Utah – Utah Community Supports Waiver; Aging Waiver; Acquired Brain Injury Waiver; Physical Disabilities Waiver; New Choices Waiver; Medically Complex Children’s Waiver; Technology Dependent Waiver

Waiver Title

Utah Community Supports Waiver; Aging Waiver; Acquired Brain Injury Waiver; Physical Disabilities Waiver; New Choices Waiver; Medically Complex Children’s Waiver; Technology Dependent Waiver

Description of Emergency

N/A

Waiver Description

Community Supports Waiver for Individuals w/ID and Other Related Conditions (0158.R06.00): Provides day supports, homemaker, personal care, residential hab, respite care-intensive, supported employment, waiver support coordination, FMS, behavior consultation I, behavior consultation II, behavior consultation III, chore, companion services, environmental adaptations, extended living supports, family and individual training and preparation services, family training and preparation services, living start-up costs, massage therapy, personal budget assistance, PERS, professional medication monitoring, respite care-routine group, respite care-routine, respite care-session, service animal, specialized medical equipment/supplies/assistive technology-monthly fee, specialized medical equipment/supplies/assistive technology-purchase, supported living, transportation (non-medical) for individuals w/autism, ID, DD ages 0 – no max age. Waiver for Individuals Age 65 or Older (0247.R05.00): Provides adult day health, case management, homemaker, respite and respite care services – LTC facility, enhanced state plan supportive maintenance home health aide services, financial management services, adult companion services, chore services, community transition services, environmental accessibility adaptations, medication reminder systems, personal attendant services, personal attendant training services, personal budget assistance, personal emergency response systems (PERS) installation, testing, and removal, PERS purchase, rental, and repair, PERS response center service, specialized medical equipment/supplies/assistive technology, supplemental meals, transportation services (non-medical) for aged individuals ages 65 – no max age. Acquired Brain Injury (0292.R05.00): Provides ABI waiver support coordination, day supports, homemaker, residential habilitation, respite, supported employment, consumer preparation services, financial management services, behavior consultation I, behavior consultation II, behavior consultation III, chore services, community transition service, companion services, environmental adaptations – home, environmental adaptations – vehicle, extended living supports, massage therapy, personal budget assistance, personal emergency response system, professional medication monitoring, specialized medical equipment/supplies/assistive technology – purchase, specialized medical equipment/supplies/assistive technology-monthly fee, supported living, transportation services (non-medical) for individuals with brain injury ages 18 – no max age. Physical Disabilities (0331.R04.00): Provides personal attendant services, financial management services, personal emergency response systems (PERS), specialized medical equipment and supplies – monthly fee, specialized medical equipment and supplies – purchase, installation, removal, replacement and repair for aged individuals 65 – no max age and physically disabled individuals 18-64. New Choices (0439.R02.00): Provides adult day care, case management, habilitation, homemaker, respite, supportive maintenance, consumer preparation, financial management services, adult residential, assistive technology devices, attendant care, caregiver training, chore services, community transition, environmental accessibility adaptations, home delivered meals, medication administration assistance, personal budget assistance, personal emergency response system, specialized medical equipment, supplies and supplements, transportation – non-medical for aged individuals 65 – no max age and physically disabled and other disabilities ages 18-64. Medically Complex Children’s Waiver (1246.R01.00): Provides skilled nursing respite and routine respite, Financial Management Services for medically fragile individuals ages 0-19. Waiver for Technology Dependent, Medically Fragile: Provides skilled nursing respite care, extended home health aide, extended private duty nursing, FMS, family support services, in-home feeding therapy for medically fragile and technology dependent individuals ages 0 – 20 Individuals (40183.R05.00)

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 across the waivers to all individuals impacted by the COVID-19 virus

Increase Cost Limits

N/A

Modify Targeting Criteria

UT.0439 (New Choices Waiver): Allow for retroactive waiver considerations/waiving break-instay policy for individuals who discharge home. Waive requirement of tri-annual open enrollment periods, allowing for applications to be submitted at any time. All waivers – allow continued enrollment if a member experiences a hospitalization, or skilled nursing facility placement greater than 90 days.

