Nebraska – Comprehensive Developmental Disabilities Services (4154.R06.00)

Waiver Title

Comprehensive Developmental Disabilities Services (4154.R06.00)

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.).

Waiver Description

Provides prevocational, residential habilitation, respite, supported employment – individual, adult companion service, adult day services, assistive technology, behavioral in-home habilitation, consultative assessment, crisis intervention support, enclave, environmental modification assessment, habilitative community inclusion, habilitative workshop, home modifications, homemaker, in-home residential habilitation, independent living, medical in-home habilitation, personal emergency response system (PERS), supported employment – follow along, supported family living, transitional services, transportation, vehicle modifications for individuals w/autism, ID/DD ages 0 to no max age

Start Date

06-03-20

End Date

06-09-20

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

N/A

Modify Scope or Coverage

Residential habilitation, Respite, Adult Day Services, Habilitative Community Inclusion, Habilitative Workshop, Independent Living, Medical In-Home Habilitation, Supported Family Living,

Exceed Service Limitations

The cap of 360 hours on use of back-up staff in Residential Habilitation – Shared Living and Residential Habilitation – Host home is waived for anyone affected to allow the participant to receive services in safe and accessible environments, as long as the participant’s needs are still being met. The requirement for prior approval of the DHHS-DD clinical team for use of Medical In-Home is waived for anyone affected in order to receive services at home without delay for completion of clinical review. The Respite cap of 360 hours may be exceeded for anyone under isolation, quarantine or following the CDC guidelines for people with disabilities to allow the participant to receive services in safe and accessible environments, as long as the participant’s needs are still being met. The cap of 70 hours per week for Independent Living is waived for anyone under isolation, quarantine or following the CDC guidelines for people with disabilities to allow the participant to receive services in safe and accessible environments, as long as the participant’s needs are still being met. The cap of 70 hours per week for Supported Family Living is waived for anyone under isolation, quarantine or following the CDC guidelines for people with disabilities to allow the participant to receive services in safe and accessible environments, as long as the participant’s needs are still being met When the participant is placed in isolation, quarantine or following the CDC guidelines for people with disabilities, groups of 3 Shared Living participants will not need approval by the Department. When the participant is placed in isolation, quarantine or following the CDC guidelines for people with disabilities, groups of 3 Supported Family Living participants will not need approval by the Department. When the participant is placed in isolation, quarantine or following the CDC guidelines for people with disabilities, groups of 3 Independent Living participants will not need approval by the Department.

Add Services

N/A

Expand Settings

Habilitative Workshop and Adult Day Service may be delivered temporarily in the participant’s residential setting, such as: • The participant’s private home, • A provider owned or controlled extended family home or congregate residential setting, or • Other residential setting, such as a hotel or shelter. Residential Habilitation – Shared Living and Residential Habilitation – Host Home may be delivered temporarily in a congregate residential setting owned or leased by the provider agency. Residential Habilitation – Continuous Home may be delivered temporarily in a Residential Habilitation – Shared Living or Residential Habilitation – Host Home operated or controlled by the provider agency. Habilitative Community Inclusion may be delivered temporarily in a residential setting for the majority of the time billed for the service.

Provide Service Out of State

When the only temporary, safe, and accessible setting for a participant is outside of Nebraska, the participant may receive any waiver services in another state, until it is safe to return to his/her residence. Other than the location/setting requirements, the services provided in another state must still be provided in accordance with the waiver service definition. DHHS-DD Service Coordination staff will monitor the services through a minimum of monthly contacts via telephone in accordance with HIPAA requirements. Providers certified in the state of Nebraska would need to accompany the participants to the other state to provide services. The state will not allow providers in other states who are not enrolled in Nebraska Medicaid and certified as Nebraska DD service providers to provide services.

Allow Payment for Services by Families

N/A

Modification of Provider Qualifications

The State will modify the following requirements for independent provider enrollment: • A certificate for completion of training in Abuse, Neglect, and Exploitation and state law reporting requirements and prevention must be obtained within 90 calendar days of initial enrollment; • A certificate for completion of Cardiopulmonary Resuscitation (CPR) training must be obtained within 12 calendar months of initial enrollment; and • A certificate for completion of Basic First Aid training must be completed within 12 calendar months of initial enrollment. The annual program compliance requirements for agency and independent provider enrollment will be waived. There will be no delay or waiver of initial and annual background checks.

