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Authors Posts by Carol Ferenz

Carol Ferenz

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From the Bureau of Supports for Autism and Special Populations:

We wanted to take a moment today to highlight a resource that might help participants who may be worried and need concrete check-ins to confirm or refute anxiety of potentially having COVID-19.

The CDC has recently updated their website with information about COVID-19 symptoms and what to do if you have any symptoms associated with COVID-19. The information is presented using concrete language and visual aids.  This site also includes a Coronavirus Self-Checker (available by clicking the above link and is the first option on the site) that gives information on next steps based off the presenting symptoms and medical history. This could be especially helpful for participants who may need a way to ease worries about their symptoms when they do not require a visit to a medical professional.

The Coronavirus Self-Checker could also be useful for providers to use while checking in with a participant who may express these concerns but might need assistance in answering the questions asked within the tool.

This Coronavirus Self-Checker can be helpful, especially for easing anxiety, but if you or a participant you support think you have been exposed to COVID-19 and develop a fever and symptoms such as a cough or difficulty breathing, call your healthcare provider for medical advice.

Please send any suggestions requests for additional resources to RA-basprovidersupprt@pa.gov

Additionally  ASERT has offered a link to ASERT’s  resource page related to COVID-19 https://paautism.org/resource/coronavirus-resources/

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The following is a brief summary of Deputy Secretary Ahrens update today via webinar regarding Appendix K: Emergency Preparedness and Response.

  • CMS process for submitted emergency changes to approved waiver agreements
  • ODP submitted emergency amendments to the 3 ID/A and the AAW 3/13/2020
  • CMS approved all emergency applications on 3/18/2020
  • Effective date of emergency amendments is 3/11/2020 – 3/11/21

Statewide Changes Effective March 12

  • Supports Coordination conducts monitoring visits and ISP team meetings remotely or by telephone
  • Limitation of visitors in residential programs
  • Community Participation Supports/Day Habilitation –suspend requirements for support in community locations
  • Annual licensing requirement for physicals for staff and participants is suspended. Providers do not need to request a waiver of this requirement; this is not considered a violation during this time.

Statewide Suspension of ODP Functions Effective March 17, 2020

  • Supports Intensity Scale (SIS) and PA Supplement Assessments
  • Quality Assessment and Improvement (QA&I) Provider and SCO Corrective Action Plans (CAPS) and Directive Corrective Action Plans (DCAPS) activities (unless otherwise instructed by ODP or the Administrative Entity)
  • Communication Assessments and Reassessments related to the Harry M Settlement
  • Annual licensing inspections as specified at 55 Pa .Code §20.31. (relating to Annual Inspection).
  • Independent Monitoring for Quality (IM4Q) interviews

Statewide Required Closures of Day Program Facilities effective Tuesday, March 17, 2020 and are in effect until further notice.

  • Older Adult Day facilities licensed under 6 Pa. Code Chapter 11
  • Adult Training Facilities licensed under 55 Pa. Code Chapter 2380
  • Prevocational Facilities licensed under 55 Pa. Code Chapter 2390

In order to help with slowing the spread of COVID-19, the following actions may be taken:

 Individual Rights may be limited:

  • Visitors
  • Sharing a bedroom
  • Access to community

ODP is recommending that staff find creative ways to help individuals keep in touch with friends and family such as Facetime, or Skype, writing letters. Calls, etc. Spending time outside of the house taking walks around the yard, or the neighborhood should be encouraged.

Remote Delivery of Services

In IDA Waivers:

  • Supports Coordination
  • In-Home and Community Supports
  • Companion
  • Community Participation Support/ Day Habilitation
  • Behavioral Support Services
  • Supports Broker

In AAW Waiver:

  • Supports Coordination
  • Specialized Skill Development
  • Therapy (counseling)
  • Family Support
  • Nutritional Consultation

ODP recommends deploying staff to services where Staff will be needed most:

  • Residential
  • Private homes where the family is the caregivers – who fall ill, are essential workers in healthcare, first responders, human services
  • In response to infections, need for isolation, quarantine
  • Support individuals in hospital settings

