Application for a §1915(c) Home and Community-Based Waiver [Version 3.6, January 2019] Instructions, Technical Guide and Review Criteria Release Date: January 2019 Disabled and Elderly Health Programs Group Center for Medicaid and State Operations Centers for Medicare & Medicaid Services Department of Health and Human Services Table of Contents Introduction .................................................................................................................................................. 1 Purpose ..................................................................................................................................................... 1 Overview of the §1915(c) HCBS Waiver Authority ................................................................................... 1 Version 3.6 HCBS Waiver Application ....................................................................................................... 2 Waiver Application Format: .................................................................................................................. 2 Instructions – Overview ............................................................................................................................ 2 Description of the §1915(c) HCBS Waiver Authority .................................................................................... 5 Overview ................................................................................................................................................... 5 Statutory Basis and Legislative History of the HCBS Waiver Authority .................................................... 5 Principal Features of the HCBS Waiver Authority ..................................................................................... 6 Basic Framework ................................................................................................................................... 6 Waiver Application Process .................................................................................................................. 6 Waivers Granted ................................................................................................................................... 6 Individuals Served by a Waiver ............................................................................................................. 7 Services Offered Under a Waiver .......................................................................................................... 7 Exclusion of Room and Board ............................................................................................................... 7 Number of Waiver Participants ............................................................................................................ 8 Service Plan ........................................................................................................................................... 8 Participant Direction of Waiver Services .............................................................................................. 8 Assuring Participant Health and Welfare .............................................................................................. 8 Waiver Administration and Operation.................................................................................................. 9 Participant Rights .................................................................................................................................. 9 Cost Neutrality ...................................................................................................................................... 9 Quality Improvement Strategy: Overview ................................................................................................ 9 Waiver Assurances and Other Federal Requirements ............................................................................ 10 Continuous Quality Improvement .......................................................................................................... 11 Discovery ............................................................................................................................................. 11 Remediation ........................................................................................................................................ 12 Sampling Approach ............................................................................................................................. 12 Roles and Responsibilities ................................................................................................................... 13 Federal Administration of the HCBS Waiver Authority........................................................................... 14 Strengthening HCBS Waiver Quality Assurance/Quality Improvement ................................................. 14 HCBS Waiver Services, the ADA and Olmstead ....................................................................................... 15 HCBS Waiver Resources on the Web ...................................................................................................... 15 Version 3.6 HCBS Waiver Application Organization ................................................................................... 17 Ongoing CMS Waiver Application Activities ........................................................................................... 18 Implementation of the Web-Based Application ................................................................................. 18 Additional Activities ............................................................................................................................ 18 Waiver Application Submission Requirements, Processes and Procedures ............................................... 21 Overview ................................................................................................................................................. 21 Submission of Applications ..................................................................................................................... 21 Making a Submission Using the Web-Based Application ................................................................... 21 Making Changes to a Submitted Application ...................................................................................... 22 Joint Central Office/Regional Office Waiver Review Process ................................................................. 22 Requesting Division Review ................................................................................................................ 22 Policies Concerning New and Renewal Waiver Applications .................................................................. 23 90-Day Clock........................................................................................................................................ 23 New Waiver Applications .................................................................................................................... 24 Special Considerations: §1915(c) Waivers that Operate with Concurrent Managed Care ................ 25 Special Considerations: §1915(a) Authority Concurrently with a 1915(c) Waiver ............................. 25 New Waiver to Replace an Approved Waiver ..................................................................................... 25 Renewal Applications .......................................................................................................................... 26 Other Changes to Approved Waivers ................................................................................................. 27 Extensions ........................................................................................................................................... 28 Policies Concerning Waiver Amendments .............................................................................................. 29 Related Topics ......................................................................................................................................... 31 CMS Technical Assistance ................................................................................................................... 31 Administrative Claiming ...................................................................................................................... 31 Waiver Termination ............................................................................................................................ 31 Post Approval Activities .............................................................................................................................. 34 Overview ................................................................................................................................................. 34 Annual Waiver Report ............................................................................................................................. 34 Annual Report Form CMS-372(S) ........................................................................................................ 34 Review of the Annual Waiver CMS-372(S) Report .............................................................................. 35 Ongoing CMS-State Dialogue During the Waiver Period ........................................................................ 35 CMS Oversight of State Waiver Operations .......................................................................................