Documentation

1915C Appendix B

(mdcd_1915c_appendix_b — waiver_version grain)

Variable	Description	Format
state	Two-letter state postal code.	char(2)
waiver_id	Waiver identifier.	varchar(16)
waiver_version_id	Waiver version identifier.	bigint unsigned
WVR_1634_STATE	§1634 State	0,1
WVR_209B_STATE	209(b) State	0,1
WVR_CST_LMT_ABV_INST	Cost Limit in Excess of Institutional Costs. The state refuses entrance to the waiver to any otherwise eligible individual when the state reasonably expects that the cost of the home and community-based services furnished to that individual would exceed the cost of a level of care specified for the waiver up to an amount specified by the state. Complete Items B-2-b and B-2-c	0,1
WVR_CST_LMT_ABV_INST_OTHR	Cost Limit in Excess of Institutional Costs - Other	0,1
WVR_CST_LMT_ABV_INST_OTHR_DESC	Cost Limit in Excess of Institutional Costs - Other -Specify	Text
WVR_CST_LMT_ABV_INST_PCT	Cost Limit in Excess of Institutional Costs - A level higher than 100% of the institutional average.	0,1
WVR_CST_LMT_ABV_INST_PCT_DESC	Cost Limit in Excess of Institutional Costs - A level higher than 100% of the institutional average - Specify the percentage	number
WVR_CST_LMT_NONE	No Cost Limit. The state does not apply an individual cost limit. Do not complete Item B-2-b or item B-2-c.	0,1
WVR_CST_LMT_SAME_INST	Institutional Cost Limit. Pursuant to 42 CFR 441.301(a)(3), the state refuses entrance to the waiver to any otherwise eligible individual when the state reasonably expects that the cost of the home and community-based services furnished to that individual would exceed 100% of the cost of the level of care specified for the waiver. Complete Items B-2-b and B-2-c.	0,1
WVR_CST_LMT_SFGRD_OTHR	Other safeguard(s)	0,1
WVR_CST_LMT_SFGRD_OTHR_DESC	Other safeguard(s) - Specify	Text
WVR_CST_LMT_SFGRD_OTHR_WVR	The participant is referred to another waiver that can accommodate the individual's needs.	0,1
WVR_CST_LMT_SFGRD_SRVC_RCVD	Additional services in excess of the individual cost limit may be authorized.	0,1
WVR_CST_LMT_SFGRD_SRVC_RCVD_DESC	Specify the procedures for authorizing additional services, including the amount that may be authorized:	Text
WVR_CST_LMT_UNDR_INST	Cost Limit Lower Than Institutional Costs. The state refuses entrance to the waiver to any otherwise qualified individual when the state reasonably expects that the cost of home and community-based services furnished to that individual would exceed the following amount specified by the state that is less than the cost of a level of care specified for the waiver.	0,1
WVR_CST_LMT_UNDR_INST_AMT	Cost Limit Lower Than Insitutional Costs - The following dollar amount	0,1
WVR_CST_LMT_UNDR_INST_AMT_CHNG	Cost Limit Lower Than Insitutional Costs -- The dollar amount is adjusted each year that the waiver is in effect by applying the following formula	0,1
WVR_CST_LMT_UNDR_INST_AMT_CHNG_1	Cost Limit Lower Than Insitutional Costs -- The dollar amount is adjusted each year that the waiver is in effect by applying the following formula - Specify the formula	Text
WVR_CST_LMT_UNDR_INST_AMT_CHNG_2	Cost Limit Lower Than Insitutional Costs -- May be adjusted during the period the waiver is in effect. The state will submit a waiver amendment to CMS to adjust the dollar amount.	0,1
WVR_CST_LMT_UNDR_INST_AMT_DESC	Cost Limit Lower Than Insitutional Costs - The following dollar amount - Specify dollar amount	number
WVR_CST_LMT_UNDR_INST_DESC	Cost Limit Lower Than Institutional Costs - Specify the basis of the limit, including evidence that the limit is sufficient to assure the health and welfare of waiver participants. Complete Items B-2-b and B-2-c.	Text
WVR_CST_LMT_UNDR_INST_OTHR	Cost Limit Lower Than Insitutional Costs - Other	0,1
WVR_CST_LMT_UNDR_INST_OTHR_DESC	Cost Limit Lower Than Insitutional Costs - Other - Specify	Text
WVR_CST_LMT_UNDR_INST_PCT	Cost Limit Lower Than Insitutional Costs - The following percentage that is less than 100% of the institutional average	0,1
WVR_CST_LMT_UNDR_INST_PCT_DESC	Cost Limit Lower Than Insitutional Costs - The following percentage that is less than 100% of the institutional average - Specify Percent	number
WVR_ELIG_ABD_209B	Aged, blind or disabled in 209(b) states who are eligible under 42 CFR §435.121	0,1
WVR_ELIG_CTGR_NDY	Optional categorically needy aged and/or disabled individuals who have income at:	0,1
WVR_ELIG_CTGR_NDY_FPL	Optional categorically needy aged and/or disabled individuals who have income at: 100% of the Federal poverty level (FPL)	0,1
WVR_ELIG_CTGR_NDY_FPL_PCT	Optional categorically needy aged and/or disabled individuals who have income at: % of FPL, which is lower than 100% of FPL -- Specify percentage.	number
WVR_ELIG_CTGR_NDY_UNDR_FPL	Optional categorically needy aged and/or disabled individuals who have income at: % of FPL, which is lower than 100% of FPL	0,1
WVR_ELIG_HCBS_300_SSI	A special income level equal to: 300% of the SSI Federal Benefit Rate (FBR)	0,1
WVR_ELIG_HCBS_ABD_SSI	Aged, blind, and disabled individuals who meet requirements that are more restrictive than the SSI program (42 CFR §435.121)	0,1
WVR_ELIG_HCBS_AD	Aged and disabled individuals who have income at:	0,1
WVR_ELIG_HCBS_AD_FPL	Aged and disabled individuals who have income at: 100% of FPL	0,1
WVR_ELIG_HCBS_AD_FPL_PCT	Aged and disabled individuals who have income at: % of FPL, which is lower than 100% -- Specify percentage amount	number
WVR_ELIG_HCBS_AD_UNDR_FPL	Aged and disabled individuals who have income at: % of FPL, which is lower than 100%.	0,1
WVR_ELIG_HCBS_ALL_GRPS	All individuals in the special home and community-based waiver group under 42 CFR §435.217	0,1
WVR_ELIG_HCBS_MDC_NDY_209B	Medically needy without spend down in 209(b) States (42 CFR §435.330)	0,1
WVR_ELIG_HCBS_MDC_NDY_SSI	Medically needy without spend down in states which also provide Medicaid to recipients of SSI (42 CFR §435.320, §435.322 and §435.324)	0,1
WVR_ELIG_HCBS_NO	No. The state does not furnish waiver services to individuals in the special home and community-based waiver group under 42 CFR §435.217. Appendix B-5 is not submitted.	0,1
WVR_ELIG_HCBS_ONLY_SME_GRPS	Only the following groups of individuals in the special home and community-based waiver group under 42 CFR §435.217	0,1
WVR_ELIG_HCBS_OTHR	Other specified groups (include only statutory/regulatory reference to reflect the additional groups in the state plan that may receive services under this waiver)	0,1
WVR_ELIG_HCBS_OTHR_DESC	Other specified groups (include only statutory/regulatory reference to reflect the additional groups in the state plan that may receive services under this waiver) -- Specify	Text
WVR_ELIG_HCBS_SPEC_INC_LVL	A special income level equal to:	0,1
WVR_ELIG_HCBS_SSI_AMT	A special income level equal to: A dollar amount which is lower than 300% -- Specify dollar amount.	number
WVR_ELIG_HCBS_SSI_PCT	A special income level equal to: A percentage of FBR, which is lower than 300% (42 CFR §435.236) -- Specify percentage	number
WVR_ELIG_HCBS_UNDR_300_SSI_AMT	A special income level equal to: A dollar amount which is lower than 300%.	0,1
WVR_ELIG_HCBS_UNDR_300_SSI_PCT	A special income level equal to: A percentage of FBR, which is lower than 300% (42 CFR §435.236)	0,1
WVR_ELIG_HCBS_YES	Yes. The state furnishes waiver services to individuals in the special home and community-based waiver group under 42 CFR §435.217.	0,1
WVR_ELIG_LOW_INC_W_CHILD	Low income families with children as provided in §1931 of the Act	0,1
WVR_ELIG_MDC_NDY_1634_SSI	Medically needy in 1634 States and SSI Criteria States (42 CFR §435.320, §435.322 and §435.324)	0,1
WVR_ELIG_MDC_NDY_209B	Medically needy in 209(b) States (42 CFR §435.330)	0,1
WVR_ELIG_OPT_ST_SPPLMNT	Optional state supplement recipients	0,1
WVR_ELIG_OTHR	Other specified groups (include only statutory/regulatory reference to reflect the additional groups in the state plan that may receive services under this waiver)	0,1
WVR_ELIG_OTHR_DESC	Other specified groups (include only statutory/regulatory reference to reflect the additional groups in the state plan that may receive services under this waiver) - Specify	Text
WVR_ELIG_SSI	SSI recipients	0,1
WVR_ELIG_U18_DSBLD_TEFRA	Disabled individuals age 18 or younger who would require an institutional level of care (TEFRA 134 eligibility group as provided in §1902(e)(3) of the Act)	0,1
WVR_ELIG_WKNG_DSBLD_BBA_XIII	Working individuals with disabilities who buy into Medicaid (BBA working disabled group as provided in §1902(a)(10)(A)(ii)(XIII)) of the Act)	0,1
WVR_ELIG_WKNG_DSBLD_TWWIIA_XV	Working individuals with disabilities who buy into Medicaid (TWWIIA Basic Coverage Group as provided in §1902(a)(10)(A)(ii)(XV) of the Act)	0,1
WVR_ELIG_WKNG_DSBLD_TWWIIA_XVI	Working individuals with disabilities who buy into Medicaid (TWWIIA Medical Improvement Coverage Group as provided in §1902(a)(10)(A)(ii)(XVI) of the Act)	0,1
WVR_LVLCARE_CRTRIA_DESC	Fully specify the level of care criteria that are used to evaluate and reevaluatewhether an individual needs services through the waiver and that serve as the basis of the state’s level ofcare instrument/tool. Specify the level of care instrument/tool that is employed. State laws, regulations,and policies concerning level of care criteria and the level of care instrument/tool are available to CMSupon request through the Medicaid agency or the operating agency (if applicable), including theinstrument/tool utilized.	Text
WVR_MAX_PTCPNTS_NO	The state does not limit the number of participants that it serves at any point in time during a waiver year.	0,1
WVR_MAX_PTCPNTS_YES	The state limits the number of participants that it serves at any point in time during a waiver year.	0,1
WVR_MAX_PTCPNTS_YR1	Waiver Year 1 - Maximum Number of Participants Served At Any Point During the Year	number
WVR_MAX_PTCPNTS_YR2	Waiver Year 2 - Maximum Number of Participants Served At Any Point During the Year	number
WVR_MAX_PTCPNTS_YR3	Waiver Year 3 - Maximum Number of Participants Served At Any Point During the Year	number
WVR_MAX_PTCPNTS_YR4	Waiver Year 4 - Maximum Number of Participants Served At Any Point During the Year	number
