PUBLC NOTICE - Public Comment Sought on Medicaid HCBS Waiver Amendment Application

PUBLIC NOTICE

Public Comment Sought on Medicaid 1915(c) Home and Community-Based Services (HCBS) Waiver Amendment Application

The North Dakota Department of Health and Human Services’ Adult and Aging Services Section is accepting public comments on an amendment of the states’ Medicaid waiver for home and community-based services. The waiver pays for a variety of in-home community-based support services that allow individuals who otherwise qualify for nursing home care to remain living in their homes and communities. 

The Department’s Adult and Aging Services proposes to amend the 1915(c) Medicaid waiver. The purpose of the amendment is to implement changes in services and programming approved during the 2023 legislative session and update language changes related to internal processes. The amendment would implement the new service of Waiver Personal Care, update the rate methodology for Family Personal Care to comply with the Fair Labor Standards Act (FLSA), update rate methodology for Adult Foster Care, and add retainer payments for Residential Habilitation and Community Support. The amendment would also update internal processes related to the state’s unwinding activities, a result of the COVID-19, public health emergency (PHE), allow for use of electronic signatures and visits by virtual means for the services of Case Management and Extended Personal Care, update language under Homemaker services and Home Delivered Meals, and update reference of the Department of Human Services (DHS) to the Department of Health and Human Services (DHHS).

Proposed changes to this waiver:

Implement changes in services and programming approved during the 2023 legislative session; 

• Waiver Personal Care – Add the new service of Personal Care to allow for individuals requiring intermittent personal cares and/or supervision with personal care tasks.
• Family Personal Care - Update rate methodology for the rate to be calculated by the number of hours the provider works per day, up to the maximum of 10 hours per day.
• Adult Foster Care- Update the rate methodology to a flat rate of $150 a day, to be comparable to other similar services.
•  Residential Habilitation- Allow a personal assistance retainer payment for reimbursement during a participant’s temporary absence from the setting. The personal assistance retainer allows for continued payment while a participant is hospitalized or otherwise away from the setting in order to ensure stability and continuity of staffing up to thirty calendar days per year per participant.  
• Community Supports- Allow a personal assistance retainer payment for reimbursement during a participant’s temporary absence from the setting. The personal assistance retainer allows for continued payment while a participant is hospitalized or otherwise away from the setting in order to ensure stability and continuity of staffing up to thirty calendar days per year per participant.  
• Case Management; Virtual Supports 
• Extended Personal Care Service; Virtual Supports
• Home Delivered Meals- change “This service is limited to no more than 7 meals per week.” to “This service is limited to no more than 2 hot or frozen meals per day.”
• Homemaker to strike “this amount allows for approximately 12 hours of service per month at the highest provider rate allowed.”
• Updated the frequency of verification in Appendix C: Frequency of Verification for Providers.

Language changes for internal processes.

• Update language throughout the waiver for the merging of ND Department of Health and ND Department of Human Services (DHS) to the Department of Health and Human Services (DHHS) 
• Electronic signatures - Appendix D-D1-d: added electronic signatures statement, electronic signatures are permitted based on State policy.

The draft HCBS waiver amendment document is online at https://www.hhs.nd.gov/sites/www/files/documents/DHS%20Legacy/draft-app… can be found on the Medicaid waivers webpage. A copy will be provided upon request. 

Comments will be accepted from Aug. 28, 2023, until 5 p.m. CT on Sept. 26, 2023.

Comments will be accepted in the following ways:

Email:         dhshcbs@nd.gov 

Phone:     (855) 462-5465 or 711 (TTY) (text telephone) 

Fax:        (701) 328-8744

Mail: North Dakota Department of Health and Human Services
        Attn:  Adult and Aging Services Section/HCBS
        1237 W. Divide Ave. Suite 6
        Bismarck, ND 58501

Date Posted: Aug. 28, 2023