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Authors Posts by Carol Ferenz

Carol Ferenz

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On June 28, 2018, the Center for Medicaid and CHIP Services (CMCS) issued an informational bulletin to address the issues outlined in a report from January 2018, “Ensuring Beneficiary Health and Safety in Group Homes Through State Implementation of Comprehensive Compliance Oversight.” This report was developed by the three agencies of the Department of Health and Human Services; Administration for Community Living (ACL), Office for Civil Rights (OCR), and Office of Inspector General (OIG).

The bulletin addresses one of the three suggestions the Joint Report made to CMS: “Encourage states to implement compliance oversight programs for group homes, such as the Model Practices, and regularly report to CMS.”

 The guidance contained in the bulletin addresses:

  • Incident Management and Investigation including: strongly encouraging states to define critical incidents to, at a minimum, include unexpected deaths and broadly defined allegations of physical, psychological, emotional, verbal and sexual abuse, neglect, and exploitation. Recognizing that reporting critical incidents plays an important role in a quality oversight program, we believe that it is necessary to ensure that an approach to incident management is not perceived as punitive, but instead as an opportunity to help make quality oversight systems stronger. CMS and the states must strike a balance to ensure that we are encouraging, not inadvertently discouraging, providers and other stakeholders to report and resolve critical incidents and to be active participants in ongoing quality improvement efforts.
  • States are encouraged to conduct Incident Management Audits of their incident management systems to ensure that information on all occurrences meeting the state’s definition of a critical incident are reported appropriately and lead to investigations to determine the need for any corrective actions.
  • Mortality reviews – while states should require a preliminary review of all beneficiary deaths, investigations should focus on deaths that are determined to be “unusual, suspicious, sudden and unexpected, or potentially preventable, including all deaths alleged or suspected to be associated with neglect, abuse, or criminal acts. Also, states are encouraged to establish relationships with relevant agencies performing autopsies to maximize the likelihood of their performance upon state request.
  • Quality Assurance – CMS wants to assure that the focus is on ensuring the provision of person-centered planning and services, and the inclusion of beneficiaries and other stakeholders in the development and implementation of an HCBS quality oversight program.
  • Next Steps – CMS encourages states, providers, and other stakeholders to become familiar with the Model Practices contained in the Joint Report. It also notes the potential availability of enhanced federal matching funds for state activities to implement the Model Practices described in the Joint Report. Enhanced federal administrative match of 75% may be available for these activities if they are part of a medical and utilization review performed by certain utilization and quality control peer review organizations.

Contact Carol Ferenz with any questions.

The Bureau of Autism Services (BAS) has announced the schedule of upcoming trainings to be presented by the BAS Clinical Team in July, August, and September 2018. These trainings are primarily designed for AWW and ACAP providers. Some of the trainings are also open to providers serving individuals with autism in other programs, including the consolidated, P/FDS, and Community Living Waivers, and those are indicated on the announcement. Pre-registration is required for each session, and each will have its own unique registration link. Once you preregister, you will receive an email with instructions to participate including a new link to join the meeting.

Topics include: Incident Management Update and Technical Assistance Opportunity, Virtual Office Hours: Seek Technical Assistance for GAS, Working with Community Psychiatry, Using Risks as an Opportunity to Enhance Quality of Life and Learning, How to Guide Your Team When Feeling “Stuck,” Professional vs. Personal Boundaries, Vocational Profile: Training and Submission, and Structured Approach to Supporting Informed Choices.

For more information see BAS Communication Number: BAW18-16. For questions about this announcement, submit via email.

The Office of Developmental Programs (ODP) has announced the start of Cycle 1, Year 2 Quality Assessment and Improvement (QA&I) process. For Year 2, all entities’ self-assessments must be submitted electronically in QuestionPro, utilizing the unique hyperlink which was sent to the AE, SCO, and provider primary contacts. The hyperlink was included in the email sent from the QA&I Process mailbox ([email protected]) with the subject line “Action Required! The (Entity) SELF-ASSESSMENT link to the Office of Developmental Programs (ODP) Quality Assessment & Improvement Tool is now available!” If the primary contact did not receive the link by the end of the day on July 1, he/she should email the QA&I Process mailbox immediately.

