Behavioral Health Division
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Waiver Redesign Update
The Behavioral Health Division is working with several work teams to research and redesign services for the new Support waiver and Comprehensive waiver in order to comply with the requirements in Senate Enrolled Act No. 0082 Medicaid Reform. This law that requires the Division implement two new waivers and address specific changes to our current waiver structure.
Want to learn more?
- Take a look at the waiver redesign project overview
- Couldn't make it to one of the community forums we held? Listen to a short presentation outlining the process, language of the new bill, and the expectations for moving forward.
- In the news! Read about this waiver redesign project in local newspapers. Also, read a recent article about conflict free case management!
Want to give us your input or have questions?
To inform the public about these changes, the Division and the Wyoming Governor’s Council on Developmental Disabilities held 11 community forums around the state to inform participants and families about the legislation and the plan for changes, gather input on their ideas for improvements to the waivers, hear their fears and concerns, and answer their questions.
- The forum schedule was posted in newspaper advertisements around the state and sent out on listserv e-mails to providers and legislators.
- A paper mailing with the schedule, project website, and survey information was sent to all active waiver participants, guardians, and people on the waiting lists.
- Attendance to the forums has totaled 780 people, including Jackson – 64, Cody – 43, Evanston – 138, Cheyenne – 200, Mountain View – 40, Riverton – 40, Casper – 92, Rock Springs- 45 , Casper (2nd forum)- 27, Gillette- 44, and Sheridan- 47.
Provider Webinar with National Experts in this field
The Division requested two national experts in the DD field, Nancy Thaler and Robin Cooper from the National Association of State Directors of Developmental Disabilities Services, or NASDDDS, to assist the Division in having a separate presentation and discussion with providers on the waiver changes. The provider forum held April 23, 2013 in Cheyenne brought 117 providers and 20 WDH staff together to learn about the changes that are coming and the importance in making these systems changes. This training was held again on May 20, 2013 by teleconference and webinar with over 100 people participating. Future provider training forums are being planned in response to surveys and other input we are receiving on education needs, changes in business models, and adapting to new outcome-based expectations. Here are the slides from their presentations:
A Stakeholder Committee was formed to help the Dept. of Health weigh in on the proposed changes to the waivers.
Membership includes: Charlie Briggs, Shannon Buller, Heather Dodson, Kathy Escobedo, Garry Freel, Shawn Griffin, Buck Gwyn, Glenda Haley, Pat Kolarik, Joy Ringbolt, Kim Latta, Chris Newman, Brenda Oswald, Colleen Pillon, Shirley Pratt, Heather Ripley, Wanda Rogers, Sandy Root-Elledge, Rory Schiffbauer, Joe Simpson, Emily Smith, Jesse Springer, Jamie Staunton, Beverly Swistowicz, Linda Treese, Aaron Wales, Shaun Wilhelm, Marilyn Skogen, Ellen Merchant, Beth Nevin, Ragen Latham, Christine Bates, Logan Meeks, Brian Tronquet, Max Michelson, Sharla Beeken, and Matt Hager.
Here is a list of members with e-mail addresses for those who may be contacted with your input or questions! Also, here is a summary from a May meeting.
Frequently Asked Questions (FAQ) Regarding Waiver Redesign
Q: When will the state implement conflict free case management?
A: The Division will transition to conflict free case management over the next two years, but no timeline is set yet. When the waivers begin in January 2014, the current case management structure will still be in place. The change will not start January 2014. As the new system for conflict free case management is decided, we will communicate the timeline and transition plan to everyone.
Q: Have the waiver changes already been decided?
A: No. The Division is researching approaches used by other states to make similar changes to their waivers and talking with Wyoming providers, participants, families, stakeholders, and consulting with national experts in the field to design and implement changes and improvements to the waivers following best practices and customizing them for Wyoming.
Q: Will my child have to move out of their residential service home (group home)?
