B-3-c Reserved Waiver Capacity – (Consolidated Waiver Only) Unanticipated Emergencies The capacity that the State reserves in each waiver year is specified in the following table: Year 1 – 20 Year 2 – 50 Year 3 – 120 Year 4 – 120 Year 5 – 20 Unanticipated Emergencies The capacity that the State reserves in each waiver year is specified in the following table: Year 1 – 20 Year 2 – 50 Year 3 – 120 Year 4 – 120 Year 5 – 20 60 Increase reserved capacity for unanticipated emergencies based on past need and usage. B-3-c Reserved Waiver Capacity – (Consolidated Waiver Only) Hospital/Rehabilitation Care The capacity that the reserves in each waiver year is specified in the following table: Year 1 – 750 Year 2 – 750 Year 3 – 550 Year 4 – 550 Year 5 – 550 Hospital/Rehabilitation Care The capacity that the reserves in each waiver year is specified in the following table: Year 1 – 750 Year 2 – 750 Year 3 – 550 Year 4 – 550 200 Year 5 – 550 200 The Department has found in the first three years of implementation of reserved capacity for this purpose that this number is higher than necessary to serve those individuals that require hospital/rehabilitation care. B-3-c Reserved Waiver Capacity – (P/FDS Waiver Only) Waiting List Initiative The capacity that the reserves in each waiver year is specified in the following table: Year 1 – 700 Year 2 – 700 Year 3 – 700 Year 4 – 0 Year 5 – 0 Waiting List Initiative The capacity that the State reserves in each waiver year is specified in the following table: Year 1 – 700 Year 2 – 700 Year 3 – 700 Year 4 – 0 600 Year 5 – 0 Increase the number of individuals that can be served in the P/FDS waiver to accommodate the FY 15/16 waiting list initiative B-3-c Reserved Waiver Capacity – (P/FDS Waiver Only) This will be a new category Purpose (provide a title or short description to use for lookup): Competitive Employment Initiative Purpose (describe): ODP reserves capacity for the following to encourage competitive employment: Encourage competitive employment by reserving space in the P/FDS Waiver for 50 individuals who have, or expect to have a successful closure with OVR.
Year 1 – 0 Year 2 – 0 Year 3 – 0 Year 4 – Year 5 – 50 Appendix C C-1/C-3 Provider Qualification Criteria Nothing is currently in the waivers standards will apply to all providers with the exception of support service workers in the participant directed service models and public transportation providers. Standard: New providers demonstrate compliance with ODP standards through completion of a self-assessment and validation of required documentation, policies and procedures. Moving the requirement for new providers to complete a self-assessment from a provider monitoring requirement to a provider qualification requirement to ensure new providers meet the same requirements as existing providers. C-1/C-3 Education Support Services – Provider Specifications for Service Provider Qualifications for Individual and Agency providers. Other Standard: 1. Have a waiver service location in Pennsylvania or a state contiguous to Pennsylvania. Provider Qualifications Other Standard: 1. Have a waiver service location in Pennsylvania, Washington DC, Virginia or a state contiguous to Pennsylvania. Increase flexibility by allowing waiver participants to received Education Support Services in Washington DC and Virginia. C-1/C-3 Home and Community Habilitation (Unlicensed) – Service Specification (The language regarding residential habilitation will only be written in the Consolidated Waiver) This is a direct service (face-to-face) provided in home and community settings to assist participants in acquiring, maintaining, and improving self-help, domestic, socialization, and adaptive skills necessary to reside successfully in home and community based settings. Services consist of support in the general areas of self-care, communication, fine and gross motor skills, mobility, personal adjustment, relationship development, socialization, and use of community resources. When services are provided by Home and Community Habilitation is a direct service (face-to-face) provided in home and community settings to assist participants in acquiring, maintaining and improving the skills necessary to live and participate fully in community life. To the extent that Home and Community Habilitation is provided in community settings, the settings must be integrated in the general community. self-help, domestic, socialization, and adaptive skills necessary to reside successfully in home and community based settings. Align the service definition with the CMS HCBS Final Rule requirements. Allow relatives/legal guardians to provide companion services. Increase flexibility regarding professionals who can provide Level 4 Enhanced Home and Community Habilitation.
