The Office of Development Programs held a webinar to provide an overview of the Adult Autism Waiver Amendment that went into effect January 1, 2023. The session was recorded and will be available for viewing in the near future. Many of the changes will go into effect six months after the Public Health Emergency and Appendix K flexibilities end. The slides from the session provide clarification regarding Remote Supports, Teleservices and Assistive Technology.
AAW
AAW Amendment Approved by CMS
ODP Announcement 23-008 announces that the amendment to the Adult Autism Waiver (AAW), effective January 1, 2023, was approved by the Centers for Medicare & Medicaid Services (CMS) on January 13, 2023. The amendment to the AAW includes the following substantive changes:
- Adding reserved waiver capacity for individuals who are discharged from a state center or are released from incarceration after a period of at least six consecutive months.
- Aligning of provider qualifications in the AAW with the Consolidated, Community Living, and Person/Family Directed Support (P/FDS) waivers, whenever possible.
- Allowing relatives to deliver the Life Sharing component of the Residential Habilitation service.
- Requiring that agencies that provide Residential Habilitation/Life Sharing be qualified and enrolled to provide Residential Habilitation/Life Sharing in the Consolidated or Community Living waivers.
- Increasing the annual fiscal limit in the Transportation service to $5,000 per participant’s Individual Support Plan (ISP) year.
- Allowing one of the four required individual monitorings conducted by the Supports Coordinator each year to be conducted remotely. NOTE: For all individuals receiving Residential Habilitation (Community Homes or Life Sharing), remote monitorings are not permitted. See ODP Announcement 22-085 for additional information.
- Allowing delivery of direct services using remote technology (teleservices). The requirements in the AAW will become effective when Appendix K flexibilities expire, six months after the expiration of the federal COVID-19 public health emergency.
- Aligning the Assistive Technology service, where possible, with the Consolidated, Community Living, and P/FDS waivers. This includes adding generators for the participant’s primary residence.
- Adding a new service, Remote Supports. A separate communication will be published in the coming weeks, providing instructions about how to add new Remote Supports procedure codes to ISPs. Remote Supports should not be added to ISPs until this communication is published.
The waiver application approved by CMS and the record of change document are available here.
ODP will be holding a webinar to discuss major changes made in the approved AAW amendment. Webinars specific to Remote Supports will be scheduled and communicated in the coming weeks. The date, time, and registration link for the general AAW amendment webinar are as follows:
- February 6, 2023
- 10:00 am – 11:00 am
- Register here
Restrictive Procedures in the Adult Autism Waiver (AAW)
ODP Announcement 22-103 serves to inform Adult Autism Waiver (AAW) providers that there are specific regulations regarding restrictive procedures that must be followed. The Office of Developmental Programs (ODP) has been made aware that some AAW providers are implementing restrictive procedure plans for individuals being served in AAW without a corresponding BSP documented in the ISP in HCSIS. This practice is not allowed.
A restrictive procedure must always be part of the behavioral support component of the ISP as required by the AAW. In the AAW, the BSP is included in the ISP in HCSIS. The Desired Behavioral Outcomes (DBOs) of the BSP must be consistent with the Behavior Support Specialist service goals and objectives.
There must be an active Behavior Support Specialist goal for each DBO, and each Behavior Support Specialist goal must have a DBO. Additionally, every Behavior Support Specialist goal must have a corresponding Goal Attainment Scale (GAS) chart and be reported on at least quarterly in a Quarterly Progress Note (QPN).
To have a restrictive procedure plan in place for an AAW participant, the Behavior Support Specialist service must be in the ISP Service Details so that a BS qualified to provide services in the AAW can develop, implement, and train staff on the participant’s BSP and CIP with the goal of fading all restrictive procedures over time.
In the AAW, the Behavioral Specialist Service (BSS) is not bundled with the Residential Habilitation service as it is with other ODP waivers. Therefore, to meet the requirements above, AAW participants who are receiving residential habilitation services and have a restrictive procedure plan in place must also have active BSS authorized in their ISP. This ensures an AAW qualified BS is working with the participant when a restrictive procedure plan is in place.
Please refer to Chapter 6100 regulations § 6100.341 – 6100.346, Bulletin 00-21-01 Guidance for Human Rights Teams and Human Rights Committees and Attachment 2 — Individual Plans and Informed Consent for additional information. Any questions should be sent to the AAW Provider Support Inbox.
