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Office of Developmental Programs

November 15 is Pressure Injury Prevention Day. ODP Medical Director Dr. Gregory Cherpes, MD released a Health Alert with important information for those who provide care to individuals at risk of developing pressure injuries.

The skin is the largest organ of the body. Skin protects the body by creating a barrier to the environment, regulates the body’s temperature, supports peripheral circulation, and helps maintain fluid balance. Skin also is a reservoir for the formation of Vitamin D. The nerves in the skin provide sensations that detect changes in the environment such as heat, cold, touch, and pain. The skin is made of two layers, the epidermis and dermis, which cover the underlying tissues, muscles, and bones. “Skin integrity” refers to the intact, unbroken nature of healthy skin. Open wounds to the skin, such as those that occur with pressure injuries, make an individual more vulnerable to infection, sickness, and death.

This document provides information defining pressure injuries, why prevention is important, who is at risk of developing pressure injuries, signs and stages, treatment, and prevention of these injuries.

Due to the serious nature of pressure injuries, the pain associated with these injuries, and the additional conditions that may result from pressure injuries, prevention and immediate action at the first sign of pressure injuries are of utmost importance. In addition to skin, muscle, and bone loss, bacteria entering the sore can cause infection. In some cases, infection in the tissue can lead to bone infection, also called osteomyelitis. Infections can worsen and result in sepsis (when infection enters the blood), which can lead to shock and even death.

IMPORTANT: Notify the health care practitioner (HCP) if there are concerns for a pressure wound. Because pressure injuries can have many different appearances, the HCP should be alerted to any skin changes that are noted, particularly in areas at risk for pressure injury. Notify the HCP at the first sign of redness that does not resolve within 15 minutes after relieving the pressure.

The Office of Developmental Programs (ODP) has released Communication Number 095-18 with updated Questions and Answers regarding the Community Participation Supports (CPS) Service. The first Q&A documentation 066-17 published in June 2017 is now obsolete. This document covers a variety of situations submitted to ODP from providers of service who have been implementing Community Participation Supports (CPS) and encountering questions such as use of SE modifier, billing practices, variances for individuals who will not meet the goal of 25% community time, how CPS differs from other waiver services, transportation issues, and how to calculate the percentage of time in the community.

The concern regarding some providers not meeting the requirement that at least 25% of individuals’ time is spent participating in community activities, excluding variances as averaged over a year’s time, is addressed — ODP will request a plan for coming into compliance from the agency who has not met this requirement. All waiver settings must meet the federal HCBS settings rule standards no later than March 2022. The 25%+ requirement is one of the objective measures in Pennsylvania’s assurances that prevocational and adult training facilities are compliant with the rule.

In total, there are fifty questions addressed in the Question and Answer Document, Version 2 Updated 10/19/18 that will serve as guidance to providers of service. Contact RCPA IDD Division Director Carol Ferenz with questions.

Temple University’s Institute on Protective Services is the entity contracted to deliver the ODP Certified Investigators (CI) Program. ODP and Temple University are conducting Certified Investigator Forums, which provide an opportunity for current Certified Investigators and other interested parties to receive up to date information about the Investigatory Process. This call will also allow participants to network, share best practices, and receive technical assistance in an effort to improve the quality of all investigations.

The next session is scheduled for Friday, November 2, 2018 — there will be two sessions available during the day. If desired, participants may register for both sessions. CI program updates will be the same but other content will be dependent on participant inquiries. Participants can submit questions prior to the session via email. For instructions on registering for the call, see ODP Communication Number 094-18.

ODP Communication Number 089-18 invites People with Disabilities, Family Members, Supports Coordinators (SCs) and SC Supervisors, Provider Staff, Administrative Entity Staff, and Organizational Leadership to participate in ODP-approved Dual Diagnosis Training curriculum.  The Dual Diagnosis Curriculum is part of a joint initiative of The Commonwealth of Pennsylvania, Office of Mental Health and Substance Abuse Services (OMHSAS) and ODP to address the needs of people who have an intellectual disability as well as mental health challenges.

The statewide Residential Strategic Thinking Workgroup, Regional Clinical Directors and Benjamin Settlement implementation leads have recommended that this training be broadly available in order to ensure that the ODP stakeholder community is more knowledgeable and equipped to meet the needs of individuals and ensure ongoing health and safety. This training is now also required for newly enrolled Residential Habilitation providers in order to expand the clinical capacity of community providers.

ODP Announcement Number 091-18 informs stakeholders that an additional Waiver Amendment Webinar has been scheduled in order to accommodate the amount of interested parties requesting attendance in the first webinar that was announced for October 17,2018.  Due to that session being full, a second session will now be available on Tuesday, October 23, 2018 2:00 pm to 4:00 pm.  Use this link to register.

Contact Carol Ferenz, RCPA IDD Division Director, with any questions.

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 issued Announcement 090-18:  College of Employment Services ACRE Update – Unlimited Seats Available today.  This certification is available to providers of the following employment services under ODP and or Autism (ID/A) waivers, including the Consolidated, Person/Family Directed Support (P/FDS), and Community Living Waivers; as well as Base-Funded services:

  • Supported Employment – Support Service Professionals under the Agency with Choice (AWC) Financial Management Service (FMS) and Vendor Fiscal/Employer Agent (VF/EA) FMS Models; Individual Providers, and Agency Staff
  • Small group employment – Agency Staff
  • Community Participation Support – Prevocational Services Component – Program Specialists and Supervisors of Direct Support Professionals

In order to obtain the complete ACRE Basic Certificate of Achievement, the participant must complete both Part 1 and Part 2 of the CES Certified Training.  There continues to be a discounted cost available through December 31, 2018.

