Substantive Changes Made to the Consolidated and P/FDS Waiver Renewals Effective July 1, 2017 This document is intended to be used as a tool to help understand where substantive changes were made to the Consolidated and Person/Family Directed Support (P/FDS) waiver renewals as a result of public comment. This document does not contain every change made to the waiver renewals. Please read the Consolidated and P/FDS waiver renewal documents for all changes made. Key: Strikethrough Text = Text has been removed Bold Text = Text has been added Waiver(s) Impacted Appendix/Service Definition Proposed Language Released For Public Comment on December 3, 2016 Final Language Submitted to CMS Reason for Change Appendix A Consolidated and P/FDS Appendix A-4: Role of Local/Regional Entities The Office of Developmental Programs (ODP) has an agreement with County Mental Health/Intellectual Disability (MH/ID) programs under the control of local elected officials to perform delegated waiver and operational administrative functions. The 55 Pa. Code Chapter 51 regulations authorize Department Designees, Administrative Entities (AEs), to perform waiver administrative functions. Each of these public agencies are delegated functions through an AE Operating Agreement. The AE implements these responsibilities and meets the requirements specified in the AE Operating Agreement. The Office of Developmental Programs (ODP) has an agreement with County Mental Health/Intellectual Disability (MH/ID) programs under the control of local elected officials to perform delegated waiver and operational administrative functions. The 55 Pa. Code Chapter 51 regulations or its regulatory successor authorize Department Designees, Administrative Entities (AEs), to perform waiver administrative functions. Each of these public agencies are delegated functions through an AE Operating Agreement. The AE implements these responsibilities and meets Public comment recommended that we reference Chapter 6100 regulations will not be promulgated by July 1, 2017. For this reason, we have inserted “or its regulatory successor” and will replace references to Chapter 51 when we amend the waivers after July 1, 2017. Public comment recommended that we provide the name of the waiting list assessment of need. ODP may be revising the Prioritization of Urgency of Need for Services (PUNS) in State
AEs perform the following delegated waiver administration functions: 1. Participant waiver enrollment – Receive/review applications, ensure initial and annual completion of a waiting list assessment of need and refer applicants for an eligibility decision. the requirements specified in the AE Operating Agreement. AEs perform the following delegated waiver administration functions: 1. Participant waiver enrollment – Receive/review applications, ensure initial and annual completion of PUNS or its successor a waiting list assessment of need and refer applicants for an eligibility decision. future years so we have inserted “PUNS or its successor.” Both of these changes were made throughout the waiver document. Each instance of this change is not reflected in this side-by-side. Waiver(s) Impacted Appendix/Service Definition Proposed Language Released For Public Comment on December 3, 2016 Final Language Submitted to CMS Reason for Change Appendix B Consolidated and P/FDS Appendix B-1-a: Target Groups Developmental Disability Minimum Age 0 Maximum Age 7 Developmental Disability Minimum Age 0 Maximum Age 7 8 Public comment recommended the maximum age for developmental disability be increased from age seven to age eight when IQ testing and diagnosis become more stable and reliable. Consolidated and P/FDS Appendix B-1-c: Transition of Individuals Affected by Maximum Age Limitation Individuals who are enrolled with a developmental disability will be reevaluated the ICF/ID or ICF/ORC criteria prior to their 8th birthday. If they are eligible, they will continue to receive waiver services. If the individual is not eligible, they will be referred to other resources. Individuals will be referred to the Individuals Participants who are enrolled with a developmental disability will be reevaluated using the ICF/ID or ICF/ORC criteria during their 8th year (prior to their 8th 9th birthday). If they are eligible, they will continue to receive waiver services. If the individual Public comment recommended the maximum age for developmental disability be increased from age seven to age eight when IQ testing and diagnosis become more stable and reliable.
