Additional CCC Plus Waiver
Information
1
Managed Care Delivery of HCBS
Combination 1915 b and 1915 c waiver authorities
1915 b Waiver
 Allows the state to
require enrollment in a
managed care delivery
system
 Must be cost-effective,
efficient and consistent
with the principles of
the Medicaid program
2
1915 c Waiver
 Must not cost more
than institutional care
 Ensures health and
welfare protections
 Services follow an
individualized and
person-centered plan of
care
Current 1915 c Waivers
Elderly or Disabled with Consumer
Direction (EDCD)
• Aging or have a physical disability
Technology Assisted (Tech)
• Dependent on technological support and
require substantial, on-going skilled nursing
care
3
Combination of Existing 1915 c Waivers
 Combines Elderly or Disabled with Consumer
Direction and Technology Assisted Waiver
 Expands current services to both populations
 Waiver becomes Commonwealth Coordinated
Care Waiver
 Effective 7/1/2017
EDCD
Waiver
4
Tech
Waiver
CCC
Plus
Waiver
CCC Plus Waiver Services
 Adult Day Health




5
Care
Personal Assistance
Services
Private Duty Nursing
Respite care
Services Facilitation
 Assistive Technology (AT)
 Environmental
Modifications (EM)
 Personal Emergency
Response
System
 Transition Services
CCC Plus Waiver Services
AT and EM
• Limited to
$5000 per
year for each
service
6
Private
Duty
Nursing
• Must meet
current Tech
waiver
criteria
Respite
• Limited to
480 hours/
fiscal year
• Increase from
360 hours for
Tech waiver
CCC Plus Waiver
Services will automatically
continue through CCC Plus Waiver
No Changes to FFS waiver
processes
Pre-admission
screening
processes
unchanged
7
Enrollment and
service
authorization
process unchanged
Current service
authorizations
will continue
No action is
required by
providers
CCC Plus Waiver
 Upcoming Medicaid Memo
 Emergency regulations being promulgated
 CCC Plus Medicaid Manual being developed
 Follow current Medicaid Manuals for EDCD
and Tech until the new manual is posted
8
VA Medicaid Behavioral Health Service
Delivery Systems
Fee For
Service
In Patient/ Out
Patient/ARTS
Community
Mental Health
Rehabilitation
Services
9
CCC Plus
2017
CCC Plus
Jan 2018
Magellan Health Plan Health Plan
Magellan Magellan
Health Plan
Medicaid
Population
Waiver Services
DD/ID Case
Management
For Individuals in
DD Waivers
Service authorization:
Provider to CSB to
DBHDS for
authorization
CSB/private
provider provides
the ID or DD case
management
Billing: DMAS FFS
pays the provider
CSB bills DMAS FFS
directly
None
CSB/private
provider provides
the ID or DD case
management, as
applicable
For individuals on
the DD waivers wait
list
CCC Plus waiver
CCC Plus waiver
(EDCD) while on DD services paid for by
wait list
CCC Plus Health Plan
CCC Plus Health Plans
CSB bills DMAS FFS
directly
CSB/private
CCC Plus Health Plan
provider provides
the ID or DD case
management, as
applicable
CSB bills DMAS FFS
directly
10
Other Services
(excluding waiver
and case
management)
CCC Plus health plans