Massachusetts – Frail Elder Waiver (FEW) MA.0059.R07.01; Traumatic Brain Injury (TBI) Waiver MA.0359.R04.01; MFP – Community Living (MFP-CL) Waiver MA.1027.R01.02; MFP – Residential Supports (MFP-RS) Waiver MA.1028.R01.01; Acquired Brain Injury with Residential Habilitation (ABI-RH) Waiver MA.40701.R02.02; Acquired Brain Injury Non-residential Habilitation (ABI-N) Waiver MA.40702.R02.01; Community Living Waiver (DDS-CL) MA.0826.R02.01; Intensive Supports Waiver (DDS-IS) MA.0826.R02.01 MA.0827.R02.01; Adult Supports Waiver (DDS-AS) MA.0828.R.02.01; Children’s Autism Spectrum Disorder Waiver MA.40207.R02.02

Waiver Title

Frail Elder Waiver (FEW) MA.0059.R07.01; Traumatic Brain Injury (TBI) Waiver MA.0359.R04.01; MFP – Community Living (MFP-CL) Waiver MA.1027.R01.02; MFP – Residential Supports (MFP-RS) Waiver MA.1028.R01.01; Acquired Brain Injury with Residential Habilitation (ABI-RH) Waiver MA.40701.R02.02; Acquired Brain Injury Non-residential Habilitation (ABI-N) Waiver MA.40702.R02.01; Community Living Waiver (DDS-CL) MA.0826.R02.01; Intensive Supports Waiver (DDS-IS) MA.0826.R02.01
MA.0827.R02.01; Adult Supports Waiver (DDS-AS) MA.0828.R.02.01; Children’s Autism Spectrum Disorder Waiver MA.40207.R02.02

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

MULTIPLE: see: https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/index.html?f%5B0%5D=waiver_state_facet%3A841#content

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 waiver to all individuals impacted by the COVID-19 virus.

Increase Cost Limits

N/A

Modify Targeting Criteria

MFP-CL and ABI-N Waivers – expand eligibility to include individuals discharged from qualifying long-stay facilities prior to reaching a continuous 90-day stay due to COVID-19. Children’s Autism Spectrum Disorder Waiver – raise maximum age to include children through age 9 (up to 10th birthday)

Modify Scope or Coverage

N/A

Exceed Service Limitations

MFP-CL, ABI-N, TBI – exceed 84-hour/week limit on in-home, non-residential services specified in Appendix C-4: All Waivers – exceed 30-day limit on Respite services. When the stay exceeds 30 consecutive days, the state has mechanisms in place to prevent duplicate billing for both institutional and HCB services. Children’s Autism Spectrum Disorder Waiver – suspend counting of length of participation in Expanded Habilitation, Education for duration of COVID-19 emergency. Children’s Autism Spectrum Disorder Waiver – increase budget limits as follows: Increase individual prospective budget limit from $25,000 to $28,000; Increase step-down budget from $7,500 to $8,500; Waive limits on individual services for all services with an individual limit.

Add Services

Assistive Technology for Telehealth Delivery of HCBS Waiver Services;

Expand Settings

All applicable waivers – Allow waiver day services to be provided in participants’ homes, including in group home settings; All waivers – Allow all waiver services, including respite, to be provided to participants residing in alternative settings as necessitated because of the COVID-19 emergency, such as hotels, shelters, or residential schools; HCBS provided in group home settings and other alternative settings will not duplicate other Medicaid services provided in those settings.

Provide Service Out of State

Intensive Supports Waiver – Allow waiver services to be provided in out-of-state settings. The state will obtain provider agreements with out-of-state providers for services in out-of-state settings.

