Pensylvannia – 0593.R02.00

Waiver Title

Adult Autism Waiver 0593.R02.00

Description of Emergency

N/A

Start Date

11-03-20

End Date

11-03-21

Description of Transition Plan

N/A

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

Service Limits in Appendix C-1/C-3 Residential Habilitation, including life sharing 1. Service definition limitations on the number of people of served in each licensed home may be exceeded. 2. Prior written authorization through the use of the Residential Habilitation Request Form will not be needed. Temporary Supplemental Services 1. Service limitations in Temporary Supplemental services can be exceeded beyond 540 hours in a twelve-month period to address the increased needs of individuals affected by the epidemic/pandemic or increased number of individuals served in a service location. Respite 1. Respite limits may be extended beyond the 30 times the day unit rate per ISP plan year without requesting an exception in order to meet the immediate health and safety needs of participants. Specialized Skill Development, Community Support 1. Community Support, when provided alone or in combination with Day Habilitation, Small Group Employment, and Supported Employment may be provided in excess of 50 hours per week without requesting an exception in order to meet the health and safety needs of participants.

Add Services

shift nursing

Expand Settings

Service Locations in Appendix C-1/C-3 Residential Habilitation, including life sharing 1. Service can be provided in licensed or unlicensed settings. Providers enrolled in the Consolidated or Community Living waivers to provide licensed or unlicensed Residential Habilitation can deliver services under the Adult Autism Waiver during this time. Respite 1. Respite services may be provided in any setting necessary to ensure the health and safety of participants. 2. Room and board is included in the fee schedule rate for Respite rendered outside the home. 3. Room and Board would be included in the fee schedule for settings used in response to the emergency. Day Habilitation 1. Day Habilitation may be provided in private homes. Specialized Skill Development, Therapy (counseling), Family Support, and Nutritional Consultation 1. These direct services may be provided using remote/tele support when this type of support meets the health and safety needs of the participant.

Provide Service Out of State

N/A

Allow Payment for Services by Families

Residential Habilitation, Temporary Supplemental Services, and Shift Nursing may be rendered by relatives or legally responsible individuals when they have been hired by the provider agency authorized on the ISP. Relatives and legally responsible individuals must receive training on the participant’s ISP for whom they are rendering these services, including training on the Behavioral Support Plan (BSP) and Crisis Intervention Plan (CIP). Training on the ISP must consist of basic health and safety support needs for that participant including but not limited to the fatal four. When one of these services is rendered by relatives or legally responsible individuals, the provider agency authorized to render the Residential Habilitation, Temporary Supplemental Services, or Shift Nursing is responsible for ensuring that services are provided as authorized in the ISP and that billing occurs in accordance with ODP requirements. The limitation for a family member to deliver services no more than 40 hours in a sevenday period will be extended to 60 hours in a seven-day period.

Modification of Provider Qualifications

To allow redeployment of direct support and clinical staff to needed service settings during the emergency, staff qualified under any service definition in the Adult Autism Waiver may be used for provision of any non-professional service under another service definition in C-1/C-3. Professional services exempt from this include; Supports Coordination, Therapies, Behavioral Specialist Services and Systematic Skill Building components of Specialized Skill Development, Nutritional Consultation, Family Support, and Shift Nursing. All staff must receive training on any individuals’ ISPs for whom they are providing support. Training on the ISP must consist of basic health and safety support needs for that individual including but not limited to the fatal four. In addition, if the participant has a Behavioral Support Plan and Crisis Intervention Plan, staff must be trained on the implementation of those plans.

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

Residential Habilitation, including life sharing 1. Maximum number of individuals served in a service location may be exceeded to address staffing shortages or accommodating use of other sites as quarantine sites. 2. Minimum staffing ratios as required by licensure, service definition and individual plan may be exceeded due to staffing shortages. Day Habilitation 1. Minimum staffing ratios as required by licensure, service definition, and individual plan may be exceeded due to staffing shortages. 2. The requirement to provide services in community locations a minimum of 25% of participant time in service is suspended.

