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Bureau of Developmental Disabilities Services General Guidance during COVID-19 outbreak


The Bureau of Developmental Disabilities Services and Bureau of Quality Improvement Services are actively working to develop and share ongoing guidance to assist in the delivery of BDDS waiver services in response to the 2019 novel coronavirus disease (COVID-19) outbreak.

BDDS/BQIS is committed to working collaboratively with case managers and providers during this extraordinary time. We appreciate the hands-on and coordinated efforts and responses our case managers and providers have demonstrated. As part of this commitment, the Division is exploring opportunities through the Centers for Medicare and Medicaid Services that will allow modifications and exceptions to the Family Supports and Community Integration and Habilitation waivers to be responsive to the current situation. Once these modifications and exceptions are approved by CMS, they will be applied retroactively to March 6, 2020, the date the Public Health Emergency was declared in Indiana.

Resources on how service providers and case managers can prepare for and manage the COVID-19 outbreak can be found here: https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/index.html

The Indiana State Department of Health is operating a call center to provide support to the general public and providers related to COVID-19. Call center hours are from 8 a.m. to 8 p.m. EDT, 7 days a week at 317-233-7125. Calls after 8 p.m. should go to 317-233-1325 and will be answered by an on-call epidemiologist.

Guidance for families and self-advocates during COVID-19 outbreak

BDDS is working with community partners, providers and case managers to prepare for the potential impact to individuals and families receiving BDDS services and supports. This includes development of a plan for how services will be delivered during this time.

We encourage you to discuss any specific concerns related to your family or individual with your case manager and/or waiver providers who can assist you in developing a plan and staying up to date as we move through this continuously changing time. General questions about COVID-19 may be directed to the ISDH Epidemiology Resource Center at 317-233-7125 [317-233-1325 after hours] or e-mail epiresource@isdh.in.gov. BDDS is currently exploring alternatives and working with our federal partners to explore options for use on a short term, as needed basis in an effort to prevent further spread of COVID-19. Currently, the use of electronic monitoring is available for use on the Community Integration and Habilitation waiver.

Options and planning considerations for families and self-advocates:

  • Phone meetings can be considered and used to replace face-to-face visits with your case manager and/or your teams and would include using private, secure, two-way communication when requested by the individual or family due to concerns of COVID-19.
  • The option of using a phone meeting should be considered when one or more team members involved are showing signs and symptoms or have been identified to be at-risk.
  • As a family member, it is important to prepare for the possibility that there could be disruptions in your daily routine.
    • Due to the uncertain nature of how COVID-19 may affect the community, there may be a need to explore and seek out supports for your loved ones should staffing and/or typical programming options become unavailable.
    • While it is expected that some notice would be given by your provider if there was a break in service, the length of notice would depend on the situation at that time.
    • It is recommended that, as a family, you begin to develop a plan should you find yourself in a situation with less formal support.
    • A family member or guardian may choose to bring the individual to their home or keep an individual in their home and out of services during this time. 
      • It is recommended that if a family member or guardian wants to pursue this option, the individual support team should meet (in person or via phone) on a regular basis as the situation evolves to ensure the safety of the individual and to allow for a smooth transition back to services once the individual, family and provider are ready to do so.
      • It is possible that certain service interruptions may occur, such as closure or short-term access limitations to day program service operations. This may require families to make schedule adjustments or prepare for other support options or plans for at home support for a period of time.
  • We recognize that some individuals and/or caregivers are at high risk for serious illness from COVID-19.

State response and coordination efforts
BDDS and BQIS are collaborating with other governmental agencies and will take precautions available to keep the individuals in our services healthy and safe while also providing the necessary and critical supports available.

  • ISDH is closely monitoring COVID-19 in Indiana. ISDH is working with federal and local partners to respond to this evolving public health situation.
  • It is important to note that the projected impact of COVID-19 in Indiana and the nation changes daily. As BDDS and BQIS continue efforts in collaboration with other state and local agencies to minimize the impact of COVID-19 on individuals and families, updates will be provided.

At this time, it is important that everyone, regardless of age or disability, take precautions to avoid the spread and contact of this virus. For information on how to prepare your family, protect your health, and what to do if you are sick visit https://www.cdc.gov/coronavirus/2019-ncov/protect/index.html

For specific information on the developing cases of the virus throughout Indiana and to receive updates, please visit the ISDH COVID-19 Dashboard: https://www.in.gov/isdh/28470.htm

As this situation continues to evolve, BDDS and BQIS will work closely with our service providers and case managers to ensure that you are made aware of any updates or announcements as they occur.

To ensure that you are receiving the most up to date and accurate information refer to the Centers for Disease Control Coronavirus (COVID-19) 2019 page at https://www.cdc.gov/coronavirus/2019-ncov/index.html. Being armed with knowledge, taking the necessary precautions, and having a plan in place may ease the anxiety and worry.

