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Authors Posts by Carol Ferenz

Carol Ferenz

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0 1687

The ODP Adult Autism Waiver (AAW) requires Supports Coordinators (SCs) to administer a battery of assessments at intake, annually, and as needs change. Included in that battery of assessments is administering the Scales of Independent Behavior – Revised (SIBr). It has come to the department’s attention that the SIBr software will not be compatible with the most recent versions of Microsoft.

ODP Announcement 19-166 informs that as of January 1, 2020, the Bureau of Supports for Autism and Special Populations (BSASP) expects all SCs to administer the SIBr and send the raw scores to BSASP, as currently designed, with these changes:

  • Since the scores will not be calculated, it is expected that SCs and teams use the raw scores and SIBr response booklet to do an item analysis that will aid in planning for the participant’s supports and services.
  • Identifying those items in the assessment in which the participant’s score is low should be a prompt for the team to consider goals and supports that address the potential area of weakness.

The SIBr response booklet should be kept in the participant’s file and may be reviewed for completion during monitoring activities. Please submit questions here.

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ODP Announcement 20-001 provides information regarding the Modified Medication Administration Training course that is now available. The modified course was designed specifically for those who administer medications in Lifesharing locations or service locations not licensed by the Department. This course does not meet the medication administration training requirements of other service locations licensed by the Department.

With the implementation of the Chapter 6100 Regulations, this course is mandatory for Lifesharers who administer medications or those who administer medications in service locations not licensed by the department. This course is not required for the administration of medication by an adult relative of an individual who receives services in an unlicensed setting. The course is required when an adult relative is supporting a family member in an unlicensed life sharing home.

The Modified Medication Administration Course may be accessed on MyODP. Questions may be directed here.

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On December 24, 2019, DHS announced the approval of the Department’s Good Faith Effort (GFE) Exemption application for the Electronic Visit Verification (EVV) implementation. This GFE does not change DHS’ expectations of providers of personal care services to comply with the requirements of the 21st Century Cures Act. The Department will continue with a soft launch period through June 30, 2020. Throughout this time, providers must begin using EVV and complete any integration and certification activities if they have not been completed already. The Department continues to develop a policy bulletin that will outline additional requirements, including compliance benchmarks for manually edited visits. This bulletin will be released as soon as it is finalized.

During claims processing in PROMISeTM, EVV validation against the EVV Aggregator will continue to be performed and EVV Error Service Codes (ESCs) will set without impacting claim payment. During the extended soft launch period, the expectation is that provider/provider agency/Agency with Choice and Vendor Fiscal/Employer Agent billing staff will note when the EVV edit(s) set and actively make corrections either to the data stored in the DHS EVV Aggregator or the claim itself to ensure errors do not repeat. DHS will be monitoring which EVV edits set and how often.

Regular updates to the stakeholder community will be made on the progress of the implementation. Outreach and technical assistance will be performed based on results and as applicable. As of July 1, 2020, any claims without a corresponding EVV visit or any mismatches between what is found on the claim versus what is found in the EVV Aggregator will be denied.

2020 EVV Implementation Timeline:

  • January 1, 2020: All Providers must begin using EVV for Personal Care Services (PCS).
  • January 2020 – March 2020: All Providers must complete system integration activities with the DHS Aggregator for fee-for-service programs. Providers who are experiencing difficulties in integrating and will not be ready by March 2020 are asked to submit an extension request using this form, documenting the difficulties they are experiencing no later than February 1, 2020. The completed form should be emailed to the EVV resource account.
  • Starting July 1, 2020: Claims submitted for Personal Care Services without a matching EVV visit will be denied.

If providers have not yet completed the necessary steps to implement EVV, please contact the appropriate entity to complete the necessary training and system integration activities.

OLTL and ODP Fee-For-Service Providers

  • The DHS Sandata system training is available for providers electing to use the DHS Sandata system. Providers using the DHS system must complete this training in order to begin setting up their agency accounts and security permissions. Providers may register for the independent web-based training offered through Sandata here.
  • The DHS Aggregator will receive information from Alternate EVV systems being used by providers in fee-for-service programs.
  • Providers using Alternate EVV systems should contact Sandata at 855-705-2407 to complete Alternate EVV system integration activities for fee-for-service programs.

