Intellectual & Developmental Disabilities

The Office of Developmental Programs (ODP) released a listing of resource accounts that provided stakeholders with more specific information on whom they could contact with their questions, suggestions, and issues in 2017. A resource account is an email box that is dedicated to a specific group or process. ODP has recently updated the Resource Account Listing on MyODP.

Additionally, ODP periodically updates a listing of communications that have been deemed obsolete. Communication Number 073-18 lists Communication Numbers, titles, and links to all communications that have been archived since the release of Announcement 082-16 on November 10, 2016. Contact Carol Ferenz, RCPA IDD Division Director, with any questions.

The Office of Developmental Programs (ODP) has announced that the current agreement with Ascend, A MAXIMUS Company for the administration of SIS assessments to individuals who receive ID/A services, will expire on September 30, 2018. In order to provide uninterrupted needs assessment services, ODP will be utilizing KEPRO to administer the SIS assessments beginning October 1, 2018. KEPRO will be utilized on an interim basis until ODP is able to finalize a procurement for needs assessment services.

KEPRO will begin contacting individuals and respondents to schedule SIS assessments starting in August 2018. Ascend will continue to schedule and administer assessments through September 30, 2018. KEPRO will be holding in-person informational sessions at multiple locations throughout Pennsylvania in the near future.

KEPRO can be reached via email. If you have any questions regarding this announcement, please email them here.

ODP is not reissuing the original communication but is providing an updated version of Announcement 071-18: Request for Approved Program Capacity and Noncontiguous Clearance.

Please use this updated attachment in place of the one originally provided.


 

ODP Communication Number 071-18 outlines the new procedure for Approved Program Capacity (APC) and the Noncontiguous Clearance to align with requirements in the Consolidated, P/FDS, and Community Living Waivers, as well as to anticipate some changes in regulatory requirements.

While ODP has established APC for residential habilitation in homes licensed under 55 Pa. Code Chapter 6400, APC will now be established for all licensed and unlicensed homes where residential habilitation, life sharing, or supported living occur. Further, the process and form include Noncontiguous Clearance of all licensed and unlicensed homes where residential habilitation and life sharing will be provided, licensed homes where Respite will be provided, as well as licensed facilities where community participation support services will be provided, to ensure that each home and facility are noncontiguous.

Prior to opening a new service location, closing an existing service location, or changing the program’s capacity, the provider will email “Request for Approved Program Capacity and Noncontiguous Location Clearance” form, attachment #1, (directions for completing this form in attachment #2) to the Regional Waiver Capacity Manager that covers the geographic area where the service location is located (see Regional Waiver Capacity Manager Contact Information, attachment #3). The form will include information about the circumstances and the location that will enable the Regional Waiver Capacity Manager to ensure that the new or existing service location meets ODP criteria contained in the waiver and applicable regulations. After the Regional Waiver Capacity Manager receives the form and reviews the information, they will document their decision on the Request for Approved Program Capacity and Noncontiguous Location Clearance form, attachment #1, and will send the determination to the provider.

This ODP Communication includes definitions for:

  • Approved Program Capacity;
  • Licensing Capacity;
  • Community Participation Support Facilities;
  • Noncontiguous Community Participation Support Facility Locations;
  • Noncontiguous Residential Service Locations;
  • Residential Services Locations; and
  • Respite Only Homes.

Providers who open a new community participation support facility must obtain approval from the Regional Waiver Capacity Managers verifying that the service location is a noncontiguous location.

The following requirements are contained in the Consolidated Waiver for Residential Habilitation and Life Sharing as well as Life Sharing in the Community Living Waiver:

All settings must be integrated and dispersed in the community in noncontiguous locations and may not be located on campus settings. To meet this requirement, the location of each setting must be separate from any other ODP-funded residential setting and must be dispersed in the community and not surrounded by other ODP-funded residential settings. Settings that share only one common party wall are not considered contiguous. Settings should be located in the community and surrounded by the general public.

This will apply to licensed settings that are funded through any source (OCYF, OMHSAS, private pay, etc.), not just through ODP funding sources.

For residential habilitation, life sharing, and supported living, the following requirements will be contained in the 55 Pa. Code Chapter 6100 regulations when published:

A provider shall submit a written request to the Department on a form specified by the Department and receive written approval from the Department prior to increasing or decreasing the Department-approved program capacity of a service location.