Office of Medical Assistance Programs for EPSDT services; Office of Long Term Living; Office of Children, Youth and Families as applicable and Office of Mental Health and Substance Abuse Services. participant is not eligible, they he or she will be referred to other resources. Individuals will be referred to the Office of Medical Assistance Programs for EPSDT services; Office of Long Term Living; Office of Children, Youth and Families as applicable and Office of Mental Health and Substance Abuse Services. Office of Long Term Living waivers do not serve individuals under the age of 18. As such, references to Office of Long-Term Living were removed as a referral resource for individuals under the age of nine. To be eligible for the waivers, children must be enrolled in the EPSDT benefit through Medical Assistance and receiving medically necessary services so that reference has been removed as well. Consolidated Appendix B-3-a: Unduplicated Number of Participants Year 1 – 18097 Year 2 – 18097 Year 3 – 18097 Year 4 – 18097 Year 5 – Year 1 – 18097 18209 Year 2 – 18097 18209 Year 3 – 18097 18209 Year 4 – 18097 18209 Year 5 – 18209 The governor’s proposed budget for Fiscal Year includes funding to serve an additional 112 people in the Consolidated Waiver. P/FDS Appendix B-3-a: Unduplicated Number of Participants Year 1 – Year 2 – 13900 Year 3 – Year 4 – 13900 Year 5 – Year 1 – 13900 14720 Year 2 – 13900 14720 Year 3 – 13900 14720 Year 4 – 13900 14720 Year 5 – 13900 14720 The governor’s proposed budget for Fiscal Year includes funding to serve 820 students age 21 who are graduating from special education. P/FDS Appendix B-3-c: Reserved Waiver Capacity Nothing written in proposal Title: Graduate Waiting List Initiative Purpose: ODP has reserved capacity in Year 1 for the waiting list initiative to serve approximately 820 students graduating from special education in May or June of 2017 who are not eligible to continue their education through the next year. In accordance with ODP The governor’s proposed budget for Fiscal Year 17/18 includes funding to serve 820 students age 21 who are graduating from special education. 2018
The capacity that the reserves in each waiver year is specified in the following table: Year 1: 820 Year 2: 0 Year 3: 0 Year 4: 0 Year 5: 0 P/FDS Appendix B-3-c: Reserved Waiver Capacity Nothing written in proposal Competitive Employment Initiative Purpose: ODP reserves capacity for individuals who are transitioning out of OVR with a competitive integrated job to encourage competitive employment. In accordance with ODP policy as enumerated in Appendix A, any new individual identified for enrollment must be identified as having an emergency need. The individuals identified for the competitive employment initiative may not meet this criteria which makes it necessary to reserve capacity for them to ensure that they have access to the waiver. All participants enrolled in the Waiver have comparable access to all services offered in the Waiver regardless of whether he or she is enrolled due to meeting reserved capacity criteria or the criteria for emergency status in Public comment recommended that this reserved capacity be restored in the P/FDS waiver to encourage competitive employment by ensuring individuals will have the supports needed after they have transitioned from services received from the Office of Vocational Rehabilitation (OVR).
Consolidated and P/FDS B-6-d: Level of Care Criteria 3. Developmental Disabilities prior to age 8 ICF/ORC i. There are four fundamental criteria that must be met prior to an individual being determined eligible for an ICF/ORC level of care: 1. Have a diagnosis of developmental disability. Eligibility criteria is defined as the following: developmental disability is defined as a condition of substantial developmental delay or specific congenital or acquired conditions with a high probability of resulting in an intellectual disability or autism, the disability manifested prior to the age of 8 and the disability is likely to continue indefinitely. 2. Individual is 7 years of age or younger; and 3. Substantial adaptive skills deficits in three or more areas of major life activity: self-care, understanding and use of language, learning, mobility, self-direction and/or capacity for independent living based on a standardized adaptive functioning; and 4. Be recommended for an ICF/ORC level of care based on a medical evaluation. 3. Developmental Disabilities prior to age 8 9 ICF/ORC i. There are four fundamental criteria that must be met prior to an individual being determined eligible for an ICF/ORC level of care: 1. Have a diagnosis of developmental disability. Eligibility criteria is defined as the following: developmental disability which is defined as a condition of substantial developmental delay or specific congenital or acquired conditions with a high probability of resulting in an intellectual disability or autism, the disability manifested prior to the age of 8 9 and the disability is likely to continue indefinitely. 2. Individual is 7 8 years of age or younger; and 3. Substantial adaptive skills deficits in or more areas of major life activity: self-care, understanding and use of language, learning, mobility, and/or capacity for independent living based on a standardized adaptive functioning; and 4. Be recommended for an ICF/ORC of care based on a medical evaluation. Public comment recommended the maximum age for developmental disability be increased from age seven to age eight when IQ testing and diagnosis become more stable and reliable. Consolidated and P/FDS B-6-f: Process for of Care Evaluation/Reevaluation The following four criteria must be met to document a diagnosis of developmental disability and The following four criteria must be met to document a diagnosis of developmental disability and Public comment recommended that we add developmental pediatricians
determine eligibility upon initial certification: 1. A licensed psychologist, certified school psychologist, psychiatrist, or licensed physician who practices psychiatry certifies that the individual has a diagnosis of developmental disability with a high probability of resulting in an intellectual disability or autism which is documented by the results of a standardized diagnostic tool. 2. A QDDP certifies that the individual has impairments in adaptive behavior based on the results of a standardized assessment of adaptive functioning which shows that the individual has both of the following: a. Substantial adaptive skill deficits in three or more areas of major life activity: self-care, understanding and use of language, learning, mobility, self-direction and/or capacity for independent living based on a standardized adaptive functioning test. 3. The individual is 7 years old or younger. 4. The results of a medical evaluation completed within the previous 365 days that reflects the individual’s current medical condition. The medical evaluation may be the medical evaluation approved by the Department (Form MA 51), or an examination that is completed by a licensed physician, physician’s determine eligibility upon initial certification: 1. A licensed psychologist, certified school psychologist, psychiatrist, developmental pediatrician or licensed physician who practices psychiatry certifies that the individual has a diagnosis of developmental disability with a high probability of resulting in an intellectual disability or autism which is documented by the results of a standardized diagnostic tool. 2. A QDDP certifies that the individual has impairments in adaptive behavior based on the results of a standardized assessment of adaptive functioning which shows that the individual has both of the following: a. Substantial adaptive skill deficits in three or more areas of major life activity: self-care, understanding and use of language, learning, mobility, and/or capacity for independent living based on a standardized adaptive functioning test. 3. The individual is 7 8 years of age old or younger. 4. The results of a medical evaluation completed within the previous 365 days that reflects the individual’s current medical condition. The medical evaluation to the list of professionals that can diagnose a developmental disability.
