Texas – Deaf Blind with Multiple Disabilities (DBMD) (0281.R05.00) and Community Living Assistance and Support Services (CLASS) (0221.R06.00)

Waiver Title

Deaf Blind with Multiple Disabilities (DBMD) (0281.R05.00) and Community Living Assistance and Support Services (CLASS) (0221.R06.00)

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.). HHSC requests approval to implement the following flexibilities up through the end of the disaster period. Based on the evolving situation, HHSC continues to determine the most appropriate timeframe for each waiver or modification, which is not to exceed the disaster period.

Waiver Description

Deaf Blind w/Multiple Disabilities (0281.R05.00): Provides case management, day habilitation, residential habilitation, respite, supported employment, prescribed drugs, financial management services, support consultation, adaptive aids and medical supplies, assisted living, audiology services, behavioral support services, chore service, dental treatment, dietary services, employment assistance, intervener, minor home modifications, nursing, occupational therapy services, orientation and mobility, physical therapy services, speech, hearing, and language therapy services, transition assistance services for individuals w/DD ages 0 – no max age. Community Living Assistance & Support Services (CLASS) (0221.R06.00): Provides case management, prevocational services, residential habilitation, respite (in-home and out-of-home), supported employment, adaptive aids, dental treatment, dietary, nursing, occupational therapy, physical therapy, prescribed drugs, speech and language pathology, financial management services, support consultation, auditory integration training/auditory enhancement training, behavioral support, cognitive rehabilitation therapy, continued family services, employment assistance, minor home modifications, specialized therapies, support family services, transition assistance services to individuals with DD ages 0 – no max age.

Start Date

3/13/2020

End Date

1/26/2021

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 across the waivers to all individuals impacted by the COVID-19 virus or in response to the virus.

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

N/A

Increase Payment Rates

N/A

Modifications of ISP

N/A

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

When an individual’s name is released from a waiver interest list, a face-to-face assessment must be conducted to determine the individual’s eligibility for the waiver program. The state requests a waiver that will allow it to suspend releasing names from the waiver interest lists; the state will offer enrollment only to individuals who are requesting waiver services through the reserve capacity group of Promoting Independence/Money Follows the Person (on a case-by-case basis). This request will allow the state to significantly reduce the number of face-to-face assessments conducted during the COVID pandemic. For CLASS, update Factor C to reflect 5568 and PIT numbers 5431 for waiver year one. The reduction in the Factor C numbers will not result in any currently enrolled waiver participants losing their eligibility.

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, monthly monitoring, other: Financial Management Services Agency (FMSA) Initial Orientation

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

When an individual’s name is released from a waiver interest list, a face-to-face assessment must be conducted to determine the individual’s eligibility for the waiver program. The state requests a waiver that will allow it to suspend releasing names from the waiver interest lists; the state will offer enrollment only to individuals who are requesting waiver services through the reserve capacity group of Promoting Independence/Money Follows the Person (on a case-by-case basis). This request will allow the state to significantly reduce the number of face-to-face assessments conducted during the COVID pandemic. For CLASS, update Factor C to reflect 5568 and PIT numbers 5431 for waiver year one. The reduction in the Factor C numbers will not result in any currently enrolled waiver participants losing their eligibility.

Other Changes Necessary

When an individual’s name is released from a waiver interest list, a face-to-face assessment must be conducted to determine the individual’s eligibility for the waiver program. The state requests a waiver that will allow it to suspend releasing names from the waiver interest lists; the state will offer enrollment only to individuals who are requesting waiver services through the reserve capacity group of Promoting Independence/Money Follows the Person (on a case-by-case basis). This request will allow the state to significantly reduce the number of face-to-face assessments conducted during the COVID pandemic. For CLASS, update Factor C to reflect 5568 and PIT numbers 5431 for waiver year one. The reduction in the Factor C numbers will not result in any currently enrolled waiver participants losing their eligibility.

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

X

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/tx-0281-0221-combined-appendix-k-appvl.pdf

Link to Approval Letter

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