New Mexico – Appendix K

Waiver Title

Developmental Disabilities Waiver, Mi Via ICF/IDD Waiver, Medically Fragile Waiver

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

Developmental Disabilities Waiver Program (0173.R06.00): Provides case management, community integrated employment, customized community supports, living supports, respite, nutritional counseling, occupational therapy for adults, physical therapy for adults, speech and language therapy for adults, supplemental dental care, adult nursing, assistive technology, behavioral support consultation, crisis support, customized in-home supports, environmental modifications, independent living transition service, intense medical living supports, non-medical transportation, personal support technology/on-site response service, preliminary risk screening and consultation related to inappropriate sexual behavior, socialization and sexuality education for individuals with autism, ID, DD ages 0 – no max age

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

N/A

Exceed Service Limitations

Assistive Technology: • To ensure health and safety and to support access to telehealth, participants who do not currently have access to a computer, tablet or other device in the home are able to utilize AT funds in excess of $250. 00 in order to purchase the needed device that allows remote video conferencing, training and monitoring by clinicians. The maximum funding allowed under AT is $250.00 per ISP year. With the Appendix K amendment to the service, the maximum allowed for AT during the emergency will be $500.00. Supported Living: • Supported Living is intended for individuals who are assessed to need residential habilitation to ensure health and safety. Supported Living services are designed to address assessed needs and identified individual outcomes. NM will temporarily allow the service to exceed the prescribed limit of two (2) to four (4) individuals in a provider operated and controlled community residence. Supported Living providers are responsible for providing an appropriate level of services and supports twenty-four (24) hours per day, seven (7) days per week. Additional Limits on Amount of Waiver Services C-4 • To address health and welfare issues of participants presented by the emergency, temporarily suspend requirements for prior authorization for waiver services which are related to or resulting from this emergency. NM.0448.R02.02: Additional Limits on Amount of Waiver Services C-4 • To address health and welfare issues of participants presented by the emergency, temporarily suspend requirements for prior authorization for waiver services which are related to or resulting from this emergency. NM.0223.R05.02: Additional Limits on Amount of Waiver Services C-4 • To address health and welfare issues of participants presented by the emergency, temporarily suspend requirements for prior authorization for waiver services which are related to or resulting from this emergency.

Add Services

N/A

Expand Settings

Service Locations in Appendix C-1/C-3 Temporarily allow the following expanded service settings in accordance with HIPAA requirements: Occupational Therapy for Adults: • Face-to-face visits may be provided by telehealth option or phone visits. This includes assessment, monitoring or follow up. All interactions will be documented. • Trainings and return demonstrations may be done by telehealth or phone as needed. Physical Therapy for Adults: • Face-to-face visits may be provided by telehealth option or phone visits. This includes assessment, monitoring or follow up. All interactions will be documented. • Trainings and return demonstrations may be done by telehealth or phone as needed. Speech and Language Therapy for Adults: • Face-to-face visits may be provided by telehealth option or phone visits. This includes assessment, monitoring or follow up. All interactions will be documented. • Trainings and return demonstrations may be done by telehealth or phone as needed. Community Customized Supports: • Community Customized Supports can be provided in the home. Behavior Support Consultation: • Face-to-face visits may be provided by telehealth option or phone visits. This includes assessment, monitoring or follow up. All interactions will be documented. • Trainings and return demonstrations may be done by telehealth or phone as needed. NM.0448.R02.02: Service Locations in Appendix C-1/C-3 Customized Community Group Supports: • Customized Community Group Supports can be provided in the home. Community Direct Support: • Community Direct Support can be provided in the home. NM.0223.R05.02: Service Locations in Appendix C-1/C-3 Case Management: • Face-to-face visits may be provided by phone visits. Private Duty Nursing: • Face-to-face visits may be provided by telehealth option or phone visits. This includes assessment, monitoring or follow up. All interactions will be documented. • Trainings and return demonstrations may be done by telehealth or phone as needed. Behavioral Support Consultation: • Face-to-face visits may be provided by telehealth option or phone visits. This includes assessment, monitoring or follow up. All interactions will be documented. • Trainings and return demonstrations may be done by telehealth or phone as needed.

Provide Service Out of State

N/A

Allow Payment for Services by Families

Home Health Aide: • To ensure health and safety needs of participants are being met, if an agency is unable to support the usual budgeted hours with substitute staff, the agency may hire a relative, friend, or parent at the home health aide rate. NM.0173.R06.02, NM.0448.R02.02, NM.0223.R05.02: Living Supports, Customized In Home Supports, and/or Customized Community Supports services may be rendered by relatives or legally responsible individuals when they have been hired by the provider agency authorized on the ISP. Relatives, Guardians, and/or legally responsible individuals must receive training on the participant’s ISP for whom they are rendering these services. Training on the ISP must consist of basic health and safety support needs for that participant including but not limited to Health Care Plans, Medical Emergency Response Plans, Comprehensive Aspiration Risk Management Plan, Behavior Support Plans and Therapy Plans. When one of these services is rendered by relatives, guardians, and/or legally responsible individuals, the provider agency authorized to render the Living Supports and/or Customized Community service is responsible for ensuring that services are provided as authorized in the ISP and that billing occurs in accordance with DDSD requirements.

