Topic Stakeholder Submitted Question Response

Transcription

1 Activities of Residential Living (e)(13)(iii) Activities of residential living Need clarification (e)(13)(iii) activities of residential living refers to activities that occur in the home and community as part of living in a residence in the community. For example, does the individual load and unload the dishwasher, fold his/her own clothes, clean up after (i.e. take dirty dishes to the kitchen if they eat outside of the kitchen), associate appropriately with neighbors, respect the privacy of housemates, manage conflict with housemates, etc. Assessment Is ODP supplying an assessment format? The assessment used must meet the requirements of , , , and ODP recognizes that there are many assessment instruments. Informal assessment may include: direct observations, interviews with family or direct care staff and/or review of previous records. Formal assessments may include, but are not limited to: statewide standardized assessments in addition to person-centered assessments utilized by provider agencies that have previously been reviewed by licensing agents. both formal and informal, that are being utilized statewide. Both types are considered to be valuable tools. Assessment (f) This assessment can be completed up to 120 days prior to an ISP meeting Need clarification The information gathering process occurs prior to the due date of an assessment, but as per (f), the assessment must be provided to the SC and plan team members at least 30 calendar days prior to an ISP meeting. As per (a), the assessment must be updated annually, meaning it needs to have been updated within the last 365 days. Assessment Assessment What is the definition of Assessment (under ) It looks like this assessment is different from the ISP and currently we are not doing any annual assessments (a)- Does the assessment need to be separate document or can we use track changes for the assessment? The assessment must meet the requirements identified in section An assessment is a determination of the individuals skill levels and abilities and is a tool used to help identify the current needs of the individual. This tool is used to determine what outcomes an individual would like to have in their ISP. The assessment is different from the ISP since the ISP is a document that creates a complete picture of the services an individual is receiving and the outcomes the individual is working towards. The assessment instead focuses on the current functioning skill level of the individual. Services provided must be based on the assessed needs which must be incorporated and substantiated in the ISP. The UPDATED ASSESSMENT referred to in this regulation cite must be a new assessment. This means a separate document, track changes are not permitted. It must be updated as per (a) and (b). 2/4/11 1 of 14

2 Assessment Assessment If we send, as our "assessment" the Individual Support Planning Tool as provided by ODP and complete the required sections based upon programmatic assessment tools, do the actual tools also need to be sent? The actual tools or items used to complete the assessment do not need to be sent. The provider does need to ensure that the information sent to the plan team has all of the components required in the regulations as per , , and (relating to assessment). Some confusion with when the assessment It does not have an impact. As per (a) each individual shall have an initial needs to be completed for a new assessment within 1 year prior to or 60 days after admission. As per (d)(2) the initial admission in a residential program. Is it 60 ISP shall be developed within 90 days after the individual's admission date to the facility. or 90 days? Residential providers say there For example, Bob s first day at ABC provider is January 1. An assesment has not been needs to be a meeting within 60 days of a completed for him. In order for the provider to be compliance they must complete the person moving into a residential program assessment up to 60 days after January 1. Therefore, the provider has until March 1 to to update the ISP so how would completing complete the assessment. By March 1, the provider must send the assessment to the SC and an assessment and getting it to the SC 30 the plan team members for their review before the meeting. days prior to the plan meeting impact on Since the intial ISP would need to completed within 90 days of the admission date, the ISP this? must be completed by April 1 to be in compliance. The meeting would need to occur by March 30, in order to update the ISP and be within the 90 days. Community Integration Should the assessment include an individual's ability to become integrated in to their community? Is this item open to the agency to select items to measure this? Yes, an assessment is your evaluation of the select item and is open to the agency as long as it meets the requirements identified in , , and (relating to assessments). Community Integration What do we need for documentation? ODP does not want to be prescriptive with documentation, but providers shall maintain records that describe the nature and extent of services provided. Documentation must support outcomes indicated in the ISP, to be in compliance with the regulations as per For example, a provider may log in the person's record that the individual ateneded a civic organization activity. 2/4/11 2 of 14

