Medically Complex Children Waiver Program Update: Increased Maximum Age Limit, Implementation of Environmental Modifications and Respite Service Provider Recruitment
The South Carolina Department of Health and Human Services (SCDHHS) is announcing the implementation of three changes to the Medically Complex Children Waiver (MCCW) program. The MCCW program serves children who meet hospital level-of-care and have chronic physical/health conditions that are expected to last longer than 12 months. MCCW participants must also meet the state-defined medical eligibility criteria, which evaluates the child's dependency on medications, medical supervision, hospitalizations, skilled nursing services, therapies and medical specialists.
- The age limit for currently enrolled MCCW participants who may receive waiver services is increased to 21 years of age;
- The age limit for individuals who may apply to receive MCCW services is increased to 20 years of age;
- Eligible MCCW participants may be authorized to receive environmental modification services; and,
- Providers are invited to join the MCCW respite provider network.
Maximum Age for MCCW Participation Increased to Age 21
The change in maximum age allows current participants meeting MCCW eligibility criteria to receive services through age 21. Waiver administration staff will coordinate transition to appropriate primary care and other waiver programs six months prior to the participant’s 21st birthday. The previous age range of eligibility for the MCCW program was zero to 18 years of age. SCDHHS will now process applications for individuals up to age 20 years and six months. Applicants who are 20 years of age may only receive MCCW services if all eligibility criteria have been met AND services are initiated six months prior to the participant’s 21st birthday.
Increasing the maximum age allows for continuity of care during the transition from pediatric to adult care systems and aligns with state plan services such as children’s personal care and children’s private duty nursing that are available up to age 21 under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.
New Environmental Modifications Service Coverage
Eligible MCCW participants may be authorized to receive coverage for environmental modifications. Environmental modifications are physical adaptions to the private residence of the participant or the participant’s family and must be identified on the service plan. The adaptations must be necessary to ensure the health, welfare and safety of the participant or enable the participant to function with greater independence in the home. Examples include the installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, provision of air units, and installation of specialized electric and plumbing systems necessary to accommodate the medical equipment and supplies required for the welfare of the participant(s). There is a $7,500 lifetime monetary cap per waiver participant.
Environmental modifications must meet certain standards and specifications as detailed under Long-term Living Environmental Modification Standards and Specifications section located in Chapter 7 of the Community Long-Term Care Provider Manual.
SCDHHS is developing guidance to allow short-term respite services to be provided to MCCW and other home and community based services (HCBS) waiver participants who are unable to care for themselves. Providers who are interested in providing respite service to HBCS waiver participants should send inquiries to MedicaidWaiver@scdhhs.gov.
Environmental Modifications and Respite Provider Requirements
Providers interested in furnishing environmental modification and respite services to MCCW participants must comply with SCDHHS standards including regulations, policies and procedures related to provider qualifications.
Detailed requirements, service definitions, allowable categories, service limits and components of each service approved underenvironmental modificationsare available for review in the MCCW waiver document.
Please direct questions regarding this Medicaid bulletin to MedicaidWaiver@scdhhs.gov.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.