Modification of Provider Qualifications

NM.0173.R06.02, NM.0448.R02.02, NM.0223.R05.02: Temporarily allow provider enrollment or re-enrollment with modified risk screening elements such as suspending fingerprint checks, or modifying training requirements to all service providers. New Mexico providers must conduct employee abuse registry screenings and document that screening has occurred. All Direct Support Face to Face Required Level One Training will be suspended for the duration of the emergency except for Abuse Neglect Exploitation, Individual Specific Training of the person ISP, and related Health Care Plans, Medical Emergency Response Plans, Comprehensive Aspiration Risk Management Plans, Behavioral Support and Therapy Plans. These required trainings can be performed via telephonic/telehealth/online modalities by Provider Agency Staff as opposed to Face to Face Training by the Therapists. NM.0173.R06.02: Provider Qualifications in Appendix C-1/C-3 To increase the pool of available direct service providers who can render services during the emergency, an exception to the Provider Enrollment Unit process to other services will be implemented to allow currently approved providers to provide services in other service types in the event of staffing shortages. Staff qualifed under any service definition in the DDW may be used for provision of any non-profesional service under another service definition in C1/C3. NM.0448.R02.02: Home Health Aide: • The requirement for supervision by a registered nurse has been extended to ninety (90) days. • The State will allow for remote supervision by a registered nurse as needed. NM.0223.R05.02: Provider Qualifications in Appendix C-1/C-3 Agency requirements for use of licensed and non-licensed staff from outside souces will follow the state’s guidance during the emergency with agencies continuing to screen and qualify staff in the best interest of the participant. Trainings may be abbrevaiated, but specific trainings for the care of the individual will remain a requirement. Service Specific Home Health Aide: • The requirement for supervision by a registered nurse has been extended to ninety (90) days. • The State will allow for remote supervision by a registered nurse as needed.

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

N/A

Modification LOC Eval and Re-Eval Processes

NM.0173.R06.02, NM.0448.R02.02, NM.0223.R05.02: The New Mexico Human Services Department is allowing the use of currently approved LOC assessments on file to fulfill the annual LOC requirement for impacted waiver participants for the duration of the emergency. Initial level of care assessments will continue to be completed as required and may be performed using telephonic or, if the capacity exists for the participant and the TPA or provider, virtual visits for assessments, in accordance with HIPAA requirements. When the initial ICF/IDD Level of Care is evaluated, it is not required that a physician recommend that the individual should receive the level of care furnished through the waiver. A history and physical form is also not required from the physician. Initial level of care evaluations will consist of confirmation of intellectual disability or developmental disability from the Department of Health substantiating that the individual meets the State’s definition of developmental disability and completion of the Long Term Care form by the case manager/consultant.

Increase Payment Rates

N/A

Modifications of ISP

NM.0173.R06.02, NM.0448.R02.02, NM.0223.R05.02: Person-Centered Service Plans that are due to expire within the next 60 days require case management 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 current service plans meet the individual’s needs through the required case management/consultant monthly contact that can be conducted telephonically with the participant or representative. During the monthly contacts, the case manager/consultant reviews all services the participant has budgeted and is accessing, any barriers to access, and the need to increase or decrease services. During the emergency, the case managers/consultant will use the information gathered at the monthly contact to determine if the current person-centered service is meeting the participant’s needs. The state will ensure the person-centered 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, but no later than 30 days, to ensure that the specific service is delineated accordingly to the date it began to be received.

Modify Incident Reporting/Med Management Safeguards

The requirement to conduct a neglect investigation of any incident of deviation in staffing as outlined in an individual plan may be suspended. The requirement to submit an incident report for Abuse Neglect and Exploitation for any deviation in staffing as outlined in an individual plan may be suspended. If this requirement is suspended, providers must report any incidents in which staffing shortages result in a failure to provide care via General Events Reporting.

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

NM.0173.R06.02, NM.0448.R02.02, NM.0223.R05.02: The State will allow for payment for services for the purpose of supporting waiver participants in an acute care hospital or short-term institutional stay when necessary supports are not available in that setting during this emergency. The payments may only be made for up to 30 consecutive days.

Inclusion of Retainer Payments

The State will temporarily include retainer payments for approved personal care services on a participant’s budget when day habilitation and community integrated employment closures are necessary due to COVID-19 containment efforts. The personal assistance 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 be authorized when a provider is providing services and will only occur on a case by case basis when a provider is directly impacted by the emergency. Additionally, retainer payments may be made: NM. 0173.R06.02: Retainer payments will be made available for the following personal care service: Customized Community Supports (Individual and Group Day Habilitation) and Community Integrated Employment during the time of the emergency. NM.0448.R02.02: Retainer payments will be made available for the following personal care services: Homemaker, Customized Community Group Supports (Day Habilitation) and Community Integrated Employment during the time of the emergency. NM.0223.R05.02: Retainer payments will be made available for the following personal care service: Home Health Aide during the time of the emergency.

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

N/A

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

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

N/A

Allow the Option to Conduct Evaluations, Assessments, and Person-Centered Service Planning Meetings Virtually/Remotely in lieu of Face-to-Face Meetings

N/A

Adjust Prior Approval/Authorization Elements Approved in Waiver

N/A

Adjust Assessment Requirements

N/A

Add an Electronic Method of Signing Off on Required Documents Duch As The Person-Centered Service Plan

N/A

Link To Application

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

Link to Approval Letter

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