County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Overview of Home and CommunityBased Services HCBS Waiver Programs Number Page 051801 1 of 5 Revision Date 05012019 Background The Social Security Act Section 1915c permits states to request waivers in order to provide certain services to people at home or in the community as a cost neutral alternative to institutionalized health care provided such noninstitutionalized services meet the health and safety needs of the beneficiary The goal is that the beneficiary will experience an enhanced and enriched quality of life if allowed to return home or to the community This section has been updated to include clarifications issued in ACWDL 1819 Purpose This section provides an overview of the Home and CommunityBased Services Waiver Programs Policy A HCBS Waivers There are currently five Home and CommunityBased Service Waivers in effect in San Diego Department of Developmental Services Home and CommunityBased DDS Waiver InHome Operations IHO Waiver Nursing Facility NF Level AB Waiver NF Subacute Waiver and InHome Medical Care Services IHMC Waiver Department of Aging Multipurpose Senior Services Program MSSP Waiver Assisted Living Waiver ALW DHS Acquired Immune Deficiency Syndrome AIDS Waiver The first four waivers follow special MediCal rules that allow the exemption of an inhome spouse or parents income and property when determining MediCal eligibility for individuals who are eligible to these waivers The AIDS Waiver follows normal MediCal rules An individual who has a shareofcost SOC or is not property eligible for MediCal under regular incomeproperty rules may benefit from these waivers Note Spousal Impoverishment SI provision allows the allocation of income and resources from the institutional spouse to the community spouse or other dependent family members B HCBS Waivers and SI Provisions Effective January 1 2014 the Affordable Care Act ACA broadened the definition of an institutionalized spouse to include HCBS recipients and those who have requested HCBS who generally reside in the home or in the community With this change SI provisions must be used to determine MediCal when an individual requests an HCBS waiver or HCBS waiver services rather than waiting for the waiver to be approved Who SI Applies To SI provisions apply to married individuals and Registered Domestic Partners RDPs who on or after January 1 2014 arewere New MediCal applicants who request HCBS waiver services inhome assistance or IHSS In an HCBS waiver program On a HCBS waiver wait list and are receiving MediCal or requesting MediCal County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Overview of Home and CommunityBased Services HCBS Waiver Programs Number Page 051801 2 of 5 Requesting or receiving HCBS waivers or program services including IHSS but were denied or discontinued due to excess property Requesting or receiving HCBS waiver or program services including IHSS and have a MediCal SOC Enrolled in InHome Supportive ServicesCommunity First Choice Option IHSSCFCO programs aid code 2K Requiring a Nursing Facility Level of Care When To Apply SI ProvisionsApplicable Application Date SI provisions are applied the first month when both of the following exist The request for either HCBS or InHome Supportive Services IHSS has been made and The individual meets a nursing facility level of care documented through the MC 604 MDV Doctors Verification form or through a Needs Assessment issued by the HCBS waiver or program The date both criteria are met is the applicable application date for SI provisions Any individual may initiate the HCBS Waiver process by Applying for MediCal Contacting a waiver administrator Contacting a carecoordinating agency that works with the waiver administrator MC 604 MDV Doctors Verification FormNeeds Assessment The Doctors Verification form and the Needs Assessment serve different functions and are not interchangeable Both may be required for an individual requesting inhome care depending on the timing of the request for services and their individual circumstances A Needs Assessment establishes that the individual meets the nursing facility level of care for at least 30 consecutive days and may state the HCBS waiver program the individual is approved for A Doctors Verification form MC 604 MDV is required to be signed by the person initiating the waiver request unless the individual provides a waiver Needs Assessment confirming eligibility to a Waiver program This form Authorizes the physician to release information to the County Establishes if the individual meets the nursing facility level of care for at least 30 consecutive days in the absence of HCBS Begins the Continuous Period of Institutionalization SI provisions are not applied until the Doctors Verification form is completed and returned by the physician C Continuous Period of