STATE OF HAWAII
DEPARTMENT OF HUMAN SERVICES
MED-QUEST DIVISION

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 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

This waiver amendment includes the following additions and revisions:
Rates for services were increased to fully implement the 2020 rate study and the minimum wage law. The Individual Supports Budgets were updated in Appendix C to correspond with the rate increases. The cost estimates for waiver services were updated in Appendix J for waiver years 3-5 to correspond with the increases in service rates.
Telehealth was added to Discovery & Career Planning in Appendix C and the annual level-of-care redetermination interviews in Appendix B.
For services provided out-of-state to the participant, the limit of one staff providing supports was removed. Community Learning Services was expanded in Appendix C that may be provided out-of-state.
Respite was revised in Appendix C to include support provided in community settings.
Training and Consultation clarified in Appendix C who may receive the service to include participants, families, caregivers, support staff, and service supervisors. Training for Vehicle Modifications was removed because it is included in the Vehicle Modification service.
Vehicle Modification expanded who may provide functional needs assessments in Appendix C to include clinicians working within the scope of their license.
Waiver Emergency Services removed the minimum of 50% face-to-face interaction and replaced it with face-to-face interaction for a portion of the interaction during Crisis Mobile Outreach. Provider qualifications were changed to a minimum of a high school diploma or equivalent and one (1) year of experience from a minimum of bachelor’s degree and one and a half (1.5) years of experience. The changes are in Appendix C.
A general change was made to services in Appendix C to clarify the provision of nursing for the purpose of developing, overseeing, training, and documenting plans for nurse delegated tasks performed during delivery of the service, as needed:
o Nursing is included in Adult Day Health (ADH) and Residential Habilitation (ResHab), as well as in provider-delivered Community Learning Services (CLS), Personal Assistance/Habilitation (PAB), and Respite.
o Nursing is provided through Training & Consultation as a separate service for Community Navigator, Discovery & Career Planning (DCP), and Individual Employment Supports (IES), as well as Consumer- Directed CLS, PAB, and Respite.
The process for provision of waiver services on an emergency basis was described in Appendix D. Emergency basis was defined as situations where additional service is needed to address a participant’s immediate health and safety needs, hospitalization, or imminent risk of more restrictive placement.
Provider monitoring was expanded in Appendix G to include remote reviews in addition to in-person reviews.
The process for fiscal accountability of Electronic Visit Verification (EVV) was added. Edits were made through Appendix I to update information about the 2020 rate study, describe cost settlement interim rates for Waiver Emergency Services, clarify processes and improve readability. The changes are in Appendix I.

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 July 17, 2023. Individuals may submit written comments using the following methods:

By email: doh.dddcrb@doh.hawaii.gov (Please identify in the subject line: Waiver Amendment)

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
(TGI1417840 6/5/23)