MISSOURI FIRST STEPS COVID-19 Guidance Manual Updated January 25, 2021 TABLE OF CONTENTS SECTION I: PHASES AND TIMELINE ................................................................................... 2 A. Phase One: Suspension of Face-to-Face Services and Meetings ........................................ 2 B. Phase Two: Optional Face-to-Face Services and Meetings ................................................ 2 C. Phase Three: Services Resume with Precautionary Measures ............................................ 3 SECTION II: SUSPENSION OF FACE-TO-FACE MEETINGS AND SERVICES ............ 4 A. Referral to Initial IFSP Development ................................................................................. 4 B. IFSP Meetings..................................................................................................................... 4 C. EIT Meetings ...................................................................................................................... 5 D. Services to Children and Families ...................................................................................... 5 SECTION III: OPTIONAL FACE-TO-FACE SERVICES AND MEETINGS ..................... 6 A. Family Requests to Continue Phone Consultation/Teletherapy for Meetings and/or Services....................................................................................................................................... 6 B. Family Requests to Resume Face-to-Face Meetings and Services ..................................... 6 C. EIT Meetings ...................................................................................................................... 7 SECTION IV: SERVICES RESUME WITH PRECAUTIONARY MEASURES ................ 8 A. Service Delivery.................................................................................................................. 8 1. Direct Services ........................................................................................................ 8 2. Teletherapy............................................................................................................ 10 3. Evaluation/Assessment......................................................................................... 10 4. Joint Visits............................................................................................................ 11 B. Billing and Claims ............................................................................................................ 11 1. Daily Therapy Log and Monthly Progress Note................................................... 12 2. No-Show and Missed Visits.................................................................................. 12 C. Meetings............................................................................................................................ 12 1. Intake and IFSP Meetings..................................................................................... 13 2. Early Intervention Team Meetings ....................................................................... 13 3. ECO Procedures…………………………………………………………………..13 Appendix A: Checklist of Activities for Referral Utilizing Phone or Secure Video Connection 14 Appendix B: Exception to In-Person Meetings ........................................................................... 16 Appendix C: Frequently Asked Questions for the Suspension of Face-to-Face Services and Meeting in Phase One and Phase Two ......................................................................................... 17 Appendix D: Frequently Asked Questions for Teletherapy Services During the COVID-19 Pandemic in Phase One and Phase Two ...................................................................................... 23 The Department of Elementary and Secondary Education does not discriminate on the basis of race, color, religion, gender, sexual orientation, national origin, age, veteran status, mental or physical disability, or any other basis prohibited by statute in its programs and activities. Inquiries related to department programs and to the location of services, activities, and facilities that are accessible by persons with disabilities may be directed to the Jefferson State Office Building, Director of Civil Rights Compliance and MOA Coordinator (Title VI/Title IX/504/ADA/ADAAA/Age Act/GINA/USDA Title VI), 5th Floor, 205 Jefferson Street, P.O. Box 480, Jefferson City, MO 65102-0480; telephone number 573-526-4757 or TTY 800-735-2966; email [email protected]. Missouri First Steps COVID-19 Guidance Updated January 25, 2021 Page 1 of 26 MISSOURI FIRST STEPS COVID-19 GUIDANCE MANUAL The intent of this document is to support the System Point of Entry (SPOE), providers and families to prepare for and implement the phases and guidance for Missouri First Steps during the COVID- 19 pandemic. As experts learn more about COVID-19 and as conditions surrounding this pandemic evolve, this guidance may change. The SPOE and First Steps providers should continue to monitor any local county or city orders related to COVID-19, as well as, follow SPOE and provider agency regulations (if applicable). The Centers for Disease Control (CDC) guidelines for preventing the spread of illness should be considered when preparing to deliver face-to-face services and meetings. SECTION I: PHASES AND TIMELINE This section consists of Missouri First Step’s phase-in plans indicated by timeframes. The actions and communications in each phase should be individualized to address the unique needs of the family. Each plan contains the following components: timeline, action, communication and guidance. The timeline for each phase is tentative based on the state and/or local orders. The action of each phase determines the available methods of service delivery (i.e. face-to-face, phone or video conferencing). The communication details how each phase is communicated to the family, SPOE and provider. The guidance indicates where to locate information related to each phase, including answers to unique questions facing SPOEs and providers. A. Phase One: Suspension of Face-to-Face Services and Meetings  Timeline: March 18 – May 31, 2020  Action: During Phase One, First Steps face-to-face services and meetings are suspended. Services may be delivered and meetings conducted via phone or video conferencing. The decision to suspend aligns with other Part C programs throughout the country and with Missouri school districts.  