with a staff member who has at least a 4 year degree or is a licensed nurse. • Level 4 - The provision of the service at a staff-to-individual ratio of 2:1. • Level 4 Enhanced - The provision of the service at a staff-to-individual ratio of 2:1 with at least one staff member who has at a minimum a 4 year degree or who is a licensed nurse. The second staff member must have at least a high school diploma. with staff members who have at least a 4 year degree or who are a licensed nurse. The use of enhanced levels of service is based on the participant‘s assessed need, not the service worker‘s personal qualifications. The fact that the service worker possesses a degree is not justification to use the enhanced level of service. When services are provided by providers, this service also includes transportation services necessary to enable the participant to participate in the Home and Community Habilitation Service, in accordance with the participant’s ISP. This service can be delivered in Pennsylvania and in states contiguous to Pennsylvania. During temporary travel, this service may be provided in Pennsylvania or other locations as per the ODP travel policy. Specify applicable (if any) limits on the amount, frequency or duration of this service:
approved program capacity on a basis. *Licensed Child Residential Service Home (55 Pa. Code Chapter 3800) located in Pennsylvania. *Licensed Community Residential Rehabilitation Services for the Mentally Ill Home (55 Pa. Code Chapter 5310) located in Pennsylvania. *Unlicensed home of a provider or a private home that is located in Pennsylvania or a contiguous state. *Other community settings such as camp where the setting meets applicable state or local codes and the provider of service meets the provider qualifications established by the Department. When respite is provided in a licensed residential setting, the settings must be integrated and dispersed in the community in noncontiguous locations, and may not be located on campus settings. Exceptions to criteria can be requested in accordance with ODP policy. Respite services may not be provided in Nursing Homes, Hospitals, Personal Care Homes or ICFs/ID. This service may be provided at the following levels: *Basic Staff Support - The provision of the service at a staff-to-individual ratio of 1:4. *Level 1 - The provision of the service at a staff-to-individual ratio range of <1:4 to >1:1. *Licensed Community Home (55 Pa. Code Chapter 6400) located in Pennsylvania within the home's approved program capacity. ODP may approve the provision of Respite Services above a home's approved program capacity on a basis. *Licensed Child Residential Service Home (55 Pa. Code Chapter 3800) located in Pennsylvania. *Licensed Community Residential Rehabilitation Services for the Mentally Ill Home (55 Pa. Code Chapter 5310) located in Pennsylvania. *Unlicensed home of a provider or a private home that is located in Pennsylvania or a contiguous state. *Other community settings such as camp where the setting meets applicable state or local codes and the provider of service meets the provider qualifications established by the Department. When respite is provided in a licensed residential setting, the settings must be integrated and dispersed in the community in noncontiguous locations, and may not be located on campus settings. Exceptions to criteria can be requested in accordance with ODP policy. Respite services may not be provided in Nursing Homes, Hospitals, Personal Care Homes or ICFs/ID. This service may be provided at the following levels: case case
Certificate Must have at a 4 year degree when providing enhanced levels of Respite Service and the participant’s assessed needs require the degree. Current State motor vehicle registration is required for all vehicles owned, leased, and/or hired and used as a component of the Respite Service. Other Standard 1.Be a resident of Pennsylvania or a state contiguous to Pennsylvania with supporting documentation (for SSWs). 2.Have a waiver service location in Pennsylvania or a state contiguous to Pennsylvania (for an individual who is not a SSW). 3.Have a signed ODP Provider Agreement on file with ODP (for an individual who is not a SSW). 4.Complete standard ODP required orientation and training (for an individual who is not a SSW). 5.Be at least 18 years of age… Certificate At least one staff member must have at least a 4 year degree when providing enhanced levels of Respite Service and the participant’s assessed needs require the degree. Current State motor vehicle registration is required for all vehicles owned, leased, and/or hired and used as a component of the Respite Service. Other Standard 1.Be a legal resident of Pennsylvania or a state contiguous to Pennsylvania with supporting documentation (for SSWs). 1.Have a waiver service location in Pennsylvania, Washington DC or Virginia or a state contiguous to Pennsylvania (for an individual who is not a SSW). 2.Have a signed ODP Provider Agreement on file with ODP (for an individual who is not a SSW). 3.Complete standard ODP required orientation and training (for an individual who is not a SSW). 4. Have at least a high school diploma for participants authorized to receive 2:1 enhanced Respite. The other staff member must have at a minimum a 4 year degree or be a licensed nurse. 5.Be at least 18 years of age… C-1/C-3 Supported Employment – Service Specification Supported Employment services are direct and indirect services that are provided in a variety of community settings for the purposes of supporting participants in obtaining and sustaining competitive Supported Employment services are direct and indirect services that are provided in a variety of community settings for the purposes of supporting participants in obtaining and sustaining competitive Information is being removed from the Supported Employment service definition to align with §1915(c)(5)(C) of the
