ODP Communication Questions and Answers Regarding the Consolidated and P/FDS Waiver Amendments Approved July 2016

Transcription

1 ODP Communication Questions and Answers Regarding the Consolidated and P/FDS Waiver Amendments Approved July 2016 ODP Announcement The mission of the Office of Developmental Programs is to support Pennsylvanians with developmental disabilities to achieve greater independence, choice and opportunity in their lives. AUDIENCE: Individuals and families, Administrative Entities, Supports Coordination Organizations, Providers of Consolidated or Person/Family Directed Support (P/FDS) Waiver Services. PURPOSE: This communication provides responses to questions received to date from stakeholders regarding the amendments to the Consolidated and P/FDS waivers effective July DISCUSSION: Amendments to the Consolidated and P/FDS waivers were approved by CMS effective July 13, 2016 and July 8, 2016 respectively. ODP held three teleconferences to discuss the changes in these amendments with stakeholders. During the teleconferences we informed stakeholders that they could send in questions regarding the amendments to which responses would be developed and published. This communication contains the questions received to date and responses to those questions. Provider Qualification 1. Is the expectation that wherever contiguous states are mentioned in the provider qualification requirements that Washington DC and Virginia are also included? Answer: Contiguous means touching along a boundary. Washington DC and Virginia do not share a border with Pennsylvania and are therefore not considered contiguous. Providers can have a service location in Washington DC and Virginia only when the provider qualification requirement for a service specifies that this is allowable. Washington DC and Virginia were added as qualified service locations for Education Support, Home and Community Habilitation, Respite and Companion as well as Transportation provided by a relative or legal guardian. ISSUE DATE 10/31/16 ODP Announcement Page 1

2 2. There are several places in the side-by-side comparison document which state allow waiver participants to receive this service from providers in Washington D.C. and Virginia. Does this mean the provider is based in Washington DC or Virginia or the individual receives the service in Washington DC or Virginia? Answer: In the qualification requirements for the services mentioned in the response to question 1, the waivers say that providers must have a waiver service location in Pennsylvania, Washington DC, Virginia or a state contiguous to Pennsylvania. A service location is defined as the address identified by a provider where services are provided or managed. This means the provider could be based in Washington DC or Virginia and provides the services to an individual in locations in Pennsylvania or it could mean that an individual receives the service in Washington DC or Virginia. Let s look at the services where this is now allowed: The service definitions for Home and Community Habilitation and Companion state that these services are provided in an individual s home and community. This means it is highly unlikely that an individual would receive these services at the service location in Washington DC or Virginia. The service definition for Respite contains a list of locations where Respite can be provided, most of which specifically state the service must be provided in Pennsylvania. This means it is highly unlikely that an individual would receive these services at the service location in Washington DC or Virginia. The nature of Transportation being a mobile service means it is also highly unlikely that an individual would receive the service at the service location (a specific address) in Washington DC or Virginia. When an individual is using Education Support to pay for college tuition, the service location may be the college campus or building where the individual is attending classes. In this case, the individual may be attending the classes in Washington DC or Virginia. 3. Why is there a limit to two additional states, Washington DC and Virginia, for Home and Community Habilitation? Why not all states? Answer: ODP or their designee (the Administrative Entities) is responsible for monitoring all providers. Provider monitoring includes an on-site review of the provider to verify that services are provided in compliance with regulations, the Waivers and federal and state requirements. The statewide implementation of this process will allow ODP to ensure that all providers adhere to important policies and procedures to ensure high quality of care for each individual enrolled in the program. ODP does not have the resources to conduct regular onsite reviews of providers located across the United States. 4. Can a support service worker in a participant directed services model (Agency with Choice or Vendor Fiscal/Employer Agent) reside in Washington DC or Virginia and provide waiver services as well? Answer: A support service worker employed through a participant directed services model can reside in Washington DC or Virginia and provide Home and Community Habilitation, Respite or Companion services. ODP Announcement page 2 of 14

