hcbs waiver provider application
Request Information (1 of 3) The State of Michigan requests approval for a Medicaid home and community-based services (HCBS) waiver under the authority of §1915(c) of the Social Security Act (the Act). All existing HCBS Medicaid Waiver providers requesting add-on waiver services are to submit a Supplemental Letter of Intent that includes initial PCR results, if applicable. between services and the HCBS is delivered as a discrete service from other funded/licensed services. It includes actions that . For first time applicants requesting provider enrollment into the DDA Home and Community Based Services (HCBS) Medicaid Waiver Program, the instructions to complete a Waiver Provider Application and other pertinent information is outlined in the General Provisions. Miscellaneous Documentation This form only gathers feedback about the website. What services your company would like to work toward providing in the future as a DDA Home and Community Based Services (HCBS) Medicaid Waiver provider. The provider enrollment process begins with the submission of the completed MassHealth provider application along with the other forms listed on this page to the University of Massachusetts (UMass) HCBS Provider Network Administration Unit. HCBS: Caregiver Family Supports and Services, Crisis Respite, Planned Respite, Supported Employment, Community Self–Advocacy Training and Support, Habilitation, Palliative Care, Prevocational Services. A waiver is a program that provides services that allow individuals to remain in their own homes or live in a community setting, instead of in an institution. Revised Abbreviated Notice - 5/20/20. HCBS Waiver Nurse Provider – RN and LVN (Individual Nurse Provider) Contact the UMass HCBS Provider Network Administration Unit for assistance in determining which information is required. Providers may obtain more information about how to enroll or assistance with the enrollment process by contacting: UMass Provider Network Administration Unit What are Home and Community Based Waiver and Alternative Care Programs? DHS obtains permission from the federal government to offer services that exceed limitations of the regular Minnesota Medicaid program but do not exceed the comparable cost … Each waiver is designed for individuals with similar needs and offers a different set of services. This draft is now also available for public comment. be utilized . Please do not place my name on a list for additional individuals. by the . Home and community based services (HCBS) provide opportunities for Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings. Revised Abbreviated Notice - 5/20/20. In addition, providers must meet applicable MRC/DDS standards for the service(s) they provide. Application for a §1915(c) Home and Community-Based Services Waiver . Application for a §1915(c) Home and Community-Based Services Waiver . 3.6): Download version 3.6 … Form 470-2917 – Medicaid HCBS Waiver Provider Application (Sections: I and III. The program permits a State to furnish an array of home and community … If any field is not applicable, please enter N/A. 1915(c) HCBS Waiver Application - 3/6/20. Application for a §1915 (c) HCBS Waiver HCBS Waiver Application Version 3.3 Submitted by: State of California Department of Health Services. Shrewsbury, MA 01545. Comprehensive Home and Community-Based Services (1915-c HCBS) Waiver The Home and Community Based Services Waiver is the Medicaid program that provides opportunities for adults and children with intellectual and developmental disabilities to receive services in their own home or community. stand. HCBS Service Application Staff Title: The title of the position that will be providing or supervising the delivery of the specific HCBS. A. Version 3.0 – Unofficial Draft – March 2005. (See HCBS waiver manual, Section 1. Revise provider qualifications Increase/decrease number of participants Revise cost neutrality demonstration Add participant-direction of services Other Specify: B. You will be notified by letter when the process is complete and your waiver billing number is assigned. 