been able to secure a competitive integrated job or has not been able to keep a competitive integrated job for more than 6 months; and 3. Meets one of the following criteria: a. Is currently in an activity receiving a sub-minimum wage; or b. After consulting with a credentialed provider, it is the opinion of the service plan team that the level of support provided through this service is needed to secure sustained competitive integrated employment. services are considered to not be available to the participant; and 2. Has had job skills training or development, has never had any work related experiences (including volunteer experiences) or in the past 2 years, with the use of Supported Employment services, has not been able to secure a competitive integrated job or has not been able to keep a competitive integrated job for more than 6 months; and 3. Meets one of the following criteria: a. Is currently in an activity receiving a wage; or b. consulting with a credentialed provider, it is the opinion of the service plan team that the level of support provided through this service is needed to secure sustained competitive integrated employment. prevents them from engaging in competitive integrated employment. The revision would allow individuals to access waiver employment services when OVR does not make an eligibility determination within 120 days of the referral being sent. Consolidated and P/FDS Eligibility shall be determined by the service plan team. The process that was undertaken to determine eligibility and its outcome shall be documented by the Supports Coordinator. Eligibility be determined by the service plan team. The process that was undertaken to determine eligibility and its outcome shall be documented by the Supports Coordinator. Public comment recommended removal of this information as it implies that the AE has no role in determining the need for this service. In accordance with the AE Operating Agreement, the AE is responsible for reviewing whether service definitions are met. This information has been removed. Consolidated and P/FDS To be eligible for job development, systematic instruction or intensive job coaching under Advanced Supported Employment, the participant must have received the discovery service under Advanced Supported Employment through its completion. To be eligible for job development, systematic instruction or intensive job coaching under Advanced Supported Employment, the participant must have received the discovery service under Advanced Supported Employment through its completion or the completion of the discovery/profile phase through OVR and the case was closed. Public comment recommended this change be made so that we do not force an individual to have a written discovery profile through the waiver when one was recently done by OVR. minimum
Individuals providing prevocational skill development to the participant in community locations must: • Hold a Certified Employment Support Professional (CESP) credential from the Association of People Supporting Employment First (APSE), or • Have been awarded a Basic Employment Services Certificate of Achievement or a Professional Certificate of Achievement in Employment Services from an Association of Community Rehabilitation Educators (ACRE) organizational member that has training. Individuals working directly with the participant to provide Community Participation Support in community locations may not do so unless they: • Complete the Department approved training on Community Participation Support which includes training on the following topics: - Person-Centered Planning Facilitation techniques. - Community mapping. - Developing and implementing fading strategies. - Using and planning for transportation access. - Community engagement strategies. Individuals not meeting qualifications may perform services while they become qualified but the length of time doing so Individuals providing prevocational skill development to the participant in community locations must have one of the following by 1/1/19: • Hold a Certified Employment Support Professional (CESP) credential from the Association of People Supporting Employment (APSE); or • Have been awarded a Basic Employment Services Certificate of Achievement or a Professional Certificate of Achievement in Employment Services from an Association of Community Rehabilitation Educators (ACRE) organizational member that has training. All individuals must complete the Department approved training on Community Participation Support by 7/1/18. working directly with the participant to provide Community Participation Support in community locations may not do so unless they: • Complete the Department approved training on Community Participation Support which includes training on the following topics: - Person-Centered Planning Facilitation techniques. - Community mapping. - Developing and implementing fading strategies. - and planning for transportation access. - Community engagement strategies. Individuals not meeting qualifications may perform services while they become qualified but the length of time doing so may not standards. Public comment also recommended that ODP develop and provide training on Community Participation Support. The revisions reflect those recommendations.
