community living waiver · 9/18/2017 >> 13 small group employment goal: help participant...

9/18/2017

1

>www.dpw.state.pa.us >www.dhs.pa.gov

Community Living Waiver

Public Comment Period

September 18, 2017

9/18/2017 1

>www.dpw.state.pa.us >www.dhs.pa.gov9/18/2017 2

• Target Effective Date: January 1, 2018

• Population to be served: – Individuals of any age with an intellectual disability;

– Individuals of any age with autism; or

– Children with a developmental disability (0 through age 8)

• Unduplicated number of individuals served: 1,000

• Limit on Services: $70,000 per year (Supports Coordination services are excluded from this limit)

Overview

9/18/2017

2


The Community Living Waiver will support Everyday Lives – Values Into Action by:

• Supporting families throughout the life span and expanding options for community living

• Promoting self-direction, choice and control

• Assuring effective communication

Everyday Lives – Values Into Action

• Promoting health, wellness, and safety and supporting people with complex needs

• Increasing employment and community participation


Public Comment

Period: August 26 –

September 25

Review Public Comment and

Make Decisions:

September 26 – September

30

Submit to CMS: October 2

Effective Date: January 1,

2018

Timeline

9/18/2017

3


The County MH/ID/DD Program determines whether individuals meet the following waiver eligibility criteria:

• Diagnosis of one of the following:– Intellectual disability

– Autism

– Developmental disability with a high probability of resulting in an intellectual disability or autism – Age 0 through age 8

• Level of Care for ICF/ID or ICF/ORC

• Emergency PUNS, transfer from P/FDS or reserved capacity

• Need for at least 1 waiver service in addition to Supports Coordination

Waiver Eligibility Criteria


The County Assistance Office determines whether individuals meet the following eligibility criteria:

• Eligibility for Medical Assistance/Medicaid

• Financial requirements for waiver eligibility

Waiver Eligibility Criteria

9/18/2017

4


Reserve Capacity

• Unanticipated emergencies– FY 2017-18: 20– FY 2018-19: 20– FY 2019-20: 20

• Hospital/rehabilitation care– FY 2017-18: 10– FY 2018-19: 10– FY 2019-20: 10


Services Identical to P/FDS

Homemaker/Chore Specialized Supplies

In-Home and Community Support Assistive Technology

Music, Art and Equine Assisted Therapy Advanced Supported Employment

Education Support Behavioral Support

Supports Coordination Benefits Counseling

Supports Broker Services Communication Specialist

Consultative Nutritional Services Companion

Home Accessibility Adaptations Family/Caregiver Training and Support

Shift Nursing Housing Transition and Tenancy Sustaining Services

Transportation Participant-Directed Goods and Services

Therapy Services

9/18/2017

5


Supports Coordination

Provided to each participant to assist the person and their family in locating, coordinating and monitoring needed services and supports.• Finding, arranging and obtaining services.

• Facilitating the Individual Support Planning process and needed assessments.

• Provides assistance and information about Participant Direction.

• Monitoring ongoing services and supports.


Employment Services

• Supported Employment‒ Assists participant whose goal is competitive integrated employment

• Advanced Supported Employment‒ Enhanced version of Supported Employment to assist participant who

needs targeted approach by staff who meet higher education and training standards to attain employment goals

• Small Group Employment‒ Enables participant to reach competitive integrated employment through

one of four service options

• Benefits Counseling‒ Support participant by explaining how to keep needed benefits through

available work incentives

9/18/2017

6


Supported Employment

Goal: Competitive integrated employment• Full or part-time with wages at minimum wage or above• Fully integrated with coworkers without disabilities

Service offers three components:1. Career Assessment2. Job Finding/Development3. Job Coaching/Support


Advanced Supported Employment

Goal: Competitive integrated employment for participants who require enhanced level of service to achieve employment

Service offers three components:1. Job Discovery2. Job Acquisition3. Job Retention

There are three outcomes for this service:1. Development of a discovery profile or portfolio2. Securing a job3. Retention of a job

9/18/2017

7


Small Group Employment

Goal: Help participant transition into competitive integrated employment by working outside of a licensed facility in one of four service options. The employer must pay minimum wage or higher.