Flexibility to Allow for Necessary Movement of Staff

Changes to use Community Participation Support (CPS)/Day Habilitation staff are asked to work in private homes and residential programs

  • In-home/alternate provision of the day service by facility staff when family caregiver employed in essential roles like healthcare, first responders or human services and reliant on CPS/Day Habilitation for coverage during work.
  • For CPS/Day Habilitation providers who have residential, companion or in-home support service offerings, prepare to redeploy staff from facilities to fill other essential staffing needs.
  • ODP encourages providers that only offer CPS/Day Habilitation to contact other provider agencies and develop cooperative arrangements to supply staff to support participants in other service areas like residential, companion, or in-home support

Staff Qualifications– Staff qualified under any service definition in the ID/A waivers may be used for provision of any non-professional service under another service definition the ID/A waivers.

  • ID/A Waivers: 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
  • AAW: Professional services exempt from this include: Supports Coordination, Therapies, Behavioral Specialist Services and Systematic Skill Building components of Specialized Skill Development, Nutritional Consultation, Family Support, 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.  It is recommended that agencies utilize methods of remote training and nurse support to respond to rapid changes

Flexibility to Meet Staffing Needs in Residential – changes may be made as needed to:

  • Size of location
  • Staffing ratios
  • Supplemental Habilitation/Temporary Supplemental services
  • Shift Nursing
  • Location

Flexibility in In-Home and Community and Companion

(including for Participant-Directed Services)

  • Suspend 40/60 rules related to overtime and provision of services by relatives
  • May be provided remotely where health and safety can be ensured

Individual Support Plan Changes

  • Guidance on plan changes/authorizations will be provided in near future. ODP is working on a strategy to make broad systems changes for CPS retainer payments, and Residential with/without day to eliminate the need for providers and SCs/AEs to change everyone’s plan individually
  • Maintain clear documentation/records
  • P/FDS and Community Living cap exceptions may be temporarily exceeded to provide emergency care provision. When the emergency is declared to end, utilization of services for individuals must return to the frequency and duration as authorized in individual plans prior to the emergency.

Long Term Stability of Community System Financial Strategies – ODP is concerned about preserving providers of service and staff and are taking the following steps to help

  • Waiver of Prudent Pay for all ID/A and AAW waiver services beginning pay cycle 3/21/2020
  • Retainer Payments for CPS/Day Habilitation Providers
    • Protocols and will provide guidance by 3/25
    • Retainer payments for CPS/Day Habilitation providers up to 75% of previous average billing
    • CPS/Day Habilitation providers highly encouraged to redeploy staff in areas most needed.  We need these DSPs in workforce now and in the future!
  • Enhanced rates– ODP will establish and provide guidance
    • ID/A waivers: Residential Habilitation, Life Sharing, Supported Employment, In-Home and Community Support, Companion, Community Participation Supports, Respite, and Shift Nursing.
    • AAW: Residential Habilitation, including life Sharing, Supported Employment, the Community Support component of Specialized Skill Development, Day Habilitation, Respite, and Shift Nursing

Operational Guidance

  • Published written guidance available by 3/24
  • Webinars for AEs and SCOs on 3/24
  • Webinars for All Stakeholders 3/25
  • Series of Virtual Office Hours sessions being scheduled
  • Information on regulatory waivers to follow

Please be patient with the pace of information flow.  The first priority is health and safety.

Organize around the information provided and make sure to document.

COVID-19 Provider Information Tool

Designed to gather service specific information about COVID-19 impact on providers. The tool will

collect information about potential risk/service closures that will help guide future decision making

and create a record for the purposes of retroactive approvals, documentation and payments.

The tool was designed to take approximately 7-10 minutes to complete. Once complete, an email will also be sent to the provider for your record. ODP suggest maintaining this information in your records.

Communication is Key
If staff or a person for whom you provide services is suspected to have COVID-19 or tests presumptively positive for COVID-19, please notify the ODP Regulatory Administration Unit.

 For ODP to be responsive to the needs related to COVID-19, timely information from the provider community is essential. Providers should follow Department of Health (DOH) guidance for evaluation, testing, and reporting related to staff or a beneficiary suspected of having COVID-19.