Communication: Phase One was communicated to families, providers and the SPOEs via an email and the First Steps website.  Guidance: See Section II: Suspension of Face-To-Face Services and Meetings B. Phase Two: Optional Face-to-Face Services and Meetings  Timeline: June 1 – July 31, 2020 Missouri First Steps COVID-19 Guidance Updated January 25, 2021 Page 2 of 26  Action: During Phase Two, families and providers will be given the option of resuming face-to-face services or continue with services delivered via phone or video conferencing on the current authorizations. Families and Service Coordinators may resume in-person intake and Individualized Family Service Plan (IFSP) meetings or continue to meet virtually. Providers and Service Coordinators will need to consider any local county or city ordinances or regulations when presenting service delivery options to families. All Early Intervention Team (EIT) meetings must continue via phone or video conferencing.  Communication: Prior to June 1, Phase Two will be communicated to families through an email and letter from the Department of Elementary and Secondary Education (DESE) and a personal contact from their Service Coordinator. The SPOEs will be given a guiding set of questions to review with each First Steps family regarding the family’s readiness to resume face-to-face visits. The communication to providers will occur via an email and a webinar posted on the DESE website. Additionally, providers will be given suggested guidance on preparing for face- to-face visits in Phase Two. The SPOE will receive the guidance via email, and conference calls with DESE staff.  Guidance: See Section III: Optional Face-to-Face Services and Meetings C. Phase Three: Services Resume with Precautionary Measures  Timeline: August 1, 2020 – until DESE announces COVID-19 guidance has concluded.  Action: During Phase Three, the intention is to resume face-to-face services and meetings wherever possible while maintaining flexibility. Providers and Service Coordinators will need to consider any local county or city ordinances or regulations when presenting service delivery options to families. The prominent change being implemented in Phase Three is how providers submit claims for services.  Communication: Phase Three will be communicated to families through an email and letter from DESE and a personal contact from their Service Coordinator. The communication to providers will occur via an email and a webinar on the DESE website. The SPOE will receive the guidance via email and conference calls with DESE staff.  Guidance: See Section IV: Services Resume with Precautionary Measures Missouri First Steps COVID-19 Guidance Updated January 25, 2021 Page 3 of 26 SECTION II: SUSPENSION OF FACE-TO-FACE MEETINGS AND SERVICES The following is temporary guidance on how to conduct First Steps referral, intake, meetings and services while face-to-face visits are suspended due to the COVID-19 pandemic. Additional guidance on meetings and services can be found in Appendix C: Frequently Asked Questions for the Suspension of Face-to-Face Services and Meetings. A. Referral to Initial IFSP Development Service Coordinators can refer to Appendix A: Checklist of Activities for Referral Utilizing Phone or Secure Video Connection for guidance on how to engage newly referred families and complete the referral process while face-to-face meetings are suspended. Service Coordinators can refer to Week 2 through Week 6 on the Checklist for 45-day Timeline Activities to complete the Evaluation of the Child activities through the development of the Initial IFSP. Service Coordinators and providers can refer to Appendix C for more considerations on the completion of evaluations and assessments during the suspension of the face-to-face services. B. IFSP Meetings During the suspension of face-to-face services, all IFSP meetings held must be conducted via phone or secure video connection. The Service Coordinator must explain the suspension of face-to-face services and meetings to the parent. The Service Coordinator must plan for and facilitate the IFSP meeting, and determine with the parent how paperwork will be sent to and returned by the parent (i.e., email, mail or fax). The Service Coordinator is responsible for all activities listed on the Checklist for 45-Day Timeline Activities. A parent may decide to delay the Initial IFSP meeting until face-to-face meetings resume. Service Coordinators must follow the Exception to In-Person Meeting guidance in Practice Manual Chapter 6 (see Appendix B) to facilitate and complete inter-periodic, six-month review and annual IFSP meetings during the suspension of face-to-face IFSP meetings.  