Implementation of Appendix K Flexibilities for COVID-19 Operational - - PowerPoint PPT Presentation

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

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

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

Hawaii’s Appendix K

• 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 Appendix K Application

• 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 Timeframe

• DDD is in the process of addressing operational requirements

Implementation

Original: 3/30/2020 | Updated: 4/7/2020 4

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

Does Appendix K Apply?

1.) What change(s)

• ccurred for the participant

as a result of COVID-19? Changes Related to Services Changes Related to Health

Original: 3/30/2020 | Updated: 4/7/2020 6

Changes Related to Services

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 services, such as Community Learning Services- Group (CLS-G) or Individual (CLS-Ind) or Discovery & 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.

Original: 3/30/2020 | Updated: 4/7/2020 7

Changes Related to Services

(cont.)

d. Is the provider unable to provide staffing at pre- COVID-19 required levels due to overall shortages

• f 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 part of social distancing? f. Is the participant’s direct support worker unable to provide services due to caring for a family 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

Changes Related to Health

• h. Is the participant isolating at home or

quarantined due to potential exposure to someone diagnosed (presumptive or confirmed) with COVID-19? i. Was the participant diagnosed with COVID-19 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

Changes Related to Health

j. Was the participant’s caregiver or a person with whom they live diagnosed (presumptive

• r confirmed) with COVID-19?
• k. Is the participant’s direct support worker

isolating at home or quarantined due to exposure to someone diagnosed (presumptive

• r 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

Does Appendix K Apply?

2.) Is the change requested covered in this Appendix K operational guide? Yes, it’s covered in these guidelines 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

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

12 Original: 3/30/2020 | Updated: 4/7/2020

Operational Guidelines

1915 (c) Appendix K

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

14 Original: 3/30/2020 | Updated: 4/7/2020

Decision Trees for Service Choices

Current Service

What is the current service?

Setting

Where will the service be delivered during the COVID-19 emergency?

Ratio

What is the staffing ratio?

(either one-to-one or group if delivered

to two or more participants)

NEW COVID-19 Service

New Service

To determine the appropriate ‘new’ service, the decision trees walk-through

3 facts - service, setting, ratio

The resulting ‘new’ service represents the general approach that will be followed to determine the new service, but there may be exceptions

15

Adult Day Health / Community Learning Services - Group

Current Service

New COVID-19 SETTING New COVID-19 RATIO New COVID-19 SERVICE

Adult Day Health (ADH)/ Community Learning Services - Group (CLS-G) Center

Group

ADH Tier

Indiv.

ADH 1:1

Staff In Home

Group

ADH Tier

Indiv.

ADH 1:1

Community

Group

CLS-G Tier

Indiv.

CLS-Ind

Telehealth

Group

ADH-G Tele- health

Indiv.

ADH 1:1 Tele- health

Original: 3/30/2020 | Updated: 4/7/2020 16

Community Learning Service – Individual

Current Service

New COVID-19 SETTING New COVID-19 RATIO New COVID-19 SERVICE

Community Learning Service – Individual (CLS-Ind) Staff in Licensed/ Certified Setting

Group

ADH Tier

Indiv.

ADH 1:1

Staff In Private Home

Group

PAB Group

Indiv.

PAB

Community

Group

CLS-G Tier

Indiv.

CLS-Ind

Telehealth

Group

ADH-G Tele- health

Indiv.

ADH 1:1 Tele- health

Original: 3/30/2020 | Updated: 4/7/2020 17

Questions? Please email - doh.dddcrb@doh.hawaii.gov

Original: 3/30/2020 | Updated: 4/7/2020 18