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. Request Information (1 of 3) Application for 1915(c) HCBS Waiver: CA.0336.R04.14 - Jan 01, 2021 … 18) Maintain compliance with Federal, State and local laws, including HCBS Waiver Services Provider Manual (BI, CAC, CADI and DD waivers) and Elderly Waiver (EW) and Alternative Care (AC) Program Provider Manual.The HCBS Waiver Services Provider Manual includes information about eligible providers, enrollment, MN-ITS, covered/non-covered services, authorization and billing. To be eligible for any HCBS program, you must meet Medicaid guidelines and HCBS program-specific eligibility guidelines. Background: This. Do not use a pencil. HCBS programs allow members to live in a community setting and avoid institutional placement. request amendment to its approved waiver. DHS manages the HCBS waiver programs under the authority of the Minnesota Legislature. HCBS Waiver Provider Application Basic Information To avoid delays in the application process, you should: Complete all required forms listed below. Application for 1915(c) HCBS Waiver: NC.0132.R07.00 - Nov 01, 2019 Page 4 of 308 09/25/2019 . For information on becoming one of the following HCBS waiver providers or to request an application, please contact Provider Enrollment at (916) 552-9105. Alabama Department of Mental Health Division of Developmental Disabilities Service Regions - 3/6/20. during emergency situations. Providers may enroll in MassHealth to provide some of the services under the four home- and community-based service waivers described below. This application will become part of, and is incorporated by reference into, the provider agreement between this applicant and MassHealth. Section 1915 (c) Home and Community-based Services (HCBS) Waivers provide opportunities for Medicaid beneficiaries to receive services in their own home or community. Specify: € Application for a §1915(c) Home and Community-Based Services Waiver 1. Waiver Survey and Certification: 512-438-4163 or WaiverSurvey.Certification@dads.state.tx.us; Community Services regional contacts for your region; HCBS information on Texas Health and Human Services Commission and Texas Department of State Health Services programs [YES Waiver, 1915(k) and 1915(i)]: Medicaid_HCBS_Rule@hhsc.state.tx.us Send the completed provider enrollment documentation to: University of Massachusetts Medical School Those providing only vehicle modification, home accessibility adaptations, or transitional assistance services must contract through the Massachusetts Rehabilitation Commission (MRC). Application for 1915(c) HCBS Waiver: MD.1466.R01.01 - Dec 01, 2019 (as of Dec 01, 2019) Page 2 of 285 11/18/2019. Application for 1915(c) HCBS Waiver: Draft TX.033.06.02 - Aug 31, 2020 Page 2 of 317 04/14/2020. We will use this information to improve the site. Providers of certain services will be required to submit additional information (for example, licenses, certifications, or letters of verification). The Medicaid Home and Community-Based Services (HCBS) waiver program is authorized in §1915(c) of the Social Security Act. s. tate . C. Application for 1915(c) HCBS Waiver: Draft AL.013.02.00 - Apr 01, 2021 Page 3 of 190 12/22/2020 Page 1 of 245 . Links & Downloads . Application for 1915(c) HCBS Waiver: PA.0235.R05.09 - Jan 01, 2020 (as of Jan 01, 2020) Page 4 of 358 11/18/2019 € A program authorized under §1915(i) of the Act. APPENDIX K: Emergency Preparedness and Response. Print proof of completion to submit with your application request. be utilized . Background: This. during emergency situations. If the provider does not already have an OMH Facility Code, call the help desk at (518) 474–5554 or (800) HELP–NYS and request access to the "Children´s SPA/HCBS online designation application". may. The MassHealth provider enrollment process includes completing and submitting the forms listed below. Interested organizations and licensed clinicians must refer to the waiver service descriptions and rules for detailed requirements to become enrolled as a Home and Community Based Services (HCBS) Medicaid Waiver Provider. Maryland Department of Health (MDH) Programs . Original Abbreviated Notice - 3/6/20. Indiana offers eight Medicaid Home- and Community-Based Services programs that target specific groups. 1915 (c) Waiver Application & 372 Reports - Click the link to access the web-based 1915 (c) Waiver Application The Medicaid Home and Community-Based services (HCBS) waiver program is authorized in §1915 (c) of the Social Security Act. Application for 1915(c) HCBS Waiver: PA.0279.R05.00 - Jul 01, 2018. Your feedback will not receive a response. A waiver is a program that provides services that allow individuals to remain in their own homes or live in a community setting, instead of in an institution. Those providing only residential habilitation or shared living-24 hour supports must contract through the Department of Developmental Services (DDS). STEP 2. 