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Intellectual & Developmental Disabilities

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OCR Issues Guidance on Telehealth Remote Communications Following Its Notification of Enforcement Discretion
March 20, 2020

On March 20, 2020, the Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) issued guidance on telehealth remote communications following its Notification of Enforcement Discretion during the COVID-19 nationwide public health emergency.

The Notification, issued earlier this week, announced that effective immediately, OCR is exercising its enforcement discretion to not impose penalties for HIPAA violations against health care providers in connection with their good faith provision of telehealth using communication technologies during the COVID-19 nationwide public health emergency.

The new guidance is in the form of frequently asked questions (FAQs) and clarifies how OCR is applying the Notification to support the good faith provision of telehealth. Some of the FAQs include:

  • What covered entities are included and excluded under the Notification?
  • Which parts of the HIPAA Rules are included in the Notification?
  • Does the Notification apply to violations of 42 CFR Part 2, the HHS regulation that protects the confidentiality of substance use disorder patient records?
  • When does the Notification expire?
  • Where can health care providers conduct telehealth?
  • What is a “non-public facing” remote communication product?

“We are empowering medical providers to serve patients wherever they are during this national public health emergency,” said Roger Severino, OCR Director. “We are especially concerned about reaching those most at risk, including older persons and persons with disabilities,” Severino added.

  • The FAQs on telehealth remote communications may be found here.
  • The press release on telehealth remote communications may be found here.
  • The Notification of Enforcement Discretion on telehealth remote communications may be found here.

For more information on HIPAA and COVID-19, see OCR’s February 2020 Bulletin, use this link.

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From ANCOR:

We’re hearing that the Senate could begin voting as early as tonight (on the third-round stimulus package, which we’re working to ensure includes funding for key I/DD programs and prioritizes Medicaid-funded services). We’ve seen a fabulous response to the action alert we sent late yesterday (thank you!), but we need to ensure several influential Senators hear from advocates on this issue. Please use this link to reach your legislator.

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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 [email protected]

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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EAST CENTRAL (Berks, Columbia, Luzerne, Montour, Northumberland, Schuylkill, Wyoming Counties) 717-561-5250

NORTH CENTRAL (Bradford, Clinton, Lycoming, Potter, Sullivan, Tioga, Union Counties)
717-561-5250

NORTHEAST (Carbon, Lackawanna, Lehigh, Monroe, Northampton, Pike, Susquehanna, Wayne Counties) 717-561-5257

NORTHERN TIER (Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean, Venango, Warren Counties) 717-561-5254

KEYSTONE (Adams, Bedford, Blair, Centre, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Mifflin, Perry, Snyder, York Counties) 717-561-5255

SOUTHEAST (Bucks, Chester, Delaware, Montgomery, Philadelphia Counties)
717-561-5251

SOUTHWEST (Allegheny, Armstrong, Beaver, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Mercer, Somerset, Washington, Westmoreland Counties) 717-561-5252

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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 Centers for Disease Control and Prevention (CDC) issued new guidance for healthcare providers that provides information on the best ways to conserve personal protective equipment (PPE), such as gowns, facemasks, N95 respirators, and eye protection as they experience supply shortages due to the outbreak of COVID-19.

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From RELIAS:

The well-being and safety of the individuals we serve is our top priority and will remain at the heart of every decision we make.

As you prepare for Coronavirus (COVID-19), Relias wants to directly support your efforts by providing accurate and impactful education on infection prevention and control. We are currently offering a free digital toolkit — How to Prepare for Coronavirus (COVID-19) and Influenza: Training & Resources, which contains unlimited access to courses and fact-driven information regarding COVID-19 preparedness and prevention.

This toolkit will continue to be updated with the latest resources; please check back often!

We encourage you to share this toolkit with colleagues, friends, and family to help combat coronavirus. At Relias, providing these types of resources is core to our mission to measurably improve the lives of the most vulnerable members of society and those who care for them.

Thank you for helping communicate this information. In times like these we listen, we learn, and we support each other.

Explore Our Toolkit

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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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