In response to the Covid-19 emergency, MT DPHHS has submitted a series of amendments to Montana’s Medicaid waivers to help lessen the impact of the situation upon providers and those who receive their services. The most recent of these was an Appendix K request which included various requests for alterations to the way that Medicaid waiver services are provided. This included all three disability waivers in our system: the Big Sky Home and Community Based Waiver (“Big Sky”), the Montana Behavioral Health Severe Disabling Mental Illness Home and Community Based Waiver (“SDMI”) and the Montana Home and Community Based Waiver for Individuals with Developmental Disabilities (“0208″). We were given the opportunity to comment on the wavier application prior to submittal, and many of our recommendations were adopted.
The federal government approved the request on April 30, 2020. Significant changes are as follows:
- Waives prior authorization limits on the following services:
- 0208 waiver – respite;
- Big Sky waiver – companion, respite, personal assistance services and non-medical transportation;
- SDMI waiver – homemaker chore services
- Permits the following services to be delivered in a participant’s home environment or alternative provider or community setting:
- 0208 waiver – day supports and activities, retirement services, supported employment-follow along support and individual employment support, personal care, companion, personal supports, homemaker, residential habilitation;
- Big Sky waiver – adult day health, day habilitation, supported living; and
- SDMI waiver – adult day health services.
It also allows services to be provided in these additional settings: the private home of the participant or a family member of the participant; a provider owned or controlled or extended family home; the private home of a direct care provider; community center or designated community gathering center; hotel/paid lodging; newly rented room; other residential setting; or telework settings.
- Approves reimbursing “legally responsible persons” as caregivers for services that already allow a relative or legal guardian to provide. These are:
- 0208 – day supports and activities, homemaker, residential habilitation, respite, companion services, personal care, personal supports, retirement services, specialized child care for medically fragile children, supported employment-follow along support, supported employment- co-worker support, supported employment- individual employment support, supported employment- small group employment;
- Big Sky – day habilitation;
- SDMI – personal assistant attendant, specially trained attendant.
- Expands provider pool by allowing any enrolled waiver provider to work in all three waivers.
- Temporarily extends deadlines for all training requirements for 60 days from the original due date. However, all direct care staff should continue to receive training on the participant’s plan of care for whom they are providing support. Training on the plan of care must consist of basic health and safety support needs for that individual. Providers must continue to ensure that direct care staff are able to demonstrate competency in the skills and techniques necessary to perform their assigned tasks under the participant’s plan of care.
- Expands provider types for specialized equipment and supplies to purchase items from nontraditional vendors who have necessary items in stock when supply or cost impacts occur due to COVID 19 on a case by case basis.
- Suspends periodic licensing and quality reviews of provider agencies throughout the duration of the pandemic. Allow provider flexibility in daytime staffing levels as long as care quality is retained.
- Temporarily modifies processes for initial level of care for waiver eligibility to allow evaluations to be conducted via telephone or other interactive electronic communication.
- Allows for payment of services to support a participant when temporarily institutionalized in a nursing facility, swing bed, critical access hospital or acute care hospital for a COVID 19-related illness. This is for providing additional supports for communication, behavior and/or extensive personal supports and such services that are not covered in such settings:
- 0208 – residential habilitation, day supports and activities, retirement services, personal supports, companion, adult foster;
- SDMI – specially trained attendant, life coach.
- Adds or increases retainer payments for providers of services identified as habilitation services that include a component of personal care and/or personal care. Retainer payments shall be available when the participant is hospitalized or otherwise unavailable to participate in habilitative services for the duration of COVID 19 related absences. The retainer time limit will not exceed the lesser of 30 consecutive days or the number of days for which the state authorizes a payment for “bed hold” in nursing facilities. The services included are:
- 0208 waiver – assisted living, companion services, day supports and activities, personal care services, residential habilitation, retirement services, supported employment follow along support, supported employment individual employment support, supported employment-small group employment;
- Big Sky waiver – residential habilitation, post-acute rehabilitation services, supported living, adult day health, day habilitation, personal care services, private duty nursing;
- SDMI waiver – residential habilitation, personal care services, specially trained attendant, private duty nursing.