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Intellectual & Developmental Disabilities

The American Network of Community Options and Resources (ANCOR) and several state provider associations wrote to Leader Schumer, Leader McConnell, Speaker Pelosi, and Leader McCarthy to urge them to support the inclusion of provisions to strengthen Medicaid disability programs in the jobs and infrastructure package Congress is crafting in response to President Biden’s American Jobs Plan.

The letter states, “We appreciate the hard work Congress put into legislation over the past 13 months to ensure that disability programs can weather the pandemic. To ensure that these programs can come back stronger to meet increased demand after the pandemic, we encourage you to adopt policies that recognize that systems designed to deliver care are as essential as physical infrastructure when rebuilding this nation’s care economy.”

The full letter is available here.

The recording and PowerPoint from today’s Federal Wage and Hour Compliance training is available to members only on our website.

Karen Welton’s contact information is:
Email: Karen Welton 
Phone: 814-769-0839

Fact Sheet #22: Hours Worked Under the Fair Labor Standards Act (FLSA)
This fact sheet provides general information concerning what constitutes compensable time under the FLSA and is available here.

We are grateful to Karen Welton, Tracy Coon, and Michael Shuey for their time and expertise that they shared with us today.

Photo by Markus Winkler on Unsplash

Health Alert Network (HAN) Updates

There has been several HANs that were updated or created last week addressing Long Term Care facilities, which includes ICFs. The DHS guidance for Long Term Care Facilities is going to be updated to reflect the changes outlined in the new HAN guidance. Please begin reviewing, making the necessary changes, and implement the necessary changes to your respective policies and procedures while the DHS guidance is updated.  Please assure that you cross reference the CMS 1135 waiver and CMS regulations to assure compliance with the CMS regulations as well. If you haven’t already, please go to the following link to view the updated HANs:
https://www.health.pa.gov/topics/prep/PA-HAN/Pages/HAN.aspx

The new or updated HANs are as follows:

Decontamination of Masks

Recent guidance from the FDA that recommends the discontinuation of N-95 and KN-95 Respirators.  The link to the guidance is attached.
https://www.fda.gov/medical-devices/letters-health-care-providers/fda-recommends-transition-use-decontaminated-disposable-respirators-letter-health-care-personnel-and

Federal Pharmacy Partnership (FPP)

The FPP is providing ongoing vaccination support for facilities that are enrolled in the program.  This will allow for ongoing vaccination of new staff and residents as well as those that have changed their mind on receiving a vaccine. You will need to contact the person that provided you vaccine support for specific details and availability in your area.

Table Top Exercise

Attached is a copy of the initial outreach and overview of the Emergency Preparedness exercise that Doug Trahey will be leading and spoke about during the most recent ICF taskforce meeting.  If you are interested in participating please reach out to the contact email addressed in the attached letter.  There is a registration deadline of 6/1/21.

Regulatory Surveys

Over the past few months I have seen an increase in the number of citations and 90-day Decertification actions with the public and private ICFs. Please remember and assure that all of the CMS regulations that apply to the ICFs remain in place in original form except those regulations outlined in the 1135 waiver.  The areas of increased citations are as follows:

  • Active treatment – assuring we are providing active treatment, updating plans to assure active treatment is provided
  • Infection Control – assure that we have infection control practices and procedures in place and staff are implementing them as written
  • Investigations – assuring a thorough investigation
  • CPR response – assuring that staff are trained on what they need to do if they have to provide CPR, when to implement and when to cease, and proper location to provide CPR

Effective April 17, 2021, ChildLine has changed the format of the FBI Clearance Result letter. The major change you will observe in the new format is the consolidation of result boxes. Instead of the four checkboxes previously used on the letter, all result letters now display only two boxes and either “ELIGIBLE” or “INELIGIBLE” will be checked.

Any agency that receives these result letters and wishes to verify the validity may contact ChildLine at 717-783-6211 or 877-371-5422. We cannot discuss the specific outcome for the applicant(s) with third parties but can verify receipt of the new letter template.

