What is the EDCD waiver and how does it work?
Mar 30, 2017 · The EDCD Waiver got its start in Virginia in 2005, merging two existing waivers; Eligible individuals must meet the nursing facility eligibility criteria; EDCD service may be used while on a wait list for other waivers ( one must meet criteria for both waivers); and. EDCD offers two methods of service delivery 1) agency-directed and 2) consumer ...
What is the CCC plus Medicaid waiver?
The EDCD Waiver got its start in Virginia in 2005, merging two existing waivers. It’s designed to prevent nursing home placement by providing significant care in the applicant’s home. The EDCD Waiver provides services that help individuals live in their own home or community instead of a nursing home. It is available to individuals 65 years ...
What is a Medicaid waiver?
Elderly or Disabled with Consumer Direction Waiver (EDCD) Government program offers financial assistance to qualifying individuals to help pay for services including: – In-home care. – Adult day health care. – Respite.
What waivers are available for people with disabilities?
Dec 01, 2021 · EDI support furnished by Medicare contractors. The information in this section is intended for the use of health care providers, clearinghouses and billing services that submit transactions to or receive transactions from Medicare fee-for-service contractors. EDI is the automated transfer of data in a specific format following specific data ...
Waiver Description
The Virginia Elderly and Disabled Medicaid Waiver provides community-based care services to nursing home eligible seniors who choose to live in their own homes or with family members.
Eligibility Guidelines
While open to disabled adults of any age, this program is primarily targeted towards those 65 and older. It is not necessary for these individuals to be completely disabled; however, they must require the level of care provided in nursing homes.
Benefits and Services
This waiver is intended to prevent persons from moving into nursing homes. The available services are selected to maximize their ability to age in place in their homes. While services are determined specifically for each applicant, they may include:
What is an ID waiver?
The Intellectual Disability (ID) waiver serves people of all ages. The Alzheimers Assisted Living Waiver (AAL) serves people of all ages. The Elderly or Disabled with Consumer Direction (EDCD) waiver serves people of all ages. The Technology Assisted (Tech) waiver serves people of all ages.
What is intellectual disability?
Intellectual disability is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates before the age of 18.
What is Medicaid waiver?
Medicaid Waivers help provide services to people who would otherwise be in a nursing home or hospital to receive long-term care in the community. Although there are waivers for many conditions, our focus is towards waivers for people who have intellectual disabilities, developmental disabilities, and autism. SEE ELDERLY / SENIOR CARE WAIVERS.
Which states have autism waivers?
Waivers For Autism. Colorado, Indiana, Maryland, and Wisconsin have waivers specifically addressing autism. They all limit waiver services to children. The first three states' waivers are only for children with autism.
What is HCBS in Medicaid?
The 1915 (c) waiver is known as the “home and community-based services waiver” (HCBS) because it allows states to treat certain Medicaid populations in home or other community based settings rather than in institutional or long-term care facilities such as hospitals or nursing homes.
Does Wisconsin have autism?
Wisconsin provides intensive in-home autism treatment under two broader waivers, one for children with DD and the other for children with social and emotional disorders. In Indiana and Wisconsin, children eligible for autism-specific services are also eligible for services under other Medicaid waivers.
What is the call for Part D?
The beneficiary or physician can call the Part D Plan to discuss what the cost sharing and allowable charges would be for the vaccine as part of the plan’s out-of-network access or inquire as to the availability of any alternative vaccine access options. Plan contact information is available at
What is a Part D plan?
Part D plans are required to provide access to vaccines not covered under Part B. During rulemaking, CMS described use of standard out-of-network requirements to ensure adequate access to the small number of vaccines covered under Part D that must be administered in a physician’s office. CMS’ approach was based on the fact that most vaccines of interest for the Medicare population (influenza, pneumococcal, and hepatitis B for intermediate and high risk patients) were covered and remain covered under Part B. Under the out-of-network process, the beneficiary pays the physician and then submits a paper claim to his or her Part D plan for reimbursement up to the plan’s allowable charge. As there likely would be no communication with the plan prior to vaccine administration, the amount the physician charges may be different from the plan’s allowable charge, and a differential may remain that the beneficiary would be responsible for paying. As newer vaccines have entered the market with indications for use in the Medicare population, Part D vaccine in-network access has become more imperative. Requiring the beneficiary to pay the physician’s full charge for a vaccine out of pocket first and be reimbursed by the plan later is not an optimal solution, and CMS has urged Part D plans to implement cost-effective, real time billing options at the time of administration. With consideration to improve access to vaccines under the Drug Benefit without requiring up-front beneficiary payment, in May 2006, CMS issued guidance to Part D sponsors to investigate alternative approaches to ensure adequate access to Part D vaccines. CMS emphasized a solution incorporating real-time processing, given that cost sharing under Part D for non-full subsidy beneficiaries can differ depending upon where the beneficiary is in the benefit (e.g., deductible, coverage gap, and catastrophic range). CMS has outlined the following options to Part D sponsors for their consideration in a letter dated 12/1/06. (See
Is a 351 a part D?
Any vaccine licensed under section 351 of the Public Health Service Act is available for payment under the Part D benefit when it is not available for payment under Medicare Part B (as so prescribed and dispensed or administered). Unlike other Part D Drugs that may be excluded when not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, Part D vaccines may be excluded from coverage only when their administration is not reasonable and necessary for the prevention of illness. Therefore, although a Part D plan’s formulary might not list all Part D vaccines, the beneficiary must be provided access to such vaccines when the physician prescribes them for an appropriate indication reasonable and necessary to prevent illness in the beneficiary.
