In response to the Covid-19 emergency, MT DPHHS has submitted a series of amendments to Montana’s Medicaid waivers to help lessen the impact of the situation upon providers and those who receive their services. The most recent of these was an Appendix K request which included various requests for alterations to the way that Medicaid waiver services are provided. This included all three disability waivers in our system: the Big Sky Home and Community Based Waiver (“Big Sky”), the Montana Behavioral Health Severe Disabling Mental Illness Home and Community Based Waiver (“SDMI”) and the Montana Home and Community Based Waiver for Individuals with Developmental Disabilities (“0208″). We were given the opportunity to comment on the wavier application prior to submittal, and many of our recommendations were adopted.
The federal government approved the request on April 30, 2020. Significant changes are as follows:
Waives prior authorization limits on the following services:
0208 waiver – respite;
Big Sky waiver – companion, respite, personal assistance services and non-medical transportation;
SDMI waiver – homemaker chore services
Permits the following services to be delivered in a participant’s home environment or alternative provider or community setting:
0208 waiver – day supports and activities, retirement services, supported employment-follow along support and individual employment support, personal care, companion, personal supports, homemaker, residential habilitation;
Big Sky waiver – adult day health, day habilitation, supported living; and
SDMI waiver – adult day health services.
It also allows services to be provided in these additional settings: the private home of the participant or a family member of the participant; a provider owned or controlled or extended family home; the private home of a direct care provider; community center or designated community gathering center; hotel/paid lodging; newly rented room; other residential setting; or telework settings.
Approves reimbursing “legally responsible persons” as caregivers for services that already allow a relative or legal guardian to provide. These are:
0208 – day supports and activities, homemaker, residential habilitation, respite, companion services, personal care, personal supports, retirement services, specialized child care for medically fragile children, supported employment-follow along support, supported employment- co-worker support, supported employment- individual employment support, supported employment- small group employment;
Big Sky – day habilitation;
SDMI – personal assistant attendant, specially trained attendant.
Expands provider pool by allowing any enrolled waiver provider to work in all three waivers.
Temporarily extends deadlines for all training requirements for 60 days from the original due date. However, all direct care staff should continue to receive training on the participant’s plan of care for whom they are providing support. Training on the plan of care must consist of basic health and safety support needs for that individual. Providers must continue to ensure that direct care staff are able to demonstrate competency in the skills and techniques necessary to perform their assigned tasks under the participant’s plan of care.
Expands provider types for specialized equipment and supplies to purchase items from nontraditional vendors who have necessary items in stock when supply or cost impacts occur due to COVID 19 on a case by case basis.
Suspends periodic licensing and quality reviews of provider agencies throughout the duration of the pandemic. Allow provider flexibility in daytime staffing levels as long as care quality is retained.
Temporarily modifies processes for initial level of care for waiver eligibility to allow evaluations to be conducted via telephone or other interactive electronic communication.
Allows for payment of services to support a participant when temporarily institutionalized in a nursing facility, swing bed, critical access hospital or acute care hospital for a COVID 19-related illness. This is for providing additional supports for communication, behavior and/or extensive personal supports and such services that are not covered in such settings:
0208 – residential habilitation, day supports and activities, retirement services, personal supports, companion, adult foster;
SDMI – specially trained attendant, life coach.
Adds or increases retainer payments for providers of services identified as habilitation services that include a component of personal care and/or personal care. Retainer payments shall be available when the participant is hospitalized or otherwise unavailable to participate in habilitative services for the duration of COVID 19 related absences. The retainer time limit will not exceed the lesser of 30 consecutive days or the number of days for which the state authorizes a payment for “bed hold” in nursing facilities. The services included are:
0208 waiver – assisted living, companion services, day supports and activities, personal care services, residential habilitation, retirement services, supported employment follow along support, supported employment individual employment support, supported employment-small group employment;
Big Sky waiver – residential habilitation, post-acute rehabilitation services, supported living, adult day health, day habilitation, personal care services, private duty nursing;
SDMI waiver – residential habilitation, personal care services, specially trained attendant, private duty nursing.
