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Tags Posts tagged with "Service Coordinator"

Service Coordinator

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The Pennsylvania Department of Human Services’ Office of Long-Term Living (OLTL) is offering a webinar on the PA Achieving a Better Life Experience (ABLE) Savings Program. A PA ABLE savings account gives individuals with qualified disabilities (Eligible Individuals) and their families and friends a tax-free way to save for a wide range of disability-related expenses while maintaining important benefits. The state and federal tax-free investment options are offered to encourage Eligible Individuals and their families to save private funds to support health, independence, and quality of life.

Some of the topics OLTL will discuss include eligibility requirements for opening a PA ABLE account; federal and state tax benefits of PA ABLE; and how a PA ABLE account interacts with current benefits.

OLTL Service Coordinators, Direct Service Providers, Community HealthChoices Managed Care Organization staff, and any individuals who work in employment supports are strongly encouraged to participate in this webinar, as it will help them understand the PA ABLE Program and how it can benefit the OLTL participants they serve.

Please register for the PA ABLE Savings Program webinar scheduled for July 23, 2025, from 12:00 pm – 1:00 pm using this registration link. After registering, you will receive a confirmation email containing information about joining the webinar.

If you require accommodations to participate in this webinar, please send them electronically.

If you have questions regarding this email, please contact Randy Loss at OLTL.

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The Office of Long-Term Living (OLTL) released a communication that focused on the update to the Health and Welfare Performance Measure #8 (HW-8) that was included in the OBRA Waiver amendment that was approved by the Centers for Medicare and Medicaid Services (CMS) and took effect on January 1, 2025. The update includes:

Number and percent of incidents for waiver participants each month with more than three reported incidents within the past 12 months where results of trend analysis were addressed by the Service Coordinator (SC). Numerator: Total number of incidents for waiver participants each month with more than three reported incidents within the past 12 months where results of trend analysis were addressed by the SC. Denominator: Total number of incidents for waiver participants with reported incidents within the past 12 months where a trend analysis was performed.

In accordance with this requirement, for any participant with more than three critical incidents within a 12-month period, the Service Coordinator (SC) must perform an analysis (trend analysis) and take action as necessary to prevent or mitigate further incidents. The SC must commence the analysis and implement the actions to address potential issues related to the health and welfare of the Participant within the 30-day investigation period. If additional time is needed to investigate and to implement any necessary actions to address potential issues related to the health and welfare of the Participant, the SC must document an extension in Enterprise Incident Management (EIM). The trend analysis document must be provided to a Critical Incident Management Unit (CIMU) team member for review upon request and subsequently uploaded to the respective EIM entry upon completion and submission of the critical incident report’s final section. If necessary, OLTL’s CIMU staff will provide additional feedback to the SC via the State Management Review in EIM.

For any questions regarding this change, please contact the CIMU via the resource account. Additionally, questions related to critical incidents may be emailed to the CIMU team member identified in any case-specific communication.

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The Office of Long-Term Living (OLTL) Critical Incident Management Unit monitors provider compliance in the application of guidance specific to critical incident management. OLTL has identified compliance concerns and is issuing the following clarification.

This communication focuses on required critical incident notification by provider agencies to the participant’s assigned service coordinator and the documentation of such notification in the Enterprise Incident Management (EIM) entry. The OLTL Critical Incident Management Bulletin, which is also available on OLTL’s website, indicates the following:

  • Within 48 hours, the Managed Care Organization (MCO), Service Coordinator (SC), provider agency that discovers or has independent knowledge of the critical incident is to submit the First Section of the critical incident report to OLTL using OLTL’s critical incident management system. If the critical incident was discovered on a weekend or holiday, the 48 hours begin at 12:00 am on the first business day after discovery of the critical incident.
  • Providers must inform the participant’s SC within 24 hours of discovering or first learning of a critical incident.

Notification to the participant’s SC that a critical incident was discovered must not be made using the HHAeXchange system. The required notification to the participant’s SC must be made by telephone call, electronic mail communication, or any other method that is agreed upon by all parties involved, excluding the HHAeXchange system.

In addition, the notification by the provider to the participant’s SC that a critical incident was discovered must be clearly documented in the EIM incident report, specifically within the “Agencies Contacted” page. Instructions are below:

  1. Enter the first name of the SC in the Person Contacted (First Name) Field.
  2. Enter the SC’s last name in the Person Contacted (Last Name) Field.
  3. Enter the contact phone number. Note that the email address field is not mandatory; however, it should be completed when notification to the SC was made via email.
  4. Click the SAVE button when all information has been entered.

