals to transition from certain long term care institutions into the community. In Washington, MFP is called Roads to Community Living. Opt-in Enrollment – The processes by which an Enrollee who is eligible for the Demonstration actively takes an action to enroll in a MMIP. This process includes transfers from one MMIP to another. Such processes include completion of an enrollment process (internet or phone) or an enrollment form, when requested in order to become an Enrollee of a MMIP. Opt Out – A process by which an Enrollee can choose not to participate in the Demonstration. Patient Activation Measure (XXX) – The Patient Activation Measure® (XXX®) assessment gauges a consumer’s knowledge, skills and confidence in managing his/her own health and healthcare. The XXX assessment segments consumers into one of four progressively higher activation levels. Each level addresses a broad array of self-care behaviors and offers deep insight into the characteristics that drive health activation. A XXX score can also predict healthcare outcomes including medication adherence, ER utilization and hospitalization. Parties – CMS and the State of Washington. Passive Enrollment – An enrollment process through which an eligible beneficiary is enrolled by the State into a MMIP, when not otherwise affirmativ...
Medicaid Waiver. Generally, a waiver of existing law authorized under Section 1115(a), 1115A, or 1915 of the Social Security Act. Medically Necessary Services – Services must be provided in a way that provides all protections to covered individuals provided by Medicare and Michigan Medicaid. Per Medicare, services must be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, or otherwise medically necessary under 42 U.S.C. 1395y. Per Medicaid, determination that a specific service is medically (clinically) appropriate, necessary to meet needs, consistent with the person’s diagnosis, symptomatology and functional impairments, is the most cost-effective option in the least restrictive environment, and is consistent with clinical standards of care. Medical necessity includes, but is not limited to, those services and supports designed to assist the person to attain or maintain a sufficient level of functioning to enable the person to live in his or her community. Medicare – Title XVIII of the Social Security Act, the federal health insurance program for people age 65 or older, people under 65 with certain disabilities, and people with End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). Medicare Medicaid Assistance Program (MMAP) – MMAP is Michigan’s State Health Insurance Program (SHIP) that assists individuals in understanding the Medicare and Medicaid programs and provides enrollment assistance to persons seeking guidance on health care options. Medicare-Medicaid Coordination Office – Formally the Federal Coordinated Health Care Office, established by Section 2602 of the Affordable Care Act. Medicare-Medicaid Enrollees – For the purposes of this Demonstration, individuals who are enrolled in Medicare Parts A, B and D and Medicaid and no other comprehensive private or public health coverage. Medicare Waiver – Generally, a waiver of existing law authorized under Section 1115A of the Social Security Act. Medication Review and Reconciliation –This includes the review of a medication regimen (including prescribed medication, over-the-counter medications, and herbal supplements) to ensure it is appropriate for the individual, determine appropriate use, identify potential medication interactions, protect the individual against over-medication, and possibly educate and MI Choice – Michigan’s existing Medicaid 1915 (c) home and community based services waiver for individuals who are e...
