STATE OF WASHINGTON



center31912900STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICESAging and Long-Term Support AdministrationHome and Community Services Division18326101769110HCS MANAGEMENT BULLETIN00HCS MANAGEMENT BULLETINPO Box 45600, Olympia, WA 98504-5600H20-023 – InformationMarch 30, 2020TO:Home and Community Services (HCS) Division Regional Administrators Area Agency on Aging (AAA) DirectorsDevelopmental Disabilities Administration (DDA) Regional AdministratorsFROM:Bea Rector, Director, Home and Community Services DivisionDebbie Roberts, Deputy Assistant Secretary, DDASUBJECT:Delivery of Environmental Modifications (E-mods), Wellness Education (WE), Specialized Medical Equipment (SME), Assistive Technology (AT) and Personal Emergency Response System (PERS) during the COVID-19 outbreak.PURPOSE:To provide information to the field about service delivery for E-mods, WE, SME, AT and PERS during the COVID-19 outbreak. This pertains to all ALTSA and DDA programs providing these services. 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. On March 18th, 2020, the Centers for Medicare and Medicaid Services (CMS) approved Washington State’s 1135 Medicaid Waiver giving emergency authority to provide a wide range of flexibilities in order to remove barriers that could interfere with the delivery of services. On March 23rd, 2020, Governor Inslee issued the “Stay Home, Stay Healthy” proclamation limiting all non-essential activities and requiring businesses that are considered essential to establish and implement social distancing measures. See MB H20-022 for more information. WHAT’S NEW, CHANGED, OR CLARIFIED:To reduce exposure and infection spread risks for clients and providers during the COVID-19 state of emergency, the delivery of E-mods, WE, SME, AT, and PERS services may be modified in some circumstances based on client and provider health and safety and related care needs. Case workers should instruct providers to follow all of the current infection control procedures outlined by the Centers for Disease Control and Prevention (CDC), including practicing social distancing.ACTION:Effective immediately and until further notice, follow the guidelines below: Environmental Modifications (E-mods)During this COVID-19 state of emergency, case workers should evaluate the need for an environmental modification on a case-by-case basis. Coordinate with the client to review any health and safety concerns. E-mod requests may be delayed during the state of emergency if requested by the client. The case worker should document this in the CARE SER or GetCare Progress Note.If it is determined that the E-mod cannot be delayed and must be completed during the COVID-19 state of emergency, the provider should follow all of the current infection control procedures outlined by the CDC, including practicing social distancing.If the contracted provider or their staff or a subcontractor develop symptoms of COVID-19 (such as fever, dry cough/shortness of breath), the provider must notify the case worker so they can inform the client. The reverse is also true: if the case worker learns the client or someone in their household has symptoms of COVID-19, the case worker must notify the contracted provider.Wellness Education (WE)A Special Edition WE (SEWE) providing basic information regarding the COVID-19 virus has been created (see attachment). It will be received by clients between March 26th and March 30th. It is being mailed to: All HCS/AAA clients with a CARE assessment in current status on March 18th (regardless of program)All current, active DDA clients as of March 18thTypically, returned WE is managed at HQ. For this SEWE, returned copies will be sorted by HQ and sent to local offices. The only reason these will be sent to the local offices is so they have the information about what may be incorrect addresses in CARE. For clients authorized WE, newsletters in the near future (April and May, at a minimum) will only include articles that are supportive in nature, include topics like social isolation, grief, depression, anxiety, COVID-19 scams, stress management, mediation, etc. Clients who are newly authorized WE will not receive the “Welcome Letter” until the supportive articles are deemed no longer necessary and the standard WE process of selecting articles based on assessment is reinstated.Specialized Medical Equipment (SME) Durable Medical Equipment (DME) Apple Health DME: Health Care Authority (HCA) has issued a bulletin regarding DME funded by the Apple Health fee-for-service (FFS) program during the COVID-19 outbreak (attached below). Please note: much of the DME needed by clients during this time will NOT be COVID-19 or hospital-surge related. For items that require a prior authorization (PA) per the Medical Equipment and Supplies Billing Guide that are unrelated to the COVID-19 response, a PA is still required prior to delivery of the item. If a client is dually eligible, Medicare remains the primary payor. For social services authorizations for DME: some DME vendors have begun either: 1) drop-shipping the item to a client’s porch; or 2) requiring a curbside pickup of the item at their place of business. Some