State of the States in Intellectual and Developmental Disabilities

These actions will apply across the waiver to all individuals impacted by the COVID-19 virus

EPD Waiver Temporarily allow payment for participant-directed services provided by family members of EPD waiver beneficiaries currently enrolled in the Services My Way program whose approved participant-directed worker (PDW) is unable to provide services as a result of the COVID-19 emergency. This option is only available to beneficiaries actively enrolled in the Services My Way program as of the start date of the COVID-19 emergency. The family members shall receive payment only for services provided in accordance with the beneficiary’s authorized plan of care, and shall comply with all requirements for participant-directed workers under the Services My Way program

EPD Waiver Temporarily allow the District’s Long Term Care Services and Supports (LTCSS) assessment contractor to conduct level of care (LOC) assessments/reassessments via video conferencing/other electronic modality (e.g., Skype, Zoom, FaceTime) or telephone for the duration of the emergency in accordance with HIPAA. LOC assessments/reassessments conducted telephonically may be followed up with in-person face-to-face assessments after the conclusion of the emergency period. If an LOC reassessment cannot reasonably be conducted, due to the inability to access the beneficiary, assessment contractor, or provider, or other unforeseen circumstances resulting from the public health emergency, the annual LOC assessment requirement may be extended for a period of up to twelve (12) months. Initial request for LOC assessment and request for re-assessment will not require physician or APRN authorization for the duration of the emergency period. IDD Waiver The Service Coordinators may review a participant’s current level of need and extend the efficacy of the current annual level of care for a period of up to twelve (12) months. The annual Level of Care (LOC) recertification requirement will be extended for a period of up to twelve (12) months when, as a result of the public health emergency, the DDS DDA Service Coordinator cannot have physical access to the participant. The DDS DDA Service Coordinator will document, in the ISP, the contact with the participant, guardian, and team to discuss the extension, as well as the projected date on which the LOC will be able to be completed. Temporarily allow the annual physical examination requirement to be extended by a period of up to 180 days, if a participant is recommended by the physician or support team not to travel into the physician’s office or clinic during this public health emergency. All documents requiring the Person or Guardian/Representative signature may be obtained via electronic signature.

