Kansas – Appendix K

Waiver Title

Autism (0476.R02.00); Brain Injury, Frail Elderly, Intellectual & Developmental Disability; Physical Disability; Serious Emotional Disturbance; Technology Assisted

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

Autism (0476.R02.00): Provides respite care, family adjustment counseling, and parent support and training (peer to peer) provider for individuals with autism ages 0 – 5; Brain Injury (4164.R06.00): Provides personal care, OT, PT, speech/language, financial management services, assistive services, behavior therapy, cognitive rehabilitation, enhanced care service, home-delivered meals, medication reminder services, personal emergency response system and installation, transitional living skills for individuals with brain injury ages 0-64; I/DD Waiver (0224.R06.00): Provides day supports, overnight respite care, personal care service, residential supports, supported employment, financial management services, assistive services, enhanced care service, medical alert rental, specialized medical care, wellness monitoring for individuals w/autism, DD, IID ages 5 – no max age; Technology Assisted (4165.R06.00): Provides medical respite care, personal care services, financial management services, health maintenance monitoring, home modification, intermittent intensive medical care, specialized medical care for medically fragile and technology dependent individuals ages 0 – 21

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

The requirement the participant must receive at least one service every 30 days is modified to: If a participant receives services less than monthly, then the participant requires regular monthly monitoring.

Modify Scope or Coverage

N/A

Exceed Service Limitations

Allow Personal Care Services to more than one individual at a time and in a group setting as long as billing time is divided to reflect the amount of time rendered to each individual. Allow Respite to more than one individual at a time and in a group setting as long as billing is divided to reflect the amount of time rendered to each individual.

Add Services

Wellness Monitoring; Telehealth Monitoring; Home Delivered Meals; Medical Supplies; Equipment & Appliances; Assistive Technology;

Expand Settings

Day Support Services: The State will allow Day Support services to be provided wherever a participant authorized to receive such services is located. Participants may receive services while living with a paid caregiver; Participants may receive services while living in a temporary family or other home including hotels or crisis housing; I/DD and BI participants may receive services in an assisted living, group home, or home plus setting; I/DD participants may receive day services provided in a home setting wherever the participant is residing. Respite Services: Respite services may include respite provided in a facility-based setting. In a facility-based setting, room and board are excluded. Such settings include hotels or crisis housing as well as assisted living, group home, or home plus setting. Day Support and/or Respite Service will be provided to a participant in any location in which they are residing.

Provide Service Out of State

N/A

Allow Payment for Services by Families

N/A

Modification of Provider Qualifications

Allow relatives of waiver beneficiaries who reside in the home and out of the home to provide services prior to background check and training for 90 days. It is understood that the background check will be submitted by the agency within 30 days after the service begins and training will occur within 90 days of hire without leaving the beneficiary without necessary care. The state is modifying provider standards for relatives to qualify as a direct worker while his/her background check and pre-employment screenings are in pending status. This allowance will be applied to both traditional and participant-directed service (PDS) arrangements. Further, should a pending screening come back demonstrating concerns with the background check and/or preemployment screening that would not allow the worker to continue employment long term that worker continues to be qualified until an alternative employee is identified unless the worker poses an immediate jeopardy to health, safety, and/or welfare of the participant (i.e. has tested positive for infectious disease) or is found to be guilty of past abuse, neglect, exploitation or violent felony and therefore is immediately unqualified. Suspend training requirements for immediate family members and/or legal representatives providing services to waiver participants. As defined by the IRS, “immediate family member” includes a spouse, child, parent, grandparent, brother, sister, grandchild, stepparent, stepchild, stepbrother or stepsister of the participant. CPR/First Aide training will be allowed to be completed online rather than in person.

Modify Provider Types

In the event that there is no Specialized Medical Care provider available to a waiver participant, the Managed Care Organization is authorized to pay Personal Care Services (PCS) in lieu of this service. This exception includes paying parents and family as PCS workers. We will allow for any hours not covered under the Specialized Medical Care due to lack of providers to be covered by Personal Care Services. Personal Care Services will substitute for Specialized Medical Care. The state will allow payment to family caregivers or legally responsible individuals, suspending the conflict of interest mitigation for PCS. We are referring to state identified COI for Guardians and DPOAs. These services may be delivered in a person’s home or a temporary setting, including a family member’s home.

Modify Licensure/Requirements for Waiver Settings

For temporary staff or for services delivered in temporary settings, the requirement to utilize the electronic check in and check out function of the state’s Electronic Visit Verification System is not required. In such instances, paper timesheets may be submitted to the employing agency or to the Financial Management Services provider for billing.

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

Kansas will submit with a nine-month delay 372 reports for 0304.R04.03 PD, 0303.R04.03 FE due 6/30/2020, and 0320.R04.03 SED due 9/30/2020. Kansas requests a three-month extension for 0224.R06.03 I/DD and 4164.R06.03 BI due 12/31/2020. Kansas will submit with a nine-month delay evidence packages for 0320.R04.03 SED, 0476.R02.02 Autism due 6/30/2020 and 4165.R06.02 TA due 10/30/2020. During this crisis, Kansas resources are focused on our COVID-19 response and we will need more time to address these reports and packages once the crisis has passed.

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

Personal Care Services and/or Enhanced Care Services may be paid for no more than 30 consecutive days.

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: Day program services

Add Home Delivered Meals

X

Add Medical Supplies, Equipment and Appliances

X

Add Assistive Technology

X

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

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/ks-combined-appendix-k-appvl.pdf

Link to Approval Letter

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