STATE OF WASHINGTON



center31912900STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICESAging and Long-Term Support AdministrationHome and Community Services Division18859501933575HCS MANAGEMENT BULLETIN00HCS MANAGEMENT BULLETINPO Box 45600, Olympia, WA 98504-5600H20-031– Policy & ProcedureApril 20, 2020TO:Home and Community Services (HCS) Division Regional Administrators Area Agency on Aging (AAA) DirectorsFROM:Bea Rector, Director, Home and Community Services DivisionSUBJECT:Temporary policy and contract changes to Home Delivered Meals (HDMs) through the COPES, New Freedom, 1115 MTD waiver programs and Roads to Community Living (RCL) program during the COVID-19 emergency.PURPOSE:To notify staff of temporary changes to policy for COPES, New Freedom, and 1115 waivers and RCL for HDM authorizations during the COVID-19 emergency, as well as temporary changes to the HDM contract requirements for the COPES and 1115 waiver programs and RCL. BACKGROUND:On February 29th, 2020, Governor Jay Inslee declared a state of emergency in response to the COVID-19 outbreak, directing state agencies to use all resources necessary to prepare for and respond to the outbreak. ALTSA staff have been in communication with the Centers for Medicare and Medicaid Services (CMS) to review the rules related to 1915(c) Waivers, 1915(k) CFC State Plan Services and the 1115 Medicaid Transformation waiver, and to request exceptions to specific rules until the COVID-19 pandemic is contained. WHAT’S NEW, CHANGED, OR CLARIFIED:HDM vendor contracts for COPES and 1115 Waivers, and RCL: Currently, Medicaid funded home delivered meal (HDM) services must comply with the DSHS Senior Nutrition Standards for home delivered meals. However, contracted suppliers or delivery methods may not be viable during the COVID-19 emergency. To address these circumstances, alternative providers and delivery methods may be used through 1/31/2021 or until notified otherwise. The flexibilities granted under this MB are allowable under special emergency waivers from CMS that are time limited. For new alternative providers who do not meet the existing contract requirements, a short-term HDM contract may be created with an end date no later than 1/31/2021. This MB waives the requirements noted below for existing HDM contracted providers and any new alternative providers through 1/31/2021 or until notified otherwise: The face to face requirement to monitor the general well-being and safety of the client. (This allows vendors to deliver meals through the mail, FedEx, etc.) The requirement to provide 1/3 of the current recommended dietary allowance. In addition, a shelf stable meal may be provided by the HDM vendor if that is all that is available. Policy Changes: For COPES, New Freedom, 1115 MTD Waiver, and RCLIncrease in meals per day: Temporarily allow a maximum of two meals a day to be authorized during the COVID-19 emergency. COPES and RCL: During the COVID-19 outbreak, the sub-criteria eligibility for HDMs outlined in WAC 388-106-0300, has been expanded to include individuals who are not considered homebound and are experiencing food insecurity as evidenced by:not having access to adequate food due to COVID-19 “stay at home” orders, ANDnot having formal or informal support who can shop/deliver/prepare meals. For those who meet the new eligibility criteria, a ? hour deduction is not required per meal. For those already on services requesting a second meal, an additional ? hour reduction per meal is not required for the additional meals. Reason code added: A COVID-19 Reason Code was added to track HDM meals that meet the expanded eligibility criteria. The COVID-19 Reason Code should also be used for any clients previously authorized who are now receiving two meals a day. 1115 Waiver: For MAC and TSOA, meals may be authorized in excess of the care receiver’s budget limit without an ETR if they are experiencing food insecurity during the COVID-19 Emergency. Case Managers may also authorize up to two meals per day. This may be authorized until further notice. Additional Information on food resources: As part of the federal COVID response, all Basic Food recipients will receive the maximum food benefit for their household size to their EBT card for March and April. Amazon and Walmart online grocery ordering can accept EBT cards for payment. See attachment for more detail on increased benefit.ACTION:Any temporary contracts created to meet the supply demand of home delivered meals must have an end date of no later than 1/31/2021. Case Managers will provide an individualized assessment of a client’s needs and support system to determine if the additional sub-eligibility criteria has been met for COPES, New Freedom and RCL. Case Managers should also consider vendor capacity when evaluating requests. Consider exploring how caregivers can assist clients to arrange grocery delivery through local retailers. COPES and RCL: When authorizing meals based on the temporary sub-eligibility criteria and existing clients who request a second meal, Case Managers should select the reason code, “COVID-19” to allow for tracking of expenses related to the COVID-19 outbreak. RELATED REFERENCES:MB H20-015 Older Americans Act Nutrition Program COVID-19 Response ATTACHMENT(S):EnhancedMetaFilefalse\f 0 CONTACT(S):Jamie Tong Waiver Program Manager Jamie.tong@dshs.. 360-725-3293Debbie JohnsonMTD Program Manager Debbie.johnson2@dshs.360-725-2531Mark TowersNew Freedom Program Manager Mark.towers@dshs. 360-725-2446Julie CopeSystems Change Specialist Julie.cope@dshs. 360-725-2529 ................
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