Service options offered:1. Mobile Work Force (lawn service, maintenance,

janitorial)2. Work Station in Industry (employment station in a

factory, business)3. Affirmative Industry (51% of coworkers do not have

disability)4. Enclave (specific job duties with coworkers without a

disability)


Benefits Counseling

• Supports the participant in understanding how he or she can be employed in a competitive integrated job and maintain needed benefits through available work incentives.

• Counseling and planning about work incentives.

• Information about benefits programs such as: SSI, SSDI, Medicaid, Medicare, housing subsidies, food stamps, etc.

• For people who are considering work or already working

• Must go to Work Incentives Planning and Assistance (WIPA) first

9/18/2017

8


Community Participation Support

Provides opportunitiesand support for:

Where is this service offered?

• Community locations – generic places, no more than 3 people• Community hubs – place where people meet and go out from there, no

more than 6 people.• Licensed facilities – Adult Training Facilities, Older Adult Daily Living

Centers, Vocational Facilities

• Community inclusion• Building potential for employment• Developing relationships, social

networks and valued roles



Reasons for varianceA participant may seek a variance regarding time spent in a licensed facility if: • The participant receives fewer than

12 hours of this service per week• The participant has current medical

needs that limit community time• The participant has an injury,

illness, behaviors or change in mental health status that result in a risk to him or herself or others

• The participant declines the option to spend time in the community

Dates to remember• 3/17/19: Licensed

facilities enrolling on or after this date may not have more than 25 participants at one time

• 7/1/19: Participant cannot receive service in a licensed facility for more than 75 percent of the time

• 1/1/22: Existing licensed facilities may not have more than 150 participants at any one time

9/18/2017

9



Community Participation Support• Prevocational services (licensed facilities or community)• Vocational skill development (licensed facilities or community)• Volunteer opportunities

OVR referral guidance

Participants under age 25 will need an OVR decision (case closed, ruled ineligible, services not available) before they can receive Supported Employment, Advanced Supported Employment, Small Group Employment, or prevocational services in Community Participation Support

>www.dpw.state.pa.us >www.dhs.pa.gov

Provider Qualification Clarification

The following clarifications have been added to the provider qualification requirements:

• Community Participation Support: – Direct support professionals, program specialists and

supervisors of direct support professionals must complete ODP-approved training by 7/1/18 or within 60 days of hire after 7/1/18 (“staff” in P/FDS)

• Community Participation Support, Supported Employment, Small Group Employment: – Program specialists and supervisors required to hold

employment certificate have 180 days after hire starting 11/1/18 to acquire certificate (“60 days” in P/FDS)

9/18/2017 18

9/18/2017

10


• The following clarification has been added to the Community Participation Support service definition:– Community Participation Support services may not be provided

at the same time as the direct provision of any of the following: Companion; In-Home And Community Supports; Small Group Employment; Job Finding or Development and Job Coaching and Support in Supported Employment; job acquisition and job retention in Advanced Supported Employment; Transportation; 15-minute unit Respite; Therapies; Education Support; Shift Nursing; Music, Art and Equine Assisted Therapy and Consultative Nutritional Services.

Community Participation Support Clarification


In-Home and Community Support

• Designed to assist participants in acquiring, maintaining and improving the skills necessary to live in the community, to live more independently, and to participate meaningfully in community life.

• Self-care• General health,

wellness and nutrition• Medical care• Mental health and

emotional wellness• Self-direction• Managing a home• Faith-based activities

Skills supported:

• Paying bills• Communication skills• Relationships and

community connections• Civic duty (voting, jury

duty)• Transportation• Personal

interests/hobbies

9/18/2017

11


Companion

• Service is intended to assist the participant in activities of daily living

• Differs from In-Home and Community Support –assistance vs. skills acquisition

• OK for overnight assistance

• OK to assist at participant’s job (personal care needs)

• Participant must be 18 and live in a private home that is not a Life-Sharing or Supported Living arrangement.


