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The Centers for Medicare and Medicaid Services (CMS) requires a statewide process to ensure providers are qualified to render services to waiver-funded individuals. The Provider Qualification Process described below outlines the steps the Assigned AE and provider must follow to meet these requirements and the steps Supports Coordinators take to transition individuals if needed. This communication does not describe the qualification process for SC organizations.
New Provider Requalification
Following the provider’s initial qualification date, all providers classified as New are to be requalified by the end of the following fiscal year as designated on the DP 1059. For example, if a New provider’s first Qualification Begin Date in HCSIS is 01/20/2017, the provider must be requalified by 06/30/2018, which is the end of the following fiscal year. A New provider’s status is updated from New to Existing after the provider is requalified.
Existing Provider Requalification Cycle
Once a provider is classified as Existing, the provider is to be requalified on a three-year cycle based upon the last digit of the provider’s MPI number. By 5/1, sixty days prior to the provider’s qualification 6/30 end date, the Qualification Status will change to Expiring. If the provider is not requalified by the end of the fiscal year (6/30), the Qualification Status will change to expired.
The qualification statuses in HCSIS are as follows:
Service Qualification Status
See ODP Announcement 20-007 for the full process and timeline.
The release of this communication obsoletes ODP Announcement 011-18 Provider Qualification Process.
ODP Announcement 20-010 serves as notice of the requirement to submit qualification documentation for providers who have an MPI number ending in 6, 7, 8, or 9. Providers within this group are due to become requalified in 2020 and must submit documentation no later than 61 days prior to the expiration of provider qualification. Specifically, supporting documentation must be submitted starting February 1, 2020, but no later than March 31, 2020. Documentation must include a completed DP 1059 form, an updated Provider Qualification Documentation Record, as well as any required supporting documentation.
Providers who fail to submit qualified documentation by April 30, 2020, will participate in transition planning for the participants currently receiving Home and Community-Based Services (HCBS). As a part of the transition, the assigned administrative entity (AE) will commence transition of waiver participants according to the process detailed in ODP Announcement 20-007. Providers whose qualifications expire June 30 will not be eligible to receive payment for waiver services rendered after June 30, will no longer be qualified to provide HCBS, and will have their name removed from the list of qualified providers of that HCBS.
For reference to provider qualification in PA Code, please see Pennsylvania Bulletin Volume 49, Number 40, Subsections 6100.83-84, which contain provider qualification citation specifications.
For inquiries regarding this communication, contact the ODP Provider Qualification mailbox.
The US Constitution requires a census of all residents in the entire country every 10 years. The census counts every person living in the US once (and only once) in the right place. You are counted based on where you are living on April 1, 2020. Please encourage individuals that you serve to participate.
WHY IT IS IMPORTANT FOR ALL TO PARTICIPATE:
Fair representation & legislative redistricting
The Census determines:
$675+ billion in federal public funding
The Census determines how much funding each state receives for the next 10 years.
Pennsylvania receives $26.8 billion each year
That’s $2,000 per Pennsylvanian
The data collected in the 2020 Census will impact the amount of federal funding our communities get for the next decade for programs like…
2020 Census will determine how much food support children, adults, and seniors receive…
2020 Census will determine how much we invest in the future of our children…
2020 Census will determine how much PA’s highways, railways, airports, and ports receive…
2020 Census will determine how much safe affordable housing will be available…
2020 Census determines how much funding rural areas receive for services and infrastructure…
2020 Census determines how much support our children and families receive…
Your census responses can never be used against you. Under Title 13 of the US Code, the US Census Bureau cannot release any information about an individual. Your answers can only be used to produce statistics.
Census employees and contractors are sworn for life to always protect your information. Violators face fines up to $250,000 and up to five years in prison.
Your information is protected from cyber-attacks, threats, and leaks. The bureau’s cybersecurity meets the highest federal standards for system protection. Your information is protected no matter if you respond online, by phone, or by mail.