3 Community Participation Content Discrepancy There may be an individual that refuses attempts to encourage community participation with groups or individuals that do not have a disability. If this is documented in monthly progress reports does this show efforts to comply this regulation? At times there are errors in the ISP that are found when the ISP is posted on HCSIS. If this occurs and the Program Specialist notifies the SC of the discrepancies when they see it, It could be a day or few days between the receipt of the ISP and start of services. Will the agency be cited when the Progam Specialist only has a small window to read the ISP and notify of a discrepancy that can not allow the ISP to be implemented as written because it is written incorrectly? Yes, documentation must verify the individual was provided with the opportunity and encouraged to engage in community participation with groups or individuals that do not have a disability as per , , , and Required by (b)(7), (b)(7), (b)(7) and (d)(7) the program specialist shall report content discrepency to the SC or plan lead as applicable. As long as it is recorded in the individual s record, the agency will not be cited. Diagnosed If the individual does not display any Psychiatric Illness symptoms related to psychiatric illness and doesn t require a protocol, in what section of the ISP should this be documented? ( ) As per , , and ; if a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a written protocol as part of the ISP. Therefore, a protocol is required whether or not symptoms are displayed. This information can be included in the medical section of the ISP under psychosocial. 2/4/11 3 of 14

4 Direct Care Staff at Meeting How does an agency show they made every effort possible to have a direct care staff at the ISP meeting. The agency can show it made every effort possible by scheduling a direct service worker's (DSW's) hours of work during the time of the meeting and requiring attendance at the meeting as part of the staff's responsibilities during those hours. The intent of the regulation was to have as many people as possible who work with the individual present at the meeting. Keeping that in mind, if a provider finds that a direct service worker is not able to attend the meeting (for instance the DSW is on vacation), there should be documentation of attempts to either secure the DSW or find another DSW to be a plan team member in their place. Direct Service Worker How is a direct service worker defined? Can a habilitation manager or line supervisor who also does direct service comply with the direct service worker requirement for attendance at the ISP planning meetings? As per the definition of a direct service worker (DSW) at , , and , a DSW is a person whose primary job function is to provide services to an individual who attends the provider s facility. Usually a habilitation manager or line supervisor's "primary" job function is to "manage" or "supervise", in those cases, the habilitation manager or line supervisor would not meet the definition of a DSW. However, in some cases, those persons have multiple roles and can be in compliance with the requirement, if they meet the definition of a direct service worker. 2/4/11 4 of 14

5 Topic Stakeholder Submitted Question Response Assessment (3)(i-iv) - Is this regulation stating that the documentation must include every item noted every time or only those items that a person is working on as an outcome at that time? (acquisition, maintenance, improvement of functions skills, personal needs, communication and personal adjustment) Perhaps an individual is not working on all of these at once due to their ability to learn items in a slower pace and not try multiple areas all at once which can be confusing (e)(3)(i-iv), (e)(3)(i-iv), ,(e)(3)(i-iv)and (e)(3)(i-iv) is in reference to the individual's assessment. The assessment must include a determination of the individual's current level of performance and progress. It is not asking for documentation. It is only asking for an assessment of the individual's skill level and progress in relation to specific areas as identified in (i) through (iv) as described above. Documenting Change If there is a change that needs to be reviewed with the individuals, can we use the quarterly review as documentation with the individual? Functional Skills (e)(3)(i) Need clarification on functional skills Goals How specific should the goals be in the ISP.? They feel that the goals were supposed to be in measurable terms in the past now it seems that specific strategies are not part of the ISP. Is this correct? As per , , and , the program specialist or family living specialist (as applicable) shall complete an ISP review with the individual every 3 months or more frequently if the individual's needs change. If a change needs to be reviewed with the individual, the review should happen as soon as possible. The provider should not wait until the quarterly meeting to review the documentation with the individual. Functional skills are activities of daily living such as: getting out of bed, brushing teeth, toileting, dressing independently, eating, etc. This regualtion can also be found in (e)(3)(i-iv), (e)(3)(i-iv), and (e)(3)(i-iv). The requirement in (3), (3), (3) and (3) is to include the method of evaluation used to determine progress toward the expected outcome. So yes; goals are to be in measurable terms that can be evaluated. Specific strategies used to support a person to achieve their goals is not a part of the ISP but could be in an addendum or attachment to the plan. Implementing New Regulations This web cast makes it clear that providers must use the ISP plan year and must convert all their documentation by January The regulations have prospective effect only. Providers are not required to revise documents created before the effective date, but instead, must comply with the regulations for development, annual update and revision pursuant to the program sections of chapters 2380, 2390, 6400 and 6500 onr the effective date and thereafter. 2/4/11 5 of 14

