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AAW

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ODP Announcement 23-027 announces that the Residential Habilitation (Life Sharing) Ineligible Rate will be removed from the Adult Autism Waiver (AAW) effective July 1, 2023. The Office of Developmental Programs (ODP) is continuing to align the AAW with the other ODP waivers. This alignment includes the removal of procedure code W7234. This procedure code will be removed from HCSIS, and providers will be unable to bill this procedure code within PROMISe for dates of service on and after July 1, 2023.

For questions, please contact the appropriate ODP Bureau of Supports for Autism and Special Populations (BSASP) Regional Office.

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ODP Announcement 23-026 announces the release of a new Adult Autism Waiver (AAW) Provider Resource Guide. The guide is available online.

Providers are responsible for compliance with all applicable regulations and requirements of the Office of Developmental Programs (ODP) services, as well as local, state, and federal regulations and laws applicable to the services provided.

The guide is designed as an online-only document with links to pertinent regulations, bulletins, communications, forms, websites, and other materials necessary to support AAW providers in the quality provision of services. The online format will allow ODP to update the guide in a timely manner as needed.

Please contact your ODP Bureau of Supports for Autism and Special Populations (BSASP) regional office with any questions.

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ODP Announcement 23-023 provides a high-level summary of how the notice that the Federal COVID-19 public health emergency (PHE) will end on May 11, 2023 will impact services rendered through the Consolidated, Person/Family-Directed Support (P/FDS), Community Living, and Adult Autism Waivers (AAW).

Two documents that provide a brief description of flexibilities available during the COVID-19 public health emergency, including the date that the flexibilities end, are included as Attachment A (related to the Consolidated, P/FDS, and Community Living Waivers) and Attachment B (related to the AAW). Additional guidance regarding how to return to regular operations (requirements in the current waivers and policies) once each flexibility ends will be published in the future. Questions about this communication should be directed to the appropriate ODP Regional Office.

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ODP Announcement 23-012 shares an updated AAW Provider Information Table to reflect changes made with the January 1, 2023, waiver amendment. This information includes waiver language, guidance, and provider qualifications. The requirements in the AAW will become effective when Appendix K flexibilities expire, six months after the expiration of the federal COVID-19 public health emergency.

The updated Provider Information Table includes these highlights:

  • Providing information on the delivery of direct services using remote technology (teleservices);
  • Introducing the AAW Travel Policy;
  • Introducing Remote Services, a new service in the AAW;
  • Adding waiver language and guidance on relatives providing the Life Sharing component of Residential Habilitation;
  • Providing clarification on the requirements for Supports Coordinators and in-person monitoring;
  • Noting the responsibility of Residential Habilitation providers to complete and update the Health Risk Screening Tool (HRST) for the individuals they serve;
  • Including the Place of Service codes and Electronic Visit Verification information for each service definition;
  • Adding other changes designed to align the AAW, where practical, more closely with the Consolidated, Person/Family Directed Support and Community Living waivers; and
  • Expanding sections on provider qualifications for each service.

Providers are reminded that they are responsible for being aware of any changes to definitions of services they provide and ensuring that individuals who furnish direct services are fully qualified prior to providing services to AAW participants. Questions or comments about this communication should be addressed to Tom Flynn.

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The Office of Development Programs held a webinar to provide an overview of the Adult Autism Waiver Amendment that went into effect January 1, 2023. The session was recorded and will be available for viewing in the near future.  Many of the changes will go into effect six months after the Public Health Emergency and Appendix K flexibilities end. The slides from the session provide clarification regarding Remote Supports, Teleservices and Assistive Technology.

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ODP Announcement 23-008 announces that the amendment to the Adult Autism Waiver (AAW), effective January 1, 2023, was approved by the Centers for Medicare & Medicaid Services (CMS) on January 13, 2023. The amendment to the AAW includes the following substantive changes:

  • Adding reserved waiver capacity for individuals who are discharged from a state center or are released from incarceration after a period of at least six consecutive months.
  • Aligning of provider qualifications in the AAW with the Consolidated, Community Living, and Person/Family Directed Support (P/FDS) waivers, whenever possible.
  • Allowing relatives to deliver the Life Sharing component of the Residential Habilitation service.
  • Requiring that agencies that provide Residential Habilitation/Life Sharing be qualified and enrolled to provide Residential Habilitation/Life Sharing in the Consolidated or Community Living waivers.
  • Increasing the annual fiscal limit in the Transportation service to $5,000 per participant’s Individual Support Plan (ISP) year.
  • Allowing one of the four required individual monitorings conducted by the Supports Coordinator each year to be conducted remotely. NOTE: For all individuals receiving Residential Habilitation (Community Homes or Life Sharing), remote monitorings are not permitted. See ODP Announcement 22-085 for additional information.
  • Allowing delivery of direct services using remote technology (teleservices). The requirements in the AAW will become effective when Appendix K flexibilities expire, six months after the expiration of the federal COVID-19 public health emergency.
  • Aligning the Assistive Technology service, where possible, with the Consolidated, Community Living, and P/FDS waivers. This includes adding generators for the participant’s primary residence.
  • Adding a new service, Remote Supports. A separate communication will be published in the coming weeks, providing instructions about how to add new Remote Supports procedure codes to ISPs. Remote Supports should not be added to ISPs until this communication is published.

