Enrollment Process for Persons Moving Out of a Large Community ICF

I. Notification

  • The Local Authority designates staff to complete HCS Program enrollments and requires designated staff to complete HHS enrollment training as outlined in the Performance Contract.
  • HHS notifies the LA when individuals served in large ICF programs are authorized for enrollment into the HCS Program.
  • The LA notifies the individual/legally authorized representative, of the opportunity to enroll into the HCS Program after notification by the state.
  • When the offer of HCS Program services is made, the LA notifies the individual/LAR of the requirement to respond to the opportunity within 20 days of the notification.
  • Once the individual/LAR has responded to the LA notification, the LA schedules a time to discuss the opportunity in more detail.
  • If the individual/LAR does not respond to the offer of waiver services and:
  • the individual is 22 years of age or older, the individual's name is removed from the waiver interest list in accordance with HCS rules; or
  • the individual is under 22 years of age, the individual's interest list registration date is changed to the date of the certified letter informing the individual/LAR of the offer of HCS Program services. In most cases, the LA is not able to change the date and should request the change from field support or HHS Program Enrollment.

II. Selection of Services

  • During the initial discussion with the individual/LAR, the LA reviews all available services with the individual/LAR. The LA provides an oral and written description of the services and supports in the HCS Program and reviews other available services as outlined in the Service Options form in Attachment XVII of the Performance Contract.
  • The Verification of Freedom of Choice form is the required documentation that indicates that the individual/LAR has selected the HCS Program or has not selected the HCS Program. The Verification of Freedom of Choice form must be signed within seven days of the individual/LAR responding to the LA notification of available services. If the individual/LAR does not sign the Verification of Freedom of Choice form within seven days of responding to the notification of the opportunity to enroll in HCS Program services the LA must:
    • retain the applicant's name on the HCS Program interest list without change to the applicant's date of registration; and
    • notify the applicant/LAR in writing of the withdrawal of the offer of the program vacancy and the retention of the applicant's name on the HCS interest list.
  • If at the time HCS Program services are offered, the individual declines HCS services and chooses to remain in the ICF, the offer for HCS Program services is withdrawn; and,
    • if the individual is 22 years of age or older, the individual's name is removed from the interest list in accordance with the HCS rules; or
    • if the individual is under 22 years of age, the individual's interest list registration date is changed to the date that the offer of waiver was declined on the signed Verification of Freedom of Choice form. In most cases, the LA is not able to change the date and should request the change from Field Support or HHS Program Enrollment.
  • The LA faxes the Verification of Freedom of Choice form to HHS Program Enrollment.

III. Pre-enrollment Activities

  • The LA ensures assignment of a local case number to those individuals who indicate a desire for services:
    • if the individual has never had a LCN before with the LA, complete this by using CARE screen 410;
    • check CARE screen C92 or 100 to see if the individual was previously registered and may have a LCN or check CARE screen 397 to review the individual's demographics; and
    • update the individual's address by using CARE screen 430 and/or the correspondent's information by using CARE screen 431.
  • The LA verifies Medicaid eligibility by checking CARE screen C63, or assists the individual/LAR with applying for Medicaid, if necessary.
  • Validate a determination that the individual applying for HCS services has a diagnosis of mental retardation or verify that the applicant has been diagnosed by a licensed physician as having a related condition, which would make the individual eligible for services. The LA is responsible for either completing a Determination of Mental Retardation or endorsing previous assessments to verify eligibility for HCS services.