Modification LOC Eval and Re-Eval Processes

When ICF/ID or ICF/ORC level of care is evaluated, it is not required that a physician recommend, certify, or verify that the individual should receive the level of care furnished through the waiver. Initial level of care evaluations will consist of: 1) confirmation of autism diagnosis; 2) QDDP certification of impairments in adaptive functioning; and 3) Documentation substantiating that the individual has had these conditions of autism and adaptive functioning deficits which manifested during the developmental period which is from birth up to the individual’s 22nd birthday. Level of care recertification can be extended from 365 days of the initial evaluation and subsequent anniversary dates to 18 months from initial evaluations and subsequent anniversary dates.

Increase Payment Rates

The following rates may be increased to account for excess overtime of direct support professionals to cover staffing needs and to account for additional infection control supplies and service costs: Residential Habilitation, including life Sharing, Supported Employment, the Community Support component of Specialized Skill Development, Day Habilitation, Respite, and Shift Nursing. The rate setting methodology is the same. Upward adjustments are made to the supply costs (additional supplies for infection control) and overtime for direct support staff. Resulting temporary rate increases are not expected to exceed 40%.

Modifications of ISP

Modifications to Supports Coordination 1. Allow remote/telephone individual monitoring by Supports Coordination where there are currently face-to-face requirements. 2. Individual plan team meetings and plan development may be conducted entirely using telecommunications. Participant Rights 1. Suspend requirements for allowing visitors (providers may prohibit/restrict visitation in-line with CMS recommendations for long term care facilities). The modification of this right is not required to be justified in the individual plan. 2. Suspend requirements for right to choose who to share a bedroom with. The modification of this right is not required to be justified in the individual plan

Modify Incident Reporting/Med Management Safeguards

N/A

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

Participants that require hospitalization due to a diagnosis of COVID19 may receive the following services in a hospital setting when the participant requires these services for communication, behavioral stabilization and/or intensive personal care needs: ? Residential Habilitation, including life sharing ? Temporary Supplemental services ? Specialized Skill Development: Behavioral Specialist, Systematic Skill Building, and Community Support services ? Therapies These services cannot be provided in a hospital for more than 30 consecutive days except in situations where it is medically necessary for the participant to be hospitalized for more than 30 consecutive days due to a diagnosis of COVID19.

Inclusion of Retainer Payments

Retainer payments may be provided for Day Habilitation. ? Retainer payments may be provided in circumstances in which facility closures are necessary due to COVID19 containment efforts. ? Retainer payments may be provided in circumstances in which attendance and utilization for the service location drop to below 75% of annual monthly average 7/1/19 to 2/28/2020. ? Retainer payments will not exceed 75% of monthly average of total billing under the 1915(c) waivers. Through billing procedures, ODP will ensure that there will be no duplicative payments. Day Habilitation services rendered in private homes or other community settings to ensure participant health and safety will be deducted from any calculations for retainer payments.

Institute/Expand Opportunities for Self-Direction

N/A

Increase Factor C

N/A

Other Changes Necessary

Given the rapid response that will be necessary to ensure participant health and welfare and to avoid delays while waiting for approval and authorization of individual plan changes in HCSIS, documentation of verbal approval or email approval of changes and additions to individual plans will suffice as authorization. Upon validation that a verbal or email approval was provided for requested changes, ODP may backdate authorizations in HCSIS for waiver services provided during the period of time specified in Appendix K

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

Given the rapid response that will be necessary to ensure participant health and welfare and to avoid delays while waiting for approval and authorization of individual plan changes in HCSIS, documentation of verbal approval or email approval of changes and additions to individual plans will suffice as authorization. Upon validation that a verbal or email approval was provided for requested changes, ODP may backdate authorizations in HCSIS for waiver services provided during the period of time specified in Appendix K

Other Changes Necessary

Given the rapid response that will be necessary to ensure participant health and welfare and to avoid delays while waiting for approval and authorization of individual plan changes in HCSIS, documentation of verbal approval or email approval of changes and additions to individual plans will suffice as authorization. Upon validation that a verbal or email approval was provided for requested changes, ODP may backdate authorizations in HCSIS for waiver services provided during the period of time specified in Appendix K

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/pa-0593-appendix-k-appvl.pdf

Link to Approval Letter

https://www.medicaid.gov/state-resource-center/downloads/pa-appendixk-appvl-ltr.pdf