Application for 1915(c) HCBS Waiver: SC.02.R01.00

Application for a �1915(c) Home and Community-Based Services Waiver

PURPOSE OF THE HCBS WAIVER PROGRAM

The Medicaid Home and Community-Based Services (HCBS) waiver program is authorized in �1915(c) of the Social Security Act. The program permits a State to furnish an array of home and community-based services that assist Medicaid beneficiaries to live in the community and avoid institutionalization. The State has broad discretion to design its waiver program to address the needs of the waiver�s target population. Waiver services complement and/or supplement the services that are available to participants through the Medicaid State plan and other federal, state and local public programs as well as the supports that families and communities provide.

The Centers for Medicare & Medicaid Services (CMS) recognizes that the design and operational features of a waiver program will vary depending on the specific needs of the target population, the resources available to the State, service delivery system structure, State goals and objectives, and other factors. A State has the latitude to design a waiver program that is cost-effective and employs a variety of service delivery approaches, including participant direction of services.

Request for a Renewal to a �1915(c) Home and Community-Based Services Waiver

1. Major Changes

PRTF Demonstration Grant

Describe any significant changes to the approved waiver that are being made in this renewal application:

Character Count: out of 12000

N/A

Application for a �1915(c) Home and Community-Based Services Waiver

1. Request Information (1 of 3)

The State of South Carolina requests approval for a Medicaid home and community-based services (HCBS) waiver under the authority of �1915(c) of the Social Security Act (the Act).
Program Title (optional - this title will be used to locate this waiver in the finder):

Community-Based Alternatives To Psychiatric Residential Treatment Facilities
Type of Request: renewal [PRTF Demonstration Grant]

Migration Waiver - this is an existing approved waiver

Renewal of Waiver:

Provide the information about the original waiver being renewed

Base Waiver Number:

Amendment Number

(if applicable):

Effective Date: (mm/dd/yy)

Waiver Number: SC.02.R01.00

Draft ID: SC.02.01.00

Renewal Number:
Type of Waiver (select only one):
Proposed Effective Date: (mm/dd/yy)

Approved Effective Date: 01/01/08

1. Request Information (2 of 3)

1. Request Information (3 of 3)

2. Brief Waiver Description

Brief Waiver Description. In one page or less, briefly describe the purpose of the waiver, including its goals, objectives, organizational structure (e.g., the roles of state, local and other entities), and service delivery methods.

Character Count: out of 6000

The purpose of this waiver is to provide community-based services to children with mental illness who would otherwise be served in Psychiatric Residential Treatment Facilities (PRTF). Families and youths will be offered the choice of behavioral health services and supports they prefer to permit the youths to remain in, or return to, the least restrictive environment- preferably their homes. To be eligible, a potential waiver participant must meet the PRTF level of care (LOC) and meet all Medicaid financial requirements. 

These services will be provided using a system of care approach. There will be a single point of entry for all waiver applicants. Families and youths who enter the waiver will participate in Service Plan Development meetings made up of stakeholders that may currently be involved with the family and any representatives the family may choose to attend. During these meeting, a Plan of Care will be developed. The family may choose providers from a Qualified Providers List (QPL), that will be comprised of both public and private providers. If the family has a provider that they have been working with that is not on the QPL, efforts will be made to contact the provider to discuss their interest in enrolling (provided they meet all requirements). The Service Plan Development team will meet regularly (every 90 days), to discuss treatment progress and any changes that are requested. If the family needs the team to meet at an earlier date than planned, they can request a meeting at any time. Annual reevaluations will be conducted to determine continued eligibility for waiver participation. 

The South Carolina Department of Health and Human Services (DHHS), as the state Medicaid agency, will have complete administrative authority over the waiver. The operational entity will be the South Carolina Department of Mental Health (DMH). A Memorandum of Agreement (MOA) has been developed and agreed upon by both parties. The MOA clearly designates roles and responsibilities for both agencies. 

A waiver of state wideness is being requested to provide for the phase-in of additional geographic areas, each waiver year. County boundaries will determine the geographic areas. For each new waiver year, at least three counties will be added and phased-in. By year five, the waiver will be statewide.

3. Components of the Waiver Request

The waiver application consists of the following components. Note: Item 3-E must be completed.

