Oregon – Children’s HCBS Waiver (0117.R06.00), Adults’ HCBS Waiver (0375.R04.00), Medically Involved Children’s Waiver (MICW) (0565.R02.00), Medically Fragile (Hospital) Model Medically Fragile (Hospital) Model (40193.R04.00), Behavioral (ICF/IDD) Model Waiver (40194.R04.00)

Waiver Title

Children’s HCBS Waiver (0117.R06.00), Adults’ HCBS Waiver (0375.R04.00), Medically Involved Children’s Waiver (MICW) (0565.R02.00), Medically Fragile (Hospital) Model Medically Fragile (Hospital) Model (40193.R04.00), Behavioral (ICF/IDD) Model Waiver (40194.R04.00)

Description of Emergency

1) nature of emergency; The Oregon Health Authority has identified several counties in Oregon with presumptive positive cases of COVID-19. COVID-19 is spread from person-to-person through droplets in the air and on surfaces that people touch. This situation is unfolding quickly and the risks for people with intellectual and developmental disabilities are high. ODDS is committed to ensuring the health and safety of the people we serve. 2) number of individuals affected and the state’s mechanism to identify individuals at risk; All participants in the Office of Developmental Disabilities Services 5 1915 (c) waivers are at risk of exposure or contracting COVID-19. 3) roles of state, local and other entities involved in approved waiver operations; and The roles of state, local, and other entities involved in approved waiver operations are defined in Appendix A in section A-1 and 2. 4) expected changes needed to service delivery methods, if applicable. The state should provide this information for each emergency checked i

Waiver Description

Children’s HCBS (0117.R06.00): Provides employment path services, supported employment – individual employment support, waiver case management, discovery/career exploration services, environmental safety modifications, family training – conferences and workshops, specialized medical supplies, supported employment – small group employment support, vehicle modifications for individuals w/DD, ID ages 0 – 17 yrs old; Adults HCBS (0375.R04.00): Provides employment path services, supported employment – individual employment support, waiver case management, direct nursing, discovery/career exploration services, environmental safety modifications, family training – conferences and workshops, specialized medical supplies, supported employment – small group employment support, vehicle modifications for individuals w/ID/DD ages 18 – no max age: Medically Involved Children’s Waiver (0565.R02.00): Provides waiver employment path services, supported employment – individual employment support, waiver case management, discovery/career exploration services, environmental safety mods, family training, individual directed goods and services, special diets, specialized medical supplies, supported employment – small group employment support, vehicle modifications for individuals with physically disabilities ages 0-17 yrs; Medically Fragile (Hospital) Model (40193.R04.00): Provides employment path services, supported employment – individual employment support, waiver case management, discovery/career exploration services, environmental safety modifications, family training, individual directed goods and services, specialized medical supplies, supported employment – small group employment support, vehicle modifications for individuals who are medically fragile ages 0-17; Behavioral (ICF/IDD) Model (40194.R04.00): Provides employment path services, supported employment – individual employment support, waiver case management, discovery/career exploration services, environmental safety modifications, family training, individual directed goods and services, specialized medical supplies, supported employment – small group employment support, vehicle modifications for individuals with ID/DD ages 0-17

Start Date

11-03-20

End Date

10-03-21

Description of Transition Plan

Individuals will transition to pre-emergency service status as directed by ODDS.

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

N/A

Add Services

N/A

Expand Settings

N/A

Provide Service Out of State

N/A

Allow Payment for Services by Families

N/A

Modification of Provider Qualifications

Allow Personal Support Workers and Agency Employment Specialists to begin providing Individual Employment Support – Job Coaching services after a preliminary fitness determination (verified that they are not on the federal exclusionary list), but before a final determination, as directed by ODDS. Allow Employment Specialists to begin providing Employment Path and Small Group Employment Support after a preliminary fitness determination (verified that they are not on the federal exclusionary list), but before a final determination, as directed by ODDS. A final fitness determination about a provider’s qualifications will occur within 180 days of the conclusion of the state of emergency. Where the extension of the waiver of provider determinations falls outside of the expiration date of the Appendix K, the state will submit either an amended Appendix K or a simple waiver amendment.

Modify Provider Types

Allow assessors, abuse investigators, eligibility specialists, Licensors and certifiers employed at Case Management Entities (CMEs) (excluding state employees) to conduct the case management service of information and referral and monitoring activities for all individuals as directed by ODDS.

Modify Licensure/Requirements for Waiver Settings

Allow quarterly Employment Path site visits to be completed by phone, email, or other Communication methods in lieu of in person, as directed by ODDS.

Modification LOC Eval and Re-Eval Processes

Allow level of care re-evaluations timeline requirements to be extended for up to one year past the due date of the re-evaluation as directed by ODDS. Allow level of care evaluations or re-evaluations to be completed by Communication methods in lieu of face to face, such as telehealth, in accordance with HIPAA, as directed by ODDS.

Increase Payment Rates

Increase all Direct Nursing Service payment rates to the highest currently approved rate of $15.50/quarter hour to help maintain nursing pool capacity as directed by ODDS.

Modifications of ISP

Allow ISP development process to be completed by communication methods other than face to face such as telehealth, in accordance with HIPAA, as directed by ODDS. The use of e-signatures that meets privacy and security requirements will be added as a method for the participant or legal guardian signing the ISP to indicate approval of the plan. Services may start while waiting for the signature to be returned to the case manager within 60 days, whether electronically or by mail. Signatures will include a date reflecting the date changes occurred. Changes to the ISP, including the amount, duration and scope of the service will be updated in the ISP within 60 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

Retainer payments for services that include Personal Care – including Direct Nursing Waiver services, agency provided Employment Path Services (facility and community based), Supported Employment – Individual Employment Support (Job Coaching), Supported Employment – Small Group Employment Support and Discovery/Career Exploration Services shall be provided in response to the impact of the COVID-19 pandemic. • Retainer payments may be provided in circumstances in which facility closures are necessary due to COVID19 containment efforts. • Retainer payments attributable to each individual will be provided in circumstances in which attendance and utilization for the service drops to below 75% of the monthly average for the period of 10/01/19 through 12/31/2019 • Retainer payments will not exceed the anticipated 75% of monthly average of total billing and will be attributable to individuals and not paid to agencies as a lump sum • When an individual receiving Individual Employment Support (Job Coaching) experiences reduced work hours, due to COVID-19 pandemic retainer payments for the Individual Employment Support provider will be paid equal to the difference between provider payments based on actual hours worked by the individual and the anticipated monthly average of hours worked by the individual. This type of retainer payment is due to the ODDS rate methodology for Individual Employment Support – Job Coaching being based on the number of hours the individual works. Through billing procedures, ODDS will ensure that there will be no duplicative payments.

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

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

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

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/or-0117-0375-0565-40194-combined-appendix-k-appvl.pdf

Link to Approval Letter

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