WVR_MAX_PTCPNTS_YR5	Waiver Year 5 - Maximum Number of Participants Served At Any Point During the Year	number
WVR_MLLR_TRST_STATE_NO	Indicate whether the state is a Miller Trust State (select one): No	0,1
WVR_MLLR_TRST_STATE_YES	Indicate whether the state is a Miller Trust State (select one): Yes	0,1
WVR_NEED_SRVC_MIN_NUM	The minimum number of waiver services (one or more) that an individual must require in order to be determined to need waiver services is:	number
WVR_PETI_300_SSI		tinyint(1)
WVR_PETI_300_SSI_1	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons -- 300% of the SSI Federal Benefit Rate (FBR)	0,1
WVR_PETI_300_SSI_2	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons -- 300% of the SSI Federal Benefit Rate (FBR)	0,1
WVR_PETI_300_SSI_3	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons -- 300% of the SSI Federal Benefit Rate (FBR)	0,1
WVR_PETI_42CFR_1	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The following standard under 42 CFR §435.121	0,1
WVR_PETI_42CFR_2	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The following standard under 42 CFR §435.121	0,1
WVR_PETI_42CFR_3	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The following standard under 42 CFR §435.121	0,1
WVR_PETI_42CFR_DESC_1	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The following standard under 42 CFR §435.121 -- Specify:	Text
WVR_PETI_42CFR_DESC_2	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The following standard under 42 CFR §435.121 -- Specify:	Text
WVR_PETI_42CFR_DESC_3	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The following standard under 42 CFR §435.121 -- Specify:	Text
WVR_PETI_AMT		tinyint(1)
WVR_PETI_AMT_1	Allowance for the needs of the waiver participant -- The following dollar amount	0,1
WVR_PETI_AMT_2	Allowance for the needs of the waiver participant -- The following dollar amount	0,1
WVR_PETI_AMT_3	Allowance for the needs of the waiver participant -- The following dollar amount	0,1
WVR_PETI_AMT_DESC		text
WVR_PETI_AMT_FORM_1	Allowance for the needs of the waiver participant -- The following formula is used to determine the needs allowance	0,1
WVR_PETI_AMT_FORM_2	Allowance for the needs of the waiver participant -- The following formula is used to determine the needs allowance	0,1
WVR_PETI_AMT_FORM_3	Allowance for the needs of the waiver participant -- The following formula is used to determine the needs allowance	0,1
WVR_PETI_AMT_FORM_DESC_1	Allowance for the needs of the waiver participant -- The following formula is used to determine the needs allowance -- Specify:	Text
WVR_PETI_AMT_FORM_DESC_2	Allowance for the needs of the waiver participant -- The following formula is used to determine the needs allowance -- Specify:	Text
WVR_PETI_AMT_FORM_DESC_3	Allowance for the needs of the waiver participant -- The following formula is used to determine the needs allowance -- Specify:	Text
WVR_PETI_AMT_NMBR		decimal(18,6)
WVR_PETI_AMT_NMBR_1	Allowance for the needs of the waiver participant -- The following dollar amount -- Specify dollar amount:	number
WVR_PETI_AMT_NMBR_2	Allowance for the needs of the waiver participant -- The following dollar amount -- Specify dollar amount:	number
WVR_PETI_AMT_NMBR_3	Allowance for the needs of the waiver participant -- The following dollar amount -- Specify dollar amount:	number
WVR_PETI_DESC		text
WVR_PETI_FMLY_AFDC		tinyint(1)
WVR_PETI_FMLY_AFDC_1	Allowance for the family (select one) -- AFDC need standard	0,1
WVR_PETI_FMLY_AFDC_2	Allowance for the family (select one) -- AFDC need standard	0,1
WVR_PETI_FMLY_AFDC_3	Allowance for the family (select one) -- AFDC need standard	0,1
WVR_PETI_FMLY_AMT		tinyint(1)
WVR_PETI_FMLY_AMT_1	Allowance for the family (select one) -- The following dollar amount:	0,1
WVR_PETI_FMLY_AMT_2	Allowance for the family (select one) -- The following dollar amount:	0,1
WVR_PETI_FMLY_AMT_3	Allowance for the family (select one) -- The following dollar amount:	0,1
WVR_PETI_FMLY_AMT_FORM_1	Allowance for the family (select one) -- The amount is determined using the following formula	0,1
WVR_PETI_FMLY_AMT_FORM_2	Allowance for the family (select one) -- The amount is determined using the following formula	0,1
WVR_PETI_FMLY_AMT_FORM_3	Allowance for the family (select one) -- The amount is determined using the following formula	0,1
WVR_PETI_FMLY_AMT_FORM_DESC_1	Allowance for the family (select one) -- The amount is determined using the following formula -- Specify:	Text
WVR_PETI_FMLY_AMT_FORM_DESC_2	Allowance for the family (select one) -- The amount is determined using the following formula -- Specify:	Text
WVR_PETI_FMLY_AMT_FORM_DESC_3	Allowance for the family (select one) -- The amount is determined using the following formula -- Specify:	Text
WVR_PETI_FMLY_AMT_NMBR		decimal(18,6)
WVR_PETI_FMLY_AMT_NMBR_1	Allowance for the family (select one) -- The following dollar amount -- Specify dollar amount:	number
WVR_PETI_FMLY_AMT_NMBR_2	Allowance for the family (select one) -- The following dollar amount -- Specify dollar amount:	number
WVR_PETI_FMLY_AMT_NMBR_3	Allowance for the family (select one) -- The following dollar amount -- Specify dollar amount:	number
WVR_PETI_FMLY_AMT_NMBR_DESC		text
WVR_PETI_FMLY_MDC_NDY		tinyint(1)
WVR_PETI_FMLY_MDC_NDY_1	Allowance for the family (select one) -- Medically needy income standard	0,1
WVR_PETI_FMLY_MDC_NDY_2	Allowance for the family (select one) -- Medically needy income standard	0,1
WVR_PETI_FMLY_MDC_NDY_3	Allowance for the family (select one) -- Medically needy income standard	0,1
WVR_PETI_FMLY_NA		tinyint(1)
WVR_PETI_FMLY_NA_1	Allowance for the family (select one) -- Not Applicable	0,1
WVR_PETI_FMLY_NA_2	Allowance for the family (select one) -- Not Applicable	0,1
WVR_PETI_FMLY_NA_3	Allowance for the family (select one) -- Not Applicable	0,1
WVR_PETI_FMLY_OTHR		tinyint(1)
WVR_PETI_FMLY_OTHR_1	Allowance for the family (select one) -- Other	0,1
WVR_PETI_FMLY_OTHR_2	Allowance for the family (select one) -- Other	0,1
WVR_PETI_FMLY_OTHR_3	Allowance for the family (select one) -- Other	0,1
WVR_PETI_FMLY_OTHR_DESC		text
WVR_PETI_FMLY_OTHR_DESC_1	Allowance for the family (select one) -- Other -- Specify	Text
WVR_PETI_FMLY_OTHR_DESC_2	Allowance for the family (select one) -- Other -- Specify	Text
WVR_PETI_FMLY_OTHR_DESC_3	Allowance for the family (select one) -- Other -- Specify	Text
WVR_PETI_FPL		tinyint(1)
WVR_PETI_FPL_1	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- A percentage of the Federal poverty level	0,1
WVR_PETI_FPL_2	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- A percentage of the Federal poverty level	0,1
WVR_PETI_FPL_3	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- A percentage of the Federal poverty level	0,1
WVR_PETI_FPL_PCT		decimal(18,6)
WVR_PETI_FPL_PCT_1	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- A percentage of the Federal poverty level -- Specify percentage:	number
WVR_PETI_FPL_PCT_2	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- A percentage of the Federal poverty level -- Specify percentage:	number
WVR_PETI_FPL_PCT_3	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- A percentage of the Federal poverty level -- Specify percentage:	number
WVR_PETI_IMPVRSH_AMT		tinyint(1)
WVR_PETI_IMPVRSH_AMT_2	Allowance for the personal needs of the waiver participant -- The following dollar amount	0,1
WVR_PETI_IMPVRSH_AMT_3	Allowance for the personal needs of the waiver participant -- The following dollar amount	0,1
WVR_PETI_IMPVRSH_AMT_DESC		text
WVR_PETI_IMPVRSH_AMT_FORM_2	Allowance for the personal needs of the waiver participant -- The following formula is used to determine the needs allowance	0,1
WVR_PETI_IMPVRSH_AMT_FORM_3	Allowance for the personal needs of the waiver participant -- The following formula is used to determine the needs allowance -- Specify formula:	0,1
WVR_PETI_IMPVRSH_AMT_FORM_DESC_2	Allowance for the personal needs of the waiver participant -- The following formula is used to determine the needs allowance -- Specify formula:	Text
WVR_PETI_IMPVRSH_AMT_FORM_DESC_3	Allowance for the personal needs of the waiver participant -- The following formula is used to determine the needs allowance -- Specify formula:	Text
WVR_PETI_IMPVRSH_AMT_NMBR		decimal(18,6)
WVR_PETI_IMPVRSH_AMT_NMBR_2	Allowance for the personal needs of the waiver participant -- The following dollar amount -- Specify dollar amount:	number
WVR_PETI_IMPVRSH_AMT_NMBR_3	Allowance for the personal needs of the waiver participant -- The following dollar amount -- Specify dollar amount:	number
WVR_PETI_IMPVRSH_DFRNT		tinyint(1)
WVR_PETI_IMPVRSH_DFRNT_2	The allowance for the personal needs of a waiver participant with a community spouse is different from the amount used for the individual's maintenance allowance under 42 CFR §435.726 or 42 CFR §435.735	0,1
WVR_PETI_IMPVRSH_DFRNT_3	The allowance for the personal needs of a waiver participant with a community spouse is different from the amount used for the individual's maintenance allowance under 42 CFR §435.726 or 42 CFR §435.735	0,1
WVR_PETI_IMPVRSH_DFRNT_DESC		text
WVR_PETI_IMPVRSH_DFRNT_DESC_2	The allowance for the personal needs of a waiver participant with a community spouse is different from the amount used for the individual's maintenance allowance under 42 CFR §435.726 or 42 CFR §435.735 -- Explanation of difference	Text
WVR_PETI_IMPVRSH_DFRNT_DESC_3	The allowance for the personal needs of a waiver participant with a community spouse is different from the amount used for the individual's maintenance allowance under 42 CFR §435.726 or 42 CFR §435.735 -- Explanation of difference	Text
WVR_PETI_IMPVRSH_MDC_EXP_LMT		tinyint(1)
WVR_PETI_IMPVRSH_MDC_EXP_LMT_2	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- The state uses the same reasonable limits as are used for regular (non-spousal) post-eligibility.	0,1
WVR_PETI_IMPVRSH_MDC_EXP_LMT_3	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- The state uses the same reasonable limits as are used for regular (non-spousal) post-eligibility.	0,1
WVR_PETI_IMPVRSH_MDC_EXP_NA		tinyint(1)
WVR_PETI_IMPVRSH_MDC_EXP_NA_2	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- Not Applicable	0,1
