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AUDIENCE: Supports Coordination Organizations (SCOs), Supports Coordinators (SCs),

Administrative Entities (AEs), All Interested Stakeholders PURPOSE: To provide a crosswalk between the current Licensed Day Habilitation and

Prevocational Services procedure codes (W codes) with the new procedure codes for Community Participation Supports service. This communication will also provide related information on Community Participation Supports.

BACKGROUND: The Office of Developmental Programs (ODP) has developed a new service definition, Community Participation Supports, in the waiver renewal for July 1, 2017. The new service is designed to support ODP’s Everyday Lives: Values in Action as well as the Centers for Medicare and Medicaid Services (CMS) Home and Community-Based Settings (HCBS) rule.

The current proposed service definition for Community Participation Supports services can be found in Attachment A of this document.

DISCUSSION: On July 1, 2017, the Consolidated and Person/Family Directed Support (P/FDS) waivers will no longer include Prevocational or Licensed Day Habilitation as discrete services; rather the new service, Community Participation Supports (CPS), which includes these services, will be available. ODP anticipates that the new service names and procedure codes for Community Participation Supports will be available in HCSIS April 14, 2017. For people who use Prevocational and Licensed Day Habilitation services, the ISPs will need to include the new procedure codes for Community Participation Supports for any services planned for July 1, 2017 forward. Please note that Prevocational and Licensed Day Habilitation procedure codes will still be

ODP Announcement Crosswalk for Community Participation Supports for

Individual Support Plan (ISP) Fiscal Year 17-18 Renewals for Consolidated and P/FDS Waivers

ODP Communication Number 028-17

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.

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visible in HCSIS until December 31, 2017 but they should not be selected as a service option for dates after June 30, 2017.

ODP is adding service offerings through an automated process to relevant provider’s Services and Supports Directory (SSD) for the majority of Community Participation Supports services. This activity is anticipated to occur on April 27, 2017 so that SCs will be able to choose Community Participation Supports to be added to the Service Details of ISPs. Existing providers of Prevocational (2390) and Day Habilitation (2380) will remain qualified for the corresponding service specialties 515 and 514 for Community Participation Support.

SCs will need to ensure that the Service Details of the ISPs are updated to reflect this new service for all individuals who currently receive Licensed Day Habilitation and Prevocational Services. To assist in this process, ODP is providing a crosswalk of the current Prevocational and Licensed Day Habilitation procedure codes with the new procedure codes for Community Participation Supports effective July 1, 2017. This crosswalk is attached (Attachment B). In addition to this crosswalk for Supports Coordinator and Administrative Entity use, ODP provided a planning tool to providers on April 6, 2017 so that they can project the new Community Participation Supports procedure code(s) for each individual to whom they provide services. See ODP Communication 026-17: Provider Crosswalk Tool for Community Participation Supports Available for Individual Support Plan (ISP) Fiscal Year (FY) 17-18 Renewals. ODP has requested that providers complete these spreadsheets and share them with the SCOs no later than April 21, 2017 to assist in the updating of the ISPs. The information supplied by providers on anticipated services for individuals should be a guideline for SCs to complete FY Renewals. SCs should also use their knowledge of an individual’s current facility ratio and the amount of time the individual spends out of the facility in community activities to inform the selection of the correct procedure code. When completing the FY Renewals to incorporate the new Community Participation Supports service, SCs should be using one of the <25% procedure codes unless they know that the individual spends a significant amount of time in the community or the provider spreadsheet planning tool indicates otherwise. It is allowable for an individual to have more than one Community Participation Supports service code authorization in the plan to accommodate circumstances including but not limited to:

different staffing ratios based on activity and need (for example, the individual typically will be supported at a 1:2 or 1:3 ratio in community locations but there is an activity that occurs once weekly for which the person will need 1:1); or

fluctuations in schedule that mean the person may spend more time in community locations seasonally or based on activity (for example, the person who typically is supported in the 0 to <25% of time in community range got a part in a play put on by a community theater group and will require support in community locations 25-49% of the time for 3 months).