3 5. Level 4 Enhanced now only requires one of the staff to have a degree or license, and the second staff would only need a high school diploma. Will the rate for such service be adjusted? How will this rate be calculated with the person directed model? Answer: The rate for traditional providers (not participant directed services) has not been adjusted. For both models of participant directed services, Vendor Fiscal/Employer Agent and Agency with Choice, the low wage for Level 4 Enhanced Home and Community Habilitation and Level 3 Enhanced Respite was reduced. This allows the common law employer or managing employer to choose wages in the wage range that reflect the education of the support service workers. 6. Please clarify the terminology Provider Qualifications Individual. Answer: Per 55 Pa. Code Chapter 51 regulations, an individual provider is defined as A person who is not employed by an agency and who directly provides the service, including an individual practitioner, independent contractor or Support Service Worker provider. After each service definition in the waivers there is a section entitled provider specifications for service with a provider category and provider type. When the provider category and/or provider type is identified as individual the provider qualification requirements apply to providers that meet this definition. Home and Community Habilitation Service Definition 7. If assistance, support and guidance is able to be provided to an individual to help them communicate face-to-face and through the use of a telephone, internet and social media and the habilitation aide is texted, called, and/or is contacted by the individual via these means during off hours; the habilitation aide, in our agency, is guided not to respond, as indirect support is not billable. In addition, the individual may call their habilitation aide from time to time for assistance and support via the phone; particularly when their supports coordinator and/or natural supports are not available. Again, that indirect conversation cannot be billed. Can Home and Community Habilitation in special circumstances be billed indirectly? Answer: The service definition for Home and Community Habilitation states that this is a direct service (face-to-face) provided in home and community settings ODP assumed that there would be some elements of indirect service involved in the provision of Home and Community Habilitation and built this into the rate. As such, providers may only bill for Home and Community Habilitation when the service is provided as direct, face-to-face time. A provider may not bill for Home and Community Habilitation for indirect services. 8. Since Home and Community Habilitation can include elements of Companion as long as Companion is not more than half of the service, how would a reviewer ascertain what is considered more than half? Answer: The Individual Support Plan (ISP) team (in determining the need for services) and the Administrative Entity in reviewing and authorizing ISPs would determine the needs of the individual and the frequency and duration of the services needed to meet those needs. Based on the information available, they would then determine if more than half of the Home and Community Habilitation service, as determined by the desired outcome, frequency and duration documented in the ISP would be Companion services. ODP Announcement page 3 of 14

4 Example: The ISP team determines that the frequency and duration for the Home and Community Habilitation service should be 40 hours a week. The ISP team should discuss, and the Administrative Entity should review, whether more than half of the 40 hours per week will be spent providing Companion services. The Home and Community Habilitation service definition still requires direct support professionals to assist support and guide individuals to meet the participants habilitative outcomes as documented in the ISP. The intent of this change is in response to public comments we have received recommending we make the Home and Community Habilitation service more flexible and supportive of individuals lives. We understand that there may be times when an individual wants to take a nap, listen to music alone in their room, or watch a television program while receiving the Home and Community Habilitation service. During these times the direct support professional might take on a more supervisory role that has historically only been allowed through the Companion service. The intent of this change is to support such incidental activities without requiring a change to the ISP or the provider to bill and document a different service. 9. When Home and Community Habilitation is provided by a support service worker in one of the participant directed services models, can Transportation services be authorized as a separate service for transportation related to Home and Community Habilitation activities? Answer: Yes, Transportation services can be authorized as a separate service for transportation related to Home and Community Habilitation activities provided by a support service worker in either the Agency with Choice or Vendor Fiscal/Employer Agent FMS models. Difference between Home and Community Habilitation and Companion 10. How can Home and Community Habilitation incorporate elements of Companion service, but Home and Community Habilitation cannot be provided at the same time as Companion services? Answer: Home and Community Habilitation and Companion are two distinct services that focus on different activities. The focus of Companion services are to supervise an individual, ensure an individual s health and safety or to do tasks for an individual. Home and Community Habilitation is focused on assisting, supporting and guiding an individual to meet the participants habilitative outcomes as documented in the ISP. If the individual needs two staff to support him or her at any given time, there are staffing ratios in several of the service definitions that would support this. The ISP team and Administrative Entity would have to determine which service would best meet the individual s needs. 11. Please explain how supervising and providing assistance to carry out functions of daily living and accompanying participants to the community to ensure health and safety is different from the Home and Community Habilitation definition of assisting, supporting and guiding ODP Announcement page 4 of 14

