HEADINGS

(Helping Elderly and Disabled in Need Gain Support)

An organization Providing Advocacy and Informational Support Group Services

Aged Disabled Support Group and Resource Site

and other helpful related items regarding the West Virginia Aged Disabled Medicaid Waiver and more...

HEADINGS began as a local community endeavor and grew into a national non-profit organization providing FREE advocacy services for the elderly and disabled that encompasses the state of West Virginia and beyond.  Our efforts to effect change both locally and nationally are chronicled on this website and new information is posted regularly.   

We work closely with the Center for Medicare and  Medicaid, Department of Health and Human Resources, Legislators, Medicaid Providers, community action groups, and most of all, directly with our elderly and disabled citizens, their family members, friends and caregivers.   

Long term care is a complex issue and constantly evolves as federal agencies generate new rules and regulations, and state agencies struggle to change local policies to reflect required changes within their budget constraints.  One of our goals is to help improve service efficiency provided to the elderly and disabled in order to maximize the limited funds available, so that more can be served with less funds.  

We must remember that our State's administrative costs for managing the many Medicaid programs receives only a 50% federal funding match.  So, when State agencies continually increase their staff, create new departments, or hire third party vendors to supply services, taxpayers must provide more of the money to help cover the cost.   

Medicaid expenses paid for direct client services receives a 75% match, such as in-home care, case management, etc.  This means for every State $1 allocated by legislators, the federal government will match it with $3 of federal funding, greatly reducing the state taxpayer's burden.  You can see how a $40 million program only requires $10 million in state funds.  

The problems and concerns facing those we serve are many, including current West Virginia DHHR policy changes that have been instituted without recipients' valuable input.  We are here to help you.  So, if you need assistance or have questions, please don't hesitate to contact us.   A difficult task is easier to bear when done as a team....so join us in our efforts!  There are no membership dues or special forms to fill out.  If all you do is complete our survey, you will have HELPED US GREATLY!   

If you'd like to be placed on our list to be notified of important updates or meeting dates, please let us know.

This site is a repository of information and current correspondence regarding:

• Understanding Home and Community Based Services:  A Primer - in PDF format for easy viewing....

• The Aged Disabled Medicaid Waiver's new policy implementation as of 2/1/02 and potential and actual impact on recipients

• The need to educate the public regarding recipients needs and concerns.

• President Bush's Freedom Initiative and Executive Order

• The State Olmstead Plan

• The Saucier Report

• Medicaid Providers are not allowed to bill recipients for missed appointments

• Recipients efforts to effect change in state and federal policy

• ...and related information that affects the lives of the disabled and elderly, as well as their family members and community, here in the state of West Virginia.  

Please help us and others to better determine the needs of the elderly and disabled, by completing our survey form.   Anyone can take this survey, those receiving services, needing services, personal caregivers (related or unrelated), organizations providing services, and others.

In the near future, we will be including summary notes on pending legislation on both the state and federal level as it relates to aged and disability issues. Until then, please use the above links to review pending legislation directly on the government sites.

As new information is learned or submitted, its merits will be considered and included in this site.  We will soon have interactive forums and more to help facilitate needed change.  In the meantime, please submit comments, noteworthy links related to the subject matter, and other helpful information to the adwaiver@knowareland.com.

President George Bush Freedom Initiative and Executive Order No. 13217 in Microsoft Word format, dated 12/21/01.

"By the authority vested in me as President by the Constitution and the laws of the United States of America, and in order to place qualified individuals with disabilities in community settings whenever appropriate, it is hereby ordered as follows: The Federal Government must assist States and localities to implement swiftly the Olmstead decision, so as to help ensure that all Americans have the opportunity to live close to their families and friends, to live more independently, to engage in productive employment, and to participate in community life."

-- President George W. Bush, Executive Order 13217

The Olmstead State Plan was submitted to Governor Wise December 2001.  You will notice that Appendix C is not included, as it contains letters that were sent directly to the printers and not put on the computer.  Barbara Judy is the WV State Coordinator of ADA Services, and submitted the plan to Governor Wise in December 2001. The Governor's office is still reviewing the plan.  For questions regarding the Olmstead Plan, contact the Governor's office at (888)438-2731 and ask to speak with the ADA Coordinator.  Files are as of 12/01 and are in Microsoft Word format.

