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home and community-based services

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.

The Office of Long-Term Living (OLTL) has announced changes that are being made to the enrollment process for Home and Community-based Services (HCBS), including the Aging Waiver, Attendance Care Waiver, CommCare Waiver, Independence Waiver, OBRA Waiver, and Act 150 Program. Effective Tuesday, March 1, 2016, OLTL will enter into a new contract with MAXIMUS, the PA Independent Enrollment Broker (IEB). According to OLTL, the adjustments being made and expectations regarding this new contract will streamline the enrollment process, as well as ensure consistency across all home and community-based programs, in anticipation of the roll-out of Community HealthChoices (CHC), a Managed Long-Term Services and Supports program for older Pennsylvanians and adults with physical disabilities. CHC will move the Commonwealth’s home and community-based waiver system from fee-for service to a capitated Medicaid managed long-term services and supports delivery system. The changes OLTL is making to the enrollment process support the Commonwealth’s efforts to ensure that the enrollment process is conflict free, strengthening necessary firewalls between enrollment in services and the provision of ongoing service coordination and other services.

Changes made to improve the IEB process:

  • The enrollment timeframe requirement has been reduced from 90 days to 60 days. This change is effective March 1, 2016.
  • The IEB will assume the Aging Waiver enrollment process effective April 1, 2016.
  • Enrollments that are already in process before April 1 will remain the responsibility of the Area Agency on Aging. Aging Waiver applications initiated prior to April 1 must be completed by the AAA prior to June 30. Applications still pending on June 30 will revert to Maximus for completion. OLTL will provide additional information on this process in an upcoming webinar.
  • These changes, which affect all OLTL Home- and Community-Based Programs – Aging, Attendant Care, CommCare, Independence, OBRA and the Act 150 program administered through the Office of Long-Term Living – will be completed by the PA Independent Enrollment Broker (IEB), Maximus.

The tasks completed by the IEB (Maximus) include the following:

  • Coordinate with the County Assistance Office to ensure timely completion of the PA 600L Medical Assistance Applications.
  • Coordinate with the Area Agency on Aging to ensure timely completion of the Clinical Eligibility Determination (formerly known as the Level of Care Determination). Complete in-home visit with applicant to gather information for enrollment.
  • Complete the Program Eligibility Determination.
  • Provide applicant with choice of Service Coordination provider.
  • Enroll applicant in waiver upon receipt of PA 162.
  • Transfer record and enrollment documentation to the selected Service Coordination agency.

If you have any questions, please contact Amy High, Office of Long-Term Living, Bureau of Participant Operations, at 717-787-8091.