COVID-19 Frequently Asked Questions

1. What kind of additional guidance/communication can we expect from DDD/AHCCCS? 
   AHCCCS is updating its guidance daily on its FAQ page and DDD has  published a webpage that includes these FAQs as well as other vendor announcements related to COVID-19. This webpage will be updated as new information becomes available.
    
2. What is the process for notifying DDD of changes to service delivery or service location?
   Please refer to the Pandemic Performance Plan Service Delivery Changes  vendor announcement sent on March 12, 2020.
    
3. What is the expected turnaround time for DDD staff to approve a request for a change in service delivery for a specific member or a change in service location when the request is sent to the [email protected] email as directed in DDD’s March 12, 2020, vendor announcement?
   We apologize for the delays providers have experienced in receiving responses.  You can expect to receive a response within 24-hours.
    
4. What is the new process for Support Coordination planning meetings?
   Please refer to the COVID-19 Update vendor announcement sent out on March 17, 2020.
    
5. Can fact finding deadlines be extended?
   All fact finding deadlines were extended by two weeks, effective March 20, 2020. The Quality Management team at DES DDD is aware of the impact COVID 19 may have on Vendor’s available staff for fact finding. The DDD QMU will evaluate each request for fact finding and will provide vendors extended timelines where appropriate.
    
6. Is there guidance on postponing and/or rescheduling non-emergency follow up appointments and wellness visits for the time being to avoid exposing individuals to sick people who may have the virus?  What documentation is needed for monitoring?  Health care providers are already proactively canceling appointments. Is this all that needs to be noted?
   Following a CMS recommendation, Governor Doug Ducey announced an Executive Order on March 19, 2020, that halts all elective surgeries in the state of Arizona in order to free up medical resources and maintain the capacity for hospitals and providers to continue offering vital services. Consult with the treating practitioner about the need for the non- emergency appointment. Document results in your records. Document provider cancellations in your records.
    
7. If a member needs additional services or supports, can DDD respond quickly by approving additional services or supports? What if an individual cannot go to their day program, will DDD authorize attendant care or respite services they do not already have in their ISP so the member can receive services in the home? (Updated April 8, 2020)
   The Support Coordinator can assist with reassessment of a member’s needs at any time. Additionally, DDD has authorized Day Treatment services to be authorized in the home.  Please see 'Day Treatment Programs' section at the bottom of the FAQ for more information about the alternate service delivery option. 
    
8. Can DDD members temporarily increase their home-based service hours as other services are being suspended or canceled and schools are closed?
   The Support Coordinator can assist with reassessment of a member’s needs at any time.
    
9. What measures has DDD taken in relation to monitoring and licensing requirements? (Updated May 5, 2020)
   Effective March 17, 2020, DDD has suspended on site monitoring. In lieu of on site monitoring, DDD will not complete routine desk audits unelss there are specific performance concerns identified. DDD will maintain investigative efforts for serious health and safety threats (e.g. allegations of abuse).

   Also effective March 17, 2020, DDD-OLCR has suspended the following types of life safety inspections until further notice: 

   • Renewal of developmental home license inspections, OLCR will utilize the most recent quarterly inspection completed by the licensing worker. 
   • Renewal inspections for HCBS certified settings such as: Respite homes, Day programs, Group supported employment (with service sites), Therapy service sites

OLCR will continue to conduct inspections for the following: 

• Initial developmental home license applications and initial HCBS certified settings 
• Developmental home relocation amendments 
• Child developmental certified home applications

Qualified Vendor’s licensing workers may conduct required monthly monitoring visits outlined in the Division’s Policy Manual Chapter 51 Oversight and Monitoring of Developmental Home Services via telephone until further notice.