Guidance for case managers during COVID-19 outbreak

As communities across Indiana work to monitor the evolving public health emergency around the novel (new) coronavirus or COVID-19, BDDS and BQIS are providing the following guidance to case management companies and case managers:

  • Individuals and families may request quarterly face-to-face or team meetings be held by phone. The option of using a phone meeting should be considered when requested by the individual and/or family or when one or more team members involved are showing signs and symptoms or have been identified to be at-risk. Phone meetings require private, visual and secure, two way communication and must maintain the individual’s privacy. Phone meetings must not be held in public spaces, such as restaurants, cafés, etc., or via a public network.
  • Case managers must document the request and need to meet by phone in case notes.
  • The phone meeting is to be documented in case notes using ‘Team Meeting’ or ‘Face-to-Face Visit’ as the category; and ‘Telephone call’ as the level of interaction.
  • Pre/Post meeting monitoring checklists are to be completed with information available. For example, questions in the environment section would be answered “N/A.”
  • For individuals receiving residential supports on the Community Integration and Habilitation Waiver, it is the responsibility of the residential provider to ensure that any change in the individual’s condition or living arrangement be communicated to each member of the individual’s Person-Centered Individualized Support Plan. Case management case notes should accurately indicate the change in condition or living arrangement, the reason for the change, and the expected time frame for the change in living arrangement.
  • If the living arrangement change is expected to be a permanent change, the case manager must ensure the individual’s living arrangement is updated.
  • Incident reports should only be filed when an individual is presumptively positive for COVID-19. It is not necessary to submit an IR for individuals who are symptomatic but have not been tested.

Additional information, including a list of frequently asked questions, is available on the ISDH website at https://on.in.gov/COVID19. Case managers, individuals and families may also sign up to receive email updates. The CDC is providing information at https://www.cdc.gov/coronavirus/2019-ncov/index.html.

Guidance for providers during COVID-19 outbreak

Suggested ways to be prepared:

  • Stay informed. Daily updates are posted online: https://www.in.gov/isdh/28470.htm?utm_source=agency-website&utm_medium=&utm_campaign=&utm_term=&utm_content=
  • Develop or review your agency's emergency plan.
  • Establish relationships with key health care and public health partners in your community.
  • Create an emergency contact list.
  • Communicate with your staff and clients about COVID-19.
  • Screen clients and visitors for symptoms of COVID-19 which includes acute respiratory illness (fever, cough, difficulty breathing).
  • Ensure proper use of personal protective equipment.
  • Conduct an inventory of available PPE.
  • Ask sick employees to stay home.
  • Practice social distancing. Stay six-feet away from others when feasible.
  • Increase handwashing and use of 60% or greater alcohol-based hand sanitizer.
  • Cover coughs and sneezes with your elbow.
  • Frequently disinfect personal surfaces (doorknobs phones, keyboards, etc.)
  • Remain home through the duration of your sickness.
  • Voluntary self-quarantine of sick people.

Service delivery consideration:
Providers shall follow CDC guidelines and protocols in connection with the spread and control of COVID-19.  The following guidance may be found at: https://www.cdc.gov/coronavirus/2019-ncov/faq.html#basics

Please consider the following service consideration:

  • If necessary, updates or modifications to the PCISP, including those that result in changes to the cost comparison budget may be conducted by phone.
  • Electronic monitoring (remote supports) is currently available on the Community Integration and Habilitation waiver. Teams should consider evaluating whether electronic monitoring is appropriate to meet a person’s needs. Electronic monitoring can be authorized for 24 hours per day or fill gaps if unexpectedly there is not support available from a direct support professional. Case managers should be contacted to explore this option. Telemedicine (including expanded use of electronic monitoring on the Family Supports waiver) options are currently being explored. If approved further guidance will be issued.
  • Providers should proactively ensure necessary supplies (e.g. medications, paper products, non-perishables, etc.) are available in each home in the event of an extended confinement in the home, staff shortages or service interruptions.
  • If an individual is exhibiting symptoms such as fever, cough and shortness of breath, or has had suspected contact with COVID-19, call the ISDH Epidemiology Resource Center at 317-233-7125 [317-233-1325 after hours] or e-mail epiresource@isdh.in.gov.  

Guidance regarding Day Service operations:

If Day Service locations remain open, consider instituting the following protocols:

At all times:

  1. Encourage your staff or community members to protect their personal health.
  2. Post the signs and symptoms of COVID-19
  3. Encourage people to stay home when sick.
  4. Clean surfaces that are frequently touched – things such as shared desks, countertops, kitchen areas, electronics and doorknobs.
  5. Limit events and meetings that require close contact.
  6. Consider restrictions on visitors
  7. Stay up to date on developments in your community.
  8. Create an emergency plan for possible outbreak.
  9. Assess if community members are at higher risk and plan accordingly.

During an outbreak in your area:

  1. Send home or separate anyone who becomes sick.
  2. If you identify a case, inform people who might have been exposed.
  3. Continue to safely clean and disinfect the person's area.
  4. Connect with your local health departments.
  5. Cancel large meetings or events.
  6. Put your infectious disease outbreak plan into action.

