Pennsylvania – 0147.R06.00

Waiver Title

Consolidated Waiver 0147.R06.00

Description of Emergency

N/A

Start Date

11-03-20

End Date

11-03-21

Description of Transition Plan

N/A

Area(s) Affected

Area Affected

statewide

Increase Cost Limits

N/A

Modify Targeting Criteria

N/A

Modify Scope or Coverage

N/A

Exceed Service Limitations

Residential Habilitation, Life Sharing and Supported Living 1. Service definition limitations on the number of people served in each licensed or unlicensed home may be exceeded. 2. Shift nursing may be provided as a discrete service during the provision of residential habilitation, life sharing and supported living services to ensure participant health and safety needs can be met. 3. Supplemental Habilitation can be provided, without requesting a variance, during the provision of licensed residential habilitation, licensed life sharing and supported living services to address the increased needs of individuals affected by the epidemic/pandemic or increased number of individuals served in a service location. Supplemental habilitation may be used to supplement staffing in the residential home itself or support a participant while the participant stays in the home of friends or family. Respite 1. Respite limits may be extended beyond 30 days annually without requesting a variance in order to meet the immediate health and safety needs of participants. Community Participant Support, Companion and In-Home and Community Support 1. Any one of these services or a combination of these services may be provided in excess of 14 hours per day without requesting a variance in order to meet the needs of participants.

Add Services

N/A

Expand Settings

Respite 1. Respite services may be provided in any setting necessary to ensure the health and safety of participants. 2. Room and board is included in the fee schedule rate for Respite in a licensed Residential Habilitation setting. 3. Room and board would be included in the fee schedule rate for settings used in response to the emergency. Community Participation Support 1. Community Participation Support may be provided in private homes. In-Home and Community Support, Companion and Behavioral Support 1. Direct In-Home and Community Support, Companion and Behavioral Support services may be provided using remote/tele support when this type of support meets the health and safety needs of the participant.

Provide Service Out of State

N/A

Allow Payment for Services by Families

Residential Habilitation, Supported Living, or Supplemental Habilitation services may be rendered by relatives or legally responsible individuals when they have been hired by the provider agency authorized on the ISP. Relatives and legally responsible individuals must receive training on the participant’s ISP for whom they are rendering these services. Training on the ISP must consist of basic health and safety support needs for that participant including but not limited to the fatal four. When one of these services is rendered by relatives or legally responsible individuals, the provider agency authorized to render the Residential Habilitation, Supported Living or Supplemental Habilitation service, is responsible for ensuring that services are provided as authorized in the ISP and that billing occurs in accordance with ODP requirements. Supplemental Habilitation may provided by relatives or legally responsible individuals in the Residential Habilitation home or the private home of the relative or legally responsible individual.

Modification of Provider Qualifications

To allow redeployment of direct support and clinical staff to needed service settings during the emergency, staff qualified under any service definition in the Consolidated waiver may be used for provision of any non-professional service under another service definition in C-1/C-3. Professional services exempt from this include; Supports Coordination, Therapy Services, Behavioral Support, Consultative Nutritional Services, Music Therapy, Art Therapy and Equine Assisted Therapy and Shift Nursing. All staff must receive training on any participants’ ISPs for whom they are providing support. Training on the ISP must consist of basic health and safety support needs for that individual including but not limited to the fatal four.

Modify Provider Types

N/A

Modify Licensure/Requirements for Waiver Settings

Residential Habilitation, Life Sharing and Supported Living 1. Maximum number of individuals served in a service location may be exceeded to address staffing shortages or accommodate use of other sites as quarantine sites. 2. Minimum staffing ratios as required by licensure, service definition and individual plan may be exceeded due to staffing shortages. Community Participation Support 1. Minimum staffing ratios as required by licensure, service definition, and individual plan may be exceeded due to staffing shortages. 2. The requirement to provide services in community locations a minimum of 25% of participant time in service is suspended. 3. The requirement that no more than 3 people can be supported at a time in a community location is suspended. Education Support Services 1. Allow all components of Education Support to be provided in accordance with any changes the university/college makes for distance/web learning.

Modification LOC Eval and Re-Eval Processes

When ICF/ID or ICF/ORC level of care is evaluated, it is not required that a physician recommend, certify, or verify that the individual should receive the level of care furnished through the waiver. Initial level of care evaluations will consist of: 1) confirmation of intellectual disability, autism or developmental disability diagnosis; 2) QDDP certification of impairments in adaptive functioning; and 3) Documentation substantiating that the individual has had these conditions of intellectual disability or autism and adaptive functioning deficits which manifested during the developmental period which is from birth up to the individual’s 22nd birthday. Level of care recertification can be extended from 365 days of the initial evaluations and subsequent anniversary dates to 18 months from initial evaluations

Increase Payment Rates

The following rates may be increased to account for excess overtime of direct support professionals to cover staffing needs and to account for additional infection control supplies and service costs: Residential Habilitation, Life Sharing, Supported Employment, In-Home and Community Support, Companion, Community Participation Supports, Respite, and Shift Nursing. The rate setting methodology is the same. Upward adjustments are made to the supply costs (additional supplies for infection control) and overtime for direct support staff. Resulting temporary rate increases are not expected to exceed 40%.