WVR_PETI_IMPVRSH_MDC_EXP_NA_3	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- Not Applicable	0,1
WVR_PETI_IMPVRSH_MDC_EXP_NOLMT_2	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- The state does not establish reasonable limits.	0,1
WVR_PETI_IMPVRSH_MDC_EXP_NOLMT_3	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- The state does not establish reasonable limits.	0,1
WVR_PETI_IMPVRSH_MDC_EXP_NO_LMT		tinyint(1)
WVR_PETI_IMPVRSH_MDC_NDY		tinyint(1)
WVR_PETI_IMPVRSH_MDC_NDY_2	Allowance for the personal needs of the waiver participant -- Medically needy income standard	0,1
WVR_PETI_IMPVRSH_MDC_NDY_3	Allowance for the personal needs of the waiver participant -- Medically needy income standard	0,1
WVR_PETI_IMPVRSH_OTHR		tinyint(1)
WVR_PETI_IMPVRSH_OTHR_2	Allowance for the personal needs of the waiver participant -- Other	0,1
WVR_PETI_IMPVRSH_OTHR_3	Allowance for the personal needs of the waiver participant -- Other	0,1
WVR_PETI_IMPVRSH_OTHR_DESC		text
WVR_PETI_IMPVRSH_OTHR_DESC_2	Allowance for the personal needs of the waiver participant -- Other -- Specify	Text
WVR_PETI_IMPVRSH_OTHR_DESC_3	Allowance for the personal needs of the waiver participant -- Other -- Specify	Text
WVR_PETI_IMPVRSH_PCT_2	Allowance for the personal needs of the waiver participant -- A percentage of the Federal poverty level	0,1
WVR_PETI_IMPVRSH_PCT_3	Allowance for the personal needs of the waiver participant -- A percentage of the Federal poverty level	0,1
WVR_PETI_IMPVRSH_PCT_NMBR_2	Allowance for the personal needs of the waiver participant -- A percentage of the Federal poverty level -- Specify percentage	number
WVR_PETI_IMPVRSH_PCT_NMBR_3	Allowance for the personal needs of the waiver participant -- A percentage of the Federal poverty level -- Specify percentage	number
WVR_PETI_IMPVRSH_SAME		tinyint(1)
WVR_PETI_IMPVRSH_SAME_2	The allowance for the personal needs of a waiver participant with a community spouse is the same as the amount used for the individual's maintenance allowance under 42 CFR §435.726 or 42 CFR §435.735	0,1
WVR_PETI_IMPVRSH_SAME_3	The allowance for the personal needs of a waiver participant with a community spouse is the same as the amount used for the individual's maintenance allowance under 42 CFR §435.726 or 42 CFR §435.735	0,1
WVR_PETI_IMPVRSH_SPEC_INC		tinyint(1)
WVR_PETI_IMPVRSH_SPEC_INC_2	Allowance for the personal needs of the waiver participant -- The special income level for institutionalized persons	0,1
WVR_PETI_IMPVRSH_SPEC_INC_3	Allowance for the personal needs of the waiver participant -- The special income level for institutionalized persons	0,1
WVR_PETI_IMPVRSH_SSI		tinyint(1)
WVR_PETI_IMPVRSH_SSI_2	Allowance for the personal needs of the waiver participant -- SSI Standard	0,1
WVR_PETI_IMPVRSH_SSI_3	Allowance for the personal needs of the waiver participant -- SSI Standard	0,1
WVR_PETI_IMPVRSH_SSI_PCT		decimal(18,6)
WVR_PETI_IMPVRSH_ST_SUPP		tinyint(1)
WVR_PETI_IMPVRSH_ST_SUPP_2	Allowance for the personal needs of the waiver participant -- Optional state supplement standard	0,1
WVR_PETI_IMPVRSH_ST_SUPP_3	Allowance for the personal needs of the waiver participant -- Optional state supplement standard	0,1
WVR_PETI_MDC_EXP_LMT		tinyint(1)
WVR_PETI_MDC_EXP_LMT_1	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- The state establishes the following reasonable limits	0,1
WVR_PETI_MDC_EXP_LMT_2	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- The state establishes the following reasonable limits	0,1
WVR_PETI_MDC_EXP_LMT_3	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- The state establishes the following reasonable limits	0,1
WVR_PETI_MDC_EXP_LMT_DESC		text
WVR_PETI_MDC_EXP_LMT_DESC_1	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- The state establishes the following reasonable limits -- Specify:	Text
WVR_PETI_MDC_EXP_LMT_DESC_2	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- The state establishes the following reasonable limits -- Specify:	Text
WVR_PETI_MDC_EXP_LMT_DESC_3	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- The state establishes the following reasonable limits -- Specify:	Text
WVR_PETI_MDC_EXP_NA		tinyint(1)
WVR_PETI_MDC_EXP_NA_1	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- Not Applicable	0,1
WVR_PETI_MDC_EXP_NA_2	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- Not Applicable	0,1
WVR_PETI_MDC_EXP_NA_3	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- Not Applicable	0,1
WVR_PETI_MDC_EXP_NOLMT_1	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- The state does not establish reasonable limits.	0,1
WVR_PETI_MDC_EXP_NOLMT_2	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- The state does not establish reasonable limits.	0,1
WVR_PETI_MDC_EXP_NOLMT_3	Amounts incurred for medical or remedial care expenses not subject to payment by a third party -- The state does not establish reasonable limits.	0,1
WVR_PETI_MDC_EXP_NO_LMT		tinyint(1)
WVR_PETI_MDC_NDY		tinyint(1)
WVR_PETI_MDC_NDY_1	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- Medically needy income standard	0,1
WVR_PETI_MDC_NDY_2	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- Medically needy income standard	0,1
WVR_PETI_MDC_NDY_3	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- Medically needy income standard	0,1
WVR_PETI_OPT_ST_SUPP		tinyint(1)
WVR_PETI_OPT_ST_SUPP_1	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- Optional state supplement standard	0,1
WVR_PETI_OPT_ST_SUPP_2	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- Optional state supplement standard	0,1
WVR_PETI_OPT_ST_SUPP_3	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- Optional state supplement standard	0,1
WVR_PETI_OTHR		tinyint(1)
WVR_PETI_OTHR_1	Allowance for the needs of the waiver participant -- Other	0,1
WVR_PETI_OTHR_2	Allowance for the needs of the waiver participant -- Other	0,1
WVR_PETI_OTHR_3	Allowance for the needs of the waiver participant -- Other	0,1
WVR_PETI_OTHR_DESC		text
WVR_PETI_OTHR_DESC_1	Allowance for the needs of the waiver participant -- Other -- Specify	Text
WVR_PETI_OTHR_DESC_2	Allowance for the needs of the waiver participant -- Other -- Specify	Text
WVR_PETI_OTHR_DESC_3	Allowance for the needs of the waiver participant -- Other -- Specify	Text
WVR_PETI_SPEC_INC_INSTLZD		tinyint(1)
WVR_PETI_SPEC_INC_INSTLZD_1	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons	0,1
WVR_PETI_SPEC_INC_INSTLZD_2	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons	0,1
WVR_PETI_SPEC_INC_INSTLZD_3	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons	0,1
WVR_PETI_SPSE_42CFR_1	Allowance for the spouse only (select one) -- The following standard under 42 CFR §435.121	0,1
WVR_PETI_SPSE_42CFR_2	Allowance for the spouse only (select one) -- The following standard under 42 CFR §435.121	0,1
WVR_PETI_SPSE_42CFR_3	Allowance for the spouse only (select one) -- The following standard under 42 CFR §435.121	0,1
WVR_PETI_SPSE_42CFR_DESC_1	Allowance for the spouse only (select one) -- The following standard under 42 CFR §435.121 -- Specify:	Text
WVR_PETI_SPSE_42CFR_DESC_2	Allowance for the spouse only (select one) -- The following standard under 42 CFR §435.121 -- Specify:	Text
WVR_PETI_SPSE_42CFR_DESC_3	Allowance for the spouse only (select one) -- The following standard under 42 CFR §435.121 -- Specify:	Text
WVR_PETI_SPSE_AMT		tinyint(1)
WVR_PETI_SPSE_AMT_1	Allowance for the spouse only (select one) -- The following dollar amount:	0,1
WVR_PETI_SPSE_AMT_2	Allowance for the spouse only (select one) -- The following dollar amount:	0,1
WVR_PETI_SPSE_AMT_3	Allowance for the spouse only (select one) -- The following dollar amount:	0,1
WVR_PETI_SPSE_AMT_DESC		text
WVR_PETI_SPSE_AMT_FORM_1	Allowance for the spouse only (select one) -- The amount is determined using the following formula	0,1
WVR_PETI_SPSE_AMT_FORM_2	Allowance for the spouse only (select one) -- The amount is determined using the following formula	0,1
WVR_PETI_SPSE_AMT_FORM_3	Allowance for the spouse only (select one) -- The amount is determined using the following formula	0,1
WVR_PETI_SPSE_AMT_FORM_DESC_1	Allowance for the spouse only (select one) -- The amount is determined using the following formula -- Specify:	Text
WVR_PETI_SPSE_AMT_FORM_DESC_2	Allowance for the spouse only (select one) -- The amount is determined using the following formula -- Specify:	Text
WVR_PETI_SPSE_AMT_FORM_DESC_3	Allowance for the spouse only (select one) -- The amount is determined using the following formula -- Specify:	Text
WVR_PETI_SPSE_AMT_NMBR		decimal(18,6)
WVR_PETI_SPSE_AMT_NMBR_1	Allowance for the spouse only (select one) -- The following dollar amount -- Specify dollar amount:	number
WVR_PETI_SPSE_AMT_NMBR_2	Allowance for the spouse only (select one) -- The following dollar amount -- Specify dollar amount:	number
WVR_PETI_SPSE_AMT_NMBR_3	Allowance for the spouse only (select one) -- The following dollar amount -- Specify dollar amount:	number
WVR_PETI_SPSE_DESC		text
WVR_PETI_SPSE_MDC_NDY		tinyint(1)
WVR_PETI_SPSE_MDC_NDY_1	Allowance for the spouse only (select one) -- Medically needy income standard	0,1
WVR_PETI_SPSE_MDC_NDY_2	Allowance for the spouse only (select one) -- Medically needy income standard	0,1
WVR_PETI_SPSE_MDC_NDY_3	Allowance for the spouse only (select one) -- Medically needy income standard	0,1
WVR_PETI_SPSE_NA		tinyint(1)
WVR_PETI_SPSE_NA_1	Allowance for the spouse only (select one) -- Not Applicable	0,1
WVR_PETI_SPSE_NA_2	Allowance for the spouse only (select one) -- Not Applicable	0,1
WVR_PETI_SPSE_NA_3	Allowance for the spouse only (select one) -- Not Applicable	0,1
WVR_PETI_SPSE_NON_CMTY		tinyint(1)
WVR_PETI_SPSE_NON_CMTY_2	Allowance for the spouse only (select one) -- The state provides an allowance for a spouse who does not meet the definition of a community spouse in §1924 of the Act. Describe the circumstances under which this allowance is provided	0,1
WVR_PETI_SPSE_NON_CMTY_3	Allowance for the spouse only (select one) -- The state provides an allowance for a spouse who does not meet the definition of a community spouse in §1924 of the Act. Describe the circumstances under which this allowance is provided	0,1
