June 16, 2022 UPDATE

The District's thirty (30) day public comment period will be open from June 16, 2022 through July 16, 2022. Interested parties may submit written comments concerning the proposed IDD Waiver renewal Appendix J to  Katherine Rogers, Director, Long Term Care Administration, Department of Health Care Finance, 441 4th Street, NW, Suite 900S, Washington, D.C. 20001, or via email at [email protected].

Proposed Renewal to the Home and Community-Based Services Waiver for People with Intellectual and Developmental Disabilities

The Director of the Department of Health Care Finance (DHCF) and the Director of the Department on Disability Services (DDS), pursuant to the authority set forth in the Department of Health Care Finance Establishment Act of 2007 and the Department on Disability Services Establishment Act of 2006, hereby give notice of the intent to submit an amendment to the District of Columbia Medicaid’s Home and Community-Based Services for People with Intellectual and Developmental Disabilities (IDD) Waiver program to the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) for review and approval.

The renewal application for the IDD Waiver contains three types of changes to be effective October 1, 2022, as follows:

1. service changes to include new services and updating scope of specific services;
2. systemic changes that relate to clarifying roles, eligibility and enrollment, reserved capacity, staff vaccination requirements and provider oversight compliance; and
3. set reimbursement rates for proposed new services, contribution to cost of residential supports and DSP supplemental payments.

Each of these types of changes is described in greater detail in the sections below.

Service Changes:

-Modifies Assistive technology services by adding additional allowable Assistive Technology items to include: virtual assistants/smart speakers, environmental controls devices, applications for prompting, and guidance and navigation. Modifies the requirement for an Assistive Technology assessment to include assistive technology that costs under $1,000, no longer requires an assessment. DDS Service Provider can acquire assistive technology based on the individual’s IDT/Support team justification of need in the individual’s support plan. Assistive technology that costs over $1,000 must include assistive technology assessment conducted by a professional of: occupational therapy; physical therapy; speech, hearing, and language services; assistive technology professional (RESNA Certified); Certified Enabling Technology Integration Specialist (ETIS) employed by a SHIFT accredited waiver service provider; or another comparable national accreditation body, as approved by DDS.

-Modifies provider qualifications for assistive technology services to include Certified Enabling Technologies Specialist Certification and Accredited Technology First Organizations for assistive technology services.

-Adds remote supports services, which will enable individuals to be more independent and less reliant on staff to be physically present to receive support. The remote supports service will be available for the following waiver services: assistive technology services, behavioral supports, bereavement counseling, creative art therapies, day habilitation, employment readiness, family training services, fitness training, nutrition evaluation/consultation services, occupational therapy, parenting supports, sexuality education, speech, hearing, and language, and supported employment. Remote support services will be a separate billable service with a specialized rate different from the in-person service delivery rate. Remote support service rates for speech, hearing, language services, occupational therapy services, bereavement counseling, fitness training services, nutrition evaluation/consultation services, sexuality education services, and creative art therapies services will maintain the same rates.

-Adds a proposed new service, telehealth, which will provide specific medical advice on when waiver participants should seek additional or in-person medical treatment via virtual applications to persons residing in host home, supported living and residential habilitation settings. A person can receive telehealth services in their home, and it acts as a triage, but does not duplicate Medicaid services covered under the State Plan. Telehealth services provide a real-time health assessment to determine the best clinical course of action, often avoiding unnecessary emergency room visits, and is available 24 hours a day, 7 days a week by a licensed physician. Telehealth includes video-assisted examinations, prescription refills, treatment plans and coordination of care.

Systemic Changes:

To comply with statutory requirements the District is also proposing changes and systems improvements in the following IDD Waiver sections:

(1) Appendix B: Proposing five changes:

-Clarifies roles and responsibilities of Health Insurance Analysts and Medicaid Waiver Specialists in completing and submitting the Medicaid recertification form to the Department of Human Services, Economic Security Administration at least sixty (60) days prior to the expiration of the person’s Medicaid eligibility period.

-Modifies who is eligible to receive waiver services by expanding IFS Waiver services to individuals with DD without a diagnosis of an Intellectual Disability (ID). The proposed DD eligibility expansion also incorporates modifications to the definitions of DD and ID and amends the waiver eligibility criteria to acknowledge that onset of ID can occur after age eighteen (18) up to age twenty-two (22). Whereas criteria before required onset of ID prior to age eighteen (18).

-Modifies the waiver enrollment process. The proposed modification will base enrollment into the IFS waiver on the individuals’ identified needs. The Interdisciplinary Team will discuss services based on the individuals’ specified need(s) and the most appropriate waiver will be explored.

-Adds a provision that at the individual service plan meeting, people will be informed of the availability of both the IDD and Individual and Family Support (IFS) waivers.

-Modifies the reserved capacity for CFSA to DDS and ICF/IDD reserved slots. The District will change reserve capacity from 15 up to 10 slots per year for each year of the waiver for young adults who are wards of the District and are transitioning from the Child and Family Services Agency (CFSA) to adult services in DDS/DDA. The District will change reserve capacity from five (5) up to three (3) slots per year for each year of the waiver to transition people who seek to move from ICF/IDD settings to HCBS waiver services. Adds new two (2) reserved capacity slots for people transitioning from the IFS waiver to the IDD waiver.

(2) Adds a new performance measure for provider oversight compliance and removes performance measures that maintained consistent oversight compliance.

Reimbursement Changes:  

(3) Appendix I: Proposing two changes:

- Adds a supplemental payment for waiver services. The District will be paying supplemental payments to DSPs starting FY2023 and as necessary annually to alleviate the workforce shortage. To the extent authorized by District legislation and approved under the District’s Section 9817 American Rescue Plan Act Spending Plan.

- Adds the requirement of contribution to cost of residential supports. Under D.C. law, all persons receiving residential services and supports are required to contribute to the cost of those services and for items such as rent, food, clothing, medical expenses, furniture, utilities, and other personal items and equipment. The law covers people living in host homes, residential habilitation, and supported living settings. Most people contribute to costs from their public benefits, such as Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). People who are employed and still receive public benefits contribute to the cost of residential services and supports based on their combined income.

(4) Adds COVID-19 vaccination requirements for direct care staff to align with the national and DC Health requirement

Public Comment:

There are two opportunities for the public to provide comments or other input on the proposed HCBS IDD Waiver renewal and amendments:

1. Written Comments:  Written comments on the proposed IDD Waiver renewal shall be submitted to: Katherine Rogers, Director, Long Term Care Administration, Department of Health Care Finance, 441 4th Street, NW, Suite 900S, Washington, D.C. 20001, or via email at [email protected] during the thirty (30) calendar day public comment period, beginning April 29, 2022 and ending May 30, 2022. The public comment/input period will end on May 30, 2022.
2. Public Forum: DHCF and DDS will hold a virtual public forum during which written and oral comments on the proposed IDD waiver renewal and amendment will be accepted. The virtual public forum will be held on:

Date: Wednesday, May 25, 2022

Time: 10:00 am to 11:30 a.m.

Web conference: Click Here to Join IDD Waiver Amendment Virtual Public Forum

Accommodations for the public forum are available upon request. Please provide your name, address, telephone number, organizational affiliation, and accommodation request, if needed to Donnise Taylor at (202) 730-1556 or email [email protected].