►
From YouTube: Exceptional Support Waiver Services Task Force
Description
Exceptional Support Waiver Services Task Force meeting located in room 171 of the Annex.
Live Stream provided by LRC Staff
A
B
C
B
A
A
A
So
on
our
order
of
events,
we're
going
to
flip
the
two
presentations
and,
at
this
time
we're
going
to
have
the
department
of
medicaid
services
an
analysis
of
the
supports
for
community
living
waiver
and
exceptional
support
waiver
services
and
we're
going
to
have
commissioner
lee
and
policy
advisor
hoffman
at
this
time.
If
they
could
go
ahead
and
start
with
their
presentation.
A
A
E
A
A
Miss
hoffman:
do
you
have
part
of
this
that
you
can
go
ahead
and
present
and
then
we'll
get
back
to
commissioner
lee
when
she
gets
on
line?
Yes,
I
can
start
when
she
gets
online
I'll,
just
let
her
take
it
over
okay.
That
sounds
great
thanks,
and
do
I
just
tell
you
when
I
want
to
advance?
Is
that
how
we're
doing
this?
Yes,
okay,.
E
E
We
must
demonstrate
cost
of
care
in
the
community
at
equal
to
or
less
than
the
institutional
cost,
and
that's
basically
the
crowd.
You
may
have
heard
that
before
we
are
held
accountable
to
conduct
monitoring
to
ensure
waiver
waivers
meet
the
quality
standards
that
we've
told
cms,
as
well
as
ensuring
safety
of
the
member
advance.
E
Please-
and
this
is
just
a
list
of
all
the
waivers
that
we
have-
we
have
the
acquired
brain
injury
and
the
acquired
brain
injury,
long-term
care
waivers,
and
that's
for
individuals
that
are
18
years
or
older.
We
also
have
the
hcbs
waiver
for
individuals
aged
65
and
older
or
individuals
of
any
age
with
a
disability.
We
have.
G
E
E
So
waiver
budgets
are
determined
by
evaluating
expenditures
from
the
previous
year.
We
determine
based
on
utilization,
budgets
must
be
cost
neutral
per
cms,
and
that's
the
budget
neutrality
that
I
spoke
about
before
and
to
because
neutral,
the
average
participant
expenditures
must
not
exceed
per
person,
cost
of
furnishing
institutional
services
for
an
individual
with
the
same
level
of
care,
and
I
will
mention
here
that
they
do
hold
us
accountable
to
include
the
costs
that
would
be
outside
of
the
waiver
for
the
holistic
cost
of
the
member.
E
E
we
used
calendar
year
2019
because
it
we
felt
like
it
would
be
the
most
accurate
when
we
go
back
and
pull
claims
and
data.
Oftentimes
providers
build
on
at
different
times.
So
we
wanted
to
make
sure
that
we
could
get
the
most
accurate
timing
for
the
claims
that
would
have
been
submitted
over
a
period
of
the
calendar
year.
E
E
This
is
the
waiting
list
that
we
currently
have
abi
abi
ltc
ac
model
way
for
two
ethiopian
scl
and
we
included
the
waiver
year
and
if
I
could
explain
that,
just
a
bit,
the
waiver
year
is
not
a
calendar
year
and
it's
not
a
physical
year
fiscal
year.
It
is
the
year
in
which
the
ms
approved
the
waiver
so
pending,
depending
on
when
we
submit
had
the
waiver
approved,
is
when
the
waiver
year
starts
waivers
run
five
years,
so
each
one
has
its
own
specific
waiver
waiver
year.
E
I'm
sorry
the
waiting
list.
I
did
want
to
mention
the
adl
long-term
care,
we're
working
starting
today
to
allocate
spots
because
that
waiver
year
just
started
as
you
can
see.
7
20.
so
we'll
allocate
those
quads
out
and
have
a
zero
waiting
list,
hopefully
soon.
