IHCA ICAL Bulletin February 1, 2016
Dedicated to promoting quality long term care
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Changes to HCBS eligilbity criteria and process
(HCBS providers)

IHCA received the message below from DHS regarding eligibility changes for HCBS waiver patients. The MCO needs to be notified by the 17th of the month for coverage to begin on the 1st of the following month. In example 2, there are two months of waiver services that are not covered even though the patient has been deemed financially eligible for Medicaid. DHS has instructed IHCA that the member and the provider need to reach an agreement for payment of the non-covered services. At this time, it looks like retro-eligibility will continue to not be available for the HCBS waiver services.

DHS message
As of January 1, 2016, the eligibility requirement of having an approved service plan completed will no longer exist for [HCBS] waiver applicants. A waiver member will now be able to be approved for waiver once Medicaid eligibility and Level of Care (LOC) have been established. For members who will enroll with an MCO, the MCO will now be the entity that will be creating and implementing the member’s service plans. Please note that this will take place outside of ISIS and MCOs will not be using ISIS in anyway.  

Medicaid eligibility will now exist as of the 1st of the month that LOC has been met, or Medicaid eligibility exists, whichever is later. Waiver eligibility will be dependent upon the date that the income maintenance (IM) approves the case in IABC. If entries are made no later than the 5th of the month, the waiver begin date will be the 1st of the following month. If approval entries are made on the 6th or after, the begin date of waiver will be the 1st of the month following the next calendar month.   

Examples:   

  1. IM has determined that applicant meets LOC and Medicaid eligibility as of January 1st and is ready to make entries to approve the waiver case in IABC on January 4th. Medical should be approved as of January 1st and the waiver will be approved as of February 1st.
  2. IM has determined that applicant meets LOC and Medicaid eligibility as of January 1st, but is not ready to make entries to approve the waiver case until January 18th. Medical should be approved as of January 1st and the waiver will be approved as of March 1st.
  3. IM has determined that applicant meets LOC as of January 3rd, but does not meet Medicaid eligibility until February 1st. IM is ready to make entries to approve the waiver case on February 3rd. Medical should be approved as of February 1st and waiver will be approved as of March 1st.
 
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Education Calendar
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NE District Meeting and Education, February 4, 9:00 a.m. - 12:00 p.m., Cedar Falls
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NW District Meeting and Education, February 8, 9:00 a.m. - 12:00 p.m., Storm Lake  NEW DATE
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SE District Meeting and Education, February 9, 10:00 a.m. - 1:00 p.m., West Liberty
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Data-Driven CNA Recruitment—Increasing Interview Show-Ups, February 9, 2:00-3:00, webinar
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SW District Meeting and Education, February 11, 9:30 a.m. - 12:30 p.m., Atlantic
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Life & Fire Safety Conference, February 15-16, Jefferson
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Life & Fire Safety Conference, February 17-18, Coralville
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Fall Prevention Workshop, February 25, West Des Moines
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LTC Nurse and Administrator Leadership Program, Part 1: March 9-10, Part 2: April 20-21, West Des Moines   
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Data-Driven CNA Recruitment—90-Day Caregiver Onboarding Best Practices, March 15, 2:00-3:00, webinar
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CNA and Direct Caregiver Mentorship Program, March 22-23, West Des Moines
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Home Health Care Conference, March 24, 2016, West Des Moines
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Spring Quarterly Education & Activity Professionals Conference, March 29-30, Embassy Suites, Des Moines
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Activity Professionals Home Study Course, Home Study Course
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ICAL Assisted Living Manager Certificate Program - Online, Ongoing, web-based
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Online Dementia Care Training and Individual Certification Program
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Click on the event link to learn more about each educational offering and to register. If you have additional questions, contact Georgene Olson at 800.422.3106.

West Des Moines area hotel discounts for IHCA ICAL members.

Map to the IHCA ICAL Education Center, 1775 90th Street, West Des Moines, IA.

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