COVID-19 Resources

COVID-19

The United States is currently experiencing a major coronavirus (COVID-19) outbreak. Older adults and people who may be immunocompromised face the highest risk of experiencing severe complications from the virus. As stakeholders in self-direction, protecting the health and safety of the participants we serve is paramount. Applied Self-Direction is maintaining close contact with federal agencies regarding emergency preparedness in self-direction and will continue to share information as it becomes available.

Appendix K Tracker

In response to the COVID-19 pandemic, states can apply for an Appendix K to request a temporary amendment to their 1915(c) waivers, and in some cases, their Section 1115 Demonstrations. Applied Self-Direction has created an Appendix K Tracker that lists each waiver and any self-direction elements included in their respective approved Appendix K. This document will be updated regularly as the Centers for Medicare & Medicaid Services (CMS) continues to approve Appendix Ks and Appendix K amendments.

Case Studies

Massachusetts’ Self-Direction Program Response to COVD-19: During an August 2020 State Program Member Open Forum with Applied Self-Direction, Liz Sandblom from The Massachusetts Department of Developmental Services (DDS) shared MA's self-direction program response to COVID-19. This resource summarizes DDS' experience as well as the benefits of self-direction during the pandemic.

New Hampshire Case Study: Self-Direction during COVID-19: In collaboration with Granite State Independent Living, Applied Self-Direction created a case study to better understand how individuals who self-direct are faring during the COVID-19 pandemic. When we compared self-directing individuals who are over 80 years old and nursing home eligible to individuals in long-term care facilities, we found that 0% of the COVID-19 deaths in New Hampshire are individuals self-directing compared to 82% of COVID-19 deaths in long-term care facilities.

Washington's Self-Direction Program Response to COVID-19: During an August 2020 State Program Member Open Forum with Applied Self-Direction, Alec Graham from The Washington State Department of Social and Health Services shared Washington's self-direction program response to COVID-19. This resource summarizes Washington's experience as well as the program changes they made to promote safety during the COVID-19 pandemic.

Electronic Signatures

During this time when many states expect more people to use self-direction to have their emergency needs met, when face-to-face meetings should not occur, and when mail may be impacted, it is imperative that all employer enrollment forms in self-direction be able to be signed electronically. We are working with the Internal Revenue Service (IRS) to get at least temporary permission for IRS Form 2678, Employer Appointment of Agent to be able to be signed electronically so that remote enrollments can occur. All other Federal employer enrollment tax forms already allow electronic signature.

We recommend electronically signing IRS Form 2678, Employer Appointment of Agent during this crisis. While we typically do not advise activities not outlined in Form instructions, we are working aggressively to get approval for electronic signature. Furthermore, if such approval is never granted, IRS Form 2678 could be physically signed later. Each F/EA should exercise their own judgment on this matter, but we think that given the facts of this crisis and weighing the possible impacts, it is prudent to electronically sign IRS Form 2678 until further notice

Electronic Visit Verification (EVV)

Due to COVID-19, it may be increasingly difficult for many states to implement electronic visit verification (EVV) for Medicaid personal care services by January 1, 2020 and avoid penalties. Federal legislation is needed to extend the deadline, but some states are delaying other interim EVV deadlines in the meantime. Applied Self-Direction created an EVV and COVID-19 Implementation Changes Tracker to note state adjustments to EVV deadlines.

ADvancing States, The National Association of Medicaid Directors (NAMD), the National Association of State Directors of Developmental Disabilities Services (NASDDDS) have requested a delay in the deadline for implementing Electronic Visit Verification (EVV) requirements that were included in the 21st Century Cures Act from Congress. See their letter here.

Employers Temporarily Serving as Paid Caregivers

In response to COVID-19, some states are temporarily allowing employers who are not the care recipient to also be a paid caregiver. Adjusting program rules to allow responsible parties, such as employers in self-direction, to also be paid caregivers is a temporary response to COVID-19. States will not maintain these responses beyond the periods authorized in their 1135 waivers or Appendix K documents.

Applied Self-Direction created FAQ on Employers Temporarily Serving as Paid Caregivers for members. The measures outlined in this document should be considered temporary and only be used in response to COVID-19. The suggestions in this document are unique and temporary solutions for what is expected to be a temporary set of issues.