2: Waiver Provider Requirements with information previously in Section 1 Updated the Verifying Eligibility for HCBS Waiver Services section Updated the Billing Instructions section, including adding the Assisted Living Billing Instructions subsection Added the Electronic Visit Verification System Required for Personal Care Services section Contact the fiscal agent for enrollment. Resources for New HCBS Waiver/245D Licensed Providers. HCBS PD Enrollment . A printed copy of the waiver application and special accommodations (i.e., interpreter, large print or taped materials) can be arranged if requested by contacting the DDD Community Resources Branch at (808) 733-2135 no later than seven (7) working days before the comment period ends. Alabama Department of Mental Health Division of Developmental Disabilities Service Regions - 3/6/20. Type or print clearly, in blue ink. Top-requested sites to log in to services provided by the state. to. An introduction of your company (organization and/or licensed clinicians) the name of the company, contact information including phone and email address. Application for a §1915(c) Home and Community-Based Services Waiver 1. Version 3.0 – Unofficial Draft – March 2005. 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. Read Mayor Bowser’s Presentation on DC’s COVID-19 Situational Update: March 11. All HCBS PD providers must enroll in the Kansas Medical Assistance Program (KMAP) and receive a provider number for HCBS PD services. STEP 2. 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. All HCBS PD waiver services require prior authorization through the Plan of Care (POC) process. Existing providers may add new services if they have been providing services to beneficiaries of the HCBS Waiver for at least six months consecutively and are in good standing with DDS/DDA policy and procedures; have passed initial PCR, if applicable; are not currently on any sanctions opposed by DDS/DDA; DHCF; DHLR: or any federal, state, and local entities governing HCBS waiver providers and program. User Training (Ver. What services that are currently being provided in the community and in what state, What services your company would like to provide as a DDA Home and Community Based Services (HCBS) Medicaid Waiver provider, how many years of experience you have providing services and supports for persons with I/DD. alone appendix . Application for 1915(c) HCBS Waiver: PA.0279.R05.00 - Jul 01, 2018. On December 31, 2014, DDS submitted an HCBS Waiver application to CMS seeking federal funding for the Self-Determination Program (SDP). When you receive KanCare as an HCBS Waiver participant, you will be able to receive all of your medically necessary services through KanCare, not just HCBS Waiver services. Application for a §1915(c) Home and Community-Based Services Waiver Application for 1915(c) HCBS Waiver: MI.0233.R05.03 - Mar 01, 2020 (as of Mar 01, 2020) Page 2 of 260 09/17/2020. HCBS Waiver, KanCare looks only at the income and assets of the person who will receive services, even for children. [First paragraph] Notifications. PURPOSE OF THE HCBS WAIVER PROGRAM . Information Technology Services (ITS) at OMH receives the help ticket and sends the provider an email requesting access to a "New Provider Form". State Agency Partners will prioritize reviews of applications from current 1915(c) waiver providers. to. Revise provider qualifications Increase/decrease number of participants Revise cost neutrality demonstration Add participant-direction of services Other Specify: B. DDS is working to implement this through training sessions and other agency wide initiatives. Services for People with Intellectual and Developmental Disabilities, Services for the Blind and Visual Impaired, DC Supporting Families Community of Practice, Randolph Sheppard Vending Facility Elected Blind Vendor Committee, HCBS Waiver Service Descriptions and Rules. Scheduled Maintenance: The system may be unavailable from Friday 9 pm to Sunday 5 am ET. Specify the program: € Dual Eligiblity for Medicaid and Medicare. Enter N/A if not applicable. G. Application for 1915(c) HCBS Waiver: Draft MI.029.01.01 - Jan 01, 2021 Page 4 of 244 09/29/2020 . The Medicaid Home and Community-Based Services (HCBS) waiver program is authorized in §1915(c) of the Social Security Act. Locations for Viewing the Community Waiver Program Documents - 3/6/20. Phone: (855) 300-7058 Revise provider qualifications Increase/decrease number of participants Revise cost neutrality demonstration Add participant-direction of services Other Specify: Supplemental rate increase to Independent Living Program. This HCBS waiver application is intended to provide a safe and supportive network of services, promote