Clarification for SCOs on Resuming SC In-Person Monitorings
ODP Announcement 22-085 announces clarification for Supports Coordination Organizations (SCO) on resuming Waiver and Targeted Support Management (TSM) Supports Coordination (SC) in-person monitoring. Many adjustments have been made to the Office of Developmental Programs (ODP) policy and operations during the COVID-19 pandemic. Appendix K allowed for SC services to be provided remotely during the pandemic. ODP planned to replace the Appendix K guidance with new requirements detailed in the Intellectual Disability and Autism (ID/A) Waiver renewals and the Adult Autism Waiver (AAW) amendment effective July 1, 2022, to allow for some SC individual monitoring to continue to be completed remotely.
Both the ID/A Waiver renewals and the AAW amendment are pending approval with the Centers for Medicare and Medicaid (CMS). Therefore, ODP is issuing guidance to clarify the expected requirements of individual monitorings performed by SCs. This announcement outlines the updated requirements for SC in-person and remote monitoring and obsoletes that section of Appendix K.
ODP expects SCOs that were unable to meet the June 30 deadline for completing the in-person monitoring for at-risk individuals to continue to follow their plan and communicate with the ODP regional office to ensure that all the priority individuals are seen in-person.
This announcement outlines requirements for SCOs to implement no later than October 1. For additional questions, please contact your appropriate ODP regional office.
ODP June External Training and Events Calendar Now Available
Now Available: AAW Amendment Submitted to CMS
ODP Announcement 22-059 informs readers that the Office of Developmental Programs (ODP) is pleased to announce that an amendment to the AAW was submitted to CMS on May 9, 2022. The submitted AAW includes modifications that were made as a result of public comment. The AAW amendment includes the following substantive changes:
- Adding reserved waiver capacity for individuals who are discharged from a state center. Reserved waiver capacity is also being added for participants who have been incarcerated for more than six consecutive months;
- Aligning provider qualifications in the AAW with the Consolidated, Community Living, and Person/Family Directed Support (P/FDS) waivers, whenever possible;
- Allowing relatives to deliver the Life Sharing component of the Residential Habilitation service;
- Requiring that agencies that provide Residential Habilitation/Life Sharing must be qualified and enrolled to provide Residential Habilitation/Life Sharing in the Consolidated or Community Living waivers;
- Increasing the annual fiscal limit in the transportation service to $5,000 per participant’s ISP year;
- Allowing one of the four required monitoring conducted by the Supports Coordinator each year to be conducted remotely;
- Adding a new service, Remote Supports; and
- Delivering direct services using remote technology.
The requirements in the AAW will become effective when Appendix K flexibilities expire, six months after the expiration of the federal COVID-19 public health emergency.
Please note that aligning the Assistive Technology service, where possible, with the Consolidated, Community Living, and P/FDS waivers includes adding generators for the participant’s primary residence.
The full AAW application, as well as a record of substantive changes, is available here.
CMS has 90 days to review the amendment, and changes may occur to the content based upon discussion with CMS during the approval process. The proposed effective date of July 1, 2022, is also subject to change. ODP will inform all stakeholders when CMS has officially approved the AAW and will make the approved waiver available at that time.
Questions about this communication should be directed via email.
AAW Provider Information Table Updated: ODP Announcement 22-038
The Office of Developmental Programs (ODP) has updated the AAW Provider Information Table and published ODP Announcement 22-038 to reflect the April 1, 2022, waiver amendment. Amended sections and new text in the table are highlighted in gray. The updated Provider Information Table includes these highlights:
- Clarification that the waiver cannot be used to fund home accessibility durable medical equipment that is covered under the Medical Assistance State Plan.
- Clarification of delivery of services while the participant is hospitalized. The requirements in the waiver will become effective when Appendix K flexibilities expire, six months after the expiration of the federal COVID-19 public health emergency.
- Extension of timeframes for staff training or credentialing for employment-related service.
- Increase in the threshold for obtaining an independent evaluation for assistive technology devices.
- Clarification on the inclusion of physical restraints in the behavioral support plan.
- Requirements for obtaining criminal history clearances for staff.
- Aligning level of care reevaluation procedures with current practice.
- Other changes designed to align the AAW, where practical, more closely with the Consolidated, Person/Family Directed Support and Community Living waivers.
- Expanded sections on provider qualifications for each service.
