Wisconsin – Self-Directed Support Waiver – Intellectual/Developmental Disability and Aged/Physical Disability (0484.R02.00)

Waiver Title

WI Self-Directed Support Waiver – Intellectual/Developmental Disability and Aged/Physical Disability (0484.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 adult day care, daily living skills training, IRIS consultant, live-in caregiver, prevocational, respite, supported employment – individual, nursing, fiscal employer agent, 1 -2 bed adult family home, 3-4 bed adult family home, adaptive aids, assistive technology/communication aids/interpreter, consultative clinical and therapeutic services for caregivers, consumer education and training, counseling and therapeutic services, customized goods and services, day services, home delivered meals, home modification, housing counseling, personal emergency response system, relocation – housing start up and related utility costs, residential care apartment complex, specialized medical equipment and supplies, specialized transportation 2, specialized transportation, support broker, supported employment – group, supportive home care, training services for unpaid caregivers, vocational and futures planning for aged individuals 65 – no  max age, DD and IID ages 18 – no max age, physical disabilities ages 18-64

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

X

Exceed Service Limitations

1. Home Modifications: Remove the limitation which requires quotes from at least three providers. 2. Respite: Remove the limitation that participants cannot receive other waiver services on the same day as receiving respite care.

Add Services

Adult Day Care, Day Services,

Expand Settings

1. Allow all home and community-based waiver services to be provided in the following temporary settings: hotels, shelters, schools, churches, and isolation facilities. 2. Adult Day Care: Expand adult day care services so that it may be provided in alternate settings (also addressed in scope of service, Appendix A below. 3. Day Services: Expand day services so that it may be provided in alternate settings (also addressed in scope of service, Appendix A below). 4. Nursing Services: Expand nursing services so that it may be provided in residential care apartment complexes. 5. Supportive Home Care: Expand supportive home care service so that it may be provided in 1-2 bed adult family homes, 3-4 bed adult family homes, and residential care apartment complexes.

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

1. The following service provider qualification requirement modifications apply to all services: a. Allow revalidation (4-year) background checks to be delayed by 90 days. These are the regularly occurring (every four years) background checks conducted on individual participant-hired workers after the initial background check. To protect participants while background checks are delayed, the program will enhance communication with participants and increase collateral contacts. The worker will be a qualified provider waiting for a revalidation background check for up to 90 days. If the worker does not pass the background check, the worker would no longer be able to provide services. The program and participant would work together to find another qualified provider as soon as possible. b. Delay provider licensing or certification reviews by 60 days. After the review is completed, if the certification is denied, the provider will no longer be qualified to render services as soon as the individual is relocated. c. Allow providers licensed in other states or enrolled in the Medicare program to perform the same or comparable services in this state. All providers must have a provider agreement with the SMA, and payment must be made directly to the provider. 2. The following provider qualification flexibilities will increase the pool of available providers: a. Consumer Education & Training – Agency & Individual Provider: Remove the provider qualification requirement that providers who are teachers must be certified by the WI Department of Public Instruction. b. Daily Living Skills – Agency & Individual Provider: Remove the provider qualification requirement that providers must have a minimum of two years’ experience working with the target population. c. Nursing Services – Agency & Individual Provider: Modify the provider qualifications to allow for students in accredited nursing programs to be qualified providers. Nursing students will perform nursing in accordance with state laws/license boards for nursing. d. Prevocational Services – Agency: Remove the provider qualification requirement that agencies must have two years’ of experience working with target population requirement. e. Supportive Home Care – Agency Provider: Relax the provider requirement that agencies must follow Wis. Admin. Code 105.17. Wis. Admin Code 105.17 details the State’s provider certification requirements for personal care providers. 3. The following provider qualifications are for the new provider types listed in K-2-d-ii below: a. Nursing Services – Nursing students (Agency):i. Other Standard: Must currently be a student in enrolled in a nursing program at an accredited college or university. Nursing students will perform nursing service tasks in accordance with state nursing laws/license boards. b. Specialized Transportation – Transportation Network Services (Agency):i. Licensure: Must be licensed pursuant to Wis. Statute 440.15 and comply with Wis. Statute 440.c. Training Services for Unpaid Caregivers – Individual providers: i. Other Standard: This training must be provided by licensed, certified, or accredited professionals who maintain current credentials in their field of practice. (For example, training could be provided by registered nurses, licensed mental health professionals or licensed therapists.) 4. Allow the SMA to extend the re-certification period for level of care evaluators/screeners whose certifications may expire due to the continuing skills test (required for continued certification) being delayed from 2020 to February 28, 2021

Modify Provider Types

The following services will have modified provider types: 1. Nursing Services: Add “Nursing Student” Agency & Individual types. 2. Specialized Transportation (& 2): Add “Transportation Network Companies” as an Agency type. 3. Training Services for Unpaid Caregiver: Add an “Individual Worker” Individual type.

Modify Licensure/Requirements for Waiver Settings

Allow the SMA to suspend provider licensing or certification reviews as needed. 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

N/A

Increase Payment Rates

Allow the SMA to temporarily increase rates for any individual or agency provider that will be providing care for COVID-19 positive participants. The increase for care providers would be up to 30% more than their existing wage and no less than $20 an hour.

Modifications of ISP

1. Allow the option to conduct evaluations, assessments, and person-centered planning meetings virtually/remotely in lieu of face-to-face meetings, in accordance with the state’s HIPAA requirements. 2. Allow verbal or electronic permission for authorization to begin services, and permit subsequent collection of signatures in order to minimize face-to-face contact. Signatures will be obtained after permission is issued, through electronic mail in accordance with HIPAA requirements or mail, with a date documenting when remote contact with the participant occurred. 3. Allow the SMA to delay updating the person-centered plan on a case-by-case basis: The SMA 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 consultant 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

Allow any necessary waiver services that are necessary for communication and intensive personal care/supervision to be provided temporarily in an acute care hospital or during 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 SMA may temporarily include retainer payments for the following waiver services which include a component of personal assistance/care or habilitation services with a personal care component: Adult Day Care, Daily Living Skills Training, Day Services, Prevocational Services, Respite, Supported Employment – Individual, 1-2 Bed Adult Family Homes, 3-4 Bed Adult Family Homes, Live-in Caregiver, Residential Care Apartment Complexes, Supported Employment – Group, 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: As data will be challenging to collect or unavailable during the pandemic, the State will: 1. Delay submission of the 372 report by 6 months and 2. Suspend the collection of data for performance measures other than those identified for the Health and Welfare assurances. As a result, the data will be unavailable for this timeframe in ensuing reports. Enrollment & Eligibility: 3. Allow the suspension of involuntary dis-enrollments.

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: As data will be challenging to collect or unavailable during the pandemic, the State will: 1. Delay submission of the 372 report by 6 months and 2. Suspend the collection of data for performance measures other than those identified for the Health and Welfare assurances. As a result, the data will be unavailable for this timeframe in ensuing reports. Enrollment & Eligibility: 3. Allow the suspension of involuntary dis-enrollments.

Other Changes Necessary

Administrative: As data will be challenging to collect or unavailable during the pandemic, the State will: 1. Delay submission of the 372 report by 6 months and 2. Suspend the collection of data for performance measures other than those identified for the Health and Welfare assurances. As a result, the data will be unavailable for this timeframe in ensuing reports. Enrollment & Eligibility: 3. Allow the suspension of involuntary dis-enrollments.

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

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-0484-appendix-k-appvl.pdf

Link to Approval Letter

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