Alaska – Appendix K

Waiver Title

People with Intellectual and Developmental Disabilities (IDD); Alaskans Living Independently (ALI) Adults with Physical and Developmental Disabilities (APDD) Children with Complex Medical Conditions (CCMC) Individualized Supports Waiver (ISW)

Description of Emergency

1) Alaska is responding to the COVID-19 virus which disproportionately impacts the populations served under its 1915(c) HCBS waivers, older adults and individuals with underlying health conditions. These individuals may be impacted in three ways: 1) they may become infected and require substantially more care and infection control procedures; 2) their family and paid caregivers may be infected causing disruptions in their current support structures; and 3) the numbers of people with whom they come into contact with will need to be limited to reduce the chance of infection (self-isolation). 2) The emergency may impact all waiver participants because the CDC is advising everyone to engage in social distancing. Care Coordinators and/or direct service providers may be required to notify the Senior and Disabilities Service Division (SDS) if a waiver participant and/or a caregiver becomes infected. 3) SDS will continue to oversee the waiver including overseeing changes to service authorizations to implement the changes. SDS will send out e-alerts to notify providers of the changes and the process for requesting a change to an authorization or service delivery requirement. 4) SDS expects to see the following types of changes to service delivery: • Services being provided in different settings, including services previously provided in the community being provided in private homes and services being provided in alternative settings, such as hotel rooms. • Waiver services being provided in acute settings so that support can be provided by someone familiar with the participants specific needs. • Substitutions across services, such as respite being used instead of day habilitation. • The need for more units of service when a participant has an active infection or if a paid caregiver becomes infected or quarantined. • Services being provided telephonically or via telemedicine to minimize the need for unnecessary in-person contact.

Start Date

11-03-20

End Date

10-03-21

Description of Transition Plan

Individuals will transition to their pre-emergency service plan as soon as they are able or when the disaster is over.

Area(s) Affected

Area Affected

statewide

Increase Cost Limits

AK 1566, or the Individualized Supports Waiver (ISW), ONLY: The cost limit for this waiver may be increased by $5,000 for individuals being treated for COVID-19 or if their primary informal caregiver is quarantined away from the waiver participant.

Modify Targeting Criteria

N/A

Modify Scope or Coverage

SDS may waive settings requirements to restrict outside visitors from visiting recipients in Residential Habilitation and Residential Supported Living settings.

Exceed Service Limitations

Respite: SDS may allow for increase in number of hours for someone being treated for COVID19. Care coordinator will submit a request for additional hours and SDS will review and approve them. Respite: SDS may allow for increase in hours to substitute for decreases in other services, such as day habilitation. The care coordinator will notify SDS of the change. SDS will review and authorize the change. Chore: SDS may increase the cap to 15 hours per week for all individuals and 20 hours per week for individuals with respiratory illnesses. Care Coordinators need to submit the request to SDS and SDS will issue the service authorization. Care Coordination: Care Coordinators may be permitted to bill for an additional monthly rate (2 monthly payments during the emergency) to support people who are without regular services because of service cancellations or being quarantined for COVID-19 or have a primary caregiver who has been quarantined because of COVID-19. This extra payment will support the need for updating plans and additional contacts with participants. The care coordinator must submit a request to SDS.

Add Services

N/A

Expand Settings

If quarantine is necessary for the participant, someone else in the participant’s residence, or the participant’s primary caregiver, the following services may be provided in other settings (described below): • Day Habilitation • Residential Habilitation (includes Group Home, Family Habilitation, In Home Supports, and Supported Living) • Respite (can include room and board if provided in facility-based setting) • Intensive Active Treatment • Residential Supported Living • Adult Day • Provider-site-specific Supported Employment. Additional settings include: • The private home of the participant or a family member of the participant; • TA provider owned or controlled or extended family home; • Community center or designated community gathering center; • Hotel/paid lodging; • Newly rented room; or • Other residential setting • Telework settings

Provide Service Out of State

N/A

Allow Payment for Services by Families

In situations when regular staffing for services approved in a support plan cannot be assured, the state may allow providers to hire family caregivers as direct service workers for the following services: • Chore • Respite • The following types of Residential Habilitation: o Supported Living Services o In Home Supports

Modification of Provider Qualifications

The following changes may be made to direct service worker requirements: • Extend first aid and CPR training certification training requirements for another year and waive the requirement for new hires during the disaster period. • Provisional background checks may be acceptable for all services beyond the regularly allowable 30 days. The following changes may be made to provider certification requirements: • Extend the certifications for up to one year for all providers needing to renew. Providers will not be penalized if they cannot get certification packages submitted in normal timelines or SDS is slow in review and approvals/denials because of staffing. • If the agency’s or home’s program administrator becomes unavailable because of COVID-19, the agency can appoint a temporary administrator who will not have to meet the educational and experience qualification requirements for program administrators (per SDS certification requirements) or administrators of assisted living homes (per DHCS Residential Licensing requirements).