Institutionalization The continuous period of institutionalization is the 60day timeframe beginning the day the county receives the completed Doctors Verification form stating the individual meets the nursing facility level of care for at least 30 consecutive days Period that determines the length of time the institutionalized spouse is eligible to SI provisions before being placed on a waiting list or actually participating in an HCBS waiver County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Overview of Home and CommunityBased Services HCBS Waiver Programs Number Page 051801 3 of 5 The beneficiary is referred to the appropriate agency to apply for HCBS but before referring staff must obtain a signed Authorization for Release of Information giving the county authorization to verify that an application for HCBS has been submitted The SI provisions will remain only if the application for HCBS is completed prior to the continuous period of institutionalization ending This period ends when The request for HCBS is denied It is determined the beneficiary is not a CFCOIHSS recipient The beneficiary fails to follow through and complete the HCBS application process The HCBS spouse or institutionalized spouse does not receive HCBS waiver or program services or inpatient care in a medical institution or nursing facility for a full calendar month Follow the steps in Processing Guide 25 to refer and confirm that the application for HCBS has been completed within the 60 days Note If the community spouse also requests HCBS there is no longer a community spouse Spouses remain in separate MFBUs and SI provisions will not apply in this scenario However the division of community property and income rules may apply D Retroactive Application of SI Provisions for HCBS Cases must be rescinded for individuals who requested an HCBS Waiver any time after January 1 2014 and were denieddiscontinued due to excess income or property based on the community spouse residing in their own home not institutionalized Rescind the case back to the date the individual would have been an eligible HCBS spouse when Retro SI must be confirmed prior to rescinding the case The County becomes aware of a case that meets these standards The individual is participating in the CFCOIHSS programs There is a new application or annual redetermination A fair hearing is requested The individual requests a retroactive redetermination The retroactive evaluation must be processed before current eligibility is established because the Community Spouse Resource Allowance CSRA applies once in the initial month of eligibility Desk Aids 83 94 and 95 have been created to provide case examples Refer to MPG 1005 for Treatment of Income and MPG 0913 for CSRA guidelines Note HCBS Waiver and LongTerm Care LTC benefits and services are provided to beneficiaries under the Modified Adjusted Gross Income MAGI coverage groups including the Optional Targeted Low Income Childrens Program OTLICP without time limits and no change in aid code if the individual meets eligibility criteria under MAGI Institutional deeming rules do not apply to MAGI E Retroactive Reimbursement A beneficiary may request reimbursement of MediCal claims or services provided by an IHSS enrolled provider under the Beneficiary Reimbursement Process AKA the Conlan process by calling the Beneficiary Services Center BSC at 9164032007 and submitting a claim The BSC provides the necessary forms and instructions for filing a claim County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Overview of Home and CommunityBased Services HCBS Waiver Programs Number Page 051801 4 of 5 F HCBS Waiver AidCodes HCBS Waiver program aid codes are for voluntary managed care enrollees The enrollment process is done through Health Care Options HCO MediCal beneficiaries with a zero SOC in a mandatory managed care plan aid code may choose to disenroll from managed care by completing HCO02 MediCal Waiver Program Exemption Certification The medical providers usually initiate this form Note Waiver aid codes are not required to be present in MEDS for individuals eligible under SI provisions or any other MediCal programs as long as they meet HCBS waiver requirements and pass the Needs Assessment Waiver aid codes will still appear on MEDS for individuals who require institutional deeming in order to be eligible for waiver services G Early and Periodic Screening Diagnosis and Treatment EPSDT EPSDT is a MediCal benefit for individuals under 21 years old which requires that states provide medically necessary screening vision hearing and dental services to MediCal beneficiaries The program may provide licensed skilled nursing in the home Therefore MediCal eligible children who are institutionalized will now be able to return home from institutionalization and those who are home can remain there when receiving additional medical