WVR_PETI_SPSE_NON_CMTY_DESC		text
WVR_PETI_SPSE_NON_CMTY_DESC_2	Allowance for the spouse only (select one) -- The state provides an allowance for a spouse who does not meet the definition of a community spouse in §1924 of the Act. Describe the circumstances under which this allowance is provided -- Specify	Text
WVR_PETI_SPSE_NON_CMTY_DESC_3	Allowance for the spouse only (select one) -- The state provides an allowance for a spouse who does not meet the definition of a community spouse in §1924 of the Act. Describe the circumstances under which this allowance is provided -- Specify	Text
WVR_PETI_SPSE_OPT_ST_SUPP		tinyint(1)
WVR_PETI_SPSE_OPT_ST_SUPP_1	Allowance for the spouse only (select one) -- Optional state supplement standard	0,1
WVR_PETI_SPSE_OPT_ST_SUPP_2	Allowance for the spouse only (select one) -- Optional state supplement standard	0,1
WVR_PETI_SPSE_OPT_ST_SUPP_3	Allowance for the spouse only (select one) -- Optional state supplement standard	0,1
WVR_PETI_SPSE_SSI		tinyint(1)
WVR_PETI_SPSE_SSI_1	Allowance for the spouse only (select one) -- SSI standard	0,1
WVR_PETI_SPSE_SSI_2	Allowance for the spouse only (select one) -- SSI standard	0,1
WVR_PETI_SPSE_SSI_3	Allowance for the spouse only (select one) -- SSI standard	0,1
WVR_PETI_SPSL_IMPVRSH_MNDTY	Spousal impoverishment rules under §1924 of the Act are used to determine the eligibility of individuals with a community spouse for the special home and community-based waiver group. In the case of a participant with a community spouse, the state uses spousal post-eligibility rules under §1924 of the Act.	0,1
WVR_PETI_SPSL_IMPVRSH_N	Spousal impoverishment rules under §1924 of the Act are not used to determine eligibility of individuals with a community spouse for the special home and community-based waiver group. The state uses regular post-eligibility rules for individuals with a community spouse.	0,1
WVR_PETI_SPSL_IMPVRSH_Y	Spousal impoverishment rules under §1924 of the Act are used to determine the eligibility of individuals with a community spouse for the special home and community-based waiver group.	0,1
WVR_PETI_SPSL_IMPVRSH_Y_REG	Spousal impoverishment rules under §1924 of the Act are used to determine the eligibility of individuals with a community spouse for the special home and community-based waiver group. In the case of a participant with a community spouse, the state elects to: Use spousal post-eligibility rules under §1924 of the Act.	0,1
WVR_PETI_SPSL_IMPVRSH_Y_SPSL	Spousal impoverishment rules under §1924 of the Act are used to determine the eligibility of individuals with a community spouse for the special home and community-based waiver group. In the case of a participant with a community spouse, the state elects to: Use spousal post-eligibility rules under §1924 of the Act.	0,1
WVR_PETI_SSI		tinyint(1)
WVR_PETI_SSI_1	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- SSI standard	0,1
WVR_PETI_SSI_2	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- SSI standard	0,1
WVR_PETI_SSI_3	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- SSI standard	0,1
WVR_PETI_SSI_AMT		decimal(18,6)
WVR_PETI_SSI_AMT_1	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons -- A dollar amount which is less than 300% -- Specify dollar amount:	number
WVR_PETI_SSI_AMT_2	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons -- A dollar amount which is less than 300% -- Specify dollar amount:	number
WVR_PETI_SSI_AMT_3	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons -- A dollar amount which is less than 300% -- Specify dollar amount:	number
WVR_PETI_SSI_PCT		decimal(18,6)
WVR_PETI_SSI_PCT_1	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons -- A percentage of the FBR, which is less than 300% -- Specify the percentage:	number
WVR_PETI_SSI_PCT_2	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons -- A percentage of the FBR, which is less than 300% -- Specify the percentage:	number
WVR_PETI_SSI_PCT_3	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons -- A percentage of the FBR, which is less than 300% -- Specify the percentage:	number
WVR_PETI_ST_PLN		tinyint(1)
WVR_PETI_ST_PLN_1	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one)	0,1
WVR_PETI_ST_PLN_2	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one)	0,1
WVR_PETI_ST_PLN_3	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one)	0,1
WVR_PETI_ST_PLN_OTHR		tinyint(1)
WVR_PETI_ST_PLN_OTHR_1	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- Other standard included under the state Plan	0,1
WVR_PETI_ST_PLN_OTHR_2	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- Other standard included under the state Plan	0,1
WVR_PETI_ST_PLN_OTHR_3	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- Other standard included under the state Plan	0,1
WVR_PETI_ST_PLN_OTHR_DESC		text
WVR_PETI_ST_PLN_OTHR_DESC_1	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- Other standard included under the state Plan -- Specify:	Text
WVR_PETI_ST_PLN_OTHR_DESC_2	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- Other standard included under the state Plan -- Specify:	Text
WVR_PETI_ST_PLN_OTHR_DESC_3	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- Other standard included under the state Plan -- Specify:	Text
WVR_PETI_UNDR_300_SSI_AMT		tinyint(1)
WVR_PETI_UNDR_300_SSI_AMT_1	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons -- A dollar amount which is less than 300%.	0,1
WVR_PETI_UNDR_300_SSI_AMT_2	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons -- A dollar amount which is less than 300%.	0,1
WVR_PETI_UNDR_300_SSI_AMT_3	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons -- A dollar amount which is less than 300%.	0,1
WVR_PETI_UNDR_300_SSI_PCT		tinyint(1)
WVR_PETI_UNDR_300_SSI_PCT_1	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons -- A percentage of the FBR, which is less than 300%	0,1
WVR_PETI_UNDR_300_SSI_PCT_2	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons -- A percentage of the FBR, which is less than 300%	0,1
WVR_PETI_UNDR_300_SSI_PCT_3	Allowance for the needs of the waiver participant -- The following standard included under the state plan (select one) -- The special income level for institutionalized persons -- A percentage of the FBR, which is less than 300%	0,1
WVR_PTCPNTS_PHASED_BASE	Beginning (base) number of Participants	number
WVR_PTCPNTS_PHASED_IN	The waiver is being (select one): Phased-in	0,1
WVR_PTCPNTS_PHASED_NO	The waiver is not subject to a phase-in or a phase-out schedule.	0,1
WVR_PTCPNTS_PHASED_OUT	The waiver is being (select one): Phased-out	0,1
WVR_PTCPNTS_PHASED_YES	The waiver is subject to a phase-in or phase-out schedule that is included in Attachment #1 to Appendix B-3. This schedule constitutes an intra-year limitation on the number of participants who are served in the waiver.	0,1
WVR_PTCPNT_LMT_STWIDE_NO	Waiver capacity is allocated to local/regional non-state entities.	0,1
WVR_PTCPNT_LMT_STWIDE_NO_DESC	Waiver capacity is allocated to local/regional non-state entities - Specify: (a) the entities to which waiver capacity is allocated; (b) the methodology that is used to allocate capacity and how often the methodology is reevaluated; and, (c) policies for the reallocation of unused capacity among local/regional non-state entities:	Text
WVR_PTCPNT_LMT_STWIDE_YES	Waiver capacity is allocated/managed on a statewide basis.	0,1
WVR_PTCPNT_PHASE_BEG_MNTH	Phase-in/Phase out begins - Month	text
WVR_PTCPNT_PHASE_BEG_YR	Phase-in/Phase out begins - Waiver Year	number
WVR_PTCPNT_PHASE_END_MNTH	Phase-in/Phase out ends - Month	text
WVR_PTCPNT_PHASE_END_YR	Phase-in/Phase out ends - Waiver Year	number
WVR_PTCPNT_PHASE_FIRST_MNTH	Phase-in/Phase out begins - Month	text
WVR_REEVAL_SCHDL_OTHR	Other schedule	0,1
WVR_REEVAL_SCHDL_OTHR_DESC	Specify the other schedule	Text
WVR_REEVAL_SCHDL_SIX_MNTH	Every six months	0,1
WVR_REEVAL_SCHDL_THR_MNTH	Every three months	0,1
WVR_REEVAL_SCHDL_TWLV_MNTH	Every twelve months	0,1
WVR_SSI_STATE	SSI Criteria State	0,1
WVR_TGT_GRP_ABD	Aged or Disabled, or Both - General	0,1
WVR_TGT_GRP_ABD_SUB_GRP	Aged or Disabled, or Both - Specific Recognized Subgroups	0,1
WVR_TGT_GRP_AGED	Aged	0,1
WVR_TGT_GRP_AGED_MAX_AGE	Aged - Maximum Age	number
WVR_TGT_GRP_AGED_MIN_AGE	Aged - Minimum Age	number
WVR_TGT_GRP_AGED_NO_MAX	Aged - No Maximum Age Limit	number
WVR_TGT_GRP_BRN_INJRY	Brain Injury	0,1
WVR_TGT_GRP_BRN_INJRY_MAX_AGE	Brain Injury - Maximum Age	number
WVR_TGT_GRP_BRN_INJRY_MIN_AGE	Brain Injury - Minimum Age	number
WVR_TGT_GRP_BRN_INJRY_NO_MAX	Brain Injury - No Maximum Age Limit	0,1
WVR_TGT_GRP_HIV_AIDS	HIV/AIDS	0,1
WVR_TGT_GRP_HIV_AIDS_MAX_AGE	HIV/AIDS - Maximum Age	number
WVR_TGT_GRP_HIV_AIDS_MIN_AGE	HIV/AIDS - Minimum Age	number
WVR_TGT_GRP_HIV_AIDS_NO_MAX	HIV/AIDS - No Maximum Age Limit	0,1
WVR_TGT_GRP_MDC_FRGL	Medically Fragile	0,1
WVR_TGT_GRP_MDC_FRGL_MAX_AGE	Medically Fragile - Maximum Age	number
WVR_TGT_GRP_MDC_FRGL_MIN_AGE	Medically Fragile - Minimum Age	number
WVR_TGT_GRP_MDC_FRGL_NO_MAX	Medically Fragile - No Maximum Age Limit	0,1
WVR_TGT_GRP_OTHR_DSBLD	Disabled (Other)	0,1
WVR_TGT_GRP_OTHR_DSBLD_MAX_AGE	Disabled (Other) - Maximum Age	number
WVR_TGT_GRP_OTHR_DSBLD_MIN_AGE	Disabled (Other) - Minimum Age	number
WVR_TGT_GRP_PHYS_DSBLD	Disabled (Physical)	0,1
WVR_TGT_GRP_PHYS_DSBLD_MAX_AGE	Disabled (Physical) - Maximum Age	number
WVR_TGT_GRP_PHYS_DSBLD_MIN_AGE	Disabled (Physical) - Minimum Age	number
WVR_TGT_GRP_TCH_DPNDT	Technology Dependent	0,1
WVR_TGT_GRP_TCH_DPNDT_MAX_AGE	Technology Dependent - Maximum Age	number
WVR_TGT_GRP_TCH_DPNDT_MIN_AGE	Technology Dependent - Minimum Age	number
WVR_TGT_GRP_TCH_DPNDT_NO_MAX	Technology Dependent - No Maximum Age Limit	0,1
WVR_UNDUP_PTCPNTS_YR1	Waiver Year 1 - Unduplicated Number of Participants	number
WVR_UNDUP_PTCPNTS_YR2	Waiver Year 2 - Unduplicated Number of Participants	number
WVR_UNDUP_PTCPNTS_YR3	Waiver Year 3 - Unduplicated Number of Participants	number
WVR_UNDUP_PTCPNTS_YR4	Waiver Year 4 - Unduplicated Number of Participants	number
WVR_UNDUP_PTCPNTS_YR5	Waiver Year 5 - Unduplicated Number of Participants	number