6 Individual Disabilities (9) Need clarification on all this regulation. As per (e)(9), there needs to be documenation of the individual's disability, including functional and medical limitations. There must be a description on what the individual is able to do on his or her own, where assistance is required or any other types of needs, and whether the individual has medical limitations due a medical diagnosis. Individual Participation The amended regulations for 2390 require As per (c), The ISP review must include the following (1) a review of the monthly that the program specialist review, sign and documentation of the client's participation and progress during the prior three months towards date monthly documentation of a client s ISP outcomes supported by services provided by the facility licensed under this chapter. The participation and performance toward monthly calendars can be used as your documentation of the individuals progress towards outcomes. There has not been a goals. Case progress notes should also be reviewed. Any documentation that supports the requirement for monthly documentation client's participation and progress towards outcomes can be used for compliance with this previously, other than the monthly tracking regulation. The only additional requirement is to make sure the program specialist reviews, of specific goal progress (such as goal signs and dates this documentation if they are not already doing so. For further guidance, calendars) and all other documentation providers should refer to the billing documentation bulletin for waiver services. consisted of case progress notes as needed and quarterly reviews of the plan. Is there an additional requirement for monthly documentation beyond those calendars? And if monthly documentation is needed, will a case note suffice? ISP If a person s IWPP was written on July 1, The regulations have prospective effect only. Providers are not required to revise documents 2010, must an ISP be written as of January created before the effective date, but instead, must comply with the regulations for 1, 2011, if the person does not also already development, annual update and revision pursuant to the program sections of chapters 2380, have an ISP done? 2390, 6400 and 6500 on the effective date and thereafter.. ISP Development The ISP development meeting is usually held 90 days before the annual review update date. Can it be held beyond the 90 day period if there is difficulty with getting team members together? As per (d)(1), (d)(1), (d)(1) and (d)(1). The ISP is required to be updated annually. There is no requirement for when the ISP plan development meeting needs to occur. However, while there is no requirement for a specific meeting date, the timeframes outlined in the ISP Manual attached to Bulletin # are important in ensuring ISPs are done in a timely manner and maintaining a reliable schedule for completion of required activities for ISP development, revision, and updating.. 2/4/11 6 of 14

7 ISP Meeting Preparation What paperwork needs to be prepared in As per (f), (f), (f), (f).the program specialist shall provide addition to the assessment before an the assessment to the SC or plan lead as applicable, and plan team members at least 30 annual ISP meeting? Does an ISP calendar days prior to an ISP meeting. The ISP Review/Outcome Action plan would be a part Review/Outcome Action Plan need to be of the current ISP and would not be completed before the team meeting. The entire team prepared in advance? If so, does it need to should have a copy of the current approved ISP before the team meeting. During the meeting, be sent again after a meeting if the team the team should review the current plan and suggest any needed or necessary additions, makes changes? Also, does the entire modifications, or deletions. plan team need copies before the annual meeting or just the SC/Plan Lead? ISP Review ISP Review The regulations specify that the finalized ISP must be reviewed with the individual; does the person s attendance at the ISP meeting and acceptance of a copy of the ISP satisfy that regulation? For an individual who has a supports coordinator, residential provider and day program provider, three (or more) separate agencies would review the ISP with each individual (a) We currently do not do 4 th quarterly reports but it appears as if we now need to do one? As per (a), (a), (a) and (a) The program specialist shall complete an ISP review of the services and expected outcomes in the ISP specific to the facility licensed under this chapter, with the individual every 3 months or more frequently if the individual's needs change. Therefore, if the individual attends multiple facilities, the program specialist will only be reviewing the services and outcomes with the individual, specific to his/her facility. An individual s attendance at the meeting and receipt of the ISP can satisfy one of the ISP review meetings. The program specialist must still review the ISP with the individual every three months following the ISP meeting or more frequently if the individual's needs change. Yes, you are correct. There is a new requirement that the family living specialist must review the ISP with the individual as identified under (c)(1-5), (c)(1-5), (c)(1-5) and 6400(c)(1-5) according to the time line identified in (a), which includes a fourth quaterly review. The ISP revision meeting can count as one of the 3 month reviews. As long as the individuals signs the signature sheet. 2/4/11 7 of 14