and/or on-the-job resources that are available to employees who are The provision of job finding services must be evaluated at least every six months by the ISP team or more frequently as needed to assess the continued need for the service and whether the service is assisting the participant with the outcome of finding community employment. If the service is not assisting the participant with this outcome, the ISP team must identify changes to the Supported Employment Service to realize this outcome or service options to meet the participant’s needs. The provision of job support services must be evaluated at least annually, as part of the ISP process, to determine whether the participant continues to require the current level of authorized services. The ISP must be updated, if necessary, to reflect the team’s determination. This service can be delivered in Pennsylvania and in states contiguous to Pennsylvania. Refer to the Provider Specification section below for criteria on provider requirements. Specify applicable (if any) limits on the amount, frequency or duration of this service: When Supported Employment services are provided or in conjunction with Prevocational, Transitional Work or Licensed Day Habilitation services, the total number of hours for these services available to employees who are The provision of job finding services must be evaluated at least every six months will be evaluated during participant monitoring by the SC ISP team or more frequently as needed to assess the continued need for the service and whether the service is assisting the participant with the outcome of finding community employment. If the service is not assisting the participant with this outcome, the SC will convene an ISP team meeting to must identify changes to the Supported Employment Service to realize this outcome or other service options to meet the participant’s needs. The provision of job support services must be evaluated at least annually, as part of the ISP process, to determine whether the participant continues to require the current level of authorized services. The ISP must be updated, if necessary, to reflect the team’s determination. This service can be delivered in Pennsylvania and in states contiguous to Pennsylvania. Refer to the Provider Specification section below for criteria on provider requirements. Specify applicable (if any) limits on the amount, frequency or duration of this service: When Supported Employment services are provided alone or in conjunction with Prevocational, Transitional Work or Licensed Day Habilitation services, the total number of hours for these services
• The participant is determined ineligible for OVR services; or • The participant has been given information about the benefits of competitive employment, the services offered by OVR to eligible individuals and has made an informed choice to decline a referral to OVR. C-1/C-3 Nursing - Service Specification 49 Pa. Code Chapter 21 (State Board of Nursing) provides the following service definition for the practice of professional nursing: "Diagnosing and treating human responses to actual or potential health problems through such services as case finding, health teaching, health counseling, provision of care supportive to or restorative of life and well-being, and executing medical regimens as prescribed by a licensed physician or dentist. The term does not include acts of medical diagnosis or prescription of medical, therapeutic or corrective measures, except as may be authorized by rules and regulations jointly promulgated by the State Board of Medicine and the Board, which rules and regulations will be implemented by the Board." This service can be delivered in Pennsylvania and in states contiguous to Pennsylvania. During temporary travel, this service may be provided in Pennsylvania or other locations as per the ODP travel policy. Refer to the Provider Specification section 49 Pa. Code Chapter 21 (State Board of Nursing) provides the following service definition for the practice of professional nursing: "Diagnosing and treating human responses to actual or potential health problems through such services as case finding, health teaching, health counseling, provision of care supportive to or restorative of life and well-being, and executing medical regimens as prescribed by a licensed physician or dentist. The term does not include acts of medical diagnosis or prescription of medical, therapeutic or corrective measures, except as may be authorized by rules and regulations jointly promulgated by the State Board of Medicine and the Board, which rules and regulations will be implemented by the Board." This service can be delivered in Pennsylvania and in states contiguous to Pennsylvania. During temporary travel, this service may be provided in Pennsylvania or other locations as per the ODP travel policy. Refer to the Provider Specification section below for criteria on provider requirements. Allow relatives and legal guardians to provide nursing services.
