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DHS

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From the Department of Human Services:

The Wolf Administration is committed to serving more people in the community whenever possible, and we believe that the work performed by direct care workers (DCWs), including personal attendants and other household aides, enables individuals with disabilities to live a more independent life. We have heard from many people asking for a policy clarification on the types of non-skilled, home care services and activities that DCWs can perform in home- and community-based settings.

Last week, the Wolf Administration issued a policy clarification surrounding the role of DCWs.

The non-skilled activities provided in the consumer’s place of residence or other independent living environment are specialized care, a type of home care service unique to the consumer’s care needs that are exempt from the licensure requirements under the Professional Nursing Law and Practical Nurse Law.

DCWs may perform these non-skilled services/activities, with evidence of competency or training, provided they do not represent or hold themselves out as being licensed nurses, licensed registered nurses, or registered nurses; or use in connection with their names, any designation tending to imply they are licensed to practice nursing.

Individuals with disabilities will have a greater chance of remaining in their homes and community when they are able to receive assistance with long-term supports and services from DCWs. These non-skilled, routine activities/services include:

  • assistance with bowel and bladder routines;
  • assistance with medication;
  • ostomy care;
  • clean intermittent catheterization;
  • assistance with skin care; and
  • wound care.

DHS appreciates the partnership with the departments of Health and State and the collaboration with ADAPT and Disability Rights Pennsylvania in issuing this important policy clarification. Further guidance will be issued as appropriate to ensure successful implementation.

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The Department of Human Services (DHS) has just issued a Medical Assistance (MA) Bulletin for providers relating to Act 62 titled, Payment of Claims for Services Provided to Children and Adolescents for the Diagnostic Assessment and Treatment of Autism Spectrum Disorder (ASD). The purpose of this bulletin is to remind providers enrolled in the MA Program, both fee-for-service (FFS) and HealthChoices, of the requirement to bill a child’s or adolescent’s private health insurance company before submitting a claim for the diagnostic assessment or treatment of ASD. It is also to inform providers of the diagnosis codes and procedure codes which will be included in the MA FFS cost avoidance process, effective Friday, September 30. HealthChoices managed care organizations will provide guidance and information to contracted practitioners and providers in the Medicaid managed care system with regard to implementation by September 30.

The DHS clinical staff has identified behavioral health, physical health, and rehabilitation procedure codes that reflect services for the diagnostic assessment and treatment of ASD covered under Act 62. The procedure codes that are on the MA Program fee schedule will be subject to the cost avoidance process for MA FFS claims beginning September 30.

Registration is open now for two webinar sessions on Thursday, August 25 that are being held by DHS in collaboration with RCPA:

  • Session 1, 12:00–1:00 pm: The target audience for this webinar session is BH-MCOs, counties, and county oversight organizations.
  • Session 2, 1:00–2:00 pm: The target audience for this webinar session is behavioral health and pediatric rehabilitation provider organizations.

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The Department of Human Services (DHS) just announced their decision to lengthen the transition time for the start of the Community HealthChoices (CHC) program. The first phase (southwest part of the state) was originally scheduled to be implemented on January 1, 2017. The implementation date of phase one has now been changed to begin July 1, 2017.

The decision to extend the start date allows more time for the 420,000 Pennsylvanians who will ultimately benefit from CHC to understand the program adjustments that will occur, including how access to and receipt of home- and community-based services will be improved.

All other established CHC timeframes will remain the same. The selection of managed care companies, changes in the Commonwealth’s information technology systems, and other changes are still proceeding on the same timeframe. The implementation of phases two and three (the southeast and remainder of the Commonwealth) also remain on the previously announced timelines of 2018 and 2019, respectively.

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Today, the Departments of Human Services and Aging announced the release of the draft of the request for proposal (RFP) to procure Community HealthChoices (CHC) and the program requirements that will be part of the agreement with the managed care organizations (MCOs).

The draft RFP, program requirements, and a summary document are available on the CHC website. Comments on the draft RFP should be sent via email (with “Community HealthChoices” in the subject line) by Friday, December 11, 2015.

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Act 153 of 2014 requires the Department of Human Services, in conjunction with the Department of Education and the Pennsylvania Commission on Crime and Delinquency, to conduct a study which includes the analysis and development of recommendations on employment bans for those having contact with children. The study must include recommendations on changes in permanent and temporary employment bans to align and make uniform the provisions under the Child Protective Services Law and the Public School Code. A report of the study’s findings and recommendations must be submitted to the certain committees of the General Assembly by Thursday, December 31, 2015.

