IRC’s Medicaid Waiver Team Wraps-up Successful Audits

Aderonke AdejuyigbeBlog

The Medicaid Waiver (Med Waiver) team is currently on cloud nine! The department just finished hosting auditors from the Department of Developmental Services (DDS) and the Department of Health Care Services (DHCS). Accolades were given to Inland Regional Center (IRC) for an outstanding review process.  Auditors also expressed appreciation for the team’s important work with the Home and Community-Based Services (HCBS) Waiver program. This program contributes to the $1.3 billion in federal funding the state receives, part of which pay for client services. IRC’s Med Waiver program contributes more than $11 million a month in federal revenue to California’s 21 Regional Centers’ operations budgets.

The Med Waiver team would like to thank the IRC departments who were actively involved in the audit including Case Control, Case Management, Consumer Support Technician IIIs, Clinical Services, Quality Assurance, and Revenue. Med Waiver would also like to recognize consumers, families, vendors, and everyone who helped with the audit process for being flexible and available to meet with the auditors. This collaboration helped facilitate an outstanding audit!

What is HCBS Medicaid Waiver?

The Home and Community Based Services Waiver is a federal program that provides funds for each state to offer community-based services to people with developmental disabilities. California receives federal funds to support this program. It allows regional center clients to live and thrive in their communities, rather than large institutional settings.

IRC’s Med Waiver team implements the HCBS program under the guidance of DDS and DHCS. This program helps our clients by bringing in federal funds to IRC, based on eligibility and enrollment in the program. IRC implements multiple waiver programs as well as the Pre-admission Screening and Resident Review program.  Currently, IRC has over 15, 400 enrollees in the 1915(c) and 1915(i) waiver programs.  These numbers change monthly based on continued eligibility or identifying of new enrollees. Increasing the number of IRC clients who are enrolled in the MW programs helps to increase federal revenue into for California Regional Centers. These funds are used to develop and enhance programs and services that support the independence, inclusion, and empowerment of our clients!

How often do Medicaid Waiver audits take place and what is audited?

DDS and DHCS conduct an audit every two years, or more often if needed, of each regional center. These agencies ensure appropriate implementation of Medicaid Waivers, the Pre-admission Screening and Resident Review, and Title XIX benefit plan.  Every two years, IRC also participates in the Payment Error Rate Measurement review conducted by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services during which only consumer records are reviewed.

All these programs are Federally aided, state-operated, and administered. The audits of these programs consist of records reviews and interviews with staff, clients, families, and service providers. The audit also includes visits to client homes and residential facilities.

Who is IRC’s Medicaid Waiver Team?

IRC’s Med Waiver team is made up of 26 employees: a Program Manager, 10 administrative staff, 14 Qualified Intellectual Disabilities Professionals (QIDPs), and a 1915(i) Waiver Coordinator.  Seven of our QIDPs are Registered Nurses allowing them to evaluate clinical records and assist staff in to understanding our client’s medical needs. The team’s diligent administrative staff collect required records and documents for hundreds of clients each month. The QIDPs then complete a thorough review of each case, identifying conditions, services, and other information, to help ensure the well-being of our clients. QIDPs review over 2,000 cases per month!

The Medicaid Waiver team celebrate a successful audit season, and the holidays, last December.

 

This blog was a joint effort by Dr. Aderonke Adejuyigbe and her esteemed Medicaid Waiver Team.

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Aderonke Adejuyigbe

Dr. Aderonke Adejuyigbe is the Program Manager for IRC’s Medicaid Waiver Department. The “Med Waiver” team as it is affectionately known collaborates with various government organizations, IRC departments, and community partners to ensure precise implementation of the Medicaid Waiver program. A woman of many passions and talents, outside of work you can find Aderonke participating in family and church activities, working on a wide array of philanthropic endeavors, cycling, and traveling!

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