Update on Home and Community-Based Services Waivers

Medicaid Home and Community-Based Services (HCBS) waivers permit a state to furnish an array of home and community-based services that help Medicaid beneficiaries live in the community and avoid institutionalization.  Waivers must be renewed on a regular basis, and can be amended as part of the renewal application process. Opportunities for public input are offered prior to submitting the applications to the federal Centers for Medicare and Medicaid Services (CMS) for their consideration.

The draft waivers will remain on the DODD website, and feedback on changes made in the SELF and Transitions (TDD) applications will be accepted until March 16. Feedback on changes in the Individual Options (IO) and Level One applications will be accepted until March 23.

The waiver applications also are available as hard copies and may be requested through DODD and through local County Boards of Developmental Disabilities. Comments may be submitted by email to waiverfeedback@dodd.ohio.gov or by U.S. Mail to the Ohio Department of Developmental Disabilities, 30 E. Broad Street, 13th Floor, Columbus, OH 43215. Current renewals and amendments are noted below.

Level One waiver

Level One Waiver Amendment

Summary of changes:  The Level One waiver amendment reflects the DODD revised eligibility assessment tool for determining eligibility for the Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Level of Care (LOC) to include more relevant items, and greater specificity in describing applicant/beneficiary disability and functioning.

The amendment reflects the HCB Settings Waiver Transition Plan and HCB Settings, as it relates to this particular waiver. Conflict of interest safeguards also are addressed in the waiver amendment. In addition, Safeguards Concerning Restraints and Restrictive Interventions reflect the Department’s “Behavior Support Strategies that Include Restrictive Measures” (OAC 5123:2-2-06) that regulate the use of all restraints and restrictive measures.

Individual Options (IO) waiver

IO Waiver Amendment

Summary of changes:  The IO waiver amendment includes reserved capacity to support the transfer of individuals currently enrolled on the Transitions Developmental Disabilities (TDD) waiver to the IO waiver, and for Statewide HCBS Waiting List Reduction in accordance with Ohio’s budget initiatives.

The amendment reflects DODD’s revised eligibility assessment tool for determining eligibility for ICF/IID Level of Care (LOC) to include more relevant items, and greater specificity in describing applicant/beneficiary disability and functioning.

The amendment reflects the HCB Settings Waiver Transition Plan and HCB Settings, as it relates to this particular waiver. Conflict of interest safeguards were addressed in the waiver amendment. In addition, Safeguards concerning restraints and restrictive interventions reflect the Department’s “Behavior Support Strategies that Include Restrictive Measures” (OAC 5123:2-2-06) that regulate the use of all restraints and restrictive measures.

Transitions DD (TDD) waiver

TDD renewal application  

Summary of changes:  As part of the TDD waiver renewal, the state plans to phase out the waiver during the first two years of the waiver span. This renewal provides for the transition of individuals enrolled in the TDD waiver into Ohio’s IO, SELF, and Level One waivers. The phase-out of TDD waiver aligns with the goal of reducing the number of waivers administered in Ohio. In addition, this process will allow individuals presently enrolled in the TDD waiver to have access to a broader array of services that enhance opportunities to enjoy the full benefits of community living.

The renewal also reflects the use of DODD’s revised eligibility assessment tool for determining whether individuals meet criteria for an ICF/IID Level of Care (LOC). The new tool includes greater specificity in describing the areas in which individuals require support, and establishes a more efficient, electronic process for LOC determinations.

The state has updated quality oversight strategy and performance measures to ensure alignment with the CMS Quality Letter, dated March 12, 2014, titled “Modifications to Quality Measures and Reporting in 1915c Home and Community Based Waivers.”

In addition, the state has updated Appendix G-2: Safeguards Concerning Restraints and Restrictive Interventions to reflect the Department’s “Behavior Support Strategies that Include Restrictive Measures” (OAC 5123:2-2-06), that regulates the use of all restraints and restrictive measures.

Self Empowered Life Funding (SELF) waiver

SELF renewal application

Summary of changes: The Self Empowered Life Funding (SELF) waiver renewal reflects the use of DODD’s revised eligibility assessment tool for determining whether individuals meet criteria for an ICF/IID Level of Care (LOC). The new tool includes greater specificity in describing the areas in which individuals require support, and establishes a more efficient, electronic process for LOC determinations. The renewal includes reserved capacity for the Statewide HCBS Waiting List Reduction, in accordance with Ohio’s budget initiatives.

The state has updated the quality oversight strategy and performance measures to ensure alignment with the CMS Quality Letter, dated March 12, 2014, titled “Modifications to Quality Measures and Reporting in 1915c Home and Community Based Waivers.”

The state has updated Appendix G-2: Safeguards Concerning Restraints and Restrictive Interventions to reflect the Department’s “Behavior Support Strategies that Include Restrictive Measures” (OAC 5123:2-2-06) that regulates the use of all restraints and restrictive measures.

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