community integration, and autonomy of choice. Locations for Viewing the Community Waiver Program Documents - 3/6/20. Do not use a pencil. If extra space is needed to answer any questions, please attach any additional pages. Appendix D Removing performance measure D.e.2 and renumbering D.e.3 to D.e.2. This page, Home- and Community-Based Services (HCBS) Waivers: ABI and MFP Information for Providers, is, Home- and Community-Based Services (HCBS) Waivers: ABI and MFP Information for Providers. Person-centered thinking is a philosophy behind service provision that supports positive control and self-direction of people’s own lives. Participant Services. Type or print all information so that it is legible. 1915(c) HCBS waiver providers are required by Administrative Code to conduct a national criminal background check with fingerprints on all employees and volunteers prior to employment and every two (2) years thereafter. HCBS Waiver Provider Application Process For first time applicants requesting provider enrollment into the DDA Home and Community Based Services (HCBS) Medicaid Waiver Program, the instructions to complete a Waiver Provider Application and other pertinent information is outlined in … 1. The reauthorization process allows CMS to evaluate states' Medicaid waiver programs for compliance with waiver assurances and federal requirements. [Second paragraph] Email: ProviderNetwork@umassmed.edu. Severe Disabling Mental Illness (SDMI) Home and Community Based (HCBS) Waiver Program (Approved 7/1/2020 - 6/30/2025) HCBS Waiver Information. Additional waiver services that are contracted through the Department of Developmental Services include: Additional waiver services that are contracted through the Massachusetts Rehabilitation Commission include: MassHealth regulations, Massachusetts Rehabilitation Commission policies, and Department of Developmental Services policies that describe waiver service and provider requirements for the waiver providers may be found through the links below. Most organizations or self-employed applicants interested in providing the listed waiver services must enroll as a MassHealth provider. The owner or managerial official for your organization must complete the required HCBS Waiver and AC Provider Training 101 and competency test. Page 1 of 245 . Under the Employment First philosophy, competitive, integrated employment is the first and overwhelmingly preferred option for working-age youth and adults with disabilities. Revise provider qualifications Increase/decrease number of participants Revise cost neutrality demonstration Add participant-direction of services Other B. Request Information (1 of 3) The State of North Carolina requests approval for a Medicaid home and community-based services (HCBS) waiver under the … 333 South Street These programs serve a variety of targeted populations groups, such as people with mental illnesses, intellectual disabilities, and/or physical disabilities. Enroll in the HCBS Waiver To receive the supports and services offered through the HCBS Waiver, you will need to enroll in the program. Home and Community-Based Services (HCBS) ... the 2018 House BIll 1696 requires the Department to compare the Medicaid rate of reimbursement with the actual cost to providers using publicly available information. 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. HCBS Provider Retainer Payment The Kansas Department for Aging and Disability Services, KDADS, has approved retainer payments to qualified Home and Community Based waiver services providers. The HCBA Waiver term ends December 31, 2021 and DHCS and has begun efforts to develop a waiver renewal application to submit to the Centers for Medicare and Medicaid Services (CMS) for reauthorization. This page includes information for various home and community-based services (HCBS) providers, including day training and habilitation centers (DT&H), group residential housing (GRH), home care nurses (RN and LPN), home health agencies (HHA), Moving Home Minnesota (MHM), personal care assistants (PCA), waiver and Alternative Care (AC) providers. The Medicaid Home and Community-Based Services (HCBS) waiver program is authorized in §1915(c) of the Social Security Act. Revised Full Public Notice - 5/20/20. These programs serve a variety of targeted populations groups, such as people with intellectual or developmental disabilities, physical disabilities, and/or mental illnesses. Individuals in an HCBS waiver can receive both traditional MassHealth services and the additional services available through the HCBS waiver in which they are