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Requirements for ISP Team Meetings for FY17-18 Renewals Due to the number of ISPs that will need to be updated, ODP is not requiring SCs to hold a team meeting before changing the ISPs to reflect the new Community Participation Supports procedure code. ODP asked providers to complete the crosswalk for individuals based on current status. Therefore, the change to Community Participation Supports service at this point in time should not involve a change requiring a meeting. It is expected that SCs will discuss this new service definition with individuals and families during scheduled meetings and monitoring to ensure the individual/family’s understanding of the new service. For the situations in which meetings are not held, SCs should use the attached letter (Attachment C) to communicate the changes to individuals. Team meetings, which could be handled via a conference call, are required to be held in the

following situations:

The service indicated for the individual by the provider would result in the individual

being over the $33,000 P/FDS cap.

The ISP doesn’t support the staffing level recommended by the provider for either facility

or community based service.

The individual and/or family does not agree with the provider’s assessment of service

need or requests additional conversation.

Important Dates

April 14, 2017 - New service names and procedure codes are available in HCSIS

April 21, 2017 – Deadline for providers to forward crosswalk for Community Participation

Supports to SCOs and ODP

April 27, 2017 - Community Participation Supports services offerings to be added to providers’ Services and Supports Directory (SSD) in order for SCs to choose Community Participation Supports to be added to the Service Details of ISPs

May 12, 2017 – ODP delivers crosswalks supplied by providers for Community Participation Supports to AEs

Attachment A: Current Proposed Service Definition for Community Participation Supports

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Community Participation Support Service Definition Submitted to CMS

Community Participation Support provides opportunities and support for community inclusion and building interest in and developing skills and potential for competitive integrated employment. Services should result in active, valued participation in a broad range of integrated activities that build on the participant's interests, preferences, gifts, and strengths while reflecting his or her desired outcomes related to employment, community involvement and membership.

Community Participation Support is intended to flexibly wrap around or otherwise support community life secondary to employment as a primary goal. This service involves participation in integrated community settings, in activities that involve persons without disabilities who are not paid or unpaid caregivers.

This service is expected to result in the participant developing and sustaining a range of valued social roles and relationships; building natural supports; increasing independence; increasing potential for employment; and experiencing meaningful community participation and inclusion. Activities include (but are not limited to) the following supports for:

Developing skills and competencies necessary to pursue competitive integrated employment;

Participating in community activities, organizations, groups, associations or clubs to develop social networks;

Identifying and participating in activities that provide purpose and responsibility;

Fine and gross motor development and mobility;

Participating in community opportunities related to the development of hobbies or leisure/cultural interests or to promote personal health and wellness (e.g. yoga class, hiking group, walking group, etc.);

Participating in community adult learning opportunities;

Participating in volunteer opportunities;

Opportunities focused on training and education for self-determination and self-advocacy;

Learning to navigate the local community, including learning to use public and/or private transportation and other transportation options available in the local area;

Developing and/or maintaining social networks and reciprocal relationships with members of the broader community (e.g. neighbors, coworkers, and other community members who do not have disabilities and who are not paid or unpaid caregivers) through natural opportunities and invitations that may occur;

Assisting participants, caregivers, and providers with identifying and utilizing supports not funded through the waiver that are available from community service organizations, such as churches, schools, colleges/universities and other postsecondary institutions, libraries, neighborhood associations, clubs, recreational entities, businesses and community organizations focused on exchange of services (e.g. time banks); and

Assisting participants and caregivers with providing mutual support to one another (through service/support exchange) and contributing to others in the community.

Attachment A: Current Proposed Service Definition for Community Participation Supports

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The service includes planning and coordination for:

Developing skills and competencies necessary to pursue competitive integrated employment;

Promoting a spirit of personal reliance and contribution, mutual support and community connection;

Developing social networks and connections within local communities;

Emphasizing, promoting and coordinating the use of unpaid supports to address participant and family needs in addition to paid services; and

Planning and coordinating a participant's daily/weekly schedule for Community Participation Supports.

Support provided may include development of a comprehensive analysis of the participant in relation to the following:

Strongest interests and personal preferences.

Skills, strengths, and other contributions likely to be valuable to employers or the community.

Conditions necessary for successful community inclusion and/or competitive integrated employment.

