Intellectual & Developmental Disabilities

Effective February 1, 2019, Supports Coordinators (SCs) are to follow the interim guidance given in ODP Announcement 19-013 on how to complete ODP’s revised Prioritization of Urgency of Needs of Services (PUNS) form that will go-live in the Home and Community Services Information System (HCSIS) on February 1, 2019. ODP also provided an Interim Guidance document. The revisions to the PUNS form were limited to text changes only. The format of the tool and HCSIS functionality remain the same.

The reasons for the changes are:

  • Refinement of questions to collect more accurate information about needs and stressors;
  • Emphasis on conversation between SC, individual, and family about short-term and long-term needs;
  • Better align the PUNS Form with the current waiver; and
  • Allow better planning for the needs of individuals locally as well as the overall ODP system.

SCs should continue to use the PUNS Disagreement Form and letter located at until the updated PUNS bulletin and attachments are published.

If you have questions, please reach out to your regional PUNS Lead:

Kristin Ahrens, Deputy Secretary for ODP and Ryan Hyde, Acting Executive Director for Office of Vocational Rehabilitation (OVR), signed a joint bulletin on February 14, 2019 to become effective on February 15, 2019. Bulletin 00-19-01 provides updated guidance regarding requirements for when individuals must be referred to OVR to align with the requirements in the current Consolidated Waiver, Person/Family Direct Support (P/FDS) Waiver, Community Living Waiver, and Adult Autism Waiver (the ODP Waivers), and the Workforce Innovation and Opportunity Act (WIOA) (Pub.L. 113-128) and clarifies that the guidance in this bulletin applies to employment-related services funded through base-funding provided for by the Mental Health and Intellectual Disability Act of 1966 (50 P.S. §§ 4101-4704).

In accordance with the Employment First Act (62 P.S. §§ 3401-3409), competitive integrated employment is the preferred outcome for individuals receiving services funded through the ODP Waivers or base-funding and OVR services. An employment outcome is the first and preferred outcome because it provides many benefits to the individual including, but not limited to: increased opportunities for economic self-sufficiency, an opportunity to contribute to the community, a chance to build a network of social relationships, and the creation of opportunities for lifelong learning. An employment outcome is also consistent with the overall goals and recommendations in Everyday Lives: Values in Action, the document that provides guiding principles for the Office of Developmental Programs (ODP).

The employment recommendation in Everyday Lives: Values in Action states: “Employment is a centerpiece of adulthood and must be available for every person. The benefits of employment for people with disabilities are significant and are the same as for people without disabilities.” In addition, Everyday Lives: Values in Action includes the following value statement developed by self-advocates: “I want to work and/or have other ways to contribute to my community. My family, supporters, and community support me to find and keep a real job that I like with good wages and benefits or start and run my own business, and/or volunteer the way I want in my community.”

ODP and OVR have been working closely together to ensure that all individuals enrolled in ODP Waivers or receiving base-funded services have access to experiences and services that will enable them to obtain an employment outcome and receive the benefits that come from being employed. Supports Coordinators must refer an individual to OVR for OVR to determine the individual’s eligibility for services when an individual who is enrolled in an ODP Waiver or is receiving base-funded services indicates an interest in seeking employment or requests that the following employment-related services be added to his or her Individual Support Plan (ISP):

Consolidated, P/FDS, and Community Living Waivers:

  • Advanced Supported Employment;
  • Supported Employment;
  • Small Group Employment;
  • Community Participation Support; and
  • Education Support.

Adult Autism Waiver:

  • Supported Employment;
  • Career Planning; and
  • Transitional Work.

All other services offered by the ODP Waivers do not require a referral to OVR.

Once an individual is referred to OVR, OVR will determine using its own eligibility standards and criteria if the individual is eligible for OVR services. OVR will not make a determination if employment-related services provided through ODP Waivers or base-funded services are needed or appropriate for the individual.