5 Answer: The focus of Companion services are to supervise an individual, ensure an individual s health and safety or to do tasks for an individual. Home and Community Habilitation is focused on assisting, supporting and guiding an individual to meet the participants habilitative outcomes as documented in the ISP. Example 1: An individual who has issues with depth-perception and balance needs a direct support professional to accompany her in the community to ensure her health and safety by assisting her to safely navigate curbs, steps and stairs. The appropriate service in this example would be Companion. Example 2: An individual is working to achieve outcomes in the ISP related to meal planning, decision making and budgeting. This individual needs a direct support professional to provide assistance in planning healthy meals, traveling to the grocery store, understanding the choices available and choosing and obtaining the necessary food items to prepare the planned meals. The direct support professional also helps the individual determine that he has sufficient funds to pay for the food items chosen and then may assist with the transaction and communication with the store clerk. The direct support professional does not complete the tasks for the person but assists the person to conduct the activity themselves. Through these activities, the direct support professional will facilitate positive interactions with people encountered in the community. As such, the appropriate service in this example would be Home and Community Habilitation. 12. If an individual is currently authorized for Home and Community Habilitation and Companion separately, do we have to combine them into Home and Community Habilitation when Companion would be less than half of the Home and Community Habilitation service? Answer: If the current authorizations for Home and Community Habilitation and Companion as separate services are meeting the individual s needs, the services do not have to be combined. The ISP team has flexibility in determining how best to meet the individual s needs. Home and Community Habilitation and Companion Provided by Relatives and Legal Guardians 13. Who is responsible to ensure a relative or multiple relatives do not exceed the maximum number of hours of service delivery across multiple services/multiple providers in a week? It does not seem at all feasible to put this expectation on Supports Coordination. Answer: For services that are not participant directed, the provider is responsible for ensuring that the maximum allowable number of hours of service delivery by staff who are relatives and legal guardians is not exceeded. Prior to providing waiver services, providers sign an agreement stating that they will comply with the approved waivers. This includes ensuring services are provided in accordance with the waivers. Further, providers are required to comply with 55 Pa. Code Chapter 51 regulations which state that as a prerequisite for participation in the Consolidated and P/FDS waivers, the provider must comply with the approved applicable waiver, including approved waiver amendments. For services that are participant directed, either the common law employer or the Agency with Choice organization is responsible for ensuring that the support service workers comply with the waivers. Prior to fulfilling employer duties, the common law employer signs an ODP Announcement page 5 of 14

6 agreement stating that he or she will ensure services are provided consistent with the approved waivers. According to ODP bulletin and 55 Pa. Code Chapter 51 regulations, the Agency with Choice organization is responsible for complying with waiver requirements. Supports Coordinators will be responsible for communicating the change in requirements with individuals and reporting any suspected violations of the rule to ODP. 14. The waiver states An exception may be made to the limitation on the number of hours of Home and Community Habilitation and Companion provided by relatives/legal guardians at the discretion of the employer when there is an emergency or an unplanned departure of a regularly scheduled worker for up to 90 calendar days in a fiscal year. Please clarify what constitutes an emergency (i.e. failure/lack of a back-up plan? And an unplanned departure (i.e. termination, extended medical leave)? Lastly, please explain 90 days in any fiscal year. Is the 90 days designation working days or calendar days for unplanned staff departure? Answer: Please refer to ODP Communication Clarifying the Provision of Home and Community Habilitation and/or Companion Services by Relatives and Legal Guardians in the Consolidated and P/FDS Waivers which contains the clarification requested. 15. Are relatives permitted to provide Home and Community Habilitation for individuals receiving Residential Habilitation Services and, if so, can the service be self-directed? Answer: When an individual receives Residential Habilitation services, Home and Community Habilitation may only be used as an alternative either part-time or full-time for a Licensed Day Habilitation Service or a Prevocational Service, not to exceed 40 hours per week. If Home and Community Habilitation will be provided in accordance with these requirements (and any other requirements specified in the waivers) a relative or legal guardian can provide the Home and Community Habilitation. Individuals who receive Residential Habilitation cannot selfdirect any service except Supports Broker in the following circumstances: The participant has a plan to transition from a residential setting to a private residence, and The participant has a plan to self-direct their services through an AWC or VF/EA FMS once they are in a private residence. 16. Can guardians and relatives that live in the same household as the individual provide Home and Community Habilitation and/or Companion limited to 40 hours /week? Answer: Relatives and legal guardians who live in the same household as the individual can provide Home and Community Habilitation and/or Companion services within the limits outlined in the waivers. Relatives and legal guardians who provide waiver services must meet the qualification criteria outlined in the waiver as well as other criteria specified in Appendix C-2-e of the waivers. 17. Would it be acceptable for a relative to provide 40 hours per week of Home and Community Habilitation through an Agency with Choice or Vendor Fiscal/Employer Agent FMS agency and also provide a few hours per week of Home and Community Habilitation through a traditional agency for the same individual? ODP Announcement page 6 of 14