DME vendors continue to provide in-home delivery for larger complex rehabilitative items or to complete repairs while practicing social distancing to clients who are asymptomatic of COVID-19 (verified by a phone screening). Other vendors are not doing any in-home deliveries at this time. Case workers should verify with the provider how the item will be provided to the client when requesting a quote. Authorization for items should be created in “Reviewing” status and changed to “Approved” status after verifying the client has received the item (this can occur over the phone). For items that require assembly, most items that can be shipped to the home or picked up in a car use a click-together process that many clients will be able to manage on their own. If the client, a household member, or caregiver are unable to assemble the item, case workers should problem solve with the client. Do not delay changing the authorization to “Approved” status while problem solving assembly of the item. If bathroom equipment is needed emergently to help a client transition from an acute care setting to a home and community-based setting to alleviate a hospital surge, please submit the supporting documentation as part of the required bathroom equipment ETR process. Please make a note in the comment box of the ETR that the request is COVID-19 surge related. However, do not wait for an approval to the ETR prior to creating the authorization in “Reviewing” status. If COVID-19 related (only), approval can be completed retroactively. Specialized Equipment and Supplies (SES)As noted on the Service Code Data Sheet (SCDS) for SA421, shipping an item directly to the client is an option for SES regardless of whether a Community Choice Guide (CCG), a client services Purchase Card (PCARD) (HCS offices only, following all protocols regarding use of the PCARD) is used or a provider with the SES contract is authorized for the purchase. This option should be fully utilized during the COVID-19 outbreak. Reasonable shipping fees can be included on the authorization as noted in the SCDS (the authorization is created in “Reviewing” status). Receipt of the SES item must be verified with the client over the telephone before changing the status of the authorization to “Approved” status. Assistive Technology (AT)Shipping an AT item directly to the client is an option for AT regardless of whether an AT contracted provider or a CCG (HCS/AAA only) is used to make the purchase This option should be fully utilized during the COVID-19 outbreak. Receipt of the AT item must be verified with the client over the telephone before changing the status of the ProviderOne authorization to “Approved”.For DDA Only regarding Purchase CardsIn addition to above, if all contracted vendors in local areas report increased cost outside of current market rates or inability to obtain an approved AT, SES or SME item, the DDA CRM may consult with their region regarding the use of a Purchaser or a Purchase Card. This option is available for DME (as SES or SME) only when the item is not covered by insurance or the client does not meet the insurance medical criteria.Personal Emergency Response System (PERS) During this COVID-19 state of emergency, when possible and appropriate based on client ability to complete installation, in-person installation of the PERS basic and add-on service(s) should be avoided. Either mailing the PERS unit to client or no-contact delivery to the client’s front door with notification to the client should be used if possible.If the PERS service is being discontinued and the PERS basic and add-on service unit(s) are to be returned to the vendor, the PERS vendor should either send a postage paid box for the PERS basic and add-on service unit(s) to the client or pick up the unit(s) from the client’s home using no-contact, meaning the PERS vendor can let the client/representative know they are outside the residence so that the client/representative can place the unit(s) to be returned to the PERS vendor outside the front door and then the PERS vendor can pick up the unit(s) being returned once the door is closed.RELATED REFERENCES:H20-022 Governors Executive Order for Essential Critical Infrastructure WorkersATTACHMENT(S):Special Edition Wellness Education FFS Apple Health PA Requirements: COVID-19 RelatedCONTACT(S):HCS:Jamie Tong, COPES Waiver Program Manager(360) 725-3293Jamie.Tong@dshs.Debbie Blackner, Ancillary Services Program Manager360-725-3231Debbie.Blackner@dshs. Victoria Nuesca, CFC Program Manager(360) 725-2393Victoria.Nuesca@dshs.Debbie Johnson, MAC/TSOA Policy Program Manager(360) 725-2531Debbie.Johnson2@dshs. Julie Cope, Systems Change Specialist(360) 725-2529Julie.Cope@dshs. DDA:Jaime Bond, State Plan Services Unit Manager(360) 407-1567Jaime.Bond@dshs.Pon Manivanh, CFC Program Manager(360) 407-1527Manipon.Manivanh@dshs. Ann Vasilev, Waiver Services Unit Manager(360) 407-1551Ann.vasilev@dshs.Josh Church, DDA HQ Social Service Payment Specialist(360) 407-1503joshua.church@dshs. Kim Calkins, DDA Wellness Education/Personal Care ETR CoordinatorKim.calkins@dshs.(360) 407.1552 ................
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