10. What is happening with Program Review Committees?
    Beginning Thursday, March 19, 2020, all scheduled PRC meetings will take place through Paper Review. This means the Behavior Treatment Plan will be reviewed by the member’s team telephonically. Each plan will have careful consideration of the requirements and teaching methodology. When the committee has completed the review, the Disposition with Recommendations/Approvals will be sent to the Qualified Vendor/Provider and Support Coordinator. If you would like to request a Full Review rather than a Paper Review, please contact your District PRC Chair (see below) to request a telephonic Full Review.

    If there is an emergency review request, please send the request to your District PRC Chair and the DDD Behavioral Health Administration at [email protected]. 

    • District Central PRC Chair: [email protected] 
    • District East PRC Chair: [email protected] 
    • District North PRC Chair: [email protected] 
    • District South PRC Chair: [email protected] 
    • District West PRC Chair: [email protected]
       
11. Is a signature required on a medication review when turning in a behavioral treatment plan (BTP) to the Program Review Committee (PRC) since behavioral health visits are often occurring via telehealth? (Added July 30, 2020)
    Although it is considered best practice to require signatures on medication reviews, there is no current policy that requires this. The intention of the medication review is to ensure and verify that there are no adverse medication side effects and that data is being reviewed with the prescribing physician to evaluate the need for a possible reduction of behavior modifying medication. In order to document this, the vendor should provide a copy of the medical notes/progress notes from the office visit (in-person or telehealth) from the prescribing physician. This will eliminate the need for agency-created forms and duplication of work by the prescriber and avoid the issue of prescribers being reluctant to complete outside forms.
12. Do providers still need to conduct in-person supervisory visits of Direct Care Workers?
    DDD is suspending in-person supervisory visits. Supervisory review of case notes/charts should continue to the extent possible, as well as supervisory engagement with staff via available telephonic or other electronic means.
     
13. Will DDD consider temporary changes to the Direct Care Worker (DCW) requirements for family members who reside with a member over age 18 to streamline hiring of family members in cases where there is no provider or where there are concerns of exposure due to providers coming into the home? (Updated March 26, 2020)
    The 90-day training requirement has been suspended, which allows DCWs to provide care while receiving training. The DCW agencies should consider remote learning opportunities to support DCWs, with evaluation of in-person skills and completion of required training following the conclusion of the COVID-19 emergency.
     
14. Are the requirements for keeping patient information private and secure different during the emergency?
    On March 17, 2020 the Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) announced, effective immediately, that it will exercise its enforcement discretion and will waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communication technologies during the COVID-19 nationwide public health emergency. More information can be found at the HHS Office of Civil Rights and SAMHSA.
     
15. Has the Respite benefit limit been increased to 720 hours? (Updated April 7, 2020)
    Yes, the Division has informed Support Coordinators that assessments for respite should consider the increase which is in effect from 10/1/19 – 9/30/20.  The Division is developing an action plan including a communication for providers.  Members will be assessed for this services, it is not a blanket increase for all members.
     
16. How is DDD documenting signatures for the ISP, spending plan and other planning documents since DDD began completing virtual 90-day reviews on March 17, 2020? (Added May 5, 2020)
    Support Coordinators are obtaining verbal consent for the plan during the virtual meeting (agree/ disagree) and documenting this consent in the member’s planning document. Within seven (7) days after the meeting, the DDD Support Coordinator sends the planning document to the member, qualified vendor (s) and other team members via secure email or US postal service as determined by the team member’s preference. AHCCCS has requested and is awaiting  approval from CMS to use virtual signatures for planning meetings. If required at the end of this emergency, DDD Support Coordinators will obtain the legally responsible person’s written signatures, confirming the consent given during the COVID-19 emergency.
     
17. Is a parent or family member who is being paid to provide services for a DDD member required to report those payments as "wages earned" for unemployment insurance benefit eligibility? (Added July 30, 2020)
    Yes. Unemployment Insurance benefits are determined based on monetary and weekly eligibility criteria established by federal regulations and state law. When filing a weekly unemployment insurance claim all earnings must be reported and may impact unemployment benefits. More information can be found at https://des.az.gov/services/employment/unemployment-individual/weekly-unemployment-insurance-benefit-claims-reported-earnings.
     
