Indiana – Aged & Disabled Waiver (A&D) and Traumatic Brain Injury Waiver (TBI)

Waiver Title

Aged & Disabled Waiver (A&D) and Traumatic Brain Injury Waiver (TBI)

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

Aged and Disabled (0210.R06.00): Provides adult day service, attendant care, care management, home and community assistance service, respite, adult family care, assisted living, community transition, home delivered meals, home modification assessment, home modifications, integrated health care coordination, nutritional supplements, personal emergency response system, pest control, specialized medical equipment and supplies, structured family caregiving, transportation, vehicle modifications for aged individuals 65 yrs – no max, physically disabled/disabled other ages 0-64; Traumatic Brain Injury (4197.R04.00): Provides adult day services, attendant care, care management, home and community assistance, residential based habilitation, respite, structured day program, supported employment, adult family care, assisted living, behavior management/ behavior program and counseling, community transition, home delivered meals, home modifications, integrated health care coordination, nutritional supplements, personal emergency response system, pest control, specialized medical equipment and supplies, transportation, vehicle modifications for individuals w/brain injury ages 0 – no max age

Start Date

01-03-20

End Date

28-02-21

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 waivers 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

Care Management; Respite; Structured Family Caregiving;

Add Services

Care Management; Respite; Structured Family Caregiving;

Expand Settings

• Temporarily expand settings to nursing facilities and adult day service provider congregate settings as respite providers for waiver participants who are unable to receive care due to provider agencies and facilities placing services on hold due to COVID-19. Room and board is not included. Respite services provided in these setting will not be extended for more than 30 days. • Allow Adult Day Service providers, who have closed, to provide the services in a participant home

Provide Service Out of State

N/A

Allow Payment for Services by Families

N/A

Modification of Provider Qualifications

Temporarily modify provider qualifications to suspend DA & state administrative code requirements 455 IAC 2-6 for Attendant Care, Home and Community Based Assistance (Homemaker), Home Delivered Meal, Respite Services, and Integrated Health Care Coordination. This includes obtaining a limited crimina

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

Temporarily modify provider licensure to suspend license requirements 455 IAC 2-6 for Attendant Care and Respite services including collecting the license and checking the nurse registry.

Modification LOC Eval and Re-Eval Processes

N/A

Increase Payment Rates

N/A

Modifications of ISP

Person-Centered Service Plans that are due to expire within the next 60 days require case management contact to the participant using allowable remote contact methods to verify with the participant or representative that the current assessment and services, including providers, remain acceptable and approvable for the upcoming year. The state will verify by obtaining electronic signatures/or electronic verification dated the day of the meeting via secure email consent from service providers and the individual or representative, in accordance with the state’s HIPAA requirements. The state will ensure the service plan is modified to allow for additional supports/and or services to respond to the COVID-19 pandemic. The specificity of such services including amount, duration and scope will be appended as soon as possible to ensure that the specific service is delineated accordingly to the date it began to be received. The care coordinator must submit the request for additional supports/services no later than 30 days from the date the service begins. Given the rapid response that will be necessary to ensure participant health and welfare and to avoid delays while waiting for approval and authorization of individual plan changes, documentation of verbal approval or email approval of changes and additions to individual plans will suffice as authorization. Services may start while waiting for the signature to be returned to the case manager, whether electronically in accordance with HIPAA requirements or by mail. Signatures will include a date reflecting the meeting date.

Modify Incident Reporting/Med Management Safeguards

N/A

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

Temporarily allow for the payment of Attendant Care, Home and Community Based Assistance, Structured Family Caregiving, and Health Care Coordination for the purpose of supporting waiver participants when these supports are not available in institutional settings. To be provided in these settings, these necessary supports: To be provided in these settings, these necessary supports: • Must be identified in an individual’s person-centered service plan; • Must be provided to meet the individual’s needs and cannot be provided in such settings; • Should not substitute for services that the setting is obligated to provide through its condition of participation under Federal or State law, or under another applicable requirements; and • Should be designed to ensure smooth transitions between the setting and the home and community-based setting and preserves the participant’s functional abilities.

Inclusion of Retainer Payments

N/A

Institute/Expand Opportunities for Self-Direction

N/A

Increase Factor C

N/A

Other Changes Necessary

N/A

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, and other: For the non-personal care activities performed by the Structured Family
Caregiving service.
• Screening of COVID-19 prior to in-home visits by any home-based provider.

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

N/A

Other Changes Necessary

N/A

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

X

Allow Other Practitioners in Lieu of Approved Providers Within the Waiver

X Adult Day Providers as Attendant Care, Home and Community Based Assistance
(Homemaker), and Respite Care

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

N/A

Link to Approval Letter

N/A