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ISP

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From the Office of Developmental Programs:

The Office of Developmental Programs (ODP) will be renewing all existing exceptional residential rates for individuals who have a current NEA, approved through 12/31/22, for the second half of the fiscal year. Providers should ensure that all individuals with exceptional rates have a current Health Risk Screening Tool (HRST).

This extension will require a critical revision to the individual’s ISP. The rate segment has been entered into PROMISe and is available for use. Please work with Supports Coordinators and Administrative Entities to ensure the ISP is updated and approved.

Thank you,

Rick Smith  l  Director
PA Department of Human Services, Office of Developmental Programs
Bureau of Financial Management and Program Support
625 Forster Street Room 412, Harrisburg, PA 17120
717-783-4873
MyODP

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The PA Family Network will be hosting a series of workshops focused on different topics and audiences over the next several weeks. A list of the workshops is below. Visit the workshop title to learn more and register.

Sibling Good Life Group
September 19 at 6:30 pm
This group of adult siblings will have the opportunity to guide the group’s direction and teach how to network with other siblings, talk about your lived experience, hear from experts on topics relevant to sibling life, have open and informative discussions, and plan for a future that holds true potential for you and your family. Anyone thought of like a sibling or in a sibling-like role is welcome!

Peace of Mind
September 20 at 11:00 am – 1:00 pm
September 21 at 6:00 pm – 8:00 pm
Join the PA Family Network in this interactive workshop to network and meet other adult siblings. Get information and strategies on handling Long-Term Planning, and identify services/supports so you and your loved one can live a good life

Healthy Relationships and Sexuality (L.E.A.D.)
September 26 at 11:00 am – 1:00 pm
Learn practical strategies and skills that encourage healthy relationships and sexuality while mitigating risk. Discuss boundaries, relationships, risks, and self-advocacy skills. Learn 4 steps to healthier relationships.

Using LC to Plan and Problem Solve
October 3 at 10:00 am – 12:00 pm
Identify service/supports so your loved one can live an Everyday Life. You will learn to use the LifeCourse framework and tools to plan for your Individualized Support Plan (ISP) and Individualized Education Plan (IEP).

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ODP Bulletin 00-22-05, dated August 9, 2022, is to provide the Office of Developmental Programs’ (ODP) requirements and standardized processes for preparing, completing, documenting, implementing, and monitoring Individual Support Plans (ISPs) to ensure they are:

  • Developed to meet the needs of the individual;
  • Developed and implemented using the core values of Everyday Lives: Values in Action, LifeCourse Principles, Positive Approaches, and Practices and Self Determination to result in an enhanced quality of life for every individual; and
  • Compliant with the approved Consolidated, Community Living, and Person/Family Directed Support (P/FDS) Waivers and Medical Assistance (MA) State Plan as it pertains to Targeted Support Management (TSM).

A summary of major changes made to information in the attachments is included as attachment 8.

ATTACHMENTS:

  • Attachment 1: ISP Manual for Individuals Receiving Targeted Support Management, Base-Funded Services, Consolidated, Community Living or P/FDS Waiver Services or Who Reside in an ICF/ID
  • Attachment 2: ODP Role Expectations and Required Timeline for ISP Activities
  • Attachment 3: DP 1032 Individual Support Plan Signature Form (Spanish form: DP 1032-S)
  • Attachment 4: Annotated Individual Support Plan
  • Attachment 5: The Basics of the LifeCourse Framework to Guide the Development of the ISP
  • Attachment 6: Questions to Help Facilitate the Development of the ISP
  • Attachment 7: DP 1022 Waiver Service Request Form
  • Attachment 8: Summary of Major Changes Made to ISP Requirements or Processes

OBSOLETE DOCUMENTS:

  • Bulletin 00-20-02, Individual Support Plans for Individuals Receiving Targeted Support Management, Base-Funded Services, Consolidated, Community Living or P/FDS Waiver Services, or Who Reside in an ICF/ID

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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.

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ODP Announcement 22-017 is to announce that Residential ISP Staffing training sessions are now available from January through June 30, 2022. Residential ISP Staffing trainings described in ODP Announcement 21-057 have been completed, but additional training can be provided by agency professionals who have volunteered to provide training and have participated in delivering training in the fall of 2021, referred to ODP Designated Trainers.

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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:

  • 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 March 1, 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 28, 2022. Compensation will be for the period January 1, 2022–February 28, 2022. The updated fee schedule rates will not be loaded in ISPs for the period January 1, 2022–February 28, 2022. Instead, the current rate will remain for that period, and 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 January 1, 2022–February 28, 2022. This is intended to eliminate the provider’s effort of voiding and rebilling claims.

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.

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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.

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ODP Announcement 21-061 announces a full-day virtual training session available for registration in August, September, and October 2021 on Residential ISP Staffing, as described in ODP Announcement 21-057.

The 20 full-day virtual training sessions are geared toward key residential provider and SCO staff who regularly attend team meetings, supervise staff who attend team meetings, or train staff that attend team meetings, and AE staff who review and approve plans. It is expected to be conducted in “mixed” audience groups (Provider, SCO, AE reps and Office of Developmental Programs’ staff) to better assure exposure to a variety of perspectives and roles.

One person per entity is invited to attend to provide a maximum of 30–35 people per session. Participants and their agencies will need to commit to the understanding that, upon completion, they will be a resource at their home agency. The training will be interactive. All training participants must complete the prerequisites located on MyODP on the course registration page.

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