Providers are reminded that they are responsible for being aware of any changes to definitions of services they provide and ensuring that individuals furnishing direct services are fully qualified before providing services to AAW participants.
The AAW amendment effective April 1, 2022, is available on the Department of Human Services’ website or here.
Questions or comments about this communication can be sent to ODP via email.
ODP Corrected April External Training Calendar
ARPA Funds and Credentialing Information
April 4, 2022, 1:00 pm–1:30 pm
Audience: Providers
Join Deputy Secretary Kristin Ahrens and Bureau Director of Policy & Quality Management Jeremy Yale to discuss the recent announcement about the ODP American Rescue Plan Act (ARPA) One-Time Supplemental Payment to Address Staff Training, Credentialing, and Business Associates Programs for Employment.
Format: ODP GoTo
Adult Autism Waiver (AAW) Updates
April 11, 2022, 10:00 am–11:30 am
Audience: All Office of Developmental Programs’ (ODP) AAW Providers and Support Coordinators
The purpose of the meeting is to provide updates on the Adult Autism Waiver, answer questions, and provide technical assistance and support. These meetings are held for all ODP providers and Support Coordinators providing AAW services. The Virtual Office Hours (VOH) starts with an overview of any new ODP Announcements and also includes a) highlights of new practices, b) a review of topics and questions sent in advance, and c) a discussion of any concerns that have come up in the past few weeks. Providers will be able to ask questions directly of AAW Regional Office (RO) Representatives.
Format: Columbus GoTo
Statewide Positive Practice Seminar
April 14, 2022, 9:00 am–3:00 pm
Audience: All Stakeholders
You are invited to participate in the Department of Human Services’ (DHS) Office of Mental Health and Substance Abuse Services (OMHSAS) and the Office of Developmental Programs (ODP) Statewide Positive Approaches & Practices Meeting.
TOPIC: Embracing Behavioral Supports and Meaningful Applications — Positive behavioral support is a process that combines evidence-based practices to address behavioral challenges and improve independence, participation, and overall quality of life of individuals living and learning in complex community environments. This session will engage participants to take an active role in behavioral interventions and expand one’s knowledge with principles and practices for dual diagnosed individuals and trauma.
Session #1 — Hard to Tell: What Individuals with Intellectual and Developmental Disabilities Need Us to Know about Trauma and Trauma-Informed Care
Dr. Caren Roser-Morris, Licensed Psychologist, OMHSAS.
Session #2 — The Importance of Quality of Life and Lifestyle Interventions in Behavioral Support
Jordan Hollander, Bureau of Supports for Autism and Special Populations Session
Session #3 — The Power of Collaboration Through Behavioral Assessment and Treatment
Lindy Mishler, Behavior Specialist, Bureau of Support for Autism and Special Populations Stacey Keilman, CEO, Torrance State Hospital.
Format: Columbus GoTo
Charting the Lifecourse Applying Principles and Using Tools to Support a Good Life for Individuals and Families
April 27, 2022, 9:00 am–1:00 pm
Audience: Individuals & Families
“Charting the LifeCourse” was created to help individuals and families of all abilities and all ages develop a vision for a good life, think about what they need to know and do, identify how to find or develop supports, and discover what it takes to live the lives they want to live.
Participants in this training will:
- Learn About the National Charting the LifeCourse Community of Practice;
- Apply LifeCourse Principles and LifeCourse Framework; and
- Practice Using LifeCourse Tools.
Format: Columbus Zoom
Open for Public Comment: Proposed Amendment to the AAW Effective July 1, 2022
ODP Announcement 22-030 shares that the proposed amendment to the Adult Autism Waiver (AAW) is available for public review and comment. There is a 30-day public comment period that starts on March 12, 2022, and ends on April 11, 2022.
The Office of Developmental Programs (ODP) is seeking your valuable feedback and comments. Information regarding the proposed waiver amendment changes, including how to provide comments, can be found in the Pennsylvania Bulletin, Volume 52, Number 11, which was published on Saturday, March 12, 2022. The waiver amendment and the record of change document are available here.
Now Available: Version 3 of the Operational Guide for the AAW During the Federal COVID-19 PHE
ODP Announcement 22-015 announces that the Operational Guide for the Adult Autism Waiver (AAW) has been updated to reflect current guidance from the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid Services (CMS), and the Pennsylvania Department of Health. Additionally, guidance has been added regarding regulatory compliance during the COVID-19 pandemic.
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