7 Answer: Any one relative may provide a maximum of 40 hours per week of Home and Community Habilitation and/or Companion services to an individual unless the criteria for an exception have been met. This limit applies regardless of whether the relative is employed by one agency or multiple agencies. Please refer to ODP communication for more information on the exception criteria. Companion 18. Can you bill for Companion services for a relative for overnight hours? The relative does not live in the home and stays with the individual when regular overnight staff cannot be there due to circumstances (weather, sick, etc.). Answer: Relatives are allowed to provide Companion services overnight in accordance with the service definition and the ISP. 19. If a relative intends to provide Companion services to an individual do they need to be employed by a provider agency or can they provide the Companion services directly without being employed by a provider agency? If they do not have to be employed by a provider agency how will they receive payment for providing the Companion services? Answer: Relatives and unrelated individuals who provide Companion services can be employed by a traditional agency provider, an Agency with Choice FMS agency and managing employer, or a common law employer through the Vendor Fiscal/Employer Agent model. Relatives and unrelated individuals may also choose to enroll as an individual provider of Companion services. Respite 20. What will suffice as valid documentation of room and board costs for camp? Most camps are paid as vendor services. Answer: You are correct that Respite Camp is a vendor service. The waiver would reimburse the fee charged to the general public if the camp is licensed or accredited. The camp should provide separate documentation of the service cost and the room and board component based on the accreditation/certification standard for the camp. 21. In regards to the increase in respite, does that increase apply to all levels of respite? Answer: The number of 15 minute units of Respite available in the P/FDS Waiver increased from 480 to This increase applies to all levels of 15 minute unit Respite in the P/FDS Waiver. 22. We have a question regarding not being able to charge room and board to individuals receiving respite, specifically extended respite over 30 days. It was our understanding that room and board could not be charged to individuals receiving respite if they are in a licensed facility for 30 or fewer days. If they are in a licensed facility for 31 days or more, are we permitted to charge room and board? If providers are not permitted to charge room and board to respite individuals that are in a licensed facility for an extended period of time, who will provide the food for the individual? Specifically, the family/guardian will continue to receive the individual s social ODP Announcement page 7 of 14

