Idaho – Appendix K

Waiver Title

ID Developmental Disabilities Waiver (0076.R06.00)

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.

Waiver Description

Provides residential habilitation, respite, supported employment, financial management services, support broker services, adult day health, behavior consultation/crisis management, chore services, community support services (participant direction), environmental accessibility adaptations, home delivered meals, non-medical transportation, personal emergency response system, skilled nursing, specialized medical equipment and supplies for individuals w/autism, DD, IID ages 18 – no max age

Start Date

27-01-20

End Date

26-01-21

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

Increase Cost Limits

N/A

Modify Targeting Criteria

N/A

Modify Scope or Coverage

homemaker, home delivered meals, PERS (unclear whether added or modified)

Exceed Service Limitations

1. Limitation on Amount of Supported Employment Services. The state may allow participants to exceed service limitation for Community Supported Employment in combination with developmental therapy and adult day health as set forth in Appendix C-1 Service Specification. A service plan addendum must be submitted to the Department with an explanation of how services in excess of the limitation will ensure the health and safety of the participant during the COVID-19 Pandemic. The Department will process plan addendums on an expedited basis and approved services will be prior authorized. 2. Limitation on Amount of Adult Day Health Services. The state may allow participants to exceed service limitation for Adult Day Health in combination with developmental therapy as set forth in Appendix C-1 Service Specification. A service plan addendum must be submitted to the Department with an explanation of how services in excess of the limitation will ensure the health and safety of the participant during the COVID-19 Pandemic. The Department will process plan addendums on an expedited basis and approved services will be prior authorized. 3. Prospective Individual Budget Amounts (as described in Appendix C-4-a). The state will allow costs in excess of a participant’s Prospective Individual Budget Amount when excess costs are a result of temporarily increased payment rates, and/or additional/modified services required to address health and safety issues presented by the COVID-19 Pandemic.

Add Services

homemaker, home delivered meals, PERS (unclear whether added or modified)

Expand Settings

Alternate Settings for Community Support Services (Participant-Direction). The state may allow community support workers to provide Community Support Services in a home, community, or a developmental disability agency’s day facility regardless of the setting identified on the participant’s plan. When providing Community Support Services in an alternate setting, the participant’s record (maintained by the community support worker) must include documentation of the alternate service location and confirm the location was changed in response to the COVID-19 Pandemic.

Provide Service Out of State

N/A

Allow Payment for Services by Families

N/A

Modification of Provider Qualifications

1. Modification of Direct Care Staff Training Requirements. The state may allow newly hired direct care staff to begin rendering services prior to completing the training requirements specified in the “Other Standards” of the “Provider Specifications for Service” found in Appendix C-3 for each waiver service. Direct care staff training requirements must be completed within 30 days of first rendering services. To support informed decision-making, the provider must advise the participant and legal guardian that the direct care staff has not completed the applicable training prior to rendering services. 2. Modification of Criminal History and Background Check Requirements. The state may allow
newly hired direct care staff to begin rendering services under the following conditions and prior to
completing a criminal history and background check as specified in Appendix C-2-a through C-2-b,
and the “Other Standards” of the “Provider Specifications for Service” found in Appendix C-3 for
each waiver service:
• The Criminal History Background Check application must be submitted prior to rendering
services.
• The provider must access the iCourts online system (https//:mycourts.idaho.gov) to complete a
search of any criminal convictions or outstanding warrants associated with the direct care staff. An
attestation that this search was conducted prior to the direct care staff rendering care must be included
with the employee’s file.
• To support informed decision-making, the provider must advise the Medicaid participant or
legal guardian that the direct care staff has not completed the criminal history and background check
prior to rendering services.
• Providers must immediately terminate any direct care staff upon notification of a failed criminal
history and background check and assign a new direct care staff person to the participant.

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

N/A

Modification LOC Eval and Re-Eval Processes

See modifications requested in item 5 of the COVID-19 Pandemic Response Addendum.