As always, information regarding clearances and fingerprinting can be found on the DHS website. For further clarification or questions please contact Jim Sharp, RCPA Director of Children’s Policy.

From ANCOR:

Over the past several weeks, we held four focus groups with an array of ANCOR members and State Association representatives. These groups reviewed the draft language for the HCBS Access Act and provided us with a wealth of feedback and comments!

Subsequently, Sarah and Doris worked to compile the comments and drafted a letter to be sent to the relevant Congressional offices.

Thanks to all who helped shape our response. With your assistance, we were able to provide rich comments to the sponsoring offices.

Donna
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Donna Martin
American Network of Community Options and Resources
Alexandria, VA
(401) 965-9411
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Pennsylvanians ages 16 and older who want a vaccine are urged to get one 
Harrisburg, PA – The Wolf administration, in coordination with the COVID-19 Vaccine Joint Task Force, announced today that mitigation orders except masking will be lifted on Memorial Day, Monday, May 31 at 12:01 AM.

The current order requiring Pennsylvanians to wear masks will be lifted when 70% of Pennsylvanians age 18 and older are fully vaccinated. Face coverings are required to be worn indoors and outdoors if you are away from your home. In accordance with the latest Centers for Disease Control and Prevention (CDC) guidance, fully vaccinated Pennsylvanians are not required to wear a mask during certain activities.

“We continue to make significant progress in the fight to stop the spread of COVID-19 and as more Pennsylvania adults get vaccinated and guidance from the CDC evolves, we can continue to move forward with our reopening efforts,” ​Department of Health Acting Secretary Alison Beam said. “I encourage Pennsylvanians to take the critical steps needed to put this pandemic behind us by getting vaccinated, follow through with both doses if you receive the Moderna or Pfizer vaccines, and continue to take steps like masking, frequent hand washing and sanitizing and social distancing.”

Requirements such as testing and reporting ​new cases will remain in place for hospitals and long-term care facilities. Maintaining requirements for hospitals and long-term care facilities wi​ll allow Pennsylvania to continue to closely monitor COVID-19 spread while lifting other restrictions.

The Department of Health recommends that Pennsylvanians refer to CDC guidance and recommendations regarding ongoing COVID-19 safety measures and procedures.

These updates will not prevent municipalities and school districts from ​continuing and implementing stricter mitigation efforts.

“With millions of Pennsylvanians getting vaccinated, it’s time to plan the transition back to normal,” said Sen. Art Haywood. “Hospitalizations and deaths are down. This action today is a key step forward.”

“While the restrictions that were put in place at the outset of the pandemic have been a major source of frustration for many Pennsylvanians and businesses, it is the collaborative work of this bipartisan Task Force that is allowing us to finally roll back the restrictions and get back to normal life,” said Sen. Ryan Aument.

“I’m thrilled after more than a year that we are able to lift these restrictions so that we can move to more normal life,” said Rep. Tim O’Neal. “This will help grow our economy and assist our small businesses that have sacrificed so much due to COVID-19. Thank you to Pennsylvanians who have chosen to be vaccinated. Your efforts have helped us arrive at today.”

“I am proud of the progress we have made with vaccinations throughout Pennsylvania,” said Rep. Bridget Kosierowski. “Lifting mitigation orders on Memorial Day and announcing that masking orders will be lifted once 70 percent of Pennsylvania’s adults are fully vaccinated are all benefits from following the scientific medical research and data. Many sacrifices had been made over the past year while we waited for help. The help is now here in the form of a vaccine and we must do everything we can to encourage everyone to receive their vaccination so we can overcome this pandemic. Let’s follow the science, because it’s the path to us all returning to normalcy.”

The governor’s Proclamation of Disaster Emergency for the COVID-19 pandemic remains in place.

All Pennsylvanians ages 16 and older are eligible to schedule a COVID-19 vaccine. The provider map is available on the Department of Health’s website. Pennsylvanians with questions about the vaccination process can call the Department of Health hotline at 1-877-724-3258.

