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community living waiver

ODP Announcement 19-126 provides information regarding the Adult Autism Waiver Amendment webinar recording that is now available. This webinar discussed the proposed amendment to the Adult Autism Waiver and obtained public comment on the proposed changes. This webinar was held on September 16, 2019. The webinar was recorded and is now available online along with the PowerPoint presentation. You may find this link on MyODP.org by following this path:

Resources > ODP Information > Waiver Renewals & Amendments > Proposed AAW Amendments

The waiver amendment is also accessible online. An online document containing a side-by-side comparison of the waiver in its previous and amended forms is available.

Questions about this communication should be directed to this email.

ODP Announcement 19-130 serves to announce that the amendments to the ID/A waivers communicated in ODP Announcement 19-102 were approved by CMS on September 24, 2019. These  amendments were submitted to CMS on July 19, 2019. Since that time, ODP has been engaged in ongoing discussions with CMS. One substantive change was made as follows, to allow indirect activities to be rendered on behalf of an individual as part of the Housing Transition and Tenancy Sustaining Service in all ID/A waivers based on those discussions:

Housing Transition services are direct and indirect services provided to participants. Indirect activities that cannot be billed include driving to appointments, completing service notes and progress notes, and exploring resources and developing relationships that are not specific to a participant’s needs as these activities are included in the rate. The following direct and indirect activities are billable under Housing Transition:

  • Conducting a tenant screening and housing assessment that identifies the participant’s preferences and barriers related to successful tenancy. The assessment may include collecting information on potential housing transition barriers, and identification of housing retention barriers… (There was no change to the list of activities covered under Housing Transition. Please see the service definition for the full list of activities).

Each full waiver application approved by CMS is available as follows:

Questions about this communication should be directed to the appropriate Office of Developmental Programs Regional Office.

ODP Announcement 19-102 provides information regarding the amendments submitted to the Centers for Medicare and Medicaid Services (CMS) regarding the Consolidated, Community Living, and P/FDS waivers. It is anticipated that the amendments will become effective October 1, 2019.

CMS has 90 days to review the amendments and changes may occur to the content based upon discussion with CMS during the approval process. Each full waiver application, as well as a side-by-side of substantive changes made as a result of public comment is available online here.

The amendments align with 55 Pa. Code Chapter 6100 regulations when effective, ensure compliance with the Home and Community-Based Settings regulations, and align with the Office of Developmental Programs’ Everyday Lives recommendations.

The amendments include a plan to serve medically complex children in a community home when transitioning from an extended hospital stay if they are unable to return to their family home. Also, the scope of professionals who can diagnose intellectual disability has been expanded.

ODP is adding the expectation that all providers of Community Participation Support services must offer individuals opportunities to participate in community activities that are consistent with the individual’s preferences, choices, and interests. On-call and remote support is proposed in order to support the fading of service and dependence on paid staff. The number of procedure codes and staffing levels has been decreased to more accurately reflect service delivery.

Starting January 1, 2022, CPS services may not be provided in any facility required to hold a 2380 or 2390 license that serves more than 150 individuals at any one time, including individuals funded through any source. All participants receiving prevocational services must have a competitive integrated employment outcome included in their service plan. There must be documentation in the service plan regarding how and when the provision of prevocational services is expected to lead to competitive integrated employment. CPS may not be provided in newly funded (on or after January 1, 2020) licensed 2380 or 2390 locations which serve more than 25 individuals in the facility at any one time.

Residential Habilitation, Life Sharing, and Supported Living Services will be required to utilize the recommendations provided in the Health Risk Screening Tool. SCs will be expected to monitor the implementation of the recommendations and incorporate them into the Individual’s Plan. Also, clarification is provided regarding the location parameters for newly funded sites.

ODP is proposing that respite can be provided by nurses for children with medical needs to assure the appropriate level of care is available.

Qualifications required for Support Service Professionals, Individuals, and Agency Providers have been clarified, including timelines for completion of certification requirements. Additionally, supported employment can be provided to individuals until OVR services are available, particularly when OVR has established a waiting list.

For a side-by-side comparison of substantive changes made as a result of public comment, see this online document. Questions about this communication should be directed to the appropriate ODP Regional Office.

ODP Announcement 19-066 serves as notice of the opportunity for public comment on proposed changes to the Consolidated, P/FDS, and Community Living Waivers. These changes (referred to as waiver amendments) are anticipated to be effective on October 1, 2019. As part of this process, ODP is seeking your valuable feedback and comments on the proposed waiver amendments. There is a 30-day public comment period that began on June 8, 2019 and ends on July 8, 2019.

