Alabama – AL Home and Community -Based Waiver for the Elderly and Disabled (EDW 0068.R07.03); AL Alabama Community Transition (ACT – 0878.R01.02) AL State of Alabama Independent Living (SAIL – (0241.R06.00); AL Technology Assisted Waiver (TA – (0407.R03.00)

Waiver Title

AL Home and Community -Based Waiver for the Elderly and Disabled (EDW 0068.R07.03); AL Alabama Community Transition (ACT – 0878.R01.02) AL State of Alabama Independent Living (SAIL – (0241.R06.00); AL Technology Assisted Waiver (TA – (0407.R03.00)

Description of Emergency

COVID-19 pandemic. This amendment will apply waiver-wide for each waiver included in this Appendix, to all individuals impacted by the virus or the response to the virus (e.g. closure of day programs, etc.)

Waiver Description

AL Home and Community -Based Waiver for the Elderly and Disabled (EDW 0068.R07.03): Provides adult day health, case management, homemaker, personal care, skilled respite, companion service, home delivered meals, and unskilled respite for aged individuals 65 no max age, individuals with physical or other disabilities ages 0 – no max age. AL Alabama Community Transition (ACT – 0878.R01.02): Provides adult day health, case management, homemaker, personal care, respite (skilled and unskilled), adult companion service, assistive technology, home delivered meals, home modifications, medical supplies, personal assistant service, personal emergency response systems-installation/monthly fee, skilled nursing, transitional assistance services for aged individuals 65 no max age and disabled individuals (physical and other) 0 to no max age AL State of Alabama Independent Living (SAIL – 0241.R06.00): Provides case management, personal care, unskilled respite, medical supplies, assistive technology repairs, assistive technology, environmental accessibility adaptations (EAA), evaluation for assistive technology, minor assistive technology, personal assistance service, PERS (installation), PERS (monthly fee) for physically disabled individuals ages 18 – 63. ; AL Technology Assisted Waiver (TA – 0407.R03.00): Provides personal care/attendant services, assistive technology, medical supplies, private duty nursing for technology dependent individuals ages 21 – no max age.

Start Date

27-02-20

End Date

26-02-21

Description of Transition Plan

All activities will take place in response to the impact of COVID-19 as efficiently and effectively as possible based upon the complexity of the change.

Area(s) Affected

Area Affected

These actions will apply across the waiver to all individuals impacted by the COVID-19 virus

Increase Cost Limits

N/A

Modify Targeting Criteria

N/A

Modify Scope or Coverage

Adult Day Health (EDW); Case Management (EDW); Companion (EDW); Home Delivered Meals (EDW); Homemaker (EDW); Personal Care (EDW); Respite-Skilled (EDW); Respite-unskilled (EDW); Personal Care (ACT); Case Management (ACT); Home Delivered Meals (ACT); Medical Supplies (ACT); Adult Day Health (ACT); Homemaker (ACT); Adult Companion Service (ACT); Assistive Technology (ACT); Personal Care (SAIL); Personal Assistance Services (SAIL); Respite (SAIL); Case Management (SAIL); Medical Supplies (SAIL); Assistive Technology (SAIL); Personal Care/Attendant Services (TA); Medical Supplies (TA); Assistive Technology (TA)

Exceed Service Limitations

EDW and ACT: • Temporarily expand eligibility for home-delivered meals to waiver participants of all ages. • Temporarily provide for two-weeks’ worth of meals in certain situations where an individual has food insufficiencies due to the COVID-19 virus, on condition that this does not exceed 2 meals per day for a maximum of 14 meals per week ACT, SAIL, TA: Temporarily allow verbal orders from a physician or other licensed health care provider for non-prescription Specialized Medical Supplies authorized in an individual’s care plan as of the date of the COVID 19 PHE, including adult protective undergarments, catheter bags and other supplies covered under that service; and for nonprescription Assistive Technology authorized in an individual’s care plan as of the date of the COVID-19 PHE. This modification will be in effect beginning March 13, 2020 and extend through the end of the month in which the PHE terminates, not to exceed the end date of the approved Appendix K.

Add Services

N/A

Expand Settings

N/A

Provide Service Out of State

N/A

Allow Payment for Services by Families

N/A

Modification of Provider Qualifications

Temporarily allow initial training for new employees to be performed via other means during the pandemic period. The training may be performed via telephone, webinars, or other online training. The annual training may be delayed during the pandemic period or conducted via electronic methods. This applies to the following services and provider types: Adult Day Health: Director, Adult Day Care Worker (EDW, ACT) Homemaker: Homemaker, Homemaker Supervisor (EDW); Home Care Agency Workers (ACT) Adult Companion: Companion Service Worker (EDW, ACT) Personal Care: Personal Care Worker, LPN (EDW, ACT, SAIL, TA) Personal Assistance Services: Home Health Agency Worker (SAIL) Unskilled Respite: Respite Care Worker, Unskilled (EDW, ACT, SAIL) Home-Delivered Meals: Delivery Driver (EDW, ACT). For existing providers, the state will suspend follow-up verifications of provider qualifications that come due during the pandemic, but will resume such verifications by the end of the month in which the Public Health Emergency ends. Upon resumption, all suspended verifications will be completed within 90 days. This does not apply to initial verifications for new providers, which the state will continue to complete throughout the PHE period.

