What's New in the Habilitation Supports Waiver?

1. What's New in the Habilitation Supports Waiver? Presented by Jill Kemp & Deb Ziegler Kemp/Ziegler presentation

2. Changes in the HSW • Separate capitation payments for HSW • Amendment approval from CMS opens new enrollments again (with limits) • Closer DCH oversight of enrollments, recertifications, and disenrollments Kemp/Ziegler presentation

3. How Is the HSW Enrollment File for Payment Generated? • DCH uses the HSW enrollment data provided by the PIHPs on the disk submitted by the 15th of each month. • Enrollment data incorporated into Master HSW database. • End Month – HSW Enrollee List transmitted to Department of Information Technology (DIT) Kemp/Ziegler presentation

4. How Is the HSW Enrollment File for Payment Generated? (Cont’d) • DIT verifies Medicaid Eligibility and Processes HSW Enrollment File which posted on DEG • HSW Payments paid 2nd Wednesday of the month • HSW Enrollment files [5089/834(5093)] • Available on DEG 7 business days before payment (Monday) Kemp/Ziegler presentation

5. How Is the HSW Enrollment File for Payment Generated? (Cont’d) • These are prospective payments, which affects “retro-eligible” HSW enrollees. • If a HSW enrollee does not have Medicaid eligibility on the day the list is checked for eligibility, payment will not be issued for that month. • However each month, DCH checks to see if the person became eligible. If so, the beneficiary will be added to the HSW Enrollee List to initiate retroactive payment. Kemp/Ziegler presentation

6. When Can We Expect Retroactive Payments or Recoveries to Begin? • Retroactive payments and recoveries will begin with the June payment. • These recoveries will only be for people paid for who were not eligible or enrolled in the program. • HSW Enrollment file posted on DEG on or before May 31 Kemp/Ziegler presentation

7. What If We See a Discrepancy In the Payment? • First, check to see if the HSW enrollee had Medicaid eligibility for the month in question. • Second, check your HSW database to make sure a status change to “Disenrolled” or “Inactive” had not been entered in error. • Finally, fax a list of the Medicaid ID numbers, Recipient Names, and the months in question to Jill Kemp at 517/335-6856. Kemp/Ziegler presentation

8. When Will Recoveries for Lack of Encounter Data Begin? • DCH expects to begin checking encounter data against the HSW enrollment file later this summer, looking back to January. • Remember, each HSW enrollee must receive at least one HSW service per month. • All encounter data for the month must be entered no later than 90 days, regardless of whether the claim has been adjudicated. Kemp/Ziegler presentation

9. What Should Supports Coordinators Monitor? • It is important for supports coordinators to be very aware of when their HSW enrollees’ annual FIA paperwork is due. • This helps to avoid unnecessary loss of Medicaid eligibility due to a lack of paperwork being filed on time. Kemp/Ziegler presentation

10. When Can We Begin Enrolling People in the HSW? • The amendment requesting additional slots, while staying within our annual appropriation, has been approved. • The number of new enrollments per PIHP will be managed by DCH. • Priority enrollments will go first to people exiting Mt. Pleasant Center and the Children’s Waiver Program. Kemp/Ziegler presentation

11. When Can We Begin Enrolling People in the HSW? (cont’d) • Packets may be submitted to Deb Ziegler. • The packets need to include the information specified in the Patrick Barrie memo dated in November, 2003. • Reminder: If no slots are available, you must still assure that the person receives the needed services, using b and b-3 services. Kemp/Ziegler presentation

12. Other Changes • Recertification forms must be submitted to DCH with the monthly disk. • Disenrollments must now be reviewed by DCH Kemp/Ziegler presentation

13. Technical Assistance • If you have questions about the HSW • For payment & database questions, call Jill Kemp at 517/373-3863 or e-mail at Kempjil@michigan.gov • For program questions (enrollments, services), call Deb Ziegler at 517/241-3044 or Zieglerd@michigan.gov Kemp/Ziegler presentation