Crosswalk - Application Instructions, Technical Guide, and Review Criteria

Crosswalk: Instructions, Technical Guide and Review Criteria
§1915(c) Home and Community-Based Waiver Application (version
3.6)
Section

New Version

Title page

Incremented waiver version from 3.5 to 3.6 and document date to
January 2019.

Throughout document

Updated to align with the current 1915(c) waiver application and
current CMS Review Instrument as well as current CMS regulations,
policy, and guidance.
Removed outdated language throughout the document.
Added “Concurrent Managed Care Authority” in several places
instead of listing specific managed care authorities such as 1915(b).
Removed outdated and no longer used Independence Plus
Designation language.
Added some regulatory citations.

1-C: Type of Request, Review
Criteria

Removed old language and revised to two yes/no questions regarding
type of application and waiver approval period.

1-F

Removed old language and inserted two review criteria regarding
level of care.

6-I, Public Input

Revised to clarify that at least one of two statements of public notice
and public notice procedures must be non-electronic to ensure the
individuals without computer access have the opportunity to provide
input.
Revised review criteria to clarify that the 30 day public input process
period has to be completed prior to waiver submission (not 30 days
prior to waiver submission).

Appendix B-1-a, Target Groups

Revised to indicate that one or more target groups may be chosen, to
align with regulations. Similar changes to language pertaining to this
were made in other sections throughout the technical guide.

Appendix C-1-b, Alternate
Provision of Case Management
Services to Waiver Participants

In addition to the Medicaid authorities mentioned, added “or another
Medicaid authority”.

Appendix C, Provider Categories,
Provider Qualifications

Added language regarding training and certification for personal care
service (PCS) providers including supervision and monitoring
requirements to ensure only qualified providers are providing PCS.
Also added these to the CMS review criteria.

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Section

New Version

Appendix E, Overview, Supports
for Participant Direction, FMS

Added language regarding the state’s responsibility to ensure that it is
operating consistently with all state and Federal requirements.

Appendix E, Instructions

Added guidance regarding operation with a concurrent 1915(j)
authority.

Appendix E-1-c

Added clarification that if the waiver will operate with a concurrent
1915(j) authority, the person self-directing may not reside in a
provider owned or operated home. Removed language pertaining to
size of living arrangement from CMS review criteria.

Appendix F-1, Opportunity to
Request a Fair Hearing

Added minor language modifications in the technical guidance
section as well as under the review criteria.

Appendix I-1, Financial Integrity
and Accountability

Added language to more clearly describe what should be addressed in
the waiver application.

Appendix I-2-a, Rate Determination
Methods

Added language to clarify what is required of the states.

Appendix I-2-d, Billing Validation
Process

Added clarifying language.

Appendix I-3-a, Method of
Payment MMIS: Added a Review
Criterion

Added language to specify that when payments for waiver services
are made by a managed care entity or entities, the waiver describes
how the monthly capitated payments are made to the managed care
entity or entities.

Appendix I-7, Participant CoPayments for Waiver services and
Other Cost Sharing

Added changes throughout this Appendix to update.

Appendix J-2-c Derivation of
Estimates for Each Factor

Updated to reflect current CMS guidance and updated review criteria.

Appendix J-2-d-ii

Updated review criteria to align with current practice.

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