8 security without having to pay for their daily needs (needs that were being provided through the room and board). Please see below as to where we feel we are permitted to charge room and board for individuals that are in respite care for 31 days or more Exemption of room and board charges. There may be no charge for room and board for respite care, as defined in (relating to additional requirements for respite care), if respite care is provided for 30 or fewer consecutive days. Answer: As stated in the waivers, room and board costs are included in the fee schedule rate solely for Respite provided in a licensed residential setting or in camp settings that are licensed or accredited. There may not be a charge for room and board to the participant for Respite that is provided in a licensed residential setting or in camp settings that are licensed or accredited. Licensed residential providers and licensed or accredited camp settings are already receiving reimbursement for room and board costs (including food) through the rate paid to the provider for Respite services. 23. Can you explain the differences between the 15-minute interval respite service and Companion Services, please? To me, they seem almost identical in the way they are provided. Answer: The main differences are that: Respite services are provided solely on a short-term basis whereas Companion services are provided based on the needs of the individual. Companion services can be short-term but are usually utilized long-term. Respite services are provided due to the absence of or need for relief of those persons normally providing care. The focus of Companion services are to supervise an individual, ensure an individual s health and safety or to do tasks for an individual. The individual does not need to have a person who normally provides care to be absent or in need of relief to receive Companion services. Supported Employment 24. Is a one-time only Office of Vocational Rehabilitation (OVR) referral and closure determination acceptable for documentation? Or is the expectation that if a participant loses a job that a new OVR referral/determination is necessary? Answer: An OVR case closure remains valid unless the individual wants to be referred to OVR again due to a change in circumstances. This guidance is provided in the current ODP bulletin titled OVR Referral Process for Employment-Related Services. 25. An individual went through the OVR assessment and received the maximum amount of supported employment allowed through OVR. OVR closed the individual s case and the individual continued to work with the assistance of Supported Employment services through the P/FDS Waiver. The individual then stopped working for a few months and is now ready to get back to work. Is this individual required to go through the OVR referral process to receive Supported Employment services through the P/FDS Waiver? Answer: In this situation, the individual is not currently competitively employed, but there is documentation that OVR has previously closed the individual s case. The OVR case closure remains valid and the individual does not need to be referred to OVR again unless he or she ODP Announcement page 8 of 14

9 wants to be referred. This guidance is provided in the current ODP bulletin titled OVR Referral Process for Employment-Related Services. 26. Do we have to refer an individual to OVR if the individual s case was closed with OVR due to medical issues and six months later is ready to go back to work? Answer: An OVR case closure remains valid regardless of the reason for the case closure unless the individual wants to be referred to OVR again due to a change in circumstances. This guidance is provided in the current ODP bulletin titled OVR Referral Process for Employment-Related Services. 27. Further explain and provide examples regarding the activities that can occur for vocational skill development purposes in the Supported Employment service definition and where these activities can occur. Answer: Vocational skill development includes the development and implementation of a preliminary plan for employment that identifies and addresses the individual's basic work interests, as well as skills and gaps in skills for their work interests. Examples of this would include working with an individual to develop the social or personal skills that would be necessary to become employed permanently in a competitive integrated environment or working with an individual to determine if competitive integrated employment is possible in a specific area of interest. It might also include situational assessments, which means spending time at an actual employer's place of business for purposes of exploring vocational interests and developing vocational skills. Vocational skill development also includes identifying available transportation to help the individual get to and from work and teaching the individual and their family (as appropriate) about basic financial opportunities and benefits information that would help the individual eventually move into competitive integrated employment. Providing supported employment for vocational skill development purposes can be used to assist an individual become ready to benefit from OVR services before a referral to OVR is made; it is not to be provided in lieu of OVR services. (OVR provides supported employment services, such as specific job development, placement, training and supports for a particular position of employment to eligible VR customers when the VR counselor considers the individual to be ready to benefit from VR services. This guidance is provided in the current ODP bulletin titled OVR Referral Process for Employment-Related Services. 28. Is job finding still a temporary service? If so what is the limit? Or is the limit based on the need? Answer: The Supported Employment service definition in the Consolidated and P/FDS Waivers states, the provision of job finding services will be evaluated during individual monitoring by the SC to assess the continued need for the service and whether the service is assisting the individual with the outcome of finding community employment. If the service is not assisting the individual with this outcome, the SC will convene an ISP team meeting to identify changes to the Supported Employment service to realize this outcome or other service options to meet the individual s needs. As such, there is no specific time limit on the job finding service. The SC will assess whether job finding is assisting the individual with the outcome of finding community employment. ODP Announcement page 9 of 14

