Texas Home Living (TxHmL) (0403.R03.00) & HCBS Program (0110.R07.00)

Waiver Title

Texas Home Living (TxHmL) (0403.R03.00) & HCBS Program (0110.R07.00)

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

Home Living Program (0403.R03.00): Provides day habilitation, respite, supported employment, prescription medications, financial management services, support consultation, adaptive aids, audiology services, behavioral support, community support, dental treatment, dietary services, employment assistance, minor home modifications, nursing, occupational therapy services, physical therapy services, speech-language pathology individuals with ID/DD ages 0 – no max ageHCBS Program (0110.R07.00): Provides day habilitation, respite, supported employment, adaptive aids, audiology, occupational therapy, physical therapy, prescribed drugs, speech and language pathology, financial management services, support consultation, behavioral support, cognitive rehabilitation therapy, dental treatment, dietary services, employment assistance, minor home modifications, nursing, residential assistance (host home/companion care, supervised living, residential support services), social work, supported home living, transition assistance services for individuals with ID/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 waiver to all individuals impacted by the COVID-19 virus or the response to the virus.

Increase Cost Limits

N/A

Modify Targeting Criteria

N/A

Modify Scope or Coverage

N/A

Exceed Service Limitations

HCS: The waiver prohibits more than four persons receiving residential support, supervised living, respite, or a similar non-waiver service from living in a four-person residence. The State requests a waiver of this prohibition to allow up to six persons receiving such services to live in a four-person residence. This waiver will allow for additional living options for persons who need residential services if staff shortages result from the COVID-19 pandemic. These homes are required to have 24-hour awake staff. In addition, it is HHSCs expectation that staffing ratios would be adjusted based on the needs of the individuals in these homes. Providers are also required to notify the State agency if they need to temporarily exceed capacity and HHSC will conduct monitoring visits as necessary to ensure that the residents are safe. In addition, local fire authorities may also require sprinklers.

Add Services

N/A

Expand Settings

Currently, an individual is prohibited from receiving waiver services in an ICF/IID. The State requests a waiver to allow an individual who is living in a three-person or four-person residence and receiving residential support or supervised living to temporarily move to and receive waiver services in an ICF/IID. This waiver will allow for persons living in a three-person or four-person residence to receive needed residential services and all other approved HCS services, if the residence becomes unavailable as a result of the COVID-19 pandemic. Individuals that are moved from an HCS home into an ICF/IID home will continue to receive HCS services and will not be admitted to the ICF/IID or receive ICF services.

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

This request only applies to the HCS waiver. 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 HCS waiver interest lists. The state will offer enrollment only to individuals who are requesting waiver services through one of the following reserve capacity groups: individuals at risk of imminent institutionalization, individuals with level of care I or VIII residing in or at imminent risk of entering a nursing facility (PI), and individuals leaving state conservatorship. This request will allow the state to significantly reduce the number of face-to-face assessments conducted during the COVID-19 pandemic. HCS updated Unduplicated participant count (Factor C) for waiver year 2 total 27,432 and PIT total 26,542. The reduction in the Factor C numbers will not result in any currently enrolled waiver participants losing their eligibility. The timeframe for the submission of the CMS TxHmL evidentiary package will be extended by 30 days.

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 Agencies (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

This request only applies to the HCS waiver. 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 HCS waiver interest lists. The state will offer enrollment only to individuals who are requesting waiver services through one of the following reserve capacity groups: individuals at risk of imminent institutionalization, individuals with level of care I or VIII residing in or at imminent risk of entering a nursing facility (PI), and individuals leaving state conservatorship. This request will allow the state to significantly reduce the number of face-to-face assessments conducted during the COVID-19 pandemic. HCS updated Unduplicated participant count (Factor C) for waiver year 2 total 27,432 and PIT total 26,542. The reduction in the Factor C numbers will not result in any currently enrolled waiver participants losing their eligibility. The timeframe for the submission of the CMS TxHmL evidentiary package will be extended by 30 days.

Other Changes Necessary

This request only applies to the HCS waiver. 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 HCS waiver interest lists. The state will offer enrollment only to individuals who are requesting waiver services through one of the following reserve capacity groups: individuals at risk of imminent institutionalization, individuals with level of care I or VIII residing in or at imminent risk of entering a nursing facility (PI), and individuals leaving state conservatorship. This request will allow the state to significantly reduce the number of face-to-face assessments conducted during the COVID-19 pandemic. HCS updated Unduplicated participant count (Factor C) for waiver year 2 total 27,432 and PIT total 26,542. The reduction in the Factor C numbers will not result in any currently enrolled waiver participants losing their eligibility. The timeframe for the submission of the CMS TxHmL evidentiary package will be extended by 30 days.

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-0403-0110-combined-appendix-k-appvl.pdf

Link to Approval Letter

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