A request for APC must be made when the service provider plans to open a new residential service location, close a residential service location, or change the program capacity for an existing residential service location. APC will be approved as follows:

  • A residential habilitation service location newly enrolled to provide waiver services on July 1, 2017 or later shall not exceed a program capacity of 4. With ODP’s written approval, an ICF/ID licensed in accordance with 55 Pa. Code Chapter 6600 with a licensed capacity of 5 to 8 individuals may convert to a Residential Habilitation Service location exceeding the program capacity of 4.
  • A residential habilitation service location enrolled to provide waiver services prior to July 1, 2017, shall not exceed a program capacity of 8. With ODP’s written approval, a residential habilitation service location with a program capacity of 8 may move to a new location and retain the program capacity of 8.
  • Residential habilitation service locations enrolled prior to the publication of the Chapter 6100 regulations, that are in a duplex, two bi-level units, or two side-by-side apartments are permitted as long as the total in both units does not exceed a program capacity of 8.
  • A life sharing service location shall not exceed a program capacity of 2.
  • A supported living service location shall not exceed a program capacity of 3.
  • Effective the date the Chapter 6100 regulations are published, any newly funded residential habilitation service locations in a duplex, two bi-level units, or two side-by- side apartments are permitted as long as the total in both units does not exceed a program capacity of four.

For questions regarding licensing, submit to this email.

On July 30, 2018, President Trump signed HR 6042 which delays the requirement for personal care service providers to utilize an electronic visit verification (EVV) system. This action changes the deadline by one year, to become effective January 1, 2020. HR 6042 was signed into law in order to delay reduction in the Federal Medicaid Assistance Percentage (FMAP) for personal care services furnished without an EVV system, and also requires more stakeholder input into the implementation process. For questions, contact Carol Ferenz, RCPA IDD Division Director.

Medical assistance and cardiology concept: red heart, case with first aid kit and stethoscope isolated on white background

The Office of Developmental Programs (ODP) has issued a Health Alert in order to make all providers, staff, and other caregivers aware of the serious issue of choking. All should become familiar with resources to aid in the identification of individuals at risk for choking, the training of staff, and the appropriate documentation of special dietary needs and choking precautions. Swift action is essential to prevent Irreversible harm or death!

There are two key issues to promote safety for individuals:

  1. The information contained in the participants’ care plans, including medical evaluations/recommendations, assessments, Individual Support Plans (ISPs), and any treatment plans used by the agency (hereafter “care plans”) must be accurate, consistent, and followed precisely for feeding plans, supervision of the individual while eating to maintain safety, proper positioning, and the use of specialized equipment.
  2. All staff providing service to an individual must be trained on the individual’s dietary needs, including awareness of proper foods and food textures, supervision needs during meals, proper positioning during a meal, and the use of specialized equipment related to the risk of aspiration and choking.

Action to Take for an Individual Choking:

  • Call 911 immediately! Seconds matter. Do not delay by seeking supervisory approval prior to calling 911.
  • Initiate First Aid with abdominal thrusts.
  • If the individual becomes unresponsive, move him/her to the floor and begin CPR.
  • Contact the health care practitioner after any episode of choking.

A single choking event may be a warning sign for future choking events. This warning sign needs to be taken seriously and follow-up with the health care practitioner can avoid tragic consequences.

Contact RCPA IDD Division Director Carol Ferenz with any questions.

The Office of Developmental Programs (ODP) reissued ODP Bulletin 00-18-04 and the accompanying Interim Technical Guidance for Claim and Service Documentation. These documents serve to provide guidance to providers of Consolidated, Community Living, and P/FDS Waiver services, as well as Targeted Support Management (TSM). On the original attachment, the watermark stating “Draft” was inadvertently left on some of the pages. Any questions, please contact Carol Ferenz, RCPA IDD Division Director.

July 26 marked the 28th Anniversary of the Americans with Disabilities Act (ADA), signed into law in 1990 by President George Bush. The White House released the following proclamation:

THE WHITE HOUSE
Office of the Press Secretary
FOR IMMEDIATE RELEASE

July 25, 2018

Anniversary of the Americans with Disabilities Act, 2018
By the President of the United States of America
A Proclamation

On the 28th anniversary of the Americans with Disabilities Act (ADA), we celebrate this historic legislation, which echoed our Nation’s founding promise to recognize and secure the equal rights of all men and women. Today, we reaffirm our commitment to cultivate further opportunities for all Americans to live full and independent lives, and recognize the many contributions enabled by expanded participation of Americans with disabilities in our society.

President George H.W. Bush signed the ADA into law on July 26, 1990. It has transformed the lives of millions of Americans living with disabilities by promoting their equal access to employment, government services, public accommodations, commercial facilities, and public transportation. Today, people of all ages with disabilities are better able to thrive in the community, pursue careers, contribute to our economy, and fully participate in American society.