Waiver Administration and Operation. Appendix A specifies the administrative and operational structure of this waiver.
Participant Access and Eligibility. Appendix B specifies the target group(s) of individuals who are served in this waiver, the number of participants that the State expects to serve during each year that the waiver is in effect, applicable Medicaid eligibility and post-eligibility (if applicable) requirements, and procedures for the evaluation and reevaluation of level of care.
Participant Services. Appendix C specifies the home and community-based waiver services that are furnished through the waiver, including applicable limitations on such services.
Participant-Centered Service Planning and Delivery. Appendix D specifies the procedures and methods that the State uses to develop, implement and monitor the participant-centered service plan (of care).
Participant-Direction of Services. When the State provides for participant direction of services, Appendix E specifies the participant direction opportunities that are offered in the waiver and the supports that are available to participants who direct their services. (Select one):

Yes. This waiver provides participant direction opportunities. Appendix E is required.

No. This waiver does not provide participant direction opportunities. Appendix E is not required.

not selected
Participant Rights. Appendix F specifies how the State informs participants of their Medicaid Fair Hearing rights and other procedures to address participant grievances and complaints.
Participant Safeguards. Appendix G describes the safeguards that the State has established to assure the health and welfare of waiver participants in specified areas.
Quality Management Strategy. Appendix H contains the Quality Management Strategy for this waiver.
Financial Accountability. Appendix I describes the methods by which the State makes payments for waiver services, ensures the integrity of these payments, and complies with applicable federal requirements concerning payments and federal financial participation.
Cost-Neutrality Demonstration. Appendix J contains the State's demonstration that the waiver is cost-neutral.

4. Waiver(s) Requested

Comparability. The State requests a waiver of the requirements contained in �1902(a)(10)(B) of the Act in order to provide the services specified in Appendix C that are not otherwise available under the approved Medicaid State plan to individuals who: (a) require the level(s) of care specified in Item 1.F and (b) meet the target group criteria specified in Appendix B.
Income and Resources for the Medically Needy. Indicate whether the State requests a waiver of �1902(a)(10)(C)(i)(III) of the Act in order to use institutional income and resource rules for the medically needy (select one):

Not Applicable

No

Yes

not selected
Statewideness. Indicate whether the State requests a waiver of the statewideness requirements in �1902(a)(1) of the Act (select one):

No

Yes

If yes, specify the waiver of statewideness that is requested (check each that applies):

Geographic Limitation. A waiver of statewideness is requested in order to furnish services under this waiver only to individuals who reside in the following geographic areas or political subdivisions of the State.

Specify the areas to which this waiver applies and, as applicable, the phase-in schedule of the waiver by geographic area:

Character Count: out of 6000

A waiver of state wideness is being requested to provide for the gradual phase-in of the waiver to additional areas of the state, each waiver year. County lines will determine the geographic areas. For the first year, the waiver will be implemented in a three-county area. The counties chosen are Richland, Lexington and Fairfield. Richland and Lexington Counties are comprised of more urban than rural areas, while Fairfield County is primarily rural. For each year of the waiver, at least three counties will be phased-in. It has not, as yet, been determined which counties will be phased in with each waiver year. By year five, however, the waiver will be statewide.

Limited Implementation of Participant-Direction. A waiver of statewideness is requested in order to make participant-direction of services as specified in Appendix E available only to individuals who reside in the following geographic areas or political subdivisions of the State. Participants who reside in these areas may elect to direct their services as provided by the State or receive comparable services through the service delivery methods that are in effect elsewhere in the State.

Specify the areas of the State affected by this waiver and, as applicable, the phase-in schedule of the waiver by geographic area:

Character Count: out of 6000

5. Assurances

In accordance with 42 CFR �441.302, the State provides the following assurances to CMS:

