Announcement #039-15 - TIU Content Management

Announcement
NOW AVAILABLE: Fourth Waiver Amendments Submitted to
CMS for ODP Consolidated and Person/Family Directed
Support Waivers Effective July 1, 2015
ODP Communication Number: Announcement 039-15
The mission of the Office of Developmental Programs is to support Pennsylvanians with developmental disabilities to
achieve greater independence, choice and opportunity in their lives.
AUDIENCE: Individuals and Families, Administrative Entities (AEs), Supports Coordinators
(SCs), SC Supervisors, Supports Coordination Organizations (SCOs), Providers, and
other interested parties.
PURPOSE:
The purpose of this announcement is to inform all interested parties that the
Office of Developmental Programs (ODP) submitted a fourth set of amendments
for the Consolidated and Person/Family Directed Support (P/FDS) Waivers to the
Centers for Medicare and Medicaid Services (CMS) on April 23, 2015. The
proposed effective date for these amendments is July 1, 2015. These amendment
applications are available on the Department of Human Services (DHS) website.
DISCUSSION:
Several changes have been included in the applications to amend the Consolidated and P/FDS
Waivers. The purpose of these changes is to:
•Reflect current practice and policies to ensure consistent implementation;
•Provide clarification based on requests received and Bureau of Hearings and Appeals
decisions;
•Streamline processes; and
•Enhance the quality of services as well as health and safety assurances for participants.
Notable changes in each Appendix in these Waiver amendments include:
Appendix A
ISSUE DATE 05/14/15
ODP Communication Number: Ann: 039-15
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•Remove the requirement for Administrative Entities to conduct an Annual Administrative
Review. The Administrative Entity may be required to conduct a Self-Review if there are
recurring and/or significant waiver compliance concerns.
•Clarify that public transportation providers do not need to participate in the provider
monitoring process.
•Remove the Performance Review phase from provider monitoring.
Appendix B
•The review of a proportionate, representative random sample of Level Of Care
redeterminations as part of the Administrative Entity Oversight Monitoring Process.
Appendix C
•Add new provider qualification requirements for training and orientation.
•Add qualification requirements for volunteers.
•Clarify what types of training and experience are qualification requirements for Supports
Brokers.
•Align the provider qualification cycle with the provider monitoring cycle.
•Clarify what is and is not covered under service definitions. Some examples include:
 Licensed Day Habilitation providers are required to provide supplemental staffing
needed in the Licensed Day Habilitation settings.
 Any participant under the age of 24 may only have Prevocational Services authorized as
a new service in the ISP when documentation has been obtained that OVR has closed
the participant’s case or that the participant has been determined ineligible for OVR
services.
 Respite provided in a licensed residential setting must be integrated and dispersed in
the community in noncontiguous locations unless an exception is requested and
approved.
 Extended state plan Nursing and Therapy services may only be provided to adult waiver
participants.
 Independent living technology, electronic devices and generators may be covered as
Assistive Technology while items such as swimming pools and hot tubs are excluded.
 Participants do not need to be referred to the Office of Vocational Rehabilitation for
Transitional Work Services.
 Waiver transportation services may not be substituted for the transportation services
that a state is obligated to furnish under the requirements of 42 CFR 431.53 (relating to
ISSUE DATE: 5/14/2015
ODP Communication Number: Announcement 039--14
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assurance of transportation), regarding transportation to and from providers of Medical
Assistance services.
Transportation trip may be used to transport participants from one waiver service to
another waiver service.
Customer satisfaction surveys for Supports Coordination services will now be conducted
through Independent Monitoring for Quality.
Supports Coordination Organizations (SCOs) are not required to have an agreement with
the local intake entity to ensure consistent referrals of eligible individuals and a smooth
transition to the SCO.
Clarify what constitutes a social science credit or social service experience to qualify a
Supports Coordinator.
•Align the definition of competitive integrated employment with the Workforce Innovation and
Opportunities Act and clarify when referrals to the Office of Vocational Rehabilitation are
required prior to receiving Supported Employment services.
•Add background check requirements for volunteers as well as align the criminal history and/or
background investigation requirements for staff and volunteers with 55 Pa. Code Chapter 51,
the Older Adults Protective Services Act and the Child Protective Services Law.
Appendix D
• Clarify that common law employers and managing employers are part of the Individual
Support Plan (ISP) team.
• Provide an exception to the requirement that Supports Coordinators must provide ISP team
member with an invitation at least 30 calendar days before the ISP meeting when emergency
situation occurs.
• Provide an exception to the SIS being completed prior to enrollment when the individual
requires immediate initiation of waiver services to ensure health and welfare.
• Remove the Performance Review phase from SCO monitoring.
• Clarify the requirement for back-up plans.
 Clarify the Supports Coordinator monitoring requirements.
Appendix E
• Clarify what is included in the monthly administrative fee for VF/EA FMS.
Appendix H
ISSUE DATE: 5/14/2015
ODP Communication Number: Announcement 039--14
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•Clarify that customer satisfaction surveys for Supports Coordination services will now be
conducted through Independent Monitoring for Quality.
The proposed effective date for these amendments is July 1, 2015. A notice was published in
the Pennsylvania Bulletin on February 28, 2015 informing stakeholders that the Office of
Developmental Programs was making the amendments available for public review and
comment. This notice also informed stakeholders that comments would be accepted regarding
the waiver amendments from February 28, 2015 through March 30, 2015. The public was given
three different methods for submitting comments: Verbally during two webinars held,
electronically via the email address (RA-odpcomment@pa.gov) or written submission by mail.
Changes were made to the following service definitions as a result of public comment:
•
Home and Community Habilitation,
•
Supported Employment,
•
Assistive Technology, and
•
Prevocational Services.
Changes were also made to Appendix C-2-a as a result of public comment to clarify that
requirements for volunteers do not apply to natural supports.
Please note: These Waiver amendments have not been approved by CMS and changes may be
made to the content based upon discussions with CMS during the approval process. ODP will
inform all stakeholders when CMS has officially approved the Consolidated and P/FDS Waivers
and will make the approved Waivers available at that time.
Information on the Consolidated and P/FDS Waiver Amendment Applications and related
Documents can be found on the DHS Website (http://www.dhs.state.pa.us/). The path to find
this information is: DHS Organization > Office of Developmental Programs > Consolidated and
P/FDS Proposed Waiver Amendments Effective 7/1/15 For Public Comment. The direct link to
access this webpage is:
http://www.dhs.state.pa.us/dhsorganization/officeofdevelopmentalprograms/odp_publiccomm
ents/index.htm .
Direct links to the Consolidated and P/FDS Waiver amendment applications are provided
below:
Consolidated Waiver Amendment Application:
http://www.dhs.state.pa.us/cs/groups/webcontent/documents/document/c_175248.pdf
Person Family Directed Support (P/FDS) Waiver Amendment Application:
http://www.dhs.state.pa.us/cs/groups/webcontent/documents/document/c_175251.pdf
If you have any questions regarding the waiver amendment process or the information posted,
please email RA-odpcomment@pa.gov.
ISSUE DATE: 5/14/2015
ODP Communication Number: Announcement 039--14
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