     - Olmstead Plan First Part

    - Olmstead Plan Second Part

    - Olmstead Plan Appendix A

    - Olmstead Plan Appendix B

    - Olmstead Plan Appendix D

Understanding Medicaid Home and Community Services:  A Primer

This report was prepared under contract HHS-100-97-0015 DO#8 between the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging, and Long-Term Care Policy and the George Washington University’s Center for Health Policy Research, Washington, DC.

files are in .PDF format and have the same "look and feel" as the book...

2/4/02  Medicaid Providers are NOT ALLOWED to bill Medicaid recipients for missed doctor or dentist appointments.  If you have paid a doctor or dentist for a missed appointment, please contact us at adwaiver@knowareland.com.  We are in the process of collecting information regarding this problem.  The State has been advising Medicaid providers since 1994 that it was okay to bill a Medicaid recipient if they failed to show up for a doctor or dentist appointment.  The Center for Medicare and Medicaid had sent a policy clarification back in 1994 to the State of West Virginia advising them they could not do this. Since the state argued with us about homemaker agencies being able to bill recipients, BMS requested written clarification from CMS.  When CMS sent the letter to them this last week, they attached a copy of the policy clarification sent back in 1994.  Please check with your friends and family to see if they may have paid money for a missed appointment.  Also, we would appreciate if you would participate in our survey form.  Thank you! 

Known as the "Saucier Report", prepared in February 2001, for West Virginia Center for Healthcare Policy and Research and The West Virginia Health Care Authority by Paul Saucier, M.A., Elise Bolda, Ph.D., Edmund S. Muskie School of Public Service, University of Southern Maine.  This report was prepared to provide West Virginia policy makers with an overview of the State’s community long-term care system for elderly and physically disabled consumers, and to identify policy options to improve or enhance the system.  The report focuses on community-based, long-term care services.  Interesting to note, no direct recipients of services were interviewed to provide valuable input.

Not everyone needs case management, but for those who do, Here is a PRIME example of the types of services that Case Management Agencies provide Waiver recipients.  This is a letter that one case management agency sent to their clients, advising them of the new policy, reminding them of a few of the services they could expect to continue to receive while under their care.  They sent us a copy with a blank area for the name. Not all are as thorough as this agency, which has also helped clients with organ transplants, etc.  In our opinion, this represents what comprises a "Good" Case Management Agency.  We hope the posting of this letter helps clarify the need for this type of service, and clearly demonstrates the need for advocacy for clients.

Know Your Civil Rights and how to file a complaint with the Office of Civil Rights, contact information included http://www.hhs.gov/ocr/knowcivilrights.html

Note: Updates and new items will be added to the beginning of this list with the posted date separating the sections.

Posted Date:  1/16/03  1-16-03 Commissioner Atkins' letter to HEADINGS explaining the reason why DHHR wants $2 million from the state to have a third party vendor handle the Pre-Admission Screening process, which currently doesn't cost the state for the initial assessments.  The letter blames Case Management for the problem, stating that over 40% of the people on waiver shouldn't be there, and implies that case managers put them there in order to make money.  She is alleging that they have committed FRAUD!  

Page 1 of Atkins Letter            Page 2 of Atkins Letter            HEADINGS response

Posted Date:  3/7/02

Definite conflict of interest! All Care Home & Community Services, Inc. and Council On Aging, Inc., Robert Graham is Executive Director for both!  Council on Aging is the homemaker agency, and All Care is the case management agency, yet both corporations IRS Form 990 show they are RELATED (see line 80a). These organizations have been operating with DHHR's approval for years! Robert Graham is also Executive Director of Association of Directors of Senior Programs, which is the association for Senior Centers.  Why did Secretary Nusbaum bring Senator Bailey with him to the February 2002 meeting that our senators requested of him regarding the new policy problems with the AD Waiver? Well, we did some research and Senator Billy Wayne Bailey shows his employer as "Council on Aging" and his job description is "Special Projects".  When we called Council on Aging to ask what Mr. Bailey's position was and what he did, they said they didn't know and to call his senate office.   Robert Graham's combined salary for 1999 for both organizations was $235,798!  It all kind of makes you wonder.....

