STATE OF HAWAII DEPARTMENT OF HUMAN SERVICES MED-QUEST DIVISION NOTICE FOR A PUBLIC NOTICE In accordance with the public notice requirement of Title 42, Section 441.304 of the Code of Federal Regulations, the State of Hawaii, Department of Human Services and Department of Health (the State), hereby notifies the public that it intends to request from the Centers for Medicare & Medicaid Services (CMS), an amendment to the Home and Community Based Services (HCBS) Waiver for Individuals with Intellectual and Developmental Disabilities (I/DD Waiver) authorized in Section 1915(c) of the Social Security Act. PURPOSE The purpose of this posting is to provide public notice and elicit public input regarding the renewal and proposed amendments to its current 1915(c) HCBS I/DD Waiver that serves individuals with developmental disabilities or intellectual disabilities who meet institutional level of care, and choose to live in their own home or in the community with appropriate and quality supports designed to promote health, safety and independence. OVERVIEW OF PROPOSED AMENDMENTS 1. Expand service description for Community Learning Service-Individual (CLS-I) to: a. Broaden definition and expand the ways the service can be used to better reflect the variety of supports provided in the community including outings and personal assistance in the community; b. Reinforce CLS-I in work settings; and c. Provide flexibility to support ongoing assistance for community engagement when needed and expectation of fading will be removed. 2. Expand service description for Training and Consultation (T&C) to: a. Include telehealth as a modality for service delivery; and b. Allow for concurrent billing for professional and paraprofessional. 3. Add a new service, Community Navigator, to support participants to navigate their community by linking or connecting participants to natural supports and building relationships in the community (e.g., volunteer opportunities, sports teams, clubs, etc.). 4. Revise service limitations related to Individual Supports Budget to remove limitations on Adult Day Health (ADH) and CLS-Group. 5. Revise service limitation related to Individual Employment Services to increase hours available for Job Development to 80 hours per plan year; remove the limit of three (3) months. 6. Revise payment rates and related items to include: a. Establish new rate methodology for Community Navigator service; and b. Establish rates for Community Learning Services at 1:2 and 1:3 ratios. 7. Include telehealth as an option for participants to choose for activities as a way to conduct the annual re-evaluation of level of care, Individual Service Plan (ISP), and monitoring by the case manager based on the participant’s individual circumstances and preferences. 8. General Updates to: a. Language throughout to clarify, remove outdated information and correct grammar; b. Information on Hawaii’s My Choice My Way transition plan for the CMS home and community-based settings final rule; c. Enhance specific performance measures for the Quality Improvement Strategy; d. Waiver services – Appendix C Qualified Providers; i. Add staff qualifications to all applicable service definitions in accordance with new CMS requirements. ii. Expand provider qualifications for Environmental Accessibility Adaptations to include both “B” Licensed General Contractor and “C” Licensed Specialty Contractor. iii. Change title of service from Vehicular Modifications to Vehicle Modifications; iv. Include statutory language to Criminal Background Check requirements to specify the types of offenses. e. Clarify inclusion of staff training requirements by consumer-directed employers for their workers in Appendix D Service Plan and Appendix E Participant Direction; and f. Information in Appendix I Financial Accountability. i. Remove requirement for independent audits by individual providers. ii. Add language related to independent audits performed by the State of Hawaii Office of the Auditor. PUBLIC COMMENT SUBMISSION PROCESS As required by 42 C.F.R. 441.304, the State must establish and use a public input process for any changes in services or operation of the waiver. The opportunity for public comment shall be held open for a minimum of 30 days prior to implementation of the proposed change or submission of the proposed change to CMS, whichever comes first. Comments will be accepted for consideration from the date when this notice is published through January 10, 2021. Individuals may submit written comments using the following methods: By email: doh.dddcrb@doh.hawaii.gov (Please identify in the subject line: Waiver Amendment) By mail: Department of Health, Developmental Disabilities Division Attention: Community Resources Branch 3627 Kilauea Avenue, Room 411 Honolulu, Hawaii 96816 A copy of the 1915(c) I/DD Waiver is available online at: https://medquest.hawaii.gov/en.html under Featured News and https://health.hawaii.gov/ddd/ for public viewing from the first working day the public notice appears in the Honolulu Star-Advertiser, Hawaii Tribune Herald, West Hawaii Today, The Maui News, and The Garden Island. A printed copy of the waiver application and special accommodations (i.e., interpreter, large print or taped materials) can be arranged if requested by contacting the DDD Community Resources Branch at (808) 733-2135 no later than seven (7) working days before the comment period ends. DEPARTMENT OF HUMAN SERVICES, MED-QUEST DIVISION JUDY MOHR PETERSON, PhD MED-QUEST DIVISION ADMINISTRATOR (HTH1304687 11/30/20)