Comments and Revisions Summary — Chapter 501: Aged and Disabled Waiver
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Comments and bureau responses proposing clarifications and operational edits to Chapter 501 (Aged and Disabled Waiver) affecting ADW providers, case managers, and related agencies.
Any reference to 'nurse' changed to 'RN' and 'nurse' defined as RN; CareConnection references replaced with UMC portal/Atrezzo; case managers must review UMC portal information; documentation upload timelines and signature requirements clarified; operational clarifications on home visits, coordination, and record retention.
Coverage and Operational Criteria
inv-01: ADW operational criteria and clarifications
Selected operational clarifications and coverage-related positions contained in the comments and bureau responses:
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- Live-in personal attendants remain eligible for exemption from EVV per the manual; agencies may require EVV for all in-home caregivers or only for those who do not reside with the member.
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- Visiting a family member or friend in a long-term-care facility or hospital is a reimbursable community activity when performed by a non-family paid personal attendant (manual language will be updated to clarify this).
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- The Service Level Request form must be signed by either the RN or the case manager; manual language will be updated to clarify this requirement.
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- Documentation, including incident reports, must be uploaded into the UMC portal within seven business days of completion; incident reports must be entered into WV IMS within 14 calendar days of learning of the incident unless documented otherwise.
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- Geographic conflict language and 25-mile selection exceptions apply to case management agencies (not personal attendant agencies); conflict-of-interest forms will be updated for clarity.
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- ADW agencies must send at least one representative to mandatory quarterly provider meetings; meetings will be conducted virtually with materials distributed via email; ongoing non-participation may result in sanctions.
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- Member signatures are required on all service-plan related documents; addenda or updates to the PCSP are allowed to reflect changes when appropriate.
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- Case managers may choose not to enter a member's home when infestations are identified and may provide alternative services (e.g., phone-based addendum to the Service Plan) until pest eradication is completed; agencies may pause services depending on landlord responsibilities.
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- When more than one agency provides services to an individual, agencies are expected to maintain ongoing communication and coordination to ensure timely, appropriate, and uninterrupted care.
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- Case managers should work with home health agencies to avoid duplication of services; documentation of home health needs and referrals should be maintained in ADW records and accessible to both agencies when available.
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- Transferring agencies must maintain original documents if they are available; manual language will be updated for clarity.
inv-02: ADW operational criteria and clarifications (planned clarifications and expectations for ADW operations - non-clinical)
Planned clarifications and expectations for ADW operations (non-clinical):
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- Non-family paid personal attendants may bill for taking members to visit family/friends in long-term care or hospitals; manual language will clarify these as reimbursable community activities when performed by non-family attendants.
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- Service Level Request requires signature by either the RN or the case manager; forms and manual language will be updated to reflect this change.
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- ONE of: Case managers may choose to enter the home for assessment and service planning.
- ONE of: Case managers may complete a phone-based addendum to the Service Plan and provide alternative services until pest eradication is completed; agencies may pause services if treatment periods extend and landlord responsibilities are relevant.
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- A member cannot be the documented unpaid or paid caregiver of another member in any HCBS waiver during service plan time; manual language will be updated to clarify this policy.
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- Case managers must coordinate with home health agencies to prevent duplication of services; documentation of home health referrals and physician orders should be maintained in ADW records if available.
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- Transferring agencies must maintain original documents for monitoring purposes if available; manual language will be updated for clarity.
Coding and EVV Considerations
| No codes listed |
Provider Responsibilities and Actions
UMC portal documentation and proactive review (7 business days)
Upload all completed documentation into the UMC portal (Atrezzo/UMC) within seven business days of completion, and case managers must proactively review information in the UMC portal rather than relying solely on portal alerts.
- Documentation timeline: upload into the UMC portal within seven business days of completion.
- Case manager responsibility: CM must review information in the UMC portal (UMC/Atrezzo) rather than depending on portal alerts.
Required inter‑agency coordination for overlapping services
When more than one agency provides services to the same member, those agencies must coordinate and communicate on an ongoing basis to ensure timely, appropriate, and uninterrupted care.
- Agencies providing overlapping services are expected to maintain ongoing communication and coordination.
- Coordination is required to prevent service gaps and ensure continuity of care.
Coordinate with home health agencies and monitor UMC notifications
Case managers must coordinate with home health agencies to avoid duplication of services and are responsible for regularly reviewing UMC portal information; CMs should receive or obtain notifications when the UMC denies or closes requests and ensure home health needs are documented in the ADW Service Plan or addendum.
- CMs should work with home health agencies to ensure no duplication of services occurs once those services are identified.
- CM responsibility: regularly review portal information; monitor UMC request denials/closings and document home health referrals and physician orders in member records.
Home‑visit safety: phone addendum and alternative continuity options
If pest infestations make in‑home visits unsafe, case managers may choose not to enter the member's home and instead complete a phone‑based addendum to the Service Plan or provide alternative services to maintain continuity until eradication is completed; agencies may be permitted to pause services if treatment periods extend.
- CMs may conduct phone meetings and document a Service Plan addendum reflecting changes to personal attendant services.
- Services may be paused by agencies when treatment periods extend; participant eligibility and landlord responsibilities may affect service decisions.
Glossary and Defined Terms
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