Oklahoma – 0179.R06.00 & 0399.R03.00

Waiver Title

Community (0179.R06.00) & Homeward Bound (0399.R03.00) [combined]

Description of Emergency

1) Nature of Emergency: On January 31, 2020 the United States Secretary of Health and Human Services declared a public health emergency due to an outbreak of Coronavirus Disease 2019 (COVID-19). The President of the United States declared a national emergency due to COVID-19 on March 13, 2020. The virus was first detected in China and has since spread to more than 100 locations internationally, including the United States. Older people and people of all ages with severe underlying health conditions appear to be at higher risk of developing serious COVID-19. 2) Number of individuals affected and the state’s mechanism to identify individuals at risk: As of March 22, 2020, there are 15,219 cases of COVID-19 and 201 deaths in the U.S. In Oklahoma, there are currently 67 confirmed cases, 102 results pending cases and two deaths. Approximately 3,474 individuals receive services through these waivers. To reduce the spread of the virus, many schools and businesses have closed. The state has identified probable negative impact on all waiver members and providers. This waiver amendment is applicable to all waiver members. 3) Roles of state, local and other entities involved in approved waiver operations: Roles of state, local, and other entities involved in approved waiver operations are defined in Appendix A. The Oklahoma State Department of Health (OSDH) is working with federal partners at the Center for Disease Control (CDC) in monitoring the developing outbreak. The OSDH is providing information to local health departments and healthcare providers across Oklahoma on how to safely and effectively evaluate ill people. The OSDH will continue to monitor the situation, work with partners to identify any possible cases, provide information and consultation to ensure that possible cases are managed safely, support laboratory testing, and implement recommendations from the CDC. 4) Expected changes needed to service delivery methods, if applicable. The state should provide this information for each emergency checked if those emergencies affect different geographic areas and require different changes to the waiver: • Temporarily allow Supported Employment providers to perform the duties of a Habilitation Training Specialist (HTS) in the event of reduced resources. • Temporarily allow HTS services to be participant directed. • Temporarily expand settings where Prevocational services and Adult Day services may be delivered. • Temporarily allow members to receive waiver services in another state. • Temporarily modify Specialized Foster Care provider qualifications by reducing frequency of verification from twice a year to once a year. • Temporarily change staffing ratios for members and allow DHS/DDS case management to conduct required monitoring using Health Insurance Portability and Accountability Act (HIPAA) compliant phone and/or video conferencing. • Temporarily update the medical examination requirements for initial and annual level of care evaluations. Also, for annual evaluations, timelines have been extended to allow a social summary that is current within 24 months of requested waiver approval date and other required reassessments may be delayed by up to 12 months. • Temporarily modify person-centered service plan development to allow authorization of service prior to updating the Individual Plan. • Temporarily suspend requirements to allow visitors except for certain compassionate care situations, such as an end-of-life situation. • Temporarily suspend requirements for community activities and community integrated employment • Temporarily allow the use of non-prescription medication without approval from a licensed healthcare professional. • Temporarily extend the deadline for providers to submit critical and non-critical incident reports. • Temporarily allow for payment of HTS services to assist with communication and stabilization when a member with COVID-19 or COVID-19 like symptoms is in a short-term care facility or hospital, not to exceed 30 consecutive days. • Temporarily allow Daily Living Supports and Agency Companion providers an extension of retainer payments from the currently approved 14 days to the lesser of 30 consecutive days or the number of days the State will pay the bedhold (60 per year), in order to maintain staff. • Temporarily allow professional providers to utilize HIPAA compliant telehealth. • Temporarily allow the use of monitoring via HIPAA compliant phone or video conferencing in the Daily Living Support service setting. • Temporarily allow the provision of the Daily Living Supports service in the home of a provider staff member when, due to staffing shortages, it is required for the safety and well-being of the member. • Temporarily allow provider agencies to share staff in the event of staff shortage due to a declared emergency and to ensure the safety and well-being of members served. Provider staff who have a background check on file, conducted within 18 months of the current date, are not required to have a new background check. New provider agency staff must obtain a background check within 45 days of employment. • Temporarily allow prescriptions from a contracted qualified health professional, when authorizing Occupational Therapy, Physical Therapy, Nutrition or Speech Therapy services, to be current within the previous 24 months. • Temporarily allow providers to monitor an employment site via HIPAA compliant phone or video conferencing when the Team determines, using a risk assessment tool, it is safe to do so. • Temporarily allow Specialized Medical Supplies and Assistive Technology to be billed without a referring/ordering physician on the claim. The state is requesting immediate implementation to avoid any adverse effect on member health and safety and provider capacity to deliver services. Should a provider be unable to deliver services during this emergency, another active DHS/DDS waiver service provider will be authorized immediately, and the member’s service plan will be updated.

