Medicaid waiver changes OK'd
The proposed manual that guides how the program is carried out was posted online Thursday and is open for a 30-day comment period.
The Medicaid Title XIX Intellectual/Developmental Disability (IDD) Waiver program is intended to help clients maintain independent lives and stay out of institutions. It serves about 4,500 West Virginians.
DHHR has said it is cutting services to operate within its
Clients, families and providers have feared that the proposed changes would lead some clients into institutions, or some families onto welfare to keep their loved ones out of institutions. As chronicled in numerous stories in
BMS last week received CMS approval for its five-year application for the program, which it submitted in May. The application contains the proposed changes, which will be implemented in the manual BMS posted Thursday.
DHHR explains
CMS reviewed the application, Samples said, and requested some changes. "The changes ... were minimal, with the biggest change being the requirement that there be fully independent service coordination and that service coordinators who work for an agency which also provides direct care services may not self-refer an IDDW member to their own agency or use their influence to affect the IDDW member's right of choice."
The manual, based on the approved waiver application, is posted on the BMS website (dhhr.wv.gov/ bms/Public%20Notices/ Pages/default.aspx -- under its "Public Notices" link) for the 30-day public comment period, through5 p.m.
Once the comment period ends, Samples said, any revisions not in conflict with the application will be made and the waiver will be implemented with an expected effective date of
The waiver application is 214 pages. The manual is more than 120 pages.
"We encourage stakeholders to provide DHHR additional ideas to help the program operate within its budget, so that more members can be served; specifically, ideas around fraud, waste and abuse," Samples said.
No changes planned
Families concerned about service cuts may find any comments about them going nowhere. APS said in its announcement, "The limits and amounts of services will not be changed due to public comments because these amounts have been approved by CMS."
APS will hold seven training sessions around the state, including one set at the
Perone had cited a client named Seth to highlight why that's a problem. Seth has spastic quadriplegia, is fed through feeding tubes and needs constant nursing care. He is happy and has a good sense of humor, but he'll never hold a job. The kind of work he could do -- feeding a paper shredder with some help -- would be worthless and an affront to his dignity.
Looking over the manual on Thursday, she said, "They have not changed a thing. It still goes away for each person in three years. This means that in three years, we have to pretend to do Pre-Vocational Services for people like Seth and then try to get him a job making minimum wage. The alternative is to start billing a Person Centered Support code that pays half of what the Day Hab code pays and try to keep the Day Programs going so that people don't have that service ripped away from them. It doesn't look good for our waiver guys."
Perone noted that DHHR's rules seem to be in conflict with the CMS goal of integrating people into their communities. "This three-year-and-out thing belongs solely to DHHR. and I am forced to conclude that it's about the money. They are trying to cut the
Fears abound
"The fear is palpable out there," he said. "People are afraid of being institutionalized. ... They are fearful the state is going backwards." Some have already seen adverse actions against family members on the waiver.
(Some of those actions, such as clients being forced out of their homes into institutional care, have been described in stories in
DHHR's cuts, Wiseman said, appear to have created a paradox. "While the federal requirement is to move to more integrated individual settings, people are reporting that new changes from
CMS says those services are meant to "provide full access to the benefits of community living and offer services in the most integrated settings ... to increase opportunities for Americans with disabilities and older adults to enjoy meaningful community living. Under the final rule,
The rule includes a transitional period for states to ensure their programs meet CMS requirements. Wiseman noted that the APS training agenda includes a state transition plan and timelines, and said he'll be curious to see how that's addressed.
As previously reported, Sen.
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