10 Nursing 29. Please clarify if there is still a distinction between Nursing services provided by a Registered Nurse or a Licensed Practical Nurse. Answer: There has been no change to this aspect of Nursing services. There continues to be two separate procedure code modifiers that denote whether the service is to be provided by a Registered Nurse or a Licensed Practical Nurse. The Individual Support Plan Manual, attachment 1 of bulletin states, The supports to be provided by each nursing professional must be determined to arrive at the appropriate units of service. 30. If there is still a distinction between service by a Registered Nurse and a Licensed Practical Nurse, how can a SC or Administrative Entity determine which type of nurse the individual needs? Answer: The nursing care plan, which is part of an initial nursing assessment, should be used to identify if the service can be provided by Licensed Practical Nurse level of training versus Registered Nurse level of training. In accordance with 28 Pa. Code , The registered nurse shall make the initial evaluation visit, regularly reevaluate the patient s nursing needs, initiate the plan of treatment and necessary revisions, provide services requiring substantial specialized nursing skill, initiate appropriate preventive and rehabilitative nursing procedures, prepare clinical and progress notes, coordinate services, inform the physician and other personnel of changes in the patient s condition and needs, counsel the patient and family in meeting nursing and related needs, participate in in-service programs and supervise and teach other nursing personnel. The licensed practical nurse shall provide services in accordance with agency policies prepare clinical and progress notes and assist the patient in learning appropriate self-care techniques. 31. If the individual has 1:1 LPN services, 18 hours daily, and the family would like to go on vacation and the LPN needs to go with them, if they leave the state of PA, how does the licensure of that LPN work, say they go to Atlantic City or Florida? Answer: ODP can only speak to the policies, regulations, service definitions and provider qualification requirements developed by ODP. Per Section 15: Waiver Travel Policy Related to Service Definitions, of the ISP Manual, Nursing services may be provided during temporary travel. The employer would need to determine whether there are any implications for licensed nurses that would be providing Nursing services outside of Pennsylvania. Supports Broker 32. How is a plan defined in regard to individuals receiving residential habilitation services who are seeking to use a Supports Broker to transition to a private residence? Must the individual have the private residence identified, leased or purchased? Is the plan defined as seeking a home, apartment in a particular area? Answer: There are no specific criteria for what must be included in a plan to transition to a private residence and self-direct one s own services. Each individual s plan will be unique ODP Announcement page 10 of 14

11 based on the circumstances specific to their situations, so it is important to ensure flexibility in planning. It is expected that the most recent ISP of an individual who seeks to use Supports Broker services in a residential habilitation setting will in some way reflect a desire to self-direct, such as by specific reference to self-direction somewhere in the ISP or as part of an outcome action to achieve a goal of greater independence, choose and manage support service workers, etc. As noted on Page 113 of the ISP Manual, progress towards transitioning to a private residence should be reviewed on an annual basis to ensure the effectiveness of the service in meeting this goal. As such, the contents of the original plan are not as important as documented progress towards achieving the ultimate goal of self-directing services in a private residence. Assistive Technology 33. Please confirm there are no criteria to determine when a generator is covered. It appears that any participant residing in a private home could purchase a generator. Answer: Generators have a lifetime limit of $5000. While generators have a separate lifetime limit, the amount spent on a generator is included in the overall Assistive Technology lifetime limit of $10,000. All Assistive Technology, including generators, must: Be used to increase, maintain, or improve an individual s functioning; Meet the applicable standards of manufacture, design, and installation; Exclude those items that are not of direct medical or remedial benefit to the individual, or are primarily for a recreational or diversionary nature; and Be recommended by an independent evaluation of the participant s assistive technology needs. The evaluation must include the development of a list of all devices, supplies, software, equipment, product systems and/or waiver services (including a combination of any of the elements listed) that would be most effective to meet the need(s) of the participant. The least expensive option from the list must be selected for inclusion on the ISP. Home Accessibility Adaptations 34. Are the adaptations listed in the side-by-side comparison document the only allowable adaptations (Break resistant window material and modifications to existing bathrooms)? Please confirm if stair glides, ramps, track lifting systems, etc. are still permitted. Answer: The side-by-side document only included language that has been added, revised or removed. The full service definition still has a limited list of modifications that are covered which include: Ramps from street, sidewalk or house. Vertical lifts. Portable or track lift systems. A portable lift system is a standing structure that can be wheeled around. A track lift system involves the installation of a track in the ceiling for moving an individual with a disability from one location to another. Handrails and grab-bars in and around the home. Accessible alerting systems for smoke/fire/co2 for individuals with sensory impairments. ODP Announcement page 11 of 14