Modify Scope or Coverage

N/A

Exceed Service Limitations

0158 (Community Supports Waiver), 0292 (Acquired Brain Injury Waiver), 1666 (Community Transitions Waiver); 0331 (Physical Disabilities Waiver): Respite – Extension for more than 13 consecutive days. Specialized Medical Equipment/Supplies/Assistive Technology & Environmental Adaptations – Approval may be made without a prescription from a licensed physician. Approval may be made without documentation of a Medicaid denial if reasonable evidence is obtained that the item is not a covered benefit. 0247 (Aging Waiver): Respite and Respite Care Services – LTC Facility – Extension for more than 13 consecutive days. Specialized Medical Equipment/Supplies/Assistive Technology & Environmental Adaptations – Approval may be made without a prescription from a licensed physician. Approval may be made without documentation of a Medicaid denial if reasonable evidence is obtained that the item is not a covered benefit. Supplemental Meals – Limit on the ‘community meal’ option will no longer be limited to $25.00/mo. Meal delivery services such as ‘Door Dash/Uber Eats’ are permissible. 0439 (New Choices Waiver): Respite – Extension for more than 13 consecutive days. Specialized Medical Equipment/Supplies/Assistive Technology & Environmental Adaptations – Approval may be made without a prescription from a licensed physician. Approval may be made without documentation of a Medicaid denial if reasonable evidence is obtained that the item is not a covered benefit. Home Delivered Meals – adoption of a ‘community meal’ option, allowing for restaurant delivery/delivery from services such as Door Dash and Uber Eats.

Add Services

N/A

Expand Settings

Direct care services, Respite Care, Day Supports and Supported Employment, may be provided in a hotel, shelter, church, or alternative facility based setting or the home of a direct care worker when the waiver participant is displaced from their home because of quarantine or hospitalization or when providers are unavailable due to illness or business closure. When appropriate, Day Supports may be provided in the individual’s home. Waivers offering overnight respite (with room and board) may use settings such as Intermediate Care Facilities or Skilled Nursing Facilities. Personal care and similar services may be provided in a hospital or other short-term institutional setting.

Provide Service Out of State

N/A

Allow Payment for Services by Families

Yes, for all waivers, the State seeks to allow payment for personal care or similar services provided by family caregivers or legally responsible individuals. Details addressed in Addendum.

Modification of Provider Qualifications

Temporarily allow provider enrollment or re-enrollment with modified employee risk screening elements such as onsite visits or fingerprint checks, or modify training requirements. Provider agencies may choose to provide on-line training such as CPR and First Aid in lieu of in-person training. Training may also be conducted by telephone/electronic means. If individual-specific training is provided electronically, a telehealth product or non-public facing remote communication product should be used to protect the individual’s confidentiality. Staff will remain eligible to perform services for a 90-day window post-expiration of training for items such as CPR, First Aid and Crisis Management during this period.

Modify Provider Types

Expand provider types for environmental adaptations, specialized medical equipment, and assistive technology to include the use of a purchase card in order to purchase items from nontraditional vendors who have necessary items in stock when supply or cost impacts occur due to COVID 19 on a case by case basis. The State may act as an intermediary to process these orders when a waiver provider cannot be secured, or the time frame to supply the requested item would pose a health and safety concern for the individual. Non-Medical Transportation through non-enrolled providers such as drivers for Uber/Lyft may be reimbursed.

Modify Licensure/Requirements for Waiver Settings

When needed, suspend provider licensing (including background checks/fingerprinting) or certification for up to 1 year when COVID 19 pandemic impacts the ability for providers to obtain license or certification due to state staff or service provider availability. Maximum number of individuals served in a service location may be exceeded to address staffing shortages or accommodate use of other sites as quarantine sites. Minimum staffing ratios as required by licensure, service definition, or the individual’s PCSP may be exceeded due to staffing shortages. Allow for delayed enforcement of HCBS Settings Rule requirements for new settings until review of location/service delivery may be completed.

