Public Notice - Renewal of the Medicaid 1915(c) Traditional Individuals with Intellectual Disabilities/Developmental Disability (IID/DD) Home and Community-Based Services (HCBS) Waiver Application

Public Comment Sought on the Renewal of the Medicaid 1915(c) Traditional Individuals with Intellectual Disabilities/Developmental Disability (IID/DD) Home and Community-Based Services (HCBS) Waiver Application 

Sept. 18, 2023 – Oct. 19, 2023

The North Dakota Department of Health and Human Services’ Developmental Disabilities (DD) Section is seeking public comment on the Medicaid Traditional IID/DD HCBS waiver renewal application. The current waiver, which serves people with Intellectual/Developmental Disabilities and includes an array of home and community-based services in the least restrictive environment, is approved for five years period and expires March 31, 2024.  

Proposed changes to this waiver:

• Increase capacity (slots) by 150 per year. 
• Emergency slots: allow the usage of emergency slots for a transition from any institutional setting (Life Skills and Transition Center, State Hospital, Skilled Nursing, ICF, etc.).
• Day Habilitation: Added language that retirement activities are allowable under this service.
• Day services (Day Habilitation, Individual Employment Support, Small Group Employment Support, and Prevocational Services): provided clarifying language in the limit section that an individual’s total service hours authorized may not exceed 40 cumulative hours per week.
• Homemaker: added language that shopping is allowed as only task and updated limits. 
• Individual Employment Support and Small Group Employment Support: added language that transportation from a participant’s residence to their workplace may be included in the authorized service hours if personal, public, or generic transportation is not available.
• Residential Habilitation: added language that the residential habilitation provider is responsible for coordinating or providing transportation needs. Participant may be responsible for the costs.
•  Adult Foster Care: added language that respite may be a component of this service.
• Environmental Modifications: 
  • Increase limit from $20,000 to $40,000 per waiver period (5 years).
  • Added language that if a vehicle is purchased with adaptations (i.e. lift, ramp), reimbursement for those adaptations may be approved if itemized on the invoice. 
• Equipment and Supplies: defined generic item(s) to align with current practices. 
• In- Home Supports (IHS): 
  • Added that a participant can be authorized for both provider managed and self-directed but cannot be furnished or billed at the same time of day.  The total authorized amounts are not transferable between the different service delivery methods (i.e., self-directed, provider managed). 
  • Updated language that will allow individuals who live in the same home as the participant to provide IHS services.  This is limited to those that are not the primary caregiver, legal decision maker or legal guardian.
• Parenting Supports: Removed due to lack of utilization. Supports and goals that were previously provided by Parenting Supports may be encompassed within other waiver services or community services.   
• Respite: 
  • New stand-alone service.  No longer a component of In-Home Supports. Purpose is to give temporary relief to the primary caregiver. 
  • Limited to total of 600 hours per State Fiscal Year per participant.
  • Participant can be authorized for both provider managed and self-directed at the same time.  The total authorized amounts are not transferable between the different service delivery methods.
  • Allow individuals who live in the same home as the participant to provide Respite services.  This is limited to those that are not the primary caregiver, legal decision maker or legal guardian. 
• Residential Habilitation, Independent Habilitation, In-Home Supports, and Respite: Participant receiving these services may continue to receive those supports while admitted to an acute care hospital setting to meet the needs of the participant that are not met through the provision of hospital services. This is not intended to substitute services that the hospital is obligated to provide under Federal or State law. 
• Appendix F Participants Rights: Language updated to align with current grievance policy.  
• Appendix G: 
  • Performance Measure updated to report on medication errors substantiated through investigation. 
  • Performance Measure removed that reported on substantiated choking incidents. 

The 1915 (c) Waiver amendment application with the proposed changes is available for review at the following link: https://www.hhs.nd.gov/waivers or https://www.hhs.nd.gov/dd. If you are unable to access this document via the web, a copy can be mailed to you.
 
The anticipated effective date of the proposed renewal is expected to be April 1, 2024. 

Comments and public input on the proposed changes will be accepted from September 18,2023 until October 19, 2023. 
 

Comments will be accepted in the following ways: 

Email: hzander@nd.gov

Phone: (701) 328-8945 or ND Relay TTY (text telephone) (800)-366-6888 or 711

Mail: North Dakota Department of Health and Human Services
Attn: Developmental Disabilities Section/Heidi Zander
        1237 West Divide Avenue Suite 1A
        Bismarck, ND 58501