Waiver Services - HCS MNP - Medically Needy Residential Waiver Program (MNRW) - E - Participation Limits and Waiting Lists
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Waiver Services - HCS MNP - Medically Needy Residential Waiver Program (MNRW) - E - Participation Limits and Waiting Lists


Revised May 13, 2013



Purpose:

 WAC 182-515-1540 

Clarifying Information: Participation limits and waiting lists

Program Participant Limits
  1. There are a maximum number of active participants in any waiver year. A waiver year runs from May - April.

  2. Active slots are filled on a first come, first served basis. All slots are available statewide and are not distributed regionally.

  3. When headquarters advises the field that all active slots have been taken, no new MNRW clients may be authorized for services without authorization from headquarters.

  4. Once the program reaches it’s maximum participation, all clients who are determined functionally and financially eligible will be put on a wait list.

  5. Spenddown clients must meet spenddown before being authorized for services or being placed on the wait list.

  6. HCS Headquarters staff will monitor the active list and notify regions when all active slots are filled.

Wait List

When all active slots are filled, functionally and financially eligible clients will be placed on a wait list.

Only clients who are both functionally and financially eligible can be placed on the wait list.  See Functional and Financial Determination

When an active slot becomes available, headquarters staff will select the next eligible client from the wait list and contact the regional HCS office. The wait list selection criteria is based on 3 factors, listed below in their order of importance:

  1. Clients residing in nursing home

  2. Acuity level (Level of care)

  3. Date of request

The Social service worker must determine if the client continues to be functionally eligible and what the cost of care will be at the anticipated residential facility. Once this is done, the social services worker notifies the financial services worker via the DSHS 14-443, Financial/Social Services Communication (ADSA).

A new application or eligibility review may be required for wait list clients that are transitioning into an active slot.

  1. For clients who are active on another Medicaid program, or are within a spenddown base period, or are not active but less than 45 days from last application:

    1. FSS completes a desk review

    2. Ensure the income and resources are accurate

    3. Neither an application nor an eligibility review will be required.

  2. For clients who are not active on another Medicaid program, are not within a spenddown base period, or are more than 45 days from last application:

    1. Financial worker must have client complete a new application.

    2. Financial worker will need to make a new financial eligibility determination.

  3. An eligibility review form can be used if the client had been active on assistance but has been closed less than 30 days.

  4. The active slot will be “held” for this client until both financial and functional eligibility decisions are made.

MNRW Database

Active participants and clients on the waiting list are tracked on the MNRW database.  (This data base is available only to DSHS staff at: http://adsaweb/mnwaiver/default2.htm).

Financial services staff will input the client data into the database after the client has been determined functionally and financially eligible for MNRW services.

  1. If there are active slots available, and services have been authorized, the FSS inputs the client into the database as active.

  2. If there are no active slots available, but a client has been determined both functionally and financially eligible, then the FSS inputs the client data into the database as on the wait list.

Updating the Data Base

FSS field staff must keep the client database updated with current information, when known, for active clients who terminate MNRW services due to a change in eligibility or death.  This frees up an active slot that can be filled by a new or wait list client.

To remove a client from an active MNRW slot, the HCS Financial worker must update the disposition code on the client data section of the website using the following codes:

  1. TN - Terminate - Enter a nursing facility

    Use this code when an active client terminates MNRW services because they have entered a nursing facility and have been out of the residential facility more than 30 days.

  2. TD - Terminate - Death

    Use this code when an active client terminates MNRW services because of death.

  3. Wait list clients who are authorized to take an active MNRW slot

    To move a wait list client into an active MNRW slot, the HCS Financial worker must change the disposition code to “A - Active” on the client data section of the website.

  4. Wait list clients who have a change in selection criteria, such as entering or leaving a nursing home or a change in their level of care

    1. This ensures they are given the correct priority on the wait list.

    2. To update the client’s selection criteria data, the HCS Financial worker must update the correct client data fields in the database:

  5. A client enters or leaves a nursing home

    1. Yes - Client is in a nursing home

    2. No - Client is not in a nursing home

  6. A client has a change in level of care

    Levels are based on the Social Services assessment. If the Social Services worker reports the client’s level of care has changed, update the client’s information.

  7. Wait list clients who are no longer eligible for MNRW services

    1. This ensures the wait list contains only those individuals who are eligible, reducing the time needed to monitor the list.

    2. To remove a client from the MNRW wait list, the HCS Financial worker must update the disposition code on the client data section of the website using the following codes:

  8. WD - Remove - Death

    Use this code to remove a wait list client who has died.

  9. WO - Remove - Other

    Use this code to remove a client from the wait list for any other reason.

Modification Date: May 13, 2013