Modification LOC Eval and Re-Eval Processes

[See Addendum]

Increase Payment Rates

Services delivered as ‘direct care’ to the participant will be eligible for enhanced reimbursement to acknowledge additional risk/cost associated with providing care, including payment of additional employee benefits, overtime/hazard pay, etc. The amount of additional reimbursement will be subject to limitations regarding the use and appropriation of State and Federal funds in both State and Federal statute. Reimbursement will follow the State’s approved rate methodology and allow up to an additional 50% of the max rate based on SMA approval. In addition, Case Management provided in 0247 (Aging Waiver); and 0439 (New Choices Waiver) may be eligible for similar enhanced reimbursement without in-person contact.

Modifications of ISP

[See Addendum]

Modify Incident Reporting/Med Management Safeguards

Allow for entry of incidents into the Incident Reporting System outside of typical timeframes in instances in which staff shortages due to COVID-19 occur. Response to incidents will not be impacted. Providers must submit critical incident reports for participants who tested positive for COVID19, and disclose in the critical incident report the exposure of COVID-19 positive participants with any other 1915(c) HCBS waiver participants and/or staff. While reports will be required, providers do not need to conduct an investigation or submit a corrective action plan related to these reports, unless instructed directly to do so at the Department’s discretion.

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

Habilitation, Supported Living and Personal Care/Attendant Care services may be provided in an acute setting or other short-term institutional setting, when the service is not able to be provided by the Acute/Institutional Setting provider. The Department will ensure no duplication of services through documentation of tasks provided and a waiver form completed by the institutional setting staff attesting that specific tasks needed in the acute care hospital or short-term institutional stay cannot be done by the facility staff due to system capacity or other critical service interruption and that the participant may have a trained attendant complete the specific tasks.

Inclusion of Retainer Payments

Retainer payments may be provided for circumstances in which providers have experienced significant decline in service utilization due to COVID-19 containment efforts. Reimbursement to providers up to 100% of average monthly pre-COVID-19 costs associated with these services. Retainer payments are subject to available funds. Legally responsible caregivers and family members are not eligible for retainer payments. Self-Directed/Self-Administered Services employees who have been diagnosed with COVID-19 or are isolating due to known exposure may be paid up to the amount of hours they would have performed for their employer over a 14-day period. 0439 (New Choices Waiver): -Residential absentee considerations (family takes individual home for extended period) -Adult Day Care -Retainer payments may be provided for Homemaker, Chore and Attendant Care 0247 (Aging Waiver): -Adult Day Care 0158 (Community Supports Waiver), 0292 (Acquired Brain Injury Waiver): -Adjustments to residential reimbursements to allow retainer payments when the person spends extended periods of time with their natural supports absent from their residential program. -Retainer payments may be provided for Personal Assistance/Personal Care, Day Supports, Supported Living, or Supported Employment.

Institute/Expand Opportunities for Self-Direction

N/A

Increase Factor C

0439 (New Choices Waiver): Increase to Factor C of an additional 250 Individuals.

Other Changes Necessary

Delay of Heightened Scrutiny submissions to CMS for sites which have not received sufficient technical assistance by the State. Compliance audits/reviews of performance measures for providers will be suspended until conditions and staffing allow for these activities to be resumed. In order to respond to the changing needs of participants due to school/employment/day activity schedules, the State will not require Notices of Agency Action to be sent when altering PCSP services to accommodate changes as a direct result of COVID-19 for these amendments. Notices of Agency Action remain required in all other instances of services being suspended, terminated or denied. Due to the inability of individuals to access the community to reduce funds, the State requests the ability to waive asset tests during the COVID-19 period and an additional 6 months following its conclusion. Items Restated from Utah’s 1135 Request: 6.6.3 Electronic Visit Verification 6.10.8 Annual Redeterminations of Eligibility 6.10.12 Reasonable Standards for Eligibility Section 1902(a)(17) 6.10.13 Post-Eligibility Treatment of Income 6.22 Cost Neutrality Requirements 6.26 Timely Filing of Claims 6.27 Home and community-based settings 42 CFR 441(b)(1)(ii) 6.28 Home and community-based settings 42 CFR 441.301(c)(4) 6.29 Signature requirements 6.39.4 Availability of services 42 CFR §438.206