Transition A parent may delay the transition meeting. If a parent chooses to hold the transition meeting, then the meeting may be held via phone conference or secure video connection, and the school district may attend if the district is open and available. If the SPOE receives a late referral for a child with a summer birthday, and a referral to ECSE cannot be made because the district is closed due to COVID-19, then the SPOE can print off documentation of the district closure and a fax receipt or dated email indicating Missouri First Steps COVID-19 Guidance Updated January 25, 2021 Page 4 of 26 the referral was sent to the district. This documentation will suffice as an indication of the referral in process, and the SPOE may proceed with conducting a Summer Third Birthday IFSP for the child. Once the school district is back in session, verify that the referral is now in process. C. EIT Meetings During this phase, all in-person EIT meetings are suspended. EIT meetings may be held via conference call or secure video connection. If teams do not have access to large group conference call capability, then EIT meetings may be postponed until face-to-face meetings resume. D. Services to Children and Families The Service Coordinator must inform families of the suspension of face-to-face services. Service Coordinators must continue service coordination activities with families during this time, including regular contacts, progress note review, data entry, case notes, authorization updates and IFSP facilitation. Missed visits due to suspension of face-to-face services will not be made up later. First Steps is offering consultation or teletherapy as alternatives to face-to-face visits during this phase. If the parent chooses an alternative to face-to-face visits, then the authorization does not need to be changed and the provider can bill the time on their direct service authorization. -- Providers may utilize various technologies to complete visits, including phone and secure video connection. Providers must complete progress notes, including documentation on how services are provided. For more information on teletherapy see Appendix D: Frequently Asked Questions for Teletherapy Services during the COVID-19 Pandemic. Missouri First Steps COVID-19 Guidance Updated January 25, 2021 Page 5 of 26 SECTION III: OPTIONAL FACE-TO-FACE SERVICES AND MEETINGS During this phase, face-to-face meetings and services may resume as determined by the comfort level of the family, the provider and the Service Coordinator. Service Coordinators and providers should speak with individual families to discuss the appropriate time to restart in-person meetings and services. Alternative options remain available for those who are apprehensive regarding the return of face-to-face services and meetings. Once face-to-face visits resume, the IFSP team may need to determine if the child and family’s needs have changed and review the child’s IFSP to determine whether modifications are needed. Providers and Service Coordinators will need to consider any local county or city ordinances or regulations when presenting service delivery options to families. Prior to face-to face meetings or services, a discussion should include the health of all individuals involved, along with any precautions including wearing a mask, social distancing and sanitizing. Providers and Service Coordinators are encouraged to follow CDC precautions. A. Family Requests to Continue Phone Consultation/Teletherapy for Meetings and/or Services If a family requests to continue with phone consultation and/or video conference for meetings, then the Service Coordinator continues to follow the Section II: Suspension of Face-to-Face Meetings and Services guidance. If a family requests to continue phone consultation or teletherapy as the service delivery method, and the provider is willing to offer service in this manner, then the provider follows the guidance in Section II: Suspension of Face-to-Face Meetings and Services guidance. If the provider is not willing to continue visits via phone consultation or teletherapy, then the Service Coordinator has a discussion with the family regarding the option of assigning a new provider who offers phone consultation or teletherapy services. B. Family Requests to Resume Face-to-Face Meetings and Services If a family requests face-to-face intake and IFSP meetings, then the meetings may resume with the individual family. The family and Service Coordinator may consider meeting in alternate locations, such as outdoors or in a safe community location. However, if the Service Coordinator is unable to participate in face-to-face meetings, then the SPOE will discuss the available options with the family, such as proceeding with phone/video meetings or a temporary assignment of a new Service Coordinator. A family may request some or all of their face-to-face services to resume. However, if the provider is unable to participate in face-to-face services, then the Service Coordinator will discuss the available options with the family, such as meeting in safe alternate locations, continuing with phone consultation/teletherapy, or the assignment of a different provider who is currently available for face-to-face visits. Missouri First Steps COVID-19 Guidance Updated January 25, 2021 Page 6 of 26 If the family requests face-to-face services to resume in a community setting or special purpose center, then the provider needs to determine if the location is currently open; and if so, is the location allowing non-employees to enter. The family and provider must consider the requirements of the community setting or special purpose center, such as the use of personal protective equipment or social distancing. If the community setting or special purpose center is not currently open, then the provider and family must determine alternate methods of service delivery until the location reopens. C. EIT Meetings During this phase, all in-person EIT meetings remain suspended. EIT meetings may be held via conference call or secure video connection. If teams do not have access to large group conference call