Current Community HealthChoices (CHC) Providers and Aging, Attendant Care, and Independence Waiver Providers

  • If providers are electing to use the HHAeXchange EVV system offered by the Managed Care Organizations (MCOs), providers must work with the MCOs to complete training and other onboarding requirements.
  • Providers using Alternate EVV systems in CHC will need to send their EVV data to the CHC-MCOs.
  • Providers should contact HHAeXchange to complete Alternate EVV system integration activities for CHC.

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HRS, Inc. has announced that their policies will be changing to allow LPNs to complete Clinical Reviews of the Health Risk Screening Tool (HRST). This change was made after a review by HRST clinical staff who determined that the Clinical Review is evolving to function primarily as a quality assurance measure to help ensure accurate screenings. Changes will be made to the current training and documentation and will become effective in January 2020.

When possible, the Clinical Review should be completed by an RN; however, the following is highly recommended for any agency that uses LPNs to complete Clinical Reviews:

  1. When possible, choose LPNs who have experience working with people with I/DD;
  2. Continue to train RNs to complete Clinical Reviews so that oversight can be given to LPNs as needed; and
  3. When possible utilize LPNs who have obtained I/DD specific credentialing, such as DDC (Developmental Disabilities Certified).

The process and steps within the HRST web-based application required to complete a Clinical Review will remain the same. Clinical Reviewer training will be updated to accommodate LPNs and/or RNs completing the Clinical Review.

Please note that the required training by RNs and LPNs to complete Clinical Reviews remains as follows:

  1. Successful completion of the HRST Online Rater Training
  2. Successful completion of the HRST Clinical Reviewer Training

If you have any questions about these changes, please submit via email.

Also, as a reminder, if you are an RN or LPN and need to register for the live training, the next round of courses is scheduled in January 2020.

Register now to reserve your place:

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ODP Announcement 19-164 advises providers that implementation of this service will not be available until the public comment period on the rates has concluded and notice of the final Fee Schedule Rates is published in the Pennsylvania Bulletin. ODP anticipates this to be in late January 2020 and will notify stakeholders of the publication via listserv. This does not impact the Public Transportation component of the Transportation service. Public Transportation may be utilized beginning January 1, 2020. Questions about this communication should be directed to Laura Cipriani.

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The Office of Developmental Programs (ODP) is pleased to announce (ODP Announcement 19-162) that the amendment to the Adult Autism Waiver (AAW) was approved by CMS on December 10, 2019. As communicated in ODP Announcement 19-136, the AAW amendment was submitted to CMS on October 15, 2019. Since that time, ODP has been engaged in ongoing discussions with CMS. Substantive changes were made as a result of those discussions and are highlighted in orange on the Side-by-Side of the AAW. The full waiver application approved by CMS, and the Side-by-Side of substantive changes, are available on the DHS website.

In Appendix A, Role of Local/Regional Non-State Entities has been changed from Not Applicable to Applicable to include Local/Regional non-state public agencies and Local/Regional non-governmental non-state entities. Language to specify the nature of these agencies has been added. Items A-5, A-6, and A-7 have been revised as well.

In Appendix B, Reserved Capacity was added to serve 15 participants in waiver years (WYs) 4 and 5 who need to be re-enrolled in the Adult Autism Waiver (AAW) after a stay in a hospital or rehabilitative care for more than 30 days.

In Appendix B, the number of unduplicated participants and maximum number of participants served is being updated to reflect current allowable waiver capacity.

Also in Appendix B, Selection of Entrants to the Waiver, Priority 2 status is removed and the Intake Process is revised and Interest List Procedure is revised to change the Interest List to a Wait List. Change in Priority status has been removed.

In Appendix C, a new service, non-medical Transportation, is being added.

Also in Appendix C, validation of provider qualifications for all services is being changed from every 30 months to every 36 months to align with a revised quality management strategy.

In Appendix C, the definitions of Day Habilitation and Residential Habilitation were revised to clarify where new facilities can be located.

In Appendix C, provider qualifications for all employment services are revised and clarification is added as to when employment services can be accessed without a referral to OVR.

In Appendix C, language was updated to reflect that family members can provide Transportation-Trip through an OHCDS.

