COVID-19 Update
March 28, 2020

Section 1135 Waiver Flexibilities & Appendix K Waiver Status
On March 26, the Centers for Medicare & Medicaid (CMS) approved some components of New York's 1135 Waiver request. CMS's approval letter to New York State can be viewed here. The waivers expand access to health care items and services. The Office for People With Developmental Disabilities (OPWDD) and the New York State Department of Health (DOH) are inquiring with CMS regarding the remaining components of the 1135 waiver. OPWDD expects that approval of the remaining components will occur soon.  Some of the approvals granted to New York state include:
  • suspension of Medicaid fee-for-service prior authorization requirements;
  • extension of preexisting authorizations through the end of the public health emergency;
  • allowance for New York state to enroll providers who are enrolled with another State Medicaid Agency (SMA) or Medicare; and
  • allowance of Intermediate Care Facilities for Individuals with Intellectual and Developmental Disabilities (ICF/IDD) to be fully reimbursed for services rendered at an unlicensed facility (during an emergency evacuation or due to other need to relocate residents, where the placing facility continues to render services).
The approvals within the waiver are effective March 1, 2020 and continue through the public health emergency.  On Monday, OPWDD and CMS will be meeting to further discuss the status of the Appendix K and 1135 waivers (and soon a 1115-waiver). OPWDD aims to extend the current retainer day provisions through April 17. OPWDD is also working on a "COVID Response Services" proposal that would carry provisions for ongoing funding beyond the first extension. More information will follow next week.

Retainer Days for Community Habilitation and Respite 
Provider Associations and CCOs were advised by OPWDD that they have accepted our proposal to include retainer days for Community Habilitation and Respite in the Appendix K Waiver request. They indicated the proposal, subject to CMS approval, would provide for retainer days for the period of March 18 - April 17. This retainer day period is intended to give providers time to identify opportunities to redeploy staff, such as to residential programs. More information, including billing guidance, will be provided as it becomes available.
Abbreviated Training for Approved Medication Administration Personnel
OPWDD has released materials for an abbreviated medication training program. This is a temporary certification. At the conclusion of the State of Emergency, all staff who received a temporary certification will need to complete the full training within 120 days. The full training materials can be found below: 
On today's call, OPWDD clarified that providers must continue to observe a newly certified staff's first three medication pours. However, this can be completed via Telehealth modalities. OPWDD will be issuing further guidance on this topic.  Please share this training with your nursing staff and incorporate it into your training program.

Updated Strategies to Optimize the Supply of PPE 
The Centers for Disease Control and Prevention (CDC) updated their guidance on strategies to optimize the supply of personal protective equipment (PPE). Guidance on eye protection, gowns and facemasks has been added. We have received several questions about extended use of PPE and alternative options when facemasks are not available. These questions, and other "Crisis Capacity Strategies" are addressed in the updated guidance. 

Executive Order 202.11
Two important new provisions were added to Governor Cuomo's latest   Executive Order (202.11). The first allows the modification of certified settings upon approval of the Commissioner of OPWDD, to provide greater flexibility with delivering services. The second permits abbreviated training and/or extension of recertification deadlines for direct support professionals employed in certified programs and facilities that are experiencing staff shortages.

School Closure Extended
All schools throughout NYS will remain closed through April 15, per the latest Executive Order. 

Special Education Guidance 
The New York State Education Department (SED) issued a guidance memo on the provision of services to students with disabilities during statewide school closures. 
NYSED reaffirmed the right to a free appropriate public education (FAPE) for individuals with IDD and the responsibility to meet the requirements of the Individuals with Disabilities Education Act (IDEA). 

Updated Essential Business Guidance from EDS 
On March 27, Empire State Development (ESD) published a new guidance for essential businesses. More information can be found here.  

CARES Act: Federal Coronavirus Stimulus 
The Coronavirus Aid, Relief, and Economic Security Act ("CARES Act"), a $2.2 trillion stimulus package designed to mitigate the economic effects of the novel coronavirus (COVID-19), was signed into law on March 27. This package supplements previous legislation, which included paid sick leave.  Some key provisions include:
  • expanded unemployment insurance to cover an additional $600 per week per individual for up to four months, waive waiting weeks, extend federally funded insurance benefits for 13 weeks, and include access for part-time workers; 
  • direct aid in the form of a refundable tax credit rebate of up to $1,200 for individuals and $2,400 for married couples, and an additional $500 per child for qualifying couples;
  • a $350 billion small businesses loan guarantee program, which are forgivable if conditions are met, to keep employees on payroll and cover necessities such as rent and utilities, specific details and guidance will follow;
  • additional education funds, which can be used for various education programs, including IDEA; and
  • Money Follows the Person (MFP) and spousal impoverishment protections are extended through Nov. 30, 2020.
General guidance on the CARES Act for small businesses can be found here

Right to Equal Access to Medical Treatment
The Arc New York has signed on to a national joint position statement on the right to equal access to medical treatment during the COVID-19 pandemic. The statement asserts that individuals with I/DD, including those with significant disabilities, have the following human and civil rights:
  • access to high-quality, appropriate medical treatment;
  • access to timely and accurate information in accessible formats;
  • access to supports to address the individual's unique support needs related to social/emotional, communication, physical, and healthcare aspects; and
  • access to supported decision making and representation during any emergency guardianship or conservatorship proceedings.
Signed copies will be sent to state and national elected leaders, medical associations, health departments, and hospitals.

Free COVID-19 Screening Tool
Apple released a free app to assist the public in determining if they should seek care for COVID-19 symptoms. The tool incorporates the Centers for Disease Control and Prevention (CDC) recommendations on next steps, including guidance on social distancing, isolating, how to closely monitor symptoms, recommendations on testing, and when to contact a medical professional. More information on the tool can be found here.

Furlough vs. Layoff 
In general, a furlough is an unpaid period of leave, whereas a layoff is a termination of employment due to lack of funds or lack of work (or both). Often furloughed employees retain access to benefits during their furlough. An article with helpful information can be found here. We have not been advised of significant furlough plans by Chapters, but please let the State Office know if additional guidance would be helpful. 

This and all related updates will be cataloged on  The Arc New York COVID-19 Resource Page   for future reference. Please contact us if you have questions regarding any of this information.

Josh Christiana , Associate Executive Director for Quality, Compliance & Chapter Relations

This email was sent to:
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