Extended Waiver Eligibility (EWE) Training and Implementation for EWE Presented by MLTSS

Transcription

1 Extended Waiver Eligibility (EWE) Training and Implementation for EWE Presented by MLTSS 1

2 Extended Waiver Eligibility (EWE) Overview Agenda and Objectives What is it? When does it happen? Who is it for? How does it work? 2

3 EWE Overview What is it? APD has received Waiver approval to implement new EWE criteria to existing LTC Service Priority rules. This criteria will allow for individuals assessed at SPL 14-17, who are determined to have a high risk for hospitalization or institutionalization within 30 days of LTSS ending to continue receiving services until the risks can be mitigated Eligibility for EWE must be reviewed on a bi-annual basis (every 6 months), and the consumer must remain actively engaged in their transition plan to maintain eligibility. 3

4 What is it? Services Consumers determined eligible for EWE will be eligible for all services for which there is an assessed need. Consumers will be authorized the following rates/hours: Assisted Living Facility: Level 1 payment; Adult Foster Home or Residential Care Facility: Base Rate; Other Settings: Authorized at their lowest contracted rates; or In-home Services (including Independent Choices Program): Up to 10 hours for ADL/IADL tasks per 2 week service period. 4

5 Timing When does it happen? Available to consumers assessed after Oct 1, 2017 Initial EWE Review Consumers assessed after October 1 st 2017 whose SPL has increased from 1-13 to may be considered. Requests must be completed and submitted by a manager to the SPD.Exceptions@state.or.us box no later than 2 weeks prior to the service plan end date. Ongoing EWE Renewal EWE may continue as long as the consumer / representative remains actively engaged in mitigating the risk(s) driving EWE eligibility. Every 6 months the CM must ensure the consumer: Still meets EWE criteria; and Is working on their transition plan. 5

6 Who is it for? Consumers who are re-assessed as SPL 14 17; and The consumer is at high risk for hospitalization or institutionalization within 30 days of LTSS ending in the following areas: 1. The consumer will most likely deteriorate or decompensate due to lack of access to adequate shelter or support; 2. The consumer lacks access to safe housing, or has a documented history of threats of eviction without access to supports; or 3. The consumer would be at a significant risk of abuse or exploitation without ongoing support. EWE is available for consumers who meet the criteria above regardless of setting. 6

7 EWE is not intended for: Who is it for? Those not currently receiving LTSS services; Those choosing to be homeless as a result of not receiving LTSS; or Those receiving temporary LTSS solely based upon an acute care incident and has since recovered. 7

8 How does it work? Detailed, step-by-by step, instructions are provided on APD-PT A consumer must exhaust all available resources prior to meeting EWE requirements. For those receiving in-home services, examples may include: State Plan Personal Care (SPPC) services; Oregon Project Independence (OPI) services; Emergency Response Systems (ERS); and Home Delivered Meals (HDM) through the Older Americans Act (OAA) 8

9 How does it work? For all consumers, examples may include: Tribal resources; Housing assistance; Energy Assistance; Senior centers; and Natural Supports Case managers then complete an EWE request form which includes completion of the EWE plan. 9

10 ADRC 855-ORE-ADRC ( ) or Oregon.org Support Services Nutrition Services Preventative Health Services Family Caregiver Support Program Elder Rights Services Senior Community Service Employment Program Long-Term Care Ombudsman Services to Native Alaskans, Native Hawaiians, and Native Americans Options Counseling Information and Assistance 10

11 EWE Request Form 11

12 How does it work? Approval If the EWE request is approved Central Office will: 1. Notify the case manager of the approval and narrate the decision in Oregon ACCESS. 2. Request an update to the service eligibility record via Mainframe Business Analysts. 3. Mainframe Business Analysts will narrate on the consumer s Oregon ACCESS case record when the service eligibility record has been updated. Local office staff will then need to either: In an in-home setting, vouchers may now be created. In a community based facility (ALF, AFH, RCF, etc.), the 512 must be touched in order to ensure the correct payment level. 12

13 How does it works? Denial If denied, Central Office will notify the case manager of the denial and narrate the decision in Oregon ACCESS. Central Office will provide the reason for the denial. The case manager will send out a notice of planned action (SDS 540), using the language found in APD-PT , which will also be provided in the APD Worker Guide. In the notice, it is important to use the reason for the denial (provided by Central Office). 13

14 How does it work? Consumers approved for EWE must work towards a safe transition plan that mitigates the identified risk(s). The following actions must take place when someone is receiving services through EWE: CM and consumer sign the Extended Waiver Eligibility Planning Form. A copy of the signed form is provided to the consumer, with an additional copy in the consumer s file. The case manager is regularly and actively working with the consumer to mitigate the identified risk(s). Document all contact and progress in Oregon ACCESS 14

15 How does it work? NARRATE, NARRATE, NARRATE! (please narrate ) The assessment will not be listed on the Benefit and Service Planning portion of Oregon ACCESS. This means that a Service Plan (001N), In-home Service Plan (546N), or a Task List (598N) cannot be generated. A fillable version of these forms is be located on CM Tools website and will eventually be updated on the Forms Server. Individuals with a pay-in for In-home Services will need to be calculated manually. Until a tool can be developed for this calculation. 15

16 How does it work? Renewals Eligibility for EWE must be reviewed every 6 months. In order to remain eligible, the following requirements must be met: Demonstrable progress towards mitigating the identified risk(s) by the consumer. Example: Consumer has signed up for low-income housing; Consumer is looking for accessible housing; Consumer is working with their family to move to their home and has requested a modification to the bathroom and a ramp to make the home accessible. A new EWE request must be submitted as outlined in APD-PT CMs must perform Direct WCM contacts monthly. The focus should be on checking on progress towards mitigating the risks identified in the EWE plan form. An assessment is required at least annually. 16

17 EWE Planning Form 17

18 CBC Waiver Transition Services Consumer s who are transitioning from CBC to in-home may now receive the same services as those transitioning from NF. A new rule has been filed. The exact same process and expectations apply. 18

19 Mat Rapoza - MATHEW.G.RAPOZA@dhsoha.state.or.us Ben Sherman - BEN.C.SHERMAN@dhsoha.state.or.us Christine Maciel - CHRISTINE.C.MACIEL@dhsoha.state.or.us Who to Contact with Questions about EWE 19