Wisconsin – Family Care Waiver (0367.R04.00)

Waiver Title

Family Care Waiver (0367.R04.00)

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.)

Waiver Description

Provides adult day care, case management, daily living skills training, day habilitation, prevocational, respite, supported employment-individual employment support, consumer directed supports (self-directed supports) broker, financial management services, adaptive aids, adult residential care-1-2 bed adult family homes, adult residential care-3-4 bed adult family homes, adult residential care-community-based residential facilities, adult residential care-residential care apartment complexes, assistive technology/communication aids, consultative clinical and therapeutic services for caregivers, consumer education/training, counseling and therapeutic resources, environmental accessibility adaptations (home mods), home delivered meals, housing counseling, PERS, relocation services, self-directed personal care, skilled nursing services RN/LPN, specialized medical equipment and supplies, supported employment-small group employment support, supportive home care, training services for unpaid caregivers, transportation (specialized transportation)-community transportation, transportation (specialized transportation)-other transportation, vocational futures planning and support for individuals aged 65 – no max age, physically disabled/disabled other ages 18-64, DD/ID ages 18 – no max age

Start Date

01-03-20

End Date

28-02-21

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 waiver to all individuals impacted by the COVID-19 virus.

Increase Cost Limits

N/A

Modify Targeting Criteria

N/A

Modify Scope or Coverage

Adult Residential Care – Community-Based Residential Facilities (CBRF): A community-based residential facility (CBRF) is a residence where five (5) or more adults, not related to the operator or administrator of the facility, reside and receive care, treatment, support, supervision, and training. An individual with an intellectual disability may only reside in a CBRF that is licensed for eight (8) or fewer residents, unless that person has been determined to require No Active Treatment (NAT) for her or his intellectual disability. Services may include supportive home care, personal care, supervision, behavior and social supports, daily living skills training, transportation, and up to three hours per week of nursing care per resident. Assistive technology/communication aids: Assistive technology is an item, piece of equipment, or product system – whether acquired commercially, modified, or customized – that enables members to (1) increase their ability to perform ADLs and IADLs or control the environment in which they live and (2) access, participate, and function in their community and in competitive integrated employment. Assistive technology service is a service that directly assists a member in the selection, acquisition, or use of an assistive technology device. Assistive technology includes the following: (A) evaluation of the assistive technology needs of a member, including a functional evaluation of the impact of the provision of appropriate assistive technology and appropriate services in the customary environment of the member; (B) services consisting of purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices for the member; (C) services consisting of selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices; (D) coordination and use of necessary therapies, interventions, or services with assistive technology devices, such as therapies, interventions, or services associated with other services in the member-centered plan; (E) training or technical assistance for the member or, where appropriate, family members, guardians, advocates, or authorized representatives of the member; and (F) training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of members. Assistive Technology includes communication aids, which are devices or services needed to assist members with hearing, speech, communication, or vision impairments. These items or services assist the member to effectively communicate with others, decrease reliance on paid staff, increase personal safety, enhance independence, and improve social and emotional well-being. Communication aids include any device that addresses these objectives, such as augmentative and alternative communication systems, hearing or speech amplification devices, aids and assistive devices, interpreters, cognitive retraining aids, and the repair and/or servicing of such systems. Communication aids also include electronic technology, such as tablets, mobile devices, and related software that assists with communication, when the use provides assistance to a member who needs such assistance. Applications for mobile devices or other technology also are covered under this service when the use is primarily medical in nature or provides assistance to a member who needs such assistance. This list is intended to be illustrative and is not exhaustive. PIHPs will be permitted to purchase goods from major retailers without the retailer. PIHPs would be required to pay normal, market prices for these items. This waiver service is only provided to individuals ages 21 and over. All medically necessary Assistive Technology/Communication Aids for children under age 21 are covered in the state plan benefit pursuant to the EPSDT benefit. Transportation (specialized transportation) – community transportation: This service may not duplicate any service that is provided under another waiver service category or through the Medicaid State Plan. Excludes transportation to receive non-emergency medical services which are covered under the Medicaid State plan transportation benefit, or in the case of a self-directing member with budget authority to purchase such services, under the Other Transportation service. Excludes emergency (ambulance) medical transportation covered under the Medicaid State plan service. Transportation (specialized transportation) – other transportation: Other Transportation consists of transportation to receive non-emergency, Medicaid-covered medical services. This service may include items such as tickets, fare cards or other fare media, reimbursement of mileage expenses, or payment for services where the provider directly conveys the member and her or his attendant, if any, by common carrier or specialized medical vehicle (SMV) as appropriate to and from receiving Medicaid–covered medical services. Members eligible for this service must have decision-making authority over a budget for the purchase of such services. Such members (1) are not limited to providers in the PIHP’s network, although the PIHP must verify credentials of specialized medical vehicle providers, (2) are not required to obtain prior authorization to purchase any transportation service from a qualified provider to any Medicaid-covered medical service if the member’s budget is sufficient to pay for the service, and (3) are not required to schedule routine trips in advance if the member can obtain transport. Legally responsible persons, relatives, or legal guardians may be paid for providing this service if they meet the conditions under Appendix C-2 d & e of this waiver. Prevocational Services: Prevocational services are designed to create a path to integrated community-based employment for which an individual is compensated at or above the minimum wage but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. Prevocational services allow the member to develop