Iowa – Appendix K

Waiver Title

Iowa Children’s Mental Health Waiver; Iowa HCBS AIDS Waiver; Iowa HCBS Elderly Waiver; Iowa HCBS Intellectual Disabilities Waiver; Iowa HCBS Waiver for Persons w/Physical Disabilities; Iowa HCBS – Brain Injury (BI) Waiver; Iowa HCBS Health and Disability Waiver

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.)

Start Date

27-01-20

End Date

26-01-21

Description of Transition Plan

N/A

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

For the Iowa HCBS Intellectual Disabilities Waiver, Iowa proposes to remove the annual cost limit for respite services during the COVID-19 emergency. Additionally, for all applicable waivers, Iowa proposes to remove the limitation on respite being provided for children while parents, or primary caregivers, are working from home in order to relieve pressure created by work, school, and daycare closures during the COVID-19 emergency

Add Services

Home Delivered Meals; Companion services will be added to all waivers that do not already include this service with the exception of the Children’s Mental Health Waiver; Homemaker services will be added to all waivers that do not already include this service with the exception of the Children’s Mental Health Waiver;

Expand Settings

The State proposes to allow HCBS settings to be expanded as follows, if necessary and appropriate, during the COVID-19 emergency: • Allowing HCBS to be provided in ICF/ID and other facility settings when the individual is quarantined within the facility due to COVID – 19 or when ICF/ID or facility placement is appropriate due to community provider limitation to provide services and for the health and safety of the member due to COVID-19. The State ensures that HCBS provided in facility settings will not duplicate services regularly provided by the facility. • Allowing direct care provider’s homes to be authorized settings – subject to IME approval through an exception to policy request after all other options have been exhausted • Allowing direct care providers to move into member’s homes – subject to IME approval through an exception to policy request after all other options have been exhausted • Lifting the existing limitation on 5 person homes to no longer designate an upper limit. Providers will be allowed to consolidate members into homes, with this allowance limited by the home’s capacity

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

N/A

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

N/A

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

Communication and personal care may be rendered by consumer directed attendant care (all waivers except CMH) and supported community living (Intellectual Disabilities and Brain Injury Waivers) providers 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. Supplemental services provided in the hospital or other institutional placement can only be provided for up to 30 consecutive days.

Inclusion of Retainer Payments

Not applicable for the Children’s Mental Health (CMH) Waiver. For all other waivers, the State proposes that retainer payments may be made for the following services when a member is unable to receive normally authorized and scheduled services due to hospitalization, short term facility stay, isolation, or closure of a service line for any of the services listed below of no more than 30 days related to the COVID-19 emergency: • AIDS Waiver; Elderly Waiver; Health and Disability Waiver – retainer payments may be made pursuant to the paragraph above for Adult Day Care and Consumer Directed Attendant Care. • Physical Disabilities Waiver – retainer payments may be made pursuant to the paragraph above for Consumer Directed Attendant Care. • Intellectual Disabilities Waiver – retainer payments may be made pursuant to the paragraph above for Adult Day Care, Consumer Directed Attendant Care, Day Habilitation, Prevocational Services, and Supported Employment. • Brain Injury Waiver – retainer payments may be made pursuant to the paragraph above for Adult Day Care, Consumer Directed Attendant Care, Prevocational Services, and Supported Employment. The State assures that all of the service categories identified for which retainer payments may be authorized, including Supported Employment and Prevocational Services, are services that include personal care.

Institute/Expand Opportunities for Self-Direction

The State proposes to add home-delivered meals, companion, and homemaker services to available self- directed services under all waivers as indicated in Section A. The State will ensure adequate participant safeguards are in place as the State has set forth in Appendix E of each of its currently approved HCBS waivers

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 require verbal cueing; in -home rehabilitation, monthly monitoring, and other: Completion of initial Level of Care and annual continued stay review
assessments

Add Home Delivered Meals

X

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

N/A

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

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

Link to Approval Letter

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