California – 0336.R04.00

Waiver Title

HCBS Waiver for Californians w/DD (0336.R04.00)

Description of Emergency

1) Nature of Emergency: COVID-19 is a respiratory illness caused by a novel virus that has been spreading worldwide. Community-acquired cases have now been confirmed in California. The Governor’s Office of Emergency Services (OES), the California Department of Public Health (CDPH), and the Department of Health Care Services (DHCS) are gaining more understanding about the spread of, and impact of, COVID-19 on the population as time progresses, and the situation is changing daily. The State of California has been working in close collaboration with the United States’ Department of Health and Human Services and local Medi-Cal Home and Community-Based Services (HCBS) providers to monitor and plan for the potential spread of COVID-19. APPENDIX K: Emergency Preparedness and Response Appendix K-1: General Information 2) Number of Individuals Affected and the State’s Mechanism to Identify Individuals at Risk: On March 4, 2020, California’s Governor declared a State of Emergency in response to the COVID-19 outbreak. As of March 12, 2020, there are 1,215 presumptive cases of COVID-19 in the United States, including 198 confirmed cases and four fatalities in California. Public Health officials expect the number of cases in California to increase, and while the general population are expected to experience mild flu-like symptoms, the population receiving HCBS Waiver services is at a greater risk for experiencing more severe symptoms, hospitalization, and death. 3) Roles of State, Local, and Other Entities Involved in Approved Waiver Operations: As of March 12, it is anticipated that all individuals enrolled on the waiver (currently approximately 135,000) may potentially be impacted, either directly or indirectly, by COVID-19. Regional centers, under contract with the State Department of Developmental Services (DDS), coordinate and oversee the provision of services for those enrolled on the waiver. 4) Expected Changes needed to Service Delivery Methods: To prevent existing and potential Waiver Participants from exposure to COVID-19, DDS will allow the following changes to current Waiver service delivery methods: a) Temporarily change service locations to allow services such as Day Services to be provided in the participant’s home (more details in section K-2(b)(iv); b) Temporarily modify provider qualifications if a participant decides to self-direct to an individual to provide a service, as long as the individual is at least 18 years of age and possess the skills and/or experience to provide the service, as verified by the participant and Financial Management Services provider; c) Temporarily modify service plan development requirements for in-person attendance of service plan development and monitoring meetings, and allow the option for telephonic or live virtual video conferencing in lieu, and in accordance with HIPAA; and d) Temporary authority to make retainer payments for Habilitation, Behavioral: Intervention Services, and Day Services due to absences for this emergency. DDS anticipates that the COVID-19 outbreak will directly impact Regional Center service delivery methods for two to three months, and possibly longer. Therefore, State reporting requirements related to the performance measures data may be impacted by a decrease in face-to-face visits; however, telephonic or video assessments will be attempted instead and documented.

Start Date

04-02-20

End Date

30-06-20

Description of Transition Plan

N/A

Area(s) Affected

Area Affected

statewide

Increase Cost Limits

N/A

Modify Targeting Criteria

N/A

Modify Scope or Coverage

N/A

Exceed Service Limitations

N/A

Add Services

N/A

Expand Settings

The following services identified below may be provided in alternate locations (e.g. the participant’s home, hotels, family homes, and other community settings) if needed, and agreed to upon by the participant: • Day Services • Behavioral Intervention services (individual) • Occupational Therapy • Physical Therapy • Psychology Services • Prevocational Services • Communication Aides • Housing Access Services • Supported Employment Individual • Speech, Hearing, and Language Services • Community Living Arrangements Additionally, to the extent requested by the participant, parent, guardian, or other authorized legal representative, a service typically provided inperson may be provided telephonically, or via live virtual video conferencing. Prior to the delivery of a service by electronic communications, the service provider must notify the regional center that the consumer(s) or representative agrees to remote or virtual services in lieu of in-person services. The regional center shall send a follow-up letter to the family, in the family’s preferred language, confirming that at the family’s request, virtual or remote services will be provided in lieu of in-person services, which may include: • Day Services • Behavioral Intervention services (individual) • Occupational Therapy • Physical Therapy • Psychology Services • Prevocational Services • Communication Aides • Housing Access Services • Supported Employment Individual • Speech, Hearing and Language Services • Community Living Arrangement Services

Provide Service Out of State

N/A

Allow Payment for Services by Families

N/A

Modification of Provider Qualifications

If a participant chooses to temporally self-direct the services listed below, individuals providing the service must be at least 18 years of age and possess the skills and/or experience to provide the service, as verified by the participant and Financial Management Services provider. The other requirements for providers of these services (e.g. education, accreditation, etc.) would not apply if participants choose to self-direct these services. • Community Living Arrangement Services (Supported Living Provider) • Day Services • Supported Employment

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

N/A

Modification LOC Eval and Re-Eval Processes

California will extend the requirement for annual level of care re-evaluations that are due in months of March, April, and May 2020. Any re-evaluations due in this timeframe will be completed by the end date of this Appendix K, June 30, 2020.

Increase Payment Rates

N/A

Modifications of ISP

California will temporarily modify requirements for in-person attendance of service plan development and monitoring meetings. DDS will allow the option for virtual or remote visits to be conducted in lieu of a face-to-face meetings. In instances where the consumer or consumer’s representative requests a remote planning meeting, the regional center will send a follow up letter in the consumer’s preferred language confirming the request and include contact information for the consumer’s service coordinator and their supervisor.

Modify Incident Reporting/Med Management Safeguards

N/A

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

N/A

Inclusion of Retainer Payments

California will make retainer payments for Habilitation services which include personal care: Habilitation, Behavioral Intervention Services, and Day Services– Retainer payments are available only for absences (maximum 30 consecutive days) in excess of the average number of absences experienced by the provider during the 12 month period prior to February of 2020. Retainer payments would only be made for the services listed when providers are not able to provide services using the flexibilities described in K-2-b-iv and services were not provided whether in person or virtually. Note: pursuant to California Code of Regulations 51535(a)(3), payments may be made to a skilled nursing facility for a maximum of 30 days for patients who are on approved leave of absence.

Institute/Expand Opportunities for Self-Direction

California willtemporarily expand self-direction opportunities to include the following services: Supported Employment, Day Services, and Community Living Arrangement Services. The same processes and safeguards regarding self-direction opportunities included in Appendix E apply for these temporarily available services including the provision of information to the participant regarding their responsibilities and functions as either an employer or co-employer, the required use of a Financial Management Services provider, vendored by the regional center to perform selected administrative functions such as payroll, taxes, unemployment insurance, etc.

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/ca-0336-appendix-k-appvl.pdf

Link to Approval Letter

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