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Tags Posts tagged with "PA Office of Developmental Programs"

PA Office of Developmental Programs

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ODP Announcement 19-157 provides information regarding the publication of the Department of Human Services (Department) proposed Fee Schedule Rates for Transportation Trip services that will be added to the Adult Autism Waiver (AAW) effective January 1, 2020. Public comment on these proposed changes will be accepted until 11:59 pm on January 7, 2020.

Effective January 1, 2020, the Department proposes to add Transportation Trip as a service available in the Adult Autism Waiver. The amendment to the Adult Autism Waiver that contains this change is currently with the Centers for Medicare and Medicaid Services (CMS) for approval. In anticipation of approval, a public notice was published in the Pennsylvania Bulletin Volume 49, Number 49 on Saturday, December 7, 2019. The notice informs stakeholders of the proposed Fee Schedule Rates for Transportation Trip services that will be funded through the AAW.

The title of the notice is Proposed Fee Schedule Rates for Transportation Trip Services Funded Through the Adult Autism Waiver.

One Fee Schedule Rate was developed for each Transportation Trip service zone. Transportation Trip services can be offered by providers who enroll directly with the Department to provide Transportation Trip services or through Organized Health Care Delivery System (OHCDS) providers. The assumption log used to develop these rates is available here.

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ODP Announcement 19-158 announces the launch of MyODP News Online, an online site that replaces our monthly newsletter with a resource containing real time online news that is most pertinent to our stakeholders. MyODP News Online is now available via MyODP.org. Through this link, stakeholders will receive relevant news and information as it happens. Readers may subscribe to an RSS feed, and eventually may share articles through social media. Past content remains available online.

Stakeholders that previously received the monthly newsletter via listserv will now receive MyODP News Online Weekly Digest. The digest is sent each Friday and contains all the week’s posted news in abstract. Individuals who received SAU1’s self-advocate edited version of the monthly newsletter will continue to receive that publication via regular mail. Readers may send inquiries or suggest story ideas via email.

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Office of Developmental Programs (ODP) Communication 19-152 announces that the final public notice for fee schedule rates and Department-established fees have been published in the Pennsylvania Bulletin.

A public notice will appear in the Pennsylvania Bulletin Volume 49, Number 47 on Saturday, November 23, 2019. The notice informs stakeholders of the final Fee Schedule Rates and Department-established fees. The title of the notice is Fee Schedule Rates and Department-Established Fees for Consolidated, Community Living and Person/Family Directed Support Waivers Services, Targeted Support Management and the Community Intellectual Disability Base-Funded Program.

The final Fee Schedule Rates and Department-established fees represent the maximum rates that the Department will pay and can be accessed on the Department’s website. Please note that the link in the public notice is no longer accurate as the DHS website was updated in the past week.

Section 6100.571(c) requires the Department to update the data used to establish the fee schedule rates at least every three years. When the data is updated, the Department will publish a notice in the Pennsylvania Bulletin of the Fee Schedule Rates. In the future, the Department will only publish a notice in the Pennsylvania Bulletin of the Fee Schedule Rates for Targeted Support Management and select services funded through the Consolidated, Community Living and P/FDS waivers and the Department-established fees for residential ineligible services when the rates are changed.

Interested persons are invited to submit written comments by 11:59 pm on December 23, 2019, regarding the final Fee Schedule Rates and Department-established fees to the Department of Human Services, Office of Developmental Programs, Division of Provider Assistance and Rate Setting, 4th Floor, Health and Welfare Building, 625 Forster Street, Harrisburg, PA 17120. Comments can also be sent via email. Use subject header ”PN Fee Schedule.”

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ODP reissued Announcement 19-049 in order to remind providers of the continued opportunity of

Getting Connected to the Community: Practical Skills for Building Person Centered Community Connections and to provide contact information for interested parties.

This interactive, three-hour training serves as a foundation for individuals receiving the Community Participation Support (CPS) service and their support teams. During this training, individuals, families, and their support teams (provider staff, Supports Coordinators) come together to brainstorm about and plan for building/enhancing person centered community connections. Training participants will practice utilizing person-centered thinking resources and techniques in the context of CPS. Information gathered using these skills can help teams develop meaningful plans for the implementation of CPS.

Provider agencies are invited to host this training at their local sites. Trainers will work with the provider agency to schedule the training on a date and time that work for the individuals, families, support teams, agency staff, and trainers. The training is designed for a maximum of 30 participants. The provider agency is asked to provide a space to hold a maximum of 30 people working in small groups. The trainers bring all of the training equipment and supplies.

If you are interested in hosting this training at your agency or have any questions, please submit your request via email. You can also call Jeff Wheeler at 800-446-5607 ext. 6881 or 412-826-6881, or Melissa Mecke at 717-901-2164.