8 ISP Revision Meeting Do all ISP revisions require revision meetings? For example a change in attendance schedule/number of days. As per (f), (f), (f and (f) if a recommendation for a revision to a service or outcome in the ISP is made, the plan lead as applicable shall send an invitation for an ISP revision meeting to the plan team members. If at the ISP revision meeting, the plan team determines a revision to the ISP should be made, at that time, the ISP would be revised. General updates to the ISP such as changes in medical information, that donot modify services and supports do not require team meetings. ISP Revisions ISP Updates When there is a revision to the ISP can that revision piece be sent to the team members or does the entire ISP need to be sent? Can we use the ISP updates (via tracking changes to the SC) as the annual assessment done 90 days prior to the ISP date? Or, does there need to be a separate document? As per , , and , a copy of the ISP, including the signature sheet, shall be provided to the plan team members within 30 days after the ISP annual update and ISP revision meetings. The revision piece can be sent and not the entire plan, for ISP revision meetings. However, if a plan team member requests the entire ISP be sent, it must be provided and. All ISP annual update meetings require that the entire plan and signature sheet be provided to all team members. The assessment must be a different document. It must be updated as per (a and b), (a and b), (a and b) and (a and b). 2/4/11 8 of 14

9 Lifetime Medical History The amended vocational regulations now specify requiring a Lifetime Medical History for the individual, which is a new requirement. This would be provided as part of the assessment through the residential provider and also, most likely through the Supports Coordinator. Must the Program Specialist for day program then turn that Lifetime Medical History in with his/her assessment for the ISP, essentially giving a copy to the team members who provided it in the first place? (e) 10 which requires that an assessment includes a Lifetime Medical History is a new requirement. Per (f), the program specialist shall provide the assessment to the SC or plan lead as applicable, and plan team members. Medical History As a day program, we are having a great deal of difficulty trying to compile a life-time medical history for each person. In addition, there are to be copies of physical examinations in the records where none were required before. Will there be a phase in period for this as previously a physical was not required for persons in vocational programs and most medical insurance will pay for only 1 physical per year. Any guidance regarding the medical history would be appreciated. The regulations have prospective effect only. Providers are not required to revise documents created before the effective date, but instead, must comply with the regulations for assessment pursuant to sections , , and after the effective date and thereafter. The day program should make every attempt possible to compile and create a lifetime medical history. If the individual has a lifetime medical history from their residential provider, this document can be used to satisfy this requirement for day program providers. If you are not able to get a full lifetime medical history, you must document attempts made and maintain this documentation in the individual s record. The processes suggested above should also be used for physical exams. The day program provider should check to see if the residential provider has the information. If not, every effort should be made to complete this task. As long as the most recent physical exam in the individual s record is within the last year, you would be meeting the requirement. If the individual has not had a physical within the last year, medical insurance should cover the expense now. 2/4/11 9 of 14

10 Medical Staff and ISP Meeting Do you really want us to ask every doctor/therapist the person sees, from their pcp and psychiatrist to the dermatologist they saw in the summer for a rash, to attend a meeting and document their response? How do we document the response if they choose not to RSVP? Are we required to send certified letters to document that they got the invitation so that the lack of a response can be considered a choice to not attend? Who incurs that cost? As per (2)(i), (2)(i), (2)(i) and (2)(i) If the following have a role in the individual's life, the plan team may also include as its members, as applicable, the following: (i) medical, nursing, behavior management, speech, occupational or physical therapy specialists. The medical professionals listed in the regulations are offered as optional meeting participants. These professionals could be given the opportunity to participate in situations where the provider feels they are needed. In situations where a medical professional was invited to be at a meeting but was not present, this could be documented as a note in the individual s record. Number of Units For the past few years, it has been necessary to request additional units for an individual just because they have been able to attend more often than was originally thought when the fiscal year ISP was completed. For this purpose, is it necessary to follow the assessment protocol as specified in the regulations. We are thinking we do not, as the requesting of additional units is not a change to an outcome or service as described in the regulations. The number of units identified in the ISP is to be based on the individual's assessed need for the units, not whether or not the individual is able to attend more often. There should not be an increase in units, unless the individual has an increased need for the units. Therefore, if the individual s need for units increases this must be based on the assessment. The need for a revised assessment as per (b), (b), (b) and (b) must be followed. Personal Adjustment (e)(3)(iii) Need clarification on progress in personal adjustment and how to document. Personal adjustment are activities that an individual performs to achieve personal goals and to improve how the individual manages problems effectively and resolves conflicts. The individual's current level of performance and progress in this area must be assessed as per (e)(3)(iii), (e)(3)(iii), (e)(3)(iii) and (e)(3)(iii). 2/4/11 10 of 14

