The Office of Developmental Programs (ODP) shared a recent communication regarding the transition of the HCSIS Help Desk to a new vendor. As of May 2, 2022, the HCSIS Help Desk responsibilities will transition from the Public Consulting Group (PCG) to the new vendor, InspiriTec.
The Office of Long-Term Living (OLTL) recently issued a reminder for Service Coordination Entities (SCEs) regarding the annual review process in HCSIS for the Act 150 Program and OBRA Waiver. Included in this reminder are the procedures and instructions for entering these service plans in HCSIS beginning April 4, 2022. OLTL encourages SCEs to use this annual review process to review caseloads and finalize any dis-enrollments or inactive service plans. The Waiver/Program Transfer instructions are here for reference. Please also reference the “OLTL Fiscal Year 2022/23 Annual Review Instructions for HCSIS” for additional information on how file closures may impact the current Annual Review process.
If you have any additional questions or wish to receive the above forms in alternate formats, please contact Brian Lester at (717) 346-0716 or via email.
ODP Announcement 22-021 provides guidance on the upcoming rate increases for the Adult Autism Waiver. Compensation is beginning March 1, 2022; the new rates will be implemented in the Home and Community Services Information System (HCSIS) on March 1, 2022. All Individual Support Plans (ISPs), including ISPs in draft, pending review, or pending approval status, will be updated with the new rates for each of the applicable services. An additional fiscal segment will automatically be added on each ISP for each service that is impacted by the rate change.
Providers are strongly encouraged to review Service Authorization Notices or the Provider Service Detail report in HCSIS to confirm the new rates were loaded, authorized, and that they are billing the increased Fee Schedule Rate before attempting to bill for any services rendered March 1, 2022, and after.
Compensation for the Period July 1, 2021, through February 28, 2022
Providers should bill normally for any services rendered from July 1, 2021, through February 28, 2022. ODP will be compensating providers, via gross adjustments, for the difference between the rate billed and the updated fee schedule rate for dates of service rendered during the period July 1, 2021, through February 28, 2022. This is intended to eliminate the provider’s effort of voiding and re-billing claims.
ODP anticipates processing gross adjustments during the April to May 2022 timeframe to ensure all billing for dates of service July 1, 2021, through February 28, 2022, has been completed. Because the rates will be loaded into HCSIS effective July 1, 2021, and the gross adjustment compensation will be issued by ODP, providers should not adjust any claims after April 1, 2022, submitted for services rendered on July 1, 2021, through February 28, 2022.
Adjustment of a claim(s) for services delivered during these dates will result in a duplication of payment that will need to be repaid. Providers are strongly encouraged to bill in a timely manner to minimize the need for corrections.
For questions on how to resolve billing errors for services that were rendered on July 1, 2021, through February 28, 2022, contact Amber Bennett.
Correction to Rates for Small Group Employment and Residential Habilitation Ineligible Fees
Because of an internal editing error, the rates for Small Group Employment and Residential Habilitation: Community Home Ineligible published in the Pennsylvania Bulletin (52 Pa.B. 1326, February 26, 2022) were incorrect. The correct rates, with the corresponding procedure codes, are higher than what was published. The corrected rates are also available on the Department of Human Services’ website.
ODP Announcement 22-007: UPDATE provides information to providers in order to prepare for upcoming rate increases that are scheduled to be published in the Pennsylvania Bulletin on February 26, 2022.
Per the final public notice for Fee Schedule Rates, Department-established fees, and the AWC FMS Department-established fees rendered through the Consolidated, Community Living (CLW), and Person/Family Directed Support (P/FDS) waivers:
ODP anticipates processing gross adjustments during the April to May 2022 timeframe to ensure all billing for dates of service January 1, 2022–February 28, 2022 has been completed. Providers are strongly encouraged to bill in a timely manner to minimize the need for corrections.
Since the new rates will have a begin date of March 1, 2022, two service/rate segments in authorized status will be present on ISPs, assuming no errors set. One service/rate segment will reflect the period July 1, 2021, to February 28, 2022, or the begin date of the service when it was initially authorized on the plan during Fiscal Year (FY) 2021–2022. The second service/rate segment will reflect the period March 1, 2022, to June 30, 2022.
Authorized units on the first service/rate segment, July 1, 2021–February 28, 2022, will reflect 67% of total authorized units for the FY 2021–2022. The second service/rate segment will reflect 33% of total authorized units for the remainder of FY 2021–2022. If an individual requires more than 33% of the total annual authorized units for the remainder of FY 2021–2022, a revision to the plan will be necessary to move units from the first service segment to the second service segment on the ISP. For the period July 1, 2021, to February 28, 2022, providers should bill normally for any services rendered.
See the ODP Announcement for the full instructions.
A message from the Office of Developmental Programs (ODP):
Due to an extended time frame for approving and loading rates into the Home and Community Services Information System (HCSIS), ODP is notifying stakeholders that several dates contained in Announcement 22-007 are no longer effective. The date for the rate load will occur after February 15, 2022.
ODP anticipates re-releasing this Announcement with updated time frames and encourages providers, Supports Coordination Organizations, and Administrative Entities to be familiar with its technical content in preparation for the pending rate load.
ODP Announcement 22-007 informs providers that the new Fee Schedule Rates and Department-established fees are anticipated to be visible on Individual Support Plans (ISPs) in HCSIS on February 14, 2022.