services under the EPSDT program if certain criteria including cost effectiveness are met H SSI Personal Needs Allowance Effective June 1 1990 federal law began allowing a former institutionalized SSI child the same Personal Needs Allowance PNA as an institutionalized SSI child as long as the noninstitutionalized child is in a home and a communitybased waiver applies The Social Security Administration SSA must confirm that a child is in a waiver program before the PNA can begin or continue Counties must request permission from the childs parent or guardian before providing verification to SSA that the child is in a waiver program The information may be requested at the time wavier coverage begins and then at the SSA redetermination The MediCal Waiver Information and Authorization form DHCS 7071 was developed to secure parental consent and allow to release this information to SSA In addition counties should be aware that in some cases when the waiver beneficiary begins receiving the PNA MEDS will convert the waiver aid code to aid code 60 If this occurs and the waiver person is still living in the home and is ineligible for a regular SSI payment counties should contact DHCS to have the aid code corrected I Manual Budget Evaluation A manual budget evaluation is required when SI provisions apply and the individual requests HCBS Under SI provisions for HCBS There is no 35 LTC needs allowance Spouses are in separate MFBUs even though the HCBS spouse may be in the home not in an institution Use all applicable NonMAGI program income deductions and disregards The FPL and MN limits for one person is used All applicable spousal and dependent family member income allocations apply Procedures Procedures for these programs are listed in Processing Guide 25 County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Overview of Home and CommunityBased Services HCBS Waiver Programs Number Page 051801 5 of 5 Program Impacts Forms 14152 Budget Steps Worksheet for HCBS Spousal Impoverishment and 14153 Referral to IHSS and HCBS Waiver Agencies have been added to EFR Automation SI approvals for HCBS in CalWIN require a manual override Special Indicator MC HCBS Spousal Impoverishment has been added in order to identify these cases References MEM PROC 19D MEPM Letter No 307 ACWDL 8777 9001 9003 9184 0322 0331 0331E 1236 1715 1725 1819 MEDIL 1438 1810 Desk Aid 77 83 94 and 95 Sunset Date This policy will be reviewed for continuance by 05312022 Approval for Release Rick Wanne Director Eligibility Operations County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Home and CommunityBased Services for the Developmentally Disabled HCBSDD Waiver Number Page 051802 1 of 3 Revision Date 01012018 Background The Department of Health Care Services DHCS applied for and received federal approval from the Federal Centers for Medicare and Medicaid Services CMS for the Home and CommunityBased Services for the Developmentally Disabled HCBSDD Waiver The Department of Developmental Services DDS Waiver is a subset of the HCBSDD Waiver This section is being updated to include changes contained in ACWDL 1725 issued July 19 2017 effective January 1 2014 and revised to the new format Purpose This section will provide guidance for processing the DDS Waiver portion of the HCBSDD Waiver Policy The DDS Waiver is for individuals no age limit diagnosed as developmentally disabled prior to their 18th birthday These individuals must live at home and meet the admission criteria for an intermediate care facility for the developmentally disabled as defined in the California Health and Safety Code The San Diego Regional Center SDRC determines if the individualindividuals family meets the criteria for the DDS Waiver program The waiver provides developmentally disabled individuals who are Regional Center consumers to receive care at home instead of care provided in an intermediate Care Facility or a State Developmental Center Procedure 051802A Referring Agency SDRC is responsible for the DDS Waiver referrals SDRC determines the medical appropriateness of waiver coverage by reviewing the individualindividuals family income When appropriate the SDRC will refer the individual to the county for an eligibility determination or redetermination via the DDS Waiver Referral form DHCS 7096 which the county must image as part of the case record If no responsible relative is available to act on behalf of the individual or the responsible relative does not wish to apply for the individual the SDRC representative may do so Staff may share ongoing eligibility information with SDCR regardless of who acts on the individuals behalf and without requiring a signed DHCS 7068 The Regional Center for San Diego and Imperial Counties is located at 4355 Ruffin Road Ste 205 8585762996 San Diego CA 921231648 858 5762873 Fax Effective January 1 2014 the DDS Waiver may be