What is the case manager's role in meeting the administrative authority assurance?
Although you do not have a direct role in meeting this assurance, your documentation has a direct impact on meeting this assurance:
- Rules and policies that define what you can do as a case manager under the HCBS waiver are developed by your state Medicaid agency. You may be asked to use standardized approaches for documenting your work. This makes it easier for your state Medicaid Agency or operating agency to monitor performance across the entire HCBS waiver program. Onsite reviews may be conducted by your state Medicaid Agency to see firsthand how the HCBS waiver is working and your agency’s compliance with policies and contracts.
- One of your participants may be involved in a hearing to appeal a decision made by your agency. Holding administrative hearings is one way that the state Medicaid Agency retains final responsibility for decisions made under the HCBS waiver.
No matter how the HCBS waiver program is organized in your state, all roads lead back to the state Medicaid Agency. In the following reflection exercise, you are asked to identify the channels through which your work connects to that final authority.