For participants age 18 and older, fading of the service and less dependence on paid support for ongoing participation in community activities and relationships is expected. Fading strategies, similar to those used in Supported Employment, should be utilized whenever appropriate.

The service also includes transportation as an integral component of the service; for example, transportation to a community activity. The Community Participation Support provider is not, however, responsible for transportation to and from a participant's home.

This service may be provided in the following settings:

Community locations - Locations must be non-disability specific and meet all federal standards for home and community-based settings. When provided in community locations, this service cannot take place in licensed facilities, or any type of facility owned, leased or operated by a provider of other ODP services. Services are provided in a variety of integrated community locations that offer opportunities for the participant to achieve his or her personally identified goals for developing employment skills, community inclusion, involvement, exploration, and for developing and sustaining a network of positive natural supports. A maximum of 3 participants can be served simultaneously by any one provider at a community location at any one time.

Community hubs - These settings primarily serve as a gathering place prior to and after community activities. Participants' time will be largely spent outside of the community hub, engaged in community activities. Community hubs should be non-disability specific, accessible, provide shelter in inclement weather, and be locations used by the general public. Community hubs could be locations that are focused on a specialty area of

Attachment A: Current Proposed Service Definition for Community Participation Supports

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interest for participant(s) served (for example, employment interest area, volunteer site, related to arts, outdoors, music or sports).

A community hub could be a private home but is not the home of support staff. The participant's home may only serve as a hub on an occasional and incidental basis. The use of a community hub must be driven by the interest of the participant(s) served. A maximum of 6 participants can be served by any one provider at any one point in time in a community hub.

Adult Training Facilities (subject to licensure under 55 Pa. Code Chapter 2380) - Community Participation Supports may be provided in Adult Training Facilities which meet all federal standards for home and community-based settings.

Older Adult Daily Living Centers (subject to licensure under 6 Pa. Code Chapter 11) - For participants 60 years or older, or participants with dementia or dementia-related conditions, Community Participation Support may be provided in Older Adult Daily Living Centers which meet all federal standards for home and community-based settings. Participants under 60 years of age receiving services in an Older Adult Daily Living Center prior to July 1, 2017 may continue to receive services in these settings.

Vocational Facilities (subject to licensure under 55 Pa. Code Chapter 2390) - Community Participation Support may be used to provide prevocational services in Vocational Facilities for participants who have a competitive integrated employment outcome included in their service plan. There must be documentation in the service plan regarding how and when the provision of this service is expected to lead to competitive integrated employment.

Facilities must meet all federal standards for home and community-based settings.

Facility-based prevocational services focus on the development of competitive worker traits through work as the primary training method. The service may be provided as:

Occupational training used to teach skills for a specific occupation in the competitive labor market, and includes personal and work adjustment training designed to develop appropriate worker traits and teach understanding work environment expectations.

Work related evaluation involving use of planned activities, systematic observation, and testing to formally assess the participant, including identification of service needs, potential for employment, and employment objectives.

This service may be used to provide prevocational services in facilities and community locations. For participants with an employment goal, prevocational services in community locations or community hubs assist them in vocational skill development, which means developing basic skills and competencies necessary for a participant to pursue competitive integrated employment. This includes the development and implementation of a preliminary plan for employment that identifies and addresses the participant's basic work interests, as well as skills and gaps in skills for his or her work interests. It may include situational assessments, which means spending time at an employer's place of business to explore vocational interests

Attachment A: Current Proposed Service Definition for Community Participation Supports

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and develop vocational skills. Vocational skill development also includes identifying available transportation to help the participant get to and from work and teaching the participant and his or her family (as appropriate) about basic financial opportunities and benefits information for a move into competitive integrated employment. This service can be used to assist a participant to become ready to benefit from OVR services prior to an OVR referral; it is not to be provided in lieu of OVR services. Participants who are under the age of 25 may not receive any type of prevocational services in a facility unless they have been referred to OVR and OVR has closed the case or the participant has been determined ineligible for OVR services.

Community Participation Support may be provided at the following levels in a licensed facility:

Basic Staff Support - Provision of the service at a staff-to-individual ratio of 1:11 to 1:15.