The waiver application approved by CMS and the record of change document are available here.

ODP will be holding a webinar to discuss major changes made in the approved AAW amendment. Webinars specific to Remote Supports will be scheduled and communicated in the coming weeks. The date, time, and registration link for the general AAW amendment webinar are as follows:

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ODP Announcement 22-103 serves to inform Adult Autism Waiver (AAW) providers that there are specific regulations regarding restrictive procedures that must be followed. The Office of Developmental Programs (ODP) has been made aware that some AAW providers are implementing restrictive procedure plans for individuals being served in AAW without a corresponding BSP documented in the ISP in HCSIS. This practice is not allowed.

A restrictive procedure must always be part of the behavioral support component of the ISP as required by the AAW. In the AAW, the BSP is included in the ISP in HCSIS. The Desired Behavioral Outcomes (DBOs) of the BSP must be consistent with the Behavior Support Specialist service goals and objectives.

There must be an active Behavior Support Specialist goal for each DBO, and each Behavior Support Specialist goal must have a DBO. Additionally, every Behavior Support Specialist goal must have a corresponding Goal Attainment Scale (GAS) chart and be reported on at least quarterly in a Quarterly Progress Note (QPN).

To have a restrictive procedure plan in place for an AAW participant, the Behavior Support Specialist service must be in the ISP Service Details so that a BS qualified to provide services in the AAW can develop, implement, and train staff on the participant’s BSP and CIP with the goal of fading all restrictive procedures over time.

In the AAW, the Behavioral Specialist Service (BSS) is not bundled with the Residential Habilitation service as it is with other ODP waivers. Therefore, to meet the requirements above, AAW participants who are receiving residential habilitation services and have a restrictive procedure plan in place must also have active BSS authorized in their ISP. This ensures an AAW qualified BS is working with the participant when a restrictive procedure plan is in place.

Please refer to Chapter 6100 regulations § 6100.341 – 6100.346, Bulletin 00-21-01 Guidance for Human Rights Teams and Human Rights Committees and Attachment 2 — Individual Plans and Informed Consent for additional information. Any questions should be sent to the AAW Provider Support Inbox.

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ODP Announcement 22-085 announces clarification for Supports Coordination Organizations (SCO) on resuming Waiver and Targeted Support Management (TSM) Supports Coordination (SC) in-person monitoring. Many adjustments have been made to the Office of Developmental Programs (ODP) policy and operations during the COVID-19 pandemic. Appendix K allowed for SC services to be provided remotely during the pandemic. ODP planned to replace the Appendix K guidance with new requirements detailed in the Intellectual Disability and Autism (ID/A) Waiver renewals and the Adult Autism Waiver (AAW) amendment effective July 1, 2022, to allow for some SC individual monitoring to continue to be completed remotely.

Both the ID/A Waiver renewals and the AAW amendment are pending approval with the Centers for Medicare and Medicaid (CMS). Therefore, ODP is issuing guidance to clarify the expected requirements of individual monitorings performed by SCs. This announcement outlines the updated requirements for SC in-person and remote monitoring and obsoletes that section of Appendix K.

ODP expects SCOs that were unable to meet the June 30 deadline for completing the in-person monitoring for at-risk individuals to continue to follow their plan and communicate with the ODP regional office to ensure that all the priority individuals are seen in-person.

This announcement outlines requirements for SCOs to implement no later than October 1. For additional questions, please contact your appropriate ODP regional office.

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ODP Announcement 22-059 informs readers that the Office of Developmental Programs (ODP) is pleased to announce that an amendment to the AAW was submitted to CMS on May 9, 2022. The submitted AAW includes modifications that were made as a result of public comment. The AAW amendment includes the following substantive changes:

  • Adding reserved waiver capacity for individuals who are discharged from a state center. Reserved waiver capacity is also being added for participants who have been incarcerated for more than six consecutive months;
  • Aligning provider qualifications in the AAW with the Consolidated, Community Living, and Person/Family Directed Support (P/FDS) waivers, whenever possible;
  • Allowing relatives to deliver the Life Sharing component of the Residential Habilitation service;
  • Requiring that agencies that provide Residential Habilitation/Life Sharing must be qualified and enrolled to provide Residential Habilitation/Life Sharing in the Consolidated or Community Living waivers;
  • Increasing the annual fiscal limit in the transportation service to $5,000 per participant’s ISP year;
  • Allowing one of the four required monitoring conducted by the Supports Coordinator each year to be conducted remotely;
  • Adding a new service, Remote Supports; and
  • Delivering direct services using remote technology.

The requirements in the AAW will become effective when Appendix K flexibilities expire, six months after the expiration of the federal COVID-19 public health emergency.

Please note that aligning the Assistive Technology service, where possible, with the Consolidated, Community Living, and P/FDS waivers includes adding generators for the participant’s primary residence.

The full AAW application, as well as a record of substantive changes, is available here.

CMS has 90 days to review the amendment, and changes may occur to the content based upon discussion with CMS during the approval process. The proposed effective date of July 1, 2022, is also subject to change. ODP will inform all stakeholders when CMS has officially approved the AAW and will make the approved waiver available at that time.

Questions about this communication should be directed via email.

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