enrolled. All waiver participants will work with a case manager/service coordinator to develop their individual service plan that will include their goals and the waiver services and supports the participant needs in the community. Application for a §1915(c) Home and Community-Based Services Waiver . s. tate . The training presentation linked below outlines the process for providers to obtain these required checks through the Mississippi Department of Health (MSDH) . request amendment to its approved waiver . not just HCBS Waiver services. The Hilltop Institute completed this draft rate study, which is now open for review. HCBS Waiver and AC Provider Training 101 Proof of Completion The owner or managerial official for your organization must complete the required HCBS Waiver and AC Provider Training 101 and competency test. Please read the materials carefully to determine what services you or your organization may be eligible to provide. Nursing Facility (NF) Level of Care: A Medicaid home and community-based services waiver that requires a nursing facility level of care provides services as an alternative to nursing facilities, hospitals or rehabilitation facilities. Application for a §1915 (c) HCBS Waiver HCBS Waiver Application Version 3.5 Submitted by: Department of Human Services, Commonwealth of Pennsylvania Submission Date: CMS Receipt Date (CMS Use) Provide a brief one-two sentence description of the request (e.g., renewal of waiver, request for new waiver, amendment) Include population served and broad description of the waiver program: … University of Massachusetts Home and Community Based Services Provider Network Administration Unit, in the scale of 1, Strongly Disagree, to 5, Strongly Agree, Professional Training & Career Development, Acquired Brain Injury (ABI) and Moving Forward Plan (MFP) Waivers, Department of Developmental Services (DDS), Massachusetts Rehabilitation Commission (MRC), Individual Support and Community Habilitation. Mass.gov® is a registered service mark of the Commonwealth of Massachusetts. If approved, you will then be directed to download your Indiana Health Coverage Programs Waiver Billing Provider Application and Profile Maintenance packet through DXC. stand. New Medicaid Home & Community-Based Waiver Providers Each waiver is designed for individuals with similar needs and offers a different set of services. s. tates can take under the existing . A program authorized under §1915(j) of the Act. Application for a §1915(c) Home and Community-Based Services Waiver 1. Email inquiries can be sent to: ProFacWAIVER@dhcs.ca.gov. If any field is not applicable, please enter N/A. The Medicaid Home and Community-Based Services (HCBS) waiver program is authorized in §1915(c) of the Social Security Act. 1915(c) HCBS Waiver Application - 3/6/20. The HCBS-CMHS and EBD waiver programs provide a variety of services to the Elderly, Blind and Disabled (EBD), and Community Mental Health Supports (HCBS-CMHS), formally known as Persons with Major Mental Illness (MI), as an alternative to nursing facility, and inpatient hospitals to qualified members. How much do you agree with the following statements in the scale of 1, Strongly Disagree, to 5, Strongly Agree? It includes actions that . Staffing Qualifications: Include certifications, licenses and degrees for each position. Continue. Original Full Public Notice - 3/9/20. Areas of interest: _____ I am enrolling to serve _____(#) of individuals. This application will become part of, and is incorporated by reference into, the provider agreement between this applicant and MassHealth. may. Disability and Community Services Section . In order to continue operations of the program, the State Medicaid Agency must submit a renewal application. HCBS waiver provider application certification Please Read Carefully and Sign This is an application to be a provider in the MassHealth program. To request enrollment, you must fill out and submit an Application for Participation. HCBS waiver provider application certification Please Read Carefully and Sign This is an application to be a provider in the MassHealth program. PURPOSE OF THE HCBS WAIVER PROGRAM . In the subject line of the email, please include the name of your company and Letter of Intent (See example). 