Level 1 - Provision of the service at a staff-to-individual ratio of 1:7 to 1:10.

Level 2 - Provision of the service at a staff-to-individual ratio of 1:2 to 1:6.

Level 3 - Provision of the service at a staff-to-individual ratio of 1:1.

Level 3 Enhanced - Provision of the service at a staff-to-individual ratio of 1:1 with a staff member who has at least a 4 year degree or is a licensed nurse.

Level 4 - Provision of the service at a staff-to-individual ratio of 2:1 to 1:1.

Level 4 Enhanced - Provision of the service at a staff-to-individual ratio of 2:1 to 1:1 with one certified staff member or nurse and one staff member with at least a high school diploma.

Community Participation Support may be provided at the following levels in community locations and community hubs:

Basic Staff Support - Provision of the service at a staff-to-individual ratio of 1:3.

Level 1 - Provision of the service at a staff-to-individual ratio of 2:3.

Level 2 - Provision of the service at a staff-to-individual ratio of 1:2.

Level 3 - Provision of the service at a staff-to individual ratio of 1:1.

Level 3 Enhanced - Provision of the service at a staff-to-individual ratio of 1:1 with a staff member who has at least a 4 year degree or is a licensed nurse.

Level 4 - Provision of the service at a staff-to-individual ratio of 2:1.

Level 4 Enhanced - Provision of the service at a staff-to-individual ratio of 2:1 with one certified staff member or nurse and one staff member with at least a high school diploma.

The use of Level 3 Enhanced, Level 4 and Level 4 Enhanced are based on the participant's behavioral or medical support needs. The need for these enhanced levels of service must be reviewed every 6 months in accordance with ODP policy for continued authorization. If a participant requires supplemental staffing during this service, the Community Participation Support provider is responsible to provide the staffing.

Level 4 staffing requires a variance in accordance with ODP policy. ODP will be issuing a separate communication outlining the procedures and process to request a variance or exception to any waiver service limit.

Attachment A: Current Proposed Service Definition for Community Participation Supports

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Specify applicable (if any) limits on the amount, frequency, or duration of this service:

Handicapped employment as defined in Title 55, Chapter 2390 may not be funded through the Waiver.

Prevocational services may not be funded through the Waiver if they are available to participants through program funding under the IDEA. Documentation must be maintained in the participant’s file to satisfy assurances that the service is not otherwise available through a program funded under the IDEA. Facility-based prevocational services may be provided without referring a participant to OVR unless the participant is under the age of 25. When a participant is under the age of 25, facility-based prevocational services may only be authorized as a new service in the service plan when documentation has been obtained that OVR has closed the participant’s case or that the participant has been determined ineligible for OVR services.

The following limits will be phased in regarding the amount of time a participant can receive Community Participation Support services in a licensed Adult Training Facility or a licensed Vocational Facility:

Beginning September 1, 2018, a participant may not receive Community Participation Support services in a licensed Adult Training Facility or a licensed Vocational Facility for more than 75 percent of his or her support time, on average, per month.

A variance may be granted, as determined by the service plan team if one of the following circumstances apply:

The participant receives fewer than 12 hours (48 units) per week of Community Participation Support by the provider;

The participant has current medical needs that limit the amount of time the person can safely spend in the community;

The participant has an injury, illness, behaviors or change in mental health status that result in a risk to him or herself or others; or

The participant declines the option to spend time in the community having been provided with opportunities to do so consistent with his or her preferences, choices and interests.

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; 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 may not be provided in a licensed Adult Training Facility or a licensed Vocational Facility that enrolls on or after March 17, 2019 and serves more than 25 individuals in the facility at any one time including individuals funded through any source.

Starting January 1, 2019 Community Participation Support services may not be provided in any facility required to hold a 2380 or 2390 license that serves more than 150 individuals at any one time including individuals funded through any source.

Attachment A: Current Proposed Service Definition for Community Participation Supports

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This service is generally provided between 8am to 5pm but is not restricted to those hours of the day. Alterations from typical day/work hours should be based on the participant’s natural rhythms, and/or preferred activities (not for convenience of a provider).