A: No. The waiver redesign teams are researching more residential service options to add to these waivers, so people in group homes have other options than traditional residential habilitation. We are also looking at new assessments to help plan of care teams learn how to support a person in a more individualized way and provide services and supports that are better suited to the person's assessed needs, any available natural or community supports, and individual preferences. Many people have voiced wanting different support services available so they can start moving into their own apartment or a shared living arrangement with 1-2 other housemates with disabilities, while still receiving the supports needed for health, safety, community involvement, and well-being. These other services have not yet been decided.
Q: Based upon the Waiver Redesign overview sent out by BHD, we as a provider want to inform our participants and their families in our organization with information about the waiver changes from SEA 82. Since the law requires the waivers to “provide for a case management system…that is free of conflicts of interest” and the BHD overview further states that the system would not "...allow a case manager to be employed by any provider on a person's plan or financially benefit from providing other services on one's plan", should we still employ our case managers for the time being? What information should we share with families?
A: There is some confusion around the case management changes in the final legislation, which states the department shall "Provide for a case management system for the waiver programs that is free of conflicts of interest." Now that the legislation has been passed and signed by the Governor, the Division has developed a project plan that details next steps as we redesign the waivers. We are just at the beginning stages of implementing the requirements of the legislation, including obtaining stakeholder input, and will be working closely with a stakeholder steering committee as we move forward on making changes, including case management. We would advise providers to not make any business decisions about case management services until a decision is made on how we plan on implementing conflict free case management, and our approach has been approved by the Centers for Medicare and Medicaid Services.
Q: How will the new IBA amounts be determined for the new waivers? The legislation states that IBAs will reflect assessed needs in consultation with guardians, case managers and providers.
A: These decisions have not been made yet. The Division currently requests input from people in responding to the ICAP assessment, and the other work that will be done to develop the new IBA methodology or changes to assessment tools will be done in consultation with professionals in this area and with stakeholder involvement. Once the Division has finalized the approach that will be used to determine IBAs for the new waivers, this information will be included in the waiver applications submitted for approval by the Centers for Medicare and Medicaid Services. The Division will hold more public forums in late summer to update participants, guardians, providers and people on the waiting lists on the waiver applications being submitted to CMS so everyone is aware of the changes being proposed. It is anticipated CMS will take three to six months to review the applications, and may require changes to the applications.
Q: What is a capped Supports Waiver?
A: The purpose of a capped Supports Waiver is to provide support services to people with an intellectual disability or related disability within a specific individual cost limit, or cap. The cost limit is meant to be a hard cap that cannot be exceeded, which will allow the Division to use existing funding to start to provide support services to people who are currently on the waiting lists. . It will still offer self-direction and many services to support the growth and independence of individuals with various levels of needs and natural supports. The waiver is not intended to cover paid services for 24 hour care of an individual.
Q: How is a comprehensive waiver different than the current DD waivers?
A: The Comprehensive Waiver combines the current Child DD and Adult DD Waivers and focuses more on people who have significantly higher paid support needs due to the lack of natural supports and other community resources. The comprehensive waiver will have targeting criteria for more intensive services and have more flexibility in the services that are less intensive and allow for more independence, employment support and community access and involvement.
Q: What is happening to the ABI waiver?
A: The Division will keep the ABI waiver active. We were recently advised from CMS that the target population for the ABI waiver and DD waivers cannot be combined into one waiver until new federal rules are finalized for home and community based waivers. Therefore, the ABI waiver will have similar changes made to it to align with the Support and Comprehensive Waiver redesign.
Q: Is Self-direction going to be available in the new waivers?
A: Yes, both waivers will have self-directions options available.
Q: After the changes have been made, how will the Division reevaluate if the waivers are working and if the changes are accomplishing what we planned?
A: The Division is required to evaluate and measure the outputs and activities of the waiver and assess whether things are working as designed and as anticipated. As we analyze data, we will work with CMS, staff and stakeholders to determine if other improvements, training, or changes are needed.