As in the previous year, QA&I activities will begin with the completion of an annual self-assessment by each entity. Each entity should complete the applicable self-assessment by COB August 31, 2018. Each entity should submit ONE self-assessment for the entire agency. The self-assessment is an evaluation of an entity’s performance on the provision of services and supports to individuals based on key quality metrics and implementation of the Everyday Lives: Values in Action recommendations. The self-assessment also provides a snapshot of the entity’s performance prior to the on-site review and will be used to inform and build quality improvement activities for the remainder of the QA&I cycle. It is expected that any issues identified during the self-assessment are remediated within 30 days of discovery.

If an entity does not complete a self-assessment, ODP and/or the AE may elect to conduct an on-site review, regardless of an organization’s regularly scheduled on-site review within the three-year cycle.

Materials and resources related to the QA&I Process are currently posted on the MyODP Training & Resource Center. Please note you must be logged into MyODP to access the information.

ODP strongly recommends that all entities and staff with a role in the QA&I Process review all resource materials so they understand and can properly complete the process.

INQUIRIES: Please direct any questions, issues, or concerns to your QA&I Regional Coordinator and CC the QA&I Process mailbox.

QA&I Regional Coordinators:

Office of Developmental Programs (ODP) has announced an extension through July 18, 2018 for ODP to communicate with providers regarding any service locations for which no HCBS Settings Self-Assessment have been submitted. The link to submit the Self-Assessment remains open, providing additional time for providers to submit information if they were unable to do so by the original deadline of June 12.

ODP has not been able to complete their communications with providers who have not submitted self-assessments as originally planned by June 30. Providers will receive direct communication from ODP regarding any active service location for which ODP does not have an HCBS Provider Self-Assessment on file by July 18, 2018.

Providers can also submit questions via email.

ODP released Communication Number 060-18, which provides a summary of changes related to Cycle 1, Year 2 of the Quality Assessment & Improvement (QA&I) Process for the 2018/19 Fiscal Year and posting of revised QA&I resource materials on the MyODP Training & Resource Center.

The QA&I process is based on a three-year cycle. All entities are required to complete a Self-Assessment every year and to participate in an onsite review at least once per cycle. FY 2018/19 begins the second year of Cycle 1 of the QA&I process. To prepare for Cycle 1, Year 2, ODP has made several changes to the QA&I process based upon a review of processes and tools that were used in Cycle 1, Year 1, the 55 Pa. Code Chapter 51 regulations, the Administrative Entity Operating Agreement, and changes to Federal regulation requirements. In addition, changes and clarifications were made to the processes and tools based on feedback received from AEs, SCOs, and Providers.

ODP has made the following changes to the QA&I process document:

  • The due date for submission of QA&I self-assessment for all entities is August 31.
  • Requirement for use and completion of QA&I Review Spreadsheet.
  • Inclusion of Agency with Choice (AWC) Financial Management Services (FMS) QA&I.
  • Inclusion of Claim and Service Documentation Review.
  • Revisions made to the Terms & Definitions section to clarify current definitions established and include additional definitions regarding Claim and Service Documentation Sample, Individual Interview, and Level of Care.
  • New section added regarding Technical Assistance.
  • In the Individual Interviews section, a requirement was added for Assigned AEs to complete and data enter individual interview responses into a web-based platform for provider organizations scheduled for an onsite review.
  • Clarification provided in the Remediation, Improvement, and QM Plans section regarding time frames, remediation activities, and plans to prevent recurrence (PPR).
  • Clarification provided in the Comprehensive Report regarding what information will be included, review and response by entities, and information posted on ODP website.
  • Changes made to the QA&I Process Timeline based on time frames updated throughout QA&I Process document.
  • Enhancements to various QA&I templates.

As a reminder, any changes to the primary and/or secondary contacts should be submitted via the ODP Quality Assessment & Improvement Contact Information Form. It is the responsibility of the entity to ensure that this information remains up to date (refer to Announcement Number 056-18).