may not exceed 18 months and during that time they must be supervised by someone who does meet the qualification. exceed 18 months and during that time they must be supervised by someone who does meet the qualification. Consolidated and P/FDS Provider Qualification Criteria for Adult Training Facility or Older Adult Day Facility Adult Training Facility staff providing prevocational skill development to the participant in the community must: • Hold a Certified Employment Support Professional (CESP) credential from the Association of People Supporting Employment First (APSE), or • Have been awarded a Basic Employment Services Certificate of Achievement or a Professional Certificate of Achievement in Employment Services from an Association of Community Rehabilitation Educators (ACRE) organizational member that has ACRE-approved training. Training Facility staff working directly with the participant to provide Community Participation Support may not do so unless they: • Complete the Department approved training on Community Participation Support which includes training on the following topics: - Person-Centered Planning Facilitation techniques. - Community mapping. - Developing and implementing fading strategies. - Using and planning for transportation access. - Community engagement strategies. Provider Qualification Criteria for Adult Training Facility or Older Adult Day Facility For programs providing prevocational training to participants, program specialists and supervisors in facilities licensed under 55 Pa. Code Chapter 2380 Adult Training Facility staff providing prevocational skill development to the participant in the community must have one of the following by 1/1/19 or within 60 days of hire if hired after 11/1/18: • Hold a Certified Employment Support Professional (CESP) credential from the Association of People Supporting Employment First (APSE); or • Have been awarded a Basic Employment Services Certificate of Achievement or a Professional Certificate of Achievement in Employment Services from an Association of Community Rehabilitation Educators (ACRE) organizational member that has training. All staff must complete the Department approved training on Community Participation Support by 7/1/18. After 7/1/18, all new hires must complete the Department approved training on Community Participation Support within 60 days of hire and during that time they must be supervised by someone who has completed the training. Adult Training Facility staff working directly with the participant to provide Community Public comment recommended that more time be given for staff to meet required certification and training standards. Public comment also recommended that ODP develop and provide training on Community Participation Support. The revisions reflect those recommendations.
Adult Training Facility staff not meeting these qualifications may perform services while they become qualified but the length of time doing so may not exceed 18 months and during that time they must be supervised by someone who does meet the qualification. Participation Support may not do so unless they: • Complete the Department approved training on Community Participation Support which includes training on the following topics: - Person-Centered Planning Facilitation techniques. - Community mapping. - Developing and implementing fading strategies. - and planning for transportation access. - Community engagement strategies. Adult Training Facility staff not meeting these qualifications may perform services while they become qualified but the length of time doing so may not exceed 18 months and during that time they must be supervised by someone who does meet the qualification. Consolidated and P/FDS Provider Qualification Criteria for Agency Community Participation Support Provider (Non- Facility) Staff providing prevocational skill development to the participant must: • Hold a Certified Employment Support Professional (CESP) credential from the Association of People Supporting Employment (APSE), or • Have been awarded a Basic Employment Services Certificate of Achievement or a Professional Certificate of Achievement in Employment Services from an Association of Community Rehabilitation Educators (ACRE) organizational member that has ACRE-approved training. Provider Qualification Criteria for Agency Community Participation Support Provider (Non- Facility) For programs providing prevocational training to participants, program specialists and supervisors must have one of the following by 1/1/19 or within 60 days of hire if hired after 11/1/18: Staff providing prevocational skill development to the participant must: • Hold a Certified Employment Support Professional (CESP) credential from the Association of People Supporting Employment First (APSE); or • Have been awarded a Basic Employment Services Certificate of Achievement or a Professional Certificate of Achievement in Employment Services from an Association of Community Rehabilitation Educators (ACRE) Public comment recommended that more time be given for staff to meet required certification and training standards. Public comment also recommended that ODP develop and provide training on Community Participation Support. The revisions reflect those recommendations.
