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The Department of Human Services (DHS) announced they will be accepting comments on Pennsylvania’s Final Statewide Transition Plan (STP) for Home and Community-Based Services (HCBS). This plan applies to Medicaid Waivers under the Office of Long-Term Living (OLTL), Office of Developmental Programs (ODP), and Office of Child Development & Early Learning (OCDEL). The notice is below and includes additional information about upcoming webinars.

HCBS Settings Rule – Background

CMS published the HCBS Rule, which amends the Medicaid regulations for HCBS waivers under section 1915(c) of the Social Security Act. The HCBS Rule supports enhanced quality of programs and services and adds protections for individuals receiving services. The HCBS Rule reflects CMS’ intent to ensure all individuals receiving services and supports through Medicaid waivers have full access to the benefits of community living, including receiving services in the most integrated setting. The HCBS Rule includes a provision requiring states to develop a transition plan to ensure that services will meet federal requirements by March 2023.

Statewide Transition Plan

The Department received initial approval of its STP on August 30, 2016, which can be accessed at the Department’s HCBS Stakeholder Waiver and Planning Team web page.

To receive final approval of Pennsylvania’s STP, the Department is required to complete the following remaining steps and submit an updated STP with this information included:

  • Complete a thorough, comprehensive site-specific assessment of all HCBS settings, implement necessary strategies for validating the assessment results, and include the outcomes of this assessment within the STP;
  • Draft remediation strategies and a corresponding timeline that will resolve issues that the site-specific settings assessment process and subsequent validation strategies uncovered by the end of the HCBS rule transition period (March 17, 2023);
  • Outline a detailed plan for identifying settings that are presumed to have institutional characteristics, including qualities that isolate HCBS beneficiaries, as well as the proposed process for evaluating these settings and preparing for submission to CMS for review under heightened scrutiny;
  • Develop a process for communicating with beneficiaries that are currently receiving services in settings that the state has determined cannot or will not come into compliance with the HCBS settings rule by March 17, 2023; and
  • Establish ongoing monitoring and quality assurance processes that will ensure all settings providing HCBS continue to remain fully compliant with the rule in the future.

This information is included in Pennsylvania’s Final STP for public comment. A presentation providing a general overview of the HCBS Rule and Pennsylvania’s Final STP will be recorded by the Department and posted by the end of August to prepare stakeholders for public comment. Information about where to access the presentation will be published when it is available.

As outlined in the public comment section below, the Office of Child Development and Early Learning (OCDEL), Office of Developmental Programs (ODP), and Office of Long-Term Living (OLTL) will each hold webinars to go over information in Pennsylvania’s STP that is specific to their waivers and programs. Public comment will be accepted during each of these webinars.

Public Comment

Pennsylvania’s Final STP is available for a 30-day public comment period at the Department’s HCBS STP web page. Comments will be accepted no later than 11:59 pm on September 22, 2022. Stakeholders may provide public comment through one of the following methods:

  1. Electronic comments submitted via email
    1. Stakeholders are asked to use the subject header “PA Final STP” and submit comments to this mailbox.
  2. Written comments submitted via mail
    1. Mailing address: Department of Human Services, Office of the Secretary, P. O. Box 2675, Harrisburg, PA 17105-2675.
  3. Verbal and written comments during public comment webinars
    1. The following dates and times below are for stakeholders to participate in the public comment webinars:
      1. Webinar Specific to STP Information for OCDEL
        September 12, 2022
        9:00 am – 10:00 am
        Please register for the webinar via email.
      2. Webinars Specific to STP Information for ODP
        September 8, 2022
        10:00 am – 12:00 pm
        Please register for the webinar.
        September 12, 2022
        1:00 pm – 3:00 pm
        Please register for the webinar.
      3. Webinar Specific to STP Information for OLTL
        September 15, 2022
        2:00 pm – 3:00 pm
        Please register for the webinar.

When submitting electronic or written comments, it is recommended that you include the following information:

  • The page number or Appendix where the information you are commenting on is located; and
  • Which office (OCDEL, ODP, or OLTL) the comment applies to, if applicable.