Modify Provider Types

The state will add a provider type of Independent Agency – Habilitative Services to Habilitative Community Inclusion and Supported Family Living.

Modify Licensure/Requirements for Waiver Settings

Required staffing ratios for a participant, as outlined in their ISP, may be modified to allow the participant to receive services in safe and accessible environments, as long as the participant’s needs are still being met. State certification survey staff are, on a case-by-case basis, postponing agency certification reviews for those agencies impacted for residential and day service settings, such as Habilitative Workshops, Shared Living/Host homes, and congregate residential habilitation settings, until the public health emergency has passed and not to exceed the end date of this Appendix K amendment. This is for the safety of the survey staff, as well as ensuring that state personnel are not spreading illness to anyone under isolation, quarantine, or those following the CDC guidelines for people with disabilities population or those remaining at home due to risk of serious illness. If a temporary service site is pulled for a certification review, as long as the site is deemed safe and sensible for the service being provided and there is no non-compliance with regulations that could reasonably be complied with, the site will be determined to be in compliance with certification requirements. State settings initial and annual reviews for the HCBS Final Rule will be reviewed through a phone call with the administrator/director/owner and outcomes will be addressed via telephone, e-mail or mail. The on-site assessment will be scheduled with the setting when local or facility restrictions allow.

Modification LOC Eval and Re-Eval Processes

The annual Level of Care (LOC) re-assessment requirement will be delayed for participants in which the DHHS-DD Service Coordinator cannot complete the re-assessment by phone in accordance with HIPAA requirements. The DHHS-DD Service Coordinator will document, in the ISP, the phone contact attempts, as well as the projected date in which the LOC will be able to be completed. The LOC re-assessment will not be extended more than 9 months from the original due date.

Increase Payment Rates

The following rates may be increased to ensure sufficient providers are available to participants. This increase may not exceed 15% of current rates. The increase would account for excess overtime of direct support professionals to cover staffing needs and to account for additional infection control supplies and service costs: Residential Habilitation, Independent Living, Supported Family Living, Habilitative Community Inclusion, and Habilitative Workshop. The rate setting methodology is the same. Upward adjustments would be made to the supply and staffing costs.

Modifications of ISP

Person-Centered Service Plans that are due to expire within the next 60 days require service coordination 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 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 Service Coordinator must submit the request for additional supports/services no later than 30 days from the date the service begins.

Modify Incident Reporting/Med Management Safeguards

N/A

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

For participants hospitalized, a provider may bill Medical In-Home Habilitation to assist with supports, supervision, communication, and any other supports that the hospital is unable to provide.

Inclusion of Retainer Payments

Retainer payments may be provided for the following habilitative services which include personal care: Residential Habilitation, Independent Living, Supported Family Living, Adult Day, Enclave, Habilitative Community Inclusion, Habilitative Workshop, Prevocational, Supported Employment – Individual, and Supported Employment – Follow-Along. Retainer payments may be provided in circumstances in which the above services were not available to the participant due to COVID-19 containment efforts because the waiver participant is sick due to COVID-19; or the waiver participant is sequestered and/or quarantined based on local, state, federal, and/or medical requirements/orders. Retainer payments will be authorized only for the amount of service attributable to when the participant is not with the provider. The retainer time limit will not exceed 30 consecutive days of billing or the number of bed hold days in the state’s SPA within the timeframe identified in this Appendix. Providers will have 90 days from the date for which a retainer payment is being billed to submit a claim. Claims will be processed on a monthly billing cycle.

Institute/Expand Opportunities for Self-Direction

N/A

Increase Factor C

N/A

Other Changes Necessary

The minimum frequency of ninety days for the provision of one waiver service will be waived for participants who are quarantined or following the CDC guidelines for people with disabilities. Monthly monitoring by the Service Coordinator will still occur.

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 rehabilitation, monthly monitoring

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

The minimum frequency of ninety days for the provision of one waiver service will be waived for participants who are quarantined or following the CDC guidelines for people with disabilities. Monthly monitoring by the Service Coordinator will still occur.

Other Changes Necessary

The minimum frequency of ninety days for the provision of one waiver service will be waived for participants who are quarantined or following the CDC guidelines for people with disabilities. Monthly monitoring by the Service Coordinator will still occur.

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

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

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/ne-4154-appendix-k-appvl.pdf

Link to Approval Letter

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