6 Publication of Policy Publish home and community-based characteristics policy. December 2015 December 2015 Home and Community-Based Characteristics Policy 7 Compliance Process for New Providers and Service Location Develop and implement a process to ensure new providers enrolling to render waiver services, existing providers changing their service locations and providers 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 9 Home and Community Based Characteristics Training Develop and distribute training regarding the home and characteristics policy. January 2016 2016 Training Tools 10 Issue Revised Regulations Issue revised regulations. June 2016 June 2016 Revised Regulations 11 Review/Revise Provider Agreement Review provider agreement and revise if necessary. March 2016 June 2016 Provider Agreement 12 Provider Service Alignment with Policy Time for providers to analyze services rendered and make changes to comply with home and characteristics policy if necessary. April 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 and community-based characteristics policy. September 2016 September 2017 Provider Tracking Tool based
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 characteristics policy or they can submit a plan outlining how operation 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 Submitted Information submitted by providers regarding how they meet or will make changes to 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 BAS’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 Participants of Decision Notify participants served by providers determined to be ineligible and Supports Coordination Agencies of provider ineligibility and what actions participants may expect. The Individual Support Plan team must discuss the option of other willing and qualified providers or other services that will meet the participant’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 20 Public Notice Issue a public notice which lists all settings/providers with the determination of whether they are ineligible or will go through the CMS heightened scrutiny process for public comment. October 2018 November 2018 Public Notice
2 Identify Information is Included in the Individual Support Plan Identify where setting options provided to individuals will be documented in the Individual Support Plan January 2016 June 2016 HCBS IT Changes List, Document Setting Options 3 Develop Communication Develop and publish communication regarding required Individual Support Plan documentation. July 2016 March 2017 Policy Document 4 Develop/Distribute Training and Policy Updates Identify, develop, and distribute training tools and policy updates as needed for compliance with this requirement. April 2017 March 2019 Training Tools and Policy Updates 5 Revise On-site Monitoring Tools Revise on-site monitoring as necessary. March 2018 August 2018 On-site Monitoring 6 Provider Monitoring Assess providers for compliance with this requirement. October 2018 March 2019 and Ongoing Individual Support Plan, On-site Monitoring Tool 7 Identify Noncompliance during On-site Monitoring Providers to be noncompliant with this requirement during on-site monitoring will be required to submit a Plan of Correction and may have their waiver provider agreement terminated if noncompliant with the Plan of Correction. March 2019 March 2019 and Ongoing Compliance Process Federal Requirement-441.301(c) (4) (iii) – The setting ensures individual rights of privacy, dignity and respect, and freedom from coercion and restraint Assessment of current waiver, regulations, standards, policies, licensing requirements, and other provider requirements: The following regulations were reviewed: 55 Pa. Code Chapters 51, 2380, 6400 and 6500. Licensing regulations for Community Homes for Individuals with an Intellectual Disability (55 Pa. Code Chapter 6400) and Family Living Homes (55 Pa. Code Chapter 6500) currently have requirements that individuals have the right to privacy in bedrooms, bathrooms, and during personal care. These regulations also contain the requirement that individuals have the right to reasonable access to a telephone and the opportunity to receive and make private calls, with assistance when necessary. 55 Pa. Code Chapter 51 requires that participants who receive HCBS through BAS be treated with dignity and respect. This regulatory chapter also states that providers of HCBS s may not use the following: seclusion; chemical restraint; mechanical restraint; prone position manual restraint; or a manual restraint that inhibits the respiratory and digestive system, inflicts pain, causes hypertension of joints and pressure on the chest or joints, or uses a technique in which the participant is not supported and allows for free fall as the participant moves to the floor.