So
it
will
take
some
time
for
folks
to
look
for
information
and.
E
E
E
E
Please
we
included
the
definitions
on
for
the
scl
waiting
list
categories,
which
is
emergency
urgent
and
future
planning
emergency.
I
think
of
as
immediate
services
needed
now
and
urgent
is
individual
services
within
one
year
and
future
planning
is
individual
services
needed
with
one
year
and
is
not
currently
receiving
other
services
not
receiving
services
and
does
not
currently
need
services
in
the
custody
of
dcbs.
E
E
Let's
see,
this
is
exceptional
supports
by
number
residential
163
consultative
and
clinical
therapeutic
services
82
respite
six.
So
that's
a
total
of
251
and
again
that
was
on
a
calendar
year
for
2019.,
and
we
also
included
the
paid
claims
in
calendar
year
2019.
We
only
had
one
individual
denied,
and
that
was
for
lack
of
information.
E
We
wanted
to
make
sure
that,
on
the
non-clinical
service
side
that
we
had
a
lesser
time
period
due
to
scope
of
work
and
a
licensure
would
hold
clinical
providers
to
evaluate
those
services
more
often
and
to
find
the
current
need
using
a
single
assessment
tool.
Dms
is
currently
evaluating
the
use
of
validated
universal
assessment
tools.
E
Cms
requires
us
to
make
sure
that
we
have
validation
and
make
sure
that
it
has
validity
and
reliability.
I
always
remember
those
two
and
not
every
tool,
even
though
they
appear
to
be
wonderful,
have
the
validity
and
reliability
that
that
looking
for,
but
we're
always
open
to
suggestions.
If
anybody
wants
to
send
anything,
this
one
will
require
a
regulation.
Change
and
a
waiver
amendment
establish
a
higher
level
of
care
while
retaining
the
exceptional
support
system.
E
Revising
the
exceptional
support
rate
methodology
cms
requires
that
states
have
a
documented,
evidence-based
rate
methodology.
Kentucky
is
working
on
an
established,
evidence-based
methodology,
you
support
provider,
reimbursement
levels,
and
this
would
also
require
a
regulation
or
an
amendment
for
the
waiver.
E
Increase
the
number
of
units
allowed
for
cons
for
clinical
and
therapeutic
services
kentucky
will
evaluate
possibility.
However,
it
is
critical,
any
crit.
Sorry,
it
is
critical
in
any
increase.
We
have
to
make
sure
there's
no
duplication
of
service
under
the
state
plan,
because
that
is
not
allowed
with
cms.
You
can't
be
duplicative
in
your
state
plan,
as
well
as
in
your
waiver,
to
establish
an
exceptional
support
rate
case
managers.
E
E
Cms
requires
again
that
states
have
a
documented,
evidence-based
re
based
rate
methodology
and
that's
something
that
we're
working
on
advance.
Please,
oh
we'll
work
together
and
I
I
am
always
open
to
listen
to
anything.
You
have
our
team
there
at
medicaid
is
always
willing
to
listen
to
any
opportunities
suggestions
that
you
may
come
up
with.
C
Hi,
thank
you
so
much
everyone
miss
hoffman,
hi
nice
to
meet
you
virtually.
I.
My
first
question
is
about
the
cost
neutrality
that
you
brought
up.
Would
you
agree
that
when
you
break
those
down,
the
cost
per
person
of
the
sel
waiver
per
day
is
about
215
a
day?
I
just
divided
the
your
total.
Your
numbers
by
the
total
participants
divided
that
by
315
a
day
and
got
excuse
me
divided
by
365
days,
got
to
215
a
day.
That's
your
average
cost
participant
in
the
spl
waiver.
C
E
E
We
have
to
add
those
in
so,
for
example,
if
a
member
went
to
the
hospital-
and
you
know
had
heart
surgery
or
I'm
just
giving
it
as
an
example,
we
do
have
to
take
those
costs
into
consideration
and
the
budget
neutrality
is
actually
based
on
the
aggregate
of
the
clients
that
are
compared
to
the
same
amount
of
days
of
stay.