IDD Waiver Temporarily increase reimbursement rates to IDD providers to support increased costs associated with services provided by Direct Support Professionals (DSP) who, due to a reduction in total available workforce, will work and receive compensation for overtime. Maximum overtime reimbursement for services provided by DSPs shall not exceed $32 per hour ($8/per 15min), except for reimbursement to specific IDD Waiver providers for services provided by DSPs for the following services: • In Home Support – $37 ($9.25/per 15 min) • Behavioral support services – $38 ($9.50/ per 15 min) • Respite – $35 ($8.75/ per 15 min) • Supported Living Periodic – $40 ($10/per 15 min) Temporarily increase reimbursement rates to IDD providers to support increased costs associated with services provided by DSPs because IDD providers, due to a reduction in total available workforce, utilize staffing agencies charging a rate higher than that reimbursed by DHCF. Reimbursement for services provided by such staff may vary, but shall reflect the reasonable, additional costs to the IDD provider. To receive the increased rate, an IDD provider will be required to: 1) identify the staffing agency in the original claim; and 2) submit an invoice for reimbursement that includes the invoice from the staffing agency showing the amount charged. Maximum reimbursement for services provided by DSPs hired through a staffing agency shall not exceed the standard DSP rate by more than 50%. Maximum overtime reimbursement for services provided by DSPs hired through a staffing agency shall not exceed the standard DSP rate by more than 100%. Temporarily increase reimbursement rates to IDD providers to support increased costs associated with DSPs providing services to and working with persons who have been medically quarantined. IDD providers will be reimbursed an increased rate for the first 40 hours worked; and IDD providers will then be reimbursed an overtime rate for any hours worked over 40 hours. For the first 40 hours worked, maximum reimbursement to IDD providers for services provided by DSPs working with persons who have been medically quarantined shall not exceed $32 per hour ($8/per 15min). For any work over 40 hours, the overtime rate for DSPs working with persons who have been medically quarantined shall not exceed $48 per hour ($12/per 15min). Reimbursement to specific IDD Waiver providers for services provided by DSPs for the following services shall not exceed: . • In Home Support – $37 ($9.25/per 15 min); Overtime rate of $56 ($14/per 15 min) • Behavioral Support Services – $38 ($9.50/ per 15 min); Overtime rate of $57 ($14.25/per 15 min) • Respite – $35 ($8.75/ per 15 min); Overtime rate of $53 ($13.25/per 15 min) • Supported Living Periodic – $40 ($10/per 15 min); Overtime rate of $60 ($15/per 15 min). EPD Waiver: Temporarily increase reimbursement rates to home health agencies (HHAs) to support
increased costs associated with services provided by personal care aides (PCAs) because
HHAs, due to a reduction in total available workforce, utilize staffing agencies charging
a rate higher than that reimbursed by DHCF. Reimbursement for services provided by
such staff may vary, but shall reflect the reasonable, additional costs to the HHA
provider. To receive the increased rate, an HHA will be required to: 1) identify the NPI
of the staffing agency in the original claim; and 2) submit an invoice for reimbursement
that includes the invoice from the staffing agency showing the amount charged.
Maximum reimbursement for services provided by PCAs hired through a staffing
agency shall not exceed the standard PCA rate by more than 50%. Maximum overtime
reimbursement for services provided by PCAs hired through a staffing agency shall not
exceed the standard PCA rate by more than 100%.
Temporarily increase reimbursement rates to HHAs for PCA services to accommodate
additional costs associated with the need to pay overtime compensation to individual
staff who, due to a reduction in total available workforce, will work over 40 hours per
hours a week. Maximum overtime reimbursement for services provided by PCAs shall
not exceed $32 per hour ($8/per 15min).
Temporarily increase reimbursement rates to HHAs to support costs associated with
PCAs working with persons who have been medically quarantined. The District will
reimburse for a quarantine period not to exceed to 14 consecutive days. HHAs will be
reimbursed an increased rate for the first 40 hours a PCA works; and will then be
reimbursed an overtime rate for any hours a PCA works over 40 hours. For the first 40
hours worked, maximum reimbursement for services provided by PCAs working with
persons who have been medically quarantined shall not exceed $32 per hour ($8/per
15min). For any work over 40 hours, the overtime rate for services provided by PCAs
working with persons who have been medically quarantined shall not exceed $48 per
hour ($12/per 15min).
Temporarily allow payments equal to 75% of the FFS per diem rate to Adult Day Health
Programs (AHDPs) for wellness checks provided via video conferencing/other
electronic modality (e.g., Skype, Zoom, FaceTime) or telephone for the duration of the
public health emergency, in accordance with HIPAA requirements. A qualifying
wellness check includes, but is not limited to, inquiries/reminders on the following:
• Overall health status, including emotional well-being, need for care, and any
signs or symptoms of illness
• Meals, routines, and medication adherence
• Social isolation and self-quarantine, including the availability/use of informal
supports and access to groceries or emergency supplies
ADHPs shall document all wellness checks in the District’s case management system,
DC Care Connect. Reimbursement is not available for wellness checks provided
simultaneously while a supervisory nurse is present with the beneficiary or the
beneficiary is receiving similar services from another Medicaid State Plan or EPD
Waiver provider.

EPD Waiver and IDD Waiver Temporarily allow case managers to conduct person-centered service plan (PCSP) initial and annual meetings with beneficiaries via video conferencing/other electronic modality (e.g., Skype, Zoom, FaceTime) or telephone for the duration of the emergency in accordance with HIPAA. IDD Waiver Temporarily allow, for the duration of the public health emergency, the use of alternative settings and the use companion services in place of day services. The use of companion services, the increase of in-home supports as needed, and other required changes may be authorized prior to updating the participant’s individual service plan (ISP). The ISP process during the public health emergency is being modified to allow for it to be conducted electronically, in accordance with HIPAA requirements, in lieu of in person. The Service Coordinator, in consultation with the team via telephone or virtually using other electronic communication systems (e.g., Skype), to verify 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, those with service or support needs changes, the ISP will be amended or modified as necessary to ensure the health and safety of the individual. The Service Coordinator will verify by obtaining electronic signatures and documenting in the ISP. The Service Coordinator will monitor the services through a minimum of monthly contact via telephone or virtually, in accordance with HIPAA requirements. The process to monitor service delivery as specified in the service plan will continue as outlined in the approved waiver. All documents requiring the beneficiary’s or Guardian’s/Representative’s signature may be obtained via electronic signature. The Service Coordinator will document in the ISP the type of contact with the participant, guardian/representative, and team.