IV. Enrollment Activities

The individual/LAR signature on Form 8601, Verification of Freedom of Choice, indicating the choice of HCS waiver services leads to the following LA enrollment activities:

  • LA completes the registration in CARE screen L01 (Waiver Enrollment).
  • LA changes the individual's waiting list status to "pending" for HCS services (W21).
  • LA completes an Inventory for Client and Agency Planning assessment, if necessary.
  • LA determines if there is an approved Mental Retardation/Related Condition assessment and existing Level of Care/Level of Need by checking CARE screen C68. (A current LOC/LON will be accepted for HCS enrollments if it does not expire within 60 days.)
  • LA electronically transmits an MR/RC purpose code 2 if a LOC/LON does not exist, is incorrect, or will expire within 60 days.
  • Begin collecting information for the development of the individual's enrollment Person Directed Plan. Develop the PDP with the individual/LAR. (Refer to the HHS website for guidance on this Person Directed Planning process [PDF]. Also refer to Form 8665, Person-Directed Plan, for documenting the enrollment PDP.)
  • If the individual is under 22 years of age and seeking residential support or supervised living services, a description of his or her permanency planning outcomes is included in the PDP. Refer to the HHS website for guidance on Permanency Planning.
  • LA assists the individual/LAR in becoming aware of the eligible providers in the local service area.
    • Provide the individual/LAR with a current list of HCS Program providers from CARE screen C80 and other provider-prepared information, if available.
    • Individual/LAR will select a HCS Program provider.
    • Individual/LAR will complete and sign a Provider Choice form.
    • The LA will fax a copy of the Provider Choice form to HHS Program Enrollment office.
  • LA develops an initial Individual Plan of Care, which identifies the type and amount of program services the individual will need for the calendar plan year. This IPC will include both waiver Program and nonprogram services. Those services identified as needed will be:
    • based on a specific need of the individual;
    • be billable according to the HHS Billing and Fiscal Monitoring Service Definitions and Billing Guidelines; and
    • not available through an alternate funding source.
  • The LA Service Coordinator or designated enrollment staff will schedule a meeting with the individual/LAR and the provider's designated staff to complete final negotiations of the initial IPC.
  • The LA ensures the development and completion of the initial IPC, recommendations for resource authorization based on the Person Directed Plan, and all necessary enrollment assessments;
  • The LA will electronically transmit the enrollment information (MR/RC and IPC) to HHS and HHS PE/UR staff will complete the CARE screens A28 (Enrollment Packet Receipt) and A05 (Enrollment Recommendation) upon receipt of this information. PE/UR will review the enrollment LON and IPC information electronically and will notify the service coordinator when an enrollment packet must be submitted for review.
  • The LA will ensure the individual's movement to a HCS waiver Program within 90 calendar days following the date the LA is informed of the availability of HCS services,

V. CARE Enrollment Screens

The LA will complete the following CARE forms/screens and electronically transmit this information to HHS:

  • L01 — Waiver Enrollment
  • L23 — Waiver MR/RC Assessment (if applicable)
  • L02 — Initial Individual Plan of Care
  • L03 — Enrollment Packet Checklist
  • L09 — Register Client Update (if the individual will not be receiving services from the public provider, contact provider for local case number)
  • L05 — Provider Choice (contact provider for contract number and location code)

VI. Enrollment Information

  • The LA will, by the date of enrollment, provide the program provider with the following information on each individual enrolled into the program provider's program:
    • written justification for, and outcome of, each service identified in the individual's IPC;
    • other consumer-related information, such as previous service plan, medical information, assessment results, DMR, and PDP, that will assist the Program provider in serving the individual;
    • MR/RC Assessment; and
    • ICAP Assessment booklet and scoring.

VII. Enrollment Completion

  • Services will be initiated by the selected HCS Program provider upon approval of the individual's enrollment to the HCS Program.
  • HHS Program Enrollment staff will complete CARE screen A06 (Enrollment Authorization) and
    • If the enrollment is not authorized, the Program Enrollment staff will generate a letter denying eligibility to the individual/LAR. Once notified of the denial, the LA will change the individual's waiting list status to "denied" for waiver services (W21).
    • If the enrollment is authorized, CARE will automatically change the individual's waiting list status to "enrolled." Program Enrollment staff will mail an Approval of Application for Enrollment letter to the individual/LAR and a copy to the program provider and the LA.

VIII. Resources