Florida – DD Individual Budgeting (0867.R02.00)

Waiver Title

DD Individual Budgeting (0867.R02.00)

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.)

Waiver Description

Provides life skills development level 3 – adult day training, residential habilitation, respite, support coordination, adult dental services, occupational therapy, physical therapy, respiratory therapy, skilled nursing, specialized medical equipment and supplies, specialized mental health counseling, speech therapy, transportation, behavior analysis services, behavior assistant services, dietitian services, environmental accessibility adaptations, life skills development level 1 – companion, life skills development level 2 – supported employment, personal emergency response system, personal supports, private duty nursing, residential nursing, special medical home care, supported living coaching for individuals w/autism, ID, DD ages 3 – no max age

Start Date

27-01-20

End Date

26-01-21

Description of Transition Plan

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

Increase Cost Limits

N/A

Modify Targeting Criteria

N/A

Modify Scope or Coverage

N/A

Exceed Service Limitations

The State may allow flexibilities for the following services: • Life Skills Development Level 1- Companion, 2- Supported Employment, and 3- Adult Day Training: The State may allow service hours to be exceeded. • Specialized Medical Equipment and Supplies: The State may allow maximum limits to be exceeded for consumable medical supplies. The waiver support coordinators and the State Operating Agency will be responsible to ensure that all changes in the provision of services in response to the COVID-19 virus are documented in the recipient’s plan of care. The waiver support coordinators and the State Operating Agency will be required to ensure that the services are being provided safely and in accordance with the waiver service definition and service limits. Additionally, the waiver support coordinators must document in the recipient’s plan of care any exceptions that are granted in accordance with this request, including all actions taken to ensure recipient safety.

Add Services

N/A

Expand Settings

The State will provide Life Skills Development Level 1, Level 2, and Level 3 in a recipient’s home, a licensed facility, or any other location in the community as necessary to ensure the safety and welfare of all iBudget recipients in the event provider locations close.

Provide Service Out of State

N/A

Allow Payment for Services by Families

N/A

Modification of Provider Qualifications

N/A

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

The State may allow flexibilities for the following services: • Life Skills Development Level 3- Adult Day Training: The State may allow additional clients to be served beyond currently authorized staffing ratios, provided client and staff safety would not be compromised. • Residential Habilitation: The State may allow additional clients to be served beyond currently authorized staffing ratios, provided client and staff safety would not be compromised.

Modification LOC Eval and Re-Eval Processes

N/A

Increase Payment Rates

N/A

Modifications of ISP

N/A

Modify Incident Reporting/Med Management Safeguards

The State may allow the flexibility to extend the reporting timeframes for providers for critical incidents from one to 24 hours and for reportable incidents from 24 to 72 hours. The timeframe for resolution of critical incidents is extended from 90 days to 120 days.

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

The State may allow the provision of personal supports, supported living coaching, and behavior assistant services in a hospital or other non-forensic institutional setting. Personal supports, supported living coaching, and behavior assistant waiver services may be rendered in an acute-care hospital or short-term institutional stay when the waiver participant is displaced from home because of COVID-19 and such supports are not otherwise available in these settings.

Inclusion of Retainer Payments

The State will implement retainer payments for the following services which include personal care services: • Residential Habilitation: Retainer payments will be offered to providers when the individuals must leave the provider setting for any reason in response to the state of emergency. Retainer payments will be made based upon the average payment amount made to the provider over a retrospective three-month period; payments will be limited to 30 consecutive days of billing or the number of days for what the State authorizes a payment for “bed-hold” in nursing facilities, which will continue during the state of emergency and not to extend past the end date of this Appendix K amendment. Multiple episodes of retainer payments may be authorized for an individual during the period of the COVID-19 pandemic. • Personal Supports: Retainer payments will be offered to providers unable to provide services in response to the public health emergency or the individual is diagnosed with COVID or must self-quarantine (due to local or state requirements) and cannot receive services. Retainer payments will be made based upon the average payment amount made to the provider over a retrospective three- month period; payments will be limited to 30 consecutive days of billing or the number of days for what the State authorizes a payment for “bed-hold” in nursing facilities, which will continue during the state of emergency and not to extend past the end date of this Appendix K amendment. Multiple episodes of retainer payments may be authorized for an individual during the period of the COVID-19 pandemic. Retainer payments will not be available when personal support services are being provided in the home. The State will implement retainer payments for the following services which include habilitation personal care services: • Life Skills Development Level 1- Companion: Retainer payments will be offered to providers unable to provide services in response to the state of emergency or the individual is diagnosed with COVID or must self-quarantine (due to local or state requirements) and cannot receive services. Retainer payments will be made based upon the average payment amount made to the provider over a retrospective three-month period; payments will be limited to 30 consecutive days of billing or the number of days for what the State authorizes a payment for “bed-hold” in nursing facilities, which will continue during the state of emergency and not to extend past the end date of this Appendix K amendment. Multiple episodes of retainer payments may be authorized for an individual during the period of the COVID-19 pandemic. Retainer payments will not be available when companion services are being provided in the home. • Life Skills Development Level 2- Supported Employment: Retainer payments will be offered to providers unable to provide services in response to the state of emergency or the individual is diagnosed with COVID or must self-quarantine (due to local or state requirements) and cannot receive services. Retainer payments will be made based upon the average payment amount made to the provider over a retrospective threemonth period; payments will be limited to 30 consecutive days of billing or the number of days for what the State authorizes a payment for “bed-hold” in nursing facilities, which will continue during the state of emergency and not to extend past the end date of this Appendix K amendment. Multiple episodes of retainer payments may be authorized for an individual during the period of the COVID-19 pandemic. • Life Skills Development Level 3- Adult Day Training: Retainer payments will be offered to providers unable to provide services in response to the state of emergency or the individual is diagnosed with COVID or must self-quarantine (due to local or state requirements) and cannot receive services. Retainer payments will be made based upon the average payment amount made to the provider over a retrospective threemonth period; payments will be limited to 30 consecutive days of billing or the number of days for what the State authorizes a payment for “bed-hold” in nursing facilities, which will continue during the state of emergency and not to extend past the end date of this Appendix K amendment. Multiple episodes of retainer payments may be authorizedfor an individual during the period of the COVID-19 pandemic. Retainer payments will not be available when adult day training services are being provided in the home. The state will implement a distinguishable process to monitor payments to avoid duplication of billing and to monitor the use of retainer payments.