More information is available on the COVID-19 Data Dashboard.

MEDIA CONTACT:  Barry Ciccocioppo

Image by StockSnap from Pixabay

During the May 4, 2021 Managed Long-Term Services and Supports (MLTSS) Subcommittee meeting, the following documents were shared with attendees. The primary focus of this meeting was on stakeholder experiences with COVID-19 with the Community HealthChoices (CHC) Managed Care Organizations (MCOs).

Erie Times — News

It was 9:30 a.m. and Eric Shull, wearing a face mask and a blue T-shirt, was focused on his work as he sat at a table at Vallonia Industries in Meadville.

One at a time, he tore small stickers — each hiding an anti-theft device inside — off a sheet and stuck them to a piece of cardboard. Each piece of cardboard will be used in the packaging of Channellock pliers, made a few blocks away in Meadville.

Shull and the other employees, most of whom have intellectual disabilities, are paid a piece rate based on how many stickers an average person could attach in an hour.

At a rate of 1.5 cents per sticker, Vallonia calculates a typical worker would earn more than $10 an hour for this job.

Some employees — Vallonia CEO Diana Walters calls them individuals — move quickly and can earn minimum wage, or even more than the $10 an hour assigned to the Channellock job.

For others who attach fewer stickers or pack a modest number of plastic straws into souvenir cups during a six-hour shift, wages could be just a couple of dollars an hour, or even less.

None of the wages are based on working at warp speed. Time studies factor in a fatigue factor, Walters said.

At Vallonia, which provides supportive employment services and training, the job is a chance to be part of the wheels of commerce, to feel like everyone else, Walters said.

“Payday is the best day in the world,” she said. “They come up and say, ‘Look what I did.’ Some people do only a few pieces a day. But that’s OK. They are safe and they are still learning.”

Shull, like most of the nearly 100 clients at Vallonia, receives Social Security that covers most of his expenses. But the 63-year-old Crawford County man still looks forward to being paid. His top priority is buying treats and toys for his dog Daisy, he said.

But there is also an incentive for him to not make too much money. He risks losing his free medical benefits if he makes too much money, Walters said.

Aside from the work that takes place five days a week at the Vallonia building on West Poplar Street, Walters said the agency uses job coaches to place some of its clients in traditional jobs in the community.

Some are successful. Some are not. She mentions a Vallonia client who was placed in a job at a fast-food restaurant. She came back when she felt like she didn’t fit in.

The right to pay less than the minimum wage comes from Section 14(c) of the Fair Labor Standards Act, which allows employers to pay less than the federal minimum wage to workers who have disabilities.

This system tells Americans with disabilities and their families that they are not worth the same as other Americans.

The 14(c) program has its critics, including President Joe Biden, who has called for the elimination of the subminimum wage as part of the $1.9 trillion American Rescue Plan.

There has been some support for the change on both sides of the political aisle.

Former Gov. Tom Ridge is among those who think it’s time to eliminate the provision that allows people with disabilities to be paid less than the minimum wage.

Ridge, chairman of the National Organization on Disability, explained his position in a February opinion column for USA Today.

“This system tells Americans with disabilities and their families that they are not worth the same as other Americans, that society values them and their labor less,” Ridge wrote.

Ridge, who represented Erie during six terms in the House of Representatives, continued: “In 1938, when the FLSA legislation was passed, it was assumed that a worker with a disability was less productive than a non-disabled worker. In retrospect, it was a flawed assumption.

“Nearly a century later, however, the law still contains Section 14(c). Now we know that workers with disabilities, given equal opportunity and appropriate tools or technologies, can perform as well as their non-disabled counterparts. This has been reaffirmed in the past year with so many of us working successfully from home, something people with disabilities have argued they could have been doing all along. ”

Ridge is not alone.

In February 2019, Sen. Bob Casey, a Pennsylvania Democrat, introduced legislation that would “end subminimum wage certificates for individuals with disabilities to provide opportunities… to be competitively employed, taxpaying citizens and participate more fully in their communities.”