1915C Appendix C

(mdcd_1915c_appendix_c — waiver_version grain)

Variable	Description	Format
state	Two-letter state postal code.	char(2)
waiver_id	Waiver identifier.	varchar(16)
waiver_version_id	Waiver version identifier.	bigint unsigned
WVR_LMTS_AMT_SRVC_INDV_BDGT	Prospective Individual Budget Amount. There is a limit on the maximum dollar amount of waiver services authorized for each specific participant.	0,1
WVR_LMTS_AMT_SRVC_INDV_BDGT_DESC	Furnish the information specified above.	Text
WVR_LMTS_AMT_SRVC_LVL_BDGT	Budget Limits by Level of Support. Based on an assessment process and/or other factors, participants are assigned to funding levels that are limits on the maximum dollar amount of waiver services.	0,1
WVR_LMTS_AMT_SRVC_LVL_BDGT_DESC	Furnish the information specified above.	Text
WVR_LMTS_AMT_SRVC_NO	Not applicable- The state does not impose a limit on the amount of waiver services except as provided in Appendix C-3.	0,1
WVR_LMTS_AMT_SRVC_OTHR	Other Type of Limit. The state employs another type of limit. Describe the limit and furnish the information specified above.	0,1
WVR_LMTS_AMT_SRVC_OTHR_DESC	Furnish the information specified above.	Text
WVR_LMTS_AMT_SRVC_SET	Limit(s) on Set(s) of Services. There is a limit on the maximum dollar amount of waiver services that is authorized for one or more sets of services offered under the waiver.	0,1
WVR_LMTS_AMT_SRVC_SET_DESC	Furnish the information specified above.	Text
WVR_LMTS_AMT_SRVC_YES	Applicable - The state imposes additional limits on the amount of waiver services.	0,1
WVR_PLCY_REL_GRDN_NO	The state does not make payment to relatives/legal guardians for furnishing waiver services.	0,1
WVR_PLCY_REL_GRDN_OTHR	Other policy.	0,1
WVR_PLCY_REL_GRDN_OTHR_DESC	Specify:	Text
WVR_PLCY_REL_GRDN_SPCFC	The state makes payment to relatives/legal guardians under specific circumstances and only when the relative/guardian is qualified to furnish services.	0,1
WVR_PLCY_REL_GRDN_SPCFC_DESC	Specify the specific circumstances under which payment is made, the types of relatives/legal guardians to whom payment may be made, and the services for which payment may be made. Specify the controls that are employed to ensure that payments are made only for services rendered. Also, specify in Appendix C-1/C-3 each waiver service for which payment may be made to relatives/legal guardians.	Text
WVR_PLCY_REL_GRDN_WHNVR	Relatives/legal guardians may be paid for providing waiver services whenever the relative/legal guardian is qualified to provide services as specified in Appendix C-1/C-3.	0,1
WVR_PLCY_REL_GRDN_WHNVR_DESC	Specify the controls that are employed to ensure that payments are made only for services rendered.	Text
WVR_REEVAL_SCHDL_OTHR		tinyint(1)
WVR_REEVAL_SCHDL_OTHR_DESC		text
WVR_REEVAL_SCHDL_SIX_MNTH		tinyint(1)
WVR_REEVAL_SCHDL_THR_MNTH		tinyint(1)
WVR_REEVAL_SCHDL_TWLV_MNTH		tinyint(1)
WVR_SRVCS	Number of services furnished under the waiver	number

1915C Appendix E

(mdcd_1915c_appendix_e — waiver_version grain)

Variable	Description	Format
state	Two-letter state postal code.	char(2)
waiver_id	Waiver identifier.	varchar(16)
waiver_version_id	Waiver version identifier.	bigint unsigned
WVR_PTCPNT_DIR_BUDG_AUTH_PYMT	Participant has the budget-making authority to: authorize payment for wiver goods and services	0,1
WVR_PTCPNT_DIR_BUDG_CHK_INVCS	Participant has the budget-making authority to: review and approve provider invoices for services rendered	0,1
WVR_PTCPNT_DIR_BUDG_OTHR	Participant has the budget-making authority to: other	0,1
WVR_PTCPNT_DIR_BUDG_OTHR_DESC	Participant has the budget-making authority to: other -- Specify	Text
WVR_PTCPNT_DIR_BUDG_QLFCTNS	Participant has the budget-making authority to: specify additional service provider qualifications consistent with the qualifications specified in Appendix C-1/C-3	0,1
WVR_PTCPNT_DIR_BUDG_REFER	Participant has the budget-making authority to: identify service providers and refer for provider enrollment	0,1
WVR_PTCPNT_DIR_BUDG_RLLCT	Participant has the budget-making authority to: reallocate funds among services included in the budget	0,1
WVR_PTCPNT_DIR_BUDG_RPLCE	Participant has the budget-making authority to: substitute service providers	0,1
WVR_PTCPNT_DIR_BUDG_SCHDL	Participant has the budget-making authority to: schedule the provision of services	0,1
WVR_PTCPNT_DIR_BUDG_SET_PYMNT	Participant has the budget-making authority to: determine the amount paid fo services within the states established limits	0,1
WVR_PTCPNT_DIR_BUDG_SRVC_PROV	Participant has the budget-making authority to: specify how services are provided, consistent with the service specifications contained in Appendix C-1/C-3	0,1
WVR_PTCPNT_DIR_CRMNL_HSTRY	Participant has the decision-making authority to: obtain criminal history and/or background investigation of staff	0,1
WVR_PTCPNT_DIR_DSCHRG	Participant has the decision-making authority to: discharge staff (common law employer)	0,1
WVR_PTCPNT_DIR_DSCHRG_AS_PRVDR	Participant has the decision-making authority to: Discharge staff from providing services (co-employer)	0,1
WVR_PTCPNT_DIR_DUTIES	Participant has the decision-making authority to: determine staff duties consistent with the service specifications in Appendix C-1/C-3	0,1
WVR_PTCPNT_DIR_EVAL_PERF	Participant has the decision-making authority to: evaluate staff performance	0,1
WVR_PTCPNT_DIR_HIRE	Participant has the decision-making authority to: hire staff as a common law employer	0,1
WVR_PTCPNT_DIR_HOME_LVNG	Participant direction opportunities are available to participants who live in their own private residence or the home of a family member.	0,1
WVR_PTCPNT_DIR_NO	This waiver provides participant direction opportunities. Complete the remainder of the Appendix.	0,1
WVR_PTCPNT_DIR_ONBOARD	Participant has the decision-making authority to: orient and instruct staff in duties	0,1
WVR_PTCPNT_DIR_ONLY	Waiver is designed to support only individuals who want to direct their services.	0,1
WVR_PTCPNT_DIR_OPTN_4_ALL	The waiver is designed to afford every participant (or the participant's representative) the opportunity to elect to direct waiver services. Alternate service delivery methods are available for participants who decide not to direct their services.	0,1
WVR_PTCPNT_DIR_OPTN_4_SOME	The waiver is designed to offer participants (or their representatives) the opportunity to direct some or all of their services, subject to the following criteria specified by the state. Alternate service delivery methods are available for participants who decide not to direct their services or do not meet the criteria.	0,1
WVR_PTCPNT_DIR_OPTN_4_SOME_DESC	The waiver is designed to offer participants (or their representatives) the opportunity to direct some or all of their services, subject to the following criteria specified by the state. Alternate service delivery methods are available for participants who decide not to direct their services or do not meet the criteria -- Specify the criteria	Text
WVR_PTCPNT_DIR_OTHR	Participant has the decision-making authority to: other	0,1
WVR_PTCPNT_DIR_OTHR_DESC	Participant has the decision-making authority to: other -- Specify	Text
WVR_PTCPNT_DIR_OTHR_LVNG	The participant direction opportunities are available to persons in the following other living arrangements	0,1
WVR_PTCPNT_DIR_OTHR_LVNG_DESC	The participant direction opportunities are available to persons in the following other living arrangements -- Specify these living arrangements:	Text
WVR_PTCPNT_DIR_RECRUIT	Participant has the decision-making authority to: recruit staff	0,1
WVR_PTCPNT_DIR_REFER	Participant has the decision-making authority to: refer staff to agency for hiring (co-employer)	0,1
WVR_PTCPNT_DIR_SCHDL	Participant has the decision-making authority to: schedule staff	0,1
WVR_PTCPNT_DIR_SELECT	Participant has the decision-making authority to: select staff from worker registry	0,1
WVR_PTCPNT_DIR_SET_QLFCTNS	Participant has the decision-making authority to: Specify additional staff qualifications based on participant needs and preferences so long as such qualifications are consistent with the qualifications specified in Appendix C-1/C-3.	0,1
WVR_PTCPNT_DIR_SML_GRP_LVNG	Participant direction opportunities are available to individuals who reside in other living arrangements where services (regardless of funding source) are furnished to fewer than four persons unrelated to the proprietor.	0,1
WVR_PTCPNT_DIR_SRVC	Both Authorities. The waiver provides for both participant direction opportunities as specified in Appendix E-2. Supports and protections are available for participants who exercise these authorities.	0,1
WVR_PTCPNT_DIR_SRVC_BUDG	Participant – Budget Authority. As specified in Appendix E-2, Item b, the participant (or the participant’s representative) has decision-making authority over a budget for waiver services. Supports and protections are available for participants who have authority over a budget.	0,1
WVR_PTCPNT_DIR_SRVC_EMPL	Participant – Employer Authority. As specified in Appendix E-2, Item a, the participant (or the participant’s representative) has decision-making authority over workers who provide waiver services. The participant may function as the common law employer or the co-employer of workers. Supports and protections are available for participants who exercise this authority	0,1
WVR_PTCPNT_DIR_SUPERVISE	Participant has the decision-making authority to: supervise staff	0,1
WVR_PTCPNT_DIR_TMSHTS	Participant has the decision-making authority to: verify time worked by staff and approve time sheets	0,1
WVR_PTCPNT_DIR_VRFY_QUAL	Participant has the decision-making authority to: verify qualifications	0,1
WVR_PTCPNT_DIR_WAGE_BENE	Participant has the decision-making authority to: determine staff wages and benefits subject to state limits	0,1
WVR_PTCPNT_DIR_YES	This waiver provides participant direction opportunities. Complete the remainder of the Appendix.	0,1