In order to complete this work, staff from the Department of Human Services have been conducting research specific to the employment bans within other states as they relate to child care service and school employees along with foster and adoptive parents. RCPA, along with other child serving and child advocacy organizations, has been invited to participate in a process to relate the recommendations to the General Assembly. This group will be meeting under the leadership of the Deputy Secretary for the Office of Children, Youth and Families over the next several months.

RCPA will be requesting that our members who provide services in the areas of child behavioral health, child welfare, pediatric rehabilitation, education, and juvenile justice, provide information regarding current employment bans on program operations, and service capacity and delivery in the communities served by members. Information requested can be sent to Connell O’Brien.

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On July 22, the Departments of Human Services and Aging announced the next steps in Governor Wolf’s plan to improve care coordination and move to Medicaid Managed Long-Term Services and Supports (MLTSS). These updates are a result of overwhelming response to the public comment period and stakeholder input.

Along with feedback on how MLTSS should be implemented in the Commonwealth, the departments heard feedback on changes that can be made today to improve the current system. They will take the following steps:

 

Doubling the number of staff who work on Nursing Home Transition (NHT)
PDA and DHS recognize that current processes to move individuals who are able to be better served in the community from institutional settings are lengthy and complicated. To address this, the departments will:

  • Increase the number of staff assigned to NHT from 5 to 10;
  • Identify and implement strategies intended to
    • improve the process
    • enhance program outcomes
    • advance the opportunities for individuals to either avoid premature placement and/or transition back into the community;
  • Evaluate and redesign the entire NHT process; and
  • Increase training for all current NHT staff and providers.

 

Creating an advisory committee with at least 50 percent representation by participants and caregivers and conducting monthly webinars
Throughout the MLTSS public input sessions, participants, advocates, and providers made it clear that more education, involvement, and communication are necessary as the Commonwealth moves to MLTSS. In order to accomplish this, the departments will:

  • Host monthly webinars on the third Thursday of every month.
  • Create an MLTSS Advisory Committee that will meet under the federally mandated purview of the Medical Assistance Advisory Committee (MAAC).
    • MLTSS program participants will comprise half of the membership, with the remaining half representing provider communities
    • Opportunities for participation via telephone for increased accessibility and convenience
    • This committee will meet bi-weekly
  • Encourage open communications; questions can be submitted via email.

 

Restructuring existing contracts to provide more choice for participants
Issue a procurement for a home modification quality improvement program in August 2015: In some cases, the transition from a nursing home to living in the community can be accomplished through a simple home modification such as the installation of a ramp for wheelchair access. The new procurement will streamline the current process to make this easier to complete these modifications, while at the same time ensuring that only high-quality contractors complete the work. The contracts will include two providers in each part of the state to provide choices in completing the work.

Issue a financial management services procurement in November 2015: There is currently one statewide vendor that acts on behalf of the consumer to make payroll, withhold and report taxes, and pay bills for individuals in home- and community-based waiver programs. Moving forward, multiple vendors will be awarded the contracts to ensure choice, and they will be required to maintain a regional presence throughout the state.

Award New Contracts for Independent Enrollment Broker (IEB) Services in November 2015: One of the most significant barriers to serving individuals in the community is the length of time it takes to enroll someone in home- and community-based services. The new contracts will be awarded in four regional lots and include new, strong performance standards, to ensure that the vendors are held accountable and participants are not stuck waiting for services.

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The Department of Human Services has announced the July training schedule and related information for the approved and required Medication Administration Training. Training will be available online and at various locations across the Commonwealth. Future classroom training sessions are being scheduled throughout the year; announcements will be released when finalized. Classroom training sites have limited capacity, and training candidates from agencies with no certified medication administration staff are required to complete the online course work before they are permitted to attend the classroom training.

Medication administration training is required for designated staff working in: adult training facilities, adult day services, personal care homes, assisted living residences, child residential and residential treatment and day treatment facilities, community homes for individuals with an intellectual disability, and intermediate care facilities. Questions about the information in the training document can be directed to (717) 221-1630 or email.

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The Department of Human Services Bureau of Human Services Licensing (BHSL) has released a draft Regulatory Compliance Guide (RCG) for Chapter 3800, relating to child residential and day treatment facilities. The RCG provides guidance about how the Department of Human Services will interpret and apply the chapter’s regulatory requirements during licensing inspections and investigations.

BHSL is inviting the Rehabilitation and Community Providers Association to work with members to review and comment on this draft guide. Please review the draft document and send your comments, suggestion and recommendations to Connell O’Brien. RCPA will collect provider input and share that information with the leadership of BHSL. Comments are due to RCPA by July 10 for submission to BHSL by July 17. The leadership of BHSL has communicated their clear interest in provider input and plans to take all comments into consideration prior to issuing a final RCG later this summer.

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