Education Support Services

Helps a participant with a goal of employment who wants to pursue education beyond high school

• Tuition for college, community college, technical school or university

• General fees charged to all students• On-campus peer support• Classes in American Sign Language• Adult education or tutoring program

for reading or math

What’s covered:• $35,000 lifetime limit

(tuition/classes)• $5,000 semester limit

(peer support)• Books• Room and board• Online classes

Limits/not covered:

9/18/2017

12


Residential Services Available in the Community Living Waiver

Life Sharing (Needs Group 1 and 2 and individuals who need less than 30 hours per week of service on average)

Supported Living (Needs Group 1 and 2)

Residential Services

Residential Services Not Available in the Community Living Waiver

Residential Habilitation

Life Sharing (Needs Group 3 and 4)

Supported Living (Needs Group 3 and 4)


Life Sharing

• Provider agency managed services where the participant is supported by a host family.

• Service available up to 24 hours a day.

• Service locations:‒ Host family home (licensed or unlicensed)‒ Participant’s home where the host family moves in

• Host families can be persons related to the participant and persons who are not related to the participant.

• Services include assistance, support and guidance in:‒ self-care‒ health maintenance‒ decision making‒ managing resources‒ communication

‒ mobility and transportation‒ relationship development and

socialization‒ community participation‒ usage of community resources

9/18/2017

13


Supported Living

• Agency-managed service to help the participant live in a home he or she owns, leases or rents.

• Service based on participant’s needs; on-call support available 24 hours.

• Supported Living Specialist available.

• Services include support in:‒ daily living activities‒ health and wellness‒ managing medical care‒ emotional, mental health care‒ making decisions‒ managing the home‒ finances‒ communication

‒ transportation‒ relationship with roommates‒ relationship with members of

the community‒ civic duty‒ personal interests and hobbies‒ shopping, going to restaurants

>www.dpw.state.pa.us >www.dhs.pa.gov 26

• Provides relief to person(s) normally providing care.

• Respite may be scheduled or due to an emergency.

• To the degree possible, the respite provider must maintain the participant’s schedule of activities including activities that allow participation in the community.

• Unit Limits– 30 units of day respite per fiscal year

– 1440 units of 15-minute unit respite per fiscal year

– A variance may be request to these limits for participants who have behavioral or medical needs or emergency circumstances

Respite Overview

9/18/2017

14


• The following clarification has been added to the Respite service definition:– This service may be provided at the following levels in private

homes and Life Sharing homes (licensed or unlicensed):• Basic Staff Support – 1:4

• Level 1 – 1:3

• Level 2 – 1:2

• Level 3 – 1:1

• Level 3 Enhanced - 1:1 with a certified staff member

• Level 4 – 2:1

• Level 4 Enhanced - 2:1 with one certified staff member and one staff member with at least a high school diploma

Respite Clarification


Behavioral Support

• Includes comprehensive assessment, development of strategies for support, and provision of interventions and training to participants, staff, parents and caregivers.

• Development of initial behavioral support plan

• Ongoing Behavioral support

• Two levels of support – Level 1 and Level 2 – different provider qualifications and participant needs

• Available to adults only – 21 and over (under 21 – covered by EPSDT)

Included as part of the Life Sharing and Supported Living services and not generally not available as a discrete service.

9/18/2017

15


Shift Nursing

• Part-time or full-time nursing care provided to participants.

• Available to adults only – children under 21 are covered by EPSDT



Family/Caregiver Training & Support

• Provides training and counseling services for unpaid family members and caregivers who support the participant

Training and counseling includes:• Building coping skills• Support during times of difficulty, crisis, loss, change,

transition• Coaching in acquiring healthy approaches to reduce stress• Improve communication and relationships• Limit 20 hours/year

Learning skills and treatments at training events, workshops, seminars, conferences• Limit: $500/year on training fees (no food, lodging, travel);

9/18/2017

16


Homemaker/Chore

Homemaker – General household care including cleaning, laundry, and meal preparation.Chore – Heavy household activities such as washing floors, windows and walls; tacking down loose carpet, rugs and tiles; moving furniture; ice, snow and/or leaf removal; and yard maintenance.

