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Tags Posts tagged with "Waiver"

Waiver

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Photo by Christina @ wocintechchat.com on Unsplash

Adult Autism Waiver (AAW) and Adult Community Autism Program (ACAP) providers are invited to sign up for a scheduled one-on-one virtual office hour (VOH) session to discuss incident management topics with ODP-BSASP. Providers may sign up for one 30-minute session, and multiple staff from the provider may join at the provider’s discretion. Topics for discussion may include:

  • Provider-specific IM issues or concerns;
  • EIM reports;
  • General questions about certified investigations;
  • Brainstorming ideas of how to improve “performance” related IM tasks;
  • A review of provider IM data and compliance; and
  • Discussion of provider trends.

We encourage AAW providers and ACAP to take advantage of this opportunity. Sessions are offered in 30-minutes intervals and are on a first-come, first-served basis.

Friday, December 15
First Scheduled Session Begins at 8:30 am
Register Here
Please be sure to complete all required information in order to reserve your time slot. 

Please contact the Provider Support Inbox with questions.

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Hole torn in a dollar bill with medicaid text

Deputy Secretary Ahrens has shared information regarding avoidable Medicaid non-renewals for individuals. If an individual is receiving waiver services and loses their MA, this has the unfortunate outcome of the individual being dis-enrolled in the waiver. In turn, services rendered during a time when the individual is ineligible will not be paid through waiver funds.

If your agency serves as a representative payee or provides waiver services, especially residential services, this can have a serious impact on both your agency and the individual receiving services. Of note:

  • As of 10/17/2023, the Office of Developmental Programs (ODP) has a record of 444 enrolled individuals (223 of whom are waiver participants) whose MA was not renewed procedurally. These participants’ renewal dates span April through September 2023.
  • 176 individuals (45 of whom are waiver participants) were registered and had their MA closed due to ineligibility.

The primary reasons appear to be that asset limits were exceeded and determination paperwork had not been returned (procedural closure). There are individuals who receive residential services in these groups. Please note that sometimes paperwork may go to a guardian or representative payee. In those situations, it’s important that there is communication between the provider and the responsible person. In particular, providers should be aware of the following:

  • Individuals receive MA renewal paperwork in the mail at their home address. Providers/SCOs should ensure that the CAO always has up-to-date contact information for individuals receiving MA.
  • Renewal dates differ. Individuals should receive renewal info about 90 days prior to the due date.
  • If a provider has questions about renewal dates for individuals, AEs and SCOs are provided data on all individual MA renewal dates.

Please ensure that your agency is aware of the renewal dates and is prepared to respond quickly and/or assist the guardian or family member who may be receiving the paperwork. Additionally, please be cognizant of the asset limits and consider opening an ABLE account if all the individual’s needs are met.

For any questions, contact Carol Ferenz.

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The Office of Developmental Programs (ODP) has shared the announcement Additional Guidance for the End of Appendix K Flexibilities in the Consolidated, Community Living, Person/Family Directed Support (P/FDS) and Adult Autism Waivers. The purpose of the communication is to provide additional guidance on which Appendix K waiver flexibilities have been added to the approved intellectual disability/autism waivers (ID/A), which are the Consolidated, Community Living, and P/FDS Waivers, and the Adult Autism Waiver (AAW), as well as which Appendix K flexibilities will be ending November 11, 2023. You can view a quick guide for ID/A Waivers and a quick guide for the Adult Autism Waiver.

Please review all documents for additional information and details.

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The Office of Developmental Programs (ODP) has shared important workshops that continue the series on Technology. Technology has become a major part of all our lives. For people with Intellectual/Developmental Disabilities, technology can offer opportunities for independence, entertainment, choice, and control. Remote Supports are now offered that provide more opportunities for services that can increase independence. Please join the discussion on Technology and Remote Supports and how they can impact an Everyday Life! These workshops are created by family members and self-advocates FOR family members and self-advocates.

Register for upcoming events.

Community Engagement Workshops

LifeCourse Workshops

Waiver Workshops

Support Groups

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October starts the PA Family Network’s series on technology. Technology has become a major part of all our lives. For people with intellectual/developmental disabilities, technology can offer opportunities for independence, entertainment, choice, and control. Remote Supports are also now offered, providing more opportunities for services that can increase independence. Join the discussion as we talk about how technology and remote supports and can impact an Everyday Life! These workshops are created by family members and self-advocates FOR family members and self-advocates.

Register for upcoming events here.

October Workshops

LifeCourse Workshops

Waiver Workshops

Community Engagement Workshops (These are offered twice each day and won’t be repeated.)

Support Groups

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ODP Announcement 23-043 shares that the proposed amendments to the Consolidated, Person/Family Directed Support (P/FDS), Community Living, and Adult Autism Waivers and proposed rates for select services are available for public review and comment. There is a 30-day public comment period that starts on May 27, 2023, and ends on June 27, 2023, at 11:59 pm.

These proposed changes are scheduled to take effect November 1, 2023. ODP is also making available for public review and comment the rate setting methodology and fee schedule rates for select services in the waivers that are scheduled to take effect January 1, 2024.

The waiver amendments in their entirety can be found here.

Additional fee schedule rates are being added for:

  • Group music therapy, art therapy, and equine assisted therapy services provided through the Consolidated, Community Living, and P/FDS Waivers.
  • Needs Group 5 Residential Habilitation services provided through the Consolidated Waiver and Life Sharing Without Day Services provided through the Consolidated and Community Living Waivers.

The new Specialty Health Assessment and Coordination service in the Consolidated, Community Living, and P/FDS Waivers will be reimbursed monthly as a vendor service based on the cost that the provider charges to the general public. The rate changes proposed above are planned to become effective January 1, 2024.

In addition, ODP proposes to adopt the temporary enhanced rates for CPS and Transportation Trip as the fee schedule rates on November 1, 2023.

Information regarding the proposed waiver amendment changes and rates, including how to provide comments, can be found in the Pennsylvania Bulletin, Volume 53, Number 21, published on Saturday, May 27, 2023.

Comments and requests for copies of this notice and documents may be submitted to ODP via email. Comments submitted should use subject header ”Waiver and Rate Comments.” There are also webinars scheduled to provide public comment.

RCPA will be asking members for their input to our comments as well and will schedule a meeting to review this information shortly. If you have any questions or comments that you would like to be sure we include, please contact Carol Ferenz or Cathy Barrick.

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Medical insurance and Medicaid and stethoscope.

Join Pennsylvania Health Access Network (PHAN) on May 22, 2023, at 1:00 pm for a community conversation about Medicaid waivers. Amy Lowenstein, Director of Policy, and Pamela Putnam Silver, Supervising Attorney from the Pennsylvania Health Law Project, will discuss:

  • The end of COVID-era policies in the CHC and OBRA waivers and what they mean for those applying or receiving waiver services;
  • What to expect from the waiver renewal process;
  • Addressing changes in income and resources that may impact eligibility;
  • Where to go for help; and
  • Any questions and concerns.

Register for the meeting here.

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