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Assurance 6 - Administrative Authority

The state Medicaid Agency is fully accountable for HCBS waiver design, operations and performance.

What are the requirements of this HCBS waiver assurance?

A state must structure its HCBS waiver so that the state Medicaid Agency retains authority over HCBS waiver decisions and oversight, even if the administration and operation of the HCBS waiver is decentralized to other state agencies or non-state entities. Whenever HCBS waiver functions are performed by entities other than the state Medicaid Agency, certain requirements must be met.

  • A state Medicaid Agency may delegate the day-to-day operations of an HCBS waiver to another state agency (known as the “operating agency”). In these cases, a written agreement must be in place specifying the activities and functions to be performed and the methods by which the state Medicaid Agency will provide supervision and oversight.

  • If the state Medicaid Agency or operating agency is going to delegate any administrative or operational functions to a local/regional non-state entity, they must develop a written agreement/contract to clearly specify the activities that they are authorized to perform, the policies governing those activities, and the methods by which the state Medicaid Agency will monitor performance.

  • A state must assure that there is consistent, uniform administration and operation of the HCBS waiver across all geographic areas.
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