If someone needs to adjust the cost plan because of the tier cap, what is the procedure to change to a service they do not currently have?
• Each individual will work with their waiver support coordinator to identify services on the cost plan. This information will then be shared with the appropriate area office and a new cost plan devised. If the plan contains new services, the cost plan will have to be reviewed by the PSA contractor for medical necessity. Each area office will have procedures for processing cost plan changes that they can share with individuals, families, or waiver support coordinators. • APD does not have a firm date for notification of a persons tier assignment due to the current rule challenge. This information will be shared when known. The WSCs will get information on tier assignments for people on their caseload. The tier assignment will also be in the enrollment file in ABC. Each individual will receive the required 30 day notice prior to the effective date of the tier assignment.
• Each individual will work with their waiver support coordinator to identify services on the cost plan. This information will then be shared with the appropriate area office and a new cost plan devised. If the plan contains new services, the cost plan will have to be reviewed by the PSA contractor for medical necessity. Each area office will have procedures for processing cost plan changes that they can share with individuals, families, or waiver support coordinators.