below for criteria on provider requirements. Specify applicable (if any) limits on the amount, frequency or duration of this service: Extended state plan nursing services can only be provided to adult waiver participants (participants age 21 and older). Nursing services may only be funded for adult participants through the Waiver if documentation is secured by the Supports Coordinator that shows the service is medically necessary and either not covered by the participant's insurance or insurance limitations have been reached. A participant's insurance includes Medical Assistance (MA), Medicare and/or private insurance. Service Delivery Method each that applies): Participant-directed as specified in Appendix E Provider managed Specify whether the service may be provided by (check each that applies): Legally Responsible Person Relative Guardian Specify applicable (if any) limits on the amount, frequency or duration of this service: Extended state plan nursing services can only be provided to adult waiver participants (participants age 21 and older). Nursing services may only be funded for adult participants through the Waiver if documentation is secured by the Supports Coordinator that shows the service is medically necessary (i.e functions that can only be provided by a registered nurse or licensed practical nurse) and either not covered by the participant's insurance or insurance limitations have been reached. A participant's insurance includes Medical Assistance (MA), Medicare and/or private insurance. Service Delivery Method each that applies): Participant-directed as specified in Appendix E Provider managed Specify whether the service may be provided by (check each that applies): Legally Responsible Person Relative Legal Guardian C-1/C-3 Therapy Services – Service Specification and Provider Specifications Therapy services include the following: Visual/mobility therapy provided by a trained visual or mobility specialist/instructor based on an evaluation and recommendation by a trained mobility specialist/instructor or a physician… Therapy services include the following: • Visual/mobility Orientation, mobility and vision therapy provided by a trained visual or orientation and mobility specialist/instructor based on an evaluation and recommendation by a trained mobility specialist/instructor or a physician… Align with current terminology and standards
Visual/Mobility Therapy: This therapy is for participants who are blind or have visual impairments… Provider Category – Agency and Individual Provider Type Title – Visual/Mobility Therapy Agency Provider Qualifications Certificate – Employees (direct, contracted, or in a consulting capacity) providing Visual/Mobility Therapy must be trained visual or mobility specialists/instructors. Standard 3. Agree to carry out the Visual/Mobility Therapy outcomes included in the ISP. Visual/Orientation, mobility and vision therapy: This therapy is for participants who are or have visual impairments… Provider Category – Agency and Individual Provider Type Title – Visual/Orientation, Mobility and Vision Therapy Agency Provider Qualifications Certificate – Employees (direct, contracted, or in a consulting capacity) providing Visual/Orientation, Mobility and Vision therapy must be certified by the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP) as one of the following: Certified Low Vision Therapist; Certified Orientation and Mobility Specialist; or Certified Vision Rehabilitation Therapist. be trained visual or mobility specialists/instructors. Other Standard 3. to carry out the Visual/Orientation, Mobility and Vision Therapy outcomes included in the ISP. C-1/C-3 Supports Broker Services – Service Specifications (Consolidated Waiver Only) Specify applicable (if any) limits on the amount, frequency or duration of this service: This service is limited to a maximum of 1040 (15-minute) units per participant per fiscal year based on a 52-week year. This service is limited to participants who are Specify applicable (if any) limits on the amount, frequency or duration of this service: This service is limited to a maximum of 1040 (15-minute) units per participant per fiscal year based on a 52-week year. This service is limited to participants who are self-directing their services through an Increase opportunities for participants to reside in private homes and their services. Supports Brokers can perform many of the activities that are listed in the Supports Broker service
self-directing their services through an AWC or VF/EA FMS. AWC or VF/EA FMS. Supports Broker services may be provided for participants in a waiver residential habilitation setting in the following circumstances: The participant has a plan to transition from a residential setting to a private residence, and The participant has a plan to their services through an AWC or VF/EA FMS once they are in a private residence. definition to ensure the participant has natural and paid supports in place that will meet the needs of the participant and help him or her be successful in the private residence. C-1/C-3 Assistive Technology – Service Specifications Generators are covered for participants residing in private when the following has been documented: • The generator purchased is the most cost-effective to ensure the health and safety of the participant; AND • The neighborhood has a history of unreliable power as documented in a letter from the power company; OR • The participant’s health and safety is dependent upon electricity as documented by a physician… Specify applicable (if any) limits on the amount, frequency, or duration of this service: Assistive Technology has a lifetime limit of $10,000.00 per participant except when the limit is extended by ODP using the standard ODP exception process. No more than one replacement electronic device is allowed every 5 years. Generators are covered for participants residing in private homes. when the following has been documented: • The generator purchased is the most cost-effective to ensure the health and safety of the participant. And: • The neighborhood has a history of unreliable as documented in a letter from the power company; OR • The participant’s health and safety is dependent upon electricity as documented by a physician. Specify applicable (if any) limits on the amount, frequency, or duration of this service: Assistive Technology has a lifetime limit of $10,000.00 per participant except when the limit is extended by ODP using the standard ODP exception process. There is also a lifetime limit of $5,000.00 for generators purchased as Assistive Technology. No more than one replacement electronic device is allowed every 5 years. Implement a lifetime limit on generators.
