STATE OF WASHINGTON



354330023114000STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICESAging and Long-Term Support AdministrationHome and Community Services Division1492250238760HCS MANAGEMENT BULLETIN00HCS MANAGEMENT BULLETINPO Box 45600, Olympia, WA 98504-5600H19-012 – Policy & ProcedureMarch 07, 2019 TO:Home and Community Services (HCS) Division Regional Administrators Area Agency on Aging (AAA) DirectorsFROM:Bea Rector, Director, Home and Community Services Division, ALTSASUBJECT:Ancillary Services Approved for the COPES Waiver and New Service Authorization Reason Codes PURPOSE:To notify staff that Community Choice Guide (CCG) and Community Support: Goods and Services are now available in the COPES waiver. In conjunction with the new services being added to COPES, new reason codes have been created.BACKGROUND:In 2007, Washington State was awarded the Money Follows the Person (MFP) demonstration grant and used the funding to establish the Roads to Community Living (RCL) program. The intent of MFP was to test services and supports which could help consumers, who wanted to make such a transition, to move from an institutional setting into the community. The Washington Roads program was later created to offer demonstration services to individuals not eligible for RCL. WA Roads services are state-funded through savings earned by the enhanced federal match received from Roads to Community Living (RCL). WA Roads includes stabilization services for individuals already residing in the community. Additionally, changes were made to WAC in 2018 that made stabilization services available through Community Transition or Sustainability Services (CTSS), which is a state funded stabilization resource similar to WA Roads (see MB H18-038).There are many reasons a client may require stabilization services to remain in the community. Examples include having frequent institutional contacts (ER visits, SNF stays, hospital admits, etc.), frequent turnover of caregivers resulting in an inability to maintain consistency of care, or the threat of imminent eviction or loss of current community setting. Some of the demonstration services available in RCL and WA Roads have proven effective in assisting individuals transitioning to the community from an institution or to maintain their community living.Adding CCG and Community Support: Goods and Services to the COPES waiver is part of the RCL sustainability plan to offer these services to clients who need them while receiving federal match for the services when eligibility criteria is met. For all COPES services:The client must be functionally and financially eligible for COPES and choose to enroll in the waiver.The service may have additional eligibility criteria the client must meet.Waiver services cannot be duplicative of each other or services available under the Medicaid state plan.To remain enrolled in COPES on a continuous basis, a client must receive at least one monthly service, such as Wellness Education.Services must be identified in the plan of care.Services must be authorized prior to the client receiving them. Services are subject to client responsibility.See Chapter 7d of the LTC Manual for more information regarding COPES.WHAT’S NEW, CHANGED, OR CLARIFIED:Beginning March 1, 2019:CCG and Community Support: Goods and Services will be available in CARE as COPES services for eligible individuals.New reason codes will be required for SA263, SA266, SA290, SA291, SA296 and SA297.Services Now Available in COPES:Community Choice Guide (CCG) CCG services can now be authorized to clients enrolled in COPES to establish or stabilize a person currently in a community living arrangement including a licensed residential setting, such as an adult family home or assisted living facility, or in a private residence. Individuals are eligible for CCG services when the person’s community living situation is unstable and the person is at risk of G services can assist a client enrolled in COPES to successfully live in the community setting of their choice by:Identifying needs and locating necessary resources to establish and successfully integrate into the community.Coordinating, educating, and linking the client to resources which will establish or stabilize their community setting.Providing and establishing networks of relevant community partners.Ensuring all necessary paperwork and documentation is identified and completed to obtain and maintain entitlements and other services necessary for community integration.Assisting with the development of a plan for, and when necessary, providing emergency assistance to sustain a safe and healthy community setting.Assisting in arranging for transportation to effectively connect the client with the munity Support: Goods and ServicesIncluded are non-recurring set-up expenses for individuals who are moving from a licensed residential setting such as an adult family home or assisted living facility to an in-home setting (excluded are lateral moves such as from one adult family home (AFH) to another AFH or stabilizing an individual in their current setting). Allowable expenses are those necessary to enable a person to establish a basic household, that do not constitute room and board, and may include:Move-in expenses required by a landlord or property management company to obtain a lease on an apartment or home.Set-up fees or deposits for utility or service access, including telephone, electricity, heating and water.Services necessary for the individual’s health and safety such as pest eradication and non-recurring cleaning prior to occupancy.Moving expenses. Activities to assess need, arrange for and procure needed resources.Excluded are on-going monthly rental or mortgage expenses, food, regular utility charges, household appliances, or items that are intended purely for diversional/recreational purposes. To facilitate the purchase of necessary items or to make necessary deposits, a CCG can be authorized to perform shopping/paying services under the COPES Community Support: Goods and Services benefit. Additional CCG services are based on the client’s eligibility for COPES CCG (see eligibility criteria above).ACTION:COPES Ancillary Services- CCG and Community Supports: Goods and Services (note that each service has distinct eligibility criteria) Community Choice Guide: to establish or stabilize an individual in the community. This includes assisting the person to move between community settings to help maintain community living. To authorize CCG