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Implementation of Appendix K Flexibilities for COVID-19 Operational Guidelines Training #1 Hawaii State Department of Health Developmental Disabilities Division March 30, 2020 **Information on these slides have been updated to reflect the

  1. Implementation of Appendix K Flexibilities for COVID-19 Operational Guidelines Training #1 Hawaii State Department of Health Developmental Disabilities Division March 30, 2020 **Information on these slides have been updated to reflect the Approved Appendix K** 1

  2. Agenda • Appendix K Overview and Timeframes • When Does Appendix K Apply? • Service Authorizations • Coordination • Communication is critical during an emergency • Temporary Operational Guidelines during the COVID-19 Emergency • Decision Tree for Choosing Services 2 Original: 3/30/2020 | Updated: 4/7/2020

  3. Overview of Appendix K • Medicaid Waiver programs, such as Hawaii’s I/DD Waiver, operate under strict federal rules related to service planning, authorization, timelines, etc. • During an emergency, States may request temporary flexibility through an ‘Appendix K’ amendment • All changes allowed under the Appendix K amendment are temporary for the period of the emergency 3 Original: 3/30/2020 | Updated: 4/7/2020

  4. Hawaii’s Appendix K Appendix K Application • Jointly developed by Med- QUEST and Department of Health’s Developmental Disabilities Division • Requested various allowances to respond to likely issues arising from COVID- 19 Timeframe • Submission: 3/20/2020 • Approval: 3/27/2020 • Effective: 3/1/2020 to 2/28/2021 or when the COVID-19 emergency ends, whichever is sooner Implementation • DDD is in the process of addressing operational requirements Original: 3/30/2020 | Updated: 4/7/2020 4

  5. Key Flexibilities • Temporarily modify: • Some service definitions to add coverages, suspend or increase limits, suspend staff ratios, and add locations where certain services may be provided • ISP processes and timeframes • AER processes and timeframes • Provider qualifications and monitoring • Grant exceptions to Individual Support Budget limits • Permit retainer payments for certain service providers 5 Original: 3/30/2020 | Updated: 4/7/2020

  6. Does Appendix K Apply? Changes Related to Services 1.) What change(s) occurred for the participant as a result of COVID-19? Changes Related to Health Original: 3/30/2020 | Updated: 4/7/2020 6

  7. a. Was the participant receiving day services, such as Adult Day Health (ADH), in a setting that closed due to the orders to “shelter in place” and/or CDC advisory for social distancing? b. Was the participant receiving community-based Changes Related to services, such as Community Learning Services- Group (CLS-G) or Individual (CLS-Ind) or Discovery Services & Career Planning (DCP), that could not be provided due to the orders to “shelter in place” and/or CDC advisory for social distancing? c. Was the participant employed and using waiver services, such as Individual Employment Services (IES) or CLS-Ind but is currently not able to work as a result of COVID- 19 “shelter in place” requirements and/or CDC advisory for social distancing. 7 Original: 3/30/2020 | Updated: 4/7/2020

  8. d. Is the provider unable to provide staffing at pre- COVID-19 required levels due to overall shortages of staffing and inability to secure additional staff as a result of the COVID-19 situation? e. Is the participant’s family choosing to not allow direct support workers (DSWs) into their home as Changes Related to part of social distancing? Services f. Is the participant’s direct support worker unable to provide services due to caring for a family (cont.) member due to closure of schools or day care programs as a result of COVID-19? g. Is the participant’s direct support worker unable to provide services due to caring for a family member diagnosed with COVID-19? Original: 3/30/2020 | Updated: 4/7/2020 8

  9. h. Is the participant isolating at home or quarantined due to potential exposure to someone diagnosed (presumptive or confirmed) with COVID-19? Changes Related to i. Was the participant diagnosed with COVID-19 Health that requires relatives to render services when direct support workers are unwilling or unable to provide services while the participant is contagious? Original: 3/30/2020 | Updated: 4/7/2020 9

  10. j. Was the participant’s caregiver or a person with whom they live diagnosed (presumptive or confirmed) with COVID-19? k. Is the participant’s direct support worker isolating at home or quarantined due to Changes Related to exposure to someone diagnosed (presumptive Health or confirmed) with COVID-19? l. Was the participant’s direct support worker diagnosed (presumptive or confirmed) with COVID-19? Original: 3/30/2020 | Updated: 4/7/2020 10

  11. Does Appendix K Apply? Yes, it’s covered in these guidelines 2.) Is the change requested covered in this Appendix K operational guide? No, please contact the participant’s case manager for guidance. During this emergency, health and safety activities for individuals and families are paramount. Original: 3/30/2020 | Updated: 4/7/2020 11

  12. Summary Service Authorization • Authorization period: 3/1/2020 to 5/31/2020 • A new authorization will be created for • Different service or • Increase in units to existing service • May be retroactively dated to the start of emergency authorization • Certain services require clinical approval • CMs may provide verbal or e-mail authorizations • Check DHS Medicaid On-Line (DMO) for confirmation • May take 4-5 business days Original: 3/30/2020 | Updated: 4/7/2020 12

  13. Operational Guidelines 1915 (c) Appendix K

  14. Development of Operational Guidelines • DDD is developing operational guidelines to implement the flexibilities approved in Appendix K, such as: • ISP processes and timeframes • Provider qualifications, monitoring, and reporting • Changes to authorizations (following slides show how certain existing services will translate to ‘new’ services based on setting and staffing ratio) • Use of telehealth for services • Rules for retainer payments • Et cetera • Guidelines will be shared as they are drafted Original: 3/30/2020 | Updated: 4/7/2020 14

  15. Decision Trees for Service Choices Current What is the current service? Service To determine the appropriate ‘new’ service, the decision trees Where will the service be walk-through Setting delivered during the COVID-19 emergency? 3 facts - service, setting, ratio What is the staffing ratio? Ratio ( either one-to-one or group if delivered to two or more participants) The resulting ‘new’ service represents NEW the general approach that will be COVID-19 New Service followed to determine the new service, Service but there may be exceptions 15

  16. Adult Day Health / Community Learning Services - Group Current Adult Day Health (ADH)/ Community Learning Services - Group Service (CLS-G) New COVID-19 Staff In Center Community Telehealth Home SETTING New COVID-19 Group Indiv. Group Indiv. Group Indiv. Group Indiv. RATIO New COVID-19 ADH-G ADH 1:1 ADH ADH CLS-G ADH 1:1 ADH 1:1 CLS-Ind Tele- Tele- Tier Tier Tier SERVICE health health Original: 3/30/2020 | Updated: 4/7/2020 16

  17. Community Learning Service – Individual Current Community Learning Service – Individual (CLS-Ind) Service Staff in New COVID-19 Staff In Licensed/ Private Community Telehealth Certified SETTING Home Setting New COVID-19 Group Indiv. Group Indiv. Group Indiv. Group Indiv. RATIO New COVID-19 ADH-G ADH 1:1 ADH PAB CLS-G ADH 1:1 PAB CLS-Ind Tele- Tele- Tier Group Tier SERVICE health health Original: 3/30/2020 | Updated: 4/7/2020 17

  18. Questions? Please email - doh.dddcrb@doh.hawaii.gov Original: 3/30/2020 | Updated: 4/7/2020 18

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