ODP made the following changes to the standard AE tool:

  • Questions were renumbered to separate data and policy questions from record review questions.
  • Guidance has been updated on some questions to provide additional clarification.
  • Three demographic questions were added to the tool to gather identifying information from the AE.
  • Other questions have been added based on current ODP requirements.
  • NA options regarding data and policy and record review questions have been added as applicable.

ODP made the following changes to the standard SCO tool:

  • Questions were ordered based on subject matter.
  • Guidance has been updated on some questions to provide additional clarification.
  • Questions have been removed based on current ODP requirements.
  • NA options regarding data and policy and record review questions have been added as applicable.

ODP completed the following changes to the standard Provider tool:

  • Questions added in Demographic section to capture services rendered by a Provider and whether or not the Provider is an AWC FMS provider.
  • Questions were renumbered to separate data and policy questions from record review questions.
  • Question regarding Quality Management Plan revised to align with AE and SCO QA&I Tools.
  • “Remediation by exception” added where applicable to take into consideration the inability to remediate non-compliance due to staff no longer being employed, or the individual is no longer receiving services from the Provider organization.
  • Nine questions have been added regarding the Home and Community-Based Services Settings Final Rule. These questions have been labeled exploratory and are not scored.
  • Two additional questions have been added regarding employment services; these questions have been labeled exploratory and are not scored.
  • Guidance to the training questions has been updated regarding review of staff and administrative staff.
  • NA options regarding data and policy and record review questions have been added as applicable.

The updated resources and materials for Cycle 1, Year 2 of QA&I are available by logging onto the MyODP Training & Resource Center. As a reminder, any information regarding the QA&I Process can be accessed under the following path on MyODP: Resources > ODP Information > QA&I Process.

NOTE: There may be other changes to the QA&I processes. ODP will update the MyODP website and distribute communications to the field regarding those changes.

Please direct any questions, issues, or concerns to your QA&I Regional Coordinator listed below and CC the QA&I mailbox.

The Office of Developmental Programs (ODP) has announced that proposed amendments to the Consolidated, P/FDS, and Community Living Waivers effective November 1, 2018, as well as new proposed Fee Schedule Rates for Transportation (per trip) effective January 1, 2019, are available for public review and comment. There is a 30-day public comment period that starts on June 23, 2018 and ends on July 23, 2018. As part of this process, ODP is seeking your valuable feedback and comments on the proposed waiver amendments. Whenever substantive changes are made to an approved waiver, ODP must submit an amendment to the Centers for Medicare and Medicaid Services (CMS) for approval.

ODP proposes to amend the Consolidated, P/FDS, and Community Living Waivers effective November 1, 2018 as follows:

  • Aligning eligibility requirements for individuals with autism, service definitions, and provider qualification requirements in the Consolidated and P/FDS Waivers with the Community Living Waiver that was approved effective January 1, 2018.
  • Transitioning rates for Transportation (per trip) to the Medical Assistance fee schedule effective January 1, 2019.
  • Allowing relatives to provide Transportation (per trip) and adding Transportation (per trip) as an available service through Organized Health Care Delivery Systems.

Follow this link to view the proposed amendments to the Consolidated, P/FDS, and Community Living Waivers effective November 1, 2018.

To submit written comments regarding the Waiver Amendments:

Comments should be addressed to:
Julie Mochon, Department of Human Services, Office of Developmental Programs, 625 Forster Street, Room 510, Harrisburg, PA 17120.

Comments may also be submitted to ODP via email.

To submit comments regarding the Transportation (Per Trip) Fee Schedule Rates:
Comments may be submitted by mail to:
Department of Human Services, Office of Developmental Programs, Division of Provider Assistance and Rate Setting
4th Floor, Health and Welfare Building, 625 Forster Street, Harrisburg, PA 17120

Comments may also be submitted by email to the Office of Developmental Programs’ rate-setting mailbox.

ODP will also hold two webinars to receive comments on the proposed waiver amendments. Dates and times are listed below. This link must be used to register for either webinar.