Health & Welfare: The State assures that necessary safeguards have been taken to protect the health and welfare of persons receiving services under this waiver. These safeguards include:
1. As specified in Appendix C, adequate standards for all types of providers that provide services under this waiver;
2. Assurance that the standards of any State licensure or certification requirements specified in Appendix C are met for services or for individuals furnishing services that are provided under the waiver. The State assures that these requirements are met on the date that the services are furnished; and,
3. Assurance that all facilities subject to �1616(e) of the Act where home and community-based waiver services are provided comply with the applicable State standards for board and care facilities as specified in Appendix C.
Financial Accountability. The State assures financial accountability for funds expended for home and community-based services and maintains and makes available to the Department of Health and Human Services (including the Office of the Inspector General), the Comptroller General, or other designees, appropriate financial records documenting the cost of services provided under the waiver. Methods of financial accountability are specified in Appendix I.
Evaluation of Need: The State assures that it provides for an initial evaluation (and periodic reevaluations, at least annually) of the need for a level of care specified for this waiver, when there is a reasonable indication that an individual might need such services in the near future (one month or less) but for the receipt of home and community based services under this waiver. The procedures for evaluation and reevaluation of level of care are specified in Appendix B.
Choice of Alternatives: The State assures that when an individual is determined to be likely to require the level of care specified for this waiver and is in a target group specified in Appendix B, the individual (or, legal representative, if applicable) is:
1. Informed of any feasible alternatives under the waiver; and,
2. Given the choice of either institutional or home and community based waiver services. Appendix B specifies the procedures that the State employs to ensure that individuals are informed of feasible alternatives under the waiver and given the choice of institutional or home and community-based waiver services.
Average Per Capita Expenditures: The State assures that, for any year that the waiver is in effect, the average per capita expenditures under the waiver will not exceed 100 percent of the average per capita expenditures that would have been made under the Medicaid State plan for the level(s) of care specified for this waiver had the waiver not been granted. Cost-neutrality is demonstrated in Appendix J.
Actual Total Expenditures: The State assures that the actual total expenditures for home and community-based waiver and other Medicaid services and its claim for FFP in expenditures for the services provided to individuals under the waiver will not, in any year of the waiver period, exceed 100 percent of the amount that would be incurred in the absence of the waiver by the State's Medicaid program for these individuals in the institutional setting(s) specified for this waiver.
Institutionalization Absent Waiver: The State assures that, absent the waiver, individuals served in the waiver would receive the appropriate type of Medicaid-funded institutional care for the level of care specified for this waiver.
Reporting: The State assures that annually it will provide CMS with information concerning the impact of the waiver on the type, amount and cost of services provided under the Medicaid State plan and on the health and welfare of waiver participants. This information will be consistent with a data collection plan designed by CMS.
Habilitation Services. The State assures that prevocational, educational, or supported employment services, or a combination of these services, if provided as habilitation services under the waiver are: (1) not otherwise available to the individual through a local educational agency under the Individuals with Disabilities Education Act (IDEA) or the Rehabilitation Act of 1973; and, (2) furnished as part of expanded habilitation services.
Services for Individuals with Chronic Mental Illness. The State assures that federal financial participation (FFP) will not be claimed in expenditures for waiver services including, but not limited to, day treatment or partial hospitalization, psychosocial rehabilitation services, and clinic services provided as home and community-based services to individuals with chronic mental illnesses if these individuals, in the absence of a waiver, would be placed in an IMD and are: (1) age 22 to 64; (2) age 65 and older and the State has not included the optional Medicaid benefit cited in 42 CFR �440.140; or (3) age 21 and under and the State has not included the optional Medicaid benefit cited in 42 CFR � 440.160.

6. Additional Requirements

Note: Item 6-I must be completed.