“Essential Worker” Identification Badge and Letter

Given the number of states issuing Shelter-in-Place orders requiring non-essential workers to stay at home during the coronavirus outbreak, we created a template identification badge and letter for Financial Management Services (FMS) organizations to customize for the direct care workers in their program.

Expanding Self-Direction in Response to COVID-19

In response to the current coronavirus crisis, the Centers for Medicare and Medicaid Services (CMS) is currently encouraging states to expand or adopt self-direction in its Appendix K: Emergency Preparedness and Response Instructions for 1915(c) waivers. Applied Self-Directed created the resource, Why States Should Expand Self-Direction in Response to COVID-19 to highlight some of the key reasons self-direction is an especially useful option during this emergency including limiting exposure to COVID-19 while maintaining services at home, supporting continuity of services despite workforce shortages, and allowing for the purchase of goods and services to meet unmet emergency needs.

Families First Coronavirus Response Act - H.R. 6201

On March 18, 2020, the President signed into law the Families First Coronavirus Response Act. Section 6008 provides a temporary 6.2% increase to each qualifying state and territory’s 1 Federal Medical Assistance Percentage (FMAP) under section 1905(b) of the Social Security Act effective beginning January 1, 2020 and extending through the last day of the calendar quarter in which the public health emergency for COVID-19, including any extensions, terminates. You can view the Increased FMAP FAQs online.

The Department of Labor released their Families First Coronavirus Response Act: Questions and Answers.

Have questions on the FFCRA Notice Poster (Spanish version)? See some helpful questions and answers from the Department of Labor here.

FFCRA: Guide to Reporting FFCRA on Form 941 and Schedule R

Applied Self-Direction developed a guide for Fiscal/Employer Agents for how to report FFCRA payments and claim tax credits on the new IRS Form 941 and Schedule R. The guide was written using the current draft versions of both Form 941 and Schedule R as a reference.

FFCRA Self-Direction Question & Answer

Applied Self-Direction created a living Q&A document for questions and answers related to FFCRA. This document will be updated regularly. If members send questions to membership@appliedselfdirection.com about FFCRA, we will anonymize the questions and then post the questions and answers in this document.

Form I-9 Compliance

Physical presence requirements for supporting documents for Form I-9 are deferred until this crisis is passed. This means that while an employer or authorized representative should still review pictures or copies of forms, reviewing actual forms is not required until the crisis has passed. Additionally, Fiscal/Employer Agents (F/EAs) may choose to ask participant employers to make staff of the F/EA their authorized representative to complete Section 2 of the Form I-9. If an F/EA does this, the F/EA and employee can complete a Form I-9 for a participant to hire a new employee. No forms are required to document that a participant employer has authorized the F/EA as an authorized representative. You may list it on other documents the participant employer executes with you if you choose and we recommend doing that.

Measures and Strategies for Self-Direction in Response to COVID-19

Applied Self-Direction has been working closely with our members in states, Managed Care Organizations (MCOs), and Financial Management Services (FMS) organizations as they respond to COVID-19. The Measures and Strategies for Self-Direction in Response to COVID-19 resource lists our members’ reported measures and strategies for self-direction programs.

Program Design Changes During the COVID-19 Response

One of the many challenges associated with the coronavirus is that direct care may not be able to be provided as it normally is. Applied Self-Direction created the Program Design Changes During the COVID-19 Response resource for programs considering program design changes in response to the COVID-19 outbreak. The document discusses program flexibilities to consider, Appendix K: Emergency Preparedness and Response to modify a 1915(c) waiver, Section 1135 Waiver Requests, 1115 demonstrations for experimental or pilot programs, and Medicaid State Plan Amendments to modify existing Medicaid State Plan services.

CMS posts the approved 1135 Waiver Flexibilities and Appendix K: Emergency Preparedness and Response for Home and Community Based (HCBS) 1915(c) Waivers on their website.

Provider Relief Fund

The deadline for submitting applications for the next round of Provider Relief funding, General Distribution Phase 2, is Friday, August 28, 2020. This round of funding was previously called the Medicaid Targeted Distribution, but was expanded to include additional populations.

While Health and Human Services (HHS) cannot and will not answer questions about applications and the guidance is ambiguous in parts for Financial Management Services entities, ASD created the resource, Provider Relief Fund Self-Direction Q&A, with our advice based on our understanding of the HHS published guidance. Please remember that nothing contained herein is legal advice.

The Provider Relief Fund Overview of Application Process resource provides an overview of the application process with information directly from the HHS website and ASD interpretations specific to the nuances of the F/EA application and associated tax forms.

Stories from Home

Applied Self-Direction is highlighting stories of individuals and families who are self-directing at home during the pandemic. Please email info@appliedselfdirection.com if you have a story to share.

Kevin's Story

Tyler's Story

Webinars

Taxability of FFCRA for FUTA and SUTA: On May 26th Applied Self-Direction hosted a member webinar on the taxability of Families First Coronavirus Response Act (FFCRA) wages for Federal and State unemployment purposes (FUTA and SUTA). The slides are available as a member-only resource.

Membership Open Forum on Coronavirus Response: On April 29, 2020, Applied Self-Direction hosted an Open Forum on COVID-19 responses for our Program, FMS, and MCO members. During the forum, we polled our members on a number of FFCRA topics. The poll results are available as a member-only resource.

Paid Emergency Sick and Paid FMLA for Self-Direction: In early April 2020, Applied Self-Direction held a two-part member webinar on Paid Emergency Sick and Paid Family and Medical Leave Act (FMLA) for Self-Direction in the Families First Coronavirus Response Act (FFCRA). The slides are available as a member-only resource.

FMS Membership Open Forum on Coronavirus Response: On March 24, 2020, Applied Self-Direction held an open forum for FMS Members to discuss self-direction program and FMS member responses to the coronavirus. Forum slides are available online.

State Program Membership Open Forum on Coronavirus Response: On March 23, 2020, Applied Self-Direction held an open forum for State Program Members to discuss self-direction program responses to the coronavirus. Forum slides are available online.

Additional Resources

ANCOR's COVID-19 Resource Center: share tips and resources that may be of use to ANCOR members and others.

ANCOR's State COVID-19 Tracker: This webpage shares examples of what state developmental disabilities agencies, departments of health and state agencies are doing and the guidance they are issuing in response to the spread of COVID-19.

COVID-19 Emergency Declaration Health Care Providers Fact Sheet: The Centers for Medicare and Medicaid Services (CMS) issued a COVID-19 Emergency Declaration Health Care Providers Fact Sheet. This fact sheet should prove helpful to our members as they navigate the challenges of the Coronavirus.

COVID-19 and the Fair Labor Standards Act Questions and Answers: The Department of Labor released reminder guidance for employers related to Fair Labor Standards Act (FLSA) obligations during the COVID-19 outbreak. In short, workers in self-direction who are paid on an hourly or otherwise non-salaried basis are not required to be paid under the FLSA when they are unable to work due to illness. Only hours worked by these employees must be paid under the FLSA.

COVID-19 and the Family and Medical Leave Act Questions and Answers: The Department of Labor prepared a short FAQ about COVID-19 and employers' FMLA obligations. For programs that use Agency with Choice FMS, the Agency with Choice FMS entity is usually covered under the Family and Medical Leave Act (FMLA).

Disaster Preparedness Toolkit: If you are considering program design changes in response to the COVID-19 outbreak, the Medicaid and CHIP Coverage Learning Collaborative Disaster Preparedness Toolkit for State Medicaid Agencies may be a helpful resource.

Disaster Response Toolkit: To help Medicaid agencies prepare for such disasters in the future, CMS developed the Disaster Response Toolkit on the strategies available to support Medicaid operations and enrollees in times of crisis.

Frequently Asked Questions for State Medicaid Agencies: CMS released FAQs for State Medicaid Agencies related to the COVID-19 outbreak. This resource responds to common state questions regarding the scope and limits of the many potential flexibilities available to state agencies who are preparing for and dealing with emergencies, including flexibilities related to Medicaid benefits, financing, cost sharing, workforce, and other topics.

Medicaid Emergency Authority Tracker: Approved State Actions to Address COVID-19: The Kaiser Family Foundation webpage aggregates tracking information on approved Medicaid emergency authorities to address the COVID-19 Coronavirus emergency.

State Data and Policy Actions to Address Coronavirus: The Kaiser Family Foundation's data tool provides state-level information related to the actions states have taken to mitigate the spread of the coronavirus and reduce barriers to testing and treatment for those affected.