What is a managed care waiver?
1915(a) Waiver Basics States can implement a voluntary managed care program simply by executing a contract with companies that the state has procured using a competitive procurement process. CMS must approve the state in order to make payment.
What is the 1115 waiver California?
Section 1115 of the Social Security Act allows states to waive certain federal statutory Medicaid program requirements or obtain federal matching funds for costs or investments that would not otherwise be allowed under the Medicaid program.
What is a 1915 waiver?
1915(c) waivers A 1915(c) waiver permits states to offer home and community based services (HCBS) to limited groups of enrollees as an alternative to institutional care. This waiver also enables the state to cap who receives HCBS services and to waive a few other Medicaid statutes, including some income requirements.
What is a 1915 B waiver?
The term, 1915 (b)/(c) Medicaid Waiver, refers to two sections of the Social Security Act that allow states to apply for waivers from federal Medicaid policy. The (b) Waiver allows Medicaid beneficiaries to enroll in managed care plans and allows Medicaid to limit the provider network based upon needs of recipients.
What is a Medi-Cal waiver program in California?
Medi-Cal waivers are programs that provide additional services to specific groups of individuals, limit services to specific geographic areas of the state, and provide medical coverage to individuals who may not otherwise be eligible under traditional Medicaid rules.
Does Medi Cal cover mental health services?
Services covered by Medi-Cal include outpatient mental health services such as individual or group counseling, outpatient specialty mental health services, inpatient mental health services, outpatient substance use disorder services, residential treatment services, and voluntary inpatient detoxification.
What is the purpose of waiver programs?
A waiver program allows the state to waive some requirements to meet the needs of individuals. For example, a waiver may help a person with an increased likelihood of requiring long-term care, such as those with behavioral issues or technologically dependent children.
What is the calaim section 1915 ( b ) waiver?
The application is a renewal and amendment to the SMHS Section 1915 (b) waiver – called the CalAIM Section 1915 (b) waiver – that includes the SMHS program, as well as streamlined authorization for Medi-Cal managed care, dental managed care, and the Drug Medi-Cal Organized Delivery System (DMC-ODS).
When do I need to renew my 1915 waiver?
To reduce the burden on states associated with the renewal process, in its March 2018 report, MACPAC recommended extending approval and renewal periods for all 1915 (b) waivers from two to five years.
Are there any renewals for the calaim waiver?
DHCS submitted two requests to CMS: (1) the CalAIM Section 1115 demonstration (formerly entitled Medi-Cal 2020 Section 1115 demonstration) for a five-year renewal, with amendment; and (2) the CalAIM Section 1915 (b) waiver for a five-year renewal, with amendment.
When does the 1915 mental health waiver expire?
1915 (b) Medi-Cal Specialty Mental Health Services Waiver California’s 1915 (b) SMHS Waiver renewal was approved for a five-year term, July 1, 2015, through June 30, 2020, and includes Special Terms and Conditions (STCs).