South Carolina – Intellectually Disabled and Related Disabilities Waiver (ID/RD) (0237.R05.00), Community Supports (CS) (0676.R02.00), Head and Spinal Cord Injury (HASCI) (0284.R05.00)

Waiver Title

Intellectually Disabled and Related Disabilities Waiver (ID/RD) (0237.R05.00), Community Supports (CS) (0676.R02.00), Head and Spinal Cord Injury (HASCI) (0284.R05.00)

Description of Emergency

COVID-19 pandemic. This amendment will apply waiver-wide for each waiver included in this Appendix, to all individuals impacted by the virus or the response to the virus (e.g. closure of day programs, etc.)

Waiver Description

ID and Related Disabilities (0237.R05.00): Provides adult day health care, adult day health care services, personal care 2, personal care 1, residential habilitation, respite care, waiver case management (WCM), adult dental services, adult vision, audiology services, incontinence supplies, prescribed drugs, adult attendant care services, adult companion services, adult day health care nursing, adult day health care transportation, behavior support services, career preparation services, community services, day activity, employment services, environmental modifications, nursing services, personal emergency response system (PERS), pest control bed bugs, pest control treatment, private vehicle assessment/consultation, private vehicle modifications, psychological services, specialized medical equipment and assistive technology assessment/consultation, specialized medical equipment, supplies and assistive technology, and support center services for individuals w/ID ages 0 – no max age. Community Supports (CS) Waiver (0676.R02.00): Provides adult day health care services, personal care services, respite care services, waiver case management (WCM), incontinence supplies, adult day health care nursing, adult day health care transportation, assistive technology and appliances assessment/consultation, assistive technology and appliances, behavior support services, career preparation services, community services, day activity, employment services, environmental modifications, in-home support services, personal emergency response systems (PERS), private vehicle assessment/consultation, private vehicle modifications, support center services for individuals w/ID ages 0 – no max age. Head and Spinal Cord Injury (0284.R05.00): Provides attendant care/personal assistance services, career preparation services, day activity, residential habilitation, respite care services, waiver case management (WCM), incontinence supplies, occupational therapy, physical therapy, speech and hearing services, behavioral support services, employment services, environmental modifications, health education for participant-directed care, Medicaid waiver nursing, peer guidance for participant-directed care, personal emergency response systems, pest control bed bugs, pest control treatment, private vehicle assessment/consultation, private vehicle modifications, psychological services, supplies, equipment and assistive technology assessment/consultation, supplies, equipment and assistive technology for individuals with physical and other disabilities ages 0-64

Start Date

27-01-20

End Date

26-01-21

Description of Transition Plan

All activities will take place in response to the impact of COVID-19 as efficiently and effectively as possible based upon the complexity of the change.

Area(s) Affected

Area Affected

These actions will apply statewide across the waiver to all individuals impacted by the COVID-19 virus

Increase Cost Limits

N/A

Modify Targeting Criteria

N/A

Modify Scope or Coverage

N/A

Exceed Service Limitations

ID/RD: For waiver participants displaced from Day Programs and Adult Day Health Care (ADHC) Services (authorized on the individual plan of care), respite services and personal care services may be added in excess of established limits to supplant services lost due to closure or diversion from Day Programs or ADHCs. The number of combined hours of respite or personal care added to the participant’s care plan may total up to those lost by not receiving Day Program or ADHC services. ID/RD, HASCI, CS: Adjust limits on Waiver Case Management to allow up to 80 units (20 hours) per calendar quarter when warranted without prior authorization by the Medicaid agency. The current waiver states “participants may receive no more than 10 hours per calendar quarter. In exceptional cases, where medical necessity has been demonstrated, additional hours can be approved through a prior authorization process.” Temporary adjustment of limits will allow for case management to address emergency needs. ID/RD: Remove limits on Adult Attendant Care (currently limited to 28 hours per week). HASCI: Remove limits on Attendant Care/Personal Assistance (currently limited to 49 hours per week). The service increases are for needs directly related to closure of SCDDSN Day Program(s) or ADHC center(s) and may total up to those lost by not receiving Day Program or ADHC services.

Add Services

In-Home Support Services (ID/RD, HASCI); Home Delivered Meals;

Expand Settings

Allow for Day Services (Day Activity, Career Preparation, Community Services, Employment
Services) to be provided in residential settings licensed or otherwise recognized by SCDDSN as
appropriate.
Allow the provision of ADHC Nursing in participant’s home if the ADHC provider suspends hours
of operation. Services provided in this manner can be billed as an hourly unit at 1/5 the rate of the
ADHC per diem.