  • Tuesday, July 10, 2018, 10:00 am to 12:00 pm
  • Wednesday, July 11, 2018, 1:00 pm to 3:00 pm

Participants are able to participate in the webinar by phone, but will need a computer to provide comments during the webinar. To assist ODP in accurately capturing comments provided during the webinars, individuals are asked to submit a written copy of their comments by email or to mail to the address provided above.

Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Relay Service by dialing 711 or by using one of the following toll-free numbers:

  • 800-654-5984 (TDD users)
  • 800-654-5988 (voice users)
  • 844-308-9292 (Speech-to-Speech)
  • 844-308-9291 (Spanish)

CONTACT: Questions about this communication should be submitted via email.

On June 19, 2018, Governor Tom Wolf signed House Bill 1641, codifying the Employment First Policy that the governor established by executive order in March 2016 to increase competitive employment opportunities for people with disabilities.

“My executive order two years ago focused Pennsylvania on being a model state that is hospitable to workers with disabilities and I’m proud to sign this bill adding the weight of law,” said Governor Wolf. “This is a win-win for Pennsylvania. Our employers need smart and skilled workers and increasing employment opportunities ensures people with disabilities can achieve greater independence and inclusion in our communities.”

House Bill 1641, sponsored by Rep. Bryan Cutler, creates the Employment First Act requiring state, county, and other entities receiving public funding to first consider competitive integrated employment as the preferred outcome of publicly funded education, training, employment, and related services, and long-term services and support for individuals with a disability who are eligible to work under state law.

The statute also creates the Governor’s Cabinet for People with Disabilities and the Employment First Oversight Commission. The Governor’s Cabinet for People with Disabilities will review existing regulations and policies to recommend changes to laws, regulations, policies, and procedures that ensure implementation of Employment First. The Employment First Oversight Commission will establish measurable goals and objectives to guide agencies and report annual progress.

Following the governor’s Executive Order 2016-03, entitled Establishing ‘Employment First’ Policy and Increasing Competitive-Integrated Employment for Pennsylvanians with a Disability, the Departments of Labor and Industry, Human Services, and Education have been working to obtain stakeholder and business input to meet the administration’s goals. The agencies, which helped to develop HB 1641, released recommendations in September 2016.

The recommendations include:

  • Review, identify, and change policy to align with Executive Order 2016-03.
  • Raise the expectations of employment goals for children with a disability at an early age. Work with parents and publicly funded programs to shift expectations towards this goal.
  • Prepare young people with a disability to become working adults with a disability.
  • Transition students from secondary education to adult life. Assist adults with a disability in getting and keeping a job.
  • Improve access to reliable transportation to get to and from work, on time, every time.
  • Lead by example – improve state contracts and reduce barriers to commonwealth employment.
  • Expand private-public partnerships.
  • Increase public awareness.
  • Collect and coordinate data.
  • Implement, monitor, and provide accountability.

In support of the Employment First initiative, 20 Pennsylvania college students with disabilities are participating in a 12-week paid internship with the Wolf Administration this summer. The interns are working in positions at state agencies related to their academic backgrounds and gaining experience in their field of study and building connections with potential employers.

ODP has announced the wage and benefit range tables for specific participant-directed services (PDS) provided to participants utilizing the Vendor Fiscal/Employer Agent (VF/EA) Financial Management Services (FMS) effective July 1, 2018. The wage ranges and benefit allowances are unchanged form Fiscal Year 2017–2018.

These wage and benefit ranges will be used to pay Support Service Professionals (SSPs) and to support claims processing in the Provider Reimbursement and Operations Management Information System in electronic format (PROMISe) by the VF/EA FMS organization.

There are ODP-established wage ranges and optional benefit allowance ranges for six participant directed services for participants who are using the VF/EA FMS model. These services are:

  1. Supports Broker;
  2. Companion Services;
  3. Supported Employment;
  4. In-Home and Community Supports;
  5. In-Home Respite and Unlicensed Out-of-home Respite; and
  6. Homemaker/Chore services.

A modifier and adjusted rates are available for Enhanced Communication Services for individuals who are eligible for the service, are in need of enhanced communication supports, and the SSP has been determined by ODP to be qualified to provide the service.