It is critical that OVR staff and Supports Coordinators engage in ongoing conversations during the OVR referral and eligibility determination process to ensure that timely eligibility determinations are made. Ongoing conversations allow OVR staff and Supports Coordinators to discuss the following topics:

  • Whether additional information is needed by OVR staff to make an eligibility determination.
  • If OVR staff has any concerns about the individual. For example, OVR staff may report that the individual has experienced a prolonged illness that has impacted OVR staff’s ability to set up meetings and determine the individual’s eligibility for OVR services.
  • The date that OVR staff expects to make an eligibility determination.
  • Services and supports that OVR staff is exploring with the individual.

In some circumstances, OVR may not have the capacity to serve every individual referred by a Supports Coordinator in a timely manner. In such cases, there are special provisions in the ODP Waivers that allow the Supports Coordinator to access Waiver funding without receipt of an OVR eligibility determination.

Please see the bulletin and:

Contact Carol Ferenz, RCPA IDD Division Director, with questions.

ODP Announcement 19-017 provides guidance for assisting individuals with transitioning from nursing facilities into waiver services. When an individual is in reserved waiver capacity status, due to requiring hospital and/or nursing home care beyond 30 days, or has been identified as eligible to receive services offered in an ODP waiver upon discharge from the nursing facility, the AE, county MH/ID program, SC, or TSM provider will need to assist the individual in transitioning from the nursing facility. As part of the transition process, a PA 1768 form needs to be completed.

It is important that the PA 1768 form is completed and submitted to the County Assistance Office (CAO) prior to the individual’s discharge, so that there is no interruption in service. The submission of the PA 1768 form in advance of the anticipated discharge date allows the CAO to enter a waiver code in the individual’s record.

The nursing facility will coordinate with the individual and family, the AE, county MH/ID program, SC, or TSM provider as appropriate, to determine an anticipated date of discharge from the nursing facility. The individual must begin to receive waiver services on the day he or she is discharged from the nursing facility.

The AE, county MH/ID program, SC, or TSM provider is responsible to complete the PA 1768 form. The completed PA 1768 form will be sent to the CAO at least two weeks prior to the anticipated date of discharge. For more information about completing the PA 1768, please refer to ODP bulletin 00-18-02, Home and Community-Based Services (HCBS) Eligibility/Ineligibility/Change Form (PA 1768) and Instructions.

The nursing facility is responsible to complete and submit the Long Term Care Admission Discharge Transmittal form (MA 103) to the CAO when the individual is discharged from the nursing facility. During the transition process, if the AE, county MH/ID program, SC, or TSM provider becomes aware that the nursing facility did not complete and submit the MA 103 to the CAO, a request should be made to the nursing facility to complete and submit this form. Enrollment into a waiver cannot be completed until the CAO receives the MA 103. Depending on the individual’s circumstances, the actual discharge date may be sooner or later than the originally anticipated discharge date, or the individual may not be discharged at all.

Please direct questions regarding this Announcement to the appropriate ODP Regional Office.

All provider members of RCPA became full members of ANCOR at the beginning of the calendar year 2019. Join in this webinar to learn about the benefits now available to you as an RCPA/ANCOR member. Gabrielle Sedor, Chief Operations Officer, will lead a discussion explaining all the resources now available to you, including:

  • Monday Capital Correspondence;
  • Friday Weekly Update;
  • Conference and webinars at member rates;
  • Action Alerts;
  • Access to the ACC; and
  • Federal Updates.

The welcome webinar will be held Wednesday, February 27, 2019, 4:00 pm – 4:30 pm. This webinar will be recorded so if you are unable to participate, you may view it at a later time. Register here to participate. For questions about ANCOR, please visit the ANCOR official website.

The United States General Services Administration announced an increase for the rate of Transportation Mile reimbursement rate, procedure code W7271, beginning January 1, 2019. The new rate is $0.58 per mile. This communication provides notice of the rate increase, as well as instruction for Supports Coordination Organizations (SCOs) on how to add transportation mileage to the vendor screen. It also instructs direct service providers on how to submit claim adjustments, if applicable.

