Nevada – HCBS Waiver for Individuals with Intellectual and Developmental Disabilities HCBS Waiver for the Frail Elderly HCBS Waiver for Persons with Physical Disabilities

Waiver Title

HCBS Waiver for Individuals with Intellectual and Developmental Disabilities
HCBS Waiver for the Frail Elderly
HCBS Waiver for Persons with Physical Disabilities

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

HCBS Waiver for Individuals with Intellectual and Developmental Disabilities (0125.R07.00): Provides day hab, prevocational, residential support, supported employment, behavioral consultation-training and intervention, counseling, career planning, non-medical transportation, nursing, nutrition counseling, residential support management for individuals w/ID ages 0 – no max age. Frail Elderly (0152.R06.00): Provides case management, homemaker, respite, adult companion, adult day care, augmented personal care (APC), chore, PERS for aged individuals ages 65 – no max age. HCBW for Persons w/Physical Disabilities (4150.R06.00): Provides case management, homemaker, respite, attendant care, specialized medical equipment and supplies, assisted living, chore, environmental accessibility adaptations, home delivered meals, PERS for aged individuals 65 – no max age and individuals with physical disabilities ages 0-64.

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

Increase Cost Limits

N/A

Modify Targeting Criteria

N/A

Modify Scope or Coverage

Attendant Care

Exceed Service Limitations

For NV 0125.R07.01 • The $100/month Non-Medical Transportation limitation will be temporarily increased to $150/month to allow transportation flexibility for the provider and individual served because public transportation may not be readily available or safe for vulnerable populations. • Increase the current $5,200/year limit on Behavioral Consultation, Training and Intervention to $7,800/year for those individuals that may require more intensive behavioral supports due to COVID-19.

Add Services

Attendant Care

Expand Settings

For NV 0125.R07.01 To be delivered in any non-facility-based settings such as the individuals’ home. • Day Habilitation • Pre-vocational Services • Career Planning • Supported Employment For NV 0152.R06.03 To be delivered in any non-facility-based settings such as the individuals’ home. • Adult Day Care

Provide Service Out of State

N/A

Allow Payment for Services by Families

For NV.0125.R07.01 • Residential Support Services- allow Legally Responsible Individuals (LRI’s) to provide services. Safeguards will include the service coordinator discussing potential risks associated with allowing LRI’s to provide services. For NV.4150.R06.03 • Attendant Care & Chore Services – allow LRI’s to provide services. Safeguards will include the case manager discussing potential risks associated with allowing LRI’s to provide services. For NV.0152.R06.03 (Attendant Care new service added under Section A) • Attendant Care, Homemaker & Chore – allow LRI’s to provide services. Safeguards will include the case manager discussing potential risks associated with allowing LRI’s to provide services. d.__X_ Temporarily modify

Modification of Provider Qualifications

In an effort to streamline hiring of staff to fill in gaps in service delivery, change the following provider qualification. All providers brought on under this Appendix K will be enrolled in Nevada Medicaid and ensured they are not on the Office of Inspector General excluded provider list. For NV 0125.R07.01 • Residential Support Services, Day Habilitation, Pre-Vocational Services & Supported Employment- waive Developmental Services Certification requirements for staff training and background checks. Allow staff that have already completed training and background check requirements for one certified provider to be hired by another certified provider without the need to complete orientation training and another background check. For employees who were not previously employed by another certified provider: 1) Extend background check timelines to having fingerprints submitted within 60 days of hire with the completion of a self-declaration form of no disqualifying criminal convictions; 2) Accept proof of other recent background checks completed such as a valid Sheriff’s card or background checks completed for healthcare workers; and 3) Full orientation training must still occur within 90 days, but initial training requirements prior to working with individuals are condensed. Requirements for background checks and training are waived for Legally Responsible Individuals (LRI’s) and other family members hired to work with their family member, ward, spouse, etc. For NV 4150.R06.03 • Attendant Care, Respite & Chore Services – waive requirement to be a licensed with the Bureau of Health Care Quality and Compliance. Allow cleaning companies with Nevada business licenses to perform chore services if needed to sanitize home after COVID-19 exposure. For NV 0152.R06.03 • Homemaker Services, Respite & Chore – waive requirement to be licensed with the Bureau of Health Care Quality and Compliance. Allow cleaning companies with Nevada business licenses to perform Chore services if needed to sanitize home after COVID-19 exposure.

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

For NV.0125.RO7.01 Waive Developmental Services Certification requirements to allow services to be delivered in a non-facility-based setting such as the individuals’ home. • Day Habilitation • Pre-vocational Services • Career Planning • Supported Employment

Modification LOC Eval and Re-Eval Processes

For NV 0125.R07.01, NV 0152.R06.03 and NV 4150.R06.03 • Waive the Face-to-Face requirement for completing the level of care evaluations and reevaluations to allow completion via phone or other electronic communications as to not cause spread of COVID-19. Extend level of care re-evaluations for up to 12 months past the due date to reduce risk of infection. Allow electronic signatures on evaluation and reevaluation paperwork. For NV 0125.R07.01 and NV 0152.R06.03 • In order to streamline and expedite waiver eligibility determinations, change the current waiver Intake process to allow Aging and Disability Services Division to determine waiver eligibility without the pre-approval of DHCFP. DHCFP will continue to review 95/5 representative sample of intake packets monthly to ensure waiver requirements are met.

Increase Payment Rates

N/A

Modifications of ISP

For NV 0125.R07.01, NV 0152.R06.03 and NV 4150.R06.03 Modify all face-to-face requirements for the development, implementation and monitoring of the person-centered plan, as well as current timeframes for completing the person-centered plan as to not cause the spread of COVID-19: • Allow for completion of meetings and contacts for the development, implementation and monitoring of the person-centered planning process to be completed via phone, videoconferencing or other electronic communications that enable direct contact with the recipient, recipient’s representative and any contracted service providers, as needed, in accordance with HIPAA requirements. • Allow for electronic signature of person-centered planning documents, including the support plan. • The person-centered plan may be updated to allow for additional or modified supports to respond to individualized needs during the COVID-19 pandemic. Modifications to the person-centered plan that are needed due to recipient need and circumstance may be completed without the input of the entire person-centered planning support team. The support plan, including the amount, duration and scope of service, will be updated within 30 days from the date the service begins. • Person-centered plans can be renewed for an additional 12 months if a meeting is held via phone, video-conferencing or other electronic communications and the recipient / recipient’s representative agree that current services are appropriate and do not need to be updated, and service providers agree to continue to render continued services. Electronic signature is allowed for approval of continued person-centered planning documents.

Modify Incident Reporting/Med Management Safeguards

For NV 0125.R07.01, NV 0152.R06.03 and NV 4150.R06.03 • 372 Reports – extend waiver year reporting due dates through time period of the Appendix K.

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

For NV 0125.R07.01 • Residential Support Services and Residential Support Management – allow payment for direct care services for the purpose of supporting individuals in acute care hospital setting excluding room and board.

Inclusion of Retainer Payments

For NV 0125.R07.01 Allow retainer payments to providers when an individual is hospitalized, absent from their home or temporary closure due to COVID-19 for up to 30 consecutive service/billing days. Retainer payments will not be made for people who continue to receive these services in other settings, such as their home, or through electronic means. • Day Habilitation • Pre-Vocational Services • Supported Employment • Residential Support Services The state assures that all of the service categories identified for which retainer payments may be authorized, including Pre-Vocational Services and Supported Employment, are services that include personal care.

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: Adult Day Care

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

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

Link to Approval Letter

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