RD542 - Report on Alzheimer's Assisted Living Waiver Work Group – December 1, 2016

Executive Summary:
To address this report mandate, the Department of Medical Assistance Services (DMAS) met with key stakeholders to review the AAL Waiver and the new federal regulations that govern the delivery of Medicaid-funded home and community-based services. Due to new federal requirements, the AAL Waiver will cease to operate on June 30, 2018. To ensure continuity of services for enrollees and address the services needs of others who are eligible for the AAL waiver, the work group recommended the following:

1. DMAS request a General Assembly appropriation to fund the federal financial participation (FFP) portion of AAL Waiver for individuals who: (1) are enrolled in the AAL Waiver and (2) choose to continue residing in an Assisted Living Facility (ALF) “safe and secure environment” when the AAL Waiver sunsets on June 30, 2018.

2. Under Managed Long-Term Services and Supports (MLTSS), DMAS contracts with the Managed Care Organizations (MCOs or Health Plans) should: (1) identify and describe, in detail, “core community-based dementia services” that MCOs should offer to individuals with Alzheimer’s disease and dementia and their families. Further, MCOs should, through their own contracts with providers, ensure the delivery of those services as required by the DMAS-MCO contract.

3. DMAS should continue to work with federal and state partners to determine if there is a way to support individuals with Alzheimer’s disease and dementia in ”safe and secure environments” in ALFs that would not require compliance with the HCBS regulations. DMAS will continue to investigate other regulatory authorities under which ALF services in a “safe and secure environment” might be provided.

4. DMAS should work more closely with the Virginia Department for Aging and Rehabilitative Services (DARS), which serves as the lead agency on dementia-related activities in the Commonwealth (§ 51.5-152). Aligning the efforts of these two agencies, including two federal grant programs underway at DARS, on the development and implementation of any dementia-related supports for individuals enrolled in Medicaid and receiving LTSS will best enable the Commonwealth to meet the needs and desires of individuals with Alzheimer’s disease and dementia.