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The Office of Developmental Programs (ODP) has issued Announcement 20-106 in order to release the non-residential service locations that have been identified as requiring an onsite Heightened Scrutiny review from ODP. ODP is requesting public comment regarding these service locations and is asking stakeholders to identify any other settings that meet the criteria provided in the announcement.

Additionally, ODP is releasing for public comment the Heightened Scrutiny Onsite Tools (Attachments 2 and 3) that will be used during the onsite visit to determine compliance with the Home and Community-Based Services (HCBS) Settings Rule as well as with ODP’s policies and regulations.

The purpose of these onsite reviews will be to determine whether each service location can overcome the institutional presumption by either showing proof that the requirements contained in the HCBS rule and state regulations in 55 Pa. Code Chapter 6100 are currently met or by ensuring that the requirements will be met within a timeframe specified by ODP (but no later than March 17, 2022). If ODP determines that the service location does not currently meet the requirements but has a plan to meet them within the timeframe specified by ODP, the service location must be submitted to the Centers for Medicaid and Medicare Services (CMS) for a Heightened Scrutiny review. CMS will then determine whether the service location has the qualities of a home and community-based setting or that of an institution.

These documents will be out for public comment for 30 days; comments will be accepted until 11:59 pm on Monday, November 23,2020. Please send electronic comments here. If electronic comments are being submitted, it is recommended to provide comments directly on the documents and to track the changes in the documents where edits are being suggested.

If written comments are being submitted, please address and send the written comments to Katie-Marie Wilson, Department of Human Services, Office of Developmental Programs, 625 Forster Street, Room 510, Harrisburg, PA 17120.

More information published by CMS on the HCBS rule, including Heightened Scrutiny requirements, can be found here.

The Residential and Non-Residential Home and Community-Based Services (HCBS) Provider Settings Self-Assessment Reports can be accessed via ODP Announcement 19-149.

For questions pertaining to this announcement, please send an email.

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The Office of Long-Term Living (OLTL) issued an updated guidance and tool that was previously issued on October 13, 2020 regarding the temporary closure and re-opening of settings. This guidance and tool were issued to support providers in their efforts to protect against community spread of COVID-19. The Community Spread Thresholds document has been updated on page two to show that the “Thresholds for Community Spread” section is not applicable to Structured Day Programs. Members should disregard the previous communication.

 

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Today, the Trump Administration released a comprehensive plan that includes proactive measures to remove regulatory barriers and ensure coverage and payment for the administration of an eventual COVID-19 vaccine. To ensure broad access to a vaccine (especially for seniors), the Centers for Medicare and Medicaid Services (CMS) released an Interim Final Rule with Comment Period (IFC) that establishes that any vaccine that received Food and Drug Administration (FDA) authorization, will be covered under Medicare as a preventive vaccine at no cost to beneficiaries. The IFC also implements provisions of the CARES Act that ensures immediate coverage of a COVID-19 vaccine by most private health insurance plans without cost sharing from both in and out-of-network providers during the course of the public health emergency (PHE).

CMS also released a set of toolkits for providers, states, and insurers to help the health care system prepare to swiftly administer the vaccine when available. These resources are designed to increase the number of providers that can administer the vaccine and ensure adequate reimbursement for administering the vaccine in Medicare while making private insurers and Medicaid programs aware of their responsibility to cover the vaccine at no charge to beneficiaries.

Additionally, CMS released new Medicare payment rates for COVID-19 vaccine administration. The Medicare payment rates will be $28.39 to administer single-dose vaccines. For a COVID-19 vaccine requiring a series of two or more doses, the initial dose(s) administration payment rate will be $16.94 and $28.39 for the administration of the final dose in the series. These rates will be geographically adjusted and recognize the costs involved in administering the vaccine, including the additional resources involved with required public health reporting, conducting important outreach and patient education, and spending additional time with patients answering any questions they may have about the vaccine. Medicare beneficiaries, those in Original Medicare or enrolled in Medicare Advantage, will be able to get the vaccine at no cost. CMS is encouraging state policymakers and other private insurance agencies to utilize the information on the Medicare reimbursement strategy to develop their vaccine administration payment plan in the Medicaid program, CHIP, the Basic Health Program (BHP), and private plans. Using the Medicare strategy as a model would allow states to match federal efforts in successfully administering the full vaccine to the most vulnerable populations.

