Section 2: Assessment – ODP’s assessment activities will include a review of policy documents and provider enrollment documents and a review of licensing requirements. Action items related to provider assessment are included in Section 3 Remediation Strategies for each HCBS requirement. # Action Item Description Start Date Target End Date Deliverable Internal Assessment (Regulations, Policies, Procedures) 1 Review of Policy Documents, Waiver Service Definitions and Provider Enrollment Requirements Based on the list of current regulations, policies, waiver service definitions and provider standards for assessment developed in Section 1, review these documents to determine what changes are necessary. February 2015 July 2015 List of current regulations and policies and whether changes need to be made. 2 Collaborate with State Departments and Offices Collaborate with the Bureau of Services Licensing (BHSL), the Department of Aging (PDA), the Office of Vocational Rehabilitation, the Department of Education and other departments and offices as necessary to identify any necessary changes to policies, regulations or other licensing requirements to comply with the HCBS rule. February 2015 June 2015 List of current licensing policies, regulations and instruments and whether changes will be made. 3 Develop, Test, & Refine Provider Survey Develop and send provider survey to all waiver providers to assist Pennsylvania to get an overall understanding of the settings in waiver services are being provided and help to determine the specifics of future assessment activities and inform policy development November 2014 2015 Provider Survey and List of ODP Waiver Providers 4 Collect and Analyze Provider Information from Survey Collect and analyze data from surveys April 2015 April 2015 Survey Finding Report 5 Analyze Fiscal Impact Analyze changes to service definitions, policies, regulations, or other licensing requirements to determine possible fiscal impacts to providers. June 2015 2019 Amendments to Rate Settings Methodology in Waivers and Public Notices
12 Provider Service Alignment with Policy Time for providers to analyze services rendered and make changes to comply with home and community based characteristics policy if necessary. 2016 August 2016 No Deliverable For This Item 13 Provider Monitoring Assess whether there are any waiver providers that have the effect of isolating individuals per home community based characteristics policy. September 2016 September 2017 Provider Tracking Tool 14 Notify Providers Presumed Not Eligible and Request Plan Notify providers that were found to have the effect of isolating individuals. Inform these providers that they can demonstrate how the service currently meets the home and community-based characteristic policy or they can submit a plan outlining how operations will be altered to meet the requirements for a home and community-based setting. October 2017 December 2017 Notification to providers 15 Provider Plan Submission Timeframe for providers to develop and submit information requested in the letter referenced above and the home and community based characteristics policy. January 2018 March 2018 Provider Tracking Tool 16 Develop Safeguards Identify and develop safeguards to preclude reimbursement for ineligible providers after the transition completion date. January 2018 October 2018 HCBS IT Changes List 17 Review Plans Submitted Information submitted by providers regarding how they meet or will make changes their program to meet the requirements for an eligible setting will be reviewed. April 2018 July 2018 Provider Tracking Tool 18 Notify Providers of Decision Notify providers of ODP’s initial decision regarding the setting’s eligibility. Information regarding providers determined to be eligible will be submitted to CMS for heightened scrutiny. Providers determined to be ineligible will be provided appeal rights. Providers will be expected to comply with applicable 55 Pa. Code Chapter 51 requirements. August 2018 September 2018 Notification to providers 19 Notify Participant of Decision Notify individuals served by providers determined to be ineligible, Administrative Entities and Supports Coordination Organizations of provider ineligibility and what actions individuals may expect. The ISP team must discuss the option of other willing and qualified providers or other services that will meet the individual’s needs and ensure their health and safety. The Supports Coordinator will be responsible for documenting this discussion. August 2018 September 2018 Notification to participants
of individuals not receiving HCBS and settings that will be considered home and community based. characteristics policy 2 Draft Revisions to Regulations If regulatory revisions are identified in Section 2, create a draft of the revised regulations with stakeholder input. January 2015 June 2015 regulations 3 Public Comment on Policy Release initial draft home and community based characteristics policy for public comment. Revise policy based on public comment as needed. August 2015 September 2015 Final Draft home and community based characteristics policy 4 CMS Review of Policy Send final draft home and community based characteristics policy to CMS for review and comment. Revise policy based on CMS feedback as needed. October 2015 November 2015 Final Draft home and community based characteristics policy 5 Public Comment on Revisions to Regulations If regulatory revisions are identified, draft regulations will be published through notice in the Pennsylvania Bulletin for public comment. October 2015 November 2015 Pennsylvania Bulletin Notice 6 Publication of Policy Publish home and community characteristics policy. December 2015 December 2015 Home and community based characteristics policy 7 Compliance process for new providers and service location move Develop and implement a process to ensure new providers enrolling to render waiver services, existing providers moving their service locations and provider requests for expansion are not unallowable per the home and community based characteristics policy. December 2015 March 2016 Compliance Process 8 Develop Tracking Tool Develop a method/tool to collect data and track provider status regarding compliance with the home and community based characteristics policy. December 2015 March 2016 Provider Tracking Tool