Limitations:• Only for private homes that are not Life Sharing or

Supported Living arrangements• The person, nor anyone else in the household, is capable• No other relative, caregiver, landlord, community/volunteer

agency, or third party payer is capable of or responsible.• Temporary basis – 40 hour limit


Therapy Services

• Physical Therapy• Occupational Therapy• Speech/Language Therapy• Orientation, Mobility and Vision Therapy

Available to adults only – children under 21 are covered by EPSDT

Must be in home and community setting – not clinic or rehab facility

Must be medically necessary and not covered by other insurances, including Medicare, Medicaid and/or private insurance

9/18/2017

17


Music, Art, Equine Assisted Therapy

• Maintain, improve, or prevent regression, and assist in the acquisition, retention, or improvement of skills necessary for the person to live and work in the community

• 1 to 1 therapies that are not primarily recreational or diversionary

• Need assessment, treatment plan and goals

• Music and art – Available to adults only – children under 21 are covered by EPSDT

• Equine – any age

• Limits: 26 hours/year


Communication Specialist

Supports participants with nontraditional communication needs by:• Determining the participant’s communication needs• Education on the participant’s communication needs and

the best way to meet those needs in their daily lives• Providing assistance in the development and

implementation of an action plan to remove communication barriers, evaluating the effectiveness of the plan following implementation, and modifying the plan based on the evaluation of its effectiveness


9/18/2017

18


Consultative Nutritional Services

• Includes assessment, development of home treatment/service plan, training and technical assistance to carry out plan, monitoring of the person and provider in implementation

• Requires physician recommendation

• Doesn’t include the purchase of food

• Available to adults only – children under 21 are covered by EPSDT


Assistive Technology

Item, equipment, or product system used to improve a person’s functioning or increase a person’s ability to exercise choice and control. Includes direct support in selection, acquisition, or use of an assistive technology device.

Independent Living Technology: 16 and older• Medication dispensers, doors sensors, window sensors, stove

sensors, water sensors, pressure pads, GPS tracking watches, panic pendants, and remote monitoring equipment

• Includes delivery, installation, adjustments, monthly testing, monitoring, maintenance and repairs

Electronic devices to meet communication or prompting needs

9/18/2017

19


Limitations

• Lifetime limit of $10,000 per participant. (ODP variance process)

• Lifetime limit of $5,000 for generators. Amount spent on a generator is included in the overall AT limit of $10,000.

• Annual limit of $5,000 for remote monitoring completed as part of independent living technology (not included in the overall AT lifetime limit of $10,000)

• No more than one replacement electronic device is allowed every 5 years.

Assistive Technology


Specialized Supplies

• Incontinence supplies that are medically necessary and not covered through the MA State Plan, Medicare or private insurance.

• Limited to diapers, incontinence pads, cleansing wipes, underpads, and vinyl or latex gloves.

• Available to adults only – children under 21 are covered by EPSDT.

• Limit: $500/year

9/18/2017

20


• Equipment or supplies not otherwise provided through other services offered in this waiver, MA, or a responsible third-party that achieve one or more of the following objectives:– Decrease the need for other Medicaid services;

– Promote or maintain inclusion in the community;

– Promote the independence of the participant;

– Increase the participant’s health and safety;

– Develop or maintain personal, social, physical or work-related skills.

– Must be used primarily for the benefit of the participant.

• $2000 annual cap

Participant-Directed Goods & Services


Home Accessibility Adaptations

• Private homes – including Life Sharing homes that are owned, rented or leased by the host family or participant

• Necessary to ensure health, security and accessibility or which enable the participant to function with greater independence in the home.

• Limit of $20,000 over a 10-year periodo Participant can get a new $20,000 if he/she moves to a new

home

• Variance requests available for:o Maintaining or repairing existing home adaptations or o Track lift systems that exceed the limit and will reduce the

need for other services

9/18/2017

21


• Tenant screening and housing assessment

• Developing an individualized housing support plan

• Assisting with the housing search process.

• Assisting with the housing application process, including assistance with applying for housing vouchers/applications.

• Identifying resources to cover expenses

• Developing a housing support crisis plan that includes prevention and early intervention services when housing is jeopardized

Housing Transition


• Providing early identification and intervention for behaviors that may jeopardize housing

• Education and training on the role, rights and responsibilities of the tenant and landlord.

