Washington (1186.R01.00)

Waiver Title

Individual and Family Services (1186.R01.00)

Description of Emergency

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).COVID-19 is spreading in several communities in Washington, 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. As of March 3rd, 2020 there are 162 confirmed cases 22 total fatalities of COVID-19. This number is expected to grow. DDA is in the process of developing emergency plans to assist communities affected by COVID-19. 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 to in order to meet immediate health and safety needs.

Start Date

3-1-2020

End Date

2-28-2021

Description of Transition Plan

IFS waiver participants will transition to emergency service status as soon as it becomes evident that they are impacted by the COVID-19 outbreak. This will be evidenced by contraction of COVID-19 by the waiver participant, their provider or their housemate, local quarantines, or other guidance of isolation or precautionary measures issued by local or federal health departments.

Area(s) Affected

Area Affected

all

Increase Cost Limits

N/A

Modify Targeting Criteria

N/A

Modify Scope or Coverage

N/A

Exceed Service Limitations

DDA proposes to extend the aggregate funding limits on the Individual and Family Services waiver. The amount of budget expansion would be determined on a case by case basis through prior approval for specific service requests. Respite provided out of state may be provided in excess of 30 days on a case by case basis. Community engagement and staff/family consultation may be provided to more than one individual at a time with a rate reduction when providing service in a 2:1 or group setting. Specialized Equipment and Supplies will cover items related to health and safety such as personal protective equipment, disinfection supplies, not otherwise available on the Medicaid state plan. Waiver transportation service will expand to travel to non-waiver service such as transportation to another family members home, when that transportation is required to prevent illness or meet immediate health and safety needs. Expand limit and provider type in staff family consultation to include emergency preparedness consultation support from a provider trained in emergency management or similar. All waiver services, except goods, respite care, may be offered remotely by providers when travel to the waiver participant is not possible due to COVID-19 infection. Approval for remote support will require a prior approval by DDA.

Add Services

Assistive Technology; Transportation; Clinical and therapeutic services; Respite; Community engagement; Speech, hearing and language services; Positive Behavior Support and Consultation; Risk assessment; OT; PT; Peer mentoring; Person-Centered Plan Facilitation; Behavioral Health Stabilization Service-Behavioral Health Crisis Diversion Bed Services; Behavioral Health Stabilization Services-Positive Behavior Support and Consultation; skilled nursing; Supported Parenting Services; Nurse delegation;

Expand Settings

Direct care services Respite Care, and 1:1 services Positive Behavior Support, staff/family consultation, crisis diversion bed services, behavioral health stabilization services- positive behavior support, nurse delegation, skilled nursing (not otherwise covered under the Medicaid state plan and not available when nursing is available in the quarantine setting) 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. Temporarily allow for Positive Behavior Support and Staff/Family Consult to be provided in a non-integrated setting (such as a hospital or other quarantine site) when DDA identifies that no other alternatives are available and a nonintegrated setting is the only service setting that service may be offered to meet an individual’s health and safety needs. This will only be authorized when the support the waiver service provider is offering is not otherwise funded by another resource. This may include other group settings such as a gymnasium or portable if provider networks become so depleted that there are no other options to provide direct care in the client’s home. The direct supports provided through these services (see service descriptions below) will not duplicate the supports already available in that setting.

Provide Service Out of State

Respite provided out of state may be provided in excess of 30 days on a case by case basis with prior approval by DDA.

Allow Payment for Services by Families

N/A

Modification of Provider Qualifications

Temporarily allow provider enrollment or re-enrollment with modified risk screening elements such as onsite visits or fingerprint checks, or modify training requirements, when requested by the waiver participant to all service providers. When needed, suspend provider licensing or certification for up to 1 year when COVID 19 pandemic impacts ability for providers to obtain license or certification due to state staff or service provider availability to all service providers. Respite Care providers include currently contracted Positive Behavior Support providers.

Modify Provider Types

Expand provider types for specialized equipment and supplies and assistive technology including the use of a purchase card and community choice guides 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.

Modify Licensure/Requirements for Waiver Settings

When needed, suspend provider licensing or certification for up to 1 year for residential providers when COVID 19 pandemic impacts ability for providers to obtain license or certification due to state staff or service provider availability to Group Homes, LSRs, Adult Day Care, Group Care Facility, Licensed foster home, for respite

Modification LOC Eval and Re-Eval Processes

Reassessments of level of care may be postponed up to one year and services will continue on a case by case basis when conditions do not allow a waiver participant, their representative, or DDA staff to participate in a reassessment due to illness or quarantine to allow sufficient time for the case manager to complete the annual reassessment paperwork. For service plans that are expiring and currently meeting an affected waiver participant’s needs, but a new person centered service plan is unable to be developed due to ongoing COVID-19 impacts, the time limit to approve the plan may be extended on a case by case basis when monthly remote or telephonic monitoring is provided to ensure the plan continues to meet the participant’s needs. Telephonic assessments may occur in place of face-to-face assessments on a case by case basis until impacts of COVID-19 are resolved. Telephonic Initial Assessments will be conducted when needed to prevent exposure related to COVID-19. For Initial CARE assessments, staff may complete the assessment and personcentered service plan via the telephone or other electronic means and then do a brief in-person visit before moving the assessment to current. If the pre-visit questionnaire response indicates it is not safe to do an in-person visit services can be authorized prior to an in-person visit occurring. • All initial CARE assessments may be sparse, ensuring that mandatory fields are completed with the minimum necessary to complete a minimal care plan. Annual assessment Inter-rater reliability monitoring will be postponed up to 1 year when workforce is limited due to COVID-19 or when the client’s household in impacted by COVID-19.

Increase Payment Rates

To respond effectively to the COVID-19 outbreak, the state requires flexibility to adjust providers’ rates to ensure that sufficient providers are available for clients. The state may reimburse providers with an additional add on COVID19 negotiated rate. This applies to all services available under the approved waiver on a case by case basis when increased rate is required to maintain paid staff due to risk factors associated with COVID-19 or other extraordinary circumstances recognized by DDA. Negotiated COVID add-on rates will be based on current market factors and additional costs incurred by the provider.

Modifications of ISP

Person centered service plans/revisions may be approved with a retroactive approval date for service needs identified to mitigate harm or risk directly related to COVID-19 impacts. Telephonic (or other Information Technology Medium) assessments may occur when the assessment cannot occur due to impacts of COVID-19. Verbal approval may be used in place of written signature for PCSP approvals by the client and/or legal guardian when necessary.

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.

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

Allow payment for communication assistance and personal care through Positive Behavior Support and staff/family consultation for purposes of supporting 1915(c) enrollees who are in an acute care hospital or receiving a short-term institutional stay on a case by case basis when prior approval by DDA is received. Services will not be authorized if otherwise available from another resource.

Inclusion of Retainer Payments

N/A

Institute/Expand Opportunities for Self-Direction

N/A

Increase Factor C

N/A

Other Changes Necessary

Allow beneficiaries to receive fewer than one service per month for a period of ninety (90) days without being subject to discharge

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

Allow beneficiaries to receive fewer than one service per month for a period of ninety (90) days without being subject to discharge

Other Changes Necessary

Allow beneficiaries to receive fewer than one service per month for a period of ninety (90) days without being subject to discharge

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