I
know
this
is
confusing
days
of
stay
in
and
icf
id.
So
it's
not
as
easy
for
me
just
to
tell
you
that
yeah,
that's
that's
correct
or
that's
not
correct.
It's.
C
E
So
it
depends
on
what
what
services
the
client
is
receiving.
If
the
client
was
receiving
a
full
array
of
services,
then
it
for
example,
you
know
residential
is
expensive
over
a
period
of
time.
Case
management.
That's
that's
every
month
required
service,
those
kind
of
things
I
don't.
I
can't
tell
you
right
offhand
of
what
you're
saying
is
correct.
B
E
B
I
guess
the
only
reason
why
I
say
it
is
because
I
have
to
agree
with
amy
that
I
can't
see
how
any
of
these
programs
could
even
approach
that
per
day,
no
matter
how
many
services
that
that
client
gets.
I
mean
I
mean
we
recognize
that
they're
in
residential
services.
They
can't
get
other
services,
except
for
adt's
and
a
few
other
little
odds
and
ends
like
behavior
supports
and
whatever,
and
that's
probably
going
to
be
your
most
expensive
client
but
you're
not
even
coming
close
to
the
1200
dollars.
B
Right,
but
you
can't
even
come
close
to
twelve
hundred
dollars,
no
matter
how
many
they're
receiving
whether
it's
scl
michelle
b
adi
or
any
other.
I
mean
you
mentioned
something
about
them,
having
heart
surgery
or
something
but
they're
going
to
have
to
have
an
additional
expense,
even
if
they're
in
an
icf.
So
that
isn't
a
change.
B
E
A
D
And
you're
not
sure
of
that
number
at
this
time,
hello.
This
is
commissioner
lee.
If
I
could
speak
please,
I
understand
what
you're
saying
you
want
to
look
into
the
budget
neutrality
piece.
As
ms
hoffman
stated,
the
costs
on
the
slide
were
strictly
for
the
waiver
programs
themselves.
It
did
not
include
any
medications
or
pharmacy
physician
office
visits
those
sorts
of
things.
D
So,
in
order
to
look
at
the
budget
neutrality
piece
and
see
if
any
individual
has
ever
gone
over
the
icf,
we
would
definitely
have
to
go
back
and
look
at
this
on
an
individual
basis,
which
we
are
more
than
happy
to
do
to
get
some
of
those
numbers
for
you.
Of
course,
we
can't
identify
any
particular
individuals,
but
we.
D
It
will
be
very
a
little
bit
detailed
in
getting
all
of
that
information
to
include
not
only
the
waiver
services
but
their
medical
and
pharmaceutical
services
as
well
to
get
that
information,
for
you
be
more
than
happy
to
take
this
back
and
come
back
and
either
provide
you
with
an
answer
through
this
committee
or
bring
it
back
to
the
next
meeting
that
we
have
regular
scheduled
meeting
that
we
have
to
give
you
a
little
bit
more
information
on
the
costs
related
to
delivering
these
services
to
web
or
participants.
Well,
commissioner
williams,
by.
B
Still
got
your
attention,
I'm
curious,
I
mean
you
know
we
have
to
compare
apples
and
apples,
not
apples
and
oranges.
Now,
if
they're
receiving
pharmaceutical
services
and
additional
things,
is
that
not
also
included
to
their
course
in
their
icf,
I'm
just
curious.
You
know
the
relationship
between
their
waiver
services
alone
versus
what
it
would
cost
the
state
of
kentucky
to
have
them
in
an
icf.
D
D
I
understand
your
question
we'll
go
back
and
make
sure
that
we
understand
what
the
icf
all-inclusive
rate
includes,
so
that
we
can
compare
apples
to
apples
as
much
as
we
can.