general, non-job-task-specific strengths and skills that contribute to employability in paid employment in integrated, community settings. Services are expected to occur over a defined period of time as determined by the member and his or her care planning team. Services are expected to specifically involve strategies that enhance a member’s employability in integrated, community settings. Prevocational services should enable each member to attain the highest possible wage and work in the most integrated setting that is matched to the member’s interests, strengths, priorities, and abilities. Services intend to develop general skills that lead to employment, including the ability to communicate effectively and establish appropriate boundaries with supervisors, co-workers, and customers; express and understand expectations; engage in generally accepted community workplace conduct and adopt appropriate workplace dress; follow directions; attend to tasks; problem-solve; manage conflicts; and adhere to general workplace safety. Services may include mobility training. Prevocational services may be delivered in a variety of locations in the community and are not limited to fixed-site facilities. Some examples of community sites include the library, job center, banks, or businesses. Prevocational services, regardless of how and where they are delivered, are expected to help people make reasonable and continued progress toward participation in at least part-time, integrated employment. Prevocational services are not considered outcomes; competitive employment and supported employment are considered successful outcomes of prevocational services. The optimal outcome of the provision of prevocational services is permanent integrated employment at or above the minimum wage in the community. Prevocational services may not duplicate services that are provided as part of an Individualized Plan for Employment (IPE), under the Rehabilitation Act of 1973, as amended, or as part of an Individualized Education Plan (IEP), under the Individuals with Disabilities Education Act (IDEA). The contracted provider of pre-vocational services must complete a six-month progress report and service plan document for the interdisciplinary care management team (IDT). The purpose is to ensure and document that prevocational services are assisting the member in progressing toward a goal of at least part-time, integrated employment. Timely completion of this document is required for the IDT to consider reauthorization of prevocational services. Participation in prevocational services is not a prerequisite for individual or small group supported employment services provided under the waiver. Members who receive prevocational services may also receive educational, supported employment, and/or day services. A member-center plan may include two or more types of nonresidential services. However, different types of non-residential services may not be billed for the same period of time. Members participating in prevocational services shall be compensated in accordance with applicable Federal and State laws and regulations. Transportation may be provided between the member’s residence and the site of the prevocational services or between prevocational service sites – in cases where the member receives prevocational services in more than one place – as a component part of prevocational services or under specialized (community) transportation but not both. All providers of transportation shall ensure that the provider qualifications for specialized (community) transportation are met. If the transportation is provided by the prevocational services provider, the cost of this transportation is included in the rate paid to the provider. Personal care provided to a member during the receipt of prevocational services may be included in the reimbursement paid to the prevocational services provider, or it may be covered and reimbursed under another waiver service so long as there is no duplication of payment. Skilled Nursing Services RN/LPN: Skilled nursing is “professional nursing” as defined in Wisconsin’s Nurse Practice Act, Wis. Stat. Ch. 441. Nursing services are medically necessary, skilled nursing services that may only be provided safely and effectively by an advanced practice nurse, a registered nurse, or a licensed practical nurse who is working under the supervision of a registered nurse. Nursing students may provide allowable nursing services. The nursing services provided must be within the scope of the Wisconsin Nurse Practice Act, consistent with the member-centered plan, authorized by the PIHP, and not otherwise available to the member under the Medicaid state plan or through Medicare. However, the lack of coverage under the State plan or through Medicare does not preclude the coverage of skilled nursing as a waiver service when services are within the scope of the Wisconsin Nurse Practice Act. This waiver service is only provided to individuals ages 21 and over. All medically necessary Skilled Nursing Services RN/LPN services for children under age 21 are covered in the state plan benefit pursuant to the EPSDT benefit. Under the Wisconsin Nurse Practice Act, professional nursing includes any of the following: Professional skilled nursing means the observation or care of the ill, injured, or infirm, or for the maintenance of health or prevention of illness of others, that requires substantial nursing skill, knowledge, training, or application of nursing principles based on biological, physical, and social sciences. Professional skilled nursing includes any of the following: (a) The observation and recording of symptoms and reactions; (b) The execution of procedures and techniques in the treatment of the sick under the general or special supervision or direction of a physician, podiatrist licensed under Wis. Stat. Ch. 448, dentist licensed under Wis. Stat. Ch. 447, or optometrist licensed under Wis. Stat. Ch. 449, or under an order of a person who is licensed to practice medicine, podiatry, dentistry, or optometry in another state if the person making the order prepared the order after examining the patient in that other state and directs that the order be carried out in this state. (c) The execution of general nursing procedures and techniques. (d) The supervision of a patient and the supervision and direction of licensed practical nurses and less skilled assistants in accordance with Wis. Stat. Ch. 441. Nursing services may include periodic assessment of the member’s medical condition when the condition requires a skilled nurse to identify and evaluate the need for medical intervention or monitor and/or modify the medical treatment services provided by non-professional care providers. Services may also include regular, ongoing monitoring of a member’s fragile or complex medical condition as well as the monitoring of a member who has a history of non-adherence with medication or other medical treatment needs. Delegation of nursing tasks to less skilled personnel shall be in accordance with Wis. Stat. Ch. 441, Wis. Admin. Code Ch. N 6, and the Wisconsin Nurses Association’s Guidelines for Registered Nurse Delegation to Unlicensed Assistive Personnel. These services are provided when nursing services identified as needed in a plan of care and furnished under the approved State plan limits are exhausted or when the nursing services are not covered under the Medicaid State Plan. For members enrolled in Medicare, this excludes services that are available through the Medicare program except for payment of Medicare cost share.