Well-intentioned, but wrong?

Walters said she doesn’t question the motives of those who would eliminate the 14(c) waiver, which enables Vallonia to provide jobs for people who might be unable to do those jobs at a normal pace in a typical setting.

She thinks their hearts are in the right place. But in many cases, she thinks opponents of the subminimum wage are simply wrong.

The reality is that many at Vallonia would not have jobs in the outside world, she said.

Some are nonverbal. Others have physical impairments that affect their dexterity. Some have mental health concerns. Some move slowly.

Vallonia serves as a facilitator, providing the professional staff who oversee the work and provide training. The nonprofit, which was closed for months during the COVID-19 pandemic, is paid with federal funds administered by the state Department of Welfare, which provides up to $33,000 a year of so-called waiver money for each person.

In exchange for transportation and professional staff — who facilitate or even complete work done by the individuals — Vallonia receives $2.27 for every 15 minutes spent with a client. Walters said that job coaching, by comparison, can cost more than $17 for a 15-minute period.

People with intellectual disabilities come in all shapes and sizes. While some work successfully in the community, many of Vallonia’s clients would be unable to hold down jobs in a community setting, Walters said.

Tina Burke, a professional employee of Vallonia, shares that view.

Burke, who drives a transport van for clients, spent a recent morning working across the table from Nathan Kossef. Dexterity issues don’t allow him to peel off stickers and attach them to the piece of cardboard. So Burke does the peeling and the sticking, allowing him to flip each card over and place them in a stack.

He’s paid as if he was doing the job himself, something that’s unlikely to happen if regulations required that he be paid the full minimum wage.

Burke said she’s happy to facilitate, happy to be part of a process that earns Kosseff a check and a sense of satisfaction.

“The places we do work for, they are not going to pay our individuals $12 an hour. They are not going to do it,” she said.

Higher wages can mean higher demands. Burke, the mother of two autistic sons, knows that what’s possible for one might not be possible for another.

One of her sons went to college and is living and working in Pittsburgh.

Her other son, Kevin Burke, is smart, talented, a high school graduate and a great cook. But until recently, autism had stood in the way of his employment.

Before a grant was approved for him to go to Vallonia about a year ago, Burke tried for several years to find her son a job through a program that provided job coaching.

“It is very hard for individuals to get jobs in Crawford once you tell them that he has autism and a seizure disorder and that he does not drive,” she said.

She continued: “It’s hard to get them employment. He went on several interviews and they made him feel like they were going to hire him.”

They never did.

He’s happier now, she said.

“Kevin likes his money, but it’s not about the money,” Tina Burke said. “He has a place to go every day.”

Kevin Burke, who was working on a recent Wednesday to assemble plastic inserts for a fire helmet, said he enjoys video games, cooking dinner for his parents — especially chili that’s tasty but not too hot — and talking with them about his day.

It’s the sort of ordinary day that is the goal at Vallonia and sheltered workshops across the country, Walters said.

“Our goal is to help every individual have an everyday life,” she said.

For Tanner Hollabaugh, that means mixing a good bit of social banter with his work, flexing his muscles when a camera appears and breaking into a dramatic verse or two of opera.

For Gregory Cornwell, that everyday life is built on chatting with friends and a predictable routine. Cornwell, 57, has been coming to Vallonia for 27 years and is quick to share the exact day, month and year that he started.

“It’s a nice place to work,” he said.

Walters said many of their clients feel that way.

“One of our board members says this is the happiest place on Earth,” she said.

However, not everyone buys into this concept of “an everyday life” at the expense of what they consider a fair wage. Many look forward to the elimination of the subminimum wage.

Walters, meanwhile, worries about the unintended consequences that could eliminate jobs at Vallonia and places like it. What others see as progress she sees as a threat to a place that brings purpose to the lives of her clients.

She doesn’t expect the status quo to be disrupted overnight.

“But I think the threat is pretty serious,” she said.