Our Nation must continue to build upon this foundation and continue to further the participation of the more than 56 million Americans living with disabilities. My Administration continues to encourage research that will lead to advancements in technology, medicine, and other fields and better enable independent living. We are also expanding and promoting equal education and employment opportunities for Americans with disabilities to live and work. In this regard, in June of last year, I signed an Executive Order to develop more apprenticeship programs for all people, including those with disabilities. Additional training will encourage better involvement from businesses and allow people with disabilities to contribute meaningfully to a wide variety of industries.

As we commemorate the anniversary of the ADA, we recommit ourselves to fostering an environment in which all Americans have the opportunity to pursue the American Dream.

NOW, THEREFORE, I, DONALD J. TRUMP, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim July 26, 2018, as a day in celebration of the 28th Anniversary of the Americans with Disabilities Act. I call upon all Americans to observe this day with appropriate ceremonies and activities that celebrate the contributions of Americans with disabilities and to renew our commitment to achieving the promise of our freedom for all Americans.

IN WITNESS WHEREOF, I have hereunto set my hand this twenty-fifth day of July, in the year of our Lord two thousand eighteen, and of the Independence of the United States of America the two hundred and forty-third.

DONALD J. TRUMP

The Office of Developmental Programs (ODP) Bulletin 00-18-03 describes the functions of the Health Care Quality Units (HCQUs) in Pennsylvania. ODP created the HCQUs due to their commitment to maintain and improve the health of people with IDD or autism living in Pennsylvania, and they are a key component of the states’ Home and Community-Based Services quality management, risk management and mitigation, and training strategies.

All HCQU activity is intended to minimize risk to individual health and wellbeing though proactive and preventive measures. The HCQUs do not provide crisis intervention services or direct health care services, write stakeholder policies and procedures, or conduct incident investigations. The HCQUs do not replace existing community resources. Each HCQU must comply with reporting requirements as per the direction of ODP.

HCQU Functions:

  1. Providing information, referral, training, and/or targeted support to community service providers and Supports Coordinators/Targeted Support Managers in areas such as:
  • Health and wellness, including good nutrition practices in food purchasing and food preparation, physical activity, fall prevention, personal care, sexuality, and mental health;
  • Risk identification and development of mitigation strategies in areas such as medication administration, medication side effects, dementia, dysphagia, bowel obstruction, aging, falls prevention, and safety needs; and
  • Targeted training and technical assistance identified through ODP or Administrative Entity oversight and monitoring.
  1. Providing training for people with I/DD or autism to improve their capacity to maintain good health.
  1. Providing training programs for families caring for individuals at home that include classes, group sessions, or individual consultations, by request.
  1. Collaborating with Administrative Entities by:
  • Supporting activity related to identified health concerns by providing education, technical assistance, and capacity building;
  • Providing assistance, guidance, and support to Supports Coordination Organizations/Supports Coordination Agencies for health-related issues; and
  • Participating on the Administrative Entity quality councils.
  1. Collaborating with community health service organizations to provide information, assistance with understanding the health needs of the ID/D and autism population, and to encourage capacity expansion.
  1. Working in cooperation with ODP to build consistency in the role the HCQUs play throughout the commonwealth, to standardize practices, and to identify health-related issues that ODP should address. HCQUs will assist ODP in the Department of Human Services Medication Administration Program in supporting the content management, planning and training processes.

There are currently eight Health Care Quality Units in Pennsylvania. ODP recognizes the lead Administrative Entity through the regional consortium. Administrative Entities enter into a contractual relationship with an HCQU and are expected to evaluate the performance with an HCQU at all times. The Administrative Entities, in coordination with ODP, are expected to collaborate with HCQUs as appropriate to develop and implement priorities such as quality management activities and behavioral health. If you have any questions, contact Carol Ferenz, RCPA IDD Division Director.

The Office of Developmental Programs (ODP) released ODP Bulletin 00-18-04 today with long awaited guidance for claim documentation and service documentation. In anticipation of new regulatory provisions being promulgated, and in order to respond to providers’ requests for guidance until the final rulemaking is effective, ODP is providing interim guidance to providers of Consolidated, Community Living, and P/FDS Waiver services, as well as Targeted Support Management.

