Oklahoma – 0811.R02.00

Waiver Title

Medically Fragile (0811.R02.00)

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. 2) Number of individuals affected and the state’s mechanism to identify individuals at risk: Approximately 92 unduplicated individuals receive services through this waiver. 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: • Allow certified case management and skilled nursing to conduct required service planning and monitoring activities using Tele-Health; phone and/or video conferencing. • Temporarily modify person-centered service plan development to allow increased service delivery after documentation of changes on the plan but prior to authorization of the service. • Temporarily allow for payment of personal care assistance services when a member is in a short-term care facility or hospital for a duration and not to exceed 30 days consecutively. • Temporarily allow professional providers to utilize telehealth and will be utilized in accordance with HIPPA requirements. The state is requesting immediate implementation to avoid any adverse effect on member health and safety to deliver services. Should a provider be unable to deliver services during this emergency, another active Medically Fragile 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. Personcentered 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

N/A

Exceed Service Limitations

During times of emergency declaration, allow for the increased provision of home delivered meals up to two times per day, seven days per week, for a total of 14 meals per week. Temporarily allow for the provision of nursing facility respite services up to a period of 30 days.

Add Services

N/A

Expand Settings

N/A

Provide Service Out of State

N/A

Allow Payment for Services by Families

Temporarily suspend Eligible Provider Exception requirements to allow family members/legal guardians to provide personal care services for Medically Fragile waiver members including personal care, advanced supportive/restorative and self-directed services.

Modification of Provider Qualifications

During the time of the emergency, temporarily cease annual recertification of Medically Fragile Waiver providers and extend to every other year. Case Management/Home Health and Provider trainings will be modified to an on-line training format.

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

Required case management assessment, reassessment, and monitoring visits will be conducted by phone or video conferencing unless an extreme situation warrants an in-person visit. Video conferencing should include face time with the member and staff when possible and will be utilized in accordance with HIPPA requirements. If that is not available, a phone call will be scheduled. Required skilled nursing visits for monitoring/supervision of personal care services may be completed via phone or video-conferencing. Nursing visits for direct care should be completed in person when feasible. In the event this is not possible, such as when entry into buildings is prohibited, visits may be completed via video-conferencing. Phone consultation for direct care supervision should occur only when member access to teleconferencing technology is unavailable. For members needing nursing facility respite in an area with no Medically Fragile waiver contracted providers, temporarily allow for services to be provided in a facility contracted with OHCA to provide nursing facility services.

Modification LOC Eval and Re-Eval Processes

During the emergency period, DHS health care management nurses will complete assessments for initial medical eligibility via teleconference using the Uniform Comprehensive Assessment Tool. Video conferencing should include face time with the member and staff when possible and will be utilized in accordance with HIPPA requirements. Member choice of service location and choice of providers will be obtained and documented as verbal consent by the registered nurse. The reassessment process for ongoing Medically Fragile waiver eligibility will continue as per the waiver. OHCA nurses will review case manager documentation on the Uniform Comprehensive Assessment Tool. When questions regarding ongoing eligibility exist, the nurse will contact the case manager and/or Medically Fragile waiver member for additional information to validate ongoing eligibility

Increase Payment Rates

N/A

Modifications of ISP

For service plan modifications, increases of personal care services may be implemented once documented on the member’s plan and prior to authorization. This does not apply to service decreases, which will continue to require service authorization. Given the social distancing requirements, it is not advisable for groups to gather in the same location to develop the annual/reassessment plan, therefore, the state will allow the use of Telehealth through options such as mobile video conferencing, Zoom, etc. and will be done in accordance with the HIPPA requirements. Signatures to verify time and date of meeting(s) will be obtained through an e-signature process or through US Postal mail with the meeting date and time. Service plans authorized pending member signature will have case management services conditionally authorized for up to 120 days to ensure receipt. Also suspended are the requirements for community activities including efforts to pursue community integrated efforts, as well as the requirements for allowing visitors (providers may prohibit/restrict visitation in-line with CMS recommendations).

Modify Incident Reporting/Med Management Safeguards

N/A

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

For members hospitalized during times of declared emergency, a provider with an active OHCA waiver agreement to provide personal care services may bill for services to assist the member with supports, supervision, communication, and any other supports that the hospital is unable to provide for a duration and not to exceed 30 days consecutively.

Inclusion of Retainer Payments

N/A

Institute/Expand Opportunities for Self-Direction

During the emergency declaration, family caregivers or legally responsible relatives will perform Personal Care and Advanced Supportive/Restorative services under the Self-Direction program.

Increase Factor C

N/A

Other Changes Necessary

Providers of Speech Therapy, Physical Therapy and Occupational Therapy, may utilize video conferencing/telehealth during times of emergency declaration and will be utilized in accordance with HIPPA requirements.

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 Speech Therapy, Physical Therapy and Occupational Therapy, may utilize video conferencing/telehealth during times of emergency declaration and will be utilized in accordance with HIPPA requirements.

Other Changes Necessary

Providers of Speech Therapy, Physical Therapy and Occupational Therapy, may utilize video conferencing/telehealth during times of emergency declaration and will be utilized in accordance with HIPPA requirements.

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-0811-appendix-k-appvl.pdf

Link to Approval Letter

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