But
I
understand
your
your
question.
I
understand
the
information
that
you
want
to
look
at
and
be
more
than
happy
to
go
back
and
look
at
that
and
bring
it
back
to
you.
B
A
D
Thank
you,
mr
chairman.
My
comments
are,
I
have
a
question
on
page
five
of
the
the
of
the
handout
where
it
says
budgets
must
be
cost
neutral
per
cms
to
be
cost
neutral.
The
average
per
average
per
participant
expenditure
must
not
exceed
the
average
per
person
cost
of
furnishing
institutional
services
for
an
individual
with
the
same
level
of
care.
My
question
is:
what
are
those
numbers.
E
I
don't
have
those
with
me.
One
thing
that
you
need
to
remember,
though,
is
that
it's
based
on
an
aggregate
for
the
waiver,
so
we
have
to
take
a
waiver
in
a
hole
and
we
report
budget
neutrality
for
that
waiver.
It's
not
it's
not
like.
What's
an
aggregate,
so
it's
it's
all
those
those
folks
that
are
in
the
program,
and
it's
also.
Oh,
I'm
sorry,
it's
also
based
on
days
of
stay.
D
A
D
C
This
is
amy
stade,
I'm
the
executive
director
at
cap.
I
quickly
did
that
calculation.
If
you
look
on
her
slide,
where
she
puts
where
she
breaks
down
the
federal
share
she
has.
One
of
the
prints
are
in
the
fl
waiver.
I
divided
the
total
cost
by
the
number
of
participants
and
then
divided
that
I
totally
65
to
get
an
average
per
day
per
person
and
not
for
215.
G
B
E
So
waiver
services,
in
combination
with
other
services,
should
be
able
to
support
the
client
out
in
the
community.
One
of
the
problems
we
run
into
is
that
cms
expects
us
to
be
able
to
care
for
that
client
and
at
the
same
level
of
care.
The
level
of
care
is
nursing
facility
level
of
care,
so
there
is
no
higher
level
of
care.
As
far
as
cms
is
concerned,
it's
nursing
facility
level
of
care.
E
Okay,
so
often
often
times
in
nursing
homes.
You
will
have
other
supports
that
are
similar
or
alike
to
waiver
services,
but
maybe
not
exactly
if
somebody
needed
you
know
nursing.
I'm
just
saying
this
is
an
example
of
14
hours
a
day
or
something
like
that.
That's
not
something
that's
covered
under
the
wafer.
A
A
Okay,
thank
you.
Thank
you.
Y'all
have
a
great
day
thanks
for
having
us
now
at
this
time.
We
will
have
commissioner
morris
and
division
director
johnson,
and
they
will
be
talking
about
development,
intellectual
disabilities,
analysis
of
supports
for
community
living
waiver
and
emotional
and
exceptional
support
waiver
services
are
both
of
you
on
online.
F
A
A
G
G
G
The
support
of
community
living
or
seo
labor
through
a
contract
with
the
department
of
medicaid
services.
So,
even
though
we're
both
in
the
same
cabinet,
we
do
have
a
contractual
agreement.
The
sel
waiver
includes
a
specialized
rate
for
people
who
have
exceptional
medical
or
behavioral
needs,
and
this
applies
to
both
the
traditional
and
participant
directed
services.
G
G
So
here's
just
some
examples.
Some
examples
of
some
services
that
are
eligible
for
exceptional
race,
ports,
one
this
residential
level,
one
that
would
be
the
staffed
residence
like
a
three-person
home
level.
Two,
your
family
home
provider,
where
there's
12
hours
for
more
supervision
needed
community
access.
G
This
might
be
allowing
a
person
to
join
a
club,
become
active
in
their
church,
join
the
choir
that
sort
of
thing
and
then
that
service,
with
back
off
as
a
person,
gains
natural
supports
in
the
community
personal
assistant,
respite
services,
so
the
caregiver
can
have
a
break
and
that
that's
on
a
person
lives
alone
with
family
day.
