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home and community-based services

This morning, the ANCOR Foundation’s Included. Supported. Empowered. campaign, along with their partners at United Cerebral Palsy, released the Case for Inclusion 2020.

The Case for Inclusion 2020 assesses all 50 states and the District of Columbia on 58 measures of how well state programs, primarily Medicaid, are supporting people with intellectual and developmental disabilities. This year’s report finds that although some states are seeing progress in their efforts to promote community inclusion, deeper investments in community-based supports are needed in order for people to live truly inclusive lives.

Among the key highlights of this year’s report, UCP and the ANCOR Foundation find that:

  • The total number of people with I/DD on waiting lists for Home and Community-Based Services (HCBS) increased by 49,000, from 424,000 in the last report to 473,000 in this year’s report. Ten states saw decreases in the number of people on their HCBS waiting lists, while 23 states saw their waiting lists grow.
  • Nationally, the turnover rate for direct support roles was 43.8%. In large part, this can be explained by low median hourly wages for DSPs, which stood at just $12.09 nationally.
  • The percentage of people with I/DD working in integrated employment — meaning they are leveraging supports to work alongside people without disabilities — creeped upward by just one percentage point, from 19% in the Case for Inclusion 2019 to 20% this year. Across the nation, there were 127,000 people with I/DD working in competitive employment, up from 124,000 in last year’s report.
  • There was an increase of two percentage points in the number of people with I/DD engaged in self-direction, from 11% in FY 2017 to 13% in FY 2018.

These high-level findings, along with comprehensive data for all 58 measures, can be found at the Case for Inclusion website.

Senators Portman (R-OH) and Gillibrand (D-NY) have introduced the Senate companion bill of the House’s Isaiah Baker and Margie Harris-Austin Act (HR 5443), called Ensuring Access to Direct Support Professionals Act (S 3220). This would extend reimbursement of Direct Support Professional (DSP) services while a person receiving Home and Community-Based Services (HCBS) is in the hospital. This addresses a longstanding challenge in the 1915(c) HCBS waiver program that prevents individuals with disabilities and seniors who go to the hospital from bringing with them the DSPs who know them best, to provide them with the support they rely on. The legislation brings 1915(c) in line with other HCBS authorities by allowing payment for DSPs to provide personal assistance and other services when the individual they support has a short-term stay in an acute care hospital.

ODP Announcement 19-149 releases data collected from Provider Self-Assessment Reports completed in 2018. The Center for Medicare and Medicaid Services (CMS) implemented a final rule regarding Home and Community-Based Service (HCBS) Settings in 2014. The final rule requires states to assess all residential and non-residential settings which receive funding or payment through an approved HCBS waiver. ODP developed a self-assessment for providers of these services to complete for each location.

In 2018, providers completed the self-assessment of over 6,000 Residential and Non-Residential service locations. The data was analyzed, and two reports were created:

For questions pertaining to these reports, please submit via email.

ODP Announcement 108-18 provides Update 5 regarding HCBS Settings Provider Self-Assessments. As of December 6, 2018, all residential providers were emailed their self-assessment reports and guidance for any needed corrective actions. Providers are encouraged to email here if a report has not been received for a residential service location for which a self-assessment was submitted.

ODP is now working on developing the self-assessment reports and guidance that will be sent to non-residential providers (Community Participation Support and/or Day Habilitation). ODP will start emailing this information to providers on December 31, 2018. It should take about a month for all reports and guidance to be sent for every service location. Non-Residential providers should email this address if a report has not been received by January 31, 2019, for a service location for which a self-assessment was submitted.

On October 1, 2018, ODP contacted residential and non-residential providers for which a self-assessment for an active service location was not submitted and informed them that an onsite assessment would be scheduled. Their current analysis shows four residential service locations and 19 non-residential service locations that meet this criterion. Staff from ODP will be completing the onsite assessments for residential service locations and Administrative Entity staff will be completing the onsite assessments for non-residential service locations. Providers who will receive an onsite assessment should be contacted by staff from ODP or an Administrative Entity soon to discuss and schedule the assessment. It is their goal to complete all onsite assessments by March 31, 2019.

Through the HCBS Settings Provider Self-Assessment process, there have been some frequently asked questions and concerns regarding corrective actions and documentation that ODP wanted to clarify to all providers involved that are addressed in this announcement.

Please be advised that ODP has received a large quantity of emails and phone calls from providers. As a result, it has been taking longer than expected to respond to each provider individually. ODP wants to thank you for your ongoing patience throughout this HCBS Settings Provider Self-Assessment process. For any questions related to this communication, please submit them via email.

ODP Communication Number 088-18 states that since the HCBS Provider Settings Self-Assessments due date of June 12, 2018, ODP staff have been analyzing and reviewing completed self-assessments.  ODP received over 6,518 HCBS Provider Settings Self-Assessments from Residential Providers, as well as over 676 self-assessments from Non-Residential Providers. ODP appreciates the cooperation of all the providers who have completed the self-assessment by the deadline.