initiated by a parent or an AR when applying for MediCal Refer to Processing Guide 25 when a DDS Waiver is initiated by other than the SDRC and no determination for the waiver has been completed County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Home and CommunityBased Services for the Developmentally Disabled HCBSDD Waiver Number Page 051802 2 of 3 051802B Eligibility Refer to Processing Guide 25 for processing an application with a DDS Waiver referral 051802C Beginning Date of Eligibility and Retroactive Coverage The effective date of eligibility for an applicant using the special rules under the DDS Waiver is the date the following two requirements are met The referring agency determines that it is medically appropriate for the Waiver applicant to be in the Waiver Normally this is the date on the wavier referral The worker determines that the Waiver applicant meets the MediCal eligibility requirements under that Waiver If an applicant requests retroactive MediCal coverage regular MediCal rules apply If the applicant requests retroactive eligibility also be evaluated using the special rules under the Waiver contact the representative of the referring agency to inquire whether the Waiver also covers the retroactive period The response must be narrated in case comments In lieu of the applicant completing the retroactive section of the SOF the original referral form may include a cover letter requesting retroactive MediCal 051802D Aid Codes The following aid codes are used for DD Waiver eligible cases 6VDD Waiver Zero SOC 6WDD Waiver SOC 051802E Redetermination If a beneficiary is currently receiving MediCal benefits through the DDS Waiver program the San Diego Regional Center must be contacted at the time of annual redetermination to ensure the beneficiary is still medically eligible for the Waiver program 051802F Notice of Action NOA An additional copy of the granting NOA must be sent to the Regional Center representative or referring agency informing them of the disposition of the applicationredetermination Program Impacts Automation The Collect Individual Attributes Detail window in CalWIN must be completed to ensure eligibility is determined under the DDS Waiver Forms and Document Capture Image all appropriate forms into the case record References MEPM 19D ACWDL 1715 1725 MEDIL 1438 Sunset Date This policy will be reviewed for continuance by 01312021 County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Home and CommunityBased Services for the Developmentally Disabled HCBSDD Waiver Number Page 051802 3 of 3 County of San Diego Health and Human Services Agency HHSA MediCal Program Guide MediCal InHome Operations IHO Waivers Number Page 051803 1 of 3 Revision Date 01012018 Background The Department of Health Care Services DHCS applied for and received federal approval from the Federal Centers for Medicare and Medicaid Services CMS for the IHO Waiver This section is being updated to include changes contained in ACWDL 1725 issued July 19 2017 effective January 1 2014 and revised to the new format Purpose To provide updated guidelines for the processing of the IHO Waiver Policy The DHCS IHO section determines if the applicant meets the criteria for the IHO Waiver MediCal IHO Waivers were limited to people who require nursing facility level of care or subacute services for at least 90 consecutive days but who wish to live at home or in the community Effective January 1 2014 Individuals who require nursing facility level of care or subacute services for at least 30 consecutive days are eligible to receive the waiver The waiver may be requested by applicant spouse or AR when applying for MediCal Refer to Processing Guide 25 when a waiver is requested by other than DHCS IHO section and a needs assessment has not been completed IHO waiver services provided include but are not limited to case management skilled nursing home health aides language services speech hearing family training and therapy physical therapy and adaptations to the home Inpatient status before enrollment of waiver series is not required Procedure 051803A Referring Agency The referring agency for the MediCal IHO Waiver is the DHCS IHO Section The purpose of IHO is to ensure that necessary appropriate and quality medical and nursing services are authorized and provided in the home setting IHO staff facilitates the proposal documentation and development between each waiver participant and provider This process allows for review of all issues related to the level of care evaluation of durable medical equipment medication nursing hours cost effectiveness and verification by IHO staff that the home environment is appropriate to meet the health and safety needs of the recipient Final approvals of individual waiver requests are subject to review by a medical physician and other staff When the medical assessment is completed