Modifications of ISP

Modifications to Supports Coordination 1. Allow remote/telephone individual monitoring by Supports Coordinators where there are currently face-to-face requirements. 2. Individual plan team meetings and plan development may be conducted entirely using telecommunications. Participant Rights ? Suspend requirements for allowing visitors (providers may prohibit/restrict visitation in-line with CMS recommendations for long term care facilities). The modification of this right is not required to be justified in the individual plan. ? Suspend requirements for right to choose who to share a bedroom with. The modification of this right is not required to be justified in the individual plan.

Modify Incident Reporting/Med Management Safeguards

Incident Management Changes ? The requirement to conduct an investigation of any incident of deviation in staffing as outlined in an individual plan may be suspended. ? The requirement to submit an incident report for any deviation in staffing as outlined in an individual plan may be suspended. If this requirement is suspended, providers must report any incidents in which staffing shortages result in a failure to provide care.

Allow Payment for Services During Acute Care Hospital/Short Term Institutional Stay

Participants that require hospitalization due to a diagnosis of COVID19 may receive the following services in a hospital setting when the participant requires these services for communication, behavioral stabilization and/or intensive personal care needs: ? Residential Habilitation ? Life Sharing ? Supported Living ? Supplemental Habilitation ? In Home and Community Support ? Companion These services cannot be provided in a hospital for more than 30 consecutive days except in situations where it is medically necessary for the participant to be hospitalized for more than 30 consecutive days due to a diagnosis COVID19.

Inclusion of Retainer Payments

Retainer payments may be provided for Community Participation Supports (day habilitation). ? Retainer payments may be provided in circumstances in which facility closures are necessary due to COVID19 containment efforts. ? Retainer payments may be provided in circumstances in which attendance and utilization for the service location drop to below 75% of annual monthly average 7/1/19 to 2/28/2020. ? Retainer payments will not exceed 75% of monthly average of total billing under the 1915(c) waivers. Through billing procedures, ODP will ensure that there will be no duplicative payments. Community Participation Support services rendered in private homes or other community settings to ensure participant health and safety will be deducted from any calculations for retainer payments.

Institute/Expand Opportunities for Self-Direction

N/A

Increase Factor C

N/A

Other Changes Necessary

Given the rapid response that will be necessary to ensure participant health and welfare and to avoid delays while waiting for approval and authorization of individual plan changes in HCSIS, documentation of verbal approval or email approval of changes and additions to individual plans will suffice as authorization. Upon validation that a verbal or email approval was provided for requested changes, AEs may backdate authorizations in HCSIS for waiver services provided during the period of time specified in Appendix K

Addendum

HCBS Regulations

Not comply with the HCBS settings requirement at 42 CFR 441.301(c)(4)(vi)(D) that individuals are able to have visitors of their choosing at any time, for settings added after March 17, 2014, to minimize the spread of infection during the COVID-19 pandemic.

Services

Add Electronic Method of Service Delivery

N/A

Add Home Delivered Meals

N/A

Add Medical Supplies, Equipment and Appliances

N/A

Add Assistive Technology

N/A

Conflict of Interest

Other Changes Necessary

Given the rapid response that will be necessary to ensure participant health and welfare and to avoid delays while waiting for approval and authorization of individual plan changes in HCSIS, documentation of verbal approval or email approval of changes and additions to individual plans will suffice as authorization. Upon validation that a verbal or email approval was provided for requested changes, AEs may backdate authorizations in HCSIS for waiver services provided during the period of time specified in Appendix K

Other Changes Necessary

Given the rapid response that will be necessary to ensure participant health and welfare and to avoid delays while waiting for approval and authorization of individual plan changes in HCSIS, documentation of verbal approval or email approval of changes and additions to individual plans will suffice as authorization. Upon validation that a verbal or email approval was provided for requested changes, AEs may backdate authorizations in HCSIS for waiver services provided during the period of time specified in Appendix K

Provider Qualifications

Allow Spouses and Parents of Minor Children to Provide Personal Care Servcies

N/A

Allow a Family Member to be Paid to Render Services to an Individual

N/A

Allow Other Practitioners in Lieu of Approved Providers Within the Waiver

N/A

Modify Service Providers for Home-Delivered Meals to Allow for Additional Providers, Including Non-Traditional Providers

N/A

Processes

Allow an Extension for Reassessments and Reevaluations for up to One Year Past the Due Date

N/A

Allow the Option to Conduct Evaluations, Assessments, and Person-Centered Service Planning Meetings Virtually/Remotely in lieu of Face-to-Face Meetings

N/A

Adjust Prior Approval/Authorization Elements Approved in Waiver

N/A

Adjust Assessment Requirements

N/A

Add an Electronic Method of Signing Off on Required Documents Duch As The Person-Centered Service Plan

N/A

Link To Application

https://www.medicaid.gov/state-resource-center/downloads/pa-0147-appendix-k-appvl.pdf

Link to Approval Letter

https://www.medicaid.gov/state-resource-center/downloads/pa-appendixk-appvl-ltr.pdf