The anticipated effective date for the increased Fee Schedule Rates is January 1, 2022; however, the effective date in the Home and Community Services Information System (HCSIS) will be February 15, 2022. The anticipated effective date for the Department-established fees for residential ineligible services is July 1, 2022, and HCSIS will reflect the same effective date. Both the Fee Schedule Rates and Department-established fees for residential ineligible services will be visible in HCSIS on February 14, 2022.
Of note, on January 6, 2022, the P/FDS cap was increased to $41,000, and the Community Living Waiver cap was increased to $85,000.
This communication provides guidance and addresses Individual Support Plan (ISP) related impacts.
The Office of Long-Term Living (OLTL) has issued additional guidance on the Enterprise Incident Management (EIM) Enhancements.
As stated in the ListServ communication sent on November 24, 2021, Critical Incident Report Extensions changes will be implemented in the EIM system on December 11, 2021. Once the maximum number of allowed extensions is reached, providers and service coordinators (SCs) will need to contact OLTL if additional extensions are needed.
When requesting incident report extensions, please follow these instructions:
OLTL staff will respond to extension requests within 3 business days by replying to the requestor to let them know if the request was approved or rejected. If rejected, the reason for the rejection will be included in the response. If approved, OLTL staff will enter the extension in EIM.
OLTL has drafted a form to use in the near future. Once the form is approved, providers will be notified. Any questions regarding the information should be directed here.
The Home and Community Services Information System (HCSIS)/Enterprise Incident Management (EIM) Quarterly Release goes live on December 11, 2021. The Release Newsletter has been posted to the HCSIS Learning Management System (LMS). The newsletter is also here. Please log in to LMS and click on the “HCSIS Release 85.00 Newsletter” link to review this and all newsletters. If you do not have access to LMS, please contact your agency’s Business Partner Administrator (BP Admin), which would be the person that gave you HCSIS/EIM access.
If you have any questions regarding this email, please contact the OLTL EIM resource account.
Effective January 1, 2022, there will be a rate increase in the OBRA Waiver and Act 150 Program for Personal Assistance Services (PAS) procedure codes W1793, W1793 TT, W1792, and W1792 TU. The new rates for the OBRA Waiver and Act 150 Program were announced in the Pennsylvania Bulletin on November 6, 2021, Volume 51, Number 45 issue and can be found on the Pennsylvania Bulletin website.
New rates are based on the participant’s county of residence. Home and Community Services Information System (HCSIS) service plans will be updated by December 31, 2021. SCs do not need to make any service plan updates for this rate change, as an HCSIS system-wide update is being deployed to make the necessary service data rate updates onto the impacted service plans.
A chart listing the OBRA Waiver and the Act 150 Program counties, categorized by fiscal region, is located here. If you have any questions related to this email, please contact the OLTL Provider Inquiry Line at 1-800-932-0939, OPTION 2, Monday–Friday from 9:00 am–12:00 pm and 1:00 pm–4:00 pm.
Office of Developmental Programs Bulletin 00-19-03 Prioritization of Urgency of Need for Services (PUNS) was published on July 23, 2019. The purpose of the bulletin is to distribute the updated PUNS Manual. Additional materials include the PUNS Form, the PUNS cover letter, and the PUNS Disagreement Form. The PUNS Form and the PUNS Disagreement Form will be translated into Spanish; ODP will release a communication once the forms are translated.
When PUNS was first implemented in 1998 and revised in April 2006, a manual was published to provide instructions on the completion of the form. The PUNS Manual was updated to reflect circumstances that better identify the individual’s and family’s experiences throughout the individual’s lifespan. It also provides new instructions for completing the form, emphasizing that is to be completed in its entirety through a face-to-face conversation between the Supports Coordinator, the individual, and family.
The PUNS Form cannot be handed or sent to the individual and family to complete on their own; however, the form can be shared with the individual and family in advance of the meeting at their request so they are prepared when meeting with the SC.
A copy of the finalized HCSIS PUNS Form and PUNS cover letter must be sent to the individual and family within five working days of finalization of the HCSIS PUNS Form. The HCSIS PUNS should contain the same information as the PUNS Form completed during the meeting. The HCSIS PUNS reflects the service needs captured at the meeting.
The PUNS is a tool used to determine the need for ID/A services and establishes the priority of need for services when there is a waiting list for the County Program or AE to provide services as requested. The information in PUNS is reviewed and updated if needed during the annual Individual Support Planning (ISP) process and as an individual’s needs change.
The PUNS indicates the urgency of need for services. The urgency of the need is identified in one of three categories:
If there is disagreement with the results of the PUNS, the PUNS Disagreement Form has detailed instructions for the individual and family to indicate disagreement with the information on the finalized PUNS Form. Concerns should be noted on the PUNS Disagreement Form and returned to the SC within 10 calendar days of receipt of the finalized HCSIS PUNS Form. The Disagreement Form will be reviewed in attempt to resolve the concerns. The SCO must contact the individual and family within seven calendar days of receipt of the Disagreement Form to initiate a review of the concerns with the individual and family and why they disagree with the PUNS Form.
Effective July 23, 2019, Bulletin 00-06-15, Prioritization of Urgency of Need for Services (PUNS) Manual, is obsolete.
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