The CMS State Medicaid Manual (2497.2) requires accounting records to be supported by appropriate source documentation and be readily available for audit. There are federal and state requirements that documentation is to be available at the time of claim submission. Providers must maintain the documentation used to generate a claim. If the provider does not have this documentation, the claim is not eligible for Federal Financial Participation (FFP) The required documentation must demonstrate that the service is:

  • Provided to a Medicaid-eligible individual (Medicaid eligibility can be verified by checking the Eligibility Verification System (EVS));
  • Provided by a qualified provider of that service meeting licensing standards;
  • Authorized based on assessed need;
  • Rendered as authorized in the Individual Support Plan (ISP); and
  • Compliant with the Centers for Medicare and Medicaid Services (CMS) State Medicaid Manual, which states that each claim for service must include the following:
  1. Date the service was rendered;
  2. Name of the recipient;
  3. Medicaid identification number, if applicable;
  4. Name of the provider agency and person providing the service;
  5. Nature, extent, or units of service; and
  6. The place(s) the service was rendered.

Pennsylvania requirements in 55 Pa. Code Chapter 1101 specify the documentation requirements for clinical services for the treatment of a medical diagnosis. These requirements must be followed as home and community-based services are covered under the scope of Chapter 1101.

One major component of a claim record is service notes. The provider or common law employer is responsible for ensuring that service notes are completed for each service delivered to an individual. Service notes include information related to the provision of home and community-based services. Service documentation is completed by the person providing the service and is used to record information related to service delivery. The completion of this documentation is typically done during or immediately after the provision of a service.

A service note is to be completed on the day the service is delivered. The provider may choose to enter multiple service notes for multiple services for one individual in the same document or form if all required information is included.

For services that are billed in 15 minute or hour units, a service note is to be completed when services are provided by the same staff person(s) for a continuous span of 15 minute or hour billing units. A continuous span of 15 minute or hour billing units is defined as the uninterrupted provision of a service by the same staff person(s) that is not stopped or discontinued. A new service note must be completed when there is an interruption of service or a change in staff person(s) providing the service within the calendar day.

For services that are billed in day units, a service note must be completed for each day unit that documents the provision of direct or indirect services (such as staff on-call or the use of remote monitoring) for the minimum number of hours required to bill for the day unit. For residential services (Residential Habilitation, Life Sharing and Supported Living) and respite provided in licensed or unlicensed residential settings or other licensed settings (private ICFs/ID, or nursing homes), a service note must be completed for each day unit that documents the provision of at least 8 hours of direct or indirect services. For Respite services provided in private homes that are billed as a day unit, a service note must be completed for each day unit that documents the provision of more than 16 hours of service. When the provider is not rendering direct services to the individual, (the individual is at work, visiting friends, etc.) a new service note is not required to be completed. When there is a change in staff providing a service billed in day units, a new service note is not required when there is a change in the staff providing the service.

The service notes describe service activities and are intended to be an information source to be used by provider staff, the provider, the common law employer or managing employer, and the Supports Coordinator. This information is used to document that the service is being delivered as required in the ISP.

When an individual is self-directing services through the Vendor Fiscal/Employer Agent model, the common law employer is responsible to ensure service notes are completed. The service notes shall be maintained in the individual’s record by the common law employer. When an individual is self-directing services through the Agency with Choice model, the managing employer or the Agency with Choice organization will ensure that service notes are completed. The service notes shall be maintained in the individual’s and Agency with Choice organization’s records.

Supports Coordinators and Targeted Support Managers document service activities that occur with or on behalf of individuals within one business day of the activity. ODP is aware that various methods are used to document these activities such as logs, electronic notes, and recorded documentation completed during service provision and that this documentation is used to complete the Home and Community Services Information System (HCSIS) service notes. Supports Coordination Organizations and TSM providers will continue to complete HCSIS service notes in accordance with ODP guidance and training. Supports Coordinators and Targeted Support Managers have 7 days from the date of contact to enter their service notes into HCSIS.

Some services require progress notes to be completed periodically. Current ODP regulations, 55 Pa. Code § 51.16 (relating to progress notes) describe progress note requirements. Progress notes are typically an assessment written by a program specialist or other provider staff who conduct routine reviews or oversight of staff or during service monitoring. The documentation will indicate whether there has been progress or lack of progress toward the individual’s desired outcomes as stated in the ISP and documentation of restrictive intervention usage as part of the progress notes are to be completed by provider staff. Because a progress note is completed after the provision of services and submission of billing, it is not a requirement for the submission of a claim.

The bulletin provides detailed information regarding the required information necessary for progress notes. The attachment to the bulletin provides interim technical guidance for Claim and Service Documentation by service type and W code.