Provider Types (PT) 54 with specialties 540 (Agency with Choice [AWC]) and 541 (Vendor Fiscal [VF]) and PT 55 (Vendor) with specialty 267 are able to receive payment from the Department for the Transportation Mile service authorized through base funding or the Consolidated, Community Living, or Person/Family-Directed Support (P/FDS) waivers.

Supports Coordinators (SCs) should ensure that individuals who receive the Transportation Mile service, procedure code W7271, are made aware of the change in the reimbursement rate. When applicable, SCs should complete a critical revision on Individual Support Plans (ISPs) that contain Transportation Mile, procedure code W7271, per ODP Bulletin 00-17-03, “Individual Support Plan Manual for Individuals Receiving Targeted Support Management, Base Funded Services, Consolidated or P/FDS Waiver Services, or Who Reside in an ICF/ID.” ODP Announcement 19-016 provides detailed instructions for making changes to reflect the new rate.

  • Providers should ensure that individuals whom they reimburse for Transportation Mile service, procedure code W7271, are made aware of the change in the reimbursement rate.
  • Providers who submitted claims for Transportation Mile (procedure code W7271), with dates of service January 1, 2019 and forward, using the old rate ($0.55) should submit claim adjustments using the appropriate rate to obtain the correct payment amount.
  • NOTE: Only paid claim detail lines can be adjusted.
  • When submitting a claim adjustment, bill the way the claim should have originally been submitted. Do not bill for the difference in rate. Include all claim lines that were originally submitted on the claim, including denied lines. Do not add or remove any claim lines when doing an adjustment.
  • Use claim frequency “7” for an adjustment.
  • Insert the last paid claim internal control number (ICN) in the “Original Claim #” field.
  • For inquiries regarding billing/claims, please contact the ODP Claims Resolution Section via email or phone at 866-386-8880, Mon–Thurs 8:30 am–12:00 pm and 1:00 pm–3:30 pm.

Upon release of this announcement, Announcement 013-18 will be archived. Questions regarding this announcement should be addressed to the appropriate ODP Regional Program Managers.

office black telephone with hand isolated on white

ODP and Temple University are conducting Certified Investigator (CI) Forums in March. These forums are an opportunity for current Certified Investigators and other interested parties to receive up-to-date information about the Quality Investigation Unit of Temple University. These calls will also allow participants to network, share best practices, and receive technical assistance in an effort to improve the quality of all investigations.

The next session is scheduled for Friday, March 8, 2019. There will be two sessions available during the day; if desired, participants may register for both sessions. CI program updates will be the same but other content will be dependent on participant inquiries. Participants can submit questions via email prior to the session. See ODP Announcement 19-015 for directions to register for the forums.

ODP Update to Announcement 19-012 is to announce an UPDATE to the new documentation requirements within the Individual Support Plan (ISP). These requirements are part of the implementation of a settlement agreement, which pertains to services received by individuals through the Consolidated Waiver.

UPDATE: To clarify guidance on Page 5 regarding “Frequency and Duration of the actions needed.” The total number of units will NOT be listed on the SD screen since a willing and qualified provider was not chosen.

*Frequency and Duration of the actions needed

Include the frequency (number of times) and the duration (length of time) for each of the needed actions. Include those provided by paid and non-paid people such as family members or friends.

List specific information on total number of units on Service Details

ISP Teams must document an estimate of frequency and duration of actions needed until a willing and qualified provider is chosen.

Please note, total number of units will be NOT be listed on the Service Detail screen since a willing and qualified provider was not chosen.

Contact Carol Ferenz, RCPA IDD Division Director, with questions.

ODP Announcement 19-014 serves to re-issue the criteria, process, and procedures for Residential Fee Schedule rate exceptions in the Consolidated Waiver. The fee schedule has been developed to provide adequate funding for individuals with varying needs of support.

