North Dakota – Medicaid Waiver for Medically Fragile Children (0568.R01.00)

Waiver Title

Medicaid Waiver for Medically Fragile Children (0568.R01.00)

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 institutional respite, program management or case management, dietary supplements, environmental mods, equipment and supplies, in-home supports, individual and family counseling, transportation for medically fragile individuals ages 3-17

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

N/A

Exceed Service Limitations

State Medicaid agency may approve an increase of In-Home Support hours on the service plan – these could be increased by a verbal approval from the State. The Case Manager would be responsible to get verbal approval from State Medicaid agency, followed by a confirming email and update the service plan within 30 days from the date the service was initiated.

Add Services

N/A

Expand Settings

If it is best for the individual to be relocated to a non-infected environment, then InHome support would be available to the individual within the temporary new environment. Case Manager would obtain verbal approval, from the State with confirmation email to follow, of change of service location and update service plan within 30 days from the date the service was initiated. Respite may be provided in a facility- based setting but would exclude room and board.

Provide Service Out of State

State Medicaid Agency may grant approval for out of state In-Home Support if family is temporarily relocated out of state during the emergency. Case Manager would be responsible to receive verbal approval from State Medicaid Agency followed by email confirmation and update the service plan within 30 days from the date the service was initiated. Temporary out of state providers of In-Home Support service would be required to enroll with ND contracted fiscal agent.

Allow Payment for Services by Families

N/A

Modification of Provider Qualifications

Allow relatives of waiver beneficiaries who reside in the home and out of the home to provide services prior to background check and training for 90 days. It is understood that the background check will be submitted by the agency within 30 days after the service begins and training will occur within 90 days of hire without leaving the beneficiary without necessary care. The state is modifying provider standards for relatives to qualify as a direct worker while his/her background check and pre-employment screenings are in pending status. This allowance will be applied to participant-directed service (PDS) arrangements. Further, should a pending screening come back demonstrating concerns with the background check and/or pre-employment screening that would not allow the worker to continue employment long term that worker continues to be qualified until an alternative employee is identified unless the worker poses an immediate jeopardy to health, safety, and/or welfare of the participant (i.e. has tested positive for infectious disease) or is found to be guilty of past abuse, neglect, exploitation or violent felony and therefore is immediately unqualified. Suspend training requirements for immediate family members and/or legal representatives providing services to waiver participants. As defined by the IRS, “immediate family member” includes a spouse, child, parent, grandparent, brother, sister, grandchild, stepparent, stepchild, stepbrother or stepsister of the participant.

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

N/A

Modifications of ISP

Case managers may complete the person-centered service planning process using telephonic, videoconferencing, or web-based conferencing platforms that enable direct communication between the case manager and participant / participant’s representative, in accordance with HIPAA requirements. Person-Centered Service Plans (PCSP) 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. As requested, and/or necessary, modifications to the person-centered plan may be made, as driven by individualized participant’s need, circumstance, consent, and 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. 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

N/A

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

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; in-home habilitation; 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

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

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

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-0568-appendix-k-appvl.pdf

Link to Approval Letter

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