18. Can vendors be paid to provide care when a member needs support to access healthcare during an inpatient hospitalization during the COVID 19 emergency? (Added September 24, 2020)
    If the planning team has determined that the hospital does not have staff (often referred to as a "sitter") to offer support and the member does not have natural supports such as a parent, guardian, or a close family member; or if the support available is not enough to cover the level of support the member needs, the team may assess for and authorize attendant care to support the member during an inpatient hospital stay. 

1. How should vendors bill for approved telehealth services? (Updated April 14, 2020)

   Please note: The billing guidance below is meant to provide vendors with the appropriate telehealth modifiers, so that vendors can begin providing telehealth services without delay. DDD is currently making changes to its billing system and intends to have new modifiers added by April 8, 2020 for the initial batch of approved services. The rest will be added by the end of April.  Any claims using these new modifiers will deny if billed. Any claims billed before implementation of the new modifiers will assist DDD in tracking use of telehealth services and DDD Business Operations will work with vendors to re-bill.

   Vendor will complete the DDD Uniform Billing Template as usual, adding the appropriate Procedure Modifier under column Y, Z, or AA.  If the member is at home during the service, the POS is 12 under column X.

   For example: Service code STA [column F], POS 12 [column X], procedure modifier GT [column Y].

   Or complete the CMS 1500 or 837 as usual, adding the appropriate Procedure Modifier in Box 24 D-Modifier.  If the member is at home during the service, the POS is 12 under Box 24 B – Place of Service.
   Definitions: Place of Service - Place of service (POS) is the originating site which is the location of the AHCCCS member at the time the service is being furnished via telehealth or where the asynchronous service originates.  Many services can be provided when the member is at home.  Home is POS 12.
   Modifiers GT [live] or GQ [pre-recorded] must be used depending on the type of telehealth services provided:

   GT: Via interactive “live” audio and video telecommunication systems- The use of telecommunications and information technology to provide access to health assessment diagnosis, intervention, consultation, supervision and information across distance.  Most DDD services will use this modifier.

   GQ: Via asynchronous “pre-recorded” telecommunication systems (Store and forward). The transfer of data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation.  Asynchronous or “store and forward” applications would not be considered telemedicine but may be utilized to deliver services.

   UD:  Via interactive "live" audio-only telecommunication systems. 

2. How do Vendors submit claims for approved telehealth services if there is Third Party Liability (TPL)? (UPDATED March 24, 2020)
   If the member has TPL coverage, this should continue to be billed.  If you receive a clean denial you can submit the denial with the usual waiver request.  If for some reason the claim cannot be adjudicated for a clean denial due to the TPL not being set up to receive the Telemedicine modifiers and your claim gets rejected prior to adjudication, please do the following: Submit the Completed Waiver Request COBV Waiver Request Form with the Copy of the Billing Rejection. This method will be accepted for date of services affected during the COVID-19 Crisis.  If the claims are adjudicated and denied for non-covered service for Telemedicine, this would be a clean denial reason and would be processed as usual through the waiver process.
    
3. How frequently can a provider bill for services during this time period?
   DDD can process claims on a daily basis if necessary.  Providers can bill as frequently as  necessary.
    
4. What other steps is DDD doing to help Vendors with Cash Flow? 
   DDD is enhancing its claims recycling where Vendors will receive hard denials for all claims that are not payable instead of the soft edit that assigned the claims to an internal pended status for recycling. Please see the additional FAQ document on the vendor announcement page for more information, Claim Recycling Frequently Asked Questions.
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5. If providers are not able to provide transportation, but family members are willing to provide transportation, can DDD allow billing for GSE for individuals and job coaches (who are willing to continue to work) if their place of employment is still open?
   Yes.
    
