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Overview of Hawaii’s Application 1915(c) Home and Community-Based Services Waiver APPENDIX K: Emergency Preparedness and Response Waiver Providers Department of Health Developmental Disabilities Division March 25, 2020, 11:30 AM Waiver Providers - Appendix K Update – 3/25/2020
Background on 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 Waiver Providers - Appendix K Update – 3/25/2020
Background on Appendix K • All changes allowed under the Appendix K amendment are temporary for the period of the emergency • The flexibilities requested will be available for the State’s use as needed, but are not intended to be applied in all situations (e.g., not all ISPs will need retroactive approval) • Participants and their families should work with their case managers to determine what supports they might need during this period Waiver Providers - Appendix K Update – 3/25/2020
Status of Hawaii’s Appendix K COVID-19 • Requested various allowances to respond to likely issues arising from COVID-19 • Jointly developed by Med- QUEST and Department of Health’s Developmental Disabilities Division Submitted • On March 20 • Pending approval from federal government DDD • is in the process of addressing operational requirements Waiver Providers - Appendix K Update – 3/25/2020
In-Person Meetings ISPs Check In & Follow ups Level of Care • May be conducted • Case Managers may • Re-determinations may electronically conduct monitoring be extended up to 12 check-ins electronically months • Use of e-sign or mail for signatures SIS Home Visits Telehealth Model • May be conducted • Providers will • When appropriate electronically temporarily be able to based on individuals’ restrict visitors in needs, certain services licensed and certified to be provided through homes telehealth model Waiver Providers - Appendix K Update – 3/25/2020
Individuals Required to Stay at Home In Home Services Consumer Directed Agency Providers • Streamline process to • Streamline the process for • Allow agency providers to establish/increase/convert approving consumer- more easily provide other services like PAB & Respite directed employers and services (e.g. qualify ADH (for Private Homes) & employees, and easing provider to deliver PAB) ARS (for licensed or requirements certified homes) Waiver Providers - Appendix K Update – 3/25/2020
Individuals Required to Stay at Home Adult Day Health Telehealth Model • Permit ADH services to be provided in-home • When appropriate based on individuals’ needs, certain services to be provided through telehealth model Respite Individual Budgets • Allows flexibility to exceed 760-hours of Respite • Budgets may be exceeded to per year accommodate changes in services (e.g. • Expand Respite settings (e.g. Home of neighbor with more 1:1 services instead of group services) an Agency providing the Respite worker) Waiver Providers - Appendix K Update – 3/25/2020
Individuals Required to Stay at Home Additional Residential Supports Telehealth Model • Expand allowable use of ARS for participants in • When appropriate based on individuals’ needs, licensed and certified settings certain services to be provided through telehealth model • ARS provider cannot be a household resident Adult Day Health Services Individual Supports Budgets • Permits ADH services provided in-home • Budgets may be exceeded to accommodate changes in services • ADH provider cannot be a household resident (e.g. more 1:1 services instead of group services) Waiver Providers - Appendix K Update – 3/25/2020
Access to Nursing Supports Private Duty Nursing Private Duty Nursing for < 22 • Allows flexibility to waive requirement • Children and young adults up to 22 that participants must receive another years old will continue to receive covered service in order to receive nursing services from their health Private Duty Nursing plan • Per-day and short-term time limits on Private Duty Nursing will be flexible as needed to protect participant health and safety Waiver Providers - Appendix K Update – 3/25/2020
Access to Infection Control Supplies Specialized Medical Equipment & Supplies • Provide coverage of personal protective equipment and infection control supplies for the participant through Specialized Medical Equipment and Supplies when not otherwise covered in the Medicaid state plan Waiver Providers - Appendix K Update – 3/25/2020
Some participants may require support in the hospital or other institutional setting Allow Providers to Bill for Supports in These Settings • PAB will be billed for individuals who reside in a private home; Additional Residential Supports will be billed for individuals who reside in a licensed or certified setting Waiver Providers - Appendix K Update – 3/25/2020
Staffing Shortages Staff Ratio Requirements Telehealth Model Health Plan Providers • Flexibility with staff • When appropriate • Evaluate opportunities ratio requirements for based on individuals’ to allow providers Adult Day Health and needs, certain services enrolled in QUEST Community Learning to be provided through Integration health plan Service-Group telehealth model networks performing programs similar work to become waiver providers • Providers will still need to be able to ensure participants’ health and safety Waiver Providers - Appendix K Update – 3/25/2020
Reduction in Billable Services ADH/CLS-G Programs & ResHab Providers Consumer Directed - PAB Employment Supports • When participant is out of • Retainer payments for • Will maintain 75% of providers’ home, would not begin until the consumer-directed Personal historic billing, duration 22nd day since the first 21 days Assistance/ Habilitation (PAB) consistent with Section 1135. of absences are built into the workers when the participant is • Since ADH and CLS-G providers rate model unavailable to receive services will be able to deliver other • The duration of retainer • Lesser of 40 hours per week or services (e.g. PAB), new payments will be consistent with the authorized number of hours revenues associated with these the limitations set in the State’s services will be offset against the • Duration of retainer payments Section 1135 waiver. payment consistent with Section 1135 waiver. • Providers will be required to maintain their staffing DDD Appendix K Update – 3/2020
Next Steps • Awaiting federal response to the proposed changes • Approval is expected • Developing operational protocols to implement the changes • Participants and their families should work with their case managers to determine what supports they might need during this period Waiver Providers - Appendix K Update – 3/25/2020
More Information and Resources • For the latest DDD information, please visit – https://health.hawaii.gov/ddd • For COVID-19 updates, please visit – https://hawaiicovid19.com/ Waiver Providers - Appendix K Update – 3/25/2020
Q&A Question/Topic Answer • Hoping it will be approved in a couple days When is the anticipated Appendix K • Fast turnaround, application received approval date? • Appendix K Approvals may by provided in segments Operational Guidelines for • DDD is currently developing Providers and Staff Are there additional steps to support • DDD provided flexibilities that are allowed under 1915c authority DSW/Direct Care Workers • Extension for Annual Requirements Requirements are regulated by Waiver Standards (not Application) • (e.g. CPR, provider competencies) DDD looking at Standards and will determine what should be adjusted • TB Clearance Press release provided – suspended for 30 day period Temporary Suspension • Being vetted by AG office and released with an Order from Gov. (by Hawaii Governor) • Supervision Visits/Onsite Supervision - App. K application covers as monitoring visits via telehealth • Home Visits (via monthly) can onsite Pending Appendix K approval • visits occur via phone? Allowed/Limits in HIPAA compliant platform Waiver Providers - Appendix K Update – 3/25/2020
Q&A Question Answer • CLS I claims as PAB Yes, will need to be converted to PAB • Will be billed as PAB (for in home) Billing in Hospital Setting • Will be billed as ARS (for Licensed and Certified Settings) • Office of Civil Rights provided guidance Guidelines for Telehealth • Overall 1135 Application has additional guidance • Some flexibilities (e.g. asking for relief for First Aid certification via online courses) Flexibility for Credentialing • DDD will provide them in operational guidelines • Some requirements are in Waiver Standards, not in Appendix K • Helping staff understand of flexibilities in Appendix K that are underway Advice/Next Steps for Agencies • Keep staff safe, practice CDC guidelines Waiver Providers - Appendix K Update – 3/25/2020
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