DEPARTMENT OF HEALTH AND SOCIAL SERVICES

Division of Medicaid and Medical Assistance

Statutory Authority: 31 Delaware Code, Section 512 (31 Del.C. § 512)

PROPOSED

PUBLIC NOTICE

In compliance with the State's Administrative Procedures Act (APA - Title 29, Chapter 101 of the Delaware Code) and under the authority of Title 31 of the Delaware Code, Chapter 5, Section 512, Delaware Health and Social Services (DHSS) / Division of Medicaid and Medical Assistance (DMMA) is proposing to amend the Division of Social Services Manual (DSSM); specifically, repealing the rules of the Attendant Services Waiver Program.

Any person who wishes to make written suggestions, compilations of data, testimony, briefs or other written materials concerning the proposed new regulations must submit same to Sharon L. Summers, Planning & Policy Development Unit, Division of Medicaid and Medical Assistance, 1901 North DuPont Highway, P.O. Box 906, New Castle, Delaware 19720-0906 or by fax to 302-255-4425 by December 31, 2008.

The action concerning the determination of whether to adopt the proposed regulation will be based upon the results of Department and Division staff analysis and the consideration of the comments and written materials filed by other interested persons.

SUMMARY OF PROPOSAL

The proposed amends the Division of Social Services Manual (DSSM) to repeal rules related to the Attendant Services Waiver Program, which was not implemented.

Statutory Authority

• 31 Del.C §107, Rules and Regulations

Background

On October 31, 2006, the Division of Medicaid & Medical Services (DMMA) submitted a §1915(c) waiver application to the Centers for Medicaid & Medicaid Services (CMS) for approval. The DMMA announced a thirty-day comment period for this Waiver application in the December 1, 2006 issue.

DMMA withdrew its proposed regulation published on December 1, 2006 at 10 DE Reg. 954 as of February 1, 2007. Please note that eligible clients continue to be placed in the State’s Attendant Services Program. This option offers more services to the client population then would be available under the Waiver.

Summary of Proposal

DSSM 20700.6 – DSSM 20700.6.7: This repeal is being undertaken to remove the eligibility regulations for the Attendant Services Waiver (ASW) Program from the Division of Social Services Manual (DSSM). Since the ASW Program was not implemented, the rules at DSSM 20700.6 through DSSM 20700.6.7 are unnecessary. Therefore, to be consistent with the agency’s withdrawal of the above-referenced Attendant Services Waiver application sections 20700.6 through 20700.6.7 are being repealed.

20700.6 ATTENDANT SERVICES WAIVER

The Attendant Services Waiver (ASW) is a home and community based services program managed by the Division of Services for Aging and Adults with Physical Disabilities (DSAAPD). The purpose of the waiver is to minimize the likelihood of institutionalization and maximize the potential for independent living for adults with physical disabilities. This program is a consumer directed support program. Participants have an opportunity to hire and train their own attendants and serve as the employer of record for these attendants. DSAAPD staff provides initial intake, assessment, service authorization, and a wavier service plan. The Division of Social Services (DSS) is responsible for determining financial eligibility for the waiver.

8 DE Reg. 1625 (05/01/05)

20700.6.1 ELIGIBILITY CRITERIA

To be eligible for this program, an individual must:

"Be a resident of the State of Delaware

"Be 18 years of age or older

"Meet the financial and medical criteria for the DSS Long Term Care Medicaid Program

"Have a medical condition that meets nursing facility (including skilled and intermediate care) admission standards

"Meet the ASW criteria as determined by DSAAPD

• Financial eligibility is determined by DSS

• Medical eligibility is determined by the Pre-Admission Screening Unit of DSAAPD

• Program eligibility is determined by DSAAPD.

An individual must meet ALL of the following criteria:

"have an anatomical/physical deficit anticipated to last 12 months or more

"be medically stable

"have ability to self-direct or have a surrogate who can support the client in making decisions

Priority is given to applicants who are:

"persons who with an attendant can complete an educational plan, or can attain or retain gainful employment;

"persons with greater environmental, social supportive and financial capacity constraints, especially those with constraints in all three areas;

"persons who are living in costly, congregate living facilities but could be living independently and more cost effectively if they had attendants.

8 DE Reg. 1625 (05/01/05)

20700.6.2 NUMBER OF RECIPIENTS

There is a maximum number of recipients who may be served under the ASW each fiscal year. The total unduplicated number of recipients served under the program cannot exceed the maximum number approved by the Centers for Medicare and Medicaid Services (CMS). DSAAPD will monitor the number of individuals receiving ASW so the maximum number is not exceeded.

8 DE Reg. 1625 (05/01/05)

20700.6.3 COST EFFECTIVE REQUIREMENT

In order for an applicant to be eligible for the ASW, the applicant's cost of care cannot exceed the cost if the same applicant were institutionalized. This determination is made on an aggregate basis which considers all ASW recipients. A DSAAPD worker determines cost effectiveness.

8 DE Reg. 1625 (05/01/05)

20700.6.4 APPROVAL

Upon approval, DSS will send a notice of approval to the applicant or his representative. The notice will include the effective date of coverage and the patient pay amount if any. The client's eligibility start date is determined by DSAAPD staff. Only individuals with a Miller Trust may be subject to a patient pay amount. See Section 20720.

8 DE Reg. 1625 (05/01/05)

20700.6.5 POST ELIGIBILITY BUDGETING

For recipients in the ASW the personal needs allowance is equal to 250% of the Federal SSI Benefit Rate. Collection of the patient pay amount from the recipient or the recipient's representative is the responsibility of the provider who is administering the most costly service.

20700.6.6 HOSPITALIZATION OR ILLNESS

Waiver services will terminate upon the 31st consecutive day of hospitalization. There are no Medicaid bed hold days for hospitalization. DSS will periodically redetermine eligibility for continued Medicaid coverage. Waiver services may restart after hospital discharge as determined by DSAAPD staff.

8 DE Reg. 1625 (05/01/05)

20700.6.7 ASW SERVICES

The Attendant Services Waiver include (s) the following:

"Attendant Services

"Adult Day Health

"Respite

"Equipment/Supplies

"Emergency Response Systems

"Supports Brokerage

"Personal Care

"Fiscal Agent

"Case Management

8 DE Reg. 1624 (5/01/05)

12 DE Reg. 740 (12/01/08) (Prop.)