In January, the Office of Developmental Programs, offered three webinars regarding the upcoming changes in the Consolidated Waiver and P/FDS Waivers for Appendices A-H. After explaining the upcoming changes via powerpoint, an hour was available for providers, individuals, and family members to comment on the changes. These comments will be considered when the changes are finalized.
During the hour- long comment period, most comments made were regarding the closure of sheltered workshops. Family members and individuals expressed their dismay that this would be the end of their loved one or themselves going to work each day in an environment where they were productive and valued by staff. Family members expressed that this would be the end of ongoing friendships their loved ones have with other workers. Many of these folks had been going to the workshop for many years. The stipulation (mentioned below), states that all the workers must be spending 75% of their time in the community by 2019 was very upsetting to family members and individuals who feel this is not their choice. In other words, it sounds like a “one size fits all” plan.
Nancy Thaler, Deputy Secretary of ODP, recently issued comments regarding these concerns. Her comments follow this summary.
There is also concern regarding those with complex/safety needs that reside in group homes. It appears that there may be a “tiered system” that will permit those who reside in these homes to remain in their homes. It also appears that group home settings (as described below under HCBS settings) will no longer be funded through the consolidated waiver, thus ending the existence of this choice for individuals and families in the future.
On the bright side, there are many support services offered that will encourage community inclusion for all individuals with disabilities. The public period ended on January 17th. ODP will review all comments and questions and consider modifying the waiver renewals. ODP will develop a summary document of the comments and questions. When the final renewals are submitted to CMS in March 2017, these documents will be posted on the Dept. of Human Services’ website.
Listed below is a summary of some of the proposed changes that could be significant to individuals, family members, and providers:
CLICK TO EXPAND THE LIST BELOW
Changes in terminology
- ISP is referred to as service plan
- PUNS is referred to as waiting assessment of need
Adding individuals of an age who are diagnosed with autism
- Also adding individuals who are age 0-7 who are diagnosed with Developmental Disability (DD)
- Individuals who are enrolled with DD will be evaluated using ICF/ID or ICF/ORC criteria prior to 8th birthday; will be referred to other resources if not eligible
No changes for eligibility for Intellectual Disability
Autism criteria added
- Have a diagnosis of autism
- Eligibility defined as a diagnosis of autism based on a standardized diagnostic tool
- Autism must have occurred before age 22
- Substantial adaptive skill deficits in three or more areas of life activity
Developmental Disability Eligibility ICF/ORC criteria added
- Diagnosis of DD
- 7 years of age or younger
- Substantive adaptive skills deficits in three or more areas of a major life activity
- Be recommended for an ICF/ORC level of care based on a medical evaluation
Support family through life-span
- Housing Tenancy and Tenancy Sustaining Serives
- Family/Unpaid Caregiver Training and Consultation
Promote self direction, choice, and control
Assure effective communication
- Communication Specialist to work with individuals
Promote health, wellness, safety, and support people with complex needs
- Consultative Nutritional Services
- Art, music, Equine-assisted Therapy
Increase employment and increase community participation
- Community Participation Supports
- Advanced Supported Employment
- Benefits Counseling
- Career Assessment, job finding or development, job coaching and support
- Companion at work site for ADL’s when cannot be provided by co-worker or natural supports
- New certification requirements
- Limited hours when not provided with any other employment service
Advanced Supported Employment
- Discovery, job development, systematic instruction for participants for whom supported employment is unsuccessful
- ISP reviews history; eligibility is determined by ISP team
- Work that participants perform during the provision of Transitional Work services must be paid at least minimum wage & compensation must be similar to compensation earned by workers without disabilities
- Affirmative Industry: business that 51% of employees do not have a disability
Day Services-Consolidated Waiver
- Includes participant rights to lease, visitors, private communication, choosing a roommate, lock on bedroom door
- Reimbursement will follow a needs-based fee schedule
- Allows individual to live in their own home, or the home of a relative or unrelated individual and receive agency-managed services
- Provides a a cost-efficient residential habilitation option for people with less intense needs
- Daily, needs based rate; includes 24/7 on-call staff availability
- 16 and older: includes remote electronic monitoring services and technology
- Examples: med dispensers, door & window sensors, stove & water sensors, GPS Tracking, etc.