Federal Requirement-441.301(c) (4) (iv) –The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to: daily activities, physical environment, and with whom to interact Assessment of current waiver, regulations, standards, policies, licensing requirements, and other provider requirements: The following regulations were reviewed: 55 Pa. Code Chapters 51, 2380, 6400 and 6500. Licensing regulations for Community for Individuals with an Intellectual Disability (55 Pa. Code Chapter 6400) and Family Living Homes (55 Pa. Code Chapter 6500) currently have requirements that day services such as employment, education, training, volunteer, civic-minded and other meaningful opportunities shall be offered to the individual. # Action Item Description Start Date Target End Date Deliverable 1 Develop Policy Develop policy with stakeholder input regarding settings that have the effect of isolating individuals receiving HCBS from the broader community of individuals not receiving HCBS and settings that will be considered home and community-based. April 2015 July 2015 Initial Draft of Home and Community-Based Characteristics Policy 2 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 Draft of Home and Community-Based Characteristics Policy 3 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 of Home and Community-Based Characteristics Policy 4 Publication of Policy Publish home and characteristics policy. December 2015 December 2015 Home and Characteristics Policy 5 Develop/Distribute Training Tools and Policy Updates Identify, develop, and distribute training tools and policy updates that are needed for compliance with this federal requirement. January 2016 January 2017 and ongoing Training and Policy Updates 6 Revise On-site Monitoring Tools Revise on-site monitoring tools as necessary to monitor provider compliance with this federal requirement. 2016 2019 and ongoing On-site Monitoring Tools 7 Provider Monitoring Assess providers for compliance with this requirement. September 2016 March 2019 and ongoing On-site Monitoring Tools 8 Identify Noncompliance During On-site Monitoring Providers found to be noncompliant with this requirement during on-site monitoring will be required to submit a Plan of Correction and may have their waiver provider agreement terminated if noncompliant with the Plan of Correction. January 2017 March 2019 Compliance Process
HCBS participant, and that the document provides protections that address eviction processes and appeals comparable to those provided under the jurisdiction’s landlord tenant law. Assessment of current waiver, regulations, standards, policies, licensing requirements, and other provider requirements: The following regulations were reviewed: 55 Pa. Code Chapters 51, 6400 and 6500. 55 Pa. Code Chapter 51 requires that a room and board contract be completed annually for each individual receiving a residential habilitation service through the waiver. This regulatory chapter also requires providers to provide written notice at least 30 days prior to the date of discharge to the participant, Department, Department’s designee and the supports coordinator. There are currently no regulations or requirements, however, that requires the room and board contract give individuals protections from eviction. # Action Item Description Date Target End Date Deliverable 1 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 Draft Regulations 2 Analyze PA’s Landlord Tenant Law Analyze PA’s landlord tenant law and determine what constitutes comparability for residential settings. June 2015 January 2016 Revised Room and Board Contract 3 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 Notice in Pennsylvania Bulletin 4 Revise Room and Contract Revise and distribute updated Room And Contract. January 2016 January 2017 Room and Board Contract 5 Issue Revised Regulations Issue revised regulations June 2016 June 2016 Regulations 6 Develop/Distribute Training Tools and Policy Updates Identify, develop, and distribute training tools and policy updates that are needed for compliance with this federal requirement. January 2017 July 2017 and ongoing Training Tools and Policy Updates 7 Revise On-site Monitoring Tool Revise on-site monitoring tools as necessary to monitor provider compliance with this federal requirement. March 2018 August, 2018 and ongoing On-site Monitoring Tools 8 Provider Monitoring Assess providers for compliance with this requirement. October 2018 March 2019 and ongoing On-site Monitoring 9 Identify Noncompliance During On-site Monitoring Providers found to be noncompliant with this requirement during on-site monitoring will be required to submit a Plan of Correction and may have their waiver provider agreement terminated if noncompliant with the Plan of Correction. March 2019 March 2019 and ongoing Compliance Process
