Pennsylvania HCBS Transition Plan UNALLOWABLE SETTINGS 441.301(c) (5) - Home and Community-Based Settings do not include a nursing facility, institution for mental diseases, ICF/ID and hospitals. Comm Updated: August 14, 2014 1 Deliverables: Report on providers in unallowable settings and the number of waiver participants each provider serves; Waiver Amendment(s) (as necessary), Policy Documents And Any Published Revised Regulations (as necessary) 1. Develop a method/tool to collect data and track provider status regarding unallowable settings 3 months 2. Develop and implement a process to ensure new providers enrolling to render waiver services and existing 3 months providers moving their service locations are not in unallowable settings 3. Analyze applicable regulations to determine if revisions are needed to be in compliance with new CMS 12 months regulations, draft revisions (as necessary) outlining recommended changes 4. Analyze provider information for unallowable locations to determine if there are providers that render 12 months licensed Day Habilitation/Adult Day services (55 PA Code Chapter 2380 or 6 PA Code Chapter 11), Prevocational services (55 PA Code Chapter 2390), Licensed Residential Habilitation services (55 PA Code Chapter 6400, 6500, 3800, 5310, 2600) or unlicensed Residential Habilitation and Structured Day Habilitation services within the following facilities: ICF/ID building where residents live, in a nursing facility, in a hospital or institution for mental diseases 5. Identify and notify providers impacted, provide date required to achieve compliance. Identify and notify 16 months individuals impacted along with their case management entity 6. Distribute public notice which lists those settings/providers that have been determined unallowable 19 months 7. Update Waiver Service Definitions for licensed Day Habilitation, Adult Day, Prevocational Services, 24 months Structured Day Habilitation, and Residential Habilitation to include the following statement, This service may not be provided in a nursing facility, institution for mental diseases, ICF/ID or hospital. 8. Notify providers that the setting has been determined unallowable and discuss the provider s plan for 25 months compliance 9. Analyze whether access issues may be created by providers who will no longer be eligible/willing to provide 26 months waiver services 10. Notify affected individuals and case management entities of the provider s plan for compliance and what 27 months actions individual can expect 11. Assist providers with action steps to ensure compliance and resolve any access issues found Ongoing 12. Work with case management entities to assist individuals who need to transition to willing qualified providers Ongoing 13. Identify, develop, and distribute training tools and policy updates that are needed for compliance Ongoing 14. Revise on-site monitoring tools as necessary Ongoing
Updated: August 14, 2014 2 15. Obtain approval and publish revised regulations Ongoing
SETTINGS PRESUMED NOT ELIGIBLE 441.301(c) (5) (v) Settings in a publicly or privately owned facility that provide inpatient treatment. 441.301(c) (5) (v) Settings on the grounds of or immediately adjacent to a public institution 441.301(c) (5) (v) Settings that have the effect of isolating individuals receiving HCBS from the broader community of individuals not receiving HCBS Comm Updated: August 14, 2014 3 Deliverables: Report on providers in settings presumed not eligible and the number of waiver participants each provider serves; Waiver Amendment(s) (as necessary), Policy Documents And Any Published Revised Regulations (as necessary) 1. Develop a method/tool to collect data and track provider status regarding settings presumed not eligible 3 months 2. Develop and implement a process to ensure new providers enrolling to render waiver services and existing 3 months providers moving their service locations are in eligible settings 3. Analyze applicable regulations to determine if revisions are needed to be in compliance with new CMS 12 months regulations, draft revisions (as necessary) outlining recommended changes 4. Analyze provider information for settings presumed not eligible to determine if there are providers that 12 months render licensed Day Habilitation/Adult Day services (55 PA Code Chapter 2380 or 6 PA Code Chapter 11), Prevocational services (55 PA Code Chapter 2390), Licensed Residential Habilitation services (55 PA Code Chapter 6400, 6500, 3800, 5310, 2600) or unlicensed Residential Habilitation and Structured Day Habilitation services: in a publicly or privately owned facility that provides inpatient treatment; on the grounds of or immediately adjacent to a public institution; or that have the effect of isolating individuals receiving HCBS from the broader community 5. Assess whether there are any residential settings that are farmstead or disability-specific farm communities, gated/secured communities for people with disabilities, residential