Increase Payment Rates

The Department will implement temporary rate changes specified below to maintain a stable workforce and preserve significantly impacted HCBS provider networks. The increased rates were established by comparing utilization during the initial weeks of the COVID-19 Pandemic to utilization during the first two months of 2020. The services experiencing the most significant drops in utilization were allocated a relative portion of available funds. The following services provided by Community Supported Employment Agencies, Developmental
Disabilities Agencies, and Adult Day Health Agencies may be reimbursed at the specified COVID-19 rates
through the specified end dates:
Code Service Title Standard
Rate per
15-min Unit
COVID-19
Rate per
15-min Unit
End Date
H2023 Supported Employment $5.25 $6.21 June 30, 2020
S5100 Adult Day Health $1.50 $2.12 October 22, 2020

Modifications of ISP

Modifications to Participant’s Annual Service Plan. When paid or unpaid support services become unavailable as a result of the COVID-19 Pandemic (e.g. a family member who normally takes care of a participant is hospitalized for COVID-19, a day habilitation facilities close, or schools close) the state may allow substitution services (or increased hours of existing services) to ensure the health and safety of the participant during the COVID-19 Pandemic. A service plan addendum must be submitted to the Department with an explanation of what services are no longer available and how the substitute services/increased hours will ensure the health and safety of the participant during the COVID-19 Pandemic. The Department will process plan addendums on an expedited basis and approved substitution services/increased hours will be prior authorized.

Modify Incident Reporting/Med Management Safeguards

N/A

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

The state may allow residential habilitation providers and community support workers (for participantdirection) to provide services in an acute care hospital during the COVID-19 Pandemic, when the services are: 1. Identified in an individual’s person-centered service plan; 2. Provided to meet needs of the individual that are not met through the provision of hospital services; and 3. Not a substitute for services that the hospital is obligated to provide throu

Inclusion of Retainer Payments

N/A

Institute/Expand Opportunities for Self-Direction

N/A

Increase Factor C

N/A

Other Changes Necessary

1. Modification of Reporting Requirements and Related Quality Assurance Data Collection. The timeframes for the submission of the CMS 372s and the evidentiary package(s) will be extended as needed pursuant to the emergency. In addition, the state may suspend the collection of data for performance measures other than those identified for the Health and Welfare assurance and notes that as a result the data will be unavailable for this time frame in ensuing reports due to the circumstances of the pandemic. 2. Modifications to Termination of Participant Enrollment. The state will not terminate a participant’s waiver enrollment during the Public Health Emergency (PHE), for reasons including (but not limited to) failure to complete an independent assessment (initial or redetermination), f

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, other: The following waiver services (not already specified above) may be delivered via
electronic methods if the service can be safely and effectively delivered via electronic
methods, and fully meets the code definition when provided via electronic methods:
1. Respite Services;
2. Supported Employment Services;
3. Financial Management Services;
4. Support Broker Services;
5. Adult Day Health Services;
6. Behavior Consultation / Crisis Management;
7. Community Support Services;
8. Skilled Nursing; and
9. Transition Services.

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

1. Modification of Reporting Requirements and Related Quality Assurance Data Collection. The timeframes for the submission of the CMS 372s and the evidentiary package(s) will be extended as needed pursuant to the emergency. In addition, the state may suspend the collection of data for performance measures other than those identified for the Health and Welfare assurance and notes that as a result the data will be unavailable for this time frame in ensuing reports due to the circumstances of the pandemic. 2. Modifications to Termination of Participant Enrollment. The state will not terminate a participant’s waiver enrollment during the Public Health Emergency (PHE), for reasons including (but not limited to) failure to complete an independent assessment (initial or redetermination), f

Other Changes Necessary

1. Modification of Reporting Requirements and Related Quality Assurance Data Collection. The timeframes for the submission of the CMS 372s and the evidentiary package(s) will be extended as needed pursuant to the emergency. In addition, the state may suspend the collection of data for performance measures other than those identified for the Health and Welfare assurance and notes that as a result the data will be unavailable for this time frame in ensuing reports due to the circumstances of the pandemic. 2. Modifications to Termination of Participant Enrollment. The state will not terminate a participant’s waiver enrollment during the Public Health Emergency (PHE), for reasons including (but not limited to) failure to complete an independent assessment (initial or redetermination), f

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

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/id-0076-appendix-k-appvl.pdf

Link to Approval Letter

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