Health Care Cost Containment System (1115 Demonstration Project No. 11-W-00275/9)
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.)
Description of Transition Plan
These actions will apply across the waiver to all individuals impacted by the COVID-19 virus
Access and Eligibility
Increase Cost Limits
Modify Targeting Criteria
Modify Scope or Coverage
Exceed Service Limitations
Home Delivered Meals
The state requests the flexibility to allow providers, in consultation with the state’s licensing agency, to provide services in alternative settings including settings that are licensed for other purposes (i.e. residential providing using a day program facility) or unlicensed settings (i.e. hotels, schools, churches and/or permanent or temporary shelters) for residential or day programming in an effort to mitigate COVID-19 spread.
Provide Service Out of State
Allow Payment for Services by Families
Modify Provider Qualifications
Modification of Provider Qualifications
Modify Provider Types
Modify Licensure/Requirements for Waiver Settings
Modification LOC Eval and Re-Eval Processes
Increase Payment Rates
Modifications of ISP
For Person-Centered Service Plans that are due to expire within the next 60 days, case managers will be required to make contact with members/Health Care Decision Makers, using allowable remote contact methods in order to verify with the members/Health Care Decision Makers that the current assessed needs, services and supports, including service providers, are still appropriate and should continue to be authorized through the next review period. Additionally, the state will ensure that member service plans are modified to allow for additional supports and/or services to respond to the COVID-19 pandemic. The state will verify by obtaining electronic signatures, electronic verification via secure email from the member/Health Care Decision Maker and service providers, in accordance with the states HIPAA requirements, and must be documented in the members case management file. The specificity of such services including amount, duration and scope will be appended in the members service plan as soon as possible to ensure that the specific services are delineated accordingly to include the date the services were received/rendered, but no later than 30 days from the date the services began. If members/Health Care Decision Makers are not able to be reached via telephone or other electronic means, outreach attempts must be documented in the members case management file.
Modify Incident Reporting/Med Management Safeguards
Allow Payment for Services During Acute Care Hospital/Short Term Institutional Stay
The state will allow for payment for services for the purpose of supporting waiver participants in an acute care hospital or short-term institutional stay when necessary supports are not available in that setting during this emergency. Payments may only be made for up to 30 consecutive days.
Inclusion of Retainer Payments
Retainer payments will be made to providers to address reductions in utilization of services related to the COVID-19 emergency, such as missed appointments or decreased frequency of members receiving services. The payments are intended to ensure provider sustainability by helping to offset the reduction in revenue experienced by providers due to members staying home and avoiding care, or providers otherwise being unable to provide in-person or telehealth services to members. AHCCCS currently intends to implement retainer payments as follows:
? Retainer payments will be authorized for providers of habilitation and personal care
? Specific provider types and procedure codes will be identified.
? Providers will be determined by AHCCCS to be qualified to bill for retainer payments
by submitting an attestation in template form that includes the following information:
? Provider information including Tax Identification Number, Provider Name, and
Provider AHCCCS ID.
? Summary description of the decline in utilization attributable to COVID-19.
? Summary estimate of weekly units by service code it anticipates it will bill each
Health Plan for retainer payments.
? Confirmation it understands and will follow the specific billing guidance,
subject to future audit.
? Confirmation it understands that retainer payments may be subject to
recoupment if an audit determines that inappropriate billing or duplicate
payments for services occurred.
? Qualifying providers will bill for specific services that would have been provided to
? Retainer payments may only be billed for specific services authorized and
documented in the members service plan.
? Units billed shall not exceed the amount, scope, and duration authorized for the
? Retainer payments may not be billed when the member chooses to receive
services through a different provider.
? Retainer payments will not be made if the member receives the same
service from a different provider within the same time period, e.g. on
the same day if a daily service, or within the same week if a weekly
? AHCCCS will designate the GY modifier to be used by providers to bill for
retainer payments during the emergency period.
? Retention payments for qualifying services may not exceed 30 consecutive
? AHCCCS will establish additional billing, reporting, submission, and payment
requirements and timelines for providers and Health Plans in order to ensure timely and
accurate payment of claims and submission of encounters.
? Retainer payments are anticipated to be made available to qualifying providers for
qualifying habilitation and personal care services for the duration of the emergency
period. Retainer payment may not exceed the lesser of 30 consecutive days or the
number of days for which the state authorizes a payment of bed hold in nursing
Institute/Expand Opportunities for Self-Direction
Increase Factor C
Other Changes Necessary
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.
Add Electronic Method of Service Delivery
Case management, personal care services that only require verbal cueing, in-home habilitation.
Add Home Delivered Meals
Add Medical Supplies, Equipment and Appliances
Add Assistive Technology
Conflict of Interest
Other Changes Necessary
Other Changes Necessary
Allow Spouses and Parents of Minor Children to Provide Personal Care Servcies
X Afford the state additional flexibility to allow for legally responsible individuals
(parents and spouses) to receive payment for direct care services. Permitting
parents of minor children to receive payment for direct care services. Removing
the 40 hour maximum hours per week of services a member can receive if they
have a spouse serving as the paid caregiver as well as allowing the spouse to
provide the total amount of attendant care the member receives. The parents and
spouses must be employed/contracted by an AHCCCS Registered Direct Care
Allow a Family Member to be Paid to Render Services to an Individual
Allow Other Practitioners in Lieu of Approved Providers Within the Waiver
Modify Service Providers for Home-Delivered Meals to Allow for Additional Providers, Including Non-Traditional Providers
Allow an Extension for Reassessments and Reevaluations for up to One Year Past the Due Date
Allow the Option to Conduct Evaluations, Assessments, and Person-Centered Service Planning Meetings Virtually/Remotely in lieu of Face-to-Face Meetings
Adjust Prior Approval/Authorization Elements Approved in Waiver
Adjust Assessment Requirements
Add an Electronic Method of Signing Off on Required Documents Duch As The Person-Centered Service Plan