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, personal care services that only require verbal cueing, in-home habilitation; monthly monitoring; other: 0158 (Community Supports Waiver), 0292 (Acquired Brain Injury Waiver):
Companion Services
Supported Living
Supported Employment
Day Supports
Personal Assistance/Personal Care
40183 (Technology Dependent Waiver):
Family Support Services
0247 (Aging Waiver):
Adult Companion Services

Add Home Delivered Meals

X

Add Medical Supplies, Equipment and Appliances

X

Add Assistive Technology

X

Conflict of Interest

Other Changes Necessary

Delay of Heightened Scrutiny submissions to CMS for sites which have not received sufficient technical assistance by the State. Compliance audits/reviews of performance measures for providers will be suspended until conditions and staffing allow for these activities to be resumed. In order to respond to the changing needs of participants due to school/employment/day activity schedules, the State will not require Notices of Agency Action to be sent when altering PCSP services to accommodate changes as a direct result of COVID-19 for these amendments. Notices of Agency Action remain required in all other instances of services being suspended, terminated or denied. Due to the inability of individuals to access the community to reduce funds, the State requests the ability to waive asset tests during the COVID-19 period and an additional 6 months following its conclusion. Items Restated from Utah’s 1135 Request: 6.6.3 Electronic Visit Verification 6.10.8 Annual Redeterminations of Eligibility 6.10.12 Reasonable Standards for Eligibility Section 1902(a)(17) 6.10.13 Post-Eligibility Treatment of Income 6.22 Cost Neutrality Requirements 6.26 Timely Filing of Claims 6.27 Home and community-based settings 42 CFR 441(b)(1)(ii) 6.28 Home and community-based settings 42 CFR 441.301(c)(4) 6.29 Signature requirements 6.39.4 Availability of services 42 CFR §438.206

Other Changes Necessary

Delay of Heightened Scrutiny submissions to CMS for sites which have not received sufficient technical assistance by the State. Compliance audits/reviews of performance measures for providers will be suspended until conditions and staffing allow for these activities to be resumed. In order to respond to the changing needs of participants due to school/employment/day activity schedules, the State will not require Notices of Agency Action to be sent when altering PCSP services to accommodate changes as a direct result of COVID-19 for these amendments. Notices of Agency Action remain required in all other instances of services being suspended, terminated or denied. Due to the inability of individuals to access the community to reduce funds, the State requests the ability to waive asset tests during the COVID-19 period and an additional 6 months following its conclusion. Items Restated from Utah’s 1135 Request: 6.6.3 Electronic Visit Verification 6.10.8 Annual Redeterminations of Eligibility 6.10.12 Reasonable Standards for Eligibility Section 1902(a)(17) 6.10.13 Post-Eligibility Treatment of Income 6.22 Cost Neutrality Requirements 6.26 Timely Filing of Claims 6.27 Home and community-based settings 42 CFR 441(b)(1)(ii) 6.28 Home and community-based settings 42 CFR 441.301(c)(4) 6.29 Signature requirements 6.39.4 Availability of services 42 CFR §438.206

Provider Qualifications

Allow Spouses and Parents of Minor Children to Provide Personal Care Servcies

X

Allow a Family Member to be Paid to Render Services to an Individual

X

Allow Other Practitioners in Lieu of Approved Providers Within the Waiver

X

Modify Service Providers for Home-Delivered Meals to Allow for Additional Providers, Including Non-Traditional Providers

X

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

X

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/ut-combined-appendix-k-appvl.pdf

Link to Approval Letter

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