Rhode Island – Appendix K

Waiver Title

Rhode Island Comprehensive Demonstration

Description of Emergency

The State of Rhode Island is experiencing a state of emergency due to the novel coronavirus disease. As of March 16, 2020, 20 individuals have received a positive diagnosis and over 2,000 have been instructed to self-quarantine due to direct contact with a person who has tested positive. In order to slow the spread of the virus, federal and state public health officials are encouraging “social distancing,” which means the entire State population has been affected by the need to reduce contact with others to the extent possible.

Start Date

27-02-20

End Date

26-02-21

Description of Transition Plan

During the state of emergency, EOHHS proposes to suspend in-person planning meetings for the duration of the novel coronavirus emergency and conduct the planning process through written, telephonic, and/or video conference as appropriate. EOHHS proposes to postpone for 6 months any service plan reviews for which the 12-month review period occurs during the novel coronavirus emergency, and conduct reviews remotely for those that are necessary due to a significant change in the individual’s circumstances or needs, or at the request of the individual. For recipients of long-term services and supports, the level of care for enrolled participants is reevaluated at least annually. EOHHS proposes to postpone for six (6) months any level of care reevaluations for which the twelve (12) month review period occurs during the novel coronavirus emergency. Additionally, EOHHS proposes to conduct initial level of care determinations for institutional, home- and community-based care, and Katie Beckett via telephonic and/or video conference, as appropriate to the needs of the individual Medicaid member. Rhode Island will immediately instruct workers not to open reviews of level of care authorizations or person-centered plans, and to work with beneficiaries to schedule all person-centered plan meetings and level of care determinations for non-in-person settings.

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

N/A

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

N/A

Modification LOC Eval and Re-Eval Processes

Before receiving eligibility for long-term services and supports (LTSS), including institutional care, home- and community-based services, and Katie Beckett, an in-person assessment must be conducted to determine if the individual has an institutional level of care. EOHHS proposes to conduct the level of care determinations via telephonic and/or video conference, as appropriate to the needs of the individual Medicaid member. EOHHS will utilize information received through records submitted by the applicant’s physician, telephonic conversations with the Medicaid member, and telephonic conversations with the individual’s caregiver/power of attorney, as applicable. The current level of care assessments will still be completed, to the furthest extent possible. EOHHS will only abbreviate the evaluation to the extent necessary to avoid face-to-face contact during the Emergency. EOHHS proposes to implement these alternative assessment procedures temporarily during the novel coronavirus State of Emergency, for new applicants and for existing Medicaid members whose level of care changes during the State of Emergency. Following the termination of the State of Emergency, EOHHS will conduct in-person assessments to confirm the level of care determination. For recipients of home- and community-based services/programs, Early Intervention services, home-based therapeutic services, the Katie Beckett program, and other long-term services and supports, the level of care for enrolled participants is reevaluated at least annually. EOHHS proposes to postpone for six (6) months any level of care reevaluations for which the twelve (12) month review period falls during the novel coronavirus emergency. If for any reason a reevaluation is needed during the State of Emergency, EOHHS proposes to use written, telephonic, and/or video conference methods to conduct the reevaluation, as appropriate for the individual beneficiary. EOHHS will only abbreviate such a reevaluation to the extent necessary to avoid face-to-face contact during the Emergency.

Increase Payment Rates

N/A

Modifications of ISP

EOHHS proposes to modify all person-centered service plan procedures, including but not limited to those required under 42 CFR 441.301(c) and 42 CFR 441.725, to ensure that Medicaid members receive authorization for appropriate services, while preventing worker exposure to the novel coronavirus. EOHHS proposes to conduct the planning process through written, telephonic, and/or video conference, as appropriate to the needs of the individual Medicaid member. EOHHS requests a waiver of the requirement that the person-centered planning process occur at times and locations of convenience to the individual, insofar as in-person meetings are the most convenient to the individual. To prevent exposure of workers and others who participate in the planning process, EOHHS proposes to suspend in-person planning meetings for the duration of the novel coronavirus emergency. This change will be implemented for all programs that would otherwise usually involve in-person service plan meetings, including, but not limited to, home- and community-based services/programs, Early Intervention services, home-based therapeutic services, and the Katie Beckett program. In addition, due to the potential for reductions in staff capacity, EOHHS requests of waiver of the requirement to conduct reviews of person-centered plans at least every twelve (12) months. EOHHS proposes to postpone for six (6) months any service plan reviews for which the twelve (12) month review period occurs during the novel coronavirus emergency. EOHHS proposes to continue conducting reviews that are necessary due to a significant change in the individual’s circumstances or needs, or at the request of the individual. These reviews will be conducted remotely, using written, telephone, and/or video conference communication as appropriate for the individual.

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

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/ri-11w00242-appendix-k-appvl.pdf

Link to Approval Letter

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