This service can be delivered in Pennsylvania and in states contiguous to Pennsylvania.

When Community Participation Support services are not provided with any other employment service (Small Group Employment, Supported Employment or Advanced Supported Employment) and the participant is not competitively employed, the hours of authorized Community Participation Support cannot exceed 40 hours (160 15-minute units) per participant per calendar week.

When the participant is competitively employed, the total number of hours for Community Participation Support, Supported Employment and/or Small Group Employment (whether utilized alone or in conjunction with one another) cannot exceed 50 hours (200 15-minute units) per participant per calendar week.

When intensive support is being requested (Level 3 Enhanced, Level 4 and Level 4 Enhanced), the reason(s) must be documented along the strategies attempted and planned to reduce this level of support, when appropriate.

Consolidated Waiver Only

Effective starting January 1, 2019, a participant may be authorized for a maximum of 14 hours per day of the following services (whether authorized alone or in combination with one another):

In-Home and Community Support.

Companion.

Community Participation Support.

A variance may be made to the 14 hour per day limitation in accordance with ODP policy, when the participant has a physical health, mental health or behavioral need that requires services be provided more than 14 hours per day.

ODP will be issuing a separate communication outlining the procedures and process to request a variance or exception to any waiver service limit.

Attachment B: Crosswalk for Community Participation Procedure Codes

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NEW STAFFING RATIOS As of July 1, 2017, all of the existing procedure codes for Prevocational and Licensed Day Habilitation services should be end dated on June 30, 2017. Please note that Prevocational and Licensed Day Habilitation procedure codes will still be visible in HCSIS until December 31, 2017 but they should not be selected as a service option for dates after June 30, 2017. All ISPs for individuals who receive these services must be updated to reflect the new Community Participation Supports service. For individuals who use some facility-based Community Participation Supports service, the following staffing ratios are available:

For each of these staffing ratios, there is a set of procedure codes for the Community Participation Supports service:

Tiers for Time in Community As Represented in HCSIS

<25% of time in community CPS<25%

25–49% of time in community CPS 25%

50-74% of time in community CPS 50%

75-99% of time in community CPS 75%

100% of time in community CPS 100%

Procedure codes have been established for people using Community Participation Supports services who do not spend any time at Licensed 2380 Day Habilitation or 2390 Prevocational facilities, meaning 100% community-based services. For people who currently use residential services and use Unlicensed Home and Community Habilitation as an alternative to Prevocational or Licensed Day Habilitation services, as of January 1, 2018, the service that replaces the Unlicensed Home and Community Habilitation service for this purpose, is Community Participation Supports and the below codes may be used:

100% Time in Community Settings

W5995 100% Community with 1:2 to 1:3

W5996 100% Community with 1:1

H2015 100% Community with 2:3

W5997 100% Community with 1:1 Level 3 Enhanced

W5993 100% Community with 2:1

W5994 100% Community with 2:1 Level 4 Enhanced

Community Participation Supports: Staffing Ratios for Time in Community Locations and Time in Facility

Community with 1:2 or 1:3 plus facility based services with 1:11 to 1:15

Community with 1:2 or 1:3 plus facility based services with 1:7 to 1:10

Community with 1:2 or 1:3 plus facility based services with 1:2 to 1:6

Community with 1:1 plus facility based services with 1:7 to 1:15

Community with 1:1 plus facility based services with 1:2 to 1:6

Community with 2:3 plus facility based services with 1:11 to 1:15

Community with 2:3 plus facility based services with 1:7 to 1:10

Community with 2:3 plus facility based services with 1:2 to 1:6

Community with 1:1 plus facility based services with 1:1

Community with 1:1 Enhanced plus facility based services with 1:1 Enhanced

Community with 2:1 plus facility based services with 2:1 to 1:1

Community with 2:1 Enhanced plus facility based services with 2:1 to 1:1. Enhanced

Attachment B: Crosswalk for Community Participation Procedure Codes

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Supports Coordinators should note that in HCSIS, the services described above will appear like this:

Sample for Service Descriptions as they appear in HCSIS

CPS < 25% Cmnty 2:3-FBS 1:2-1:6

Translation

CPS “Community Participation Supports”

