Resources

CMS.gov is committed to making its electronic and information technologies accessible to people with disabilities. We strive to meet or exceed the requirements of Section 508 of the Rehabilitation Act (29 U.S.C. 794d), as amended in 1998.

States must have a clear idea on the cost of maintaining the structural changes once they are in place.  Therefore, States should submit the overall maintenance budget of the structural changes and sources of funding.

All staff should be trained on the NWD/SEP processes by the time the system is implemented for testing. As a related deliverable, States should submit the training documents used by NWD/SEP staff to follow the NWD/SEP processes, in addition to the training agenda.  To be effective, documents should include flow diagrams and clear guidelines for each type of NWD/SEP staff member.

This task involves a much more detailed design structure of the NWD/SEP system.  If the State plans to contract a vendor to build an automated system, the deliverable associated with this task could be the Request for Proposal (RFP) disseminated to potential vendors.  The RFP should include the data flow, highlighting which entity(ies) will house the data, data transfer mechanisms, levels of user access, and data security measures.

 A single toll free number should route individuals to central NWD/SEP staff or to a local NWD/SEP, where they can find out about community LTSS options in the State, request additional information, and schedule appointments at local NWD/SEPs for an assessment.  The number should be accessible to non-native English speakers and those with disabilities, providing translation services and TTY.

The Balancing Incentive Program requires states to use a Core Standardized Assessment (CSA) instrument(s) to 1) determine eligibility for Medicaid-funded community long-term services and supports (LTSS), 2) identify individuals’ support needs, and 3) inform their service and support planning (e.g., plan of care).

One of the three structural change requirements Balancing Incentive States must implement is a conflict-free case management system. “Conflict of interest” is defined as a “real or seeming incompatibility between one’s private interests and one’s public or fiduciary duties.” Some State social services systems allow the agent that conducts the functional assessment and/or case management to also provide services to that individual.

A key component of a Statewide NWD/SEP system, and a requirement of Balancing Incentive Program states, is an informative website about community LTSS options in the State. It should provide broad access to standardized information about community LTSS and contact information for NWD/SEPs and the 1-800 number where individuals can get more information or complete an assessment. Websites must be 508 compliant and accessible for individuals with disabilities.

States must develop standardized informational materials that NWD entities provide to individuals. Informational materials can include pamphlets, summaries of programs and related eligibility criteria, case worker scripts, and websites.

Kentucky Medicaid Waiver Management Application Page: A one-stop resource for the latest information related to the MWMA project and its implementation.

Below, we present example request for proposals (RFPs) related to the Program.   

Texas State Supported Living Center Electronic Health Record/Electronic Life Record Procurement

In housed data center or cloud located in vendor  hosted Electronic Health Record(EHR)/Electronic Life Record (ELR) Commerical Off the Shelf (COTS) software solution which will be used by DAD 12 State Supported Living Centers (SSLCs). 

Nursing homes, hospitals, community-based organizations, medical providers, and other governmental social programs should be aware of and refer clients to the NWD/SEP system.  Therefore, the state must develop and submit a plan for advertising the system to all potential referring partners. 

To improve access across diverse populations and large geographic areas, CMS expects that States will rely on multiple types of NWD/SEPs within their systems.  These entities may not have worked together in the past.  Therefore, it is essential that States foster productive working relationships by establishing clear guidelines on each entity’s responsibilities and confirming support through Memoranda of Understanding (MOUs).  MOUs should specify changes that NWD/SEPs need to make to their current processes to become compliant with the Balancing Incentive Program.  

CMS requires States to implement a two-level assessment process across populations seeking LTSS, involving a Level I screen and a Level II assessment. The purpose of a Level I screen is to identify those individuals who are likely to be eligible candidates for Medicaid-funded community LTSS.  The Level I screen must be available for completion by the potential applicant and/or his/her representatives in person or over the phone (by calling a 1-800 number with live support available). 

Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation

The Balancing Incentive Program can be found in Section 10202 of the ACA. 

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