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The Office of Mental Health and Substance Abuse Services (OMHSAS), in collaboration with the Office of Child Development and Early Learning (OCDEL), will be hosting a webinar on September 9 from 9:00 am – 11:00 am to support counties in their use of annual Infant and Early Childhood Mental Health (IECMH) funds. This webinar will include an overview of IECMH, organizations that host IECMH-related conferences, summits, and/or trainings that are preapproved for reimbursement, and instruction for counties on how to submit an IECMH funding request that is not preapproved.

See the Program Flyer for additional details.

MEETING REGISTRATION:

Please register for the IECMH Funding Webinar on September 9, 2022, 9:00 am EDT. After registering, you will receive a confirmation email containing information about joining the webinar.

Call-in Number: 415-655-0052
Access Code: 733418631#

For questions regarding the webinar, please contact Amy Kabiru or RCPA Children’s Policy Director Jim Sharp.

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The purpose of this bulletin is to provide guidance to the county and private children and youth social service agencies, county mental health/behavioral health programs, early intervention (EI) programs, and managed care organizations on the process for referring children to the county intellectual disability and autism program when a child has a diagnosis of an intellectual disability, developmental disability, and/or autism (ID/DD/A) (information regarding eligibility and diagnostic criteria can be found here) or when it is suspected that a child may have one of these diagnoses.

Referring the child to the county ID/A program can provide eligible children and their families with access to information, services, and supports in the community, as well as assistance with preparing for life’s transitions through childhood into adulthood.

The Department of Human Services (DHS) wants to improve services and supports to all children and their families or legal guardians so that children can grow to adulthood living in a home with loving adults. The Office of Developmental Programs (ODP), the Office of Child Development and Early Learning (OCDEL), the Office of Children, Youth, and Families (OCYF), the Office of Mental Health and Substance Abuse Services (OMHSAS), and the Office of Medical Assistance Programs (OMAP) work closely together to ensure children with ID/DD/A and their families have access to high quality services that support the child’s growth and development. Please visit here for further information about each DHS Office addressed in this bulletin.

During the registration and eligibility process for services, the county ID/A program or TSM provider should offer families information about the Charting the LifeCourse framework and tools that were developed by the UMKC Institute for Human Development, UCEDD.

If stakeholders have any questions about the bulletin, they should send their questions via email.

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FDA Safety Advisory (Issued June 28, 2022): Do not use neck floats with babies for water therapy interventions, especially with babies who have developmental delays or special health care needs.

See the full FDA Communication here.

If you have any questions, please contact RCPA Children’s Policy Director Jim Sharp. Please share with those in your networks. Thank you.

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PDE and DHS are offering the following policy clarification on the Head Start/Early Head Start vaccination mandate:

PDE and DHS are cognizant of the staffing challenges that many providers are facing. Providers are thus encouraged to work creatively to ensure that children continue to receive a free and appropriate public education during these trying times. In this regard, providers should examine whether unvaccinated individuals may continue to provide services in accordance with an allowable exemption, and, where appropriate, consider whether parental agreement to alternative delivery of services may be prudent.

OCDEL has clarified that this is to include all individuals working with Head Start enrolled children and families, including early intervention and behavioral health. OCDEL further requests that agencies work with Head Start partners to address this requirement and asks for support considerations, including; encouraging staff and contractors to become fully vaccinated; working to identify fully vaccinated EI personnel to support children in Head Start; when possible, working to provide written assurance to Head Start partners to only send fully vaccinated staff and contractors to go into classrooms; and exploring technological solutions to help support children within their Head Start classroom activities and routines.

The United States Department of Health and Human Services (HHS) has implemented an Interim Final Rule (IFR) requiring all staff who work with Head Start/Early Head Start (Head Start) children and families in any capacity to be vaccinated. According to HHS guidance, this includes those individuals who do not have any contact with children. The IFR also requires contractors whose activities involve contact with or providing direct services to Head Start children and families and volunteers in classrooms or working directly with Head Start children and families be vaccinated. The IFR is now understood to apply to all individuals working with Head Start children and families, including but not limited to services provided by Preschool Early Intervention, 0-3 Early Intervention, and behavioral health specialists in Head Start programs, including those provided pursuant to a memorandum of understanding or other agreement by which Head Start programs provide for or permit the provision of such services.

