Public Comment Webinars January 14, 2015 and January 15, 2015 Amendments and Transition Plans for the Consolidated, P/FDS and Adult Autism Waivers Public Comment Webinars January 14, 2015 and January 15, 2015 11/10/2018

Waiver Amendments

General Waiver Amendment Info The Office of Developmental Programs will request amendments to the Consolidated, Person/Family Directed Support (P/FDS) and Adult Autism Waivers. Changes are mostly related to the waiting list initiative approved for Fiscal Year 14/15 (July 1, 2014 through June 30, 2015). There will be changes to Appendix J of all three Waivers to reflect the increased number of users in Fiscal Year 14/15 as a result of the waiting list initiative. Due to the nature of the changes, ODP will request that the amendments be effective retroactive to July 1, 2014.

Consolidated Waiver Consolidated Waiver Amendment – Unduplicated Number of Participants Served Found in Appendices B-3-a and J-2-a Year 3 (FY 14/15) – Increase from 17,867 to 18,067 Year 4 (FY 15/16) – Increase from 17,982 to 18,067 Increase needed due to waiting list initiative

Consolidated Waiver Consolidated Waiver Amendment – Reserved Capacity for Unanticipated Emergencies Found in Appendix B-3-c ODP will reserve capacity for individuals/participants who are identified as meeting the unanticipated emergency criteria in accordance with ODP's unanticipated emergency policy. Year 3 (FY 14/15) – Increase from 20 to 120 Increase needed due to implementation of Adult Protective Services.

Consolidated Waiver Consolidated Waiver Amendment – Reserved Capacity for Hospital/Rehabilitation Care Found in Appendix B-3-c ODP reserves waiver capacity for waiver participants requiring hospital/rehabilitation care beyond 30 consecutive days and up to 6 consecutive months from the first date of leave. Year 3 (FY 14/15) – Decrease from 750 to 550 Year 4 (FY 15/16) – Decrease from 750 to 550 Year 5 (FY 16/17) – Decrease from 750 to 550 Decrease needed as the Department has found in the first two years of implementation that this number is higher than necessary to serve those individuals that require hospital/rehabilitation care.

P/FDS Waiver P/FDS Waiver Amendment – Unduplicated Number of Participants Served Found in Appendices B-3-a and J-2-a Year 3 (FY 14/15) – Increase from 12,600 to 13,300 Year 4 (FY 15/16) – Increase from 12,600 to 13,300 Year 5 (FY 16/17) – Increase from 12,600 to 13,300 Increase needed due to waiting list initiative

P/FDS Waiver P/FDS Waiver Amendment – Reserved Capacity for Waiting List Initiative Found in Appendix B-3-c ODP has reserved capacity for the waiting list initiative to serve approximately 700 students graduating from special education who are on the waiting list in Years 1, 2 and 3. Year 3 (FY 14/15) – Increase from 0 to 700 Increase needed due to waiting list initiative

Adult Autism Waiver Adult Autism Waiver Amendment Unduplicated Number of Participants Found in Appendices B-3-a and J Year 4 (FY 14/15) – Increase from 439 to 544 Year 5 (FY 15/16) – Increase from 439 to 544 Limitation on the Number of Participants Served at Any Point in Time Found in Appendices B-3-b and J Year 4 (FY 14/15) – Increase from 418 to 518 Year 5 (FY 15/16) – Increase from 418 to 518

Adult Autism Waiver Adult Autism Waiver Amendment Reserved Capacity for People identified in Adult Protective Services investigations Found in Appendix B-3-c Capacity is reserved for adults with ASD who have a protective services plan developed pursuant to the Adult Protective Services Act that specifies a need for long-term support. Individuals must be eligible for the Adult Autism Waiver The capacity that the AAW reserves in each waiver year is: Year 4 (FY 14/15) – 5 Year 5 (FY 15/16) – 5

Adult Autism Waiver Adult Autism Waiver Amendment In addition, this waiver amendment: Adds data for a new field in the waiver application for the home and community-based services taxonomy, Adds data for a new field in the waiver application on seclusion, and Revises the bulletin number that specifies training for certified investigators of critical incidents in Appendix G-1-d.

Transition Plans

Intent of CMS Final Rule CMS published the final rule amending regulations contained in 42 CFR 441.301 on January 16, 2014 The rule supports enhanced quality in Home and Community Based Services (HCBS) programs and adds protections for individuals receiving services. In addition, this rule reflects CMS’ intent to ensure that individuals receiving services and supports through Medicaid’s HCBS programs have full access to the benefits of community living and are able to receive services in the most integrated setting.

What is the Transition Plan The transition plan is the document in which states determine their compliance with the regulatory requirements for home and community-based settings and describe to CMS how they will comply with the new requirements. Statewide Plan vs. Waiver Specific Plan Both are required Both require public input What is the difference between the two?

Important Transition Plan Dates The regulations were effective March 17, 2014 It is CMS’ expectation that states be fully compliant with the Federal requirements by the time frames approved in their transition plan, but no later than March 17, 2019. Statewide Transition Plan due to CMS by March 17, 2015

Important Transition Plan Dates Public Comment period for the Consolidated, P/FDS and Adult Autism Waivers is from December 20, 2014 through February 2, 2015. Waiver specific transition plans due when first waiver amendment submitted after March 17, 2014. It is ODP’s goal to submit waiver amendments and accompanying transition plans in late March 2015.

Why Must We Comply The state’s failure to submit an approvable transition plan as required or to comply with the terms of the approved transition plan may result in compliance actions, including but not limited to deferral/disallowance of Federal Financial Participation

What about Person-Centered Planning For the most part, person-centered planning requirements are not part of the proposed transition plan CMS limits the purpose of the transition plan to settings where waiver services are delivered. Requirements related to person-centered planning are to be met in addition to a waiver’s transition plan for settings. Example - You will see action steps regarding information that must be in a plan in order for a person to be exempt from certain requirements in the transition plan.

Purpose of This Webinar, Next Steps and Other Important Information

Purpose for Webinar To obtain public comment on the proposed transition plans for each waiver. Comments received today will be considered to formulate the final waiver specific transition plans that will be submitted to CMS. To allow stakeholders to ask questions

Next Steps After the public comment period, ODP will: Consider the public comment received and modify the transition plans as needed Submit the final transition plan along with a summary of the comments received, reasons why comments were not adopted and any modifications to the transition plan based upon those comments to CMS Post the summary and final transition plans on the DHS website Determine the best way to have ongoing dialogue with stakeholders regarding the implementation of the transition plans and progress made

Today’s Public Input Process We have reserved 30 minutes of this call for participants on this webinar to ask questions about the waiver amendments and transition plans The remaining time is reserved for obtaining public input on the waiver amendments and transition plans 5 minute limit on comments

Written Comments While we will be recording this webinar we encourage you to submit your comments in writing. You have 2 options: Email comments to the DHS at RA-odpcomment@pa.gov. 2. Mail Consolidated and P/FDS Waiver comments to Julie Mochon, Department of Human Services, Office of Developmental Programs, 625 Forster Street, Room 501, Harrisburg, PA 17120 Mail Adult Autism Waiver comments to Lea Sheffield, Department of Human Services, Office of Developmental Programs, Bureau of Autism Services, 625 Forster Street, Room 605, Harrisburg, PA 17120

Resources CMS information resources can be found at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Home-and-Community-Based-Services.html http://hcbsadvocacy.org/ The Consolidated, P/FDS and Adult Autism waiver amendments and accompanying transition plans are available at: http://www.dhs.state.pa.us/dhsorganization/officeofdevelopmentalprograms/index.htm