Questions? Call 1-877-PA-HEALTH (1-877-724-3258)

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The following information was provided to RCPA by Jeffrey J. Worley, Esq. | Gibbel Kraybill & Hess LLP.  We appreciate his sharing of this important information.

FMLA and Paid Leave
Congress passed the Families First Coronavirus Response Act on March 18, 2020, and the President signed the legislation shortly thereafter. The provisions below become effective within 15 days. We will provide further guidance on the details of below as they are released in the coming days. The Act contains the following provisions that will affect a business’s employees directly:

The Family Medical Leave Act Expansion.
The following modifies the rules under the expansion of FMLA due to the COVID-19 emergency and does not change the other sections of the Act :

  • Employers* with “fewer than 500 employees” in 20 or more calendar weeks in 2020 or 2019 are now subject to the FMLA extension.
  • Eligible employees** are now those that were employed for 30 calendar days or more.
  • Qualifying need for leave now means an employee who is unable to work or telework due to the need to care for a child under the age of 18 years old if such child’s elementary or secondary school, or place of care is closed or a childcare provider is unavailable due to a COVID-19 emergency declared by a Federal, State, or local authority.
  • Leave: 1. The first 10 days of leave under the expansion may be unpaid leave; 2. If an employee has accrued vacation, personal, medical, or sick leave he or she may substitute it for unpaid leave; 3. After an employee has exhausted the first 10 days of leave, an employer must provide paid leave each additional day of leave taken; 4. These payments are set at two-thirds of the employee’s normal pay at the normal scheduling period, but cannot exceed $200/day or $10,000 aggregate.
  • Return: employers with fewer than 25 employees may not be required to put an employee on leave back in his or her position that no longer exists due to the health emergency. Several requirements apply.
  • Tax relief may be available for payment made pursuant to the expansion.

*Regulations may be passed to exempt small businesses with fewer than 50 employees if compliance would jeopardize the business as a going concern

**Regulations may be passed that exclude health care providers and emergency responders and those employers may elect to exclude employees from the definition without further regulations

Emergency Paid Sick Leave.
The following modifies establishes rules for paid sick leave due to the COVID-19 emergency:

  • Employers* who employ “fewer than 500 employees” are subject to the requirements.
  • Eligible employees** are all employees of an employer, regardless of the amount of time employed.
  • Qualifying need for leave means an employee that is unable to work or telework due to the following: 1. The employee is subject to a Federal, State, or local quarantine or isolation order related to COVID–19; 2. The employee has been advised by a health care provider to self-quarantine due to concerns related to COVID–19; 3. The employee is experiencing symptoms of COVID–19 and seeking a medical diagnosis; 4. The employee is caring for an individual who is subject to an order as described in (1) or has been advised as described in (2); 5. The employee is caring for a son or daughter of such employee if the school or place of care of the son or daughter has been closed, or the child care provider of such son or daughter is unavailable, due to COVID–19 precautions; 6. The employee is experiencing any other substantially similar condition specified by the Secretary of Health and Human Services in consultation with the Secretary of the Treasury and the Secretary of Labor.
  • Leave: 1. Full-Time employees shall receive 80 hours of paid leave; 2. Part-Time employees shall receive leave equal to the number of hours usually worked in a two-week period; 3. Compensation for (1)-(3) above shall be at the regular rate of pay, but not exceed $511 per day and $5,110 in the aggregate, and compensation for (4)-(6) above shall be at the rate of two-thirds of normal pay, but not exceed $200 per day and $2,000 in the aggregate.
  • Employers may not: 1. Require an employee to find a person to cover their hours; 2. Require an employee to use other paid leave; 3. Retaliate against an employee for seeking paid sick leave; 4. To the extent their current policies provide more benefits or leave, substitute their policies with this Act.
  • A posted notice is required under the Act, but the Secretary of Labor will release examples before compliance is required.

* Regulations may be passed to exempt small businesses with fewer than 50 employees if compliance would jeopardize the business as a going concern

** Except that an employer of an employee who is a health care provider or an emergency responder may elect to exclude such employee from the application of this subsection.