The IFC (CMS-9912-IFC) is scheduled to display at the Federal Register as soon as possible with an immediate effective date and a 30-day comment period.

Additional information on this IFC can be found in the fact sheet.

The COVID-19 vaccine resources for providers, health plans, and State Medicaid programs can be found here.

The FAQs on billing for therapeutics can be found here.

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Harrisburg, PA – Pennsylvanians are encouraged to ask their job search and unemployment compensation (UC) questions during the Pennsylvania Department of Labor & Industry’s (L&I) twenty-third virtual town hall, which will be held from 1:00 pm to 2:00 pm today, Thursday, October 29.

How to Participate in the Town Hall

A livestream will be online at the Pennsylvania Department of Labor & Industry website. Those without Internet access can listen by calling 833-380-0719; however, phone lines are limited, so we ask that they be reserved for individuals who need them.

Participants using the phone lines can ask questions directly of our UC expert. Individuals livestreaming the town hall can submit typed questions that will be read to the UC expert by a moderator. To protect participants’ personal confidential information, detailed answers about individual claim questions cannot be answered during the town hall.

Reminder to Guard Personal Information

L&I recently became aware of fraudsters who are posing as L&I employees during calls to Pennsylvanians. These fraudsters will ask for personal and confidential information such as usernames, passwords, and social security numbers, under the guise of helping with issues related to unemployment compensation. Pennsylvanians are reminded that L&I employees will never call and ask for your username, password, or full social security number.

Scammers have also been posing as L&I and US Department of Labor (DOL) officials in emails and social media messages in attempts to obtain individuals’ personal and confidential information. L&I does not offer assistance over social media due to the inability to guarantee confidentiality and security; as a result, any messages received from “L&I” over social media are likely fraudulent and should be ignored.

Emails appearing to come from L&I or the US DOL may be spoofed by fraudsters. Individuals should never click a link in an email and provide their username and password. The safest way to log into an account is to type the URL of the website into the browser window.

For more information on identifying fraud, what to do if you believe you have been a victim of fraud, or how to report fraud, visit L&I’s website.

MEDIA CONTACT: Sarah DeSantis

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To the Intellectual Disabilities and Autism Community,

October 27 marks a painful anniversary for Pennsylvania and for our nation. Two years ago today in Pittsburgh, 11 lives were taken during the brutal attack on the Tree of Life/L’Simcha Synagogue. Three of those people were members of the ID/A community. While we send strength and loving energy to the bereaved families and friends of all of those who perished that day, we are reminded of the need to keep their memories alive and to do all we can to muster the courage and hope to navigate times that test us to the core. We mark this day in quiet reflection but also with an awareness of the need to move forward even through the enormity of our sadness.

This year has brought unprecedented challenges for us all both individually and collectively. The pandemic is a stark reminder of our own vulnerability and of the fragility of life. At the same time, for so many, this is a time that has powerfully illustrated how much we all need and rely on one another. Even with the physical separation that this pandemic has necessitated, we have persevered and forged paths to connect and engage with each other.

With the myriad challenges and upheaval in our day-to-day lives and the tragic losses so many have endured, 2020 has gifted us with tremendous examples of courage, hope, and an unparalleled commitment to finding our way through unprecedented times. We see examples of this in our daily lives within our safe circles of family and friends. We also see this from our efforts with colleagues to do the most important work that focuses on helping keep others stay safe and connected to their communities and support systems.

Finally, as I sit at my desk looking out my window, I am awed by the beautiful and dramatic colors of the changing season. I don’t remember an autumn when the colors were quite so vivid and spectacular.

Perhaps the message on this day of remembrance and reflection is that, even in the midst of the hardest and most daunting challenges, there is always beauty and a reason for hope.

Kristin Ahrens

Deputy Secretary

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Rick Smith sent the following message on October 28, 2020:

To Providers of Community Participation Supports (CPS):

For those providers who have signed attestations, the Office of Developmental Programs (ODP) is currently processing the September retainer payments allowed under Appendix K at 25 percent of your pre-COVID CPS billing. These payments should be visible on your November 2 remittance advice. ODP has also reviewed CPS billing from July to September and has identified some CPS providers who have signed attestations and are at or near pre-COVID billing levels with the combination of retainers and billings. Additionally, ODP has identified a number of CPS providers who have signed attestations and currently have receivable balances beyond 30 days with the office. If you fall into either of these two categories, you will not automatically see a retainer payment and should contact Rick Smith for further details.

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