IDD Waiver Incident Management changes: • The requirement to conduct an investigation of any incident of deviation in staffing as outlined in an individual plan may be suspended. • The requirement to submit an incident report for any deviation in staffing as outlined in an individual plan may be suspended. If this requirement is suspended, providers must report any incidents in which staffing shortages result in a failure to provide care. The Incident Review Committee that meets daily, in conjunction with the IMEU Supervisory Investigator or designee will make a determination on the level of risk or harm to the person and whether an immediate face-to-face follow-up visit is required. Face-to-face follow-up may be extended virtually, such as utilizing Skype. The Incident Review Committee, Supervisory Investigator, or designee can waive the 72-hour faceto-face visit. The IMEU supervisor or designee will review all reported incidents within 72 hours to determine whether employees who are targets of an investigation may return to work. Investigations will be reviewed by the Supervisory Investigator and Service Coordinator to determine if an extension of the time frame for closure is required, to ensure that all evidence can be gathered relative to social distancing recommendations during this public health emergency. The District’s submission of the 372 reports will be delayed by up to thirty (30) days during the public health emergency. EPD Waiver The District’s submission of evidentiary reports will be delayed up to thirty (30) days during the public health emergency

IDD Waiver Participants that require hospitalization due to a diagnosis of COVID-19 may receive the following services in a hospital setting when the participant requires these services for communication, behavioral stabilization and/or intensive personal care needs: • Residential Habilitation Supported Living • In Home and Companion

EPD and IDD Waiver Retainer payments will be made in accordance with the limitations and requirements set forth in Olmstead update letter #3 (July 25, 2000). EPD Waiver Temporarily allow retainer payments equal to 25% of the standard per diem rate to an AHDP if a participant was unable to attend the ADHP because services could not be rendered as a result of the public health emergency. Retainer payments are not available to ADHP providers that also providing traditional ADHP services or providing services via video/telephonic/electronic conferencing to the same beneficiary on a given date of service. Authorized ADHP providers may receive retainer payments for periods up to18 consecutive days. Reimbursement is available for multiple consecutive day periods. Authorized ADHPs may bill for retainer payments for the duration of the public health emergency. IDD Waiver Temporarily allow retainer payments for authorized day program services providers if a participant was unable to attend day program services as a result of the public health emergency, and the participant instead received natural supports, companion services, or in-home supports. Retainer payments are not available to day program providers that also provide the participant with residential services, in-home supports, or companion services. Authorized day program providers may submit claims for retainer payments for up to 18 consecutive days. Reimbursement is available for multiple consecutive day periods. A day program provider seeking a retainer payment must document that the individual was unable to attend the day program as a result of the public health emergency and immediately notify the DDA Service Coordinator. Providers must submit claims for retainer payments within 90 days from the date on which the participant was unable to attend the day program. Retainer payments will not be authorized when a provider is providing services. Day programs are eligible for retainer payments as follows: • Day Habilitation – 33% of standard rate • Day Habilitation 1:1 – 43% of standard rate • Day Habilitation Small Group –46% of standard rate • Individualized Day Supports – 30% of standard rate • Individualized Day Supports 1:1 – 52% of standard rate • Supported Employment – 33% to 35% of standard rate • Employment Readiness – 28% of standard rate Day Program Service Providers that have stopped or reduced services in response to the COVID-19 public health emergency may bill for retainer payments. Retainer payments are received by billing for units authorized in an individual’s service plan that were not provided due to the COVID-19 public health emergency. Units billed shall not exceed the amount, scope, and duration otherwise authorized for the Day Program Service provider. Retainer payments may not be billed when the individual chooses to receive day program services through a different provider. Retainer payments for day services are limited to 5 days per week (Mon-Sun).

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