Consolidated and P/FDS Participants authorized to receive Music Therapy, Art Therapy and Equine Assisted Therapy may not receive the following services at the same time as this service: Community Participation Support; Transitional Work; Supported Employment; Advanced Supported Employment; Benefits Counseling; unit Respite; Transportation; Therapies; Education Support; Shift Nursing; Consultative Nutritional Services and Supports Broker. Participants authorized to receive Music Therapy, Art Therapy and Equine Assisted Therapy may not be provided at the same time as the direct provision of the following receive the following services at the same time as this service: Community Participation Support; Small Group Employment Transitional Work; Supported Employment; Advanced Supported Employment; Benefits Counseling; 15-minute unit Respite; Transportation; Therapies; Education Support; Shift Nursing; Consultative Nutritional Services and Supports Broker. Public comment recommended that shift nursing be allowed to accompany a participant to this service. Public comment also indicated that Supports Broker helps with common law employer and managing employer functions and as such should be allowed at the same time as other services. Consolidated and P/FDS Provider Qualifications for Art Therapists To provide Art Therapy the individual must have one of the following certificates: 1. Certified by the Art Therapy Certification Board (ATCB); or 2. Other ODP-approved certification board. Provider Qualifications for Art Therapists To provide Art Therapy the individual must have one of the following certificates: 1. Certified by the Art Therapy Credentials Certification Board (ATCB); or 2. ODP-approved certification board. Public comment recommended that the correct name be used, Art Therapy Credentials Board. Waiver(s) Impacted Proposed Language Released For Public Comment on December 3, 2016 Final Language Submitted to CMS Reason For Change Appendix C – Residential Habilitation Consolidated Only Assistance, support and guidance (which includes prompting, instruction, modeling and reinforcement) in the following activities must be provided to meet each participant’s habilitative outcomes as documented in the service plan: The Residential Habilitation provider must provide the level of services necessary to enable the participant to meet habilitation outcomes. This includes ensuring the following assistance, support and guidance (which includes prompting, instruction, modeling and reinforcement) in the following activities will be provided as needed to enable the participant to: must be provided to Public comment indicated that the proposed language was confusing in that it implied all of the supports must be provided to every participant regardless of the participant’s needs.
ongoing support with participants and their employers. This may include systematic instruction. The service must be necessary for participants to maintain acceptable job performance and work habits, including assistance in learning new work assignments, maintaining job skills, and achieving performance expectations of the employer. Other examples of activities include direct intervention with an employer, employment-related personal skills instruction, support to re-learn job tasks, training to assist participants in using transportation to and from work, worksite orientation, job aide development, coordination of accommodations, ensuring assistive technology is utilized as specified in the plan, maintenance of appropriate work and interpersonal behaviors on the job, follow-along services at the work site after OVR-funded services are discontinued or OVR referral requirements are satisfied, and technical assistance and instruction for the participant’s coworkers that will enable peer support. Ongoing use of the service requires that the service is needed to maintain employment and is limited to providing supports for participants not otherwise available through the employer such as support offered through regular supervisory channels, reasonable accommodation required the Americans with Disabilities Act, available and appropriate natural supports, or participants and their employers. This may include systematic instruction. The service must be necessary for participants to maintain acceptable job performance and work habits, including assistance in learning new work assignments, maintaining job skills, and achieving performance expectations of the employer. Other examples of activities include direct intervention with an employer, employment-related personal skills instruction, support to re-learn job tasks, training to assist participants in using transportation to and from work, worksite orientation, job aide development, coordination of accommodations, ensuring assistive technology is utilized as specified in the plan, maintenance of appropriate work and interpersonal behaviors on the job, follow-along services at the work site after OVR-funded services are discontinued or OVR referral requirements are satisfied, and technical assistance and instruction for the participant’s coworkers that will enable peer support. As part of a participant’s ongoing use of job coaching and support, it is expected that the provider will develop a fading plan or fading schedule that will address how use of this service will decrease as the participant’s productivity and independence on the job increases and as he or she develops unpaid supports through coworkers and other resources. Ongoing use of the service job coaching and support requires that the service is needed to maintain employment and is limited to providing supports for participants not otherwise available through
Function as a conflict free entity… Waiver(s) Impacted Proposed Language Released For Public Comment on December 3, 2016 Final Language Submitted to CMS Reason For Change Appendix C – Supports Broker Consolidated and P/FDS The direct portion of Supports Broker services may not be provided at the same time as the direct portion of the following: In-Home and Community Supports, Benefits Counseling, Transportation, Consultative Nutritional services and Education Support. The direct portion of Supports Broker services may not be provided at the same time as the direct portion of the following: In-Home and Community Supports, Benefits Counseling, Transportation, Consultative Nutritional services and Education Support. Public comment recommended this information be removed. Supports Broker services are used to help with Managing Employer and Common Law Employer functions can happen when other direct services are occurring. Consolidated and P/FDS Supports Broker Services may be provided by individual and agency providers that provide other Waiver, intellectual disability or autism services but the Supports Broker provider must be conflict free. In order to be conflict free, the Supports Broker provider may not provide other direct or indirect waiver services or base funded intellectual disability services when authorized to provide Support Broker services to the participant. In addition, Supports Broker providers may not provide administrative services such as Health Care Quality Unit or Administrative Entity functions. However, an IM4Q program may provide Support Broker services to individuals who do not reside in the geographic area that is monitored by the IM4Q program. Supports Broker Services may be provided by individual and agency providers that provide other Waiver, intellectual disability or autism services but the Supports Broker provider must be conflict free. In order to be conflict free, the Supports Broker provider may not provide other direct or indirect waiver services or base funded intellectual disability services when authorized to provide Support Broker services to the participant. In addition, Supports Broker providers may not provide administrative services such as Health Care Quality Unit or Administrative Entity functions. However, an IM4Q program may provide Supports Broker services to individuals who they are not responsible for interviewing. who do not reside in the geographic area that is monitored by the IM4Q program. Public comment recommended more clarity regarding when an IM4Q program can provide Supports Broker services. Consolidated and P/FDS Provider Qualification for All Provider Types An individual Supports Broker must successfully complete a Supports Broker Provider Qualification for All Provider Types An individual Supports Broker must successfully complete a Supports Broker Certification Program provided by ODP or its Public comment requested clarification regarding when Supports Brokers must have successfully completed the certification program.
