Michigan – Habilitation Supports Waiver (HSW)(0438.R03.00); Children’s Waiver Program (CWP) (4119.R06.00); Waiver for Children with Serious Emotional Disturbances (SEDW)

Waiver Title

Habilitation Supports Waiver (HSW)(0438.R03.00); Children’s Waiver Program (CWP) (4119.R06.00); Waiver for Children with Serious Emotional Disturbances (SEDW)

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

Habilitation Supports Waiver (0167.R06.00): Provides out-of-home non-vocational habilitation, prevocational services, respite, supported employment, supports coordination (authority change effective 10/1/2019), enhanced medical equipment and supplies, enhanced pharmacy, fiscal intermediary, goods and services, community living supports, environmental modifications, family training, non-family training, overnight health and safety support, personal emergency response system, private duty nursing for individuals w/IID ages 0 – no max age. Children’s Waiver Program (4119.R06.00): Provides respite, enhanced transportation, fiscal intermediary, community living supports, environmental accessibility adaptations and specialized medical equipment & supplies, home care training,-family, home care training- non-family, overnight health and safety support, specialty service for individuals w/autism, DD, IID ages 0 – 17 years. Waiver for Children w/SED (0438.R03.00): Provides respite, fiscal intermediary, child therapeutic foster care, community living supports, community transition (this service terminates effective 10/1/2019), family home care training, family support and training, home care training-non-family, overnight health and safety support, therapeutic activities, therapeutic overnight camping, wraparound for individuals w/mental illness SED 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

Access and Eligibility

Increase Cost Limits

N/A

Modify Targeting Criteria

N/A

Services

Modify Scope or Coverage

N/A

Exceed Service Limitations

HSW Service Limits in Appendix C-1/C-3 Out-of-Home Non-Vocational Habilitation: • Temporarily allow for in home non-vocational habilitation. • Temporarily remove the frequency of one or more days per week. Private Duty Nursing: • Temporarily suspend 16 hour/day limit on Private Duty Nursing services when increased hours are medically necessary. • Temporarily allow private duty nursing services to be provided without the individual receiving at least one of the habilitative services through the waiver. Non-family training: Temporarily suspend the limit of up to four sessions per day, but no more than 12 sessions per 90-day period when increased sessions are needed in training new providers to provide CLS and respite services. CWP Service Limits in Appendix C-1/C-3 Respite: Temporarily suspend the 1152 hours limit on respite service per fiscal year when increased hours are medically necessary. Enhanced Transportation: Temporarily suspend the requirement of transportation being limited to local distances, where local is defined as within the child’s county or a bordering county. Home Care Training, Family: Temporarily suspend the limit of up to four sessions per day, and no more than 12 sessions per 90-day period when increased sessions are needed in training the family. Home Care Training, Non-Family: Temporarily suspend the limit of up to four sessions per day, and no more than 12 sessions per 90-day period when increased sessions are needed in training new providers. SEDW Service Limits in Appendix C-1/C-3 Respite: Temporarily suspend the limit of 1248 units per month on respite service when increased units are medically necessary. Community Living Supports: Temporarily suspend the limit of 744 units per month when increased units are medically necessary. Family Home Care Training: Temporarily suspend the limit of up to four sessions per month when increased sessions are needed in training the family. Home Care Training, Non-Family: Temporarily suspend the limit of up to four sessions per calendar month when increased sessions are needed in training the new providers.

Add Services

N/A

Expand Settings

Expand settings to allow services to be provided in the provider’s home or other alternate settings such as temporary hospitals/shelters/hotels/churches when the enrollee is displaced from their home because of quarantine or hospitalization or when providers are unavailable due to illness or business closure. Respite services may be provided in the enrollee’s home, in the home of another, in licensed Adult Foster Care or Home for the Aged facilities, or other State-approved facilities. Respite does not include the cost of room and board in instances when the service is provided in the enrollee’s home or in the home of another person.

Provide Service Out of State

N/A

Allow Payment for Services by Families

N/A

Modify Provider Qualifications

Modification of Provider Qualifications

CWP/SEDW/HSW: MDHHS will extend the timelines of provider training requirements during the pandemic. Providers are still required to be aged 18 or older, trained in universal precautions, competency for completing required tasks, and the ability to effectively communicate with the individual for direct support professionals (DSP). All required training would be completed as soon as possible once the state of emergency is over, but not to exceed the end date of the Appendix K, February 28, 2021.

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

N/A

Modification LOC Eval and Re-Eval Processes

CWP/SEDW/HSW: MDHHS will extend annual level of care determinations that will expire during the effective period by one year past the original due date or for the duration of the approved Appendix K. Additionally, MDHHS will extend acceptance of waiver services in place of services in a ICF/IID setting beyond the typical 36 months if the consent expires during the effective period of the pandemic. The state will allow for verbal or email approval in order to authorize and commence services, while awaiting the written or electronic signed document due to COVID-19 emergency in accordance with HIPAA. An updated consent would be completed as soon as possible once the effective period ends. MDHHS temporarily extends the timeline requirements for some of the additional supporting documentation (i.e. individual educational plans (IEP) from schools, or medical reports for health care office, etc.) required for evaluation of level of care when the documents are unable to be acquired due to the COVID emergency. Following the termination COVID-19 emergency period, but not to exceed the end date of the appendix k, this supporting documentations should be obtained as soon as feasible to validate information, as appropriate.