ODP has instituted a process for identifying potential exceptions to the fee schedule, due to the extraordinary behavioral or medical needs of an individual. The Residential Rate Exception Process is a process to review individuals in Needs Group 4. These individuals, due to extraordinary behavioral or medical needs, require a staffing pattern and/or staff expertise (example, extensive clinical supports) that exceeds the assumptions that are the basis for the rate for individuals in Needs Group 4.

(Providers serving Individuals in Needs Group 1-3 (Needs Level 1-4) should continue to follow the existing processes for questions related to the Supports Intensity Scale (SIS) assessment findings.)

If an individual experiences a significant change in need, the provider should contact the Supports Coordinator to initiate a team discussion on the changes identified. If the team agrees that the current SIS assessment no longer represents the support needs of the individual, an expedited request can be submitted by the Supports Coordinator. This is accomplished via the vendor’s online portal for approval by the AE and ODP Regional SIS lead. The re-assessment will be scheduled upon completion of the approval process. Providers should complete a review of the recently completed SIS assessment for accuracy and changes to the Needs Group/Needs Level. If a provider has disagreements regarding the content and/or determined Needs Group/Needs Level, they should contact the Supports Coordinator to initiate a team discussion.

If discrepancies are identified between the information provided during the SIS assessment and the information captured on the SIS Family Friendly Report, the provider can contact the vendor to discuss these discrepancies. The provider should be prepared to identify and discuss specific areas of the SIS assessment that were not accurately captured. The vendor will facilitate a discussion to understand the requested changes and will consult with the assessor who completed the assessment and the respondents present during completion.

To qualify for consideration for a Residential Rate Exception, the individual must have a Needs Group 4 (Needs Level 5, 6, or 7) as determined by the most recent SIS assessment. The provider must complete the “Needs Exception Allowance Tool” (NEAT) (Appendix A), which provides information on the number of staff needed and the type of specific staff credentials that are needed. Accompanying the NEAT, the provider must submit a signed release of information for the counties who are completing the Life Experience Assessment Protocol (LEAP) to access the individual’s records. The NEAT and signed release of information should be submitted to the ODP rate setting mailbox.

The ODP Bureau of Financial Management and Budget will review the staffing information described in the NEAT (Appendix A) submission and determine if the individual meets criteria for a possible rate exception.

If a determination is made that an exception should be considered, a LEAP will be initiated, which involves a comprehensive record review of information about the individual’s history and current status. The LEAP record review will be sent to the Administrative Entity (AE) by the ODP regional office; the AE will complete the review.

The LEAP currently includes two tools, the “Desk Review” (Appendix B) and the “Assessment Review” (Appendix C), as well as a Findings Report (Appendix D). Following this review, the results will be returned to the ODP Bureau of Financial Management and Program Support to perform rate calculations. The provider will then be notified of the determination regarding the request. The registering AE will use the attached letters (Appendix E) when communicating the LEAP findings with the provider for currently approved requests that are subject to a post-approval LEAP. Appendix F diagrams how this process will operate.

Residential fee schedule rates were effective January 1, 2018. At a minimum, exceptions will need to be approved/re-approved on an annual basis. For individuals and providers with approved rate exceptions, the new LEAP process will be implemented during FY 18/19. It is anticipated that all approved rate exceptions will receive a LEAP review prior to April 1, 2019. Continuation of previously approved requests that conclude on 6/30/19 should include information on how considerations identified during a LEAP review were addressed.

Effective February 1, 2019, ODP will only accept NEAT requests for exceptional residential rates in the following circumstances:

  1. There has been an identified change in need for an individual currently receiving residential services as documented in their ISP and SIS assessment. The change in need requires an increased need for amount of staffing or qualifications of staff that exceed the need identified at the time of the current SIS assessment and are not supported with in the current fee schedule rate.
  2. The individual is new to the Consolidated waiver, new to residential services, or new to the provider and meets criteria for an exceptional rate request (i.e. NG4).

For questions or assistance related to the rate exception process, please email the ODP rate setting mailbox.