Each situation is different and you should contact our offices or your legal counsel for specific guidance.  Should you have any questions concerning the above, particularly when leave starts and stops, and calculating the amount of leave and pay required by the act, please do not hesitate to contact Jeff at jworley@gkh.com or 717.291.1700. More laws, regulations, and guidance will be issued to provide greater detail to employers in how they are to enact the requirements of the new Act.

As we go through this, I would encourage all of you to keep open lines of communications with your employees.  This is something that none of us have been through.  Your employees are concerned about their health, their finances, and their jobs.  Keep a listening ear-but also know that you do not have to provide instantaneous responses.  Things are changing hour by hour.  It is ok to not know how to respond.  But is important that you are listening and communicating.

For additional information as to how GKH is responding this situation, please see the link below-
https://gkh.com/news/2020/03/coronavirus-preparations/

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This presentation involves discussion on the emergency amendments to the Consolidated, P/FDS, Community Living, and Adult Autism Waivers that were approved by the Centers for Medicare and Medicaid Services on March 18, 2020. 

Please join one of the two sessions available today, Friday, March 20, 2020:

12:30 pm – 1:30 pm – https://attendee.gotowebinar.com/rt/2940351784066091787
4:00 pm – 5:00 pm – https://attendee.gotowebinar.com/rt/497822986845449739

A recorded copy will be posted and available on MyODP within 3 hours after the webinars.

Look for it and all ODP COVID-19 Webinars on this page.

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For all home and community-based service and intermediate care facility providers offering services funded or administered through the Office of Developmental Programs, please note that you are considered life-sustaining and are therefore exempt from the Governor’s directive asking for the closure of all non-essential businesses. Home and community-based service and intermediate care facility providers offer services that maintain basic health and safety requirements in a multitude of essential ways and those providers are expected to continue offering those services through the COVID-19 crisis period.

Thank you for all of your valuable and life-sustaining work and for your commitment to serving Pennsylvanians with intellectual disabilities and autism.

Kristin Ahrens | Deputy Secretary
PA Department of Human Services | Office of Developmental Programs

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From ANCOR:
Two minutes of your day is all we need to ensure the well-being of people with intellectual and developmental disabilities (I/DD) and that the supports they rely on aren’t overlooked during the COVID-19 outbreak.

The Ask: Use our email tool to remind your members of Congress that I/DD supports and services are essential lifelines to people with I/DD and their families. They must be funded so that their delivery is not compromised during this public health crisis.

The Details: Congress is working at breakneck speed to address the unique needs of various populations in our country through three different funding packages, one of which is expected to be focused on health care. We need your voice right now to ask Congress to include I/DD supports, including Home and Community-Based Services, in that package.

It is crucial for Congress to understand that disability supports are a key component of health services for people with I/DD, and to understand the implications for people’s lives in the community after the crisis if community supports cannot remain financially viable during this crisis.

The COVID-19 crisis is exposing key vulnerabilities in I/DD supports, as people are asked to stay home as community centers and day programs close to try to limit the spread of COVID-19. In turn, providers of those programs face uncertain futures. When the dust settles and we return to life after the pandemic, will there be any place for people with I/DD to go? We need Congress to ensure the answer is yes.

The I/DD workforce is already in crisis. These staffing shortages will be significantly exacerbated as DSPs fall sick or have to tend to loved ones. This is the time for Congress to work on strengthening disability supports through funding for key provisions such as overtime and hazard pay to incentivize DSPs to stay and other workers to join the field; priority access to protective gear and training; financial relief for supports such as day services so they remain viable after the outbreak; and more. Most importantly, we need Congress to include I/DD services in any stimulus package to ensure there are supports to return to once the current pandemic subsides. With 700,000 people on states’ waiting lists for services, now is not the time to lose critical capacity.

Please speak up TODAY for the inclusion of disability supports in any package Congress prepares to address COVID-19 today, to help ensure people with disabilities have the support they need, when they need it the most.

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One of our fellow ANCOR members in Ohio shared a template they developed to track employees and visitors to their programs. The form explains that the individuals served at the location are at risk and in order to protect individuals, they are asking people entering the building to disclose if they have any symptoms associated with COVID-19, including a temperature check. The attached template is available for anyone interested in utilizing the tool.

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