CCC Plus Waiver Process

Overview

In 2017, the the Department of Medical Assistance Services combined the EDCD Waiver and the Tech Waiver into the Commonwealth Coordinated Care (CCC) Plus Waiver. Individuals previously served under the Elderly and Disabled with Consumer Direction (EDCD) and the Technology Assistance Waivers are included in CCC Plus, which operates under a fully integrated model across the full continuum of care that includes physical health, behavioral health, community-based, and institutional services. CCC Plus operates with very few carved out services. CCC Plus serves individuals who are aging and/or living with disabilities as an alternative to institutionalization.

The Application Process

The CCC Plus Waiver requires individuals meet both financial and functional criteria. For financial eligibility, only the income/assets of the individual seeking Medicaid are considered. Children are considered a household of one for the purposes of the CCC Plus Waiver financial determinations. Functional eligibility is determined through a screening process completed by the individual’s local Department of Health (DOH). In order to be approved, you must meet the eligibility criteria for both financial need and functional dependencies.

Applying for Medicaid:

  • Print and complete a Medicaid Application. Only include information regarding the individual requesting Medicaid. Do not complete with the household information, even though it asks for it. If completing for someone else, please answer the questions on behalf of that person, not yourself. Write “CCC Plus/Long Term Care Screening Request” at the top of the form.
  • Print and complete the financial component of the Medicaid Application, known as Appendix D. If completing for someone else, please answer the questions on behalf of that person, not yourself. Do not complete with the household information. Only the income/assets of the individual seeking eligibility are considered.
  • Bring completed Application and Appendix D to your local Department of Social Services (DSS) and request a screening for Long Term Care.

The Waiver Screening

Once you have turned in your Medicaid Application, a nurse from your local DOH and a representative from DSS will schedule a screening with you. The screening will take place in the individual’s home – the individual being screened must be present. The nurse and representative will be looking for a documented disability, functional capacity, medical/nursing needs, and risk of facility placement.

Screening Process:

  • Find your local DOH
  • A Uniform Assessment Instrument (UAI) will be used to assess the individual
  • Helpful hints:
    • Documented Disability
      • It is often helpful to have a diagnostic list.
    • Functional Capacity
      • Evaluates an individual’s ability to perform activities of daily living (ADLs), ambulation mobility, and instrumental ADLs (IADLS) in a community environment.
        • ADLs: Bathing, Dressing, Toileting, Transferring, Eating/Feeding,
        • Ambulation: Walking, Wheeling, Stair Climbing, Mobility
        • Continence: Bowel/Bladder
        • IADLs: Meal Prep, Housekeeping, Laundry, Money Management, Transport, Shopping, Cellphone Use, Home Maintenance
        • Physical Health Assessment: Joint Motion, Medication Administration, Behavior, Orientation
    • Medical/Nursing Needs
      • Determines if the individual meets the medical criteria for facility level of care and/or admission.
    • Risk of Facility Placement
      • In order to qualify and be authorized for Medicaid Waiver services, an individual must also be at risk for facility placement within 30 days in the absence of the CCC Plus Waiver.
    • Screening Considerations for Children
      • Assistance in refraining from unsafe interactions: impaired safety skills
      • Exhibits disruptive or dangerous behavior:
        • Abusive/Aggressive/Disruptive
        • Self-harm
        • Wandering/Eloping/Passive
        • Destroying property
        • Hyper/Hypo sensitivity
        • Constant vocalizations/perseveration
        • Sleep deprivation
        • Reported cognitive impairment
        • Lack of awareness
        • Unable to respond to cues
        • Unable to communicate basic needs and wants
        • Disorientation/Disassociation
        • Unable to follow directions
        • Unable to process information or social cues
        • Unable to recall personal information

Screening Criteria

A child may meet the functional capacity requirements for care when one of the following applies:
    • Rated dependent in two to four ADLs AND also rated semi-dependent OR dependent in behavior pattern AND orientation, AND also semi-dependent in joint motion OR dependent in medication administration.
    • Rated dependent in five to seven ADLs AND also rated dependent in mobility.
    • Rated semi-dependent in two to seven of the ADLs AND also rated dependent in mobility AND behavior pattern AND orientation.

Medical/Nursing Needs: A child with medical or nursing needs is a child whose health needs require medical or nursing supervision or care above the level, which could be provided through assistance with ADLs, medication administration, and general supervision and is not primarily for the care and treatment of mental diseases. Medical or nursing supervision or care beyond this level is required when any one of the following describes the child’s need for medical or nursing supervision:

    • The child’s medical condition requires observation and assessment to ensure evaluation of the child’s need for modification of treatment or additional medical procedures to prevent destabilization and the child, as developmentally appropriate, has demonstrated an inability to self-observe or evaluate the need to contact skilled medical professionals.
    • Due to the complexity created by the child’s multiple, interrelated medical conditions, the potential for the child’s medical instability is high or medical instability exists; OR
    • The child requires at least one ongoing medical or nursing service. Ongoing means that the medical/nursing needs are continuing, not temporary, or where the individual is expected to undergo or develop changes with increasing severity in status. “Ongoing” refers to the need for daily direct care and/or supervision by a licensed nurse that can’t be managed on an outpatient basis.
    • The child may also be at “risk” for facility placement if the individual’s current condition and available supports are insufficient to enable the individual to remain in the home. Some examples include:
      • Deterioration in the individual’s condition 
      • Change in support that prevents needs from being met, such as behaviors increasing, medical condition worsening
      • Change in family situation, such as new child, deployment, divorce
      • No change in condition or support, but evidence that functional, medical/nursing needs are not being met, such as inability to potty train or inability to manage all therapies

After Approval

Select a model of service delivery and choose either an Agency-Directed or Consumer-Directed provider: 

  • Agency-Directed:
    • Model of service delivery where an agency is responsible for providing direct support staff, for maintaining individuals’ records, and for scheduling the dates and times of the direct support staff’s presence in the individuals’ homes for personal and respite care.
  • Consumer-Directed:
    • Model of service delivery for which the individual or the individual’s Employer of Record, as appropriate, is responsible for hiring, training, supervising, and firing the attendants who render the services that are reimbursed by DMAS.
    • Consumer-Directed receives assistance from a Service Facilitator.

If You Choose Consumer-Directed Care

Service Facilitator Conducts Initial Visit:

  • Trains Employer of Record (EOR) on hiring procedures.
  • Initiates process by contacting Medicaid’s Fiscal Agent (PPL).
  • Conducts initial assessment.
  • Creates Plan of Care (POC).
  • Estimates how many hours the Individual will qualify for.

Post Initial Meeting:

  • Service Facilitator – Requests prior-authorization for hours through a prior authorization 3rd party.
  • EOR is set up to be employer.
  • EOR recruits, hires, and schedules attendants.

To Review the DMAS CCC Plus Waiver Manual (manual will be updated to the CCC Plus Waiver manual when it becomes available):

Visit DMAS’s Website:

https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/ProviderManual

Select the drop down option of: “Elderly or Disabled with Consumer Direction Services.” This will return all the chapters of the manual.  Chapter four outlines the services available via this waiver.