State of the States in Intellectual and Developmental Disabilities

These actions will apply across the waiver to all individuals impacted by the COVID-19 virus

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.

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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.

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.

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.

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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.