The Federal Office of Head Start (OHS) is responsible for ensuring compliance with the IFR through their identified monitoring processes. PDE or DHS is not responsible for monitoring programs for compliance with this mandate.

Head Start IFR and guidance do allow for exemptions for individuals who are not vaccinated. In the event individuals meet this exemption, OHS has issued guidance regarding circumstances in which unvaccinated individuals may be able to continue to work with Head Start children and their families.

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Message from the Department of Human Services (DHS):

FOR IMMEDIATE RELEASE
December 20, 2021 

Department of Human Services Discusses Spending Plan for Home and Community-Based Services Enhanced Federal Funding to Support Mental Health Services, Children 

Harrisburg, PA — Pennsylvania Department of Human Services (DHS) today highlighted Pennsylvania’s spending plan for approximately $1.2 billion in enhanced federal Medicaid funding made available to states through the American Rescue Plan Act (ARPA). This funding will support Medicaid’s home and community-based services (HCBS) system throughout the commonwealth, which helps seniors, people with disabilities, children with complex medical needs, and many other groups safely live in their community among their family and peers. This funding will strengthen Pennsylvania’s home and community-based services system by allowing more Pennsylvanians access to critical services in their communities and supporting service providers that perform this work every day.

“We owe a huge debt of gratitude to the professionals who care for our most vulnerable, including children, seniors, people with disabilities, and those needing mental health services,” said Acting Secretary Meg Snead. “This enhanced funding through the American Rescue Plan Act will allow employers to recruit and retain skilled workers and allows them to plan for the future to provide training, certification, technology access, and much more.”

DHS received conditional approval of its spending plan on December 1 from the Centers for Medicare & Medicaid Services. On today’s call, DHS outlined how funding will be used through the Office of Mental Health and Substance Abuse Services (OMHSAS), the Office of Child Development and Early Learning (OCDEL), and the Office of Medical Assistance Programs (OMAP).

  • OMHSAS will prioritize funding for workforce recruitment and retention to qualifying providers, specifically mobile crisis mental health services, intensive behavioral health services (IBHS), psychiatric rehabilitation, and family-based mental health services. While many mental health services are not considered HCBS under ARPA, within the parameters of this funding opportunity, OMHSAS also will invest in training clinicians in trauma-informed treatment modalities, technology and training for telehealth, and updating the state hospital system’s technology infrastructure and providing staff training for use of electronic health records to facilitate more efficient transitions to community-based placements and services.
  • OCDEL supported a 3 percent rate increase for Infant/Toddler Early Intervention services, which allows all providers of Early Intervention services, including Service Coordination, to receive a 3 percent rate increase for services. This rate increase went into effect on July 1, 2021.
  • OMAP will use the recommendations of its pediatric shift care nursing work group to inform ARPA spending with a focus on achieving the following goals: improve care and service coordination for children with complex medical needs; support training of private duty nurses; leverage health information technology to allow for the sharing of clinical information; use a value-based payment structure for managed care organizations to improve outcomes of children receiving pediatric shift care nursing services; and facilitate co-training opportunities for both shift nurses and families to help improve coordination, continuity, and support among caregivers.

“When we invest in the caring workforce, Pennsylvania benefits both socially and economically,” said Acting Secretary Snead. “Having care provided in your own home or within your community allows family caregivers to be part of the workforce themselves and it allows those needing home and community-based services to stay safe, healthy, and to thrive.”

More information about Pennsylvania’s home and community-based services spending plan is available on DHS’s website.

RCPA continues to meet with DHS advocating for members on the spending plan and distribution strategies to ensure the workforce issues are front and center of the plan. If you have any questions, please contact your RCPA Policy Director.

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