See an example of page completion below.

Providers who are experiencing difficulty meeting the Critical Incident Management Bulletin requirements may email concerns to the resource account. Additionally, questions related to critical incidents may be emailed to the Critical Incident Management team member identified in any case-specific communication.

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The Office of Long-Term Living (OLTL) issued a Critical Incident Management Bulletin, with indications that they and the Managed Care Organizations (MCO) will be enforcing these regulations. Per OLTL:

Investigation of critical incidents and its documentation is an integral part of a Service Coordinator’s (SC) responsibilities, not a stand-alone function. During the course of quality reviews, Office of Long-Term Living’s (OLTL) Incident Management staff has found that critical incident investigations are not consistently following the established policy and procedure. OLTL wants to reinforce the following requirements found in various OLTL policy and procedure documents, which remain unchanged. Non-compliance with these requirements is subject to corrective action by OLTL.

1. Investigation of Critical Incidents

a. According to the Critical Incident Management Bulletin dated 2/23/2023, Community HealthChoices (CHC) managed care organizations (MCO) and SC must begin investigating a critical incident within 24 hours of discovery or of learning of the incident. This requirement was also indicated in the 2015 version of the document. The bulletin reinforces the onsite visit requirement for fact finding. The critical incident facts, sequence of events, interview of witnesses, and observation of the participant and/or environment is required. The onsite investigation is not the same as a comprehensive needs reassessment or assessment of need, and it must be completed regardless of participant choice. The participant reserves the right to refuse involvement in the critical incident investigation. However, the onsite visit must be completed. The Telephone Investigation referenced in the Bulletin does not replace the onsite investigation requirement, and is meant for instances when more information is necessary to complete the incident report. For example, when a protective services investigation is occurring and the SC needs to gather details to ensure mitigation measures are in place. Please note that while required to cooperate in the investigation, SCs are not required to investigate reported allegations of abuse, neglect, or exploitation, which are referred to a protective services agency. However, SCs remain responsible for ensuring participants health, safety, and welfare by means of risk mitigation and appropriate service implementation.

b. The 24-hour requirement to initiate an investigation is not to be interpreted as one business day. The only time business days apply is when submitting a critical incident report in Enterprise Incident Management (EIM), which is required within 48 hours excluding weekends and holidays. Please note that while the investigation must be initiated within 24 hours of incident discovery/learning of the incident, the CHC-MCO and SC will still have 30 calendar days to complete the investigation. It is also important to note that the onsite visit does not necessarily have to occur within 24 hours of incident discovery as long as it occurs at a time that enables ensuring the health and welfare of the participant, and within the allotted 30 calendar days or extended due date in the case where a timely EIM report extension was requested.

c. The Critical Incident Management bulletin also indicates the following:
No further action is required when the critical incident report meets all three of the following conditions:

  1. The facts and sequences of events are outlined with sufficient detail; and
  2. Preventative action through the service plan is either not required or is implemented and documented; and
  3. The participant is not placed at any additional risk.

Therefore, CHC-MCOs and SCs must ensure that, prior to submitting the Final Section of the incident report in EIM, the participant is aware of the critical incident, its resolution, and the measures taken to prevent recurrence. This includes determining whether a comprehensive needs reassessment or assessment of need must be conducted, based on the requirements outlined in OLTL’s policy and procedure documents. The SC must also ensure thorough documentation in the critical incident report of all actions taken to ensure participants health and welfare.

2. Notice to Participant

The Critical Incident Management Bulletin indicates that:

  1. The agency staff that discovered or first became aware of the critical incident is to notify the participant (and representative if requested by the participant) that a critical incident report has been filed. This notice must be provided to the participant within 24 hours and in a cognitively and linguistically accessible format. If the participant’s representative is suspected to be involved in the critical incident, the representative should not be notified.
  2. Within 48 hours of the conclusion of the critical incident investigation, the SC must inform the participant of the resolution and measures implemented to prevent recurrence.

CHC-MCOs and SCs must ensure the required notifications are made to the participant, and document completion within the Referrals and Notifications page in the EIM critical incident report.

OLTL encourages all CHC-MCOs and SCs to review the Critical Incident Management Bulletin to ensure all requirements are met.

If you have any questions, please contact Fady Sahhar.

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