Allow Payment for Services by Families

N/A

Modification of Provider Qualifications

1. All waivers – The Governor of Massachusetts has issued a series of executive orders extending the professional and occupational licenses, certifications, and registrations of individual licensed health care and other registered professionals in good standing that are set to expire during the state of emergency, for the duration of the COVID-19 emergency plus 90 days. In addition, where provider agency licensure/certification requirements are included in waiver provider qualifications, the state will consider provider agencies’ credentials in good standing that are set to expire or are due for review/renewal during the state of emergency, to continue for the duration of COVID-19 emergency plus 90 days. The extension of licensure/certification applies to individual and agency providers of the following waiver services (grouped by service type for ease of reference): Residential Support Services (Residential Habilitation; Shared Living – 24 Hour Supports; Assisted Living Services; Independent Living Supports; Shared Home Supports); Personal Care ADL/Supports (Home Health Aide, Personal Care, Supportive Home Care Aide); In-Home Supports/IADL Supports (Homemaker); Community Engagement and Skills Training (Community Based Day Services; Evidence Based Education Programs; Goal Engagement Program; Peer Support); Therapy and Nursing (Complex Care Training & Oversight; Occupational Therapy, Physical Therapy, Skilled Nursing, Speech Therapy); Family Support/Respite Services (Alzheimer’s/Dementia Coaching, Respite, Stabilization); Environmental Modifications and Accessibility Supports (Home / Environmental Accessibility Adaptations, Home Safety & Independence Evaluations, Orientation and Mobility Services); Behavioral Supports (Behavioral Supports and Consultation, Community Behavioral Health Support & Navigation, Expanded Habilitation, Education); 2. Children’s Autism Spectrum Disorder Waiver – For Direct Support staff (Expanded Habilitation, Education; Behavioral Supports and Consultation; Community Integration), waive requirement for Bachelor’s Degree; require minimum age of 18. For all provider levels in the following services, waive in-service training hours requirements: Expanded Habilitation, Education, Behavioral Supports and Consultation, Community Integration, Family Training); 3. Community Living, Intensive Supports, Adult Supports, and Children’s Autism Spectrum Disorder Waivers – For all services in these waivers, and for DDS-licensed residential and day providers in ABI-N, ABI-RH, MFP-CL, MFP-RS, and TBI, suspend requirements for providers to obtain national criminal background checks, including fingerprint requirements, before beginning work; and extend conditional employment/certification for those with scheduled national criminal background check appointments. If, once the background check is conducted, it is determined that a provider should not continue working with the participant, such provider immediately will be found to be unqualified to render services.

Modify Provider Types

Children’s Autism Spectrum Disorder Waiver – Allow licensed Special Education teachers to qualify as Therapist and Senior Therapist provider types for Expanded Habilitation, Education, Behavioral Supports and Consultation, and Family Training

Modify Licensure/Requirements for Waiver Settings

N/A

Modification LOC Eval and Re-Eval Processes

All waivers – allow delay of completion of annual LOC re-evaluations due for completion during COVID-19 emergency; All waivers – allow LOC assessments to be conducted via electronic methods, (telephone/video)

Increase Payment Rates

To effectively respond to the COVID-19 outbreak, the state requires flexibility to adjust provider rates to ensure availability of providers for waiver participants. The state may reimburse providers with enhanced COVID-19 add-on rates up to 10% of historic average monthly billing, based on current market factors and additional costs impacting specific service sectors: Enhancements to residential rates to account for increased daytime staffing needs; and Enhancements for in-home support services rates to account for complexity of providing services during COVID-19 emergency. In the Frail Elder Waiver only, for in-home services including Home Health Aide, Supportive Home Care Aide, Personal Care, Homemaking, Companion, Chore, Complex Care Training and Oversight, when the participant or a member of the participant’s household has been diagnosed as COVID-19 positive or has been advised to self-quarantine, the state may pay providers of these services an enhanced rate to account for complexity of providing services. The enhanced rates for these services will include compensation for willing workforce, necessary personal protective equipment (PPE) consistent with CDC and OSHA guidance; i.e., based on risk level, and required training on use of PPE during interactions with waiver participants. Payment rates for these services may be increased up to an additional 50% of the maximum rate for each service.

Modifications of ISP

All waivers, allow electronic (e.g., telephonic/video) performance of person-centered planning meetings; All waivers, for completion of annual person-centered planning process where review was due for completion during COVID-19 emergency, with documentation of participant consent, waive requirements for full Team participation in person-centered planning meetings, allowing case managers and participants to jointly make updates and revisions in a timely manner. Note: Any authorization to substitute documented verbal consent for a regulatory requirement for person-centered service plans will come through an 1135.

Modify Incident Reporting/Med Management Safeguards

Allow six-month delay of submission of all HCBS waiver reports due during COVID-19 emergency, including CMS-372 reports.

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

For all waivers, allow delivery of applicable waiver services in acute care hospitals or short-term institutional stays when necessary supports are not available in that setting, or when needed for purposes of behavioral stabilization or communication facilitation and such services are not otherwise covered in such settings. Services include: Residential Habilitation, Personal Care, Adult Companion/companion, Behavioral Supports and Consultation & Expanded Habilitation, Education

Inclusion of Retainer Payments

For Day Habilitation Supplement services in the Community Living, Intensive Supports, and Adult Supports Waivers, to ensure sufficient availability of providers during and after the COVID-19 emergency, the state requires temporary authorization of retainer payments for waiver providers of habilitation programs that have been closed due to COVID-19 related public health concerns for the duration of the COVID-19 state of emergency. The retainer time limit may not exceed the lesser of 30 consecutive days or the number of days for which the State authorizes a payment for “bed-hold” in nursing facilities. Retainer payments will not duplicate payments for services delivered through alternate methods, and must be attributable to each individual absent from the habilitation program.