use the following service codes: HYPERLINK "" SA263: CCGHYPERLINK ""SA266: shopping/paying-client is not presentImportant to remember:Community Choice Guide in COPES is not available to help an individual transition from an institution to the community. When a CCG makes an purchase or issues a payment for a service like a utility hook-up fee or security deposit, two service lines are required: one for issuing payment to the CCG and one for reimbursement for the purchase or payment made. See MB H15-088 for more information regarding authorizing a CCG to make a purchase.A CCG cannot issue payment and be reimbursed for services that require a qualified provider to have a current contract in the Agency Contracts Database, such as pest eradication, moving and janitorial services (see MB H15-088).Community Supports: Goods and Services: To assist an individual transition from a residential setting to an in-home setting, authorize the following service codes: HYPERLINK ""SA296 Community Transition and Sustainability Services: Items (Matched Funds) HYPERLINK "" SA297 Community Transition and Sustainability: Services (Matched Funds)Important to remember:COPES Community Support: Goods and Services are not available to help an individual:Transition from an institution to the community. Stabilize in their current setting.Move between two residential settings (a lateral move)Move from an in-home setting to a residential setting.Move between two in-home settings (a lateral move). Reference tools have been created to help you determine what your client is eligible for under the various programs (see attachments below).Completing a PAN for the new COPES Ancillary Services:Follow all policy regarding PANs. Until these services can be added to COPES in CARE, select “Other HCS Services” and then type in either CCG or Community Supports: Goods and Services and the COPES WAC 388-106-0300 when authorizing these services. Reflect all services on a single PAN. (Per policy: A PAN is not sent for WA Roads services)New Reason CodesNew reason codes will be available on March 1, 2019 for service codes frequently used to assist with transitions and stabilization. If the reason codes are not available per this MB after March 1 or if you get an error for “wrong reason code” please notify your JRP or payment specialist so they can coordinate with HQ to resolve.Reason codes ensure the correct funds are paying for the service being authorized, that we claim the correct amount of federal match and that services are captured accurately for budget forecasting purposes. Reason codes will be required when the following service codes are authorized (note that Service Code Data Sheets have been updated to reflect these changes, effective 3/1/2019):HYPERLINK ""SA263: CCGHYPERLINK ""SA266 Shopping/paying: no client presentHYPERLINK ""SA290 Community Transition or Sustainability Services: Items- State-only FundsHYPERLINK ""SA291 Community Transition or Sustainability Services- State-only Funds HYPERLINK "" SA296 Community Transition and Sustainability Services: Items (Matched Funds) HYPERLINK "" SA297 Community Transition and Sustainability: Services (Matched Funds)Most of the reason codes are based on an action (transitioning from an institution, moving between community settings or stabilization) AND the client’s setting. If a client is transitioning or moving, select the setting to which they are moving.1. To Transition from Institution to [insert community setting]:In-homeAFHARC/EARCALESFUse for services to assist a client transition from an institution to a community setting.There may be program specific rules regarding transitions from an institution to the community [for example, to be eligible for CTS in a nursing facility, a client must be able to discharge onto Community First Choice (CFC)]. For individuals transitioning from an institution using WA Roads or CTSS using SA290 and SA291, select the setting to which the individuals is moving.Transition from Residential Setting (ESF, AL, AFH, ARC/EARC) to In-HomeUse when a client is moving from one of the listed residential settings to a home or apartment. [Insert community setting] Stabilization:In-homeAFHARC/EARCALUse when an individual needs stabilization services to maintain their current community setting.Based on program eligibility, these reason codes may be available when the client is moving from one community setting to another. Programs may have rules/limits regarding stabilization or moving between community settings (for example, some reason codes say “RCL only”). For individuals stabilizing or moving between community settings through WA Roads or CTSS using SA290 and SA291, select the setting in which they are stabilizing or to which they are moving.Purchase of Covered Assistive Technology (SA266 only)Use for the purchase of AT that is covered by the client’s program.See the Reason Code Crosswalk below for the service code - reason code associations.The reference tools below are from previous management bulletins and have been updated to incorporate this change. The CCG Activity Tracking Forms that are submitted by a CCG have been consolidated into one Excel workbook. CCGs can use the tab that best suits their needs. PDF versions will be made available, if requested. (See MB 17-082)Two training webinars were held and the final presentation can be found here: RELATED REFERENCES: HYPERLINK "" Service Code Data Sheets HYPERLINK "" Long Term Care Manual: HYPERLINK "" WA Roads (5a) CFC (7b)COPES (7d)Nursing Facility Case Management and Relocation (10)Roads to Community Living (29)MB H15-088: Purchasing Necessary Items and Services for Transition and Stabilization HYPERLINK "" MB H18-038: Residential Care Discharge Allowance WAC ChangeATTACHMENT(S):Which Program to Use: Goods and ServicesWhich Program to Use: Community Choice GuideReason Code CrosswalkDecision Charts: CCG and Goods/ ServicesService Option ChartsCCG Activity Tracking FormTransition and Sustainability Checklist (HCS only: account specific checklists are available within each region) \sCONTACT(S):Debbie Blackner, Ancillary Services Program Manager360-725-3231Benned@dshs.Jamie Tong, COPES Waiver Program Manager (360) 725-3293Jamie.Tong@dshs.Julie Cope, Systems Change Specialist(360) 725-2529copejf@dshs. Victoria Nuesca, CFC Program Manager (360) 725-2393Victoria.Nuesca@dshs.Jacquelyn Pinkerton, Social Service Payment Program Manager360-725-2636pinkejm@dshs. ................
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