Wisconsin – Children’s Long Term Support Waiver Program (0414.R02.00)

Waiver Title

WI Children’s Long Term Support Waiver Program (0414.R02.00)

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 consumer education and training, day services, respite, support and service coordination, supported employment – individual, supportive home care, financial management services, adaptive aids, adult family home, child care services, children’s foster care, communication aids/assistive technology/interpreter services, community integration services, counseling and therapeutic services, daily living skills training, home modification, housing counseling, mentoring, nursing services, personal emergency response system (PERS), relocation services, specialized medical and therapeutic supplies, supported employment – small group, training for parents/guardians & families of children with disabilities, transportation for individuals with physical disabilities, other- disabled, serious emotional disturbance, autism, DD, ID ages 0-21

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

Typically, in counties that have implemented the Family Care waiver and the self-directed Include, Respect, I Self-Direct (IRIS) waiver, young adult CLTS Waiver Program participants, 18 through 21 years of age, must be enrolled in those programs without delay. If a participant is not able to enroll in one of those programs, they may maintain enrollment in the CLTS Waiver Program during the pandemic or up until the end date of this Appendix K.

Modify Scope or Coverage

N/A

Exceed Service Limitations

N/A

Add Services

Home-Delivered Meals;

Expand Settings

N/A

Provide Service Out of State

N/A

Allow Payment for Services by Families

Allow spouses and parents of minor children, family caregivers, and legally responsible individuals to be paid to render services to participants for Assistive Technology and Communication Aids, Child Care, Community Integration Services, Counseling and Therapeutic Services, Daily Living Skills Training, Day Services, Home Modifications, Mentoring, Respite, Supported Employment – Small Group, Supported Employment – Individual, Supportive Home Care, and Transportation services. Allow spouses and parents of minor children, family caregivers, and legally responsible individuals to be paid to render personal care services. The state will use safeguards currently authorized in the approved waiver to ensure that participants receive necessary services as authorized in the plan of care, and procedures currently authorized in the approved waiver to ensure that payments are made for services rendered. Service Coordinators authorize necessary services and oversee the care plan implementation including billing.

Modification of Provider Qualifications

Support and Service Coordination: Provider type: Individual – Other Person appropriately qualified as approved by the State and as related to the unique service being provided. Changes to provider qualifications: In order to expand the provider pool and expedite participant access to necessary services, suspend the following required standards in the approved waiver: Meets requirements for state certification/licensure as a social worker and one-year experience with the target group. Has completed a course of study leading to a BA/BS degree in a health or human services related field and one year of experience working with persons of the specific target group for which they are employed. An equivalent combination of training and experience that equals four years of long-term support practice in long-term support case management practice, or the completion of a course of study leading to a human services degree and one year of employment working with persons of the specific target group for which they are employed. In lieu of the suspended standards, allow county waiver agencies to employ individuals with the following qualifications who will conduct assessments and service planning activities. These individuals must have knowledge of the wide-ranging strengths and needs of children with disabilities and their families. They will also be familiar with the Wisconsin Medicaid Program and local resources for families who have children with disabilities. They must possess any combination of four years of post-secondary education and/or work experience working directly with children and families who have long-term support needs. Being bilingual and/or bicultural can count toward some of an individual’s experience, as long as they are also well-qualified with relevant disability experience and/or knowledge.

Modify Provider Types

Assistive Technology and Communication Aids: Allow general retailers to expand the provider pool. Transportation: Add “Transportation Network Companies” as an Agency type to expand the provider pool.

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

1. Allow the option to conduct evaluations, assessments, and person-centered service planning meetings virtually/remotely in lieu of face-to-face meetings, in accordance with the state’s HIPAA requirements. 2. The use of e-signatures that meets privacy and security requirements will be added as a method for the participant or legal guardian signing the person-centered service plan to indicate approval of the plan. Services may start while waiting for the signature to be returned to the case manager, whether electronically in accordance with HIPAA requirements or by mail. Signatures will include a date reflecting the meeting date. 3. Person-Centered Service Plans that are due to expire within the next 60 days require case management contact to the participant using allowable remote contact methods to verify with the participant or representative that the current assessment and services, including providers, remain acceptable and approvable for the upcoming year. The state will verify by obtaining electronic signatures/or electronic verification via secure email consent from service providers and the individual or representative, in accordance with the state’s HIPAA requirements. The state will ensure the service 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 appended as soon as possible to ensure that the specific service is delineated accordingly to the date it began to be received. The care coordinator must submit the request for additional supports/services no later than 30 days from the date the service begins.

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

Retainer payments for habilitation services which include personal care (Community Integration Services, Consumer Education and Training, Counseling and Therapeutic Services, Daily Living Skills Training, Day Services, Mentoring, Supported Employment-Individual, Supported Employment-Small Group) will be provided because the waiver participant is sick due to COVID-19; or the waiver participant is sequestered and/or quarantined based on local, state, federal and/or medical requirements/orders. Payments will not exceed the total amount that the provider would have received had services been provided as expected. The retainer time 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

Suspend Involuntary Dis-enrollments: Suspend all dis-enrollments, outside of voluntary, from the waiver program. When the pandemic ends or until the end date of this Appendix K, re-evaluations and any indicated dis-enrollments will be completed for affected participants.

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

X

Add Medical Supplies, Equipment and Appliances

N/A

Add Assistive Technology

N/A

Conflict of Interest

Other Changes Necessary

Suspend Involuntary Dis-enrollments: Suspend all dis-enrollments, outside of voluntary, from the waiver program. When the pandemic ends or until the end date of this Appendix K, re-evaluations and any indicated dis-enrollments will be completed for affected participants.

Other Changes Necessary

Suspend Involuntary Dis-enrollments: Suspend all dis-enrollments, outside of voluntary, from the waiver program. When the pandemic ends or until the end date of this Appendix K, re-evaluations and any indicated dis-enrollments will be completed for affected participants.

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

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

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/wi-0414-appendix-k-appvl.pdf

Link to Approval Letter

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