Waiver(s) Impacted Proposed Language Released For Public Comment on December 3, 2016 Final Language Submitted to CMS Reason For Change Appendix C – Benefits Counseling Consolidated and P/FDS Benefits Counseling provides work incentives counseling and planning services. It is provided only to participants considering or seeking competitive integrated employment or career advancement. Benefits Counseling provides work incentives counseling and planning services. It is provided only to participants considering or seeking competitive integrated employment or career advancement or to participants who need problem solving assistance to maintain competitive integrated employment. Public comment recommended we align this section of the service definition with the limits section that states the service can be used to help participant who need problem solving assistance to maintain competitive integrated employment. Waiver(s) Impacted Proposed Language Released For Public Comment on December 3, 2016 Language Submitted to CMS Reason For Change Appendix C – Communication Specialist Consolidated and P/FDS This service supports participants with nontraditional communication needs by determining the participant’s communication needs, educating the participant and his or her caregivers on the participant’s communication needs and the best way to meet those needs in their daily lives. This is a direct and indirect service that supports participants with nontraditional communication needs by determining the participant’s communication needs, educating the participant and his or her caregivers on the participant’s communication needs and the best way to meet those needs in their daily lives. Public comment requested clarification as to whether this is solely a direct service or if indirect components are allowable. Consolidated Only The following services may not be authorized for participants who receive Communication Specialist services: Residential Habilitation, Life Sharing and Supported Living. The following services may not be authorized for participants who receive The rates for the following services include communication specialist services: Residential Habilitation, Life Sharing and Supported Living. As such, participants who are authorized to receive one of these services may only be authorized to receive Communication Specialist services as a discrete service when it is used to support the participant during Community Participation Support. Public comment recommended that clarification be added regarding the expectations for providers of residential services. Public comment also recommended that this service be allowed at the same time as residential services.
Consolidated and P/FDS Therapy services include the following: • Physical therapy provided by a licensed physical therapist based on a prescription for a specific therapy program by a physician. • Occupational therapy by a registered occupational therapist on a prescription for a specific therapy program by a physician. • Speech/language therapy provided by an American Speech-Language-Hearing Association (ASHA) certified and state licensed speech-language pathologist. This service requires an evaluation and recommendation by an ASHA certified and state licensed speech-language pathologist or a physician. Therapy services include the following: • Physical therapy provided by a licensed physical therapist based on a prescription for a specific therapy program by a physician. • Occupational therapy by a registered occupational therapist based on a prescription for a specific therapy program by a physician. • Speech/language therapy provided by an American Speech-Language-Hearing Association (ASHA) certified and state licensed speech-language pathologist. This service requires based on an evaluation and recommendation by an ASHA certified and state licensed speech-language pathologist or a physician. • Orientation, mobility and vision therapy provided by a trained orientation and mobility specialist based on an evaluation and recommendation by a trained mobility specialist/instructor or a physician. Qualification standards for providers will be enumerated in the provider qualification section of the service definition. Consolidated and P/FDS Provider Qualification Criteria for Speech/Language Therapy Agency and Individual Speech/Language Therapists Staff (direct, contracted, or in a consulting capacity) providing Speech/Language Therapy must be ASHA certified. Provider Qualification Criteria for Speech/Language Therapy Agency and Individual Speech/Language Therapists Staff (direct, contracted, or in a consulting capacity) providing Speech/Language Therapy must be ASHA certified. Staff who teach American Sign Language to participants must have at a minimum, Qualified Level Certification from the American Sign Language Teachers Association (ASLTA). Public comment recommended that staff who teach American Sign Language as part of the Therapy service have a qualified level certification from the American Sign Language Teachers Association (ASLTA). Waiver(s) Impacted Proposed Language Released For Public Comment on December 3, 2016 Final Language Submitted to CMS Reason For Change Appendix C – Transportation
Waiver, they are informed at enrollment of the total limit. Waiver(s) Impacted Appendix/Service Definition Proposed Language Released For Public Comment on December 3, 2016 Final Language Submitted to CMS Reason for Change Appendix D Consolidated and P/FDS Appendix D-1-d: Service Plan Development Process The service plan is initially developed when a participant is entering service and is updated annually and at any time is a change in need or at the request of the participant… Qualified providers of services are responsible for the following service plan and functions: • Collaboration with the team members to coordinate the date, time and location for the initial and annual service plan meeting… (C) How The Participant Is Informed Of The Services That Are Available Under The Waiver SCs are responsible to inform and fully discuss with participants and his or her family all services available under the waiver prior to the initial service plan meeting and at least annually thereafter, and of the right to choose among and between services and willing and qualified providers to support participants’ needs. The SC assists participants and his or her family in linking with The service plan is initially developed to enrollment in the waiver to determine need for services when a participant is entering service and is updated annually and at any time there is a change in need or at the request of the participant. Qualified providers of services are responsible for the following service plan roles and functions: • Collaboration Cooperate with the team members to coordinate the date, time and location for the initial and annual service plan meeting… (C) How The Participant Is Informed Of The Services That Are Available Under The Waiver SCs are responsible to provide information to participants and his or her family about services that are available under the waiver, their rights to choose willing and qualified providers to support participants’ needs, and Public comment requested additional clarification about the responsibilities of Supports Coordinators during ISP development.