Lincoln County - Alice Tomblin in 1999 made $171,998!    View their Form 990s.

Posted Date:  2/17/02

2/14/02 DHHR sends letter to recipients advising them of new policy!  While visiting the Capitol on 1/28/02, Ken Ervin, Vicki Shaffer, Karen Davis, Dawna Smith, David Smith, and Delegate Brent Boggs met with Speaker Kiss.  Speaker Kiss then requested a meeting with Mr. Nusbaum the following Monday.  We were told that Speaker Kiss requested DHHR to notify recipients and personalize the letter.  Although we discovered the letter was to go out and we contacted DHHR, no recipients were able to provide comment or view the letter before it was sent.   The letter contains wording that can be misconstrued...."The nurse who develops your plan of care for homemaker services will now work directly with the homemaker agency rather than with the case management agency".  This implies that they HMA RN and CMA will not be communicating, and from information we have heard it may appear some HMA RNs feel this way.

DHHR did not advise recipients of the following important changes:

• The ability to "bank the homemaker hours" received within a monthly time frame, and that the hours can now be utilized in a flexible manner at the convenience of the recipient, not for the convenience of homemaker or senior center agency.  This is such an important aspect, as some recipients are afraid to anger their homemaker and senior center agencies, and are just thankful to be receiving whatever hours they get.

• Direct reduction in services by prohibiting the homemaker from attending recipients outside the home, unless it is for a doctor appointment, grocery shopping, outpatient care, or to go to a laundry facility.  This greatly restricts recipients, who need assistance with personal bodily functions, mobility, etc.  It prevents them from being actively involved in their community, especially if they must rely on their homemaker to assist them while away from their home.  Many recipients do not have strong informal support, and cannot rely on their neighbor or church member to be available to attend to them while out in the public. 

• Direct reduction in services caused by capping Case Management Agency hours to just 4 hours per month.  Many pre-authorization requests are being denied, and this is causing a direct reduction in services that some recipients would otherwise receive.

• Direct reduction in monitoring of homemaker and senior center agencies, thereby reducing quality assurance by not allowing Case Management Agency to monitor homemaker services being provided to the client.

• Direct reduction in quality assurance by removal of case management social worker and case management registered nurse, who would visit the recipient as a "team approach" to ensure clients' social and medical needs were being met.

• Direct reduction in visits by a registered nurse to just two visits per year.

• Direct reduction in training required to be a homemaker before entering the home, from a total of 32 hours per year to only 8 hours basic training, which can be waived with a letter of reference.   Recipients have the right to know that the worker performing the duty is not fully trained, and that DHHR is allowing them to work under those conditions, and giving the agency a full year to complete the training. This is a quality assurance problem. 

• Direct reduction in chore provider services - new limit is 360 hours per year, whereas before there was no limit (but Consultec capped it at 730 hours per year, or the bill would be spit back at the agency requesting)

• Change in procedure as to how the chore provider is to be paid, as they are no longer paid by the Case Management Agency, but must file for a Medicaid Provider Number and bill Medicaid directly for services.  Recipients need to know why their chore provider may decide not to work for them anymore.  Chore Providers still have not received the information on how to do this, nor have they been notified of the changes by DHHR.  The policy has already been implemented, was supposed to have been implemented on December 1, 2001, and Chore Providers still are not aware of these new policy changes and neither are recipients. 

• Direct reduction in quality assurance due to change in procedure for monitoring Chore Provider Service.  This is a definite quality assurance problem, since CMAs will not be privy to time worked as all billing information is sent direct to the state.

•  

2/7/02 Paul Nusbaum letter to Senator Jon Blair Hunter, in response to his questions and comments about the letter from Dawna and David Smith. Click here to View Page one.  View Page Two. 

