Purpose

• To modify how disability waiver services are paid and authorized, align inflation-related changes with the waiver program, and make conforming changes to several state statutes. The goal is to better control costs while ensuring services match a recipient’s needs and approved waiver requirements.

Main Provisions

• Service screening and authorization
  • Recipients must be screened and authorized for services using the federally approved waiver application and any amendments.
  • Lead agency supervisors must review and accept all service agreements entered into the Medicaid management information system (MMIS) before the state commissioner approves the agreement.
• Oversight of large increases in service funding
  • If a proposed service agreement would raise the total authorized amount beyond the recipient’s prior level by more than the value of legislatively enacted rate increases, the commissioner must manually review and approve the agreement.
  • A prior service agreement means the agreement that was in effect 12 months before the start date of the new proposed agreement.
• Information required for approved service agreements
  • Lead agencies must submit detailed information for all service agreements subject to approval, including:
  • Changes in the number of units
  • New services added
  • Changes in the calculations used to determine service rates (with certain automatic adjustments excluded)
  • Changes in the person’s level of need that require more services
  • Documentation showing why the previous service level was not sufficient
  • The anticipated impact if total funding is not increased
• Conditions on approving service agreements
  • Except for certain rate increase adjustments and legislated rate changes, the commissioner may not approve a service agreement unless there is documented evidence of a change in the person’s needs or proof that the previous service level was insufficient.
• Expiration tied to waiver redesign
  • This stricter review and approval framework expires when the statewide “waiver reimagine” program is fully implemented. The commissioner must inform the state’s Revisor of Statutes when waiver reimagine is fully in place.

Significant Changes to Existing Law

• Tightened controls on increasing service funding for disability waivers:
  • Requires manual approval for large increases, increasing state oversight.
  • Adds formal documentation requirements before approvals.
  • Requires lead agencies to justify changes with evidence of need and impact.
• Strengthened alignment with the federally approved waiver application process:
  • Integrates the MMIS review step and lead agency oversight into the approval process.
• Link to waiver reform timing:
  • Places the new rules on a timeline connected to the broader “waiver reimagine” effort, with a cutoff once that reform is fully implemented.

Implementation Details and Context

• Lead agencies and the MMIS play central roles in authorizing services and tracking changes.
• The changes apply to the disability waiver rate system and related sections cited in the bill, with specific references to rate calculations and inflationary adjustments.
• Some provisions are temporary and tied to the progress of the waiver reimagine project, creating an endpoint once that reform is completed.

Potential Impacts

• For recipients: services may be more carefully matched to assessed needs, with added documentation; possible delays if approvals take longer.
• For providers: greater scrutiny of service expansions and rate changes; requirements to submit detailed justifications and data.
• For the state: tighter control of waiver costs and alignment with federal waiver requirements and reform efforts.

Relevant Terms - disability waiver - services - service agreements - lead agency - MMIS (Medicaid management information system) - federally approved waiver application - level of need - units - total authorized amount - prior service agreement - rate increases - rate calculation values - 256B.4914 (inflationary adjustments and rate rules) - manual review/approval - documentation - waiver reimagine - Revisor of Statutes - authorized services - new services - anticipated impact