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

Allow providers to temporarily move recipients to a new facility because of a COVID-19 concern. Services and facilities may include: • Residential Habilitation (Group Home or Family Habilitation Home provided in an unlicensed setting) • Residential Habilitation (In Home Supports or Supported Living provided in a recipient’s home or another setting) • Residential Supported Living (provided in an unlicensed setting)

Modification LOC Eval and Re-Eval Processes

The initial Level of Care (LOC) evaluations and change of status evaluations will be modified to include the option for a telephone or other technological contact to determine LOC. SDS may extend LOC determinations for up to one year to reduce risk of infection and burden on participants and State staff. SDS can securely communicate electronically with care coordinators on LOC determinations and approval of support plans, but may need additional time to send hard copy results to recipients

Increase Payment Rates

The Department may increase rates in situations in which the participant or someone in the participant’s household is quarantined because of COVID-19 (to reflect additional operational and cleaning costs, additional staffing costs like overtime, etc.) for the following services and current rates: • Residential Habilitation Group Home: $324.78/day; $359.58 acuity add-on • Residential Habilitation Family Home Habilitation: $122.93 – $153.76/day • Residential Supported Living: $148.08 – $162.70/day; $359.58 acuity add-on • Respite: $4.33 – $6.42/15 minute unit; $207.75 – $307.27/day • Chore: $6.87/15 minute unit Current rates, per the methodology in the currently approved waivers, may be increased by up to 50%. The percentage will be determined based on the availability of services. If the State receives no reports of shortages of a particular service, rates will not increase. Rates will be increased for each service based on reports from care coordinators, participants, and service providers of current or impending shortages that would impact the ability of participant’s to receive the service.

Modifications of ISP

The Person-Centered Service Plan can be renewed in total for an additional 12 months if the meeting is held with individual and individual agrees. The annual plan of care may simply be a continuation of the services currently being rendered under the current service plan if a meeting is held with the individual and the individual agrees and signs off that assessment and services remain appropriate and the providers agree to continue to render the services. This can be accomplished remotely (electronically) with a State approved electronic signature process that is authorized or approved through the State HIPAA compliance officer. The state will ensure the 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 to ensure that the specific service is delineated accordingly to the date it began to be received. The care coordinator must submit the request for additional supports/services no later than 30 days from the date the service begins.

Modify Incident Reporting/Med Management Safeguards

Due to the emergency, SDS requests an extension of 120 days to respond to CMS evidence reports for the period FY17-FY19 for the following 1915(c) waivers: • Control Number 0260.R05 • Control Number 0261.R05 • Control Number 0262.R05 • Control Number 0263.R05

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

The following services may be provided in an acute setting such as a permanent or temporary hospital, when the service is not able to be provided by the Acute Setting provider in a manner that minimizes the risk of inducing disruptive behavior from or causing physical harm to the participant: • Respite • Day habilitation • Intensive Active Treatment Payments for services provided in acute settings will only be allowed as a temporary change during this emergency, and will not exceed 30 consecutive days of service.

Inclusion of Retainer Payments

Retainer payments shall be provided when an individual is under medical quarantine for the duration of the quarantine and shall not exceed the total amount that the provider would have received had services been provided as expected for the following services: • Residential Habilitation Group Home and Family Home Habilitation • Residential Supported Living • Site based Day Habilitation • Adult Day In no cases will these retainer payments exceed 30 consecutive days.

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

N/A

Add Home Delivered Meals

N/A

Add Medical Supplies, Equipment and Appliances

N/A

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

N/A

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

N/A

Adjust Prior Approval/Authorization Elements Approved in Waiver

N/A

Adjust Assessment Requirements

N/A

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

N/A

Link To Application

https://www.medicaid.gov/state-resource-center/downloads/ak-combined-appendix-k-appvl.pdf

Link to Approval Letter

https://www.medicaid.gov/state-resource-center/downloads/ak-appendix-k-appvl-ltr.pdf