Medicaid Home and Community-Based Waiver Amendments Submitted to the Centers for Medicare and Medicaid Services

PUBLIC NOTICE: 
SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

The South Carolina Department of Health and Human Services (SCDHHS) gives notice that amendments to three of its home and community-based waiver programs, operated through the Community Long Term Care (CLTC) Program, have been submitted to the Centers for Medicare and Medicaid Services (CMS) for review. Amendments will be effective upon CMS approval. These waivers are:

  1. SC.0186 HIV/AIDS Waiver
  2. SC.0405 Community Choices Waiver
  3. SC.40181 Mechanical Ventilator Dependent Waiver

The waiver amendments will address Healthy Connections Prime.

These changes will enable SCDHHS to implement a second phase of transitioning home and community-based services (HCBS) as part of a joint Medicare-Medicaid demonstration program known as Healthy Connections Prime. Through Healthy Connections Prime, people age 65 and older who receive both Medicare and Medicaid and meet other eligibility criteria will receive all of their care, including primary care, behavioral health and long-term care services, from a Coordinated and Integrated Care Organization (CICO). In Phase 1 of Healthy Connections Prime, the CICOs began serving waiver participants, but did not develop care plans for waiver services. These Phase 2 amendments will allow CICOs to develop participants' care plans, drawing on their knowledge of the participants' health needs within and beyond the waiver services they receive, and make the care plan subject to state review and approval. The CICO will also prior authorize waiver services, and develop contractual oversight of waiver providers, excluding attendant care providers. Waiver participants will have access to an appeals process and the Healthy Connections Prime Advocate to assist in disputes.

Public comments and responses to the waiver amendments may be found on the SCDHHS website, scdhhs.gov, in the "Waiver" section.

Draft waiver amendments submitted to CMS may also be found on the SCDHHS website, scdhhs.gov, in the "Waiver" section:

 

The changes have a proposed effective date of Jan. 1, 2016, which is the date that Phase 2 of the transition of HCBS under the Healthy Connections Prime demonstration project begins, or upon CMS approval.

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