12 Provider Service Time for providers to analyze services rendered and make changes to 2016 August 2016 No Deliverable For Alignment with comply with home and community based characteristics policy if This Item Policy necessary. 13 Provider Assess whether there are any waiver providers that have the effect of September September Provider Tracking Monitoring isolating individuals per home community based characteristics policy. 2016 2017 Tool 14 Notify Providers Notify providers that were found to have the effect of isolating October 2017 December Notification to Presumed Not individuals. Inform these providers that they can demonstrate how the 2017 providers Eligible and service currently meets the home and community-based characteristic Request Plan policy or they can submit a plan outlining how operations will be altered to meet the requirements for a home and community-based setting. 15 Provider Plan Timeframe for providers to develop and submit information requested in January 2018 March 2018 Provider Tracking Submission the letter referenced above and the home and community based Tool characteristics policy. 16 Develop Identify and develop safeguards to preclude reimbursement for ineligible January 2018 October 2018 HCBS IT Changes Safeguards providers after the transition completion date. List 17 Review Plans Information submitted by providers regarding how they meet or will April 2018 July 2018 Provider Tracking Submitted make changes their program to meet the requirements for an eligible Tool setting will be reviewed. 18 Notify Providers of Notify providers of ODP’s initial decision regarding the setting’s eligibility. August 2018 September Notification to Decision Information regarding providers determined to be eligible will be 2018 providers submitted to CMS for heightened scrutiny. Providers determined to be ineligible will be provided appeal rights. Providers will be expected to comply with applicable 55 Pa. Code Chapter 51 requirements. 19 Notify Participant Notify individuals served by providers determined to be ineligible, August 2018 September Notification to of Decision Administrative Entities and Supports Coordination Organizations of 2018 participants provider ineligibility and what actions individuals may expect. The ISP team must discuss the option of other willing and qualified providers or other services that will meet the individual’s needs and ensure their health and safety. The Supports Coordinator will be responsible for documenting this discussion.
12 Provider Service Alignment with Policy Time for providers to analyze services rendered and make changes to comply with home and community based characteristics policy if necessary. 2016 August 2016 No Deliverable For This Item 13 Provider Monitoring Assess whether there are any waiver providers that have the effect of isolating individuals per home community based characteristics policy. September 2016 September 2017 Provider Tracking Tool 14 Notify Providers Presumed Not Eligible and Request Plan Notify providers that were found to have the effect of isolating individuals. Inform these providers that they can demonstrate how the service currently meets the home and community-based characteristic policy or they can submit a plan outlining how operations will be altered to meet the requirements for a home and community-based setting. October 2017 December 2017 Notification to providers 15 Provider Plan Submission Timeframe for providers to develop and submit information requested in the letter referenced above and the home and community based characteristics policy. January 2018 March 2018 Provider Tracking Tool 16 Develop Safeguards Identify and develop safeguards to preclude reimbursement for ineligible providers after the transition completion date. January 2018 October 2018 HCBS IT Changes List 17 Review Plans Submitted Information submitted by providers regarding how they meet or will make changes their program to meet the requirements for an eligible setting will be reviewed. April 2018 July 2018 Provider Tracking Tool 18 Notify Providers of Decision Notify providers of ODP’s initial decision regarding the setting’s eligibility. Information regarding providers determined to be eligible will be submitted to CMS for heightened scrutiny. Providers determined to be ineligible will be provided appeal rights. Providers will be expected to comply with applicable 55 Pa. Code Chapter 51 requirements. August 2018 September 2018 Notification to providers 19 Notify Participant of Decision Notify individuals served by providers determined to be ineligible, Administrative Entities and Supports Coordination Organizations of provider ineligibility and what actions individuals may expect. The ISP team must discuss the option of other willing and qualified providers or other services that will meet the individual’s needs and ensure their health and safety. The Supports Coordinator will be responsible for documenting this discussion. August 2018 September 2018 Notification to participants
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