12 Electronic systems that enable someone with limited mobility to control various appliances, lights, telephone, doors, and security systems in their room, home or other surroundings. Outside railing from street to home. Widened doorways, landings, and hallways. An additional doorway needed to ensure the safe egress of the participant during emergencies, when approved by the ODP Regional Office. Swing clear and expandable offset door hinges. Flush entries and leveled thresholds. Replacement of glass window panes with a shatterproof or break resistant material for participants with behavioral issues as noted in the participant s ISP. Slip resistant flooring. Kitchen counter, major appliance, sink and other cabinet modifications. Bathroom modifications to existing bathrooms for bathing, showering, toileting and personal care needs. Bedroom modifications of bed, wardrobe, desks, shelving, and dressers. Stair gliders and stair lifts. A stair lift is a chair or platform that travels on a rail, installed to follow the slope and direction of a staircase, which allows a user to ride up and down stairs safely. Workroom modifications to desks and other working areas. 35. Are there guidelines for payments made to the contractors performing Home Accessibility Adaptations? For example, can contractors be paid in 2 installments, 3 installments or can they not be paid until the job is complete. Answer: In accordance with 55 Pa. Code (c), payment for waiver services may only be made after the service has been rendered. It is not allowable for waiver funds to be utilized to provide a deposit for services that are to be performed at some point in the future. 36. Does each county determine the guidelines for having a home modification completed? For example: a. The number of contractor estimates the family is required obtain. b. Determining which contractor will perform the renovations for the family Answer: Each Administrative Entity must ensure that the waiver service definition, provider qualifications, regulations and policies regarding vendor services and Home Accessibility Adaptations must be followed. At one time there was guidance that three bids should be obtained for Home Accessibility Adaptations. Some Administrative Entities may be following this guidance as a best practice and are encouraged to do so. Services Provided By Relatives/Legal Guardians 37. Please elaborate on how the team is to determine an individual has expressed a preference to have a relative provide the service when someone has limited communication skills. Answer: All decisions about service providers should be based on the individual s person centered plan taking into careful consideration preferences like Know and Do, Important To, What Makes Sense and the necessary provider qualifications for the service. The team ODP Announcement page 12 of 14

13 should make every effort to carefully match workers with the person s needs, preferences, provider qualifications, job description and job requirements. The team should make every effort to ensure that the individual should be offered a choice of providers. 38. Does the relative/legal guardian need to carry an active nursing license as any other nurse would be required? Answer: Appendix C-2-e of the waivers states that relatives and legal guardians are required to meet the qualification criteria for the service they are providing. If the qualification criteria state that an active nursing license is required, the relative or legal guardian would have to have an active nursing license to provide the service. 39. Does the change with a spouse now being considered a relative impact the definition of a relative for Supports Coordination monitoring requirements? If an individual lives only with a spouse and they are enrolled in the PFDS waiver, are they now considered to be living with a relative and can have monitoring on a quarterly basis instead of monthly? Answer: An individual who lives with a spouse will be considered as living with a family member. As such, and in accordance with Appendix D-2-a of the P/FDS waiver for individuals who are receiving a monthly service, the supports coordinator shall conduct a phone monitoring with the waiver participant once every three calendar months at a minimum and shall conduct a face-to-face monitoring once every six calendar months at a minimum. At least one face-to-face monitoring per calendar year must take place in the participant's home. 40. Is there an expectation that the relative/multiple relatives do not exceed the maximum number of hours of service delivery across multiple services/multiple providers, as is the case for Home and Community Habilitation and Companion? Answer: This limit is only written in the service definitions for Home and Community Habilitation and Companion. As such, this limit does not apply to any other services beyond Home and Community Habilitation and Companion. 41. Are there any changes to the Respite service for Consolidated waiver? We have a family where two relatives provide a combined total of 60 hours per week of Home and Community Habilitation through the Vendor Fiscal/Employer Agent model. Can these relatives also provide 20 hours per week of Respite services? Answer: There are no limits that specifically apply to Respite services provided by relatives. The limits on the amount of 15 minute unit and day unit Respite services that can be provided in each waiver per fiscal year must be adhered to regardless of who provides the service. Appendix C-2-e of the waivers also states that relatives/legal guardians who are not the individual s primary caregiver can provide Respite services. CONTACT ODP Announcement page 13 of 14

14 Questions about this memorandum should be directed to the appropriate Developmental Programs Regional Office. ODP Announcement page 14 of 14