Service Plan. In accordance with 42 CFR �441.301(b)(1)(i), a participant-centered service plan (of care) is developed for each participant employing the procedures specified in Appendix D. All waiver services are furnished pursuant to the service plan. The service plan describes: (a) the waiver services that are furnished to the participant, their projected frequency and the type of provider that furnishes each service and (b) the other services (regardless of funding source, including State plan services) and informal supports that complement waiver services in meeting the needs of the participant. The service plan is subject to the approval of the Medicaid agency. Federal financial participation (FFP) is not claimed for waiver services furnished prior to the development of the service plan or for services that are not included in the service plan.
Inpatients. In accordance with 42 CFR �441.301(b)(1) (ii), waiver services are not furnished to individuals who are in-patients of a hospital, nursing facility or ICF/MR.
Room and Board. In accordance with 42 CFR �441.310(a)(2), FFP is not claimed for the cost of room and board except when: (a) provided as part of respite services in a facility approved by the State that is not a private residence or (b) claimed as a portion of the rent and food that may be reasonably attributed to an unrelated caregiver who resides in the same household as the participant, as provided in Appendix I.
Access to Services. The State does not limit or restrict participant access to waiver services except as provided in Appendix C.
Free Choice of Provider. In accordance with 42 CFR �431.151, a participant may select any willing and qualified provider to furnish waiver services included in the service plan unless the State has received approval to limit the number of providers under the provisions of �1915(b) or another provision of the Act.
FFP Limitation. In accordance with 42 CFR �433 Subpart D, FFP is not claimed for services when another third-party (e.g., another third party health insurer or other federal or state program) is legally liable and responsible for the provision and payment of the service. FFP also may not be claimed for services that are available without charge, or as free care to the community. Services will not be considered to be without charge, or free care, when (1) the provider establishes a fee schedule for each service available and (2) collects insurance information from all those served (Medicaid, and non-Medicaid), and bills other legally liable third party insurers. Alternatively, if a provider certifies that a particular legally liable third party insurer does not pay for the service(s), the provider may not generate further bills for that insurer for that annual period.
Fair Hearing: The State provides the opportunity to request a Fair Hearing under 42 CFR �431 Subpart E, to individuals: (a) who are not given the choice of home and community- based waiver services as an alternative to institutional level of care specified for this waiver; (b) who are denied the service(s) of their choice or the provider(s) of their choice; or (c) whose services are denied, suspended, reduced or terminated. Appendix F specifies the State's procedures to provide individuals the opportunity to request a Fair Hearing, including providing notice of action as required in 42 CFR �431.210.
Quality Management. The State operates a formal, comprehensive system to ensure that the waiver meets the assurances and other requirements contained in this application. Through an ongoing process of discovery, remediation and improvement, the State assures the health and welfare of participants by monitoring: (a) level of care determinations; (b) individual plans and services delivery; (c) provider qualifications; (d) participant health and welfare; (e) financial oversight and (f) administrative oversight of the waiver. The State further assures that all problems identified through its discovery processes are addressed in an appropriate and timely manner, consistent with the severity and nature of the problem. During the period that the waiver is in effect, the State will implement the Quality Management Strategy specified in Appendix H.
Public Input. Describe how the State secures public input into the development of the waiver:

Character Count: out of 6000

Families, youth and major stakeholders collaborated extensively to develop both the grant proposal and this waiver application. For the waiver application, workgroups were developed and were comprised of representatives from DHHS, DMH, other child placing agencies, public/private providers and families. These workgroups provided vital input on the system of care processes that will be used to implement the waiver. The workgroup participants regularly reviewed waiver drafts and provided comments. Conference calls were held on a regular basis with family members who could not attend workgroup meetings. All materials discussed in each workgroup meeting were emailed with updates, to allow participants that could not meet on a particular day the opportunity to provide input. Each participant was given an equal voice in the discussions, and all viewpoints were given equal consideration. Typically, decisions were made by majority consent.
Notice to Tribal Governments. The State assures that it has notified in writing all federally-recognized Tribal Governments that maintain a primary office and/or majority population within the State of the State's intent to submit a Medicaid waiver request or renewal request to CMS at least 60 days before the anticipated submission date is provided by Presidential Executive Order 13175 of November 6, 2000. Evidence of the applicable notice is available through the Medicaid Agency.
Limited English Proficient Persons. The State assures that it provides meaningful access to waiver services by Limited English Proficient persons in accordance with: (a) Presidential Executive Order 13166 of August 11, 2000 (65 FR 50121) and (b) Department of Health and Human Services "Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons" (68 FR 47311 - August 8, 2003). Appendix B describes how the State assures meaningful access to waiver services by Limited English Proficient persons.

7. Contact Person(s)

The Medicaid agency representative with whom CMS should communicate regarding the waiver is:

Last Name:
First Name:
Title:
Agency:
Address:
Address 2:
City:
State:	South Carolina
Zip:
Phone:	Ext: TTY
Fax:
E-mail:

If applicable, the State operating agency representative with whom CMS should communicate regarding the waiver is:

Last Name:
First Name:
Title:
Agency:
Address:
Address 2:
City:
State:	South Carolina
Zip:
Phone:	Ext: TTY
Fax:
E-mail:

8. Authorizing Signature

This document, together with Appendices A through J, constitutes the State's request for a waiver under �1915(c) of the Social Security Act. The State assures that all materials referenced in this waiver application (including standards, licensure and certification requirements) are readily available in print or electronic form upon request to CMS through the Medicaid agency or, if applicable, from the operating agency specified in Appendix A. Any proposed changes to the waiver will be submitted by the Medicaid agency to CMS in the form of waiver amendments.