• Assistance in resolving disputes with landlords and/or neighbors to reduce risk of eviction or other adverse action.

• Limit on entire service of 160 hours per fiscal year.

Housing Tenancy

9/18/2017

22


Transportation

Provided to help the person access services and activities specified in their support plan.

1. Transportation Mile • paid by mile (one-way, only with participant in vehicle)

2. Public Transportation• outcome-based vendor service• helps participant become self-sufficient

3. Transportation Trip• paid per one-way trip• Zones 1 (0-20 miles)• Zone 2 (21-40 miles)• Zone 3 (41-60 miles)


• For participants under the age of 21, Transportation may only be used to travel to and from waiver services or a job that meets the definition of competitive integrated employment.

• Participants authorized to receive Life Sharing or Supported Living may only be authorized for Transportation services as a discrete service when the participant requires transportation to or from a job that meets the definition of competitive employment.

Transportation

9/18/2017

23


Vehicle Accessibility

• Certain modifications to the vehicle that the participant uses as his or her primary means of transportation to meet his or her needs.

• The vehicle must be owned by:– The participant

– A family member with whom the participant lives

– A non-relative who provides primary support to the participant and is not a paid provider agency of services

– A vehicle owned by a life sharing host that is not owned by the Life Sharing provider agency.

• Limit of $20,000 per participant during a 10-year period.


• Transportation Mile – Mileage will be paid per trip versus round trip. A trip is from the point of pick-up to the destination as identified in the service plan.

• For participants under the age of 21, Transportation may only be used to travel to and from waiver services or a job that meets the definition of competitive integrated employment.

• Participants authorized to receive Residential Habilitation, Life Sharing or Supported Living may only be authorized for Transportation services as a discrete service when the participant requires transportation to or from a job that meets the definition of competitive employment.

Transportation

9/18/2017

24


• Individuals enrolled in the Community Living Waiver cannot live in a personal care home. (This is currently enforced in the Consolidated Waiver but the P/FDS allows it for specific individuals.)

• Any home that provides Life Sharing shall not be located in any development or building where more than 25% of the apartments, condominiums or townhouses have waiver funded Residential Habilitation, Life Sharing or Supported Living being provided. They must also be integrated and dispersed.

• Waiver services cannot be provided in any private home purchased for, developed for or promoted as serving people with an intellectual disability or autism in a manner that isolates or segregates the participant from the community of individuals not receiving waiver services. Further waiver funding cannot be provided in a private home that is a farmstead or gated/secured community for people with disabilities.

CMS HCBS Compliance


Participant-Directed Services

• Promotes self-direction goal as defined in “Everyday Lives: Values in Action”

• Participant has choice, control over who supports them, how they are supported and when they receive supports

• 2 types of participant-directed services: ‒ Vendor Fiscal/Employer Agent‒ Agency With Choice

• Supports Broker service – assists individuals with participant-directed services

9/18/2017

25


Rate Determination Methods

• All services with the exception of Transportation Trip and vendor/outcome-based services will have a fee schedule rate

• Transportation Trip will have cost-based rate

• Vendor/outcome-based services include:− Home and Vehicle Accessibility Adaptations− Assistive Technology− Specialized Supplies− Education Support− Public Transportation− Registration and Fees for Family /Caregiver Training and

Support− Participant Directed Good and Services− Respite Camp


Public Comment

Public comment period August 26 through September 25 Link to access Community Living Waiver documents:

http://www.dhs.pa.gov/learnaboutdhs/waiverinformation/communitylivingwaiver/index.htm

Email comments to: [email protected]

Mail comments to: Julie Mochon Department of Human Services Office of Developmental Programs625 Forster Street, Room 501 Harrisburg, PA 17120

9/18/2017

26


• Once the public comment period ends on September 25th ODP will review all of the comments and questions received and will consider modifying the waiver renewals.

• ODP will develop a summary document of the comments and questions received along with any modifications made to the renewals based upon comments and questions.

• When the final renewals are submitted to CMS in October 2017, those documents will be posted on the Department of Human Services’ website. Notification of this activity will also be sent to our stakeholders.

Next Steps

community living waiver · 9/18/2017 >> 13 small group employment goal: help participant...

Documents