Connecticut – 1085.R01.00

Waiver Title

Acquired Brain Injury Waiver II (1085.R01.00)

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.) 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

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 is 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 Community Options clinical staff

Modify Targeting Criteria

N/A

Modify Scope or Coverage

N/A

Exceed Service Limitations

The 18-hour daily limit on Companion Services will be temporarily suspended, with care manager approval, when necessary to support individuals safely in the community.

Add Services

N/A

Expand Settings

N/A

Provide Service Out of State

This authority is being requested under an 1135 waiver

Allow Payment for Services by Families

N/A

Modification of Provider Qualifications

For ABI Group Day (Community Integration Agency Provider, Employment Services/Supports Agency Provider, Rehabilitation Hospital Outpatient Department Provider), Personal Care (Agency Provider), Respite (Agency Provider or Private Household Employee), ABI Recovery Assistant II (Rehabilitation Hospital Outpatient Department, Community Integration Services Agency, Certified Individual provider), ABI Recovery Assistant I (Rehabilitation Hospital Outpatient Department, Community Integration Services Agency, Certified Individual provider),Community Living Support Services (Agency or Rehabilitation Hospital Provider) , Companion (Agency Provider or Private Household Employee), Independent Living Skills Training (Agency Provider, Individual Private Provider, Rehabilitation Hospital Outpatient Department), and Substance Abuse Programs (Substance Abuse Diagnostic and Treatment Centers)rec, waive the initial premployment training requirement that providers have completed an approved training program concerning acquired brain injury and person-centered planning, given by a state agency, the fiduciary, community providers, Brain Injury Alliance of CT, or an Independent Living Center. The trainings(s) will still be available, and will be made available in a virtual format for providers, but will not be a prerequisite to providing services during the emergency period. Training would need to be completed within 60 days of the date of hire.

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

N/A

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 3 months beyond the initial re-evaluation deadline.

Increase Payment Rates

In the event of staffing shortages, Companion Service (Agency and Private Household Employee) and Personal Care (agency)will be entitled receive payment at time-and-a-half when working over 40 hours per week, if such additional hours are necessary to support members in the community safely. A new rate is being developed that would permit a higher rate only for hours of service paid at time and a half. This is subject to departmental approval. The rate methodology for the overtime payments is consistent with currently approved rate methodology.

Modifications of ISP

N/A

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

N/A

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, such as substituting a Companion for a Homemaker or an ILST, or Companion or Homemaker for a Recovery Assistant, when necessary and in order to maximize use of available staffing resources.

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; other: Companion Service: Permit Companion service to be provided electronically
or telephonically for up to two hours per day

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

Permit substitution of lower level staff in a service plan, such as substituting a Companion for a Homemaker or an ILST, or Companion or Homemaker for a Recovery Assistant, when necessary and in order to maximize use of available staffing resources.

Other Changes Necessary

Permit substitution of lower level staff in a service plan, such as substituting a Companion for a Homemaker or an ILST, or Companion or Homemaker for a Recovery Assistant, when necessary and in order to maximize use of available staffing resources.

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

X

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

https://www.medicaid.gov/sites/default/files/2020-03/ct-1085-appendix-k-appvl.pdf

Link to Approval Letter

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