The COVID-19 is affecting all of us. This invisible virus is sweeping across Montana, our country and the world and is disrupting our lives and daily routines. We are all being asked to do our part to “flatten the curve” and practice “social distancing”.
The virus does not discriminate. That being said, policies and practices that are implemented, though intended for the greater good, can be unintentionally discriminatory having negative and disproportionate impacts on people with disabilities. Disability Rights Montana staff is working with and monitoring city, county, and state officials as policies and practices are implemented.
This week we sent a letter to Governor Bullock itemizing steps we believe are necessary to protect Montanans with disabilities. We highlighted discrimination in the delivery and access to medical services, quarantine capacity for people who live in congregate living settings, capacity to provide in-home services, halting termination or redetermination of Medicaid eligibility, flexibility for providers who deliver in-home and day program services, support and expansion of mental health services, and the monitoring of institutionalized settings. We are gratified in knowing that some of our recommendations are being implemented and that others are being considered.
In an effort to support Chief Justice McGrath’s letters to courtsof limited jurisdiction encouraging the release of nonviolent offenders, we filed a petitionto the supreme court requesting the release of prisoners with disabilities who will be at great risk if this pandemic breaks out in the prison. We are very mindful of community safety and request the release of prisoners with disabilities be handled through the appointment of a special master. The Supreme Court granted our petition and has orderedthe parties to full brief the issue.
Many people with disabilities already live in social isolation and now with the outbreak of this pandemic disease we are being asked/required to “social distance” even more. The social distancing requirements add unintentional burden on people with disabilities. We are asking you to be mindful of your neighbors and friends with disabilities who may need a helping hand during this time. Call them and check in. If you suspect unintentional or intentional discrimination, call DRM and report it to us.
Although our office is physically closed, DRM staff are working and available to answer questions and provide information.
We encourage you to call our office and leave a detailed voice message and phone number or email address where we can contact you. Please note that return calls may be made from blocked numbers since staff are working remotely.
DRM will continue to stay in touch with you as we monitor the situation. In the meantime, may you and your loved ones remain healthy and safe. We will get through this together.
Today we filed an emergency petition with ACLU of Montana to ask the Montana Supreme Court to protect prisoners with disabilities by reducing the number of people who are now in or who will enter Montana’s jails and prisons. The ACLU of Montana, together with the Beck, Amsden and Stalpes law firm filed the petition on behalf of Disability Rights Montana.
The novel coronavirus that causes COVID-19 is spreading exponentially across the country and the state. According to the petition, the Montana Supreme Court has the power to immediately reduce the number of incarcerated people in Montana in these extraordinary circumstances. Doing so would mitigate the mortal harm to incarcerated people with disabilities while also protecting other incarcerated people from undue harm, public health, and public safety.
According to public health experts, the two most important ways to prevent the spread of the highly-fatal COVID-19 are social distancing and frequent handwashing. For people in Montana’s prisons and jails, complying with those methods is virtually impossible. An estimated 32 percent of prisoners and 40 percent of those in jail report having at least one disability. These disabilities make them particularly susceptible to COVID-19. Further, when the outbreak reaches Montana correctional facilities, it is likely that care rationing programs that discriminate against prisoners with disabilities will be implemented, such as has already occurred in Washington State.
Also at higher risk of infection are the medical and correctional staff who come and go between correction facilities and their homes, potentially spilling the outbreak into communities across the state.
“With a virus this contagious and this lethal, the state has an obligation to act immediately,” said Bernadette Franks-Ongoy, executive director of Disability Rights Montana. “Without swift action, the ripple effect of an outbreak in correctional facilities will endanger everyone, hitting people with disabilities especially hard. Reducing the number of people in prisons and jails is consistent with the recommendations of public health experts and will save lives.”