the worker receives a copy of the MediCal IHO Waiver MediCal Eligibility Notice Letter No 1 from the MediCal Program Specialist Some individuals receiving benefits under the Developmentally Disabled Waiver may be referred by DHCS IHO to change to the MediCal IHO Waiver due to a better match for services The worker receives a copy of the MediCal IHO Waiver Eligibility Notice Letter No 3 from the MediCal Program Specialist The worker must change the aid code to the appropriate MediCal IHO Waiver aid code County of San Diego Health and Human Services Agency HHSA MediCal Program Guide MediCal InHome Operations IHO Waivers Number Page 051803 2 of 3 Note Individuals under the age of 21 must be able to access a waiver service which is not covered under the Early and Periodic Screening Diagnosis and Treatment EPSDT program Refer to MPG 051801 for EPSDT information HCBS Care Coordinator Needs Assessment Received When the needs assessment has been completed by a HCBS coordinator before applying for MediCal spousal impoverishmentAllocation Deeming rules apply regardless if the waiver referral is received or the individual is on a waiver waiting list 051803B Eligibility Refer to Processing Guide 25 to process an application with a MediCal IHO Waiver ReferralDoctors Verification form 051803C Beginning Date of Eligibility and Retroactive Coverage The effective date of eligibility for an applicant using the special rules under the IHO Waiver is the date the following requirements are met The referring agency determines that it is medically appropriate for the Waiver applicant to be in the Waiver Normally this is the date on the IHO Wavier referral or The person requests both MediCal and HCBS for the Waiver applicant and the completed Doctors Verification form has been received and The worker determines that the Waiver applicant meets the MediCal eligibility requirements under that Waiver If an applicant requests retroactive MediCal coverage regular MediCal rules apply If the applicant requests retroactive eligibility also be evaluated using the special rules under the Waiver contact the representative of the referring agency to inquire whether the Waiver also covers the retroactive period The response must be narrated in case comments In lieu of completing the retroactive section of the SOF the original referral form may include a cover letter requesting retroactive MediCal 051803D Aid Codes The following aid codes are used for MediCal IHO Waiver eligible cases 6X MediCal IHO Waiver Zero SOC 6Y MediCal IHO Waiver SOC 051803E Redetermination At annual redetermination unless the worker has been notified otherwise the beneficiary is still considered medically eligible to the MediCal IHO Waiver program It is not necessary for the worker to contact IHO or the MediCal Program Specialist to verify if the individual is still eligible to the Waiver program 051803F Notice of Action NOA Use appropriate approval denial or discontinuance NOA MC 343 IHO Waiver approval NOA MC 344 IHO Denial discontinuance NOA It is not necessary to send a copy of the granting NOA to the referring agency or the MediCal Program Specialist County of San Diego Health and Human Services Agency HHSA MediCal Program Guide MediCal InHome Operations IHO Waivers Number Page 051803 3 of 3 Program Impacts Automation The Collect Individual Attributes Detail window in CalWIN must be completed to ensure eligibility is determined under the IHO Waiver Forms and Document Capture Image all appropriate forms into the case record References ACWDL 0331 0331E 1725 MEDIL 1438 MEPM 19D Sunset Date This policy will be reviewed for continuance by 01312021 County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Department of Aging Multipurpose Senior Services Program MSSP Waiver Number Page 051804 1 of 2 Revision Date 01012018 Background The Department of Health Care Services DHCS applied for and received federal approval from the Federal Centers for Medicare and Medicaid Services CMS for the MSSP Waiver This section is being updated to include changes contained in ACWDL 1725 issued July 19 2017 effective January 1 2014 and revised to the new format Purpose This section provides guidelines for processing of the MSSP Waiver Policy The MSSP Waiver Program is limited to individuals who are Aged Age 65 or older Receiving fullscope MediCal under an acceptable aid code Certifiable for placement in a nursing facility Living within Aging and Independent Services AIS service area Able to be served within a programs cost limitations Eligible for care management services Many of the waiver participants live at home and were on MediCal before being accepted into the Waiver Services include case management adult social day care housing assistance protective services personal care respite care transportation meal services and special communications Procedure 051804A