The Office of Developmental Programs (ODP) recently organized a small work group to develop a “simplified rate structure” for the Community Participation Service. Kristin Ahrens and Rick Smith from ODP met with the representative providers who were invited to participate on this work group earlier this week. The first item of business was to review the Proposed Rate Structure Chart that was originally developed by RCPA’s work group, which met in April and May of this year with the intention to make solid recommendations for improvement in the implementation of this service. The stakeholders that participated in the work group all agreed that this proposed structure would be a great improvement in the method utilized to properly bill for services, and to calculate community percentages. A few representatives of RCPA’s committee presented our proposal to ODP staff in June. We are very pleased that our recommendations have been considered for implementation.

The ODP work group is also reviewing the budget assumptions that were utilized to build the rates for FY 18/19. There are concerns that the assumptions utilized do not accurately represent actual costs realized by providers. It is likely that ODP will be requesting updated information from providers in the near future via a survey, in order to obtain more accurate information, particularly regarding staff salary and benefit expenses.

As ODP works on restructuring the rates, the end result will be expected to be budget neutral. The hope is to have the new plan implemented in July 2019 for fiscal year 19/20. As we learn more about the progress of the work group, we will keep members up to date.

Thank you to all who participated in the RCPA Community Participation Work Group meetings; it is rewarding to see that our efforts have made a positive impact in our system. For more information contact Carol Ferenz, RCPA IDD Division Director.

Today the long awaited Chapter 6100 regulation package has been sent in final form to the Independent Regulatory Review Commission (IRRC). It is anticipated that an IRRC public meeting for the regulation package will be held on October 18, 2018. Everyone that commented is receiving a copy either via email or hard copy; also the whole regulatory package can be accessed here. This should also be posted on the IRRC website sometime next week.

Here are some tips for reading the regulations:

Chapter 6100 — underlines are the additions from the proposed rulemaking; [brackets] are the deletions from the proposed rulemaking.

Chapters 2380, 2390, 6400, 6500 — (four codes appear) underlines are the proposed additions from the current regulation; [brackets] are the proposed deletions from the current regulation; UPPERCASES are the final additions from the proposed rulemaking; strikethroughs are the final deletions from the proposed rulemaking.

We plan to have an opportunity to review the regulation package with ODP representatives at our upcoming IDD Division meeting on September 13.
Contact Carol Ferenz, RCPA IDD Division Director, with any questions.

The Office of Developmental Programs (ODP) will be performing an automated data fix to adjust service segments (i.e. split service authorizations) on all applicable FY 2018/19 plans to account for the new VF/EA FMS organization, Palco, Inc. After the data fix and once notified that the participant has transitioned to Palco, Inc., AEs and SCOs should review each impacted ISP to determine if the data fix adjusted the plan appropriately to meet the needs of the individual. SCs/SCOs should collaborate with AEs to confirm if any additional ISP changes are required and perform critical revisions as needed.

The anticipated Data Fix Implementation Date is Thursday August 30, 2018. Please refer to ODP Communication Number 078-18 for instructions to handle this transition process.  For further information and questions regarding this process, contact your ODP PDS Regional Lead.

The Office of Developmental Programs (ODP) issued three announcements recently regarding training opportunities available to providers of service.

ODP Communication Number 074-18 announces the Fall/Winter 2018 schedule of face to face Medication Administration classroom training sessions. The Medication Administration program provides instruction in a train-the-trainer format. Classes are offered throughout PA beginning at the end of August and are scheduled through December 2018. Classes are assigned on a first-come, first-served basis, based upon successful completion of prerequisite examinations. Space is limited and some locations fill quickly. Others may be cancelled if enrollment is too low. Please visit Pennsylvania’s Medication Administration Program to see an overview and frequently asked questions about the program.

ODP Communication Number 075-18 announces the availability of more sessions of the two day, Person-Centered Thinking training over the next several months. Person-Centered Thinking is a core concept at the foundation of the services and supports provided to people with intellectual disabilities and autism in Pennsylvania. People with disabilities, self-advocates, families, and other stakeholders are invited to come and learn about Person-Centered Thinking and how it can be used to enhance the quality of life of the people we support. This is a professional development opportunity. Training begins at 9:00 am and ends at 4:00 pm. You must attend both days in order to complete the training and receive a certificate of attendance.

ODP Communication Number 076-18 announces that ODP is requiring newly enrolling providers of Residential Habilitation services to complete the ODP-approved Dual Diagnosis Training curriculum. Providers who are currently in the process of becoming qualified to provide Residential Habilitation services in the Consolidated, Community Living and Adult Autism Waivers, and Adult and Community Autism Program (ACAP), or who may be interested in enrolling to be a provider of Residential Habilitation services and Administrative Entities (AE), will be required to complete this training. This applies to new Residential Habilitation providers who will be enrolled and qualified to provide these services effective September 1, 2018 and thereafter.

This requirement is implemented based on the recommendation of ODP’s residential stakeholders (via the statewide Residential Strategic Thinking Work Group), as well as the experience of our Regional Clinical Directors and Benjamin Settlement implementation leads. It was determined that many new Residential Habilitation providers will need additional training in order to support individuals with complex needs. To expand the clinical capacity of our Residential Habilitation services, ODP is strengthening the training standards for newly enrolling Residential Habilitation providers. Completion of the Dual Diagnosis Training course by these providers ensures that they are both knowledgeable and equipped to meet the needs of individuals with complex challenges and protects these individuals’ ongoing health and safety.

Contact Carol Ferenz, RCPA IDD Division Director, with questions.