Louisiana – New Opportunities Waiver (0401.R03.00), Residential Options Waiver (ROW) (0472.R02.00), Children’s Choice (CC) Waiver (0361.R04.00), Supports Waiver (0453.R03.00)

Waiver Title

New Opportunities Waiver (0401.R03.00), Residential Options Waiver (ROW) (0472.R02.00), Children’s Choice (CC) Waiver (0361.R04.00), Supports Waiver (0453.R03.00)

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.)

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 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

LA. 0401-C1/C3, Individual/Family Support: Allow sharing of staff when needed. Day Habilitation: Convert Day Habilitation Hours to one to one IFS hours weekly of Individual/Family Support as Day Habilitation programs are closed. LA. 0472-C1/C3, Community Living Supports: Allow sharing of staff when necessary. Day Habilitation: Convert Day Habilitation Hours to one to one CLS hours weekly of Community Living Supports as Day Habilitation programs are closed. LA.0453 Day Habilitation: Day Habilitation: Convert Day Habilitation Hours to 20 hours weekly of Respite Supports as Day Habilitation programs are closed. LA. 0361 Family Support Service: Allow the addition of 20 hours weekly to address health and safety needs presented due to school closures in the event participant has used all hours in the capped waiver.

Add Services

LA.0401; LA.0472 Add the Monitored In Home Care Giving Service to the New Opportunities Waiver and the Residential Options Waiver to increase home care services where the caregiver will be provided oversight of the individual’s health condition.

Expand Settings

LA. 0401-C2,3 of 3. e; Allow participant and worker to live in the same setting so that the recipient may receive Individual and Family Support services LA. 0453-C2, 3 of 3.e; Allow participant and worker to live in the same setting so that the recipient may receive respite and habilitation services LA. 0361-C2, 3 of 3.e; Allow participant and worker to live in the same setting so that the recipient may receive Family Support services LA. 0472-C2, 3 of 3.3; Allow participant and worker to live in the same setting so that the recipient may receive Community Living Services

Provide Service Out of State

N/A

Allow Payment for Services by Families

LA.0401, LA.0472, & LA.0361-Allow legally responsible relatives to be temporary Individual Family Support, Companion Care, Community Living Support and Family Support workers during the pandemic crisis in the absence of Direct Support Worker care LA.0453-C-2 3 of 3.e; Allow payment to legally responsible relatives for Respite and Habilitation during the pandemic crisis if necessary during the absence of Direct Support Worker care. Documentation of services rendered is required and will be verified by the Support Coordination Agency.

Modification of Provider Qualifications

LA 0472 & LA0361 Allow the age 16 and up if necessary (emergency-no other staff/support available) and remove the requirement for a high school diploma for Direct Support Workers in Self-Direction. LA.0401, LA.0472, LA.0453 & LA.0361 Suspend background checks for immediate family members who live in the home with the participant.

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

N/A

Modification LOC Eval and Re-Eval Processes

LA.0401, LA.0472, LA.0453, LA.0361:B.6i: Re-evaluation requires a doctor’s visit (well visit) to obtain a 90L for the waiver level of care. To reduce viral exposure to participants; allow the current evaluation to remain in effect until resolution of pandemic crisis not to exceed beyond 12 additional months past when the level of care is due. LA.0401, LA.0472, LA.0453, LA.0361:B.6i: For initial waiver participants allow the Statement of Approval of ID/DD services to suffice for the level of care until the pandemic crisis is resolved so as not to hold up waiver services for those who have been waiting.

Increase Payment Rates

LA. 0401, LA.0472, LA.0361 & LA. 0453: Add $2.00 per hour ($.79 per quarter hour) for services of Individual Family Supports, Community Living Supports, Family Support, Respite and Habilitation for a hazard premium for Direct Support Workers who still go into the homes of persons who are positive or presumptive positive or quarantined for the Coronavirus.

Modifications of ISP

LA. 0401, LA.0472, LA. 0361, & LA. 0453: The following services and processes will be modified: Allow virtual/remote/phone call visits in accordance with HIPAA requirements and in place of  10-day initial home visit  Initial assessment  Quarterly home visit  OCDD waiver certification visits  Yearly plan-of-care visit (signatures may be obtained electronically or by mail)  Waive the 30-day Continuity of Care rule in the NOW (LA.0401) as families are frightened of the virus at this time and may elect to provide natural supports in lieu of services The participant will continue to receive monthly monitoring by support coordination.

Modify Incident Reporting/Med Management Safeguards

N/A

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

N/A

Inclusion of Retainer Payments

LA. 0401, LA. 0472, & LA.0453: Under this declared federal and state emergency, when an Adult Day Habilitation Center and an Adult Day Health Care who provide personal care services is ordered to close by local, state or federal officials, the state may elect to make retainer payments to providers to assure their ability to resume community based services. Retainer payments will be made based on the number of enrollees absent from the Day Habilitation Program and/or the Adult Day Health Care Center at 75% of the current rate. Retainer payments will be made for 22 consecutive days of billing which corresponds to Louisiana’s nonmutually exclusive Nursing Home bed hold periods of 15 days for home leave and 7 days for hospital leave.

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 veral cueing; monthly monitoring, in-home habilitation, other: Supervised Independent Living visits, Monitored In Home Caregiving

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

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

N/A

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/la-0401-0472-0361-0453-combined-appendix-k-appvl.pdf

Link to Approval Letter

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