WAIVER ASSURANCES

Level of Care (LOC) (Quality Improvement: Appendix B)

• An evaluation for LOC is provided to all applicants for whom there is reasonable indication that services may be needed in the future.
• The LOC of enrolled participants are reevaluated at least annually or as specified in the approved waiver.
• The processes and instruments described in the approved waiver are applied appropriately and according to the approved description to determine participant LOC.

Service Plan (Quality Improvement: Appendix D)

• Service plans address all participants’ assessed needs (including health and safety risk factors) and personal goals, either by waiver services or through other means.
• The state monitors service plan development in accordance with its policies and procedures.
• Service plans are updated/revised at least annually or when warranted by changes in the waiver participant’s needs.
• Services are delivered in accordance with the service plan, including in the type, scope, amount, duration, and frequency specified in the service plan.
• Participants are afforded choice:
  • Between waiver services and institutional care; and
  • Between/among waiver services and providers. 

Qualified Providers (Quality Improvement: Appendix C)

• The state verifies that providers initially and continually meet required licensure and/or certification standards and adhere to other standards prior to their furnishing waiver services.
• The state monitors non-licensed/non-certified providers to assure adherence to waiver requirements.
• The state implements its policies and procedures for verifying that provider training is conducted in accordance with state requirements and the approved waiver. 

Health and Welfare (Quality Improvement: Appendix G)

• The state, on an on-going basis, identifies, addresses, and seeks to prevent the occurrence of abuse, neglect and exploitation.

Administrative Authority (Quality Improvement: Appendix A)

• The Medicaid agency retains ultimate administrative authority and responsibility for the operation of the waiver program by exercising oversight of the performance of waiver functions by other state and local/regional non-state agencies (if appropriate) and contracted entities.

Financial Accountability (Quality Improvement: Appendix I)

• State financial oversight exists to assure that claims are coded and paid for in accordance with the reimbursement methodology specified in the approved waiver.