MT 0371 (Community Supports) Waiver
A listing and brief description of the sections of the MT 0371 Waiver
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Cover Letter to CMS - This document briefly summarizes the contents of an application for a new waiver. The cover letter is used to briefly summarize requested changes in applications fgor amendments and renewals. The cover letter is signed by the DPHHS Director.
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Waiver Format - This section is a summary of the basic CMS assurances. The state agrees to comply with the conditions attached to the use of Federal funds. This section is signed by the DPHHS Director.
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Appendix A - This section identifies the state agency responsible for administration of the waiver.
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Appendix B - This section defines the reimbursable services available, and the minimum qualifications for providers of waiver services.
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Appendix C - This section identifies the target population for the waiver and the initial and ongoing eligibility criteria for service recipients.
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Appendix D - This section defines the level of care process, including the qualifications of persons who are responsible for initial and redetermination activities, record maintenance details and includes the forms used to complete these activities.
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Appendix E - This section defines the annual plan of care (IP) process, persons responsible for coordinating the IP, the IP forms used (in kids' and adult services) and the process used for the maintenance of records.
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Appendix F - The "audit trail" section defines the billing and payment system and record retention system used for invoicing and payments.
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Appendix G - This section projects service utilization based of projected numbers of persons to be served and service costs. This section defines the process for calculating "cost neutrality" (Medicaid saves $ by serving persons in the waiver, as opposed to serving persons in ICFs-MR).
Page last updated 07/26/2006
