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ODP Communication Number 085-18 announces that the amendments to the ID/A waivers that were submitted to CMS in August have now been approved by CMS as of September 25, 2018. The approved waivers include changes that were made as a result of public comment. Each full waiver application approved by CMS, as well as a side-by-side of substantive changes made as a result of public comments, is available online.

ODP will hold a webinar on Wednesday October 17, 2018 from 1:00 pm to 3:00 pm. To register for the webinar, follow this link.

Some of the changes include:

  • Clarification that residents of licensed personal care homes, or assisted living residences are excluded from enrollment in the consolidated waiver.
  • Higher numbers of unduplicated numbers of waiver participants due to increase in turnover in waiver in year one, and governor’s budget including an increase of funding for graduates.
  • Level of care criteria for Autism to be consistent across all waivers.
  • Tools used to diagnose autism has been expanded, and the scope of professionals who can diagnose autism and developmental disabilities has also been expanded.
  • Community Participation Support clarification is added regarding when referrals to the Office of Vocational Rehabilitation are required and where prevocational activities may occur. It has been clarified that all participants receiving prevocational services must have a competitive integrated employment outcome in their service plan.
  • Program Specialists and Supervisors of DSPs providing CPS have a six-month period of time to complete certification (CESP or ACRE) requirements.
  • In Consolidated waiver providers of Residential Habilitation, the types of experience that at least one executive level staff must have in order to be qualified has been expanded. The acceptable qualifications now include a minimum of five years’ experience as a manager with responsibility for providing residential services for individuals with an intellectual disability, developmental disability, autism, or serious mental illness. The provider must also notify the ODP Regional office and Administrative Entity within 10 business days of the hiring date of a new CEO. This also applies to Lifesharing Providers.
  • Clarification is added about requirements for Respite in licensed community homes that is dependent upon the size of the home.
  • Clarification that career assessment may be done in a vocational facility in certain circumstances, and that job coaching and support many not be provided in licensed settings.
  • Support Service staff providing supported employment, who work directly with individuals, have six months after hire to obtain certification in CESP, or ACRE, and until that time, must be supervised by a staff who is certified.
  • A standard was added to ensure that Supports Coordination Organizations communicate with AEs when they identify concerns about provider performance and services to participants.
  • Speech and Language therapy now includes issues related to swallowing.
  • Clarification of settings where companion services may be provided.
  • Home accessibility adaptations now include modifications needed to accommodate special sensitivity to light, sound, and other environmental conditions.
  • Clarification was added that service plan teams should make a determination regarding which transportation service best meets the individual’s needs.
  • Individual transportation providers for qualification in the participant directed service model are considered Support Service Professionals and must follow those qualification requirements.
  • Frequency of SC monitoring visits has been redefined to include face to face monitoring shall occur every two months, replacing the former language of every 60 days, in order to reduce the burden of tracking exact days.
  • Alignment of claims review process with the QA&I process to be completed on an annual basis.

Contact Carol Ferenz, RCPA IDD Division Director, with any questions.

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E&C #SUBHEALTH

FOR IMMEDIATE RELEASE | September 27, 2018
Contact: Press Office | (202) 226-4972

#SubHealth Convenes Hearing Titled “Better Data and Better Outcomes: Reducing Maternal Mortality in the U.S.”

Live Webcast
Click here to watch the hearing beginning at 10:00 a.m. ET.

Opening Statement of Health Subcommittee Chairman Michael C. Burgess, M.D.
Good morning. Thank you to everyone for joining us this morning to discuss a topic that is important to each and every one of us, maternal mortality. This is a subject matter that has been brought to the forefront by Members of this Subcommittee, actions of State Legislatures, and the media. Having spent nearly three decades as an OB/GYN, I believe it should be a national goal to eliminate all preventable maternal mortality – even a single maternal death is too many.

All too often do we read about stories of seemingly healthy pregnant women who are thrilled to be having a child, and to everyone’s surprise, suffers severe complications, or death during pregnancy, birth, or post-partum. The death of a new or expecting mother is a tragic event that devastates everyone involved, but in many cases these are preventable scenarios.
Read more…

Opening Statement of Chairman Greg Walden
Today the Subcommittee on Health is holding a discussion on the critical issue of maternal mortality. In fact, we will examine as issue that is literally a matter of life and death for women all across the country. Thank you, Dr. Burgess, for calling this hearing. As someone with decades of real-world experience as an OB/GYN, you know better than most how important this issue is.

This is a difficult topic, and one that is close to my heart. Far too many mothers die because of complications during pregnancy and the effects of such a tragedy on any family is impossible to comprehend.
Read more…

Witness Testimony and Additional Background 
Click here to view the hearing background memo and witness testimony on the Energy and Commerce Committee website.

# # #

ENERGYCOMMERCE.HOUSE.GOV

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RCPA has been collaborating with the Hospital Association of Pennsylvania (HAP) and other statewide health care associations on Senate Bill 780 (SB 780). SB 780 establishes the Telemedicine Act, which will authorize health care providers to use telemedicine and require insurers to provide coverage and reimbursement for its use (a detailed summary of the bill can be found here).

Currently, SB 780 is in jeopardy. The bill, which was unanimously approved by two Senate committees, the full Senate, and the House Professional Licensure Committee, could die before a House vote is taken. The Insurance Federation is strongly advocating against the bill with rank and file members and leadership. They assert the bill provides opportunities for fraud and lower quality of care.