ODP staff have been reaching out to providers that did not complete a self-assessment for an active service location, providers who completed a self-assessment but ODP staff could not match it to a service location, or providers who completed multiple self-assessments for one service location.  ODP previously stated that all providers that completed a self-assessment would receive a report by September 30, 2018 that identifies any areas indicated in the self-assessment that require a transition plan.  Due to amount of outreach and analysis needed, ODP needs additional time to create these reports and will send them to providers by October 31, 2018.

Providers for which ODP has no record of receiving a self-assessment for an active service location were emailed on October 1, 2018 to inform them that an on-site inspection would be scheduled.
scheduled.  This aligns with the latest ODP Announcement, Home and Community Based Services (HCBS) Settings Self-Assessment Status Update 1, ODP Communication Number 054-18, which states that service locations for which ODP has not received a completed self-assessment will be deemed non-compliant and will have an on-site inspection scheduled.

For questions related to this communication, please contact RA-OWODPHCBSSETTINGS@pa.gov

The Office of Developmental Programs (ODP) has distributed Announcement 035-18: Home and Community Based Services (HCBS) Settings Self-Assessment Period. Providers of the services listed below are required to complete the online HCBS Provider Self-Assessments in response to the HCBS Settings Rule published by the Centers for Medicare and Medicaid Services (CMS) by 11:59 pm on June 12, 2018. Service locations for which ODP has not received a completed self-assessment will be deemed non-compliant.

  • Community Participation Support in the Consolidated, Person/Family-Directed Support, and/or Community Living Waivers;
  • Day Habilitation in the Adult Autism Waiver and/or Adult Community Autism Program;
  • Residential Habilitation in the Consolidated Waiver and/or Adult Autism Waiver;
  • Life Sharing in the Consolidated and/or Community Living Waivers; and
  • Family Living in the Adult Autism Waiver.

Compliance with the HCBS Settings Rule for service settings for all other ODP Waiver services will be completed through the Quality Assessment and Improvement (QA&I) Process.

The HCBS Settings Rule requires that states assess all residential and non-residential settings which receive funding or payment through an approved HCBS waiver. The intent of the HCBS Settings Rule is to:

  • Ensure individuals receiving HCBS have full access to benefits of community living and the opportunity to receive services in the most integrated setting appropriate;
  • Enhance the quality of HCBS; and
  • Provide protections to participants.

This includes opportunities to seek employment, work in competitive and integrated settings, engage in community life, control personal resources, and receive services in the community to the same degree as people who do not receive HCBS.

Adjustments to these tools were made based on feedback received through the pilot, and also based upon public feedback after the tools were released for public comment February 22 – March 16, 2018. The Provider Self-Assessment will assist in identifying potential areas of non-compliance and allow the provider to develop a corrected action plan outlining how they plan to achieve full compliance. It is important to note that the intent of the self-assessment is not to close or terminate any home or community-based services but instead to enable stakeholders to plan for transition to meet compliance with the Settings Rule.

The following documents have been made available for viewing/download:

Today Governor Wolf announced that the departments of Human Services (DHS) and Community and Economic Development (DCED) are now accepting applications for the Home and Community-Based Services (HCBS) loan program.

The loans are intended to support long-term care providers as they position themselves to successfully transition to managed care in Community HealthChoices, Governor Tom Wolf’s plan to improve the quality of care for seniors and individuals with disabilities through managed long-term services and supports.

“HCBS will allow seniors and individuals living with disabilities to transition from living in long-term care facilities to residing in the community, ensuring that people have choices about where they live and receive services,” Governor Wolf said. “My administration is committed to serving more people in the community – where they want to live.”

It’s expected that loans – for startups, reconfiguration, or expansion – will range from $50,000 to $200,000.

“These loans will support projects that help the Commonwealth to improve the quality of care for seniors and people with disabilities by building infrastructure so individuals will have more choices available to them,” DHS Secretary Ted Dallas said. “Through these funds, individuals will be served in the right setting with the proper amount of services and supports to help all Pennsylvanians live full, independent lives on their own terms.”

DHS can receive loan applications at any time of the year and will process them on a first-come, first-served basis. DCED will then work with DHS to process the loans.

“The collaborative effort necessary to launch this program is a demonstration of our commitment to Governor Wolf’s government that works initiative for a common goal of creating a better Pennsylvania,” said DCED Secretary Dennis Davin, “DCED is proud to be a part of such an important program.”

Visit here for more information on the HCBS loan program, or here (PDF) for the loan application.

On February 23, 2017, the Pennsylvania Department of Health (DOH) released guidance to Home Care Agencies and Registries in follow-up to a policy clarification issued on November 23, 2016 regarding Direct Care Workers Non-Skilled Services in Home and Community-Based Services Settings.

The guidance includes a tool for organizations to use to comply with the Department of Health’s Home Care Agency and Registry regulations. The tool describes the consumer characteristics of individuals who can receive non-skilled activities/services, defined as Specialized Care. In addition, it describes the Home Care Agency/Registry responsibility for training and documentation of the direct care worker’s competency prior to delivering the Specialized Care. The guidance also establishes guidelines for the inclusion of Specialized Care into an individual’s care or service plan. RCPA’s policy statement in support of this clarification and guidance for expanded service options is available here.