Smith's response to Mr. Nusbaum's letter (above), a copy of which was provided to all Senators and Delegates on the Health and Human Resources and Finance Committees.  Included in the letter is request for ventilator services and additional funding for Aged Disabled Waiver to help improve community based services to facilitate integrating nursing home residents back into the community.

    Just a note:    He's incorrect regarding "During December and January,  comments on the new policy were solicited, the program manual was modified, and provider training on the change was offered regionally throughout the state."  The cutoff date was December 15, 2001, and the printed policy of 2/1/02 showed no evidence that any of the comments or suggestions were heeded or incorporated.  Vicki Shaffer was one of the recipients who suffered from false information being relayed to her that the comment period had been extended to 2/1/02, and her subsequent email to her notification list brought an angry response from Secretary Paul Nusbaum.  

To see an example of a Senior Center Agency sending incorrect information to their waiver clients regarding the 2/1/02 policy changes, click here.  DHHR has been notified of this letter, but we wonder how many others have been sent, and have they made agencies who send wrong information rescind their comments?

Posted Date:  2/13/02

2/13/02 Dawna and David Smith's request for Emergency Meeting with DHHR regarding new policy affecting recipients, and requesting that Paul Nusbaum, Nancy Atkins, Ann Stottlemyer, Steve Mullins, and Chuck Conroy be in attendance to help ".....simplify and expedite the process by having all the above persons in attendance, so we may resolve at least some of the immediate issues facing recipients". 

2/10/02 Dawna Smith's request for Interim Study regarding the aged/disabled waiver policy issues sent to Delegate Boggs and Delegate Leach.

2/7/02 Dawna Smith's letter to Nancy Atkins regarding letter DHHR is  sending to recipients to notify them of policy changes....part of the letter includes this comment "We and Ruth were privy to a comment made by the Harrison County nurse during the1/14/02 training where she said “…if they don’t like the hours, they can stick it where the sun don’t shine”.  What a lovely sentiment from an RN who is the one actually visiting the sick and elderly and assessing their needs and determining their hours." The letter went out without any input from recipients, and failed to include needed wording regarding flexible hours now being available to recipients.

2/7/02 Dawna Smith's response to 2/2/02 letter from Paul Nusbaum.

2/1/02 Paul Nusbaum letter to Dawna and David Smith in response to a letter he received from Senator Minear regarding our "concerns".  Although we had met with Paul Nusbaum, Nancy Atkins, and  Phil Lynch on January 4, 2002, and he had been apprised personally of our "concerns", I responded to his letter (see above). 

2/6/02 Dawna Smith's letter to President Earl Ray Tomblin and Speaker Robert Kiss (Senate and  House, respectively) requesting money from Tobacco Settlement for elderly and disabled and ventilator services.

2/2/02 Dawna Smith's letter to Delegate Leach, updating her on major problems occurring since implementation of Aged/Disabled Waiver policy.

Posted Date:  1/31/2002

This is a general update regarding our visit to the Capitol on 1/28, 1/29, and 1/30.  We had the pleasure to spend Monday and Tuesday with ADAPT members Ken Ervin and Vicki Shaffer, as well as Karen Davis.  We "made" the newspaper, with an article in the Charleston Daily Mail on 1/29/02, and Vicki and Ken did a radio interview in the Governor's Reception Room, right after he finished a press conference.  Here is a link to the article from the Charleston Daily Mail.  

Posted Date:  1/28/2002

1/28/02 Letter with HCBS Primer to Governor and Legislative members of the Health and Human Resources and Finance Committees, requesting they review the Primer we received from US Health and Human Services, which explains what the states can and can't do regarding Medicaid Waivers.  Also, includes article regarding high percentage of disabled population in West Virginia.  The letter explains how we have "banded together" and created this site to help keep constituents informed promptly and efficiently, and that we have included a survey form which also asks the question "Do you know who your State Delegate or Senator is?".

Posted Date:  1/26/2002

1/18/02 Letter to President Bush requesting meeting as it relates to the needs of the elderly and disabled, as well as caregivers in the state of West Virginia.  Attached to our letter to President Bush, is the article about .....

