What we call recipients of Mi Via Services: Participants
Mi Via participants get Mi Via Consultant Services from AAA Participant Direction
The Mi Via program is managed by the Department of Health (DOH)/Developmental Disabilities Support Division (DDSD). AAAPD has a service agreement with DDSD to provide Mi Via Consultant services. We are considered a Mi Via Consultant Agency.
Participant registers on the waiting list for the Developmental Disabilities Waiver (DDW ) or the Medically Fragile Waiver (MFW). They must have an intellectual/ developmental disability or be medically fragile.
When a waiver slot becomes available, the participant receives an allocation letter to the Developmental Disabilities Waiver (DDW) or the Medically Fragile Waiver (MFW). They select Mi Via at this time, instead of the DDW or MFW.
Participant gets a list of Mi Via Consultant Agencies from DDSD and selects one using the Primary Freedom of Choice Form (PFOC). DDSD sends the PFOC to AAAPD. That is how the participant selects AAAPD.
Participant completes the financial eligibility process through the Income Support Division (ISD)/HSD.
Participant completes medical eligibility by submitting the Abstract and History & Physical (H&P) forms completed with their doctor and completing an in-home assessment. This information goes to the Third Party Assessor (TPA), which is Qualis. Qualis decides if participant is medically eligible. This is also referred to as Level of Care (LOC).
Upon receiving LOC approval, the participant receives an Individual Budget Allocation (IBA) as per a rate schedule based on age. This is the budget amount they have to use to purchase their supports, goods, and services.
Participant meets with their Mi Via Consultant for enrollment with AAAPD and orientation to Mi Via.
Participant decides who will be the Employer of Record (EOR). It is usually the participant. A participant that has a guardian cannot be the EOR. Consultant helps participant complete an Employer of Record (EOR) Request Form and sign all necessary forms.
Participant completes a Mi Via Services & Support Plan (SSP) using person-centered planning. The consultant enters the SSP into FOCOSonline.
Participant and consultant, using information from the SSP and following the description of Mi Via services and the range of rates for services, develop the Plan/Budget. The consultant enters the Plan/Budget into FOCOS. Once the participant approves of the SSP and Plan/Budget as the consultant entered it, the consultant submits it to Qualis, the TPA, for approval.
The participant completes an Emergency/Back-up Plan which is part of their SSP. They initial the Emergency/Back-up Acknowledgement Form and keep a copy.
The participant can submit a Plan/Budget that exceeds their IBA. However, the participant must meet the criteria for additional funding to get the increase in their budget. They have to get professional health care providers to document how the participant’s needs cannot be met within their IBA.
Qualis approves or denies each service, support or good that the participant has requested. They can also issue a Request for Additional Information (RFI) before they decide to approve or deny an item. The consultant helps the participant respond to the RFI from Qualis. After Qualis receives and reviews the RFI information, they will approve or deny the item. Qualis sends out an approval/partial approval letter to the participant and the consultant.
The participant has options if they don’t feel that the TPA should deny an item:
- Provide additional information for why the denied item is necessary for reconsideration;
- Request a Medicaid Fair Hearing to determine if the denial will hold or be overturned;
- Prior to the Medicaid Fair Hearing, the participant can have an Agency Conference with all parties to understand the TPA’s decision and maybe come to a resolution.
The consultant contacts the participant monthly and visits the participant quarterly to track how the implementation of the SSP/Plan is going.
Once the SSP/Plan is approved, the participant/EOR implements the SSP/Plan with the support of the Financial Management Agency (FMA), which is Conduent. The participant will complete Employee Enrollment Packets and Vendor Enrollment Packets and submit to Conduent. To get employees paid, the participant/EOR submits timesheets and Payment Request Forms (PRF) to Conduent for payment. The consultant educates, guides and assists the participant to implement their SSP/Plan.