14. Page 6 Waiver services will not be furnished to individuals who are inpatients of a hospital, NF, or ICF/MR.
The state offers an exception for the location of respite services for individuals with extensive
behavioral needs that arise due to the temporary change in environment while in a Medicaid
certified hospital or a temporary crisis placement in an ICF-MR group home due to behavioral,
medical, or socio-emotional issues. Reference section B-1 for location of respite services.

There needs to be a provision in here for individuals who are hospitalized due to surgeries or a short tem illnesses, because people with disabilities do not get well taken care of in a hospital setting.

15. Page 6 What is FFP?

__X_ The waiver will be operated by the Bureau for Health and Health Facilities, (BHHF) a separate
agency of the State, under the supervision of the Medicaid agency. The Medicaid agency exercises
administrative discretion in the administration and supervision of the waiver and issues policies,
rules and regulations related to the waiver. A copy of the inter-agency agreement setting forth the
authority and arrangements for this policy is on file at the Medicaid agency.
The Bureau for Medical Services (BMS) contracts with the Bureau for Health and Health Facilities
(BHHF) for the overall operation, day to day management, and systemic administration of the
MR/DD Waiver. The identified role for BHHF includes Level of Care determination, Quality
Monitoring and Improvement, policy interpretation, technical assistance, and training. BMS
provides oversight and supervision of the management activities conducted by BHHF. The Quality
System addresses both individual and systemic areas of improvement and works in conjunction with
an administrative service organization around the implementation of a person-centered planning
approach to services and utilization management.
The Bureau for Medical Services (BMS) contracts with an administrative service organization, APS
Healthcare, Inc., for the purpose of the development and implementation of an independent
assessment process for Level of Service, Utilization Review, and Prior Authorization of services
related to the plan of care (Individual Program Plan). The Bureau is committed to creating and
implementing a self-directed service delivery system incorporating a person centered plan approach
with individual budgeting. To assure appropriate system analysis and stakeholder input, a phased-in
approach will be executed over a period of time.
APS, Healthcare, Inc. under the supervision of the State Medicaid Agency and operates in
coordination with the operating agency, BHHF. A copy of the contractual agreement between BMS
and APS Healthcare, Inc. is on file at the Medicaid agency. A memorandum of understanding
between the state operating agency, BHHF, and the administrative service organization, APS
Healthcare Inc., is on file with BHHF. In an effort to implement systems change and quality
improvement, the state’s definition of the expanding role of the administrative service organization,
APS Healthcare, Inc. will be implemented as follows...:

Person Centered Planning? Where? You were even told strongly that people did not want APS Healthcare as another layer of bureaucracy. Did you listen? What kind of person centered planning is that? It just costs the State of West Virginia more money as in 9.4 million dollars when people are dying waiting for services. Not to mention your illegal waiting list.

X Other Service Definition (specify):
The Case Manager must forward all initial and annual reassessments to the state operating
agency for Level of Care (LOC) determinations and
re- determinations. Case Managers will be defined as Service Coordination and
Case Management will be defined as Service Coordination.
The state identifies Waiver case management (service coordination) as an intense level of
coordination of care for a minimal number of individuals requiring an intense level of
services, supports, and training and living within the variability of a diverse community
setting.

Where is advocacy of the individual in this statement? That if the department really does want to save money then they should closely monitor the billing of case managers. The Department should specify that nothing is billed for that does not relate directly to the benefit of the individual and carrying out the IPP.

Transportation will be provided between the individual's place of residence
and the site of the habilitation services, or between habilitation sites (in cases
where the individual receives habilitation services in more than one place) as
a component part of habilitation services. The cost of this transportation is
included in the rate paid to providers of the appropriate type of habilitation
services.
1. Yes 2. X No

Why is transportation being cut? Isn’t this a community based program. No wonder we have trouble keeping habilitation workers.

X Other service definition (specify):
Transportation services will not exceed a limit of 500 miles per recipient per
month or 62 trips per recipient per month.

There is no reason why this should have been changed. Again the idea of this program is to get people out into the community. It needs changed back. If you want to save in this category you need to monitor venders.

Crisis Services:
Does a person have to act out to be in crisis? This definition should be expanded.

Why is there nothing in this waiver for people with mental illness? This is discriminatory!!!

The state operating agency, BHHF, maintains a memorandum of understanding between the operating
agency and the Bureau for Public Health, the Office of Health Facility Licensure and Certification
(OHFLAC). The state operating agency, BHHF, maintains a copy of the memorandum of understanding
between Department of Health and Human Resources (DHHR) and Division of Rehabilitation Services, the
state agency responsible for certification of vocational rehabilitation programs (pre-vocational and
supported employment services)

OHFLAC must be more accessible and responsive consumers and their advocates. Concerns must be responded to in a more timely manner.

FREEDOM OF CHOICE
There is no freedom of choice. If you do not believe this talk to consumers and their families. People are being held hostage by one provider. Mircoboards and lessening provisions on the CON Process would give people better freedom of choice.

APPENDIX D-3
a. MAINTENANCE OF RECORDS
The records should also automatically be given to the family of the person receiving services or the person receiving services.

a. PLAN OF CARE DEVELOPMENT
1. The following individuals are responsible for the preparation of the plans of care:
Registered nurse, licensed to practice in the State
______Licensed practical or vocational nurse, acting within the scope of practice
under State law
___ Physician (M.D. or D.O.) licensed to practice in the State
Social Worker (qualifications attached to this Appendix)
X Case Manager (Service Coordinator)
Other (specify):

The plan of care is a team process. Which should include all team members and be driven by the individual. Failure to provide services specified on a Plan of care should be considered a breach of contract.

A wait list that moves at a reasonable pace will be maintained by the State

People are being told they must wait 5 months before receiving Waiver services. This violates Benjamin H.

A copy of the Individual Program Plan (IPP or DD-5)) is included in the appendix. The IPP
form includes written prompts for each requirement.
The Quality Management System monitors IPP requirements by means of a statewide sample
where quality issues are identified and addressed within the Quality Improvement Council.
Prior to the receipt of services, IPP’s outlining specified services that exceed service limits or
require exceptional services such as nursing require a prior authorization of the services

The Quality Management Council must recognize IPP’s as contracts.

The state Medicaid agency, BMS, maintains a copy on file of provider agreements
between BMS and Medicaid Waiver provider agencies.

Providers that do not meet the needs of individuals should be subject to sanctions.

X The State will make waiver services available to individuals in the target group up to the number
indicated as factor C for the waiver year.
The State will make waiver services available to individuals in the target group up to the lesser of the
number of individuals indicated as factor C for the waiver year, or the number authorized by the State legislature for that time period.

There must be new slots to meet Olmstead obligations and honor Benjamin H.
The ABS is not an accurate measure of skills for someone with Developmental Disabilities or related conditions.

ADAPT WV