Medical & Behavioral Support
- Speech Therapy, Physical Therapy, OT, Visual/Mobility Therapy
- Only home and community based setting (MA pays for those in residential settings)
Music, Art & Equine Services
- Music and Art-21 yrs or older
- Equine-any age
- Tuition for those spending at least 75% of their time on campus, general fees are covered
- On campus peer support
- Adult education
Family/Caregiver Training & Support
- Training and Counseling for unpaid caregivers
- Support for all issues related to independent living in the community-housing applications, etc.
- Providing early identification and intervention for behaviors that may jeopardize housing
- Education & training on tenant and landlord responsibilities
- Assistance in solving disputes
- Respite nursing eliminated (can be covered under Shift Nursing)
- When participant has documented medical or behavioral health needs and cannot locate community – respite can be provided by ICF/ID or Nursing Facility
Participant-Directed Goods & Services (promote inclusion in community & independence)
- Supports participants with non -traditional communication needs/ determines needs/educates caregivers about needs
- Paid by trip versus round trip
Community Participation & Supports
- Flexibility wrap around & support community life secondary to employment as primary goal
- This service involves participation in integrated community settings, in activities that involve persons without disabilities who are not paid or unpaid caregivers
January 1, 2018: 25% community participation
January 1, 2018: 50% community participation
January 1, 2019: 75% community participation
Community Participation Supports
- Prevocational skill development
- Building & maintaining relationships and social networks
- Participation in community activities (volunteer, clubs, etc.)
- Development of hobbies/leisure/ health and wellness, etc.
- Navigating the community
- Relatives/legal guardians may be paid for providing services whenever the relative/legal guardian is qualified to provide services-must meet criteria established by ODP
- Waiver funding cannot be sued to provide any service in any private home purchased for, developed for or promoted as serving people with intellectual disability and/or autism in a manner that isolates or segregates the participant from the community of individuals not receiving waiver services
- This includes farmstead, gated/secured community for people with disabilities
READ THE LETTER FROM NANCY THALER, DEPUTY SECRETARY OF THE ODP
Letter from Nancy Thaler, Deputy Secretary ODP
The PA Department of Human Services (DHS) has heard concerns from consumers and families regarding the department’s recently proposed amendments to DHS’ Office of Developmental Programs’ (ODP) Consolidated and Person/Family Directed Support waivers that are due for renewal on July 1, 2017. These waivers serve 32,000 Pennsylvanians with intellectual disabilities. I wanted to take a moment to provide an update on where that stands.
We are not closing workshops. The Wolf Administration is committed to serving more people in the community and giving them access to high-quality services. In that light, and in accordance with new federal guidelines, ODP’s five-year renewal of the waiver programs includes a new service called Community Participation Support Services. These supports include the current sheltered workshops and adult training programs, but add in a full range of options that would support people to participate in activities in the community.
In December, we published waiver documents for public review. We were looking to get comments from all impacted people on the feasibility of the proposal, the time frames, the requirements, and what would be needed to implement. The Department is committed to full transparency on this critical process and published the documents seeking valuable public input for consideration.
The comment period has since ended and we received more than 2,000 comments that we will thoroughly review and consider. Over all, the comments we have received have been supportive of the services in the waivers to better support families and broaden residential services options. Many commentators have endorsed the flexibility this service gives individuals, families, and providers. The objection that many commenters have expressed are related to the requirement to achieve a specific percentage of participation and the time frames for meeting those benchmarks in the Community Participation service. There are several components to the proposed waiver amendments, but the main focus of concern, and even fear, that we are hearing from clients and their family members is on the sheltered workshops. They worry that the services they value are going to be taken away. We want to assure you that this is not the case.
We are proposing changes that allow providers to modify their service models over time to support people in integrated community settings in alignment with the Centers for Medicare and Medicaid Services Home and Community-based Settings rule. DHS is looking to increase opportunities for employment, community involvement, and participation. Expectations have also changed – our young people with disabilities are now in integrated, not secluded, classroom settings. They enter the post-education world desiring jobs in the community making competitive wages. That being said, we know that is not an option for everyone, but when possible, we hope to make that goal a reality.
Moving forward, we will continue to carefully analyze all of the comments and will go through a thoughtful process to determine what changes should be made to the original proposal. While we proceed to finalize the waivers we must assure that the result will be a much fuller range of options that leads to each person realizing their full potential and fully participating in the life of their community.
The Department of Human Services, Office of Developmental Programs, will continue to update you with our progress.
Office of Developmental Programs
This post brought to you by Linda Marino, Special Needs Coordinator for Jewish Family & Children’s Service of Pittsburgh; family member and advocate for 35 years. In my next article I will discuss my comments on this matter.