Referring Agency The California Department of Aging CDA is the referring agency Aging and Independent Services AIS is the local administrator in San Diego County The assessment for the MSSP wavier is completed before the applicant is referred to the County The MSSP individual is referred using form MC 364 Effective January 1 2014 the waiver may be requested by applicant spouse or AR when applying for MediCal Refer to Processing Guide 25 when a waiver is requested by other than CDA 051804B Eligibility Individuals must be in the following qualifying MediCal aid codes to receive MSSP services 10 14 16 18 1H 1X and 1Y Refer to Processing Guide 25 to process a case under the MSSP Waiver 051804C Beginning Date of Eligibility and Retroactive Coverage The effective date of eligibility for an applicant using the special rules under the MSSP Waiver is the date the following two requirements are met The referring agency determines that the applicant is medically eligible to the Waiver Normally this is the date on the MSSP Wavier referral The worker determines that the Waiver applicant meets the MediCal eligibility requirements under that Waiver County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Department of Aging Multipurpose Senior Services Program MSSP Waiver Number Page 051804 2 of 2 If an applicant requests retroactive MediCal coverage regular MediCal rules apply If the applicant requests retroactive eligibility also be evaluated using the special rules under the Waiver contact the representative of the referring agency to inquire whether the Waiver also covers the retroactive period The response must be narrated in case comments In lieu of completing the retroactive section of the SOF the original referral form may include a cover letter requesting retroactive MediCal 051804D Aid Codes The following aid codes are used for MediCal IHO Waiver eligible cases 1X MSSP Waiver Zero SOC 1Y MSSP Waiver SOC 051804E Notice of Action NOA When an applicants MediCal eligibility is approved or denied under a Waiver in addition to the copy sent to the applicant a copy of the approvaldenial NOA is also sent to the representative of the referring agency Program Impacts Automation The Collect Individual Attributes Detail window in CalWIN must be completed to ensure eligibility is determined under the MSSP Waiver Forms and Document Capture Image all appropriate forms into the case record References ACWDL 0322 1725 MEDIL 1438 MEM Proc 19D9 Sunset Date This policy will be reviewed for continuance by 01312021 County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Assisted Living Waiver ALW Number Page 051805 1 of 3 Revision Date 01012018 Background The Department of Health Care Services DHCS applied for and received federal approval from the Federal Centers for Medicare and Medicaid Services CMS for the ALW This section is being updated to include changes contained in ACWDL 1725 issued July 19 2017 effective January 1 2014 and revised to the new format Purpose This section provides policy guidelines for processing the ALW Policy ALW provides a viable alternative to longterm care for certain individuals because it allows individuals to live in the community while receiving many of the services that would be available in longterm care The ALW provides the assisted living benefits in two settings Residential care facilities for the elderly RCFEs Publicly funded senior andor disabled housing PSH ALW benefits include Assisted living benefit as rendered by the RCFE setting Assisted living benefit as rendered by a MediCal licensed and certified home health agency in the PSH setting Care coordination MediCal eligible persons residing in an ALW provider site and enrolled into the ALW have the following characteristics Have fullscope MediCal eligibility without a MediCal share of cost SOC Determined to have enough disposable income by DHCS Are aged or disabled Note Blind applicants for the ALW will need to be determined disabled to be part of this waiver Meet the nursing facility NF A or B level of care Are at least 21 years of age Individuals ineligible for the ALW are those who Reside in a residential care facility under state only aid code AC 53 Are in a limited scope AC due to failure to comply with DRA citizenship and identity regulations Are enrolled in another Home and Community Based waiver Note The ALW is available in San Diego and there are ALW provider facilities in San Diego For a list of ALW facilities go to httpswwwdhcscagovservicesltcDocumentsCareCoordinationAgencies2018pdf County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Assisted Living Waiver ALW Number Page 051805 2 of 3 Procedure 051805A Referring Agency The waiver is operated by the DHCSLongTerm Care Division Monitoring and Oversight Section MOS DHCS has also contracted with Care Coordinator Agencies CCAs to conduct some aspects of the ALW