18) Maintain compliance with Federal, State and local laws, including HCBS Waiver Services Provider Manual (BI, CAC, CADI and DD waivers) and Elderly Waiver (EW) and Alternative Care (AC) Program Provider Manual.The HCBS Waiver Services Provider Manual includes information about eligible providers, enrollment, MN-ITS, covered/non-covered services, authorization and billing. Application for a §1915(c) Home and Community-Based Services Waiver PURPOSE OF THE HCBS WAIVER PROGRAM The Medicaid Home and Community-Based Services (HCBS) waiver program is authorized in §1915(c) of the Social Security Act. Note: Providers on the list are still required to submit the appropriate attestation forms and are subject to a review process for final approval to receive retainer payment. Notifications. alone appendix . All new providers are required to submit a completed DDA Medicaid Waiver Provider Application and submit the required supporting documentation in the form of policies and procedures, licensure and/or certification that demonstrates the provider agency’s compliance with the specific rules for each of the waiver services the provider agency is requesting enrollment. Contact the UMass HCBS Provider Network Administration Unit for assistance in determining which information is required. Any currently approved provider who met 2008 waiver application qualifications on the date of approval of this application will be grandfathered in and the exception will terminate at the time the staff terminates employment with the provider. EFFECTIVE IMMEDITELY: Pursuant to the iBudget Waiver program, authorized under 1915 (c) of the Social Security Act, and because of critical needs for some specific provider types, APD will no longer operate two open enrollment periods each year for provider applicants of services furnished under the iBudget waiver. Timeframes. November 13, 2020 Public Notice for SDMI Waiver Amendment effective January 27, 2021 If you must make corrections, please line through, date, and initial in blue ink. For example: Application for 1915(c) HCBS Waiver: NY.0269.R04.00 - Sep 01, 2017 Page 1 of 199 If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site. HCBS Provider Network Administration Unit §1915(b)(4) (selective contracting/limit number of providers) A program operated under §1932(a) of the Act. Provider … MassHealth offers HCBS waivers that make long-term community services available to eligible individuals. If intending to contract and credential with the MCOs, complete section IV.) To request enrollment, you must fill out and submit an Application for Participation.. At the time of enrollment, you must live at home or in a certified Family Care … The Medicaid Home and Community-Based Services (HCBS) waiver program is authorized in §1915(c) of the Social Security Act. Request Information.....Application: 2 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. Do not include sensitive information, such as Social Security or bank account numbers. Do not use staples on this application or on any attachments. The program permits a State to furnish an array of home and community … Section . Print proof of completion to submit with your application request. Appendix C specifies the home and community-based waiver services that are furnished through the waiver, including applicable limitations on such services. Original Abbreviated Notice - 3/6/20. 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. APPLY FOR KANCARE (FINANCIAL ELIGIBILITY) If you already have KanCare: Your information will be updated by entry point or state staff to show that you are eligible for or receiving an HCBS Waiver. Prior to submitting an application, as a Microsoft Word attachment, potential providers must submit a letter of intent to [email protected] . §1915(c) HCBS Waiver Application: The web-based 1915(c) Home and Community Based Services Waiver Application was launched on November 17, 2006. [Third paragraph] 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. A printed copy of the waiver application and special accommodations (i.e., interpreter, large print or taped materials) can be arranged if requested by contacting the DDD Community Resources Branch at (808) 733-2135 no later than seven (7) working days before the comment period ends. by the . HCBS Waiver Provider Application Basic Information To avoid delays in the application process, you should: Complete all required forms listed below. B. PROVIDER SUPPLEMENT TO HCBS WAIVER APPLICATION GEOGRAPHIC LIMITATION CASELOAD LIMITATION Unless you indicate limits of geographic areas of interest below, your services will be available statewide. Click here for Draft 1915 (c) HCBS Waiver Application The full text of the SIP can be viewed here: PDF, Word HCBS Waiver Provider Supplemental Application SECTION A Important: Read all instructions before completing the application. Do not leave any questions, boxes or lines blank.