Washington (1086.R01.00)

Waiver Title

Residential Support Waiver (1086.R01.00)

Description of Emergency

1) On February 29th, 2020 Governor Jay Inslee declared a state of emergency in response to new cases of COVID-19, directing state agencies to use all resources necessary to prepare for and respond to the outbreak. The risk posed by a virus outbreak depends on factors including how well it spreads between people, the severity of the illness it causes, and the medical or other measures in place to control the impact of the virus (for example, vaccine or treatment medications). There are currently no vaccine or treatment medications that are effective against COVID-19 which is spreading rapidly in several communities in Washington, and the risk of exposure is increasing for people who live in our state. Healthcare workers caring for patients with COVID-19 are at elevated risk of exposure. Those who have had close contact with persons with COVID-19 are at elevated risk of exposure. Travelers returning from affected international locations where community spread is occurring are at elevated risk of exposure. Our knowledge of COVID-19 is still rapidly evolving. Individuals who are sick are advised to stay home. 2) As of March 10rd, 2020 there are 162 confirmed cases and 22 total fatalities of COVID-19. This number is expected to grow. 3) ALTSA is in the process of developing emergency plans to assist communities affected by COVID-19. 4) A number of requirements we have committed to in our state plan and waiver applications are dependent on staff and provider ability to perform tasks. Due to the evolving nature of this crisis we may reach a point where we must adjust service delivery methods, suspend home visits, and shift workload priorities due to staff shortages in order to meet immediate health and safety needs.

Start Date

2-29-2020

End Date

1-31-2021

Description of Transition Plan

Individuals will transition to pre-emergency service status as soon as circumstances allow. Individual needs will be reassessed, as necessary, on a case by case basis following the return to pre-emergency services.

Area(s) Affected

Area Affected

all

Increase Cost Limits

N/A

Modify Targeting Criteria

N/A

Modify Scope or Coverage

Adult Day Health is a supervised daytime program providing nursing and rehabilitative therapy services to adults with medical or disabling conditions that require the intervention or services of a registered nurse, or a licensed speech therapist, occupational therapist, or physical therapist acting under the supervision of the participant’s physician, when required. Services provided are specified in the participant’s service plan and encompass both health and social services needed to ensure the optimal functioning of the participant. Meals provided as part of the Adult Day Health services shall not constitute a full nutritional regime. A skilled nursing or rehabilitative therapy service must be provided by staff operating within their scope of practice under Washington State law and regulation on each service day for which reimbursement is claimed. Transportation between the participant’s place of residence and the Adult Day Health site is included as a component of Adult Day Health services and is reflected in the rate paid to the Adult Day Health providers. To ensure duplicate billing does not occur, The P1 system will have a conflict edit that will result if skilled nursing and transportation are authorized at the same time as Adult day health. For areas in which COVID-19 has closed an Adult Day Health Center, and to ensure continuity of care is maintained for health and safety, services provided by Adult Day Health Centers will be delivered in the client’s residence. Specialized medical equipment and supplies include devices, controls, or appliances, specified in the plan of
care, which enable the participants to increase their abilities to perform activities of daily living, or to perceive,
control, or communicate with the environment in which they live.
This service also includes items necessary for life support, ancillary supplies and equipment necessary to the
proper functioning of such items, and durable/non-durable medical equipment not available under the Medicaid
State Plan. Items reimbursed with waiver funds shall be in addition to any medical equipment and supplies
furnished under the State Plan and shall exclude those items which are not of direct medical or remedial benefit
to the individual. All items shall meet applicable standards of manufacture, design and installation.
This service also includes maintenance and upkeep of items covered under the service and training for the
participant/caregivers in the operation and maintenance of the item. Training may not duplicate training
provided in other waiver services.
The services under the waiver are limited to additional services not otherwise covered under the state plan,
including EPSDT, but consistent with waiver objectives of avoiding institutionalization.
During the COVID-19 outbreak, this service will be expanded to allow the purchase of items related to health
and safety such as personal protective garments and disinfectant supplies.

Exceed Service Limitations

Implement a temporary increase in the amount and duration for the following services within the waivers, as necessary on a cases by case basis. • Skilled Nursing • Adult Day Health • Specialized Medical Equipment and supplies • Client Support Training/Wellness Education • Adult Family Home Specialized Behavior Support Service • Nurse delegation • Enhanced Residential Services • Expanded Community Services

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

Temporarily waive timing requirements for initial training and certification requirements and revalidation of waiver provider renewal requirements related to continuing education and recertification during the state of emergency. This applies to staff in Adult family home and Assisted living facility settings. Temporarily waive timing requirements for initial and revalidation of waiver provider renewal requirements during the state of emergency. Adult Family Home and Assisted Living programs: Staff providing personal care for these Provider types may provide services to participants prior to completing Basic training or obtaining certification as a Home Care Aide. Unless exempt under state law, these staff must complete Basic training and obtain certification as a Home Care Aide as soon as feasibly possible. If not exempt under state law, these staff, who have passed a state background check, must complete a federal background check as soon as feasibly possible, but may continue providing services without a federal background check. Unless exempt under state law, staff must complete continuing education credits every 12 months, but may continue providing services if continuing education requirements are not completed.

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

N/A

Modification LOC Eval and Re-Eval Processes

The state has discretion, based on the availability of resources, to determine who (DDA, HCS, or AAA Case Managers) is responsible for completing initial assessments and/or reassessments. The State may modify timeframes or processes for completing assessments: 1) Case Managers may complete all Initial and reassessments telephonically or via other audio/video options in lieu of face-to-face assessments. If an assessment is done telephonically all components of the CARE assessment will still be completed except the MMSE, which cannot be done over the phone. 2) Annual reassessments of level of care that exceeds the 12 month authorization period will remain open and services will continue to allow sufficient time for the case manager to complete the annual reassessment. A reassessment may be postponed for up to one year.

Increase Payment Rates

To effectively respond to the COVID-19 outbreak the state requires the flexibility to adjust providers’ rates if deemed necessary to ensure that essential services are available for clients. If deemed necessary, the state may reimburse providers with an additional add-on COVID-19 rate. This may apply to all services available under the approved waiver as determined by the state on a case by case basis when an increased rate is deemed necessary to maintain services due to risk factors associated with COVID-19. Negotiated COVID add-on rates will be based on current market factors and verified additional costs incurred by the provider. The add-on rate will be determined by the state, but may not exceed 25% of the provider’s current rate.

Modifications of ISP

The State may modify timeframes or processes for completing person-centered service plans: 1) Case Managers may complete the person-centered service planning process telephonically or via other audio/video options in lieu of meeting face-to-face. 2) Person centered service plans adjustments may be approved with a retroactive approval date for service needs identified to mitigate harm or risk directly related to COVID-19 impacts.

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

In response to the emergency situation and in order to maintain a viable workforce, the state may elect to make retainer payments to residential providers for up to 30 days in instances where the participant is hospitalized, or the participant is absent from his/her home due to COVID-19. The state will determine the rate and scope of retainer payments based on the severity of the situation.

Institute/Expand Opportunities for Self-Direction

N/A

Increase Factor C

N/A

Other Changes Necessary

Visitors to residential settings may be limited if directed by Public Health Authorities

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

Visitors to residential settings may be limited if directed by Public Health Authorities

Other Changes Necessary

Visitors to residential settings may be limited if directed by Public Health Authorities

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

N/A