Federally approved BI, CAC, CADI and DD waiver plans

Process that a required case manager must follow to involuntarily discharge a person from CDCS.

Persons will be immediately exited from CDCS and offered waiver services and/or MA state plan home care services under the following instances:

Required case managers may provide additional technical assistance and support over and above the standard training and materials due to an identified need. When a 4th occurrence requiring additional technical assistance beyond reasonable efforts arises, the person will be immediately discharged from CDCS and may choose to receive other waiver and/or state plan home care services.

Reasons for technical assistance may include but are not limited to:

Note: The FMS provider will need to copy the required case manager on all notices requesting missing required information from the CDCS recipient, such as invoices or timesheets, and FMS provider notifications that requests to purchase services or materials are not included in the approved CSP.

Reasonable efforts

Three documented events of need for additional technical assistance and support during one service plan year. Documentation must include:

These events are described as ‘documented’ so required case manager may choose to offer support for less significant concerns, without rising to this level of documentation. The required case manager will document additional technical assistance and support. This action may occur up to three times. An event that would otherwise trigger a fourth notice is cause for involuntary exit from the CDCS service for the remainder of the service plan year.

In the event the person is involuntarily exited from using CDCS, the following procedure will be followed:

1. Required case manager discovers and documents a reason for immediate involuntary exit from CDCS or a 4th event requiring additional technical assistance and support.

2. Required case manager immediately begins planning with the person and implementing access to other waiver and/or state plan home care services.

3. Required case manager sends notice informing the person of return to other waiver services and/or MA state plan home care services.

4. Person receives other waiver and/or MA state plan home care services.

If health, safety or abuse concerns are suspected, the case manager must report to the appropriate agencies, such as the county vulnerable adult or child protection agencies.

The case manager must report suspected fraud to Surveillance and Integrity Review Division.

When a person is involuntarily exited from CDCS, the CDCS Waiver service is terminated. The waiver program does not have to be terminated, unless the person’s needs can be met through MA state plan services. All Medical Assistance fair hearing and Medical Assistance notice requirements apply.

CDCS is not available to the person during an appeal when the involuntary exit criteria are met. The ability to discontinue CDCS service due to an involuntary exit, pending appeal, is unique to this service and differs from other waiver services that require services stay intact pending an appeal hearing.

The county or state is required by law to provide notice any time a change is made to services. This can be an increase, decrease or termination of services. The county uses Long-Term Services and Supports Notice of Action – Explanation of Changes to Your Support Plan, DHS 2828B to notify a person of changes to waiver services.

When a person and/or their legal representative do not agree with a county or state agency action, they have the right to ask for the following: