The coronavirus (COVID-19) state of emergency has brought many changes in everyone's daily lives, including new challenges and difficult decisions. People's health and well-being have been the focus when deciding how to best respond during the state of emergency.
One difficult decision was the announcement and implementation of Governor Mike DeWine and Dr. Amy Acton’s Stay-at-Home Order in order to minimize the spread of COVID-19 and ensure as many people as possible could stay healthy. Although this has been a difficult time, the order to stay home has been beneficial in minimizing the spread of COVID-19.
Because of the stay-at-home order in conjunction with the Ohio Department of Health (ODH) order to limit adult day service locations to fewer than 10 people, many people who once attended an adult day service now spend their entire day at home. This has changed the daily lives of many Ohioans with developmental disabilities.
The Ohio Department of Developmental Disabilities (DODD) strongly encourages providers of the array of services typically delivered in congregate settings during the day or in employment settings with multiple people to do all that is possible to continue to support people, in person, within their residence through the various adult day services and/or the Homemaker/Personal Care (HPC) service.
In guidance issued March 13, Adult Day and Vocational Habilitation providers have been authorized to deliver Adult Day and Vocational Habilitation services in any home and community-based services (HCBS) residential setting and have also been provided additional options for providing HPC.
Temporary ADS Changes
Supporting a person directly in their home or residential setting remains a top priority for DODD and is the preferred method of service delivery during this state of emergency. However, it is acknowledged that this may not always be possible for everyone. Most services within the adult day array already permit services to be delivered in ways other than in-person for specified situations. For example, the Vocational Habilitation service allows for monitoring and counseling to be delivered through contact over the telephone.
In Ohio, Adult Day Support (ADS) has only allowed for services to be delivered in-person and does not allow for those services to be provided in the home of the person with disabilities. Therefore, DODD is seeking approval from the Centers for Medicare and Medicaid Services (CMS) to temporarily modify the service definition of ADS within its home and community-based services (HCBS) waivers in three specific ways:
- Include the delivery of ADS services in the home of a person with disabilities,
- include the delivery of ADS services on behalf of a person with disabilities,
- and include the delivery of services through technological means, such as by phone or other electronic options.
These changes permit ADS services to be delivered in locations other than the physical adult day centers and to support people by offering ADS services on behalf of the person, such as picking up and delivering groceries or medication for people who might need assistance in those areas. It also allows for ADS services to be delivered through electronic means in situations where there are no direct support services needed at home during the day or the needed ADS services cannot be delivered in-person in the home of the person.
ADS provided through technology, or virtual ADS, is not the same service as in-person, on-site ADS, as there is no provision for it in the permanent definition of ADS. Any authorization for virtual ADS requires a determination that the person has a need for and would benefit from ADS delivered through technology. The person’s team will evaluate if the service is needed and at what frequency and duration. The team also must consider whether the person has the proper equipment and is comfortable and capable to participate in the service using technology. If the need for virtual ADS is identified by the team, a new authorization in the Individual Service Plan (ISP) must be completed and can be authorized by electronic means.
Virtual ADS can be authorized for specific units of time when a person is actively participating and interacting with the provider and it will rarely result in a full-day rate. Virtual ADS is not a primary service and cannot be delivered at the same time as HPC services or other direct support services, but it is an additional support option during the day when there is no direct, in-person support service that can be provided.
Providers should continue documenting supports as required by rule and may need to alter or add elements when services are delivered on behalf of the person or using technology. Documentation for services delivered through technology must include verification of the length of time the participant was logged into the activity, such as time in and time out, as well as the content of the activity or the support delivered.
DODD acknowledges that these temporary changes are a significant deviation from the way ADS services have been traditionally delivered, and the department is taking these steps to continue vital services for people while remaining compliant with the stay-at-home order to help the minimize spread of COVID-19.
Providers can contact the Community Life Engagement Manager in their region for specific guidance on the practical utilization of adult day array services through technology and the possibilities for these services during the state of emergency.
Providers may also learn more from the following guidance.