Modify Provider Types

ACT, SAIL, TA: Providers may be reimbursed at the approved waiver service limits, per existing Waiver limits and guidelines, when purchasing Specialized Medical Supplies and Assistive Technology items from any available vendor, regardless of inclusion on the existing approved vendor list, who can provide necessary and potentially short-supplied items in stock when supply shortages or costs are impacted by circumstances related to the COVID19 pandemic.

Modify Licensure/Requirements for Waiver Settings

N/A

Modification LOC Eval and Re-Eval Processes

N/A

Increase Payment Rates

EDW, ACT: For Personal Care, Homemaker, and Respite services, temporarily increase DSP rates by 10% to cover additional staffing requirements and infection control/PPE supplies due to COVID-19. Temporarily increase Case Management by 5.5% to cover additional staffing requirements and infection control/PPE supplies due to COVID-19. The rate development otherwise remains the same. These rate increases will be in effect beginning on June 1, 2020, and extend through the end of the month in which the PHE terminates, not to exceed the end date of the approved Appendix K. Service Base Rate New Rate Homemaker $3.75 $4.13 Personal Care $3.83 $4.21 Unskilled Respite $3.83 $4.21 Skilled Respite $7.11 $7.82 Case Management Monthly $271.48 $286.48 SAIL: For Specialized Medical Supplies, temporarily increase the monthly rate from $150 to $175 to cover cost increases due to supply shortages. These rate increases will be in effect beginning on June 1, 2020 and extend through the end of the month in which the PHE terminates, not to exceed the end date of the approved Appendix K.

Modifications of ISP

EDW, ACT, SAIL, TA: The state will ensure the person-centered service plan is modified to allow for additional supports/and or services to respond to the COVID-19 pandemic. The specificity of such services including amount, duration and scope will be appended as soon as possible but no later than 30 days to ensure that the specific service is delineated accordingly to the date it began to be received. In the event a PCCP and/or Plan of Care cannot be developed in time to obtain the required signatures through the mail or other means (e.g., HIPAAcompliant electronic methods) before their effective dates, the Support Coordinator may document verbal approval of the services on the part of the person/guardian and verbal agreement from the provider to deliver the services to substitute until the signatures can be obtained. The use of e-signatures that meets privacy and security requirements will be added as a method for the participant or legal guardian signing the PCCP to indicate approval of the plan. Services may start while waiting for the signature to be returned to the case manager, whether electronically or by mail. Signatures will include a date reflecting the PCCP meeting date. An electronic or written signature is required within 45 days of the change(s) made to the PCCP.

Modify Incident Reporting/Med Management Safeguards

EDW, ACT, SAIL, TA: Providers must submit incident reports for participants who test positive for COVID-19 within 48 hours of receiving notification and disclose any exposure of the COVID-19- positive participant to any other waiver participants and/or staff persons. Incident reports must also be submitted within 48 hours for each other participant potentially exposed. While incident reports are required in these instances, there is no automatic requirement for an investigation or corrective action plan, unless the Medicaid Agency or Operating Agency specifically directs that either/both be completed.

Allow Payment for Services During Acute Care Hospital/Short Term Institutional Stay

N/A

Inclusion of Retainer Payments

EDW, ACT: In response to the defined emergency, and in order to maintain a viable workforce, the state may elect to make retainer payments to waiver providers. The State confirms that retainer payments are for direct care providers who normally provide services that include habilitation that includes a component of personal care and personal care, but are currently unable to due to complications experienced during the COVID-19 pandemic because the waiver participant is sick due to COVID-19; or the waiver participant is sequestered and/or quarantined based on local, state, federal and/or medical requirements/orders. The state will implement a distinguishable process to monitor payments to avoid duplication of billing. The habilitation (Adult Day Health) and personal assistance retainer will begin on March 13, 2020, and the time limit may not exceed the lesser of 30 consecutive days or the number of days for which the State authorizes a payment for “bed-hold” in nursing facilities

Institute/Expand Opportunities for Self-Direction

N/A

Increase Factor C

N/A

Other Changes Necessary

N/A

Addendum

HCBS Regulations

Not comply with the HCBS settings requirement at 42 CFR 441.301(c)(4)(vi)(D) that individuals are able to have visitors of their choosing at any time, for settings added after March 17, 2014, to minimize the spread of infection during the COVID-19 pandemic.

Services

Add Electronic Method of Service Delivery

Case management, personal care services that only require verbal cueing, monthly monitoring

Add Home Delivered Meals

X

Add Medical Supplies, Equipment and Appliances

X

Add Assistive Technology

N/A

Conflict of Interest

Other Changes Necessary

N/A

Other Changes Necessary

N/A

Provider Qualifications

Allow Spouses and Parents of Minor Children to Provide Personal Care Servcies

N/A

Allow a Family Member to be Paid to Render Services to an Individual

N/A

Allow Other Practitioners in Lieu of Approved Providers Within the Waiver

N/A

Modify Service Providers for Home-Delivered Meals to Allow for Additional Providers, Including Non-Traditional Providers

N/A

Processes

Allow an Extension for Reassessments and Reevaluations for up to One Year Past the Due Date

X

Allow the Option to Conduct Evaluations, Assessments, and Person-Centered Service Planning Meetings Virtually/Remotely in lieu of Face-to-Face Meetings

X

Adjust Prior Approval/Authorization Elements Approved in Waiver

X

Adjust Assessment Requirements

X

Add an Electronic Method of Signing Off on Required Documents Duch As The Person-Centered Service Plan

X

Link To Application

N/A

Link to Approval Letter

N/A