process Effective January 1 2014 the waiver may be requested by the applicant spouse or AR when applying for MediCal When an individual asks DHCS an ALW facility or a CCA about the waiver the individual must be eligible for full scope MediCal with or without a SOC before any ALW assessments are made by DHCS or CCAs 051805 B Eligibility The county of residence is responsible for determining initial MediCal eligibility for the ALW beneficiary When an individual asks the county about the ALW 1 Complete a standard MediCal determination Refer to processing Guide 25 for steps 2 Refer the individual to the CCA a list of CCAs can be found at httpswwwdhcscagovservicesltcDocumentsCareCoordinationAgencies2018pdf Refer to processing Guide 25 for steps when ALW is requested and no referral has been received The ALW rules apply to an individual who was found MediCal eligible with a SOC or was denied MediCal for excess property but is married and may be eligible if evaluated as if they were residing in a licensed board and care provider site Refer to processing Guide 25 for steps when the applicant is treated as if heshe were institutionalized for purposes of determining the amount of income and property the waiver applicant has 051805C Aid Codes DHCS has not created aid codes specifically for this waiver Until they develop ALW aid codes if an individual is determined eligible for zero SOC MediCal using the waiver rules they must be placed in one of the following aid codes 14 for aged individuals 64 for disabled individuals 051805D Notice of Action NOA If an individual is to move into an ALW provider site and is then eligible using regular MediCal rules staff shall use a regular MediCal NOA If eligibilityineligibility is based on the use of the special ALW rules such as institutional deeming rules and spousal impoverishment provisions staff must use one of the three ALW specific notices of action below MC240 Approval for Enrollment in Assisted Living Waiver with MediCal Changes for Beneficiary MC241 Approval for Enrollment in Assisted Living Waiver and Initial MediCal only use if initial eligibility and ALW eligibility is determined simultaneously MC 242 Denial of Enrollment in Assisted Living Waiver andor MediCal Referral Form County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Assisted Living Waiver ALW Number Page 051805 3 of 3 Program Impacts Forms and Document Capture The ALW NOAs are not available in CalWIN but are available in Xerox Follow existing procedures to Document Capture any client correspondence issued outside of CalWIN References ACWDL 9001 1725 MEPM Letter No 307 MEDIL 1438 Sunset Date This policy will be reviewed for continuance by 01312021 County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Acquired Immune Deficiency Syndrome AIDS Waiver Number Page 051806 1 of 2 Revision Date 01012018 Background The Department of Health Care Services DHCS applied for and received federal approval from the Federal Centers for Medicare and Medicaid Services CMS for the AIDS Waiver This section has been updated to the new format no other changes have been made Purpose This section will provide guidelines for the processing of the AIDS Waiver Policy The AIDS Waiver is limited to persons with a diagnosis of Human Immunodeficiency or Acquired Immune Deficiency Syndrome AIDS with symptoms related to Human Immunodeficiency Virus HIV disease who would otherwise require care in skilled nursing facilities or acute hospitals Services provided include Case management Skilled nursing Attendant care Psychosocial counseling Nonemergency medical transportation Homemaker services Equipment and minor physical adaptations to the home Limited room and board supplement for infants and children in foster care Nutritional counseling Nutritional supplementshome delivered meals Procedure 051806A Referring Agency Medical certification for the AIDS Waiver is completed by the California Department of Public Health Office of AIDS The medical assessment for this wavier is completed before the applicant is referred to the County There should be few if any of this type of referral to the County 051806B Eligibility Process using regular MediCal eligibility rules no special MediCal eligibility rules apply 051806C Notice of Action NOA When an applicants MediCal eligibility is approved or denied under a Waiver in addition to the copy sent to the applicant a copy of the approvaldenial NOA will also be sent to the representative of the referring agency whose name and address are on the referral form with an exception of the MediCal IHO Waiver Program County of San Diego Health and Human Services Agency HHSA MediCal Program Guide Acquired Immune Deficiency Syndrome AIDS Waiver Number Page 051806 2 of 2 References MEM PROC 19D ACWDL 9001 1715 1725 MEDIL 1438 Sunset Date This policy will be reviewed for continuance by 01312021