<25% (percentage of time in community based on a

weekly average)

Cmnty X:X staffing ratio for community

FBS: X:X TO X:X “facility-based services” staffing

ratio range

CPS < 25% Cmnty 2:3-FBS 1:2-1:6

CPS < 25% Cmnty 2:1-FBS 2:1-1:1

CPS < 25% Cmnty 2:1-FBS 2:1-1:1

CPS < 25% Cmnty w/1:2-1:3-FBS 1:11-1:15

CPS < 25% Cmnty w/1:2-1:3-FBS 1:7-1:10

CPS < 25% Cmnty w/1:2-1:3-FBS 1:2-1:6

CPS < 25% Cmnty w/1:2-1:3-FBS 1:2-1:6

CPS < 25% Cmnty with 1:1-FBS 1:7 to 1:15

CPS < 25% Cmnty with 1:1-FBS 1:2 to 1:6

CPS < 25% Cmnty with 1:1-FBS 1:2 to 1:6

CPS < 25% Cmnty 1:1-FBS 1:1

CPS < 25% Cmnty 1:1-FBS 1:1

Attachment B: Crosswalk for Community Participation Procedure Codes

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CURRENT DAY HABILITATION

COMMUNITY PARTICIPATION SUPPORTS

Procedure Codes by Average Weekly Time in Community

Proc. Code

Service Level Service Description

Service Description 0 < 25% 25-49% in Comm.

50-74% in Comm.

75-99% in Comm.

W7072 Basic Staff Support

1:6

<25% Community 1:2 or 1:3 and >75% Facility 1:2 to 1:6

W5947

W5960 W5972 W5984

<25% Community 2:3 and >75% Facility 1:2 to 1:6

W5942 W5955 W5967 W5979

W7073 Staff Support Level 1

<1:6 to 1:3.5

<25% Community 1:1 and >75% Facility 1:2 to 1:6

W5950 W5962 W5974 W5990

<25% Community 1:2 or 1:3 and >75% Facility 1:2 to 1:6

W5947 W5960 W5972 W5984

<25% Community 2:3 and >75% Facility 1:2 to 1:6

W5942 W5955 W5967 W5979

W7074 Staff Support Level 2

<1:3.5 to >1:1

<25% Community 2:3 and >75% Facility 1:2 to 1:6

W5942 W5955 W5967 W5979

<25% Community 1:1 and >75% Facility 1:2 to 1:6

W5950 W5962 W5974 W5990

W7075 Staff Support Level 3

1:1 <25% Community 1:1 and >75% Facility 1:1

W5951 W5963 W5975 W5991

W7076 Staff Support Level 3 Enh.

1:1 staff degreed or a nurse

<25% Community 1:1 Enhanced and >75% Facility 1:1 Enhanced

W5952

W5964 W5976 W5992

W7035 Staff Support Level 4

2:1

<25% Community 2:1 >75% Facility 2:1 to 1:1 W5943 W5956 W5968 W5980

W7036 Staff Support Level 4 Enh.

2:1 with staff who are both degreed or both nurses

<25% Community 2:1 Enh. >75% Facility 2:1 Enhanced (1 staff degreed or Nurse)