Provide Service Out of State

N/A

Allow Payment for Services by Families

N/A

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 ID/RD, HASCI and CS waiver may be used for provision of any non-professional service under another service definition in C-1/C-3. All staff must receive training on any participant’s Service Plan (Support Plan) for whom they are providing support. Training on the Support Plan must consist of basic health and safety support needs for that individual. Direct care workers must have a national federal fingerprint-based criminal background check if the prospective employee cannot establish South Carolina residency for the 12 months preceding the date of the employment application and/or the prospective employee will work with children under the age of 18. For the purposes of Appendix K, this requirement may be temporarily waived if: • The direct care worker is a family member of the participant; • A state and national background check is obtained that is equivalent in scope to the waived background check, but for the use of fingerprints to verify the worker’s identity; • The participant, or participant’s legal guardian, provides informed consent; and • The direct care worker obtains a fingerprint background check within 90 days.

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

For Residential Habilitation, current requirements are for providers to be licensed in accordance with Code of Laws of SC, 1976 as amended: 40-20-710 through 44-10-1000; 44-20-10 et seq.; and 44-21-10 et seq.; SC licensing regulations: 61-103. Allow, when needed, Residential Habilitation to be provided in settings other than settings licensed by the state such as non-licensed group homes and adult host homes. SCDDSN will issue provisional licenses for settings whose licenses expire and cannot be renewed due to COVID-19.

Modification LOC Eval and Re-Eval Processes

N/A

Increase Payment Rates

N/A

Modifications of ISP

PCSP that are due to expire within the next 60 days can be renewed for an additional 12 months if a meeting is held with the individual and/or representative. The PCSP may be a continuation of the services currently being rendered under the current service plan if the case manager contacts the participant using allowable remote contact methods to verify with the participant and/or representative that the current PCSP assessment and service, including providers, remain acceptable and approvable. The state will verify by obtaining electronic signatures from service providers and the individual and/or representative, in accordance with the state’s HIPAA requirements. The state will ensure the service plan is modified to allow for additional supports/and or services to respond to the COVID-19 pandemic. The specificity of such services including amount, duration and scope will be appended as soon as possible to ensure that the specific service is delineated accordingly to the date it began to be received. The PCSP will be updated no later than 30 days from the date the service was initiated.

Modify Incident Reporting/Med Management Safeguards

ID/RD, CS, HASCI: Allow for completion of critical incident or ANE final report outside of typical timeframes (10 days) upon approval of an extension request. No changes are requested to incident response or initial reporting requirements.

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

The state will modify the requirement of receipt of two (2) waiver services monthly to if the individual receives waiver services less than monthly the individual will receive monthly monitoring. Allow all reviews by the state’s Quality Improvement Organization and other auditing activities to be performed as off-site, desk reviews of information shared by the provider, or deferred past the required timeliness period if onsite reviews are required.

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

Case management, in-home habilitation, monthly monitoring, other: ID/RD, HASCI, CS: Case managers must ensure that the same number of contacts required by each waiver, including at least one case management activity per month, is completed. The contacts that require a face to face visit (initial visit, quarterly visits, and re-evaluation visits) will be completed during telephonic communication during the declared public health emergency. For in-home habilitation, only hourly units of residential habilitation offered in a Supervised Living Program Level I may be allowed to be offered telephonically

Add Home Delivered Meals

X

Add Medical Supplies, Equipment and Appliances

N/A

Add Assistive Technology

N/A

Conflict of Interest

Other Changes Necessary

The state will modify the requirement of receipt of two (2) waiver services monthly to if the individual receives waiver services less than monthly the individual will receive monthly monitoring. Allow all reviews by the state’s Quality Improvement Organization and other auditing activities to be performed as off-site, desk reviews of information shared by the provider, or deferred past the required timeliness period if onsite reviews are required.

Other Changes Necessary

The state will modify the requirement of receipt of two (2) waiver services monthly to if the individual receives waiver services less than monthly the individual will receive monthly monitoring. Allow all reviews by the state’s Quality Improvement Organization and other auditing activities to be performed as off-site, desk reviews of information shared by the provider, or deferred past the required timeliness period if onsite reviews are required.

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

X

Allow the Option to Conduct Evaluations, Assessments, and Person-Centered Service Planning Meetings Virtually/Remotely in lieu of Face-to-Face Meetings

X

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

X

Link To Application

https://www.medicaid.gov/state-resource-center/downloads/sc-0237-0676-0284-combined-appendix-k-appvl.pdf

Link to Approval Letter

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