1915C Appendix I

(mdcd_1915c_appendix_i — waiver_version grain)

Variable	Description	Format
state	Two-letter state postal code.	char(2)
waiver_id	Waiver identifier.	varchar(16)
waiver_version_id	Waiver version identifier.	bigint unsigned
WVR_COPYMNTS_COPYMNT	Co-Payment	0,1
WVR_COPYMNTS_CO_INS	Coinsurance	0,1
WVR_COPYMNTS_DEDCTBLE	Nominal deductible	0,1
WVR_COPYMNTS_NO	No. The state does not impose a co-payment or similar charge upon participants for waiver services.	0,1
WVR_COPYMNTS_OTHR	Other charge	0,1
WVR_COPYMNTS_OTHR_DESC	Other charge -- Specify:	Text
WVR_COPYMNTS_PTCPNT_GRP_DESC	Participants Subject to Co-pay Charges for Waiver Services.	Text
WVR_COPYMNTS_YES	Yes. The state imposes a co-payment or similar charge upon participants for one or more waiver services.	0,1
WVR_CRT_FNDS_DESC	For each source of funds indicated above, describe the source of the funds in detail:	Text
WVR_CRT_FNDS_FDLFNDS	Federal funds	0,1
WVR_CRT_FNDS_HLTH_CR_TX	Health care-related taxes or fees	0,1
WVR_CRT_FNDS_NO	None of the specified sources of funds contribute to the non-federal share of computable waiver costs	0,1
WVR_CRT_FNDS_PRVDR_DNT	Provider-related donations	0,1
WVR_CRT_FNDS_YES	The following source(s) are used Check each that applies:	0,1
WVR_FOOD_RNT_LIVE_IN_CRGVR_NO	No. The state does not reimburse for the rent and food expenses of an unrelated live-in personal caregiver who resides in the same household as the participant.	0,1
WVR_FOOD_RNT_LIVE_IN_CRGVR_YES	Yes. Per 42 CFR §441.310(a)(2)(ii), the state will claim FFP for the additional costs of rent and food that can be reasonably attributed to an unrelated live-in personal caregiver who resides in the same household as the waiver participant. The state describes its coverage of live-in caregiver in Appendix C-3 and the costs attributable to rent and food for the live-in caregiver are reflected separately in the computation of factor D (cost of waiver services) in Appendix J. FFP for rent and food for a live-in caregiver will not be claimed when the participant lives in the caregiver's home or in a residence that is owned or leased by the provider of Medicaid services.	0,1
WVR_LCL_FNDS_APP	Appropriation of Local Government Revenues.	0,1
WVR_LCL_FNDS_APP_DESC	Specify: (a) the local government entity or entities that have the authority to levy taxes or other revenues; (b) the source(s) of revenue; and, (c) the mechanism that is used to transfer the funds to the Medicaid Agency or Fiscal Agent, such as an Intergovernmental Transfer (IGT), including any matching arrangement (indicate any intervening entities in the transfer process), and/or, indicate if funds are directly expended by local government agencies as CPEs, as specified in Item I-2-c:	Text
WVR_LCL_FNDS_NO	Not Applicable. There are no local government level sources of funds utilized as the non-federal share.	0,1
WVR_LCL_FNDS_OTHR	Other Local Government Level Source(s) of Funds.	0,1
WVR_LCL_FNDS_OTHR_DESC	Specify: (a) the source of funds; (b) the local government entity or agency receiving funds; and, (c) the mechanism that is used to transfer the funds to the state Medicaid agency or fiscal agent, such as an Intergovernmental Transfer (IGT), including any matching arrangement, and/or, indicate if funds are directly expended by local government agencies as CPEs, as specified in Item I-2-c:	Text
WVR_LCL_FNDS_YES	Applicable	0,1
WVR_MCO_HP_1915A	The state contracts with a Managed Care Organization(s) (MCOs) and/or prepaid inpatient health plan(s) (PIHP) or prepaid ambulatory health plan(s) (PAHP) under the provisions of §1915(a)(1) of the Act for the delivery of waiver and other services. Participants may voluntarily elect to receive waiver and other services through such MCOs or prepaid health plans. Contracts with these health plans are on file at the state Medicaid agency.	0,1
WVR_MCO_HP_1915A_DESC	Describe: (a) the MCOs and/or health plans that furnish services under the provisions of §1915(a)(1); (b) the geographic areas served by these plans; (c) the waiver and other services furnished by these plans; and, (d) how payments are made to the health plans.	Text
WVR_MCO_HP_1915B	This waiver is a part of a concurrent §1915(b)/§1915(c) waiver. Participants are required to obtain waiver and other services through a MCO and/or prepaid inpatient health plan (PIHP) or a prepaid ambulatory health plan (PAHP). The §1915(b) waiver specifies the types of health plans that are used and how payments to these plans are made.	0,1
WVR_MCO_HP_1915C_1115	This waiver is a part of a concurrent ?1115/?1915(c) waiver. Participants are required to obtain waiver and other services through a MCO and/or prepaid inpatient health plan (PIHP) or a prepaid ambulatory health plan (PAHP). The ?1115 waiver specifies the types of health plans that are used and how payments to these plans are made.	0,1
WVR_MCO_HP_MULTI	If the state uses more than one of the above contract authorities for the delivery of waiver services, please select this option.	0,1
WVR_MCO_HP_MULTI_DESC	In the textbox below, indicate the contract authorities. In addition, if the state contracts with MCOs, PIHPs, or PAHPs under the provisions of §1915(a)(1) of the Act to furnish waiver services: Participants may voluntarily elect to receive waiver and other services through such MCOs or prepaid health plans. Contracts with these health plans are on file at the state Medicaid agency. Describe: (a) the MCOs and/or health plans that furnish services under the provisions of §1915(a)(1); (b) the geographic areas served by these plans; (c) the waiver and other services furnished by these plans; and, (d) how payments are made to the health plans.	Text
WVR_MCO_HP_NO	The state does not contract with MCOs, PIHPs or PAHPs for the provision of waiver services.	0,1
WVR_OHCDS_DESC	Specify the following: (a) the entities that are designated as an OHCDS and how these entities qualify for designation as an OHCDS; (b) the procedures for direct provider enrollment when a provider does not voluntarily agree to contract with a designated OHCDS; (c) the method(s) for assuring that participants have free choice of qualified providers when an OHCDS arrangement is employed, including the selection of providers not affiliated with the OHCDS; (d) the method(s) for assuring that providers that furnish services under contract with an OHCDS meet applicable provider qualifications under the waiver; (e) how it is assured that OHCDS contracts with providers meet applicable requirements; and, (f) how financial accountability is assured when an OHCDS arrangement is used:	Text
WVR_OHCDS_NO	No. The state does not employ Organized Health Care Delivery System (OHCDS) arrangements under the provisions of 42 CFR §447.10.	0,1
WVR_OHCDS_YES	Yes. The waiver provides for the use of Organized Health Care Delivery System arrangements under the provisions of 42 CFR §447.10.	0,1
WVR_OTHR_COST_SHARE_DESC	Yes. The state imposes a premium, enrollment fee or similar cost-sharing arrangement -- Describe in detail the cost sharing arrangement, including: (a) the type of cost sharing (e.g., premium, enrollment fee); (b) the amount of charge and how the amount of the charge is related to total gross family income; (c) the groups of participants subject to cost-sharing and the groups who are excluded; and, (d) the mechanisms for the collection of cost-sharing and reporting the amount collected on the CMS 64:	Text
WVR_OTHR_COST_SHARE_NO	No. The state does not impose a premium, enrollment fee, or similar cost-sharing arrangement on waiver participants.	0,1
WVR_OTHR_COST_SHARE_YES	Yes. The state imposes a premium, enrollment fee or similar cost-sharing arrangement.	0,1
WVR_PRVDR_RTNS_PYMNT_MNGD	Providers are paid by a managed care entity (or entities) that is paid a monthly capitated payment.	0,1
WVR_PRVDR_RTNS_PYMNT_MNGD_DESC	Specify whether the monthly capitated payment to managed care entities is reduced or returned in part to the state.	Text
WVR_PRVDR_RTNS_PYMNT_YES	Providers receive and retain 100 percent of the amount claimed to CMS for waiver services.	0,1
WVR_SRVC_RES_NO	No services under this waiver are furnished in residential settings other than the private residence of the individual.	0,1
WVR_SRVC_RES_YES	As specified in Appendix C, the state furnishes waiver services in residential settings other than the personal home of the individual.	0,1
WVR_ST_FNDS_OTHR	Other State Level Source(s) of Funds.	0,1
WVR_ST_FNDS_OTHR_DESC	Specify: (a) the source and nature of funds; (b) the entity or agency that receives the funds; and, (c) the mechanism that is used to transfer the funds to the Medicaid Agency or Fiscal Agent, such as an Intergovernmental Transfer (IGT), including any matching arrangement, and/or, indicate if funds are directly expended by state agencies as CPEs, as indicated in Item I-2-c:	Text
WVR_ST_FNDS_TX_MDCD	Appropriation of State Tax Revenues to the State Medicaid agency	0,1
WVR_ST_FNDS_TX_NOT_MDCD	Appropriation of State Tax Revenues to a State Agency other than the Medicaid Agency.	0,1
WVR_ST_FNDS_TX_NOT_MDCD_DESC	If the source of the non-federal share is appropriations to another state agency (or agencies), specify: (a) the state entity or agency receiving appropriated funds and (b) the mechanism that is used to transfer the funds to the Medicaid Agency or Fiscal Agent, such as an Intergovernmental Transfer (IGT), including any matching arrangement, and/or, indicate if the funds are directly expended by state agencies as CPEs, as indicated in Item I-2- c:	Text

1915C Appendix J

(mdcd_1915c_appendix_j — waiver_version grain)

