Missouri – DD Comprehensive (0178.R06.00), Community Support (0404.R03.00); Partnership for Hope (0841.R02.00); Children w/DD (MOCDD) (4185.R05.00)

Waiver Title

DD Comprehensive (0178.R06.00), Community Support (0404.R03.00); Partnership for Hope (0841.R02.00); Children w/DD (MOCDD) (4185.R05.00)

Description of Emergency

COVID-19 pandemic. This amendment will apply to all waivers included in this Appendix, and all individuals supported through those waivers and impacted by the virus

Waiver Description

DD Comprehensive (0178.R06.00), Community Support (0404.R03.00); Partnership for Hope (0841.R02.00); Children w/DD (MOCDD) (4185.R05.00)

Start Date

27-01-20

End Date

26-01-21

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 all waivers to all individuals supported through the waivers and impacted by the COVID-19 virus

Access and Eligibility

Increase Cost Limits

N/A

Modify Targeting Criteria

N/A

Services

Modify Scope or Coverage

Home Delivered Meals; Group Home; Individualized Supported Living; Day Habilitation; Personal Assistant; Temporary Residential Service; Out of Home Respite; In Home Respite

Exceed Service Limitations

• Self-Directed Personal Assistant Service will allow for a family member to exceed the maximum 40 hours per week.

Add Services

N/A

Expand Settings

Out of Home respite and Temporary Residential Services may be provided in the following alternate locations to ensure the individual’s health and safety needs can be met:

An individual’s private home;
A waiver residential setting; or
Other setting such as a hotel, shelter, school or church
- If a Day habilitation location closes due to Covid -19, Day habilitation can be provided in the following alternate locations:
An individual’s private home;
- A waiver residential setting; or
- Other setting such as a hotel, shelter, school or church.
Prevocational services may be provided in an individual’s home
Services may be provided in any setting necessary such as state alternative care facilities (hospital overflow), hospitals, and emergency shelter locations (including hotel or other arrangements as necessary to isolate individuals) to ensure the individual’s health and safety needs can be met during the public health emergency.

Provide Service Out of State

N/A

Allow Payment for Services by Families

Family members must be employed by or contracted with a DD contracted provider. Family members who do not live in the same residence and are not legally responsible individuals, spouses or legal guardians, may provide: Day Habilitation (except for professional portion of Medical or Behavioral exceptions), Group Home (excluding the RN Oversight), In-Home Respite, Individualized Supported Living (excluding the RN Oversight), Prevocational Services, Supported Employment, Career Planning, Community Integration, Community Specialist, Individualized Skill Development, Job Development, Out-of-Home Respite, Temporary Residential, Shared Living, and Transportation services, when no other caregiver is available. This will be extremely critical in situations where a participant may be diagnosed with COVID-19 and the family member is the only willing individual to provide care. Family members must receive training on the participant’s needs and individual support plan for whom they are rendering these services. When family members render a waiver service, the provider agency authorized to render the service is responsible for ensuring that services are provided and that billing occurs in accordance with billing and service documentation requirements.

Modify Provider Qualifications

Modification of Provider Qualifications

For all waiver services the following are temporary modification for provider qualifications:

For all Direct contact staff, written verification of education status requirement will be temporarily suspended due to records not being available while schools are closed.
In the event a contracted provider agency is unable to meet the following certification requirement(s) due to the COVID-19 Pandemic for:
- CPR & First Aid Initial Certification Training: DD will waive the requirement to utilize certification that requires “hands-on” training. DD will accept the successful completion of on-line training for CPR & First Aide by nationally recognized courses currently accepted. Evidence of successful completion must be placed in the staff’s personnel record.
- CPR & First Aid Recertification Training: DD will waive the requirement to utilize recertification that requires “hands-on” training. DD will accept the successful completion of the Relias Learning online recertification training for CPR & First Aide, or other nationally recognized on-line courses currently accepted.
- DMH Medication Administration Initial Certification Training: DD will waive the requirement for in-seat (in-person) learning to allow for remote instruction (I.e. use of WebEx or other applications that allow the student interact with the instructor, to interface with questions, etc.). The student may take the written portion of test online in lieu of an in-person paper test. Upon successful completion the required documentation should be placed in the personnel record and copied to the applicable Regional Office for entry into the Registry.
- DMH Medication Administration Recertification Training: DD will waive the requirement for a face-to-face two year update (recertification). DD will accept completion of the Relias Learning online course “Medication Administration for Unlicensed Paraprofessionals”. Upon successful completion the certificate should be printed and attached to the Two-Year Update form which should be placed in the personnel record and copied to the applicable Regional Office for entry into the Registry. The contracted agency Registered Nurse providing oversight should evaluate the Med Aides’ ability to continue administering medication and document. The Registered Nurses are encouraged to use professional judgment and may conduct their evaluation as a telehealth service. Note: The above reference to remote instruction and telehealth service may be conducted via telephone, tele-monitoring, or non-public facing remote communication methods. Examples of non-public facing products include Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype. It is important to note that Facebook Live, Twitch, TikTok, and similar video communication applications are public facing and should not be used in the provision of telehealth.
Certification requirements for family members providing direct care services through a DD contracted provider will be determined through the individual’s assessment and planning process and reflected in the Individual Support Plan(ISP).

