DDES Memo Series
2005-18
ACTION MEMO
October 12, 2005
TO:
Area Administrators/Human Services Area Coordinators
County Departments of Community Program Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
County LTS/COP Coordinators
County Developmental Disabilities Services Coordinators
DDES Bureau Directors
DDES Section Chiefs
County/Tribal Aging Directors
Tribal Chairpersons/Human Services Facilitators
FROM:
Sinikka Santala
Administrator
RE: Medicaid
Waiver Services Termination Date
Document Summary
Effective January 1, 2006, the termination date of
Medicaid waiver services will be consistent with the termination of
Medicaid waiver eligibility. This memo describes the process used by the
Long Term Support Agencies and Economic Support Agencies to implement the
policy change.
The purpose of this memo is to align termination of Medicaid waiver
services with the termination of Medicaid waiver eligibility to be in
compliance with Centers for Medicare and Medicaid Services requirements.
Background.
Currently, when an individual eligible for and receiving Medicaid
waiver services loses eligibility, the Long Term Support Agency (LTSA)
terminates services by issuing a manual 10-day notice. The Medicaid
waiver services end 10 days from the date the notice was issued. However,
the Medicaid waiver eligibility is terminated in CARES by the
Income Maintenance Agency (IMA) using adverse action logic, resulting in
eligibility being extended beyond the date the services are actually
ending.
Medicaid waiver services are subject to the same termination rules that
apply to any service under the Medicaid State Plan. To this end, the
termination date of Medicaid waiver services must be aligned with the
termination date of Medicaid waiver eligibility. The change will
affect the processing of fewer than 200 Medicaid waiver participants who
lose waiver eligibility statewide per year.
Exceptions: Individuals on Medicaid due to SSI, SSI-E, 1619 or Katie Beckett eligibility are not always
entered in CARES. Termination for these programs is handled by the Social
Security Administration, except for Katie Beckett cases, which are handled
by the Bureau of Long-Term Support, Children Services Section. LTSA shall
continue issuing 10-day termination notices when SSI, 1619 or Katie
Beckett eligibility ends, just as they currently do.
New Termination Process of Waiver Services effective January 1,
2006.
Under the new process, termination of Medicaid waiver services will
coincide with termination of Medicaid waiver eligibility. When reported
changes relate to issues such as income, assets, divestments, permanent
institutionalization, etc., the Economic Support Staff (ESS) determines if
and how Medicaid waiver eligibility is affected. When reported changes
relate to level of care, need for waiver services, non-payment of
cost-shares, etc., the care manager (CM) will determine if Medicaid waiver
eligibility is affected.
In all cases, the sequence is as follows:
1a) Waiver participant notifies ESS of a change that could affect
eligibility.
ESS runs eligibility in CARES. If eligibility for waiver is impacted,
ESS generates an "Interagency Notification Termination of Medicaid
Waiver Eligibility for a Community Waiver Participant" (Form HCF
10142 - See Attachment # 1) and forwards it to the CM. If termination is
not warranted, ESS will not issue a notice.
OR
1b) Care Manager notifies ESS of a change that could affect
eligibility.
The CM will first complete and deliver an Interagency Notification
Termination of Community Waiver Participation (Form DDE 2637 - See
Attachment # 2) to ESS, to inform ESS of the possible reason for
termination of waiver services. It is important for CM to complete and
deliver this notice to ESS promptly (prior to adverse action whenever
feasible). The sooner a change is reported to ESS, the earlier it can be
entered in CARES, and, when applicable, a Medicaid waiver eligibility
termination date will be generated.
ESS runs eligibility in CARES. If eligibility for waiver is impacted,
ESS generates an "Interagency Notification Termination of Medicaid
Waiver Eligibility for a Community Waiver Participant" (Form HCF
10142) and forwards it to the CM. If termination is not warranted, ESS
will not issue a notice.
2) CM or participant has notified ESS of a participant's change in
eligibility criteria, and CM receives Form HCF 10142 from ESS.
The CM will issue a Notification of Waiver Program Termination (Form
DDE 2638 - See Attachment # 3) to the participant, using as the effective
date of termination for waiver services the same termination date noted by
ESS on Form HCF 10142.
3) CM or participant has notified ESS of a participant's change in
eligibility criteria, and CM does not receive Form HCF 10142 from ESS.
CM should always follow up with ESS to ascertain disposition of the
case. If termination is not required, a case note will be entered in the
case file documenting the conversation with ESS. If termination is
required, CM will proceed as outlined in # 3.
4) ESS and CM will continue to send two separate termination notices to
the participant.
The termination dates for waiver services and termination for Medicaid
waiver eligibility on these two notices will coincide. ESS will continue
to screen waiver participants for Medicaid eligibility under other
Medicaid subprograms.
Action Required: Effective January 1, 2006, LTSA must use the Medicaid
waiver eligibility end date as the termination date for Medicaid waiver
services, using the process described above.
REGIONAL OFFICE CONTACT:
Human Services Area Coordinators-Adult
Services
CENTRAL OFFICE CONTACT:
Rita Cairns
Bureau of Long-Term Support
P. O. Box 7851
Madison, WI 53707-7851
608-266-6891
CairnRI@dhfs.state.wi.us
MEMO WEB SITE:
http://dhfs.wisconsin.gov/partners/local.htm
Attachments:
1) Form HCF-10142
(PDF, 16 KB) - Interagency Notification of Termination of Medicaid
Waiver Program Eligibility for a Community Waiver Participant. (Issued by
ESA to LTSA)
2) Form DDE-2637
(PDF, 9 KB) - Interagency Notification Termination of Community Waiver
Participation. (Issued by LTSA to ESA)
3) Form DDE-2638 (Word
Fillable, 48 KB) or Form DDE- 2638
(PDF, 31 KB) - Notification of Waiver Program Termination (issued by
LTSA to Community Waiver Participant).
4) Flow Chart (PDF,
12 KB) Aligning Termination of Medicaid Waiver Services with
Termination of Medicaid Waiver Eligibility.
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