Start Date

27-01-20

End Date

31-12-20

Description of Transition Plan

Any temporary modifications made during the state of emergency will revert back to original form when the declarations of emergency have been revoked and the threat of COVID-19 has ended. In the event it is determined this change may adversely affect a member, the member and his/her Team will discuss the member’s needs and options available to meet those needs. Person-centered planning is used in all phases of the service development process.

Area(s) Affected

Area Affected

statewide

Increase Cost Limits

N/A

Modify Targeting Criteria

N/A

Modify Scope or Coverage

Daily Living Supports – Temporarily allow providers to monitor a home via HIPAA compliant phone or video conferencing when the Team determines it is safe to do so. During times of emergency, Daily Living Supports may be provided in the home of provider staff when, due to staffing shortage, it is required for the safety and well-being of the member. During emergency declaration, providers of Daily Living Supports may receive up to the lesser of 30 consecutive days or the number of bedhold days the State will pay (60 per year). Agency Companion Services – During emergency declaration, providers of Agency Companion services may receive up to the lesser of 30 consecutive days or the number of bedhold days the State will pay (60 per year). Supported Employment – Temporarily allow Supported Employment providers to perform the duties of a Habilitation Training Specialist (HTS) in the event of reduced resources. During times of emergency, an employment site may be monitored via HIPAA compliant phone or video conferencing when the Team determines it is safe to do so. Habilitation Training Specialist – Temporarily allow Habilitation Training Specialist (HTS) services to be participant directed. Temporarily allow for payment of HTS services to assist with communication and stabilization when a member with COVID-19 or COVID19 like symptoms is in a short-term care facility or hospital, not to exceed 30 consecutive days. Prevocational – Temporarily expand settings where Prevocational services may be delivered. Adult Day – Temporarily expand settings where Adult Day services may be delivered. Specialized Foster Care – Temporarily modify Specialized Foster Care provider qualifications by reducing frequency of verification from twice a year to once a year. Specialized Medical Supplies and Assistive Technology – During times of declared emergency, Specialized Medical Supplies and Assistive Technology may be billed without a referring/ordering physician on the claim.

Exceed Service Limitations

N/A

Add Services

N/A

Expand Settings

During times of emergency declaration, Prevocational services and Adult Day services may be delivered temporarily in the member’s residential setting, which is defined as: the member’s private home, a provider owned or controlled extended family home or congregate residential setting, or other residential setting, such as a hotel or shelter. Temporarily allow the provision of the Daily Living Supports service in the home of a provider staff member when, due to staffing shortages, it is required for the safety and well-being of the member

Provide Service Out of State

During times of emergency declaration, a member may temporarily receive any waiver service in another state, until it is safe to return to their residence. Other than the location/setting requirements, the services provided in another state must still be provided in accordance with the waiver service definition. Department of Human Services Developmental Disabilities Services (DHS/DDS) case management staff, using HIPAA compliant phone calls or video conferencing, will monitor services through a minimum of monthly contacts. Providers certified in the state of Oklahoma would need to accompany the member to the other state to provide services. The state of Oklahoma will not allow providers in other states who do not have active waiver agreements with the Oklahoma Health Care Authority (OHCA) to provide services.

Allow Payment for Services by Families

N/A

Modification of Provider Qualifications

For providers of the Specialized Foster Care service, frequency of verification of qualifications is reduced from twice yearly to once yearly during times of emergency declaration. For providers of Habilitation Training Specialist services, the participant-directed service delivery method has been added. During times of emergency declaration, for the participant directed service delivery method: the background check requirement is temporarily waived for individuals deemed a relative by the employer of record; required provider training may be completed no later than 21 business days following the first service delivery date; and First Aide and CPR training, which are components of sanctioned training curriculum, may be completed on-line within 120 days. Temporarily extend certifications for First Aid, CPR and Medication Administration Training during the emergency. During times of emergency declaration, provider agencies may share staff in the event of staff shortage to ensure the safety and well-being of members served. Provider staff who have a background check on file, conducted within 18 months of the current date, are not required to have a new background check. New provider agency staff must obtain a background check within 45 days of employment. Temporarily extend timeframe to complete Foundations training, effective teaching course, First Aid, CPR to within 120 days of providing waiver supports, and allow First Aid, CPR and Medication Administration Training to be completed by HIPAA compliant video conferencing or online. Temporarily extend certifications for First Aid, CPR and Medication Administration Training during the emergency.

