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Tags Posts tagged with "Waiver"

Waiver

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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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The Centers for Medicare and Medicaid Services (CMS) has approved the renewal of the Community HealthChoices (CHC) 1915(b) waiver effective January 1, 2023, for a 5-year period. Under the 1915(b) waiver, Pennsylvania operates the CHC managed care program.

As part of the CHC 1915(b) waiver renewal, the Office of Long-Term Living (OLTL) was required to obtain an independent evaluation or assessment of its CHC waiver program and submit the findings when renewing the CHC 1915(b) waiver.

The CHC 1915(b) waiver renewal and the Independent Assessment of the 1915(b) waiver are posted to the CHC-Supporting Documents website. Questions about the CHC 1915(b) waiver amendment or Independent Assessment can be submitted electronically.

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ODP Announcement 23-017 provides information regarding Remote Supports as a separate, discrete service in all four of the Office of Developmental Programs’ (ODP) waivers. Remote Supports is no longer covered as a component of the Assistive Technology service in the Consolidated, P/FDS, and Community Living waivers.

Guidance in the announcement includes how to add remote supports to the ISP, necessary provider qualifications, and enrollment process. Please refer to Attachment A for more instructions on how to add Remote Supports services for the P/FDS, Community Living, or Consolidated Waiver. Please refer to Attachment B for more instructions on how to add Remote Support Services for the AAW. Additional information about the qualification of a new specialty is contained in ODP Announcement 22-122 “Provider Qualification Process.”

Existing providers must submit the approved DP 1059 (ID/A) or DP 1088 (AAW) along with the “PROMISe™ Provider Service Location Change Request,” which can be found on the MyODP website, to the ODP provider enrollment inbox and/or AAW provider enrollment inbox in order to add a new Specialty 364 to an EXISTING active service location with the same Provider Type. Providers that do not have a Provider Type 51 service location open in PROMISe will need to submit an application through the Provider Enrollment system.

Questions regarding ISP requirements should be sent to the appropriate ODP Regional Office. Questions regarding provider qualification requirements should be sent to the ODP Provider Qualification inbox and the AAW Provider Enrollment Lead.

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The Centers for Medicare & Medicaid Services (CMS) has approved the Office of Long-Term Living’s (OLTL) Community HealthChoices (CHC) Waiver amendment that transfers oversight of Financial Management Services (FMS) from an OLTL-held contract to an administrative function of the CHC-MCOs and revises waiver performance measure AA-5. The amendment became effective on July 1, 2022.

The current approved CHC 1915(c) Waiver document with the FMS amendment can be viewed here. The link can be found under the heading “Community HealthChoices 1915(b) Managed Care and 1915(c) Home and Community-Based Waivers.”

Questions about the CHC Waiver amendment should be sent via email.

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The Pennsylvania Department of State (DOS) has reversed course and extended its waiver allowing for an initial prescription of buprenorphine without an in-person physical exam. DOS had announced previously that the waiver would expire on June 30, 2022; however, DOS’s waiver will now continue until the last day of the federal public health emergency declaration, unless the exemptions are ended sooner by the Substance Abuse and Mental Health Services Administration (SAMHSA) or the US Drug Enforcement Administration (DEA).

On Sept. 4, 2020, DOS issued a waiver suspending the State Board of Medicine’s regulation at 49 Pa. Code § 16.92(b)(1), which requires an initial physical examination of a patient prior to prescribing buprenorphine for the treatment of opioid use disorder. This waiver was sought specifically to complement the Department of Drug and Alcohol Programs’ (DDAP) suspension of 28 Pa. Code § 715.9(a)(4) and “relates to Federal exemptions granted under the Federal public health emergency (PHE) declaration,” specifically the exemptions granted by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Drug Enforcement Agency (DEA).

Therefore, in accordance with section 2102-F(a.3) of the Pennsylvania Administrative Code of 1929 (amended by Act 14 of 2022), the Department of State’s waiver will continue until the last day of the federal public health emergency declaration, unless the exemptions are ended sooner by SAMHSA or the DEA. This waiver will not expire on June 30, 2022. More information about the federal public health emergency can be found here.