Upon approval by CMS, the waiver application serves as the State's authority to provide home and community-based waiver services to the specified target groups. The State attests that it will abide by all provisions of the approved waiver and will continuously operate the waiver in accordance with the assurances specified in Section 5 and the additional requirements specified in Section 6 of the request.

Signature:
	State Medicaid Director or Designee
Submission Date:

Last Name:
First Name:
Title:
Agency:
Address:
Address 2:
City:
State:	South Carolina
Zip:
Phone:
Fax:
E-mail:

Attachment #1: Transition Plan

Specify the transition plan for the waiver:

Character Count: out of 12000

Transition plan for all participants who are still in the waiver at the end of this PRTF demonstration project:

Six months prior to the end of the PRTF demonstration project, the TCM will send a letter to the families remaining, notifying them of the transition planning procedures. A Family Advocate will be available to meet with the family to discuss the transition process. 

The family's Service Plan Development team will meet to develop a transition plan. The family/youth must designate they approve of the transition plan by signing the Plan of Care (POC). After the meeting, appropriate referrals will be made by the Targeted Case Manager.

The participant�s Plan of Care shall specify transitional services being pursued on their behalf and shall contain evidence that appropriate referrals/coordination have been initiated. Services and supports may include referrals to agencies such as Department of Mental Health, Continuum of Care, Vocational Rehabilitation, Department of Disabilities and Special Needs (if the participant meets the criteria for services), and Housing and Urban Development. In addition, if the participant is in the custody of the state at the time of transition, the Department of Social Services offers an array of supports, benefits and services for children.

Appendix A: Waiver Administration and Operation

State Line of Authority for Waiver Operation. Specify the state line of authority for the operation of the waiver (select one):

The waiver is operated by the State Medicaid agency.

Specify the Medicaid agency division/unit that has line authority for the operation of the waiver program (select one: do not complete Item A-2):

The Medical Assistance Unit.

Specify the unit name:

Another division/unit within the State Medicaid agency that is separate from the Medical Assistance Unit.

Specify the unit name: Do not complete item A-2.

not selected

The waiver is operated by a separate agency of the State that is not a division/unit of the Medicaid agency.

Specify the unit name: South Carolina Department of Mental Health
In accordance with 42 CFR �431.10, the Medicaid agency exercises administrative discretion in the administration and supervision of the waiver and issues policies, rules and regulations related to the waiver. The interagency agreement or memorandum of understanding that sets forth the authority and arrangements for this policy is available through the Medicaid agency to CMS upon request. Complete item A-2.

not selected

Appendix A: Waiver Administration and Operation

Medicaid Agency Oversight of Operating Agency Performance. When the waiver is not operated by the Medicaid agency, specify the methods that the Medicaid agency uses to ensure that the operating agency performs its assigned waiver operational and administrative functions in accordance with waiver requirements. Also specify the frequency of Medicaid agency assessment of operating agency performance:

Character Count: out of 12000

DHHS and DMH have entered into a Memorandum of Agreement (MOA), which will be renewed annually. The MOA ensures an understanding between DHHS and DMH regarding operation and administration of the waiver. The MOA designates that the waiver will be operated by DMH, under the supervision of DHHS. DHHS will exercise administrative discretion in the administration and supervision of the waiver and will be responsible for issuing all policies, rules and regulations related to the waiver. The MOA clearly states that DHHS is the final authority and shall make all final decisions regarding all matters related to the administration of the waiver. The MOA also establishes a formal communication schedule between the agencies. Monthly operational level meetings and quarterly policy level meetings will be held between DHHS and DMH. Weekly/multiple contacts by telephone and email will be conducted between DMH and DHHS, as necessary. The MOA specifies that DMH is responsible for managing the day-to-day operations and procedures for the waiver. Among other duties, DMH will be responsible for provider enrollment, assurances of freedom of choice and level of care (LOC) determinations (While DMH will make LOC determinations, DHHS will retain ultimate authority for LOC determinations. For example, all adverse LOC decisions will be sent to DHHS by DMH for review. If there is a disagreement concerning the determination, appropriate staff from DMH and DHHS will reveiw, but DHHS retains the authority to make the final decision). DHHS, or its contracted entity, will review operations at least annually, to ensure quality and compliance. DHHS shall approve all operational policies, rules and regulations prior to issuance and implementation. DMH shall submit any proposed policy or procedure changes in writing to DHHS, who shall review and respond in a timely manner. Other waiver related issues should be presented in writing by DMH at the regularly scheduled meetings for discussion and response by DHHS. DHHS is responsible for assuring compliance with Federal standards and regulations to assure health and welfare safeguards, and to ensure that provider standards have been met. DHHS or its designated entity shall review waiver case records on an annual basis and as needed, to determine appropriateness and adequacy of services and to ensure that services furnished are consistent with the nature and severity of the individual�s disability. DMH shall cooperate with DHHS in a review of DMH admission and waiting list procedures to assure that they are in compliance with Medicaid requirements. These reviews will take place annually and as needed. Problems identified by the DHHS quality assurance process shall be communicated in writing to DMH. DMH shall respond in writing to DHHS, addressing the reported concerns and indicating corrective action plans. DHHS shall review the corrective action plans to assure the problems identified have been appropriately addressed. DMH shall have a quality assurance system (see Appendix H) responsible for the monitoring of standards and qualifications for all contractors and providers under the waiver. DHHS will at least annually obtain and review copies of DMH internal audits, quality assurance, and follow up reports related to waiver services and enrolled providers.

Appendix A: Waiver Administration and Operation

Use of Contracted Entities. Specify whether contracted entities perform waiver operational and administrative functions on behalf of the Medicaid agency and/or the operating agency (if applicable) (select one):

Yes. Contracted entities perform waiver operational and administrative functions on behalf of the Medicaid agency and/or operating agency (if applicable).

Specify the types of contracted entities and briefly describe the functions that they perform. Complete Items A-5 and A-6.:

Character Count: out of 6000

1. DHHS contracts with a quality assurance entity as part of the agency's regular reviews of state Medicaid programs. This contractor may be designated, on the behalf of DHHS, to perform reviews of quality assurance issues for waiver functions and outcomes. 2. DHHS will contract with Family Advocacy organizations to disseminate and provide information about the waiver, assist families with the enrollment process, assist families with the Fair Hearing and grievance processes, and provide assistance with training.

No. Contracted entities do not perform waiver operational and administrative functions on behalf of the Medicaid agency and/or the operating agency (if applicable).

not selected

Appendix A: Waiver Administration and Operation

Role of Local/Regional Non-State Entities. Indicate whether local or regional non-state entities perform waiver operational and administrative functions and, if so, specify the type of entity (Select One):

not selected

Not applicable

Applicable - Local/regional non-state agencies perform waiver operational and administrative functions.

Check each that applies:

Local/Regional non-state public agencies perform waiver operational and administrative functions at the local or regional level. There is an interagency agreement or memorandum of understanding between the State and these agencies that sets forth responsibilities and performance requirements for these agencies that is available through the Medicaid agency.

Specify the nature of these agencies and complete items A-5 and A-6:

Character Count: out of 6000

Local/Regional non-governmental non-state entities conduct waiver operational and administrative functions at the local or regional level. There is a contract between the Medicaid agency and/or the operating agency (when authorized by the Medicaid agency) and each local/regional non-state entity that sets forth the responsibilities and performance requirements of the local/regional entity. The contract(s) under which private entities conduct waiver operational functions are available to CMS upon request through the Medicaid agency or the operating agency (if applicable).

Specify the nature of these entities and complete items A-5 and A-6:

Character Count: out of 6000

Note: For the purposes of this waiver application, when the term "family" is used, it is meant to include a waiver participant acting on their own behalf, a waiver participant and a parent/legal guardian acting together, or a parent/legal guardian acting on behalf of the participant. DHHS will contract with Family Advocacy Organizations to: - Disseminate and provide information about the waiver - Assist families with the enrollment process - Attend Service Plan Development meetings with the family - Assist with administering the satisfaction surveys as part of the evaluation process - Assist families with the Fair Hearing and Grievance process. - Provide assistance to the operational entity with training for waiver providers, as needed. Family Advocacy Organizations are local, non-state, non-governmental entities.