Exceed Service Limitations

Remove requirement to complete a six month progress report to reauthorize service.

Add Services

N/A

Expand Settings

Allow all home and community-based waiver services to be provided in temporary settings including hotels, shelters, schools, churches, and isolation facilities. Residential Services (CBRF): Permit community-based residential facilities (CBRFs) with greater than 8 beds to provide services to individuals with IDD who do not have a NAT (no active treatment) designation.

Provide Service Out of State

Temporarily provide home and community-based waiver services in out of state settings. Providers must have a provider agreement with the SMA, and payment must be made directly to the provider.

Allow Payment for Services by Families

N/A

Modification of Provider Qualifications

Suspend requirements to complete initial and required periodic credentialing of network providers. If the credentialing denied, the provider will no longer be qualified to render services as soon as the individual is relocated. Allow providers certified or licensed in other states or enrolled in the Medicare program to perform the same or comparable services in this state. Providers must execute a provider agreement and payment must be made directly to the provider. Transportation (specialized transportation) – community transportation: Individual providers must have a valid driver’s license and liability insurance coverage. These are individuals not affiliated with a company or other provider agency. PIHPs are required to conduct a background check on these individuals. Transportation Network Company providers must be licensed pursuant to Wis. Stat. § 440.15 and must comply with Wis. Stats. Ch. 440. Transportation (specialized transportation) – other transportation: Transportation Network Company providers must be licensed pursuant to Wis. Stat. § 440.15 and must comply with Wis. Stats. Ch. 440. Skilled Nursing Services RN/LPN: Nursing students must currently be a nursing student at an accredited college or university. Nursing students will perform nursing service tasks in accordance with state laws/license boards for nursing. Allow the SMA to extend the certification period of level-of-care screeners by delaying the continuing skills test for individuals conducting level of care evaluations from 2020 to February 28, 2021.

Modify Provider Types

Transportation (specialized transportation) – community transportation – Expand providers to include individuals and transportation network companies. Transportation (specialized transportation) – other transportation – Expand providers to include transportation network companies. Assistive Technology/communication aids – Expand providers to include general retailers. Skilled Nursing Services RN/LPN – Expand to include nursing students.

Modify Licensure/Requirements for Waiver Settings

When needed, suspend provider licensing or certification reviews. After the review is completed, if the licensure/certification is denied, the provider will no longer be qualified to render services as soon as the individual is relocated.

Modification LOC Eval and Re-Eval Processes

Allow an extension for reassessments and reevaluations for up to one year past the due date. Allow the option to conduct evaluations, assessments, and person-centered service planning meetings virtually/remotely in lieu of face-to-face meetings.

Increase Payment Rates

N/A

Modifications of ISP

Add an electronic method of service delivery (e.g,. telephonic) allowing services to continue to be provided remotely in the home setting for case management services. Allow verbal or electronic permission for authorization to begin services, and permit subsequent collection of signatures in order to minimize face-to-face contact. PIHPs are directed to obtain signatures through electronic mail in accordance with HIPAA requirements or mail, document why an in-person signature could not be obtained, and document the date when telephonic or other remote contact with the member occurred.