punishment, for the convenience of staff persons or as a substitution for individual support. Prone position physical protective restraints are prohibited. Mechanical restraints such as handcuffs, anklets, wristlets, camisoles, papoose boards, chest restraints, and other locked restraints are prohibited. Chemical restraints are prohibited. During licensing surveys and oversight monitoring activities, the Department and ODP validates that restraints, if administered, were applied in accordance with requirements. Restrictive intervention plans must be developed and approved by a human rights committee prior to implementation. The restrictive procedure plan must be reviewed, and revised, if necessary, according to the time frame established by the human rights committee, not to exceed 6 months. The restrictive intervention plan must include: • The specific behavior to be addressed and the suspected antecedent or reason for the behavior. • The single behavioral outcome desired stated in measurable terms. • Methods for modifying or eliminating the behavior, such as changes in the individual’s physical and social environment, changes in in immediate danger of harming oneself and/or others and risk mitigation strategies are ineffective. Restraints are only permitted when the conditions outlined below are met. Manual restraints, referred to as “physical protective restraints”, are permitted. A physical protective restraint is a hands-on hold of an individual. Physical protective restraints may not be used for a period of more than 15 minutes within a 2-hour period. A physical protective restraint may not be used as a behavioral intervention, consequence, retribution, punishment, for the convenience of staff persons or as a substitution for individual support. Prone position physical protective restraints are prohibited. The following restraints are prohibited: • Prone position physical restraints and any physical restraint that inhibits digestion or respiration, inflicts pain, causes embarrassment or humiliation, causes hyperextension of joints, applies pressure on the chest or joints or allows for a free fall to the floor is prohibited.
the individual’s routine, improving communications, teaching skills and reinforcing appropriate behavior. • Types of restrictive procedures that may be used and the circumstances under which the procedures may be used. • A target date for achieving the outcome. • The amount of time the restrictive procedure may be applied, not to exceed the maximum time periods specified in this chapter. • Physical problems that require special attention during the use of restrictive procedures. • The name of the staff person responsible for monitoring and documenting progress with the plan. In addition, a protocol to eliminate the use of restrictive interventions is required when restrictive interventions are utilized. The protocol must address the following: • An assessment to determine the causes or antecedents of the behavior. • A protocol for addressing the underlying causes or antecedents of the behavior. • The method and timeline for eliminating the use of restrictive procedures. • A protocol for intervention or redirection without utilizing restrictive procedures. • Aversive conditioning, defined as the application of startling, painful or noxious stimuli. • Pressure techniques, defined as the application of pain for the purpose of achieving compliance. A clinically-accepted bite release technique that is applied only as long as necessary to release the bite is not considered a pressure point technique. • A chemical restraint, defined as a drug used for the specific and exclusive purpose of controlling acute, episodic behavior. A Pro Re Nata (PRN) order for controlling acute, episodic behavior is a chemical restraint. • A mechanical restraint, defined as a device used to control episodic behavior that restricts the movement or function of an individual or portion of an individual’s body including a geriatric chair, bedrail that restricts the movement or function of the individual, helmet with fasteners, waist strap, head strap, restraint vest, camisole, restraint sheet, restraint board, handcuffs, anklets, wristlets, muffs and mitts with fasteners and similar devices. A mechanical restraint does not include the
(3) The outcome desired. (4) Methods for facilitating positive behaviors such as changes in the individual’s physical and social environment, changes in the individual’s routine, improving communications, recognizing and treating physical and behavior health conditions, voluntary physical exercise, redirection, praise, modeling, conflict resolution, de-escalation and teaching skills. (5) Types of restrictive procedures that may be used and the circumstances under which the procedures may be used. (6) A target date to achieve the outcome. (7) The amount of time the restrictive procedure may be applied. (8) The name of the staff person responsible for monitoring and documenting progress with the individual plan. • The specific behavior to be addressed and the suspected antecedent or reason for the behavior. • The single behavioral outcome desired stated in measurable • Methods for modifying or eliminating the behavior, such as changes in the individual’s physical and social environment,