If you respond online, make sure the website address begins with HTTPS and includes a lock symbol.
Census workers will never ask for your SSN, banking information, money, or anything on behalf of a political party.
Real census workers carry identification. They will have an official ID badge with photo, a US Department of Commerce watermark, and an expiration date. You can call 800-923-8282 to verify a worker’s identity.
Report suspicious activity. Call your local police department if you receive a visitor falsely claiming to be representing the US Census Bureau.
April 1, 2020 is National Census Day
Join in community outreach. Learn more and download resources at the official website.
On February 5, 2020, ninety-nine members of the House of Representatives signed and sent a letter to Seema Verma, Administrator, Centers for Medicare and Medicaid Services (CMS), that questions the proposed eight percent cut to therapy services. The proposed cut was included in the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) final rule that was published on November 15, 2019. The letter contained two questions asked of CMS, including the methodology and data that were used in this decision making. The responses to these questions were requested by February 21, 2020. Contact RCPA Rehabilitation Services Division Director Melissa Dehoff with questions.
ODP Bulletin 00-20-02 provides the Office of Developmental Programs’ (ODP) requirements and standardized processes for preparing, completing, documenting, implementing, and monitoring Individual Support Plans (ISPs) to ensure they are:
This bulletin and attachments have been updated to align with the October 1, 2019 amendments of the Consolidated, Community Living, and P/FDS Waivers and provide clarification regarding approved waiver service definitions.
A full ISP is required for any individual who:
Or
An abbreviated ISP may be completed for any individual who is not eligible for Medical Assistance and receives under $2,000 in non-waiver services in a Fiscal Year. Base-Funded Case Management services are not included in the $2,000 limit. Administrative Entities or Supports Coordination Organizations still have the option of completing a full ISP and are encouraged to do so.
All ISPs, including abbreviated ISPs, must:
Further, the Consolidated, Community Living, and P/FDS Waivers stipulate that Supports Coordination Organizations (SCOs) must ensure that ISPs are thoroughly reviewed to assure services accurately reflect an individual’s needs prior to submission to the Administrative Entity for approval and authorization. Upon receipt of the ISP, the Administrative Entity is responsible for:
Once the ISP is approved and authorized by the Administrative Entity, the Supports Coordinator is responsible to provide a completed copy of the signature form to all team members and distribute all approved ISPs to all appropriate team members unless otherwise requested. Providers that have access to the approved ISP in HCSIS are responsible for distributing the ISP to all appropriate staff within their agencies.
ISPs are not required, but are encouraged, for individuals residing in an Intermediate Care Facility for Persons with an Intellectual Disability (ICF/ID). For individuals residing in ICFs/ID, the ICF/ID personnel are responsible for developing the individual plan (outside of HCSIS) in accordance with ICF/ID regulations. This includes ensuring that services in the plan meet the individual’s needs. Although Supports Coordinators are not required to develop an ISP for individuals residing in State Centers and private ICFs/ID, they are responsible for maintaining regular contact with the ICF/ID facility, evaluating the individual, and participating in plan development as required under the County Intellectual Disability Service regulations – see 55 Pa. Code §6201.14 (relating to aftercare services). For individuals residing in State Centers and private ICFs/ID, the County Program is not responsible to authorize the plan.
ATTACHMENTS:
OBSOLETE DOCUMENTS:
The Chapter 6400 Regulatory Compliance Guide, or RCG, was released for immediate implementation on February 3, 2020. ODP will be presenting a live webinar about the purpose of the RCG and how it will be used for applying and enforcing Chapter 6400. General information about why RCGs are used will also be presented.
This session is open to providers, advocates, Administrative Entities, Supports Coordinators, and all other interested parties.
Two additional sessions have been made available:
Tuesday, February 18, 2020 • 9:00 am – 12:00 pm and 1:00 pm – 4:00 pm
To register, use this link.