Training
is
also
eligible
if
it's
as
long
as
it's
not
provided
by
an
adult
day,
healthcare,
which
is
which
is
a
licensed
facility
that
follows
a
medical
model.
G
G
So
there
is
a
packet
of
information,
that's
needed
in
order
for
us
to
evaluate
the
request
and
that's
in
the
mwma
system.
It's
a
medicaid
waiver
management
application,
so
it's
done
online.
What's
needed
is
a
name
and
some
basic
identifying
information,
a
description
of
the
supports
that
are
being
requested.
G
This
updated
service
plan
will
need
to
be
put
into
the
mwma
system
and
then,
if
there's
an
ongoing
request,
there'd
be
a
description
of
any
interventions
that
had
been
taken
and
what
the
results
were
and
then
a
detailed
cost
analysis,
and
there
is
a
great
determination
template
that
all
costs
all
requests
need
to
use
when
they're
asking
for
a
cost
increase
next
slide.
Please.
G
So
again,
for
just
for
the
process,
all
our
requests
have
to
be
made
with
the
consensus
of
the
person-centered
team,
which
I
just
talked
about,
and
that's
that
that's
all
outlined
the
process
is
outlined
in
a
provider
letter
that
came
out
a
couple
three
years
ago
and
other
than
emergency
situations.
The
services
are
not
to
be
started
until
they're
approved
if
it
is
an
emergency.
G
There's
a
process
to
review
that
retroactively
within
one
business
day
of
that
team
meeting
the
case
manager
can
submit
the
packet
to
our
department
via
mwma,
and
we
have
three
business
days
to
process
that
request.
We
may
need
to
ask
for
additional
information
from
the
case
manager,
and
that's
referred
to
as
an
li
or
lack
of
information.
G
I
can
tell
you
that
happens
in
about
39
of
the
cases
may
be
a
little
simple
question.
It
may
be
a
series
of
questions.
Some
providers
will
case.
Managers
will
turn
that
into
around
really
quickly.
Others
never
respond
to
our
questions.
They're.
The
providers
case
managers
have
no
required
turnaround
time
again.
We
have
three
days,
but
the
rate
doesn't
require
you
to
turn
around
it's.
What
I
will
tell
you
for
fiscal
year
20,
we
only
denied
four
requests.
G
G
Again,
this
waiver
program
is
a
medicaid
program
and
the
department
of
medicaid
services
said
set
the
policies
in
accordance
with
9s7,
kr12010
and
12020,
but
two
of
the
recommendations
that
were
made
actually
don't
require
a
regulation
change
and
we
are
in
agreement
with
dms
that
these
changes
could
be
made.
One
is
to
extend
the
prior
authorization
of
non-clinical
exceptional
supports
to
a
year.
We
agree
that
that
is
doable.
The
second
is
to
back
date,
approvals
to
the
date
of
the
initial
submission.
B
B
What's
the
rationale
for
the
one-day
turnaround
by
the
case
managers,
I
mean
if
I've
heard
one
thing,
I've
heard
case
managers
complain
and
this
kind
of
harps
out
something
that
steve
shannon
talked
about
at
the
last
meeting.
Because
of
this
you
know
difficulty
the
case.
Managers
have
about
getting
this
thing
done
in
one
business
day,
a
lot
of
them
just
kind
of
love
it
they
don't
do
it
and
a
lot
of
individuals
that
need
these
supports,
don't
get
them
because
their
case
managers
they're
busy.
F
B
You
know,
like
I
say
if
this
this
kind
of
goes
in
hand
in
hand
with
something
that
steve
shannon
talked
about
at
the
last
meeting
that
case
managers,
I'm
not
gonna,
I'm
not
gonna
accuse
them
of
not
doing
their
job,
but
a
lot
of
them
sometimes
are
just
so
busy
that
they
can't
meet
that
one-day
turnaround.