The petition argues that subjecting non-dangerous prisoners with disabilities to the inevitable outbreak of COVID-19 amounts to deliberate indifference to prisoners’ health and safety and also violates the Eighth Amendment to the U.S. Constitution as well as the Montana Constitution.
The petition asks the Montana Supreme Court to reduce the number of people currently in custody — by reducing both those detained before trial (currently about 60 percent of Montana’s jail population) and those already sentenced — and by taking fewer people into custody in the first place.
As of March 31, Montana had 198 confirmed COVID-19 cases, two of which are correctional officers at the Yellowstone County Detention Center. According to the petition, many of Montana’s prisons and jails are overcrowded, making it virtually impossible to control the inevitable spread of the virus in those facilities without reducing the number of incarcerated people.
“We’ve long been concerned about Montana’s overcrowded correctional facilities,” said Caitlin Borgmann, executive director of the ACLU of Montana. “This public health emergency serves as an important reminder about the dangers of overpopulated prisons and jails. If the state doesn’t act now to reduce incarceration levels, lives will be lost.”
The Montana Supreme Court has already recognized the threat of COVID-19 and issued a number of orders designed to slow the spread of the disease. Furthermore, Chief Justice McGrath has noted that it is “only a matter of time” before the virus spreads in Montana’s correctional facilities.
States across the country are taking similar steps to slow the spread of COVID-19. At least fifteen state and local court systems have already taken steps to limit incarceration during this crisis.
This petition to the Montana Supreme Court follows a letter that, the ACLU of Montana, Disability Rights Montana and other organizations sent to Governor Bullock, the Montana Department of Corrections, and other stakeholders across the state, imploring them to reduce the population of incarcerated individuals. While the state and some counties have made some changes, those efforts are simply inadequate to address the inevitable spread of COVID-19 in prisons and jails across the state.
“This is a dire emergency,” said Justin Stalpes, attorney at Beck, Amsden and Stalpes. “The response cannot be patchwork – the only thing that will stop, or at least slow, the risk of a COVID-19 outbreak in correctional facilities and communities is a swift and uniform state-wide response. Lives are at stake – we cannot afford to wait another minute.”
Given the seriousness of the situation, we created the following health and safety guidelines to support and protect our staff and clients.These guidelines will be in place for the foreseeable future, but we will reassess as new information emerges.
Please know we are equally committed during this time to continuing our services to protect and advocate for people with disabilities.
Starting March 16, 2020 until further notice:
Our office is closed to outside visitors indefinitely. Our phone lines will remain open during regular business hours. Please understand that we may return calls from blocked numbers, as some of our staff may be working from home.
If you are a Montana resident and are seeking assistance from our office, please contact us by phone at 1-800-245-4743 or complete and submit the Request for Services Form. We will do our best to respond in a timely manner. We appreciate everyone’s patience as we navigate these unprecedented circumstances.
All in-person meetings will either be rescheduled or held by phone or video conference. We believe this is the most responsible action we can take to safeguard the health and safety of our staff while protecting the wider community.
All non-essential staff travel is suspended.
All staff speaking engagements and exhibiting events are cancelled.We would be glad to send our brochures upon request. Email: Advocate@DisabilityRightsMT.org.
All meetings scheduled to take place in DRM’s conference rooms are cancelled and DRM’s conference rooms will not be available for use until further notice.
Almost 50 years after the passage of the Rehabilitation Act of 1973, the Catholic College has failed to prioritize accessibility despite the struggles that people with disabilities face on the campus. Carroll College has included accessibility in the Master Plan for the College, but has refused to create an action plan or designate personnel to oversee this process. Students, alum, former faculty, and community members have come together to tell their stories regarding the inaccessibility of the College. We will be sharing these stories here on our website. A new story will be available each day during the week of March 9, 2020. Please check them out to learn about the experience of people with disabilities at Carroll College.