Not applicable - Local/regional non-state agencies do not perform waiver operational and administrative functions.

Appendix A: Waiver Administration and Operation

Responsibility for Assessment of Performance of Contracted and/or Local/Regional Non-State Entities. Specify the state agency or agencies responsible for assessing the performance of contracted and/or local/regional non-state entities in conducting waiver operational and administrative functions:

Character Count: out of 6000

SCDHHS and SCDMH will jointly share the responsibility.

Appendix A: Waiver Administration and Operation

Assessment Methods and Frequency. Describe the methods that are used to assess the performance of contracted and/or local/regional non-state entities to ensure that they perform assigned waiver operational and administrative functions in accordance with waiver requirements. Also specify how frequently the performance of contracted and/or local/regional non-state entities is assessed:

Character Count: out of 6000

The MOA clearly sets forth both the operational agency's responsibility for quality assurance and the administering agency's oversight of the quality assurance process. DHHS and DMH will jointly share the responsibility of assessing the performance of contracted and local/regional non-state entities in conducting waiver operational and administrative functions. There are two entities listed in A-3 and A-4, the quality assurance entity (Qualis) and the Family Advocacy organizations. DMH will be responsible for assessing the performance of the Family Advocacy organizations. The DMH Program Integrity Officer will be responsible for developing a comprehensive quality assurance strategy for the waiver. This will include oversight of the Family Advocacy organizations. DMH will submit annual reviews to DHHS, including all follow-ups on corrective actions. Currently, DMH is working to develop the documentation that will be used in the quality assurance reviews. The monitoring process will include monthly contract monitoring via progress reports supporting monthly reimbursement claims; desk reviews; on-site review and inspection of records; and review of summary/trend data. Reviews will take place at least annually. Ad hoc reviews may also be conducted in the interim, if an issue arises that may warrant such action. Qualis may be requested to assist with some of the quality assurance requirements, on behalf of DHHS. Qualis is a private, non-profit healthcare quality improvement organization that has been contracted by DHHS to conduct a wide array of QI tasks for the agency. DHHS staff directly responsible for the waiver will monitor and review submissions by Qualis pertaining to the waiver. DHHS, or its designee, will be responsible for reviews of the operational functions and the quality of care for the waiver demonstration services. This includes the reviews on contracted and local/regional non-state entities. These reviews will be conducted annually unless an issue arises that may warrant an earlier review. In addition, upon request, the DHHS Medicaid Program Integrity (MPI) Division may conduct reviews. Follow-up to the MPI reviews are based on a Report of Findings. Contracted Entity: Qualis Staff at DHHS will monitor reviews conducted by Qualis on DMH�s oversight of participant service plans and/or any other waiver function. It will be expected that any reviews Qualis may conduct on behalf of DHHS will be done in a timely manner and may include both onsite and desk reviews of service plans reviewed by DMH for QA purposes. Such reviews will be conducted for oversight of DMH as the operational entity. Contracted Entity: Family Advocacy Organizations The monitoring process will include monthly contract monitoring via progress reports supporting monthly reimbursement claims; desk reviews; on-site review and inspection of records; and review of summary/trend data. Reviews will take place at least annually. Ad hoc reviews may also be conducted in the interim, if an issue arises that may warrant such action. All assessments conducted by DMH on contracted entities or local/regional non-state entities will be reviewed by DHHS. This will also include follow-ups to any pending corrective actions (See Appendix H under Monitoring/Reviews).

Appendix A: Waiver Administration and Operation

Distribution of Waiver Operational and Administrative Functions. In the following table, specify the entity or entities that have responsibility for conducting each of the waiver operational and administrative functions listed (check each that applies):

In accordance with 42 CFR �431.10, when the Medicaid agency does not directly conduct a function, it supervises the performance of the function and establishes and/or approves policies that affect the function.

Function	Medicaid Agency	Other State Operating Agency	Contracted Entity	Local Non-State Entity
Disseminate information concerning the waiver to potential enrollees
Assist individuals in waiver enrollment