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

Required staffing ratios for a member, as outlined in their Individual Plan, may be temporarily modified during times of emergency declaration to allow the member to receive services in safe and accessible environments, as long as the member’s needs are still being met. HIPAA compliant phone calls, video conferencing or face time should include the member and staff when possible. During this period, provider program coordinators will be encouraged to utilize HIPAA compliant video conferencing in order to limit the number of people going into homes.

Modification LOC Eval and Re-Eval Processes

Information used to conduct an initial evaluation is submitted to OHCA by the DHS/DDS Intake Case Manager. This information includes a psychological evaluation that includes a full scale functional and/or adaptive assessment and a statement of age of onset of the disability and intelligence testing that yields a full scale intelligence quotient; a social service summary current within 12 months of requested waiver approval date that includes a developmental history; a medical evaluation current within 90 days of requested waiver approval date; a completed ICF-IID Level of Care Assessment form; and proof of disability according to Social Security Administration (SSA) guidelines. If a disability determination has not been made by SSA, OHCA may make a disability determination using the same guidelines as SSA. During times of emergency declaration, the medical evaluation requirement is waived for initial evaluations. Annual reevaluations are conducted by DHS/DDS Level of Care Reviewers unless a significant change has occurred which questions a member’s qualifying diagnosis. In those cases, the same, but current, information used for the initial evaluation is submitted to OHCA for reevaluation. During times of emergency declaration, the medical evaluation may be current within two years, instead of one year, of the requested waiver approval date. Also, the social summary may be current within 24 months of requested waiver approval date and other required reassessments may be delayed by up to 12 months.

Increase Payment Rates

N/A

Modifications of ISP

During times of emergency declaration, alternative settings for Prevocational services and Adult Day services may be authorized prior to updating the member’s service plan. The DHS/DDS Case Manager will update the Individual Plan (Plan) within 60 days following the authorization and may backdate authorizations for waiver services provided during this period of time. The process for Plan development will remain the same as outlined in the approved waiver. Required DHS/DDS case management monitoring visits will be conducted by HIPAA compliant video conferencing, unless an extreme situation warrants an in-person visit. DHS/DDS staff will make site visits only when there is reason to believe the person’s health or safety is at significant risk, i.e., it is reported that required supports are not available and a wellness check by local authorities cannot be secured within 24 hours. The need for an in-person home visit will require approval of the DHS/DDS supervisor. Given the social distancing recommendation, it is not advisable for groups to gather in the same location. As a result, team meetings, including individual planning meetings, may be held via HIPAA compliant teleconference or videoconference. Required signatures, including the date the individual planning meeting was held, may be obtained via mail or electronically. We will suspend the requirements for community activities including efforts to pursue community integrated employment efforts. Suspend requirements for allowing visitors except for certain compassionate care situations, such as an end of life situation. The modification of this right is not required to be justified in the Individual Plan.