W5944

W5957 W5969 W5981

Attachment B: Crosswalk for Community Participation Procedure Codes

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CURRENT PREVOCATIONAL COMMUNITY PARTICIPATION SUPPORTS

Procedure Codes by Average Weekly Time in Community

Proc. Code

Service Level

Service Description

Service Description 0 < 25% 25-49% 50-74% 75-99%

W7087 Basic Staff Support

1:15

<25% Community 1:2 or 1:3 and >75% Facility 1:11 to 1:15

W5945 W5958 W5970 W5982

<25% Community 2:3 and >75% Facility 1:11 to 1:15

W5940 W5953 W5965 W5977

W7088 Staff Support Level 1

<1:15 to 1:7.5

<25% Community 1:2 or 1:3 and >75% Facility 1:7 to 1:10

W5946 W5959 W5971 W5983

<25% Community 2:3 and >75% Facility 1:7 to 1:10

W5941 W5954 W5966 W5978

<25% Community 1:1 and >75% Facility 1:7 to 1:15

W5948 W5961 W5973 W5985

W7089 Staff Support Level 2

<1:7.5 to >1:1

<25% Community 1:2 or 1:3 and >75% Facility 1:2 to 1:6

W5947 W5960 W5972 W5984

<25% Community 2:3 and >75% Facility 1:2 to 1:6

W5942 W5955 W5967 W5979

<25% Community 1:1 and >75% Facility 1:2 to 1:6

W5950 W5962 W5974 W5990

W7090 Staff Supp. Level 3

1:1 <25% Community 1:1 and >75% Facility 1:1

W5951 W5963 W5975 W5991

W7091 Staff Support Level 3 Enh.

1:1 with staff who is degreed or a nurse

<25% Community 1:1 Enhanced and >75% Facility 1:1 Enhanced

W5952

W5964 W5976 W5992

W7092 Staff Supp. Level 4

2:1 <25% Community 2:1 and >75% Facility 2:1 to 1:1

W5943 W5956 W5968 W5980

W7093 Staff Support Level 4 Enh.

2:1 where both staff are degreed or nurses

<25% Community 2:1 Enh. and >75% Facility 2:1 Enhanced (1 staff degreed or Nurse)

W5944

W5957 W5969 W5981

Attachment B: Crosswalk for Community Participation Procedure Codes

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Community Participation Supports in Older Adult Daily Living Centers The procedure code for services provided in Older Adult Daily Living Centers (subject to licensure under 6 Pa. Code Chapter 11) remains the same - Older Adult Day W7094. Note that Older Adult Daily Living Centers providing Community Participation Supports are not subject to time in community standards as outlined in the waivers (25% of time in community settings by September 1, 2018). As of July 1, 2017, the Consolidated and P/FDS waivers may not provide payment for services in Older Adult Daily Living Centers for new admissions unless the individual is over 60 years old or the person has dementia or a dementia-related diagnosis. Additional Considerations The phase-in for the requirement for providers to offer opportunities in community locations at least 25% of an individual’s time becomes effective September 1, 2018. A variance process will be in place for an individual who meets any one of the following:

Has current medical needs that limit the amount of time he or she can safely spend in the community; the individual has an injury, illness, a change in mental health status.

Exhibits behaviors that are a risk to him/herself or others.

Declines the option to spend time in the community having been provided with opportunities to do so consistent with his or her preferences, choices and interests.

Receives services from a provider who is in the process of transitioning their services to provide more opportunities for participation in the community.

Receives fewer than 12 hours (48 units) per week of Community Participation Support by the provider. ISP teams will not need to complete a variance for exceptions to time spent in community locations until ISP Renewals for FY2018-19.

Attachment C: Community Participation Supports ISP FY17-18 Renewal

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Dear Waiver Participant, Every year your Individual Support Plan (ISP) is updated to ensure that needed services authorized in your annual plan continue without any interruption throughout the State fiscal year. When there are no service changes in the Person/Family Directed Support (P/FDS) or Consolidated waivers, the only thing that changes at this time are the service authorization dates, which are changed to align to the State fiscal year. Your current annual ISP indicates that you are receiving the following day services:

Provider Service Name Service Level Service Description

Procedure Code

Effective July 1, 2017, ODP is offering a new service called Community Participation

Supports which incorporates Prevocational and Licensed Day Habilitation/Adult Training Facility services while providing additional opportunities for more integrated activities in the community. This new service is designed in line with ODP’s Everyday Lives: Values in Action.

Current day service providers were asked to identify the day supports they anticipate providing to you using the new Community Participation Supports service definition. As a result, your day service provider indicates that the following supports are anticipated for you beginning July 1, 2017:

Proposed Community Participation Supports

Provider Service Name Service Level Service Description

Procedure Code

We understand that you may have questions about these changes. I am available to

discuss them with you further or you may request a team meeting to have this discussion. Please feel free to contact me at (phone) if you have any questions or want to schedule a team meeting.

Please contact me by (date) with any questions. Unless we hear from you by (date),

your individual support plan will be updated to include the proposed service(s) referenced above.

Sincerely, SC