In Appendix C, the educational qualifications for staff providing Career Planning were revised based on public comment.

Appendix I is revised to include a more detailed description of the rate setting methodology.

Revisions were made based on the new Chapter 6100 regulations, as applicable.

Changes were made to performance measures.

ODP changed all references to Family Living to Life Sharing.

ODP changed all references to Supports Coordination Agencies to Supports Coordination Organizations.

ODP changed the name of Transitional Work Service to Small Group Employment.

ODP changed references to the Bureau of Autism Services (BAS) to the Bureau of Supports for Autism and Special Populations (BSASP) or the Office of Developmental Programs (ODP), as applicable.

Questions about this communication can be directed to Laura Cipriani.

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Many agencies and providers have successfully participated in the DHS Sandata EVV training. These providers are successfully using the DHS Sandata EVV system during the PA-DHS soft-launch period. As a reminder, the soft-launch period is scheduled to end Dec 31, 2019.

While Pennsylvania is seeking a Good Faith Effort Exemption (GFE) from the Centers for Medicare and Medicaid Services (CMS) to extend the soft launch period, it has not yet been approved. If your agency is one of the few that still needs to complete Sandata EVV training to get your DHS Sandata EVV credentials, it is not too late!

Online self-paced training is still available 24/7 and can be accessed here. To receive your agency credentials, at least one provider representative must complete training.

The first person in your agency who enrolled and completes training will receive an emailed Welcome Kit with your agency’s credentials.

Welcome Kits: Presently, Welcome Kits are distributed within two business days after the completion of training. Due to the holidays, any agency completing training on or after December 20, 2019, will not be guaranteed a Welcome Kit by January 1, 2020.

If your agency has competed training and did not receive a Welcome Kit, please contact PAC at 800-248-2152 or via email.

Questions?

For questions on whether a provider or services are included in the EVV mandate, contact Provider Enrollment:

  • ODP Provider Enrollment: 866-565-9435 or email
  • OLTL Provider Enrollment: 800-932-0939 option 1

For DHS Sandata EVV application questions, call 800-248-2152 or email. Submit EVV program questions here. For ALT-EVV Certification, call 855-705-2407 or email.

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ODP Announcement 19-159 is to notify providers of an update to the Variance Form (DP 1086) and related Instructions. As part of the October 1, 2019 amendments to the Consolidated, P/FDS, and Community Living waivers, the following language was added and approved regarding the provision of Respite by a nurse for children with medical needs:

Respite “may be provided at the following levels in private homes, including Life Sharing homes (licensed or unlicensed):

  • Level 3 Enhanced – Staff-to-individual ratio of 1:1 with a licensed nurse (only available to children with medical needs as described below) or a certified staff member.
  • Level 4 Enhanced – Staff-to-individual ratio of 2:1 with one licensed nurse (only available to children with medical needs as described below) or one certified staff member and one staff member with at least a high school diploma.

Children (under age 21) who have medical needs that require Respite by a nurse can request a variance when the following criteria are met:

  • The child is authorized to receive less than 24 hours a day of nursing through private insurance or Medical Assistance;

And one of the following:

  • The child requires administration of intravenous fluid or medication, which is specified in a written order by a licensed doctor of the healing arts; or
  • The child uses monitoring, defibrillating, or resuscitating equipment, or a combination of the three; or
  • The child requires other skilled activities that must be provided by a nurse. A list of non-skilled activities that can be performed by professionals other than a nurse is available here.

Any waiver participant age 21 or older who needs nursing services can receive this type of support through the Shift Nursing service.”

Requests for a variance to the day or 15-minute unit limit may be made for participants who have behavioral or medical support needs, or for emergency circumstances, using the standard ODP variance process. A request for a variance to this limit may not be approved for Respite provided by a nurse, unless there is an emergency circumstance involving a child with medical needs who meets the criteria described above.

Ongoing nursing needs for children with medical needs are addressed through Medical Assistance Fee-for-Service or Physical Health Managed Care Organizations.

Please begin using the updated DP 1086 and instructions found at these links on the Department of Human Services website for all variance requests:

The DP 1086 can also be found on the Forms page of MyODP.org or at this link. Comments may be directed to the appropriate ODP Regional Office.

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