Whenever substantive changes are made to an approved waiver, ODP must submit an amendment to the Centers for Medicare and Medicaid Services (CMS) for approval. ODP proposes to amend the Consolidated, P/FDS, and Community Living Waivers as follows:

  • Increase the number of individuals served in the Consolidated and Community Living waivers as provided for in the Governor’s proposed budget to support more people in the community.
  • Add planning requirements for Administrative Entities to address access to needed waiver services upon graduation to individuals who will graduate from special education and who are not eligible to continue their education through the next year.
  • Provide for support of children with medical needs who transition from a facility that does not meet waiver home and community-based settings requirements to live with their families or, if living with their family is not possible, in the home of another nurturing caregiver.
  • Increase community participation of waiver participants through changes in service definitions, such as the addition of an on-call and remote support component to the Community Participation Support service and clarification as to where newly enrolled licensed facilities can be located.
  • Increase competitive integrated employment of waiver participants by allowing Supported Employment services to be provided when a waiver participant has received an offer of competitive integrated employment and the Office of Vocational Rehabilitation (OVR) has not made an eligibility determination at that time and by clarifying where Advanced Supported Employment services can be provided.
  • Develop and support qualified staff by extending the timeframe by which requirements for employment credentials or certificates must be obtained to July 1, 2019 for Supported Employment, Small Group Employment, and the prevocational component of the Community Participation Support service.
  • Promote health, wellness, and safety by clarifying that Supports Coordinators should review information in health risk screening tools when applicable and determine whether there have been any changes in orders, plans, or medical interventions prescribed or recommended by medical or behavioral professionals when Supports Coordinators monitor a waiver participant’s health and safety, and develop Individual Support Plans (ISPs).
  • Clarify the role direct service professionals perform through Communication Specialist services.

The proposed amendments to the Consolidated, P/FDS, and Community Living Waivers effective October 1, 2019 are available here.

Information regarding the proposed waiver amendment changes, including how to provide comments, can be found in the Pennsylvania Bulletin, Volume 49, Number 23, published on Saturday, June 8, 2019.

Comments received by 11:59 pm on July 8, 2019 will be reviewed and considered for revisions to the waiver amendments submitted to CMS.

Comments should be addressed to Julie Mochon, Department of Human Services, Office of Developmental Programs, 625 Forster Street, Room 510, Harrisburg, PA 17120. Comments may also be submitted to ODP at this email.

ODP will also hold two webinars to receive comments on the proposed waiver amendments. Dates, times, and links for registration to attend these webinars are as follows:

  • Thursday, June 20, 2019, 1:00 pm to 3:00 pm
  • Monday, June 24, 2019, 10:00 am to 12:00 pm

Register for webinars using this link. Questions about this communication should be submitted via email.

The Office of Developmental Programs issued ODP Communication Number 102-18 announcing delays in two areas that were scheduled to go into effect for ODP Waiver programs. Amendments to the Consolidated, P/FDS, and Community Living Waivers were recently approved by the Centers for Medicare and Medicaid Services (CMS) effective November 1, 2018. This communication is regarding the following two changes in the amendments that were scheduled to take effect on January 1, 2019:

  1. Transportation Trip was to transition from a cost-based rate to a fee schedule rate

Implementation of the changes to Transportation Trip will be delayed until July 1, 2019. This delay includes all of the following changes associated with transitioning Transportation Trip from a cost-based service to a fee schedule service:

  • Changes to the number of miles covered in each zone designation;
  • Expanding the service to be provided by relatives, legal guardians, and Organized Health Care Delivery Systems; and
  • Expanding the service to be self-directed through the Agency With Choice or Vendor  Fiscal/Employer Agent participant-directed services models.

These changes are not to be included in a person’s Individual Support Plan effective January 1, 2019. ODP has submitted an amendment to CMS to maintain the Transportation Trip service definition and cost-based rate methodology in its current approved state with no changes effective January 1, 2019.

  1. As part of qualification requirements, staff were to complete the Certified Employment Support Professional (CESP) credential, Basic Employment Services Certificate of Achievement or a Professional Certificate of Achievement in Employment Services certification for certain employment services and components of Community Participation Support.

ODP has received feedback that providers are struggling to have all required staff complete the Basic Employment Services Certificate of Achievement or Professional Certificate of Achievement in Employment Services prior to the pending January 1, 2019 deadline. As a result, the requirement for staff to have one of those qualifications will be delayed until July 1, 2019.

It is imperative that all impacted providers and common law employers that have staff who are required to have one of these employment credentials or certificates start the process now if they have not already done so. There will be no further delays granted in implementation of this qualification criteria.

ODP is drafting another set of amendments to the Consolidated, P/FDS, and Community Living Waivers that will be effective July 1, 2019. Both the changes to transition Transportation Trip to a fee schedule rate and the delay of the qualification criteria regarding employment credentials and certificates discussed in this communication will be included in those amendments with other proposed changes. ODP anticipates that the proposed amendments will be released for public comment in February or March of 2019.

