MEDICAL ASSISTANCE PROGRAM- SECTION 0399- The Global Consumer Choice Waiver: Rebalancing the Long-Term Care System

Regulation Authority:

RIGL 40-8; Title XIX of the Social Security Act

Purpose and Reason:

Effective July 1, 2009, under the authority of the Global Consumer Choice Compact Waiver, the Department of Human Services will transition from its existing section 1915 (c) home and community based service waivers (HCBS), which have different eligibility criteria and services, into its newly approved section 1115 (a) Global Waiver. Under the Global Waiver, the scope of services is based on a comprehensive assessment that includes an evaluation of the medical, social, physical and behavioral health needs of each applicant. The rule establishes the new criteria for determining clinical eligibility for a nursing facility level of care. Beneficiaries eligible under the section 1915 (c) HCBS waivers who were living in institutions on or before 6/30/09 will continue to be evaluated based on the former institutional level of care criteria. Persons applying for Medicaid funded long-term care services on or after July 1, 2009, are subject to the needs-based processes for determining level of care and developing an individualized plan of care. The final rule contains minor changes and technical revisions based on public comments, such as elaborating on the transition process from a nursing facility to home and community-based services and the addition of adult day services as a core HCB/LTC service.