Connecticut – 0437.R03.00

Waiver Title

Comprehensive Supports (0437.R03.00); Employment and Day Supports (0881.R01.00); Individual and Family Support (0426.R03.00) [combined]

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.) CT is currently under a Stay Home Stay Safe executive order

Start Date

16-03-20

End Date

15-03-21

Description of Transition Plan

Emergency Plan and Transition Plan 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.) CT is currently under a Stay Home Stay Safe executive order. 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 and are being implemented statewide.

Increase Cost Limits

The state will temporarily permit an emergency increase in the individual cost limit for existing participants if needed to support such participants in the community safely during the emergency, and in order to avoid institutionalization. All modifications resulting in exceeding the individual cost cap are subject to prior authorization by PRAT.

Modify Targeting Criteria

N/A

Modify Scope or Coverage

N/A

Exceed Service Limitations

Waive current 30 day respite limitation with increase up to 90 days at the discretion of the DDS Commissioner to ensure Health and Safety.

Add Services

N/A

Expand Settings

N/A

Provide Service Out of State

For the following services: CLA – Community Living Arrangement, CRS – Continuous Residential Supports, Individual Home Supports, Individualized Day Supports, Personal Supports: In order to ensure health and safety, these services may temporarily be provided out of state provided that the provider meets CTs provider qualifications for those services.

Allow Payment for Services by Families

Individualized Home Supports- (COMP and IFS Waiver) and Individualized Day Support (COMP, IFS and EDS Waiver) The state will temporarily permit family members and legally liable relatives to provide services. Individuals on the OIG’s excluded provider list remain excluded from payment. DDS Family Hire Process will be used as a safe guard

Modification of Provider Qualifications

For self-directed providers of Individualized Home Supports, Personal Supports, Individualized Day Supports, the Department proposes to: • Extend time limit to complete required training from 90 to 180 days •Amend provider standards to qualify a direct worker while his/her background check and preemployment screenings are in pending status. This allowance will be applied to participantdirected service (PDS) arrangements. Further, should a pending screening come back demonstrating concerns with the background check and/or pre-employment screening that would not allow the worker to continue employment long term that worker continues to be qualified until an alternative employee is identified unless the worker poses an immediate jeopardy to health, safety, and/or welfare of the participant or is found to be guilty of past abuse, neglect, exploitation or violent felony and therefore is immediately unqualified.

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

CLA and CCH qualified providers’ licensure will be extended 90 days past current expiration dates.

Modification LOC Eval and Re-Eval Processes

The state will allow assessments and reassessments to be conducted virtually, waiving the faceto-face assessment requirement. The requirements for frequency of reassessments will be temporarily waived, and will be extended to a maximum of 12 months beyond the initial re-evaluation deadline.

Increase Payment Rates

N/A

Modifications of ISP

N/A

Modify Incident Reporting/Med Management Safeguards

Human Rights Committee (HRC) approval will be suspended until after the outbreak, as long as the individual’s team approve of the proposed measures. In case of an emergency, the Regional Director may override the planning team’s decision for remote monitoring based on the needs of the individual and availability of staff. If this remote monitoring is being used to assist staff during times when minimum staffing levels are not met, the provider must have staff available to monitor the individual’s home during the entirety of the time the equipment is in use and staff are not directly supporting the individual. Once the outbreak has ended, continuance of the remote monitoring equipment will require HRC approval.

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

Pay self directed workers during member hospitalization associated with COVID19 for up to 30 days when necessary supports are not available. The payments may not exceed the lesser of 30 consecutive days or the number of days for which the state authorizes a payment for bed holds in nursing facilities.

Inclusion of Retainer Payments

Permit retainer payments for all habilitation programs both residential and days supports that include personal care to ensure continuous operations and sustainability of waiver services. The retainer payments may not exceed the lesser of 30 consecutive days or the number of days for which the state authorizes a payment for bed holds in nursing facilities.

Institute/Expand Opportunities for Self-Direction

N/A

Increase Factor C

N/A

Other Changes Necessary

Permit substitution of lower level staff in a service plan, in order to maximize use of available staffing resources. Continuous Residential Services (COMP and IFS) increase bed capacity temporarily if necessary. DDS currently limits size to no more than 3 unrelated individuals.

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 require verbal cueing; in -home rehabilitation

Add Home Delivered Meals

X

Add Medical Supplies, Equipment and Appliances

N/A

Add Assistive Technology

N/A

Conflict of Interest

Other Changes Necessary

Permit substitution of lower level staff in a service plan, in order to maximize use of available staffing resources. Continuous Residential Services (COMP and IFS) increase bed capacity temporarily if necessary. DDS currently limits size to no more than 3 unrelated individuals.

Other Changes Necessary

Permit substitution of lower level staff in a service plan, in order to maximize use of available staffing resources. Continuous Residential Services (COMP and IFS) increase bed capacity temporarily if necessary. DDS currently limits size to no more than 3 unrelated individuals.

Provider Qualifications

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

X

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

X

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

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

Link to Approval Letter

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