schools, or multiple settings co-located and operationally related that congregate a large number of people with disabilities together and provide for significant shared programming and staff such that people s ability to interact with the broader community is limited 6. Identify and notify providers impacted, provide date required to achieve compliance, and notify of opportunity to submit information for DPW and CMS review. Identify and notify individuals impacted along with their case management entity 12 months 16 months 7. Review the plan submitted by providers (as applicable) and document the decision regarding whether the 25 months setting is/will be eligible or not eligible 8. Notify providers of setting eligibility 31 months 9. Analyze whether access issues may be created by providers who will no longer be eligible/willing to provide 32 months waiver services 10. Notify affected individuals and case management entities of provider eligibility and what actions individuals 33 months can expect 11. Distribute public notice which lists all settings/providers with determination of whether they are eligible or not 36 months eligible
12. Analyze waivers to determine if amendments are needed Ongoing 13. Assist providers with action steps to ensure compliance and resolve any access issues found Ongoing 14. Work with case management entities to assist individuals who need to transition to willing and qualified Ongoing providers 15. Identify, develop, and distribute training tools and policy updates that are needed for compliance Ongoing 16. Revise on-site monitoring tools as necessary Ongoing 17. Obtain approval and publish revised regulations Ongoing Updated: August 14, 2014 4
ALL SETTINGS MUST MEET THE FOLLOWING QUALIFICATIONS 441.301(c) (4) The setting is integrated in and supports full access to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community to the same degree of access as individual not receiving Medicaid HCBS waivers 441.301(c) (5) (v) Is selected by the individual from among setting options including non-disability specific settings and an option for a private unit in a residential setting. The setting options are identified and documented in the person-centered service plan and are based on the individual s needs, preferences, and for residential settings, resources available for Comm Comm Deliverables: Waiver Amendment(s), New Or Revised Policy Documents (as necessary) 1. Explore employment data collection systems 12 months 2. Assess whether participants in all settings are integrated in to the greater community, have competitive 12 months employment opportunities, control personal resources, and have equal access 3. Analyze current services, policies, and regulations to identify gaps 24 months 4. Develop and communicate expectations regarding meaningful day opportunities in non-disability specific 24 months settings 5. Review and revise employment service definitions in the waivers 26 months 6. Identify, develop, and distribute training tools and policy updates that are needed for compliance Ongoing 7. Provide ongoing engagement with service providers to help build capacity for provision of services in more Ongoing integrated settings 8. Revise on-site monitoring tools as necessary Ongoing Deliverables: New Or Revised Policy Documents (as necessary) 1. Assess whether individuals have a choice of setting and private room (where relevant), the choice is documented in the individuals service plan, the setting is based on participant needs, and the participant has resources for room and board 2. Identify where this information will be included in the ISP in order to strengthen documentation requirements to reflect that setting options are identified 18 months 3. Analyze current services, policies, and regulations to identify gaps 24 months 4. Develop and communicate expectations regarding meaningful day opportunities in non-disability specific 24 months settings 5. Monitor completion of the ISP per current policy and regulations 30 months 6. Identify, develop, and distribute training tools and policy updates that are needed for compliance Ongoing 7. Revise on-site monitoring tools as necessary Ongoing Updated: August 14, 2014 5
room and board 441.301(c) (5) Ensures individual rights of privacy, dignity and respect, and freedom from coercion and restraint 441.301(c) (4) Optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to: daily activities, physical environment, and with whom to interact 441.301(c) (4) Facilitates choice regarding services and who provides them Comm Comm Comm Deliverables: New Or Revised Policy Documents (as necessary) 1. Analyze current services, policies, and regulations to identify gaps 24 months 2. Analyze restraint information to identify any patterns or trends and provide training and technical assistance 24 months to providers as needed 3. Identify, develop, and distribute training tools and policy updates that are needed for compliance Ongoing 4. Revise