Institute/Expand Opportunities for Self-Direction

Currently, self-direction is only available for individuals enrolled in the 1915(j) CDC+ program. The State may allow self-direction for the following services through the 1915(c) authority: personal supports and transportation. The waiver support coordinators and the State Operating Agency will be responsible to ensure that all changes in the provision of services in response to the COVID-19 virus are documented in the recipient’s plan of care, including any services that will be provided by any provider type authorized in response to the public health emergency, including all actions taken to ensure recipient safety. The waiver support coordinators and the State Operating Agency will be required to ensure that the services are being provided safely and in accordance with the waiver service definition and service limits.

Increase Factor C

N/A

Other Changes Necessary

The State will delay submission of the evidentiary report and the 372 report for up to six months past the end of the public health emergency, as necessary and not to extend past the end date of this Appendix K amendment. Additionally, the State may allow the following flexibilities: • Extend the re-evaluation timeframe for a period not to exceed 12 months for the Questionnaire for Situational Information (QSI), which is to be administered every three years, for individuals scheduled for re-evaluation during the public health emergency. • Extend timeframes for CDC+ purchasing plan reviews and quick updatesfrom 10 days for CDC+ program staff to 30 days. • Move the CDC+ Quality Advisory Committee meetings from quarterly to semiannually, as well as eliminate the requirement for quorum on voting items. • Extend the timeframe to resolve CDC+ complaints and payment issues from 48 hours to 96 hours. • Extend the timeframe to conduct monitoring of CDC+ consultants and representatives from 3 to 10 days subsequent to document submission. • Suspend preparation and dissemination of CDC+ monthly statements as necessary in the event of office closure until staff are permitted to return to the office.

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 only require verbal cueing, in-home habilitation, monthly monitoring

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

The State will delay submission of the evidentiary report and the 372 report for up to six months past the end of the public health emergency, as necessary and not to extend past the end date of this Appendix K amendment. Additionally, the State may allow the following flexibilities: • Extend the re-evaluation timeframe for a period not to exceed 12 months for the Questionnaire for Situational Information (QSI), which is to be administered every three years, for individuals scheduled for re-evaluation during the public health emergency. • Extend timeframes for CDC+ purchasing plan reviews and quick updatesfrom 10 days for CDC+ program staff to 30 days. • Move the CDC+ Quality Advisory Committee meetings from quarterly to semiannually, as well as eliminate the requirement for quorum on voting items. • Extend the timeframe to resolve CDC+ complaints and payment issues from 48 hours to 96 hours. • Extend the timeframe to conduct monitoring of CDC+ consultants and representatives from 3 to 10 days subsequent to document submission. • Suspend preparation and dissemination of CDC+ monthly statements as necessary in the event of office closure until staff are permitted to return to the office.

Other Changes Necessary

The State will delay submission of the evidentiary report and the 372 report for up to six months past the end of the public health emergency, as necessary and not to extend past the end date of this Appendix K amendment. Additionally, the State may allow the following flexibilities: • Extend the re-evaluation timeframe for a period not to exceed 12 months for the Questionnaire for Situational Information (QSI), which is to be administered every three years, for individuals scheduled for re-evaluation during the public health emergency. • Extend timeframes for CDC+ purchasing plan reviews and quick updatesfrom 10 days for CDC+ program staff to 30 days. • Move the CDC+ Quality Advisory Committee meetings from quarterly to semiannually, as well as eliminate the requirement for quorum on voting items. • Extend the timeframe to resolve CDC+ complaints and payment issues from 48 hours to 96 hours. • Extend the timeframe to conduct monitoring of CDC+ consultants and representatives from 3 to 10 days subsequent to document submission. • Suspend preparation and dissemination of CDC+ monthly statements as necessary in the event of office closure until staff are permitted to return to the office.

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

X

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/state-resource-center/downloads/fl-0867-appendix-k-appvl.pdf

Link to Approval Letter

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