Carroll College student, Taylor Tyson, talks about her experience as a student with a disability explaining that “𝒊𝒕 𝒘𝒂𝒔 𝒋𝒖𝒔𝒕 𝒕𝒉𝒊𝒔 𝒘𝒉𝒐𝒍𝒆 𝒃𝒊𝒈 𝒑𝒓𝒐𝒄𝒆𝒔𝒔 𝒋𝒖𝒔𝒕 𝒇𝒐𝒓 𝒎𝒆 𝒕𝒐 𝒈𝒆𝒕 𝒂 𝒓𝒐𝒐𝒎 𝒕𝒉𝒂𝒕 𝑰 𝒘𝒂𝒔 𝒂𝒃𝒍𝒆 𝒕𝒐…𝒆𝒏𝒕𝒆𝒓.”
“𝑪𝒂𝒓𝒓𝒐𝒍𝒍 𝒊𝒔 𝒂 𝑪𝒂𝒕𝒉𝒐𝒍𝒊𝒄 𝑪𝒐𝒍𝒍𝒆𝒈𝒆 𝒘𝒊𝒕𝒉 𝑪𝒂𝒕𝒉𝒐𝒍𝒊𝒄 𝑺𝒐𝒄𝒊𝒂𝒍 𝑻𝒆𝒂𝒄𝒉𝒊𝒏𝒈, 𝒂𝒏𝒅 𝒔𝒉𝒐𝒖𝒍𝒅 𝒃𝒆 𝒄𝒐𝒏𝒄𝒆𝒓𝒏𝒆𝒅 𝒇𝒐𝒓 𝒕𝒉𝒆 𝒍𝒆𝒂𝒔𝒕 𝒐𝒇 𝒖𝒔.” Hear from Professor Emeritus, Lois Fitzpatrick, about her experience as a faculty member with a disability at Carroll College.
“𝑻𝒉𝒆 𝒑𝒆𝒐𝒑𝒍𝒆 𝒂𝒕 𝑪𝒂𝒓𝒓𝒐𝒍𝒍 𝒉𝒂𝒗𝒆 𝒃𝒆𝒆𝒏 𝒓𝒆𝒂𝒍𝒍𝒚 𝒐𝒑𝒆𝒏 𝒕𝒐 𝒉𝒆𝒓, 𝒊𝒕’𝒔 𝒎𝒐𝒓𝒆 𝒋𝒖𝒔𝒕 𝒃𝒆𝒆𝒏 𝒑𝒉𝒚𝒔𝒊𝒄𝒂𝒍 𝒃𝒂𝒓𝒓𝒊𝒆𝒓𝒔 𝒕𝒉𝒂𝒕 𝒂𝒓𝒆 𝒊𝒏 𝒕𝒉𝒆 𝒘𝒂𝒚.” Carroll College graduate, Jenna Starke, speaks to her and her friend’s experience trying to attend Catholic Mass and religious classes on the campus of Carroll College.
“𝑼𝒏𝒇𝒐𝒓𝒕𝒖𝒏𝒂𝒕𝒆𝒍𝒚, 𝑰 𝒅𝒐𝒏’𝒕 𝒕𝒉𝒊𝒏𝒌 𝑪𝒂𝒓𝒓𝒐𝒍𝒍 𝒓𝒆𝒂𝒍𝒍𝒚 𝒊𝒔 𝒗𝒆𝒓𝒚 𝒐𝒑𝒆𝒏 𝒕𝒐 𝒉𝒆𝒍𝒑𝒊𝒏𝒈 𝒔𝒕𝒖𝒅𝒆𝒏𝒕𝒔 𝒘𝒊𝒕𝒉 𝒉𝒊𝒅𝒅𝒆𝒏 𝒅𝒊𝒔𝒂𝒃𝒊𝒍𝒊𝒕𝒊𝒆𝒔,” Carroll College student Sarah Swingley told Disability Rights Montana, as she described her experience as a student with a disability.