Variable	Description	Format
state	Two-letter state postal code.	char(2)
waiver_id	Waiver identifier.	varchar(16)
waiver_version_id	Waiver version identifier.	bigint unsigned
WVR_AVG_LNGTH_OF_STAY_DESC	Average Length of Stay. Describe the basis of the estimate of the average length of stay on the waiver by participants in item J-2-a.	Text
WVR_FCTR_D_AVGSTAY_YR1	Waiver Year 1. Average Length of Stay on the Waiver:	Number
WVR_FCTR_D_AVGSTAY_YR2	Waiver Year 2. Average Length of Stay on the Waiver:	Number
WVR_FCTR_D_AVGSTAY_YR3	Waiver Year 3. Average Length of Stay on the Waiver:	Number
WVR_FCTR_D_AVGSTAY_YR4	Waiver Year 4. Average Length of Stay on the Waiver:	Number
WVR_FCTR_D_AVGSTAY_YR5	Waiver Year 5. Average Length of Stay on the Waiver:	Number
WVR_FCTR_D_CALC_YR1	Waiver Year 1. Factor D (Divide total by number of participants):	Number
WVR_FCTR_D_CALC_YR2	Waiver Year 2. Factor D (Divide total by number of participants):	Number
WVR_FCTR_D_CALC_YR3	Waiver Year 3. Factor D (Divide total by number of participants):	Number
WVR_FCTR_D_CALC_YR4	Waiver Year 4. Factor D (Divide total by number of participants):	Number
WVR_FCTR_D_CALC_YR5	Waiver Year 5. Factor D (Divide total by number of participants):	Number
WVR_FCTR_D_DESC	Factor D Derivation. The estimates of Factor D for each waiver year are located in Item J-2-d. The basis and methodology for these estimates is as follows:	Text
WVR_FCTR_D_PRIME_DESC	Factor D' Derivation. The estimates of Factor D' for each waiver year are included in Item J-1. The basis of these estimates is as follows:	Text
WVR_FCTR_D_PRIME_YR1	Waiver Year 1. Factor D'	Number
WVR_FCTR_D_PRIME_YR2	Waiver Year 2. Factor D'	Number
WVR_FCTR_D_PRIME_YR3	Waiver Year 3. Factor D'	Number
WVR_FCTR_D_PRIME_YR4	Waiver Year 4. Factor D'	Number
WVR_FCTR_D_PRIME_YR5	Waiver Year 5. Factor D'	Number
WVR_FCTR_D_TOTCOST_YR1	Waiver Year 1. Grand Total Cost.	Number
WVR_FCTR_D_TOTCOST_YR2	Waiver Year 2. Grand Total Cost.	Number
WVR_FCTR_D_TOTCOST_YR3	Waiver Year 3. Grand Total Cost.	Number
WVR_FCTR_D_TOTCOST_YR4	Waiver Year 4. Grand Total Cost.	Number
WVR_FCTR_D_TOTCOST_YR5	Waiver Year 5. Grand Total Cost.	Number
WVR_FCTR_D_UNDUP_YR1	Waiver Year 1. Total Estimated Unduplicated Participants:	Number
WVR_FCTR_D_UNDUP_YR2	Waiver Year 2. Total Estimated Unduplicated Participants:	Number
WVR_FCTR_D_UNDUP_YR3	Waiver Year 3. Total Estimated Unduplicated Participants:	Number
WVR_FCTR_D_UNDUP_YR4	Waiver Year 4. Total Estimated Unduplicated Participants:	Number
WVR_FCTR_D_UNDUP_YR5	Waiver Year 5. Total Estimated Unduplicated Participants:	Number
WVR_FCTR_G_DESC	Factor G Derivation. The estimates of Factor G for each waiver year are included in Item J-1. The basis of these estimates is as follows:	Text
WVR_FCTR_G_PRIME_DESC	Factor G' Derivation. The estimates of Factor G' for each waiver year are included in Item J-1. The basis of these estimates is as follows:	Text
WVR_FCTR_G_PRIME_YR1	Waiver Year 1. Factor G'	Number
WVR_FCTR_G_PRIME_YR2	Waiver Year 2. Factor G'	Number
WVR_FCTR_G_PRIME_YR3	Waiver Year 3. Factor G'	Number
WVR_FCTR_G_PRIME_YR4	Waiver Year 4. Factor G'	Number
WVR_FCTR_G_PRIME_YR5	Waiver Year 5. Factor G'	Number
WVR_FCTR_G_YR1	Waiver Year 1. Factor G	Number
WVR_FCTR_G_YR2	Waiver Year 2. Factor G	Number
WVR_FCTR_G_YR3	Waiver Year 3. Factor G	Number
WVR_FCTR_G_YR4	Waiver Year 4. Factor G	Number
WVR_FCTR_G_YR5	Waiver Year 5. Factor G	Number

1915C Main Application

(mdcd_1915c_main_application — waiver_version grain)

Variable	Description	Format
AMND_WVR_APPRVD_EFFDATE	Approved Effective Date of Waiver being Amended	Date
AMND_WVR_PRPSD_EFFDATE	Proposed Effective Date of Waiver being Amended	Date
STATE	State	Text
waiver_id	Waiver identifier.	varchar(16)
waiver_version_id	Waiver version identifier.	bigint unsigned
WVR_3YR	Requested Approval Period - 3 years	0,1
WVR_5YR	Requested Approval Period - 5 years	0,1
WVR_APNDX_E_NO	No. This waiver does not provide participant direction opportunities.	0,1
WVR_APNDX_E_YES	Yes. This waiver provides participant direction opportunities.	0,1
WVR_APPRVD_EFFDATE	Approved Effective Date	Date
WVR_BASE	Original Base Waiver Number	Text
WVR_DUALELIGIBLES	This waiver provides services for individuals who are eligible for both Medicare and Medicaid.	0,1
WVR_EFFDATE	Effective Date: (mm/dd/yy)	Date
WVR_GEO_LMT	Request for waiver of statewideness requirements - Yes. A waiver of statewideness is requested in order to furnish services under this waiver only to individuals who reside in certain geographic areas or political subdivisions of the state.	0,1
WVR_GEO_LMT_DESC	Request for waiver of statewideness requirements - Yes. A waiver of statewideness is requested in order to furnish services under this waiver only to individuals who reside in certain geographic areas or political subdivisions of the state. Specify the areas to which this waiver applies and, as applicable, the phase-in schedule of the waiver by geographic area	Text
WVR_GEO_LMT_PTCPNT_DIR	Request for waiver of statewideness requirements - Yes. A waiver of statewideness is requested in order to make participant-direction of services available only to individuals who reside in certain geographic areas or political subdivisions of the state.	0,1
WVR_GEO_LMT_PTCPNT_DIR_DESC	Request for waiver of statewideness requirements - Yes. A waiver of statewideness is requested in order to make participant-direction of services available only to individuals who reside in certain geographic areas or political subdivisions of the state. Specify the areas of the state affected by this waiver and, as applicable, the phase-in schedule of the waiver by geographic area.	Text
WVR_HSPTL_LVLCARE	Level(s) of Care - Hospital	0,1
WVR_HSPTL_LVLCARE_HSPTL	Level(s) of Care - Hospital - Hospital as defined in 42 CFR §440.10	0,1
WVR_HSPTL_LVLCARE_HSPTL_DESC	Level(s) of Care - Hospital - Hospital as defined in 42 CFR §440.10 - If applicable, specify whether the state additionally limits the waiver to subcategories of the hospital level of care.	Text
WVR_HSPTL_LVLCARE_PSYCH	Level(s) of Care - Hospital - Inpatient psychiatric facility for individuals age 21 and under as provided in 42 CFR §440.160.	0,1
WVR_ICFIID_LVLCARE	Level(s) of Care - Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) (as defined in 42 CFR §440.150	0,1
WVR_ICFIID_LVLCARE_DESC	Level(s) of Care - Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) (as defined in 42 CFR §440.150 - If applicable, specify whether the state additionally limits the waiver to subcategories of the ICF/IID level of care.	Text
WVR_MDC_NDY_NA	Request for waiver of institutional income and resource rules for the medically needy - Not applicable	0,1
WVR_MDC_NDY_NO	Request for waiver of institutional income and resource rules for the medically needy - No	0,1
WVR_MDC_NDY_YES	Request for waiver of institutional income and resource rules for the medically needy - No	0,1
WVR_MDL_REG	Type of Waiver	Text
WVR_NAME	Program Title	Text
WVR_NRSE_LVLCARE	Level(s) of Care - Nursing Facility	0,1
WVR_NRSE_LVLCARE_MNTLINST	Level(s) of Care - Nursing Facility - Institution for Mental Disease for persons with mental illnesses aged 65 and older as provided in 42 CFR §440.140	0,1
WVR_NRSE_LVLCARE_NRSEFCLTY	Level(s) of Care - Nursing Facility - Nursing Facility as defined in 42 CFR §440.40 and 42 CFR §440.155	0,1
WVR_NRSE_LVLCARE_NRSEFCLTY_DESC	Level(s) of Care - Nursing Facility - Nursing Facility as defined in 42 CFR §440.40 and 42 CFR §440.155 - If applicable, specify whether the state additionally limits the waiver to subcategories of the nursing facility level of care.	Text
WVR_NUM	Waiver Number	Text
WVR_OTHR_AUTHRTY	Concurrent with Other Programs - Applicable	0,1
WVR_OTHR_AUTHRTY_1115	Concurrent with Other Programs - A program authorized under §1115 of the Act.	0,1
WVR_OTHR_AUTHRTY_1115_DESC	Concurrent with Other Programs - A program authorized under §1115 of the Act - Specify the program.	Text
WVR_OTHR_AUTHRTY_1915A	Concurrent with Other Programs - Services furnished under the provisions of §1915(a)(1)(a) of the Act and described in Appendix I	0,1
WVR_OTHR_AUTHRTY_1915B	Concurrent with Other Programs - Waiver(s) authorized under §1915(b) of the Act.	0,1
WVR_OTHR_AUTHRTY_1915B1	Concurrent with Other Programs - §1915(b)(1) (mandated enrollment to managed care)	0,1
WVR_OTHR_AUTHRTY_1915B2	Concurrent with Other Programs - §1915(b)(2) (central broker)	0,1
WVR_OTHR_AUTHRTY_1915B3	Concurrent with Other Programs - §1915(b)(3) (employ cost savings to furnish additional services)	0,1
WVR_OTHR_AUTHRTY_1915B4	Concurrent with Other Programs - §1915(b)(4) (selective contracting/limit number of providers)	0,1
WVR_OTHR_AUTHRTY_1915B_DESC	Concurrent with Other Programs - Waiver(s) authorized under §1915(b) of the Act - Specify the §1915(b) waiver program and indicate whether a §1915(b) waiver application has been submitted or previously approved	Text
WVR_OTHR_AUTHRTY_1915I	Concurrent with Other Programs - A program authorized under §1915(i) of the Act.	0,1
WVR_OTHR_AUTHRTY_1915J	Concurrent with Other Programs - A program authorized under §1915(j) of the Act.	0,1
WVR_OTHR_AUTHRTY_1932A	Concurrent with Other Programs - A program operated under §1932(a) of the Act.	0,1
WVR_OTHR_AUTHRTY_1932A_DESC	Concurrent with Other Programs - A program operated under §1932(a) of the Act - Specify the nature of the state plan benefit and indicate whether the state plan amendment has been submitted or previously approved.	Text
WVR_OTHR_AUTHRTY_NA	Concurrent with Other Programs - Not applicable	0,1
WVR_OTHR_WVR_1915B_DESC		text
WVR_PRPSD_EFFDATE	Proposed Effective Date	Date
WVR_RQST	Type of Request	Text
WVR_SHRT_DESC	In one page or less, briefly describe the purpose of the waiver, including its goals, objectives, organizational structure (e.g., the roles of state, local and other entities), and service delivery methods.	Text
WVR_STWIDE_NO	Request for waiver of statewideness requirements - No	0,1
WVR_STWIDE_YES	Request for waiver of statewideness requirements - Yes	0,1
WVR_SUBMISSION_DATE	Submission Date	Date

