North Dakota – Medicaid Waiver for Home and Community Based Services (0273.R05.00)

Waiver Title

Medicaid Waiver for Home and Community Based Services (0273.R05.00)

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 adult day care, adult residential care, case management, homemaker, residential habilitation, respite care, supported employment, adult foster care, chore, community support service, community transition services, companionship service, emergency response, environmental modification, extended personal care, family personal care, home delivered meals, non-medical transportation, specialized equipment & supplies, supervision, transitional living for individuals who are aged 65 – no max age, disabled-physical ages 18-64, and disabled-other ages 18-64 yrs.

Start Date

01-03-20

End Date

31-08-20

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

Adult Foster Care; Home Delivered Meals; Supervision;

Exceed Service Limitations

Adult Foster Care 1. Service definition limitations on the number of people served, without requesting a variance, in each licensed or unlicensed home may be exceeded. Home Delivered Meals 1. Increase service cap to two meals per day. 2. Waive dietary restrictions for meals. Supervision 1. Remove the live alone requirement for individuals impacted by COVID-19. 2. Increase the rate to encourage participation and expand provider access

Add Services

N/A

Expand Settings

• Locations may vary outside of the scope of the service definition in order to meet the health and safety needs of the participant. Settings may include but are not limited to hotels, shelters, schools and churches. • Case Managers are responsible to ensure that individuals are receiving the necessary services as described in the person centered plan of care. • Respite care can be provided in a skilled nursing facility or specialized basic care facility. The rate for facility-based settings includes room and board.

Provide Service Out of State

May grant approval to temporarily expand where services can be provided because of displacement brought on by the emergency including allowing services to be provided out of state.

Allow Payment for Services by Families

Modify who can receive payment for services rendered for the following services to include a legal guardian. • Homemaker, Respite Care, Chore, Supervision, Companionship Modify who can receive payment for services rendered for the following services to include a family member. • Companionship Case Managers are required to assure that services are being carried out as listed on the person centered plan of care. Case Managers authorize services after the consumer has made an independent choice of provider. Case management oversight will continue via telehealth/phone throughout the event. Payment to a legally responsible person, relative or legal guardian is only made to individuals who have individually enrolled as Qualified Service Providers with the State Medicaid office. These providers are required to submit claims via our North Dakota Medicaid Management Information System (MMIS). The MMIS system contains edits that would not pay a provider who is no longer enrolled or is not authorized to provide the service. The system also contains edits to assure that we are only paying the rate that was authorized. Payment is also limited to the services listed on the care plan. Every provider receives a copy of the authorization to provide services before they are eligible to provide the service. The authorization lists the allowable task, rate and service authorization period. Qualified Service Providers are required to maintain records and are subject to the provider review process.

Modification of Provider Qualifications

The minimum qualifications are required for the following services for providers: • Chore • Companionship • Family Personal Care • Homemaker • Non-medical transportation • Respite care • Supervision Agency Providers: Competency Requirements: Direct service provider must be a: • Current CNA, RN, LPN, or OT licensed in state of ND • CNA whose ND license has expired within the last six months • RN, LPN, OT licensed in good standing in another state per Executive Order 2020/05. • Direct Service Associate employed by licensed Developmental Disability provider per NDAC 75-04-01 Individual Providers: Competency Requirements: Direct service provider must be a: • Current CNA, RN, LPN, or OT licensed in state of ND • CNA whose ND license has expired within the last six months • RN, LPN, OT licensed in good standing in another state per Executive Order 2020/05. • Direct Service Associate employed by licensed Developmental Disability provider per NDAC 75-04-01 • Legal family member Agency & Individual Minimum Screening Requirements: – QSP termination/ denial list – Collection/ accounts receivable – High risk provider list – DEX verification – State exclusion list – Certified nurse assistant registry – Board of Nursing credential verification – Adult Foster Care – Fingerprinting and BCI check Agency providers must assure minimum screening requirements are met within 30 days of hire. Agency staff may provide services during the 30 days. State provider enrollment staff will assure minimum screening requirements are met at time of temporary enrollment for individual providers. QSPs approved during the national emergency will be given a Temporary Enrollment approval. After August 31, 2020 providers will be required to send ND Medicaid all the information that was not requested as part of the temporary enrollment process. If the additional information is not submitted within the required time limit of 6 months, the temporary enrollment will end, and the provider status would be stopped.
Agency & Individual provider re-enrollment for all waiver services:
• Extend re-enrollment period for 6 months during the pandemic beyond the
current 2 year deadline for providers who are up for renewal during this period.

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

N/A

Modification LOC Eval and Re-Eval Processes

N/A

Increase Payment Rates

To effectively respond to the COVID-19 outbreak, the state requires flexibility to adjust providers’ rates for supervision services to assure sufficient providers are available. The decision to increase rates will be based on the individualized needs of waiver recipients taking into consideration provider availability and provider risk. Increased payment rates would follow the approved rate methodology in the waiver and allow up to an additional 50% of the max rate based on department approval.

Modifications of ISP

The State will modify mandated processes and required timeframes for completing personcentered service plans as permitted by HIPAA: 1) Case managers may complete the person-centered service planning process using telephonic, video-conferencing, or web-based conferencing platforms that enable direct communication between the case manager and participant / participant’s representative. in accordance with HIPAA requirements. 2) 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 PCSP assessment and service, including providers, remain acceptable and approvable for the upcoming year. The state will verify by obtaining electronic signatures from service providers and the individual or representative, in accordance with the state’s HIPAA requirements. If requested and/or necessary, modifications to a person-centered plan may be made, as driven by individualized participant need, circumstance and consent reviewed on an individualized basis, without the input of the entire person-centered service team. The Department will temporarily allow changes to be modified primarily by the case manager and participant/participant’s representative – with signature from the provider to deliver modified services as documented in the updated plan. Physical signature to the plan can be obtained from third parties using remote transmission methods. The case manager may share forms requiring signature and receive documented signature consenting to a modified plan using fax or by sharing scanned documents via secured email. Consent may also be provided electronically via email. Electronic signature is also acceptable during the emergency period Planning and development of modified person-centered service plans may be conducted using remote contact methods, in keeping with all other allowances for case management activities during the emergency period. 3) 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 to ensure that the specific service is delineated accordingly to the date it began to be received. The PCSP will be updated no later than 30 days from the date the service was initiated.

Modify Incident Reporting/Med Management Safeguards

During an emergency, the web-based incident reporting system or phones may not be accessible. Notification of reportable incidents to the required entities needs to be completed as soon as reasonably possible, not to exceed 24 hours. Immediate emergency risk management steps must be implemented to ensure the health and safety of the participant involved.

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

N/A

Inclusion of Retainer Payments

N/A

Institute/Expand Opportunities for Self-Direction

N/A

Increase Factor C

N/A

Other Changes Necessary

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 to ensure that the specific service is delineated accordingly to the date it began to be received. The PCSP will be updated no later than 30 days from the date the service was initiated.

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-hom habilitation; monthly monitoring; other: Companionship- use electronic methods to deliver services to reduce social isolation

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 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 to ensure that the specific service is delineated accordingly to the date it began to be received. The PCSP will be updated no later than 30 days from the date the service was initiated.

Other Changes Necessary

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 to ensure that the specific service is delineated accordingly to the date it began to be received. The PCSP will be updated no later than 30 days from the date the service was initiated.

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

X RN, LPN, OT licensed in good standing in another state per
Executive Order 2020/05.

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/nd-0273-appendix-k-appvl.pdf

Link to Approval Letter

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