capability, then EIT meetings may be postponed until face-to-face meetings resume. Missouri First Steps COVID-19 Guidance Updated January 25, 2021 Page 7 of 26 SECTION IV: SERVICES RESUME WITH PRECAUTIONARY MEASURES First Steps recognizes the importance of maintaining flexibility with how home visits are delivered for the duration of the pandemic. As Phase Three begins, face-to-face meetings and services may resume with consideration of the comfort level of the family, the provider and the Service Coordinator. Providers and Service Coordinators must consider any local county or city ordinances or regulations when presenting service delivery options to families. Prior to any face-to-face meetings or services, a discussion should include the health of all individuals involved, along with any and all necessary precautions, including wearing a mask, social distancing, meeting outdoors and sanitizing. Providers and Service Coordinators are encouraged to follow CDC precautions. In Phase Three, a temporary change in provider claim submissions is implemented and teletherapy returns to the standard rate as stated in the Provider Rates Schedule. A. Service Delivery Face-to-face visits with families are still considered best practice in delivering First Steps services; however, DESE recognizes that during the COVID-19 pandemic there must be flexibility in service delivery. All individuals in First Steps (family members, providers and Service Coordinators) must consider their own comfort level with participating in face-to-face services and meetings. As the pandemic continues, decisions about face-to-face services and meetings may change many times, so it is paramount that all individuals involved continually communicate and discuss any issues and concerns. In particular, an ongoing discussion prior to each face-to-face service or meeting should include the following:  What is the current comfort level of all involved regarding face-to-face services and meetings?  What is the current health status of the providers, Service Coordinators and all members of the family living in the home?  Which service delivery option works best for this particular visit or meeting: face- to-face or remote (phone call or video conference) services?  If holding face-to-face services or meetings, what precautions will need to be taken (e.g., wearing masks, distancing, sanitizing)? Throughout the pandemic, an individual’s comfort level with face-to-face visits may change on a daily, weekly or monthly basis as new data and statistics become available, so maintaining communication is key. 1. Direct Services Direct services are authorized by the IFSP team with the intention of being delivered face- to-face. However, with COVID-19, the method of service delivery may need to change Missouri First Steps COVID-19 Guidance Updated January 25, 2021 Page 8 of 26 based on an individual’s current comfort level or local ordinances. During Phase Three, direct services may be delivered either face-to-face or remotely (via phone call or video conferencing) as the situation requires. When remote services are necessary in lieu of a face-to-face visit, an IFSP meeting is not required to change the location. Some examples of offering remote services include the following:  In preparing for a home visit, a provider calls a family to confirm the appointment and review some health screening questions. The family states that someone in the home is not feeling well. During Phase Three, the provider can offer this family remote visits until the family confirms everyone in the home is healthy.  A family may request all visits remain remote throughout the pandemic if someone in their household has a medical issue.  A provider is not feeling well or has a pending COVID-19 test; the provider then offers all direct service visits remotely until the provider is feeling better or receives a negative COVID-19 test. Services offered remotely should have the same components as a high-quality home visit, including the use of coaching strategies, routines-based interventions and naturalistic teaching opportunities. The child is typically present for this method of service. For services held remotely, the provider must be in a location that ensures confidentiality. If the provider chooses to offer services via video conference, the video conferencing platform must be dependable, of no cost to the family and accommodate the necessary number of people for the visit. The conferencing platform must be a secure, non-public facing platform (e.g., Zoom, Cisco WebEx, Microsoft Teams, Skype, FaceTime). Video conferencing applications that are public facing are not allowed (e.g., Facebook Live, Twitch, TikTok). Providers may not record remote visits to review later, since any recordings become part of the child’s educational record and First Steps does not have the capacity to store such recordings. As with all direct services, a provider may not bill for time spent planning for or writing out instructions for remote visits. Additionally, if a family sends a video to a provider to review, the provider cannot bill for time spent reviewing the video outside of the remote visit.  Limited Access to Remote Services If the family declines face-to-face services and has no access to phone or internet, but the family does have access to text messaging, then the provider may offer support via text messaging. The IFSP team will have to meet to discuss this service delivery type and then authorize no more than 30 minutes (2 units) per week of Consultation/Facilitation with Others for text conversations with a family. The provider’s daily therapy log or monthly progress note must document the text message Missouri First Steps COVID-19 Guidance Updated January 25, 2021 Page 9 of 26