It is important to note that, to be considered within the acceptable and prevailing standard of care, the physician/prescriber must be following the applicable SAMHSA/DEA guidelines.

Pennsylvania has not received notification that the PHE will be terminated on July 15. The commonwealth expects the PHE to be extended again. If this occurs, this waiver and others tied to or related to the PHE will be extended until mid-October 2022.

Additional information:

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ODP Bulletin 00-22-02, effective June 2, 2022, is to establish the process for requesting a waiver of a regulatory requirement. This bulletin applies to entities seeking to be licensed or are currently licensed under one or more of the following chapters:

  • 55 Pa. Code Chapter 2380 (relating to Adult Training Facilities);
  • 55 Pa. Code Chapter 2390 (relating to Vocational Facilities);
  • 55 Pa. Code Chapter 6400 (relating to Community Homes for Individuals with an Intellectual Disability or Autism);
  • 55 Pa. Code Chapter 6500 (relating to Life Sharing Homes); and
  • Providers of home and community-based services (HCBS) for individuals with an intellectual disability or autism subject to 55 Pa. Code Chapter 6100 (relating to Services for Individuals with an Intellectual Disability or Autism).

Licensees and ODP-enrolled providers are expected to comply with all applicable regulations. However, the Department recognizes that there are occasions where compliance with a regulation impedes the licensee’s or ODP-enrolled provider’s ability to provide services to an individual. As a result, the Department permits licensees and ODP-enrolled providers to request that a section, subsection, paragraph, or subparagraph of a regulation not apply when it is in the best interest of an individual or group of individuals who receive services from the licensee or ODP enrolled provider.

Not all regulations can be waived. Section 6100.43(a) prohibits waivers of the following regulations:

  • Sections 6100.1–6100.3 (relating to General Provisions);
  • Sections 6100.41–6100.56 (relating to General Requirements);
  • Sections 6100.181–6100.186 (relating to Individual Rights); and
  • Sections 6100.341–6100.350 (relating to Restrictive Procedures).

Additionally, section 6500.12(7) prohibits waivers of sections 6500.1–6500.4 (relating to General Provisions). While Chapters 2380, 2390, and 6400 do not address waivers of regulation, waivers for these chapters are at the discretion of the Department and can be requested pursuant to 1 Pa. Code section 35.18.

Providers should utilize the Office of Developmental Programs’ form “Request for Regulatory Waiver.”

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ODP Announcement 22-059 informs readers that the Office of Developmental Programs (ODP) is pleased to announce that an amendment to the AAW was submitted to CMS on May 9, 2022. The submitted AAW includes modifications that were made as a result of public comment. The AAW amendment includes the following substantive changes:

  • Adding reserved waiver capacity for individuals who are discharged from a state center. Reserved waiver capacity is also being added for participants who have been incarcerated for more than six consecutive months;
  • Aligning provider qualifications in the AAW with the Consolidated, Community Living, and Person/Family Directed Support (P/FDS) waivers, whenever possible;
  • Allowing relatives to deliver the Life Sharing component of the Residential Habilitation service;
  • Requiring that agencies that provide Residential Habilitation/Life Sharing must be qualified and enrolled to provide Residential Habilitation/Life Sharing in the Consolidated or Community Living waivers;
  • Increasing the annual fiscal limit in the transportation service to $5,000 per participant’s ISP year;
  • Allowing one of the four required monitoring conducted by the Supports Coordinator each year to be conducted remotely;
  • Adding a new service, Remote Supports; and
  • Delivering direct services using remote technology.

The requirements in the AAW will become effective when Appendix K flexibilities expire, six months after the expiration of the federal COVID-19 public health emergency.

Please note that aligning the Assistive Technology service, where possible, with the Consolidated, Community Living, and P/FDS waivers includes adding generators for the participant’s primary residence.

The full AAW application, as well as a record of substantive changes, is available here.

CMS has 90 days to review the amendment, and changes may occur to the content based upon discussion with CMS during the approval process. The proposed effective date of July 1, 2022, is also subject to change. ODP will inform all stakeholders when CMS has officially approved the AAW and will make the approved waiver available at that time.

Questions about this communication should be directed via email.

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