All other changes contained in the waiver amendments effective November 1, 2018 remain effective and must be followed. The current approved waivers can be accessed here.

Contact RCPA IDD Division Director Carol Ferenz with questions.

ODP issued Communication Number 099-18: Requesting an Enhanced Communication Rate for Services for Individuals Who Use Sign Language. This communication provides a process for providers to request an enhanced communication rate for Consolidated, Person/Family-Directed Support (P/FDS), and Community Living Waiver services for individuals who use Sign Language to communicate. The Harry M settlement agreement was approved by a federal court judge on August 20, 2013 to ensure Pennsylvanians are provided with necessary communication assistance services based on their assessed needs. The enhanced communication rate is available for services for individuals who are enrolled in the Consolidated, P/FDS, and Community Living waiver from providers who have signing staff to serve individuals who use Sign Language to communicate.

An enhanced communication rate is available for the following services:

  • Companion Services
  • In-Home and Community Supports
  • Older Adult Daily Living Centers
  • Community Participant Support (CPS)
  • Small Group Employment
  • Benefits Counseling
  • Supported Employment to include: Career Assessment, Job Finding and Development, Job Coaching and Support
  • Advanced Supported Employment to include: Discovery Profile Outcome, Job Acquisition Outcome, Job Retention Outcome
  • Respite
  • Supports Broker Services
  • Housing Transition and Tenancy Sustaining
  • Residential Habilitation
  • Shift Nursing RN
  • Shift Nursing LPN
  • Behavioral Supports
  • Communication Specialist
  • Therapies to include: Physical, Occupational, Speech/Language, Orientation, Mobility, and Vision
  • Music Therapy
  • Art Therapy
  • Equine Assisted Therapy
  • Consultative Nutritional Services
  • Family Caregiver Support Counseling (with participant present)
  • Supplemental Habilitation
  • Supported Living
  • Life Sharing

Providers who wish to request an enhanced communication rate must complete the Enhanced Communication Rate Request Form and submit the completed form to: ODP’s Deaf Services Mailbox. The Enhanced Communication Rate Request Form can be accessed at MyODP.

The following documentation must be provided in addition to the form:

  • Certificates of completion for the Harry M web-based training
  • Quiz on Harry M training (sent to the provider once the request for the enhanced rate is made)
  • Video of signing skills (sent to the provider once the request for the enhanced rate is made)

Following receipt of a provider’s request, ODP will review the information submitted and determine whether the provider is eligible for the enhanced communication rate. The provider will be notified of ODP’s decision following the review. If additional information or discussion concerning the request is required, ODP will reach out to the contact persons identified on the Enhanced Communication Rate Request Form.

Questions about the contents of this communication may be directed to the ODP Deaf Services Mailbox. This communication obsoletes ODP Announcement 002-17, Requesting Enhanced Communication Residential Habilitation Rates for Harry M Class Members.

ODP Announcement 098-18 announces availability of the recording of the webinar regarding the Consolidated, Community Living, and P/FDS Waiver amendments effective November 1, 2018. The Office of Developmental Programs (ODP) held two webinars to discuss the changes made to the waiver amendments as a result of public comment and ODP review. These webinars were held on October 17 and October 23, 2018. The session on October 23 was recorded and is now available online along with the PowerPoint presentation used at the sessions.

The waiver amendments are also accessible online. An online document containing a side-by-side comparison of the waiver in its previous and amended form is available. Contact Carol Ferenz, RCPA IDD Division Director, with questions.

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.

The Office of Developmental Programs (ODP) has issued updated provider agreements that must be completed and returned to ODP by May 1. All providers of Waiver Services in Pennsylvania, including Supports Coordination Organizations (SCO) and Agency With Choice (AWC), must sign and return the ODP IDA Waiver Provider Agreement. Each waiver provider only needs to submit one provider agreement for the legal entity, regardless of the number of services provided or the number of service locations operated by the legal entity.

The provider agreement is essentially the same as the current agreement with the addition of the Community Living Waiver, with an effective date of January 1, 2018, and the addition of condition number two. Condition number two states that the provider agrees “To comply with the approved waiver; including all standards enumerated in the service definition(s) which the Waiver Provider will be rendering, provider qualification requirements and other requirements established by the Department as outlined in the approved waivers.” The letter that was sent to providers from Deputy Secretary Nancy Thaler can be found here.

The Office of Developmental Programs (ODP) has announced that a change will be made in the Community Living Waiver regarding an 18 month limitation on vocational skill development in the Community Participation Support service definition. Currently, the Community Living Waiver service definition specifies that the vocational skill development activities could not be authorized for more than 18 months. After further consultation with stakeholders, ODP has determined that they will not implement this requirement. In the near future, ODP will be issuing a waiver amendment for public comment, and this change will be a part of the amendment. The announcement is available here.