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MEDICAID HOME & COMMUNITY-BASED
WAIVERS MANUAL

Community Options Program Waiver (COP-Waiver)
Community Integration Program II (CIP II)

This table of contents applies to CIP II and COP-W only. Please refer to the DD website: dhfs.wisconsin.gov/bdds/waivermanual/index.htm for waiver programs CIP IA, CIP 1B, BIW and CLTS. Notification will be sent when remaining chapters are completed. The table of contents will apply to all waivers at that time.1

Memo Announcing Release of Revised Manual (PDF, 45 KB)

List of Chapters and Sections of the Revised Interim Manual
Chapter Pages
Chapter I – OVERVIEW AND ADMINISTRATION (PDF, 33 KB) I-1
1.01 Long Term Support in Wisconsin I-1
1.02 Reserved I-2
1.03 The Medicaid Waiver Mandate I-2
1.04 Exemptions from the Mandate I-3
1.05 Registering Applicants on HSRS reporting system I-4
1.06 County Waiting Lists I-4
   
Chapter II – WAIVER ELIGIBILITY (PDF, 107 KB) II-1
2.01 Waiver Eligibility II-1
2.02 Waiver Target Groups II-1
2.03 Waiver Services for Persons with Severe & Persistent Mental Illness II-5
2.04 Active Treatment and No Active Treatment (NAT) Determination II-6
2.05 Medicaid Non-financial Eligibility Requirements II-8
2.06 Parental Payment Limits II-10
2.07 Level of Care (LOC) II-11
2.08 Eligible Living Situations II-13
2.09 Waiver Participant Moves II-15
2.10 Denial of Participation or Termination of Program Participation II-20
2.11 COP Eligibility After Waiver Program Participation II-24
   
Chapter III – FINANCIAL ELIGIBILITY (PDF, 73 KB) III-1
3.01 Medicaid Eligibility III-1
3.02 Children Applying for the Waiver –Special Considerations III-3
3.03 Medicaid Waiver Income Groups III-3
3.04 Spousal Impoverishment III-10
3.05 New Applicants Leaving an Institution III-11
3.06 Payments, Prepayments and Repayments to Medicaid III-12
3.07 Other Payments III-12
   
Chapter IV – ALLOWABLE SERVICES (PDF, 614 KB)2 IV-1
4.01 Introduction IV-1
4.02 County Role in Ensuring Providers are Qualified IV-1
4.03 Ensuring Choice of Providers IV-2
4.04 Conflict of Interest IV-2
4.05 Provider Screening Requirements-Caregiver Background Checks IV-4
4.06 Medicaid Waivers: General Limitations IV-7
4.07 Participant Contributions IV-8
4.08 Reserved for future use IV-9
4.09 Allowable Services Index IV-10
   
Chapter V – USE OF FUNDING IN SUBSTITUTE CARE (PDF, 92 KB) V-1
5.01 Introduction V-1
5.02 Determining Waiver Allowable Costs in Substitute Care V-1
5.03 Determining the Participants Ability to Pay for Room and Board V-2
5.04 Waiver Specific Requirements: CIP 1A/1B, BIW and CLTS V-3
5.05 Waiver Specific Requirements: CIP II/COP-W V-6
5.06 Contracting for Substitute Care Services V-11
   
Chapter VI – THE WAIVER APPLICATION PACKET (PDF, 95 KB) VI-1
6.01 Introduction: The Application VI-1
6.02 The Content of the Waiver Application Packet VI-1
6.03 Waiver Program Start Date VI-12
6.04 Medicaid Waiver Plan Submission and Approval Process VI-14
6.05 The Waiver Application Packet – Summary VI-16
   
Chapter VII – RECERTIFICATION, PLAN REVIEW AND ISP UPDATE (PDF, 92 KB) VII-1
7.01 Introduction VII-1
7.02 Annual Recertification VII-1
7.03 Timeliness of Recertification and Documentation VII-7
7.04 Individual Service Plan Review VII-8
7.05 Individual Service Plan Updates VII-9
   
Chapter VIII – PARTICIPANT RIGHTS (PDF, 26 KB) VIII-1
8.01 Medicaid Waiver Applicant/Participant Rights VIII-1
8.02 Responsibility for the Notification of Rights VIII-1
8.03 Extent of Notification VIII-1
8.04 Notice of Decision to Provide an Assessment or Service Plan VIII-2
8.05 Notice of Reduction or Termination VIII-2
8.06 Additional Rights Provisions VIII-3

Chapter IX – ASSURING THE HEALTH AND SAFETY OF MEDICAID WAIVER  PARTICIPANTS

Please continue to use current manual material on Assuring the Health and Safety of Waiver Participants until the revised manual material is available.

Chapter X – QUALITY ASSURANCE

Not available at this time.

Chapter XI – REPORTING AND REIMBURSEMENT

Please continue to use current manual material on Reporting and Reimbursement until the revised manual material is available.

APPENDIX LIST

ARCHIVE

1 For CIP II/COP-W contact the Bureau of Long Term Support Community Options Section. For CIP 1A/1B, BIW, & CLTS, refer to the Bureau’s website at: http://dhfs.wisconsin.gov/bdds/waivermanual/index.htm

2 Refer to section 4.09 beginning on page IV-9 of this manual for a complete list of services available to participants using a specific Waiver program.

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Last Revised: March 14, 2008