Institute/Expand Opportunities for Self-Direction

N/A

Increase Factor C

N/A

Other Changes Necessary

All waivers – temporarily suspend waiver provider monitoring/oversight activities that are impacted by the COVID-19 emergency, including but not limited to on-site licensure visits, desk reviews, and credential verification functions. Provider monitoring/oversight activities typically require providers to produce a range of documentation such as required staff trainings and other administrative/operational processes. During the COVID-19 emergency, providers may be temporarily closed, operating with reduced staff, lack of access to electronic infrastructure/resources, and/or directing all available resources to addressing the immediate challenges and complexities of delivering services to waiver participants during the COVID-19 emergency, and consequently unable to collect and produce required documentation. In addition, the entities responsible for verifying provider qualifications face operational barriers to completing monitoring/oversight activities due to limitations on on-site visits, receipt of documentation, and the need to focus resources on the COVID-19 response effort during the emergency.

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

personal care services that nonly require verbal cueing; in-home habilitation; monthly monitoring, other: In all applicable Waivers (examples provided where remote provision of services may need clarification):
• Adult Companion/Companion
• Alzheimer’s/Dementia Coaching
• Assistive Technology (assessments, training)
• Behavioral Supports and Consultation
• Community Based Day Supports (facilitation of online or telephonic community integration/socialization activities)
• Community Support and Navigation
• Complex Care Training and Oversight (where, based on clinical judgement of nurse, the task can be effectively performed using telehealth)
• Day Services
• Goal Engagement Program
• Environmental Accessibility Adaptation (consultations, walk-throughs, planning)
• Evidence-based Education Programs
• Expanded Habilitation, Education
• Family Training
• Home Health Aide (limited to cueing and supervision)
• Homemaker (facilitating online grocery orders, guidance/supervision for in-home tasks)
• Home Accessibility Modifications/Adaptations (consultations, walk-throughs, planning)
• Individualized Home Supports
• Individual Support and Community Habilitation (habilitation, facilitating access to services)
• Orientation and Mobility Services (orientation to and training for accessing services during COVID-19 emergency)
• Peer Support
• Personal Care (limited to cueing and supervision)
• Physical Therapy/Occupational Therapy/Speech Therapy
• Skilled Nursing (where, based on clinical judgement of the nurse, the task can be effectively performed using telehealth)
• Specialized Medical Equipment (assessment and training)
• Supported Employment (facilitating remote work)
• Supportive Day Program
• Supportive Home Care Aide (limited to cueing and supervision)
• Transitional Assistance (planning, exploratory discussions, online shopping)
• Vehicle Modifications (consultations, planning)

Add Home Delivered Meals

X

Add Medical Supplies, Equipment and Appliances

X

Add Assistive Technology

X

Conflict of Interest

Other Changes Necessary

All waivers – temporarily suspend waiver provider monitoring/oversight activities that are impacted by the COVID-19 emergency, including but not limited to on-site licensure visits, desk reviews, and credential verification functions. Provider monitoring/oversight activities typically require providers to produce a range of documentation such as required staff trainings and other administrative/operational processes. During the COVID-19 emergency, providers may be temporarily closed, operating with reduced staff, lack of access to electronic infrastructure/resources, and/or directing all available resources to addressing the immediate challenges and complexities of delivering services to waiver participants during the COVID-19 emergency, and consequently unable to collect and produce required documentation. In addition, the entities responsible for verifying provider qualifications face operational barriers to completing monitoring/oversight activities due to limitations on on-site visits, receipt of documentation, and the need to focus resources on the COVID-19 response effort during the emergency.

Other Changes Necessary

All waivers – temporarily suspend waiver provider monitoring/oversight activities that are impacted by the COVID-19 emergency, including but not limited to on-site licensure visits, desk reviews, and credential verification functions. Provider monitoring/oversight activities typically require providers to produce a range of documentation such as required staff trainings and other administrative/operational processes. During the COVID-19 emergency, providers may be temporarily closed, operating with reduced staff, lack of access to electronic infrastructure/resources, and/or directing all available resources to addressing the immediate challenges and complexities of delivering services to waiver participants during the COVID-19 emergency, and consequently unable to collect and produce required documentation. In addition, the entities responsible for verifying provider qualifications face operational barriers to completing monitoring/oversight activities due to limitations on on-site visits, receipt of documentation, and the need to focus resources on the COVID-19 response effort during the emergency.

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

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

Link to Approval Letter

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