"W.Va. leads nation in number of disabled

CHARLESTON (AP) -- Nearly one quarter of West Virginians have some type of disability, a rate that leads the nation, a new census survey shows.

1/6/02 Vicki Shaffer statement regarding being her own case manager and dealing with aged disabled waiver problems.

Posted Date:1/20/2002

1999 A/D Waiver Policy Manual as pulled from DHHR Website, cost effective formula cap for A/D Waiver has been $1,565 since 1995.

2001 MRDD Waiver Policy Manual in PDF format, as pulled from DHHR Website.  This policy contains more services available to its clients than AD Waiver, including Adult Companion, Respite Care and more.  MRDD cost effective formula cap is $6,400.

Comparisons between New AD Waiver policy dated February 1, 2002, and 1999 Waiver policy, and the adverse affects of new policy.  Note:  Case Management Agency Advocacy section has been deleted.  Microsoft Word format.

Letter to Congresswoman Shelley Moore Capito dated January 18, 2002.  Microsoft Word document.

Legislative Oversight Committee for Health and Human Resources (LOCHHRA) information presented on January 7, 2002, by David and Dawna Smith. Includes Disparity Comparison between MRDD Waiver cap and recipients served on A/D Waiver. Microsoft Word format.

Letter to Legislators dated December 17, 2001, from David and Dawna Smith.  Microsoft Word format. 

Letter to Commissioner Nancy Atkins on December 14, 2001, requesting extension of time for submitting comments and suggestions, as well a request for specific information.  We have not received any of the items requested, except for the state plan which we personally went to Charleston to pick up the day after Christmas.  Microsoft Word format.

Helpful Links and phone numbers.  Need to reach DHHR, Secretary of the State, and other government departments...call (888)438-2731 and ask them to transfer you to where you want to go.  To reach your Senator or Delegate, during the legislative session, call (877)565-3447.

Estate Recovery? Find out if you are or could be subject to Estate Recovery. Get the facts NOW so you can plan for your long term care needs.  Service is FREE. DHHR refers calls to (304)342-1604 x21 Rick Levock with the Public Consulting Group.  If you don't get the help you need from Rick, CALL US!!

ADAPT - Check out the "What's New" section, which includes how to file an Olmstead Complaint, notes on various meetings ADAPT has had with Secretary Nusbaum's office and the Governor's office, as well as ensuring taxi cabs pick up the disabled and not leave them stranded!  ADAPT is on TOP of things and a wonderful resource....be sure to let them know!

Medicaid Work Incentive Network project. The purpose is to improve services and policies that support the employment of persons with disabilities. The project will provide work incentive information, implement personal assistance services in the workplace and create a cost-sharing Buy-In that helps individuals obtain and retain work while maintaining their Medicaid coverage.

Transitioning to Inclusive Communities (TIC) is a nursing facilities transition project. TIC is a statewide collaborative project to assist persons with disabilities or those in need of long-term care, to make informed decisions about their living choices.

U.S. Senator Jay Rockefeller's efforts to help the disabled and elderly 

Centers for Medicare & Medicaid Services - The State of West Virginia submits to CMS its five year plan and renewals regarding Medicaid waivers, and cost neutrality.  Should you experience any problems with your Medicaid Provider (i.e. homemaker, senior center, or case management agency), you can contact Ronna Bach, CMS, at (215)861-4223 or fax her at (215)861-4280.

Know Your Civil Rights - Office of Civil Rights at US Health and Human Services.

West Virginia Legislature contact information.  Use this to find your Senator or Delegate's address, phone, and email.

Congresswoman Shelley Moore Capito.  This is her website, and includes current legislative information, as well as contact information.

West Virginia Budget Information

US Department of Health and Human Services - information guide to various departments - EXCELLENT source of information

WV Department of Health and Human Resources - to find Bureau of Medical Services, click on "medical services" link.

WV Bureau of Senior Services

WV Provider Agencies for Aged and Disabled Medicaid Waiver - This is a listing of all the area agencies on aging, community care/personal care, long-term care ombudsmen, senior employment, legal services, homemaker, county senior center, and case management agencies.