I
think
it's
something
that
maybe
you
might
wanna
you
know
take
a
look
at.
Thank
you
very
much.
A
C
Hi,
commissioner,
morris
or
claudia
I
have,
whichever
one
is
better
hope
to
answer
those
questions.
I
have
two
questions.
The
first
question
is
about
the
testimony
that
we've
heard
regarding
greg
changes
to
implement
some
of
these
proposals,
which
I
totally
understand.
I
know
a
lot
of
stuff
has
to
go
through
the
right
process,
but
I
would
wanted
to
point
out
and
ask
a
question:
is
that
currently,
if
you
look
at
the
payment
reg
for
the
exceptional
supports
protocol,
the
exceptional
supports
protocol
is
incorporated
by
reference
in
that
rank.
C
F
Amy,
this
is
claudia
and
that's
why
we
said
that
it
would
not
require
a
rate
change
to
do
the
extend
the
non-clinical
to
a
year
or
to
back
date,
because
those
are
not.
Those
are
not
regulatory
changes.
Those
were
put
in
place
with
the
provider,
one
so
medicaid,
but
the
other
is
the
medicaid
question
about
what
they
can
and
can't
change
with.
Without
a
raise.
C
Correct,
that's
a
medicated
question.
Okay.
My
next
question
is
about
the
level
of
care
discussions,
so
I
think
that
what's
really
kind
of
getting
lost
in
this
level
of
care
terminology-
and
we
that
could
be
my
fault
for
using
the
incorrect
term,
but
I
think
that
what
happens
often
is
that
providers
will
accept
a
referral
of
an
either
an
individual
who's
coming
out
of
an
icf
or
an
individual
or
from
another
provider.
C
Who
is
has
a
very
complex
set
of
support
needs,
and
you
know
the
exceptional
supports
protocol
will
be
requested.
All
of
that,
but
then
the
provider
realizes
that
the
individual's
needs
are
far
too
great
for
to
be
served
either
in
the
waiver,
or
maybe
just
by
that
particular
provider
and
the
problem
with
the
current
system,
which
is
why
we
included
that
sort
of
next
level
of
care.
C
C
F
F
I
thought
I
mean
my
understanding
is
this
is
talking
about
the
exceptional
supports
process?
That
is
a
conversation
that
was
being
held
in
medicaid's
level
of
care
task
force.
So
I
don't
know
if
anyone
wants
to
respond
to
that.
But
what
you're
talking
about
amy
is
a
regulatory
requirement
that
a
provider
has
to
make
referrals
and
continue
to
support
someone,
so
they're
not
left
without
needed
supports
until
they
can.
G
And
I
would
just
I
would
just
go
on
to
say
I
mean
that's
that
it's
something
we've
talked
about
with
you
and
and
here
at
the
camera
quite
a
bit,
and
if
it
was
a
simple
answer,
we
certainly
would
have
resolved
it
by
now.
But
the
way
I
can
assure
you
those
conversations
continue,
because
we
recognize
that
it's
a
challenge
for
everybody
and
it's
certainly
a
challenge
for
the
people
we're
trying
to
serve
to
be.
You
know
in
the
care
of
someone
who
feels
overwhelmed.
So
we
share.
A
Commissioner,
morris
and
and
mrs
johnson,
I
don't
think
we
have
any
more
questions.
We
appreciate
your
testimony
today
that
calls
for
the
end
of
our
meeting.
Our
next
meeting
is
on
monday
september
28th
at
one
o'clock
september,
28th
eastern
time,
one
o'clock
eastern
time
september
28th
and
senator
adams
will
chair
that
that
meeting
we
appreciate
everybody
being
here
today
if
somebody
wants
to
make
a
motion
with
journal,
we'll
adjourn
motion
by
senator
parrott
we're
adjourned.
Thank
you.
Everybody.