Increase Payment Rates

CWP/SEDW/HSW: MDHHS will temporarily require the flexibility to account for increased risk factors associated with COVID-19 in the rates paid to providers. This flexibility will apply to authorized services billable to Community Living Supports, Personal Care, Overnight Health and Safety, Respite, Out of Home Non-Vocational Habilitation, and Prevocational services in which face to face contact is essential for beneficiary health and safety. The amount of the increase in payment rates to providers and the effective time periods will be determined by MDHHS and paid to the PIHPs for these populations. The rate increase will not exceed 50% of the currently approved rates.

Modifications of ISP

The state will ensure the person-centered 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, but no later than 30 days 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. PIHP/CMH may contact beneficiaries or their authorized representatives telephonically, using telehealth or other available technology as appropriate. Providers must ensure the privacy of the beneficiary and the security of any information shared via telephonic, telehealth and video technology, in accordance with HIPAA. For required in-person visits for case management/supports coordination and provider assessment/monitoring activities, MDHHS will expand telehealth options: Telephonic, telehealth and video technology commonly available on smart phones are acceptable options for program functions that require in-person communication and the beneficiary or legal representative consents to the method. This includes care planning meetings, home visits, case management, and provider initial and annual assessment and monitoring. The use of this option must be documented as a comment on the provider claim and in the beneficiary record, as appropriate. Providers must ensure the privacy of the beneficiary and the security of any information shared via telephonic, telehealth, and video technology, in accordance with HIPAA. If a beneficiary is unable to communicate over the phone, these activities may be completed with a guardian or other representative of the beneficiary that is familiar with their needs. For initial assessments, it is recommended that the supports coordinator/case manager initiates contacts with individuals in addition to the beneficiary, such as family members, guardians, caregivers, and friends. It is also recommended that the supports coordinator request two pieces of identifying information such as DOB and first or last four numbers of the Social Security Number. Following the termination of the COVID-19 emergency, in-person contacts should be made as soon as feasible to validate information gathered telephonically or through telehealth and to reassess as appropriate and may not exceed the duration of the approved Appendix K. In accordance with HIPAA, the state will allow for verbal or email approval in order to authorize and commence services, while awaiting the written or electronic signed document dated the day of the meeting due to COVID-19 emergency. There will be no penalties for delayed contacts. For individuals who are unable to receive the services on the person-centered service plan because of the social distancing recommendations, MDHHS will allow services to be furnished on a less than monthly basis in lieu of requiring the provision of at least one waiver service monthly. This includes individuals who cannot find a replacement caregiver when their usual caregiver is unable to deliver services as well as individuals who may normally attend a nonresidential service and that service is temporarily closed.

Modify Incident Reporting/Med Management Safeguards

CWP/SEDW/HSW: Temporarily allow for entry of incidents into the Incident Reporting System outside of typical timeframes, by 7 days in instances, other than abuse or neglect, in which administrative staff shortages due to COVID-19 for the duration of the approved Appendix K. Physical abuse and neglect resulting in injury must be reported immediately and response to incidents will not be impacted.

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

HSW/CWP/SEDW: Temporarily allow payment for personal, community living, behavioral and communication supports (e.g., services to promote ADLs and IADLs), not otherwise provided in that setting, to support waiver individuals in an acute care hospital or short-term institutional setting, when MDHHS identifies that no other alternatives are available, and an institution or hospital is the only setting that service may be offered to meet an individual’s health and safety needs. Waiver services provided will not be duplicative of hospital or short-term institutional services provided in those settings.

Inclusion of Retainer Payments

N/A

Institute/Expand Opportunities for Self-Direction

N/A

Increase Factor C

N/A

Other Changes Necessary

CWP/SEDW/HSW: The timeframes for the submission of the CMS 372s and the evidentiary package(s) will be extended as needed pursuant to the emergency. In addition, the state may suspend the collection of data for performance measures other than those identified for the Health and Welfare assurance and notes that as a result the data will be unavailable for this time frame in ensuing reports due to the circumstances of the pandemic

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 habilitation, monthly monitoring, other: Out of Home Non-Vocational Habilitation, Supported/Integrated Employment, Family HomeCare Training, and Home-Care Training Non-Family Services

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

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

N/A

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

Adjust Prior Approval/Authorization Elements Approved in Waiver

Adjust Assessment Requirements

Add an Electronic Method of Signing Off on Required Documents Duch As The Person-Centered Service Plan

Link To Application

Michigan Appendix K Application (PDF)

Link to Approval Letter

Michigan Appendix K Approval Letter (PDF)