Modify Incident Reporting/Med Management Safeguards

N/A

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

Allow payment for any necessary waiver services that are necessary for communication and intensive personal care/supervision to be provided in an acute care hospital or receiving a short-term institutional stay. The state has mechanisms in place to prevent duplicate billing for both institutional and HCB services. These necessary waiver services: Must be identified in an individual’s person-centered service plan; Must be provided to meet the individual’s needs and are not covered in such settings; Should not substitute for services that the setting is obligated to provide through its condition of participation under Federal or State law, or under another applicable requirements; and Should be designed to ensure smooth transitions between the setting and the home and community-based setting and preserves the participant’s functional abilities.

Inclusion of Retainer Payments

The state may temporarily include retainer payments for the following waiver services which include personal care or personal assistance: Adult Day Care Services, Daily Living Skills Training, Day Habilitation Services, Prevocational Services, Respite, Supported Employment – Individual Employment Support, Adult Residential Care – 1-2 Bed Adult Family Homes, Adult Residential Care – 3-4 Bed Adult Family Homes, Adult Residential Care – Community-based Residential Facilities, Adult Residential Care – Residential Care Apartment Complexes, Self-Directed Personal Care, Supported Employment – Small Group Employment Support, and Supportive Home Care. Retainer payments may be provided if: The waiver participant is sick due to COVID-19; The waiver participant is sequestered and/or quarantined due to local, state, federal and/or medical requirements/orders; or If the provider agency or individual is unable to continue normal operations due to local, state, or federal requirements/orders. Payments will not exceed the total amount that the provider would have received had services been provided as expected. The retainer limit may not exceed the lesser of 30 consecutive days of billing or the number of days for which the State authorizes a payment for ‘bed-hold’ in nursing facilities.

Institute/Expand Opportunities for Self-Direction

N/A

Increase Factor C

N/A

Other Changes Necessary

Administrative 1. Due to the need for record review and in-person site visits, extend timelines for submission of 372 reporting up to six months. In addition, the state may suspend the collection of data for performance measures other than those identified for the Health and Welfare assurance and as a result the data will be unavailable for this time frame in ensuing reports due to the pandemic. 2. Allow all administrative requirements, such as initial level of care evaluation and options counseling, that can be provided with the same functional equivalency of face-to-face services to occur remotely. Enrollment and Eligibility 3. Allow the SMA to suspend any involuntary dis-enrollments. Fiscal 4. The state will ensure the person-centered plan is modified to allow for additional supports/and or services to respond to the COVID-19 pandemic. The specificity of such services including amount, duration, and scope will be updated as soon as possible to ensure that the specific service is delineated accordingly to the date it began to be received. The care team must submit the request for additional supports/services no later than 30 days from the date the service begins.

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 rehabilitatoin, monthly monitoring; other: All waiver services that can be provided with the same functional equivalency of face-to-face services occur remotely.

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

Administrative 1. Due to the need for record review and in-person site visits, extend timelines for submission of 372 reporting up to six months. In addition, the state may suspend the collection of data for performance measures other than those identified for the Health and Welfare assurance and as a result the data will be unavailable for this time frame in ensuing reports due to the pandemic. 2. Allow all administrative requirements, such as initial level of care evaluation and options counseling, that can be provided with the same functional equivalency of face-to-face services to occur remotely. Enrollment and Eligibility 3. Allow the SMA to suspend any involuntary dis-enrollments. Fiscal 4. The state will ensure the person-centered plan is modified to allow for additional supports/and or services to respond to the COVID-19 pandemic. The specificity of such services including amount, duration, and scope will be updated as soon as possible to ensure that the specific service is delineated accordingly to the date it began to be received. The care team must submit the request for additional supports/services no later than 30 days from the date the service begins.

Other Changes Necessary

Administrative 1. Due to the need for record review and in-person site visits, extend timelines for submission of 372 reporting up to six months. In addition, the state may suspend the collection of data for performance measures other than those identified for the Health and Welfare assurance and as a result the data will be unavailable for this time frame in ensuing reports due to the pandemic. 2. Allow all administrative requirements, such as initial level of care evaluation and options counseling, that can be provided with the same functional equivalency of face-to-face services to occur remotely. Enrollment and Eligibility 3. Allow the SMA to suspend any involuntary dis-enrollments. Fiscal 4. The state will ensure the person-centered plan is modified to allow for additional supports/and or services to respond to the COVID-19 pandemic. The specificity of such services including amount, duration, and scope will be updated as soon as possible to ensure that the specific service is delineated accordingly to the date it began to be received. The care team must submit the request for additional supports/services no later than 30 days from the date the service begins.

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

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/wi-0367-appendix-k-appvl.pdf

Link to Approval Letter

https://www.medicaid.gov/state-resource-center/downloads/wi-appendix-k-appvl-ltr-2.pdf