Modify Incident Reporting/Med Management Safeguards

Approval for a member to use or be administered a nonprescription (over-the-counter) medication is received in writing from the member’s licensed healthcare provider at least annually. During times of emergency declaration, the requirement for a Medication Administration Technician (MAT) to obtain written approval for non-prescription medication by a licensed healthcare provider is waived during the emergency. If an individual is in isolation or quarantined, at home, due to COVID-19 and is instructed by a licensed health care provider, state or local health official to use or be administered non-prescription medication and an existing written approval is not in place, the provider will ensure medication(s) is administered according to manufacturer’s label instructions and follow documentation requirements, per Oklahoma Administrative Code (OAC) 340:100-5-32, including documenting the response to the non-prescription medication(s). If the instruction contradicts a previous written prescription or the recommendation exceeds the label instruction the primary health care provider should be contacted and a written order should be obtained. If medication is administered by a licensed nurse, the nurse must comply with the Oklahoma Nurse Practice Act. All persons administering medication should be aware of licensing or certification requirements and employer specific rules and regulations. DDS only waives the requirement for annual written approval of non-prescription medication, per Oklahoma Administrative Code (OAC) 340:100-5-32. DHS policy directs providers who have entered into Agreements with OHCA to provide waiver services, as well as DHS/DDS staff, to report critical and non-critical incidents involving the health and welfare of any person receiving services. Contract provider staff report critical and non-critical incidents electronically via the DHS/DDS Provider Reporting System. The DHS/DDS Case Manager is notified immediately when there is a critical incident. If the incident occurs outside regular working hours, the DHS/DDS Case Manager is notified the next working day. During times of emergency declaration, notification of the critical incident via electronic reporting may occur within three business days, with the exception of critical incidents involving death, suspected abuse, neglect or exploitation or unplanned hospital admission, which should be reported by phone within one business day. As long as notification to the DHS/DDS Case Manager and/or the Office of Client Advocacy (OCA) is completed within one business day, the requirement for the submission of an electronic critical incident report is extended to three business days as staff may not be able to access a computer to submit in a more timely manner. Modification of notification does not change requirement by provider and DHS/DDS case manager to ensure the individual is safe following the critical incident, preventative measures are implemented and notification to appropriate entities such as guardian and investigative authority has occurred. Non-critical incidents reports must be provided to DHS/DDS case management within five business days of the incident, instead of three business days, when an emergency declaration has been made. Modification of notification via electronic reporting is effective during declaration of the emergency.

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

For members with COVID-19 or COVID-19 like symptoms who are in a short-term care facility or hospital during times of declared emergency, a provider with an active OHCA waiver agreement to provide Habilitation Training Specialist (HTS) services may bill for HTS services to assist the member with supports, supervision, communication, and any other supports that the hospital is unable to provide, not to exceed 30 consecutive days.

Inclusion of Retainer Payments

Providers of Daily Living Supports services and Agency Companion services may receive retainer payments, aka therapeutic leave, for the individual receiving services for 14 consecutive days per event, not to exceed 60 days per member’s plan of care year in order to maintain staff. During emergency declaration, providers of Daily Living Supports and Agency Companion services may receive up to the lesser of 30 consecutive days or the number of bedhold days the State will pay (60 per year). Prevocational, Supported Employment and Adult Day Services include personal care. Providers of these services, per Olmstead Letter #3 dated July 25, 2000, may receive retainer payments up to the lesser of 30 consecutive days or the number of bedhold days the State will pay (60 per year). Retainer payments won’t exceed 60% of the monthly average of total billing for prevocational, supported employment and adult day services for any provider. Retainer payments for prevocational, supported employment and adult day services are limited to 6 hours per day and a total of 5 days per week (Monday – Sunday).

Institute/Expand Opportunities for Self-Direction

The Participant Directed service delivery method may be used for the delivery of Habilitation Training Specialist services during times of emergency declaration.

Increase Factor C

N/A

Other Changes Necessary

Providers of Physical Therapy, Occupational Therapy, Speech Therapy, Nutritional Services, Family Counseling, Family Training, Nursing and Psychological services may utilize HIPAA compliant video conferencing/telehealth during times of emergency declaration. Temporarily allow prescriptions from a contracted qualified health professional, when authorizing Occupational Therapy, Physical Therapy, Nutrition or Speech Therapy services, to be current within the previous 24 months.

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

Providers of Physical Therapy, Occupational Therapy, Speech Therapy, Nutritional Services, Family Counseling, Family Training, Nursing and Psychological services may utilize HIPAA compliant video conferencing/telehealth during times of emergency declaration. Temporarily allow prescriptions from a contracted qualified health professional, when authorizing Occupational Therapy, Physical Therapy, Nutrition or Speech Therapy services, to be current within the previous 24 months.

Other Changes Necessary

Providers of Physical Therapy, Occupational Therapy, Speech Therapy, Nutritional Services, Family Counseling, Family Training, Nursing and Psychological services may utilize HIPAA compliant video conferencing/telehealth during times of emergency declaration. Temporarily allow prescriptions from a contracted qualified health professional, when authorizing Occupational Therapy, Physical Therapy, Nutrition or Speech Therapy services, to be current within the previous 24 months.

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/ok-0179-0399-combined-appendix-k-appvl.pdf

Link to Approval Letter

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