on-site monitoring tools as necessary Ongoing Deliverables: On-Site Monitoring Tool, New Or Revised Policy Documents (as necessary) 1. Analyze current services, policies, and regulations to identify gaps 24 months 2. Identify, develop, and distribute training tools and policy updates that are needed for compliance Ongoing 3. Revise on-site monitoring tools as necessary Ongoing Deliverables: Provider Directory(s), New Or Revised Policy Documents (as necessary) 1. Analyze current services to identify gaps within current policies 12 months 2. Identify, develop, and distribute training tools and policy updates that are needed for compliance Ongoing 3. Revise on-site monitoring tools as necessary Ongoing 4. Maintain publicly accessible directories of providers Ongoing Updated: August 14, 2014 6
REQUIREMENTS FOR PROVIDER-OWNED OR CONTROLLED HOME AND COMMUNITY BASED RESIDENTIAL SETTINGS - The unit or dwelling is a specific physical place that can be owned, rented, or occupied under a legally enforceable agreement by the individual receiving services, and the individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord/tenant law of the State, county, city, or other designated entity. For settings which landlord tenant laws do not apply, the State must ensure that a lease, residency agreement, or other form of written agreement will be in place for each HCBS participant, and that the document provides protections that address eviction and processes and appeals comparable to those provided under the jurisdiction s landlord tenant law. Deliverables: Revised Room And Board Agreement (as needed), On-Site Monitoring Tool 1. Analyze PA s landlord tenant law and determine what constitutes comparability for residential settings 12 months 2. Review regulations to determine whether revisions are needed based on landlord tenant law requirements 24 months 3. Identify, develop, and distribute training tools and policy updates that are needed for compliance Ongoing 4. Revise regulations as needed based on the review Ongoing 5. Revise on-site monitoring tools as necessary Ongoing Updated: August 14, 2014 7
Units have entrance doors lockable by the individual, with only appropriate staff having keys to doors Individuals sharing units have a choice of roommates in that setting Individuals have the freedom to furnish and decorate their sleeping or living units within the lease or other agreement (C) Individuals have the freedom and support to control their own schedules and activities and have access to food at any time Deliverables: On-Site Monitoring Tool 1. Coordinate with regulatory and enforcement bodies any implications for impacts on regulations and provide 18 months an outline of changes recommend 2. Issue communication informing that potential modifications are allowed if documented in the ISP in 24 months accordance with CMS requirements 3. Identify, develop, and distribute training tools and policy updates that are needed for compliance Ongoing 4. Revise on-site monitoring tools as necessary Ongoing Deliverables: New or Revised Policy Documents, On-Site Monitoring Tool 1. Determine providers who allow for a shared bedroom (assuming unit = bedroom) 12 months 2. Survey participants who share a bedroom to determine roommate preference 18 months 3. Develop communication providing guidance on right of roommate choice 24 months 4. Develop guidance on frequency of assessment, documentation, and roommate compatibility determination 24 months 5. Revise on-site monitoring tools as necessary Ongoing Deliverables: Revised Room And Board Agreement (as needed), New or Revised Policy Documents, On- Site Monitoring Tool 1. Revise and distribute updated Room And Board Agreement 24 months 2. Revise on-site monitoring tools as necessary Ongoing Deliverables: New or Revised Policy Documents, On-Site Monitoring Tool 1. Collaborate with BHSL to determine the potential impact of this requirement 18 months 2. Review policies and regulations, providing outline of recommended changes 18 months 3. Develop communication that specifies individual rights to have control of schedules and activities along with 24 months access to food at any time 4. Identify, develop, and distribute training tools and policy updates that are needed for compliance Ongoing Updated: August 14, 2014 8
(D) Individuals are able to have visitors of their choosing at any time (E) The setting is physically accessible to the individual Deliverables: New or Revised Policy Documents, On-Site Monitoring Tool 1. Determine how providers can accommodate this requirement in a manner that respects the rights of others 12 months in the home 2. Develop communication that specifies individual rights to have visitors of their choosing at any time 18 months 3. Revise on-site monitoring tools as necessary Ongoing Deliverables: On-Site Monitoring Tool 1. Develop process/tool to determine how individual accessibility can be verified during on-site monitoring Ongoing Updated: August 14, 2014 9