human rights committee, not to exceed 6 months. The restrictive intervention plan must include: • The specific behavior to be addressed and the suspected antecedent or reason for the behavior. • The single behavioral outcome desired stated in measurable terms. • Methods for modifying or eliminating the behavior, such as changes in the individual’s physical and social environment, changes in the individual’s routine, improving communications, teaching skills and reinforcing appropriate behavior. • of restrictive procedures that may be used and the circumstances under which the procedures may be used. • A target date for achieving the outcome. • The amount of time the restrictive procedure may be applied, not to exceed the maximum time periods specified in this chapter. • Physical problems that require special attention during the use of restrictive procedures. • The name of the staff person responsible for monitoring and documenting progress with the plan. In addition, a protocol to eliminate the use of restrictive interventions is required when restrictive necessary, according to the time frame established by the human rights team committee, not to exceed 6 months. The service plan with restrictive interventions including physical restraints must include: (1) The specific behavior to be addressed. (2) An assessment of the behavior including the suspected reason for the behavior. (3) The outcome desired. (4) Methods for facilitating positive behaviors such as changes in the individual’s physical and social environment, changes in the individual’s routine, improving communications, recognizing and treating physical and behavior health conditions, voluntary physical exercise, redirection, praise, modeling, conflict resolution, de-escalation and teaching skills. (5) of restrictive procedures that may be used and the circumstances under which the procedures may be used. (6) A target date to achieve the outcome. (7) The amount of time the restrictive procedure may be applied. (8) The name of the staff person responsible for monitoring and
interventions are utilized. The protocol must address the following: • An assessment to determine the causes or antecedents of the behavior. • A protocol for addressing the underlying causes or antecedents of the behavior. • The method and timeline for eliminating the use of restrictive procedures. • A protocol for intervention or redirection without utilizing restrictive procedures. documenting progress with the individual plan. The restrictive intervention plan must include: • The specific behavior to be addressed and the suspected antecedent or reason for the behavior. • The single behavioral outcome desired stated in measurable terms. • Methods for modifying or eliminating the behavior, such as changes in the individual’s physical and social environment, changes in the individual’s routine, improving communications, teaching skills and reinforcing appropriate behavior. • Types of restrictive procedures that may be used and the circumstances under which the procedures may be used. • A target date for achieving the outcome. • The amount of time the restrictive procedure may be applied, not to exceed the maximum time periods specified in this chapter. • Physical problems that require special attention during the use of restrictive procedures. • The name of the staff person responsible for monitoring and documenting progress with the plan.
Consolidated and P/FDS H-1-a: System Improvements Information used for trending and prioritizing opportunities for system improvements is also obtained through Independent Monitoring for Quality (IM4Q), a statewide method the has adopted to independently review quality of life issues for people in the ID system that includes a sample of waiver participants. IM4Q monitors satisfaction and outcomes of participants receiving services through indicators organized into areas of satisfaction, dignity and respect, choice and control, inclusion, and physical setting. IM4Q also monitors satisfaction with supports coordination services. Pennsylvania also collects and submits data to National Core Indicators through the IM4Q process and compares its performance to the aggregate performance of all States participating in National Core Indicators when identifying strengths and opportunities for systemic improvement. Information used for trending and prioritizing opportunities for system improvements is also obtained through Independent Monitoring for Quality (IM4Q), a statewide method the State has adopted to independently review quality of life issues for people in the ID system who receive services from ODP that includes a sample of waiver participants. IM4Q monitors satisfaction and outcomes of participants receiving services through indicators organized into areas of satisfaction, dignity and respect, choice and control, inclusion, and physical setting. IM4Q also monitors satisfaction with Supports Coordination services. Pennsylvania also collects and submits data to National Core Indicators through the IM4Q process and compares its performance to the aggregate performance of all States participating in National Core Indicators when identifying strengths and opportunities for systemic improvement. Public comment recommended that individuals with autism be included in this section. Waiver(s) Impacted Appendix/Service Definition Proposed Language Released For Public Comment on December 3, 2016 Final Language Submitted to CMS Reason for Change Appendix I