service is a covered service under the MA State Plan… Specify applicable (if any) limits on the amount, frequency or duration of this service: Companion Services may not be authorized for participants who receive Residential Habilitation services. Companion Services and Home and Community Habilitation have a maximum limit of 24 hours (96 15-minute units) per participant per calendar day whether used in combination or alone. Companion Services may not be provided at the same time as any of the following: Home and Community Habilitation, the direct portion of Supported Employment, Licensed Day Habilitation, Prevocational Services and Transitional Work Services. on their own but does not have the ability to safely evacuate in the event of an emergency. Companions may supervise and provide assistance in carrying out the functions of with daily living activities, including grooming, health care, household care, meal preparation and planning, and socialization. This service may not be provided at the same time as any other direct service (with the exception of Supports Coordination). This service can also be used to accompany participants to the community to ensure the participant’s health and safety. supervise participants during socialization or non-habilitative activities when necessary to ensure the participant’s safety. When Companion services occur in the community and are provided by agency-based providers, this service also includes the necessary transportation services necessary to enable the participant to community participation in the Companion Service, in accordance with the participant's ISP. This service is not available to participants when a legally responsible person is required to provide supervision or assistance or when the service is a covered service under the MA State Plan… Specify applicable (if any) limits on the amount, frequency or duration of this service:
Supported Employment services, the total number of hours for these services (whether utilized alone or in conjunction with one another) cannot exceed 40 hours (160 15-minute units) per participant per calendar week based on a 52-week year. Transitional Work Services may not be provided at the same time as any of the following: Companion Services, the direct portion of Supported Employment, Licensed Day Habilitation, Prevocational Services and Home and Community Habilitation Services. C-1/C-3 Transportation – Provider Specifications for Service Individual Relative/Legal Guardian Provider Qualifications Other Standard: 1.Be a legal resident of Pennsylvania or a state contiguous to Pennsylvania with supporting documentation (for SSWs or vendors in the VF/EA FMS option). 2.Have a waiver service location in Pennsylvania or a state contiguous to Pennsylvania (for individual providers that are not SSWs or vendors in the VF/EA FMS 3.Have a signed ODP Provider Agreement on file with ODP (for individual providers that are not SSWs or vendors in the VF/EA FMS model)… Individual Guardian Provider Qualifications Standard: 1.Be a resident of Pennsylvania or a state contiguous to Pennsylvania with supporting documentation (for SSWs or vendors in the VF/EA FMS option). 1.Have a waiver service location in Pennsylvania, Washington DC or Virginia, or a state contiguous to Pennsylvania (for individual providers that are not SSWs or vendors in the VF/EA FMS model). 2.Have a signed ODP Provider Agreement on file with ODP (for individual providers that are not SSWs or vendors in the VF/EA FMS Increase flexibility by allowing waiver participants to receive this service from relative/legal guardian providers in Washington DC and Virginia. C-2-a Criminal History and/or Background Investigations Requirements for employees and volunteers who are responsible for the welfare of or have direct contact with participants who are under age 18. **Requirements for employees and volunteers who are responsible for the welfare of or have direct contact with participants who are under age 18.** Update the requirements pertaining to working with participants who are under age 18 to align with Act 15 of 2015 which amended the
Volunteers are also required to renew these clearances every 36 months. The definitions for “responsible for the welfare of a child” and “direct contact with a child” are the same as described above for employees. For further specific requirements regarding volunteers please refer to 23 Pa C.S. §§ 6344, 6344.2, and 6344.4. Volunteers who have residency in another or country may begin serving provisionally for a single period not to exceed 30 days if the volunteer has clearances from their home state or country. For specific requirements please see 23 Pa C.S. § 6344.2 (f). Compliance with background requirements is verified through initial and ongoing provider qualification reviews, as well as provider monitoring conducted by ODP or the ODP Designee. For licensed providers, compliance with the Pennsylvania Code is also verified through annual licensing inspections. abuse history certification from the Department of Human Services (Child Abuse) clearance. A volunteer is relieved of the requirement to obtain the fingerprint based federal criminal history submitted through the PSP or its authorized agent (FBI) federal criminal history clearance if: 1) The position the volunteer is applying for is unpaid. 2) The volunteer has been a resident of Pennsylvania for the entirety of the previous ten-years. period. 3) The volunteer swears in writing that they are not disqualified from service as required under 23 Pa C.S. § 6344 (c) (grounds for denying employment or participation in program, activity, or service). If a volunteer has not been a resident of Pennsylvania for the past 10 but obtained their FBI certification at any time since establishing residency, they must provide a copy of the certification to the person responsible for the selection of volunteers and they are not required to obtain any additional FBI certifications. Volunteers who have residency in another state or country may begin serving provisionally for a single period not to exceed a total of 30 days in a calendar year if the volunteer is in compliance with the certification standards under the law or jurisdiction where they reside has clearances from their home state or country. For specific requirements please see 23 Pa C.S. § 6344.2 (f).