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HCBA Solicitation for Application Public Notice

October 19, 2017

The Department of Health Care Services (DHCS) has released a Solicitation for Application (SFA), #17-10118, to invite eligible organizations to apply to become Waiver Agencies under the Home and Community-Based Alternatives (HCBA) Waiver, previously known as the Nursing Facility/Acute Hospital (NF/AH) Waiver. The HCBA Waiver provides Comprehensive Care Management (CCM) and Home and Community-Based Services (HCBS) and support to eligible Medi-Cal recipients who would otherwise receive care in a long term care facility. The primary goal of the HCBA Waiver is to support Medi-Cal recipients' choice to return to/remain in the community setting of their choice by providing them with HCBS that include, but are not limited to, private duty nursing, case management and Waiver Personal Care Services (WPCS). The HCBA Waiver shifts waiver administration and CCM responsibilities from the state to selected Waiver Agencies at the local level, and is expected to improve participant access to waiver services, enhance care management and improve statewide quality control.

Current HCBS providers interested in expanding their business models are encouraged to submit an application in response to this SFA. Organizations that are selected to become Waiver Agencies will contract with DHCS, and will receive two per member, per month (PMPM) payments to perform waiver administrative functions and provide the CCM Waiver services. All direct services will be reimbursed through the Waiver Agency via the DHCS Fiscal Intermediary (FI). At the end of each month, DHCS will pay the Contractor $186.56 per member for the administration of the waiver program at the local level. Contractors will also receive a tiered PMPM payment for the provision of CCM services to each waiver participant based on his or her Acuity Level.

Payments for CCM by Acuity Level are included in the following table:

Authorized Level of Acuity CCM PMPM
1 $33.51
2 $175.37
3 $374.63
4 $562.01

Waiver Agencies will be responsible for, but not limited to, reviewing person-centered Plans of Treatment (POT), establishing an adequate network of HCBA Waiver service providers, authorizing requests for services based on medical necessity, billing the Medi-Cal FI for all authorized services, reimbursing contracted home and community-based service providers within their service area, monitoring provider performance and ensuring the health and safety of participants receiving waiver services in the community.

The HCBA Waiver SFA requires applicants to demonstrate that they have the experience, organizational capacity and fiscal stability to meet minimum Waiver Agency qualifications and to meet the needs of participants within their proposed service area over the five-year term of the waiver.

For more information on the HCBA Waiver and the SFA, visit the HCBA Waiver page of the DHCS website. Should questions arise after reviewing the SFA, please email them to the HCBA Waiver Inbox at HCBAlternatives@dhcs.ca.gov and include “SFA #17-10118 – Question” in the subject line of the email.