Quarantine guidelines for individuals or staff that have been directly exposed and/or have symptoms (fever, cough and shortness of breath):

Incident reporting: https://www.in.gov/fssa/ddrs/3838.htm

  • An incident report shall be filed for an individual that has tested as presumptively positive for COVID-19.
  • Providers shall communicate to BDDS via BQIS.Help@fssa.in.gov any changes to daily operations (i.e., day service closures)

 
Guidance for ICF/IDD visitors:

Supervised Group Living settings and comprehensive rehabilitative management needs facilities should follow the guidelines established by the Centers for Medicare and Medicaid services regarding visitors

Guidance for congregate residential home- and community-based service site visitors:

Providers supporting congregate residential HCBS sites are encouraged to assess each setting to determine the need for restrictions or other measures regarding visitors. In particular, they should consider whether and to what extent the site supports individuals more at risk for COVID-19 including:

  • Older adults
  • People who have serious chronic medical conditions like:
    • Heart disease
    • Diabetes
    • Lung disease

The following checklist published by CMS may be useful in making these types of determinations:
https://www.cdc.gov/coronavirus/2019-ncov/downloads/novel-coronavirus-2019-Nursing-Homes-Preparedness-Checklist_3_13.pdf 

Guidance for visitors:

  • Consider screening visitors for recent international and national travel along with recent symptoms associated with COVID-19 which include fever, cough and shortness of breath within the last 14 days.
  • Consider posting signs on entry doors and other appropriate areas to inform visitors, staff and volunteers of any screening process or visitor restrictions you have established.
  • Consider posting signs educating visitors, staff and volunteers on the symptoms and travel history that may be a potential risk to the individual(s) they would be exposing.
  • Consider educating visitors, family members, staff and volunteers on the proper prevention practices before, during and after their visit. This includes, but is not limited to:
    • Washing hands often with soap and water for at least 20 seconds
    • Using hand sanitizer that contains at least 60% alcohol
    • Avoid touching eyes, nose and mouth with unwashed hands
    • Avoid close contact with people who are sick
    • Put distance between yourself and other people if COVID-19 has been identified in  your community
    • Stay home if you are sick
    • Cover coughs and sneezes, throw used tissues in trash and immediately wash your hands
    • Wear a facemask if you are sick. If you are not sick you do not need to wear facemask unless you are caring for someone who is sick and unable to wear a mask.
    • Clean and disinfect frequently touched surfaces at least daily

Emergency preparedness plans:

  • Review and update your emergency preparedness plans. If you do not have a plan, a template can be found here https://asprtracie.hhs.gov/technical-resources/resource/3206/emncy-preparedness-packet-for-home-health-agencies
  • Identify your public health and professional resources now.
    • Local health department contact________________________________
    • State health department contact________________________________
    • State long-term care professional/trade association_________________
  • Identify your contacts for local, regional or state emergency preparedness groups, especially communicable disease coordinators now.
    • City___________________________
    • County________________________
    • Other_________________________
  • If you think an individual needs to be hospitalized, call 9-1-1 if it is a life-threatening emergency. If it is not a life-threatening emergency, call the physician for instructions.

Business cleaning:
If you have a location with an individual, employee or visitor, with a known, confirmed case of COVID-19, the following steps should be followed prior to reopening the location.

  • Cleaning staff should wait at least six hours before entering the workplace to do the cleaning.
  • Surfaces that are commonly touched in the workplace (e.g. tables, hard-backed chairs, doorknobs, light switches, remotes, handles, desks, toilets, sinks) should be cleaned and disinfected.
  • Cleaning staff should wear disposable gloves and discard the after cleaning.
  • If surfaces have dirt on them they can use a standard detergent with soap and water prior to disinfection.
  • To disinfect surfaces they should use diluted bleach solutions (never mix bleach with other cleaners). Household bleach is effective against coronaviruses when properly diluted (five tablespoons [1/3 cup] of bleach per gallon of water). If bleach is not available then use an approved product shown to have antiviral activities (https://cfpub.epa.gov/giwiz/disinfectants/index.cfm)
  • For soft surfaces (carpets, rugs and floors), removable any visible contamination and clean with standard cleaners. For items than can be laundered, handle them with gloves and wash them according to manufacturer recommendations; if possible use the warmest water setting.

For more detailed information go to the CDC website - https://www.cdc.gov/coronavirus/2019-ncov/community/home/cleaning-disinfection.html


This guidance is in effect until further notice. As circumstances evolve, we will provide additional guidance. Guidance and communication is being developed and shared with providers related to operations of their specific settings.

Contacts related to COVID-19

ISDH is operating a call center to provide support to the general public and providers related to COVID-19. The call center hours are from 8 am to 8 pm, 7 days a week at 317-233-7125. Calls after 8 p.m. should go to 317-233-1325 and will be answered by an on-call epidemiologist.

For questions specific to BDDS programs and COVID-19:

Please visit the CDC’s website for additional COVID-19 resources: https://www.cdc.gov/coronavirus/2019-ncov/index.html