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 IFS Waiver amendment 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 Amendment 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 Individual and Family Supports (IFS) Waiver program to the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) for review and approval.

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

1. service changes to include adding new services and updating scope of specific services;
2. systemic changes that relate to clarifying roles, eligibility and enrollment and reserved capacity and staff vaccination requirements; and
3. set reimbursement rates for proposed new services 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.

-Adds the option for participant-directed services, which means that participants, or their representatives if applicable, have decision-making authority over certain services and take direct responsibility to manage their services with the assistance of a system of available supports. The PDS delivery model is an alternative to traditionally delivered and managed services, such as an agency delivery model. Participant-direction of services allows participants to have the responsibility for managing all aspects of service delivery in a person-centered planning process. The PDS delivery option will be offered for the following services: in-home supports service, individualized day supports services, companion services, respite daily services, and individual-directed goods and services.

-Adds a new service, Individual-directed goods and services, which are services, equipment, or supplies not otherwise provided through the IFS Waiver or State Plan. Furthermore, IDGS are only available if the individual does not otherwise have the funds to purchase the good or service or the good or service is not available through another source. IDGS are purchased from the participant-directed budget. Experimental or prohibited treatments are excluded. These goods and services must address an identified need in the participant's individual service plan (ISP). IDGS are only available to waiver participants who are enrolled in the participant-directed services program.

-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.

-Modifies the scope of companion services to allow the service to be rendered by the individual’s relative when participant[1]directed.

Systemic Changes:

Appendix B: Proposing four 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.

-Modifies the reserved capacity for CFSA to DDS and ICF/IDD reserved slots. The District will decrease the reserve capacity from 15 to 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 decrease reserve capacity from five (5) to 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 COVID-19 vaccination requirements for direct care staff to align with DC Health requirements.

-Adds a vendor for Financial Management Services (FMS)/Support Broker entity to provide financial management and information and assistance services for participants in the PDS program.

Reimbursement 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 rate-setting methodology for participant-directed services. The rate-setting methodology used for Medicaid services delivered through traditional agency-based model will remain the same for services that are participant-directed. Participants who elect to use PDS will determine hourly rate paid to their participant-directed workers within range set by DHCF, which falls between District’s established living wage and the rate paid to PCAs delivering Waiver services through the agency-based model. The Vendor Fiscal/Employer Agent Financial Management Services (VF/EA FMS) - Support Broker entity will assist participants who elect to use PDS through provision of financial management and support broker services and will receive a PMPM payment for provision of these services.

Public Comment:

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

1. Written Comments:  Written comments on the proposed IFS Waiver amendment 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 IFS waiver amendment will be accepted. The virtual public forum will be held on:

Date: Monday, May 23, 2022

Time: 11:30 a.m. to 1:00 p.m.

Web conference: Click Here to Join IFS 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].