January 22, 2001
MB-AASA-AAA/HCS-DDD-RCS-00-02
MANAGEMENT BULLETIN
TO: Area Agency on Aging (AAA) Directors
Home and Community Services (HCS) Regional Administrators
FOR: All AAA and HCS Field Staff Authorizing Medicaid Personal Care (MPC)
and COPES Services
DEVELOPMENTALLY DISABLED (DD) CLIENTS
ll. TRANSFERRING COPES CLIENTS TO MPC—Additional Information
AASA and the Division of Developmental Disabilities (DDD) recognize that in limited situations, some adults will request and be eligible for both DDD and AASA services. In these situations, AASA and DDD will share the responsibility for these persons. For example, DD clients who request placement in nursing facilities (NFs) must have these services authorized by AASA but they retain their DDD eligibility and case manager. However, COPES services for DD clients must be managed by HCS or AAA.
The following clarifies our separate responsibilities:
A. DD Clients Seeking COPES Services
MPC is the priority program. Only those clients who need additional COPES services and meet COPES eligibility may be authorized COPES.
Some parent providers seek to transfer their adult DD children from MPC to COPES in order to access the higher COPES rate paid to parent providers. Under WAC 388-71-0435(3), one is eligible for COPES only if one is not eligible for MPC because the “amount, duration, and scope of your needs is beyond what MPC can provide.”
Ø DDD clients may be eligible for COPES only when MPC clearly does not meet the client’s need.
Ø The need for additional hours of service or the provider’s wish for higher payment is not justification for putting a DD client or any client on COPES instead of MPC.
B. DDD Clients Receiving COPES Through AASA
While a DSHS client may receive both DDD and AASA services, he/she can only receive services through one waiver. Therefore, if the person is receiving services through the CAP waiver, he/she cannot access COPES services.
Ø DDD clients on COPES may continue to receive DDD services such as community access or financial management as long as the DDD services are state-funds only.
Ø The DDD services must not duplicate COPES services, including the residential contracted services for the clients living in COPES residential settings.
C. Responding to DD Adults Seeking HCS Services
Since MPC services are authorized by both AASA and DDD under the same federal and state rules, there is no advantage for a person eligible for DDD to receive MPC services from AASA. It is important that persons be informed of the existence of DDD services and referred to DDD for assessment and service. DD clients are best served through DDD where other appropriate services and specialized case management options are available. Only when a DD client’s needs cannot be met through MPC, should HCS authorize COPES.
In the event a DD client exercises his/her right to dis-enroll from DDD in order to receive MPC services through AASA, it would be appropriate for HCS to staff the case with DDD to assure that all related circumstances are considered, and ultimately, that both HCS and DDD are offering equal services. There are no sanctioned waiting lists in DDD for assessment or authorization of MPC.
Ø It is critical to the integrity of the program that we avoid the appearance of unequal treatment under MPC.
D. Availability of Flex Rate or ETP Funding
Both AASA and DDD have the option to use flex rates or limited ETP funding to exceed the program rates for compelling situations. When to exercise that option is determined internally by each administration. DDD is responsible for MPC payments for all DDD clients.
E. Shared Living Arrangement (SLA)
(The SLA definition is found in WAC 388-15-202(45) and WAC 388-71-0460; SLA rates are in the SSPS Manual, codes 4501 and 4504 under Additional Data.)
The rules governing SLA rates are unique to MPC and apply to both AASA and DDD. In DDD, SLA rules apply to parent providers of adult clients, while most SLA cases in AASA apply to parents being cared for by their adult children.
It is DDD’s policy to meet a client’s need for ETP hours exceeding the SLA rate through the use of another individual or agency provider. Parent providers have no right to a fair hearing based on denial of an ETP to increase the parent’s hours or rate. Only the client has a right to a hearing and if DDD is meeting the client’s needs, there is no issue for a hearing. HCS and AAA staff should follow this established DDD policy when authorizing MPC service plans and hours for DD clients. Unless they are functionally eligible for COPES and have unmet needs that exceed what is provided under MPC, a DD client should receive the identical provision of MPC services from the AASA network as they would from DDD.
ll. TRANSFERRING COPES CLIENTS TO MPC—Additional Information
MB-AASA-AAA/HCS–DDD-00-51 dated 10/10/00 directs staff to assure that MPC is the priority personal care program assigned. The following two issues need additional clarification:
In the process of converting current clients from COPES to MPC, clients living with non-responsible relative providers, i.e., parents, sons, or daughters, will meet the SLA definition for MPC.
Ø However, since the SLA rates are lower than these clients have been receiving on COPES, staff may use the new MPC flex rate procedure to keep the rate the same on MPC as these transferred clients were receiving on COPES.
All other MPC clients who meet the SLA definition should continue to be authorized SLA rates unless circumstances justify using an ETP to increase that rate.
Transfer COPES residential clients who meet the MPC eligibility to MPC at the time of their next reassessment.
Ø MPC is only authorized in adult family homes (AFH’s) and adult residential care facilities (ARC’s).
Ø MPC is not authorized to clients in assisted living (AL) facilities. Do not transfer COPES clients living in AL’s to MPC. They should remain on COPES as long and they reside in the facility and remain COPES eligible.
Ø Many enhanced-ARC’s (EARC’s) are also contracted to provide MPC. Therefore, clients in EARC’s who meet eligibility may be transferred to MPC in settings with MPC contracts.
Ø If a client resides in a facility that does not have an MPC contract, they should be left on COPES as long as they remain COPES eligible and remain in the COPES facility.
Clients whose sole income is SSI will have their PNA (CPI) dropped to $38.84 when transferred to MPC, reference WAC 388-71-0470(3). Those with other income in addition to SSI will continue to receive the $58.84 PNA which they were receiving under COPES. The PNA rate for SSI recipients is set by federal regulations and therefore, cannot be changed.
Facility residents, who no longer meet the functional eligibility for COPES, but do meet MPC functional eligibility, can be transitioned to MPC as long as their cost of care is more than their income.
Remember: Notify financial by 14-084 anytime you change programs.
Inquiries to:
Lois Wusterbarth, MPC Program Manager Marrianne Backous, COPES Program Manager
Tele: (360) 725-2536 Tele: (360) 725-2535
Fax: (360) 438-8633 Fax: (360) 438-8633
Email: wustela@dshs.wa.gov Email: backomr@dshs.wa.gov
______________________________
Penny Black, Acting Director
Home & Community Services Division