Between today and the weekend, it is imperative that supporters of this bill contact their House members directly and ask them to “Tell House Speaker Mike Turzai to bring the bill up for a vote in the House without amendment on Monday, October 1.” This is our final opportunity to secure passage of a bill that will expand access to health care for all Pennsylvanians by requiring insurers to pay for telemedicine services if they pay for the same service in person.

If the bill is not voted in the House, we will have to introduce a new bill during 2019, the beginning of a new legislative session, ending nearly two years of advocacy on this critical issue.

Again, between today and the weekend, it is imperative that supporters of the bill contact House members directly and ask them to “Tell House Speaker Mike Turzai to bring the bill up for a vote without amendment in the House on Monday, October 1.”

Here are the top talking points to support the main message:

  • We want consistency in payment from insurers (We are not directing how to negotiate rates);
  • 38 states have some type of law requiring this coverage;
  • The Centers for Medicare and Medicaid Services has said more must be done to expand payment for telemedicine services and lessen restriction for patient access;
  • The bill will ensure greater access for primary and specialty care;
  • Fewer people will have to travel if they are isolated, older, or without transportation (especially in rural and urban areas);
  • It will expand the reach of care to people with opioid use disorder and behavioral health needs;
  • It will help providers manage patients’ chronic conditions and avoid hospital admissions or readmissions;
  • It will help schools address physical and behavioral health issues; and
  • Help caregivers of elderly or seriously ill patients.

There are already protections in place to ensure appropriate care is provided through telemedicine. Providers are governed by state licensing boards, follow a medical code of ethics, and there are strong insurance fraud laws in place to protect against such behavior.

Questions, contact RCPA Director of Government Affairs Jack Phillips.

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The Office of Developmental Programs (ODP) distributed Communication Number 084-18 to announce a revised qualification process for new providers to becomes effective on October 1, 2018..In order to become a qualified provider, new provider applicants must submit acceptable provider qualification documentation designated for new provider applicants as well as supporting qualification documentation. Applicants must review all source documents referenced within ODP’s New Provider Assessment Tool before completing the tool.  While completing the tool, the provider applicant shall ensure that all policies, procedures, processes and/or protocols are developed and aligned with ODP requirements.  The Assigned Administrative Entity (AE) will validate the documentation that applicants submit with the New Provider Self-Assessment Tool.  The Assigned Ae is the AE with whom the provider applicant intends to provide the most service and is chosen by the provider applicant during orientation registration.

New provider applicants must also complete the ODP Provider Qualification Form DP 1059 as well as the Provider Qualification Documentation Record. All supporting documentation required for each service specialty the provider applicant intends to render should be included.

Informational Memos 044-16, 068-12, and 010-14, and ODP Announcement 114-17 are obsolete as of the publication of this announcement. For complete information regarding this process, please refer to ODP Communication Number 084-18.

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The Office of Developmental Programs (ODP) Announcement 083-18 provides detailed instructions and clarification on the use of Housing Transition and Tenancy Sustaining Services available through the Intellectual Disability and/or Autism (ID/A) waivers which include the Consolidated, Person/Family Directed Support, and Community Living waivers.

The Housing Transition and Tenancy Sustaining services were established to assist individuals with tenancy in their own homes, whether rented, leased, or owned. This announcement lists all required Provider Qualifications which include knowledge of, and ability to access, several programs and resources in the community such as the various types of housing vouchers and housing services, fair housing, reasonable accommodations, homeownership programs, Olmstead requirements, Prepared Renters Program (PREP), etc., in addition to general waiver provider requirements.

The announcement also lists several resources and their purposes including; Cents and Sensibility by the Pennsylvania Assistive Technology Foundation, Consumer Financial Protection Bureau, Financial Education and Coaching Program by the Pennsylvania Housing Finance Agency (PHFA), Local Lead Agency, Local Referral Network, Medical Assistance Transportation Program, Money Smart by the Federal Deposit Insurance Corporation (FDIC), Nursing Home Transition Tenant-based Rental Assistance, PA Housing Search, PA ABLE Program, Pennsylvania Housing Finance Agency, Regional Housing Coordinators, Section 811 Program, and the US Department of Housing and Urban Development.

The Housing Transition and Tenancy Sustaining Service includes pre-tenancy and housing sustaining supports to assist individuals in being successful tenants in private homes owned, rented, or leased by the individuals. The concepts and philosophy of person-centered planning should be incorporated throughout the development and implementation of individual housing service plans.

Tenancy support services may not be authorized for individuals who have the following authorized services on their Individual Support Plans (ISP):

  • Residential Habilitation;
  • Life Sharing; or
  • Supported Living services.

Housing Transition services may be authorized when the individual has a plan to move from the home where Residential Habilitation or Life Sharing is provided into a private home that the individual will own, rent, or lease. Financial support that constitutes a room and board expense is excluded from federal financial participation in the ID/A waivers.

Contact Carol Ferenz, RCPA IDD Division Director, with any questions.

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RCPA’s Rehabilitation Services Divisions (Medical Rehabilitation Committee and Outpatient Rehabilitation Committee) will convene their first networking session in November 2018. To prepare for this session, a Survey Monkey was created to obtain member feedback on their preference for the date and topic for discussion. Members are encouraged to respond to the survey by October 2, 2018. Contact Melissa Dehoff, RCPA Rehabilitation Services Director, with any questions.

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