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ODP Announcement 19-150 is to inform stakeholders that Pennsylvania will formally request a Good Faith Effort (GFE) Exemption from CMS to delay the implementation of the electronic visit verification (EVV) mandate. More time is needed in order to allow providers to fully prepare for EVV. ODP has heard from many providers who are using Alternate EVV systems and have been working with Sandata to certify their systems for integration with the DHS Aggregator. Since the time for certification is taking longer than originally projected, the Department is seeking an extension to allow additional time for these systems to go through the necessary testing with Sandata and become integrated to feed EVV data to the DHS Aggregator.

The Department is seeking a GFE to extend the soft launch period and to delay the denial of payments. The timeframe between system launch and the EVV mandate is referred to as the soft launch. The soft launch is an opportunity to:

  • Test and interface Alternate EVV systems
  • Familiarize providers with EVV prior to claims integration. Claims will continue to pay and EVV errors will appear on remittance advice.
  • Inform policy and system development
  • Help the Department identify and develop supplemental training materials
  • Facilitate EVV participation by caregivers and members

If approved by CMS, the GFE will allow the Department to extend the soft launch period and implement a tiered compliance structure before the denial of payments. EVV system implementation, training, and vendor interfacing will proceed on the current project schedule. Since the exemption has not yet been approved, providers are still required to begin using EVV by January 1, 2020. Provider participation will produce valuable data for system modification and policy development.

Please visit the DHS EVV website to view the ODP EVV technical guidance, public meeting notices, training resources, and Frequently Asked Questions (FAQs).

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ODP Announcement 19-149 releases data collected from Provider Self-Assessment Reports completed in 2018. The Center for Medicare and Medicaid Services (CMS) implemented a final rule regarding Home and Community-Based Service (HCBS) Settings in 2014. The final rule requires states to assess all residential and non-residential settings which receive funding or payment through an approved HCBS waiver. ODP developed a self-assessment for providers of these services to complete for each location.

In 2018, providers completed the self-assessment of over 6,000 Residential and Non-Residential service locations. The data was analyzed, and two reports were created:

For questions pertaining to these reports, please submit via email.

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ODP Announcement 19-147 serves to clarify the billing process of respite services in a non-residential setting. Respite services are direct services that are provided to supervise and support participants living in private homes on a short-term basis for planned or emergency situations, giving the person(s) normally providing care a period of relief that may be scheduled or due to an emergency. This communication does not apply to services in the Adult Autism Waiver or any services offered by the Bureau of Supports for Autism and Special Populations (BSASP).

The correct procedure code to use for these services depends on the Needs Level of the individual and the site where the respite is provided.

Respite services could be provided as a service at a residential site or in the community under a site enrolled as a Provider Type 51 specialty 513. Services can be provided under this specialty combination in settings such as:

  • A residential site such as a private licensed home in Pennsylvania under the 6400, 6500, 3800, 5310 licensure requirements;
  • An unlicensed residential Life Sharing home in Pennsylvania;
  • A participant’s private home or an unlicensed private home located in Pennsylvania, Virginia, Washington, DC or a state contiguous to Pennsylvania;
  • Other private homes, hotels, or rentals during temporary travel in accordance to ODP’s travel policy;
  • Camp settings that meet applicable state or local codes; or
  • Community settings that maintain the participant’s schedule of activities.

A new billing option has been created for respite services provided in respite-only homes under the 52 / 513 combination:

  • The site would be a respite only home.
  • The site would be licensed under the 55 Pa Code Chapter 6400 and the Approved Program Capacity approved prior to enrollment.
  • This would not be the same as a residential home licensed under the 55 Pa Code Chapter 6400 providing residential services being billed as a site enrolled under the Provider Type 52 specialty 521. You would not enroll the specialty 513 in combination with a specialty 521 at a PT 52 site.
  • The site could also be providing Exceptional Day Respite at a licensed intermediate care facility for individuals with ID (55 Pa Code Chapter 6600) that are owned and operated by private agencies or a Licensed Nursing Home (28 Pa Code Chapters 201, 203, 205, 207, 209 and 211).

When a participant has a Needs Group 3 or 4 that indicates medical or behavioral needs, and the participant is unable to locate a respite provider to render services in a community setting, they may be approved for Exceptional Day Respite. A variance may be requested for Respite services in licensed intermediate care facilities for individuals with an intellectual disability (55 Pa. Code Chapter 6600) that are owned and operated by private agencies, Licensed Nursing Homes (28 Pa. Code Chapters 201, 203, 205, 207, 209 and 211).

And Licensed Community Homes (55 Pa. Code Chapter 6400) located in Pennsylvania within the home’s approved program capacity of 5 to 8 may be requested for approval from the regional office.

For more detailed information, including charts with the appropriate billing codes, please refer to the ODP Announcement.

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