1915C Request For Amendment

(mdcd_1915c_request_for_amendment — waiver_version grain)

Variable	Description	Format
state	Two-letter state postal code.	char(2)
waiver_id	Waiver identifier.	varchar(16)
waiver_version_id	Waiver version identifier.	bigint unsigned
WVR_AMND_ADD_PTCPNT_DIR	Add participant-direction of services	0,1
WVR_AMND_ADD_RMV_SRVCS	Add/delete services	0,1
WVR_AMND_APNDX_A	Appendix A	0,1
WVR_AMND_APNDX_A_SUBSCTN	Subsection(s) of Appendix A	Text
WVR_AMND_APNDX_B	Appendix B Affected	0,1
WVR_AMND_APNDX_B_SUBSCTN	Subsection(s) of Appendix B	Text
WVR_AMND_APNDX_C	Appendix C	0,1
WVR_AMND_APNDX_C_SUBSCTN	Subsection(s) of Appendix C	Text
WVR_AMND_APNDX_D	Appendix D	0,1
WVR_AMND_APNDX_D_SUBSCTN	Subsection(s) of Appendix D	Text
WVR_AMND_APNDX_E	Appendix E	0,1
WVR_AMND_APNDX_E_SUBSCTN	Subsection(s) of Appendix E	Text
WVR_AMND_APNDX_F	Appendix F	0,1
WVR_AMND_APNDX_F_SUBSCTN	Subsection(s) of Appendix F	Text
WVR_AMND_APNDX_G	Appendix G	0,1
WVR_AMND_APNDX_G_SUBSCTN	Subsection(s) of Appendix G	Text
WVR_AMND_APNDX_H	Appendix H	0,1
WVR_AMND_APNDX_H_SUBSCTN	Subsection(s) of Appendix H	Text
WVR_AMND_APNDX_I	Appendix I	0,1
WVR_AMND_APNDX_I_SUBSCTN	Subsection(s) of Appendix I	Text
WVR_AMND_APNDX_J	Appendix J	0,1
WVR_AMND_APNDX_J_SUBSCTN	Subsection(s) of Appendix J	Text
WVR_AMND_APPRVD_EFFDATE	Approved Effective Date	Date
WVR_AMND_APPRVD_EFFDATE_ORIG_WVR	Approved Effective Date of Waiver being Amended	Date
WVR_AMND_CHNG_CST_NTRLTY	Revise cost neutrality demonstration	0,1
WVR_AMND_CHNG_PRVDR_RULES	Revise provider qualifications	0,1
WVR_AMND_CHNG_PTCPNT_CNTS	Increase/decrease number of participants	0,1
WVR_AMND_CHNG_SRVC_PRVSNS	Revise service specifications	0,1
WVR_AMND_MEDICAID_ELIG	Modify Medicaid eligibility	0,1
WVR_AMND_NUM	Amendment Number	Text
WVR_AMND_OTHER	Other	0,1
WVR_AMND_OTHER_DESC	Other-Specify	Text
WVR_AMND_PRPSD_EFFDATE	Proposed Effective Date	Date
WVR_AMND_SHRT_DESC	Describe the purpose(s) of the amendment:	Text
WVR_AMND_TGT_GROUP	Modify target group(s)	0,1
WVR_AMND_WVR_APP	Waiver Application affected by the amendment	0,1
WVR_AMND_WVR_APP_SUBSCTN	Subsection(s) of Waiver Application	Text

1915C Request For Renewal

(mdcd_1915c_request_for_renewal — waiver_version grain)

Variable	Description	Format
state	Two-letter state postal code.	char(2)
waiver_id	Waiver identifier.	varchar(16)
waiver_version_id	Waiver version identifier.	bigint unsigned
WVR_RNWL_MJR_CHNGS	Describe any significant changes to the approved waiver that are being made in this renewal application:	Text

1915C Appendix C Service

(mdcd_1915c_appendix_c_service — waiver_version_service grain)

Variable	Description	Format
state	Two-letter state postal code.	char(2)
waiver_id	Waiver identifier.	varchar(16)
waiver_version_id	Waiver version identifier.	bigint unsigned
WVR_NUM		text
WVR_SRVC_ALT_NAME	Alternate Service Title (if any):	Text
WVR_SRVC_GRP_1	HCBS Taxonomy: Category 1:	Text
WVR_SRVC_GRP_2	HCBS Taxonomy: Category 2:	Text
WVR_SRVC_GRP_3	HCBS Taxonomy: Category 3:	Text
WVR_SRVC_GRP_4	HCBS Taxonomy: Category 4:	Text
WVR_SRVC_LGLY_RESP	Legally Responsible Person	0,1
WVR_SRVC_LGL_GRDN	Legal Guardian	0,1
WVR_SRVC_LMTS_DESC	Specify applicable (if any) limits on the amount, frequency, or duration of this service:	Text
WVR_SRVC_MODIFIED	Service is included in approved waiver. The service specifications have been modified.	0,1
WVR_SRVC_NAME	Service name.	text
WVR_SRVC_NAME_APNDX_C	Service Title:	Text
WVR_SRVC_NEW	Service is not included in the approved waiver.	0,1
WVR_SRVC_NO_CHNG	Service is included in approved waiver. There is no change in service specifications.	0,1
WVR_SRVC_PRVDRS	Total number of providers specified for service.	number
WVR_SRVC_PRVDR_CRTFCT_DESC_n	Certificate (specify):	Text
WVR_SRVC_PRVDR_GRP_n	Provider Category:	Text
WVR_SRVC_PRVDR_LCNSE_DESC_n	License (specify):	Text
WVR_SRVC_PRVDR_OTHR_STD_DESC_n	Other Standard (specify):	Text
WVR_SRVC_PRVDR_TYPE_n	Provider Type:	Text
WVR_SRVC_PTCPNT_DIR	Participant-directed as specified in Appendix E	0,1
WVR_SRVC_RLTVE	Relative	0,1
WVR_SRVC_SUB_GRP_1	HCBS Taxonomy: Sub-Category 1:	Text
WVR_SRVC_SUB_GRP_2	HCBS Taxonomy: Sub-Category 2:	Text
WVR_SRVC_SUB_GRP_3	HCBS Taxonomy: Sub-Category 3:	Text
WVR_SRVC_SUB_GRP_4	HCBS Taxonomy: Sub-Category 1:	Text
WVR_SRVC_TYPE	Service Type:	Text

1915C Appendix E 1 G Service

(mdcd_1915c_appendix_e_1_g_service — waiver_version_service grain)

Variable	Description	Format
state	Two-letter state postal code.	char(2)
waiver_id	Waiver identifier.	varchar(16)
waiver_version_id	Waiver version identifier.	bigint unsigned
WVR_NUM		text
WVR_PTCPNT_DIR_SRVC_BUDG_AUTH	Budget Authority	0,1
WVR_PTCPNT_DIR_SRVC_EMPL_AUTH	Employer Authority	0,1
WVR_PTCPNT_DIR_SRVC_NAME		text
WVR_SRVC_NAME_APNDX_E	Participant-Directed Waiver Service	Text

1915C Appendix J Service

(mdcd_1915c_appendix_j_service — waiver_version_service grain)

Variable	Description	Format
state	Two-letter state postal code.	char(2)
waiver_id	Waiver identifier.	varchar(16)
waiver_version_id	Waiver version identifier.	bigint unsigned
WVR_NUM		text
WVR_SRVC_COMPNT_COST_YR1	Waiver Year 1. Component Cost	Number
WVR_SRVC_COMPNT_COST_YR2	Waiver Year 2. Component Cost	Number
WVR_SRVC_COMPNT_COST_YR3	Waiver Year 3. Component Cost	Number
WVR_SRVC_COMPNT_COST_YR4	Waiver Year 4. Component Cost	Number
WVR_SRVC_COMPNT_COST_YR5	Waiver Year 5. Component Cost	Number
WVR_SRVC_HEADER		text
WVR_SRVC_NAME	Service name.	text
WVR_SRVC_NAME_APNDX_J	Waiver Service/Component	Text
WVR_SRVC_UNITTYPE_YR1	Waiver Year 1. Unit	Text
WVR_SRVC_UNITTYPE_YR2	Waiver Year 2. Unit	Text
WVR_SRVC_UNITTYPE_YR3	Waiver Year 3. Unit	Text
WVR_SRVC_UNITTYPE_YR4	Waiver Year 4. Unit	Text
WVR_SRVC_UNITTYPE_YR5	Waiver Year 5. Unit	Text
WVR_SRVC_USERAVGCOST_YR1	Waiver Year 1. Average Cost/Unit	Number
WVR_SRVC_USERAVGCOST_YR2	Waiver Year 2. Average Cost/Unit	Number
WVR_SRVC_USERAVGCOST_YR3	Waiver Year 3. Average Cost/Unit	Number
WVR_SRVC_USERAVGCOST_YR4	Waiver Year 4. Average Cost/Unit	Number
WVR_SRVC_USERAVGCOST_YR5	Waiver Year 5. Average Cost/Unit	Number
WVR_SRVC_USERAVGUNITS_YR1	Waiver Year 1. Average Units Per User	Number
WVR_SRVC_USERAVGUNITS_YR2	Waiver Year 2. Average Units Per User	Number
WVR_SRVC_USERAVGUNITS_YR3	Waiver Year 3. Average Units Per User	Number
WVR_SRVC_USERAVGUNITS_YR4	Waiver Year 4. Average Units Per User	Number
WVR_SRVC_USERAVGUNITS_YR5	Waiver Year 5. Average Units Per User	Number
WVR_SRVC_USERS_YR1	Waiver Year 1. # Users	Number
WVR_SRVC_USERS_YR2	Waiver Year 2. # Users	Number
WVR_SRVC_USERS_YR3	Waiver Year 3. # Users	Number
WVR_SRVC_USERS_YR4	Waiver Year 4. # Users	Number
WVR_SRVC_USERS_YR5	Waiver Year 5. # Users	Number