7 Revise On-site Monitoring Tool Revise on-site monitoring as necessary to monitor provider compliance with this federal requirement. March 2018 August 2018 and ongoing On-site Monitoring Tool As Necessary 8 Provider Monitoring Assess providers for compliance with this requirement. October 2018 March 2019 and ongoing On-site Monitoring Tools 9 Identify Noncompliance During On-site Monitoring Providers to be noncompliant with this requirement during on-site monitoring will be required to submit a Plan of Correction and may have their waiver provider agreement terminated if noncompliant with the Plan of Correction. March 2019 March 2019 and ongoing Compliance Process Federal Requirement-42 CFR 441.301(c) (4) (vi) (B) (3) – In a provider-owned or controlled residential setting, individuals have the freedom to furnish and decorate their sleeping or living units within the lease or other agreement. Assessment of current waiver, regulations, standards, policies, licensing requirements, and other provider requirements: The following regulations were reviewed: 55 Pa. Code Chapters 51, 6400 and 6500. 55 Pa. Code Chapter 51 requires that a room and contract be completed annually for each individual receiving a residential habilitation service through the waiver. There is no requirement, however, that the room and board contract state that individuals have the freedom to furnish and decorate their sleeping or living units. Licensing regulations for Community for Individuals with an Intellectual Disability (55 Pa. Code Chapter 6400) and Family Living Homes (55 Pa. Code Chapter 6500) currently have the requirement that an individual has the right to receive, purchase, have and use personal property. # Action Item Description Start Date Target End Date Deliverable 1 Revise Room and Board Contract Revise and distribute updated Room And Board Contract. January 2016 June 2017 Room and Board Contract 2 Identify Information is Included in the Individual Support Plan When a modification to one of the requirements is needed, identify where required information will be documented in the Individual Support Plan. January 2016 June 2016 HCBS IT Changes List, Document Setting Options 3 Develop Communication Develop and publish communication regarding required Individual Support Plan documentation. This communication will include the additional information that must be included in July 2016 December 2016 Policy Document
3 Identify Where Information is Included in the Individual Support Plan When a modification to one of the requirements is needed, identify where required information will be documented in the Individual Support Plan. January 2016 June 2016 HCBS IT Changes List, Document Setting Options 4 Develop Communication Develop and publish communication regarding ISP documentation. This communication will include the additional information that must be included in the Individual Support Plan when a modification to a requirement is needed. July 2016 December 2016 Policy Document 5 Revise On-site Monitoring Tool Revise on-site monitoring tool as necessary to monitor provider compliance with this federal requirement. March 2018 August 2018 and ongoing On-site Monitoring Tool 6 Provider Monitoring Assess providers for compliance with this requirement October 2018 March 2019 and ongoing On-site Monitoring Tools 7 Identify Noncompliance During On-site Monitoring Providers found to be noncompliant with this requirement during on-site monitoring will be required to submit a Plan of Correction and may have their waiver provider agreement terminated if noncompliant with the Plan of Correction. March 2019 March 2019 and ongoing Compliance Process Federal Requirement-42 CFR 441.301(c) (4) (vi) (E) – In a provider-owned or controlled residential setting, the setting is physically accessible to the individual. Assessment of current waiver, regulations, standards, policies, licensing requirements, and provider requirements: The following regulations were reviewed: 55 Pa. Code Chapters 51, 6400 and 6500. Licensing regulations for Community for Individuals with an Intellectual Disability (55 Pa. Code Chapter 6400) currently have a requirement that requires physical accessibility and accommodations for individuals with physical disabilities. # Action Item Description Date Target End Date Deliverable 1 Develop a Process/Tool Develop and publish a process/tool to determine how individual accessibility can be verified during on-site monitoring to monitor provider compliance with this federal requirement. March 2016 August 2016 On-site Monitoring Tool 2 Provider Monitoring Assess providers for compliance with this requirement October 2016 June 2017 and ongoing On-site Monitoring Tool 3 Identify Noncompliance Providers found to be noncompliant with this requirement during on-site monitoring will be required to submit a Plan of May 2017 July 2017 and ongoing Compliance Process