Modify Provider Types

N/A

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

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 to ensure that the specific service is delineated accordingly to the date it began to be received. The support coordinator must submit the request for additional supports/services, as well as the date the verbal consent was provided, no later than 30 days from the date the service begins. The state is allowing verbal consent by telephone for signatures as authorized by Section 1135 authority.

Modify Incident Reporting/Med Management Safeguards

N/A

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

For individuals hospitalized, a provider may bill waiver services to assist with supports, supervision, communication, and any other supports that the hospital is unable to provide. The services will: be identified in an individual’s person-centered service plan; provided to meet needs of the individual that are not met through the provision of hospital services; not substitute for services that the hospital is obligated to provide through its conditions of participation or under Federal or State law, or under another applicable requirement; and be designed to ensure smooth transitions between acute care settings and home and community-based settings, and to preserve the individual’s functional abilities. Individuals that require hospitalization may receive the following services in a hospital setting when the above criteria are met:

Personal Assistant
Staffing supports for the above listed needs normally provided through the individuals Group Home, Individual Supported Living, and Shared Living providers
Applied Behavior Analysis
Person Centered Strategies

Inclusion of Retainer Payments

N/A

Institute/Expand Opportunities for Self-Direction

N/A

Increase Factor C

N/A

Other Changes Necessary

To reduce the risk of exposure to individuals, agency staff, and provider staff during the COVID-19 pandemic, DD will modify current quality management processes. Quality management processes that require face-to-face contact with the participant will be modified to allow for the process to be conducted via other methods. Other methods that may be utilized include non-public facing products such as Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype. Modifications may impact the ability to collect data and temporarily suspend some monitoring processes while continuing to address core Health & Welfare assurances.

the reporting processes for Evidentiary and 372’s during the timeframe of January 27, 2020 through January 26, 2021 will be modified due to some performance measure data for Appendix C Qualified Provider and Appendix D Service Planning not being available. These processes have been impacted due to reliance on the ability for staff to collect and access paper documentation (Performance measurement source) during the COVID-19 public health emergency.
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

Personal care services that only require verbal cueing, in-home habilitation, monthly monitoring, other: Allow for the modification of the face-to-face requirements in all other waiver services, except transportation and environmental accessibility adaptations, for the billing purposes of services delivered to participants. Traditional face-to-face services may be delivered through non-face-to-face methods (i.e. telephone, video, text, email), if practical and necessary.

Add Home Delivered Meals

Add Medical Supplies, Equipment and Appliances

N/A

Add Assistive Technology

N/A

Conflict of Interest

Other Changes Necessary

the reporting processes for Evidentiary and 372’s during the timeframe of January 27, 2020 through January 26, 2021 will be modified due to some performance measure data for Appendix C Qualified Provider and Appendix D Service Planning not being available. These processes have been impacted due to reliance on the ability for staff to collect and access paper documentation (Performance measurement source) during the COVID-19 public health emergency.
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.

Other Changes Necessary

the reporting processes for Evidentiary and 372’s during the timeframe of January 27, 2020 through January 26, 2021 will be modified due to some performance measure data for Appendix C Qualified Provider and Appendix D Service Planning not being available. These processes have been impacted due to reliance on the ability for staff to collect and access paper documentation (Performance measurement source) during the COVID-19 public health emergency.
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.

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

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

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

Missouri Appendix K Application (PDF)

Link to Approval Letter

Missouri Appendix K Approval Letter (PDF)