6. Will the Division create rates for different ratios for Employment Services? (Updated May 15, 2020)
   The Division updated the permanent rate book to include new ratios for Center-Based Employment and Transition to Employment services. The new ratios are effective April 1, 2020.

1. What procedures should be used for ICFs and other Long-Term Care Facilities?
   To mitigate spread of COVID-19 among our most vulnerable Arizonans, the Governor’s Executive Order issued on March 11, 2020 directs ADHS to make emergency rules for skilled nursing, intermediate care, and assisted living facilities to implement visitor policies designed to prevent the spread of COVID-19 including: 
   • Instituting policies to require screening and triage before entry by staff, visitors, vendors, and contractors; 
   • Establishing disinfectant schedules for frequently touched surfaces; and 
   • Establishing policies of distancing patients who exhibit symptoms of COVID-19 from other patients in common areas.

DDD has followed up with its Contracted Assisted Living Facilities (ALFs), Intermediate Care Facilities (ICFs), its sub-contracted Health Plans that operate Skilled Nursing Facilities (SNFs) and its own State Operated Intermediate Care Facilities to ensure that these measures are implemented.

ADHS has also issued guidance prohibiting visits to long-term care facilities except to provide critical assistance.  Please refer to ADHS and CDC guidance about general strategies recommended to prevent the spread of COVID-19 in these facilities. 

2. What procedures should be used for congregate settings like DDD Group Homes and Developmental Homes? (Updated March 29, 2020)
   To the extent possible, providers should utilize the guidance issued by ADHS and CDC above.  For instances where the guidance may not apply to the congregate setting that you operate, DDD has compiled best practices from around the country that are more specific to settings such as Group Homes, and Developmental Homes, COVID-19 QVA Guidance for Congregate Settings (Group Homes / Developmental Homes).
    
3. Will DDD be able to assist providers in obtaining personal protective equipment (PPE) and cleaning supplies considering these items are being rationed and in some cases are not available?
   The Arizona Department of Health Services has issued this COVID-19 Infection Control and Personal Protective Equipment (PPE) Guidance for Arizona.
    
4. Some providers have expressed concern related to basic supplies (cleaning supplies, toilet paper, adult diapers, etc.) and food for our programs. Is the Division aware of these concerns and is there anything the state can do to assist providers who do not have access to basic supplies and/or food?
   The Division does not have additional avenues for securing these items at this time.  Adult briefs should be supplied by the DD Health Plans contractors. Please report any issues with delivery of covered items to our Customer Service Center at 1-855-432-7587.
    
5. Are providers able to provide services to members in different locations like hotels or other non-licensed settings if the member tests positive? (Updated April 7, 2020) 
   Yes. AHCCCS has received this authority from CMS.  DDD has preliminary guidance for alternative settings in the COVID-19 QVA Guidance for Congregate Settings (Group Homes / Developmental Homes) document. DDD will be updating this document and providing billing clarifications.

1. DDD has asked us to screen staff and visitors for illness. Can we ask if group home staff and visitors have a fever instead of actually taking their temperatures?
   DDD would advise vendors to actually take temperatures, if possible. Taking temperatures and keeping a log of temperatures is more reliable and recommended.
    
2. Are Vendors expected to purchase their own supplies i.e. alcohol, masks, etc.?
   Vendors are responsible for purchasing Personal Protective Equipment (PPE) and for sanitation. DES DDD Is providing Value Based Payment to offset COVID 19 costs. It  may take more time (multiple trips to stores or online shopping) to get all the necessary supplies.
    
3. Should we seek testing anytime we suspect someone may have COVID-19?
   Testing should be occurring via the official testing centers or with the primary care physicians.  It is understood that not everyone will be tested if suspected.
    
4. What if a staff member is cleared by their doctor without a test or 14-days of quarantine?
   Follow the directions of the treating physician.  If the physician says the person is not infected, you can follow their doctor’s written instructions.  However, you should try to adhere to the 14-day quarantine unless the instructions say otherwise.
    
