DRAFT: Community-Based Health Care and Other Services for Personal Enrolled in Home and Community-Based Services Waiver

Purpose

The Division of Developmental Disabilities has recently learned that some waiver providers have arrangements with health care and other (non-medical) providers that result in needed services being given in a segregated, non-integrated, setting rather than support persons to access those same services in community-based locations that persons without disabilities use.  This bulletin will clarify expectations for the provision of such services for participants in Home and Community-Based Services waivers.

Process and Procedures

• Essential components of Home and Community-Based Services (HCBS) are community integration and community access for persons receiving waiver-funded services. The expectation is that persons with Medicaid waiver funding receive all needed and desired services from an array of options and in the same manner as community members who do not receive waiver funding.
• The provision of medical examinations and treatments, professional hair care services (cuts, color, etc.), counseling sessions, breast exams, x-rays, laboratory testing, and similar professional services within a CILA, developmental training, or other waiver-funded location is not supported by the Division of Developmental Disabilities.
• HCBS waiver providers that also operate intermediate care facilities (ICF) may not use those ICF locations for the provision of related services to persons receiving waiver funded services.
• On rare occasions, some HCBS participants may have conditions that prevent them from leaving their CILA home to obtain such services. In such cases, an individualized plan for ensuring the delivery of those services within the person's home could be supported if the plan is based on the specific needs of the individual and not the convenience of the providers involved.
• The Division recognizes the struggles providers sometimes have in meeting the needs of the individuals they serve during these difficult financial times. Providers are commended for their efforts to ensure individuals' healthcare and personal needs are addressed. In spite of financial difficulties, it is critical that service provision is individualized and community-based.
• Providers must also ensure that bills submitted are for services covered by the Medicaid Waiver service definitions. Hair-cuts and medical laboratory work, as examples, would not fall under the definition of developmental training.
• Providers with questions concerning this issue are invited to discuss concerns with their Region Facilitator or Region Representative or the Independent Service Coordination agency for their county.

Effective Date

This information bulletin reflects current policy and procedural expectations and are effective immediately upon posting as a final.