5. Are there guidelines on how staff can enter and exit an infected person's room without furthering the spread?
   If a Qualified Vendor is aware of a DDD member who has tested positive or is a person under investigation (PUI), they should follow the Division’s reporting procedure. If there is a confirmed positive case, coordination should take place with your county health department who will provide specific instructions applicable to your situation.  DDD staff will also be able to provide technical assistance on best practices should there be additional guidance that you need.
    
6. Are group homes going to be allowed to provide day treatment services in the group home settings if members are choosing to remain at home?
   See DDD FAQ Day Treatment FAQ #6... When members live together the Vendor should consider if it can provide the services in a the member’s family home or developmental home at 1:2 or 1:3 rates. For members who live in a group home and can’t or don’t want to go to Day treatment programs, we will support a meaningful day with adjustments to the residential staffing schedules (DDD codes HAB, HPD), as needed, instead of with Day Treatment services.
    
7. Nursing Supported Group Homes have concerns with the therapies being delivered by telehealth  in a residential setting:  
   • *Require an aide or nurse to be with the resident throughout the sessions.  
   • *Neither the aides nor the nurses are trained to do these therapies and there are safety concerns. *These therapies are taking staff away from their other responsibilities.
     If there's a particular member who might not be appropriate for telehealth, please elevate to the member’s planning team; however, nursing and direct care staff should be trained and be implementing the members' therapy programs.
      
8. Can we postpone all therapies of any format until the COVID-19 threat passes for the residents that cannot participate in their own care?
   This should be addressed with the Planning  team; the member/ guardian and the clinician would need to determine.
    
9. Can DDD assist in procuring cleaning supplies especially items like disinfecting wipes which are practically unavailable. Sites like Amazon have limited it to Government Agencies and Hospitals only. Since DDD is a Government body, is there a way Providers can procure supplies?
   DDD cannot procure supplies directly for vendors.  DDD is providing funding to offset the cost of obtaining necessary supplies.
    
10. The surveys sent were several weeks ago and things have changed drastically. Will there be another survey so that DDD will see the true costs we are experiencing?
    Yes,  DDD plans to continue to survey vendors.
     
11. If a member goes home with a family member to self-isolate and the parent wants to be employed by the agency, what service would this be under and are the parents exempt from needing fingerprint clearance?
    The member’s planning team will assess needed services. The only service that exempts parent providers from the fingerprint requirement is Attendant Care. For all other services, parents are required to meet the fingerprint requirement.
     
12. When touch-free thermometers are not available and protective coverings run out, what can we do to prevent spreading this through the thermometers themselves?
    If taking temperatures causes a greater risk, then you may have to forgo taking the temperatures and rely on self-reporting.  If you can obtain methods of taking temperatures, it is recommended to do that, as the temperature taking is more reliable.
     
13. If a day treatment setting is used for quarantine and is currently licensed as a day treatment setting, would it need to be inspected before being used?
    Please see Appendix 4 in the  the Division’s Congregate care Guidance Document posted here https://bit.ly/DDDProviderGuidance.
     
14. Is there a way to expedite approval of staffing matrices (schedules) especially negotiated rates to avoid billing pressure on the Group home?
    We have worked with the Network Teams to ensure schedules are approved as quickly as possible.  If you’re having trouble, please contact the Customer Service Center.
     
15. Does the vendor need to hold a place in the group home or developmental home if a Member or family  temporarily moves out of a group home or developmental home to their family home due to group home or developmental home staffing issues or COVID 19 concerns/mitigation strategies?
    Yes. Governor Ducey’s March 24th Executive Order freezes all evictions in Arizona. The Division will continue room and board authorizations for up to 30 days after the member temporarily moves home to their family home.  Please see Question # 18 on AHCCCS General COVID 19 questions which specifically addressed group homes during the COVID 19 emergency.