11 Personal Property (viii) Managing personal property Need clarification Managing person property relates to an individual's ability to care fo his/her person belongings suca as books, CD collection, or stamp collection. This also relates to the individual's ability to put his/her personal belongings away. The individual's progress over the last 365 days and current level of performance must be assessed as per (e)(13)(viii), (e)(13)(viii), (e)(13)(viii) and (e)(13)(viii). Plan Team Members Program Specialist Responsibilities There will be instances where extended family members may attend an ISP unexpectedly. Will allowance be given for the provider not sending these people copies of the assessments? In addition, staff from other providers may not be known in advance of the meeting. Is it sufficient to send only to that agency's program specialist? In (e) it specifies that the Program Specialist is responsible for instructing the Direct Service Workers in meeting the health and safety needs of the individuals. What precisely does that mean? Are Program Specialists now responsible for the training of the Floor supervisors? Each person identified as a plan team member must be sent a copy of the assessment as per (f), (f), (f) and (f). If an extended family member is a plan team member they must receive a copy of the assessment. Anyone who the individual wishes to have at their ISP meeting may attend even if they are not a plan team member, but they are not required to have a copy of the assessment. Providers should be communicating with each other and the individual in advance of the meeting to identify who should be a plan team member. A per (b)(18), the program specialist is responsible for the coordination of the training of direct service workers in the content of health and safety needs relevant to each individual. This does not mean the program specialist must do the instructing of the training. Protocol Definition ODP needs to define what they will accept related to "protocol". The term protocol as referenced in many sections of the regulations, means an established or reasonable written method of doing something. 2/4/11 11 of 14

12 Quarterly Reviews 1) If a person is both a program specialist As per (b), (b), (b) and (b) at least three plan team and a direct service worker, does there still members, in addition to the individual, if the individual chooses to attend, shall be present for need to be four people at an ISP meeting? the ISP, annual update and ISP revision meeting. No, one person cannot count as two 2) Do four quarterly reports need to be held attending the meeting. An individual s in addition to the ISP, as opposed to three attendance at the meeting and receiving a copy of the plan can satisfy one of the ISP review quarterlies does the ISP, as it used to be? meetings. The program specialist must still review the ISP with the individual every three months following the ISP meeting or more frequently if the individual's needs change as per (a), (a), (a) and (a). Record Content In the amended regulations, it is stated that the client record must contain copies of invitations to the Initial ISP meetings, the annual update meetings and the ISP Revision Meetings. ( (5) i, ii, iii. However, in the ISP manual, it is not clear that invitation letters are needed to be sent by the SC for the Revision Meetings. Clarification is needed as to the provider's responsibility to obtain these invitation letters if they are not received from the SCO. As per (5) copies of invitations to the meetings must be maintained in the individual's record. If the provider was not given a copy of the required invitations, it is the provider's responsibility to contact the SC regarding this discrepency and to record this contact made with the SC in the individual's record. If the individual attends a 2380 facility and has an SC, who is then regarded as the plan lead, invitation letters are only required for the initial ISP meetings and the annual update meetings, not ISP revision meetings. If the 2380 program specialist is the plan lead because there is not an SC, the 2380 program specialist must comply with the requirements under this sectionof the regulations. The Licensing Inspection Instrument will cover this so that providers of individuals who have an SC who is the plan lead will not be cited. 2/4/11 12 of 14

13 Topic Stakeholder Submitted Question Response SEE Plan For someone who is diagnosed with an intellectual disability, and let s say has a diagnosis of depression, and this person takes Zoloft.but, the Primary Care Physician gave Zoloft for their depression, do we now have to do a plan of support (SEEP-Social, Emotional and Environmental Plan)? Per (b) if a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a written protocol as part of the ISP to address the social, emotional and environmental needs of the individual related to the symptoms of the psychiatric illness. SEE Plan (5) What if a day program has a plan BUT the home does not have to follow the plan? Why is the Family Living Specialist responsible for gathering the information? As per (5), (5) and (5) if a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a written protocol as part of the ISP to address the social, emotional and environmental needs of the individual related to the symptoms of the psychiatric illness. If the individual is diagnosed with a psychiatric illness and is prescribed medication for the symptoms of that illness, there needs to be a protocol for both the day program and the home. Sign Off Sheet Signature Sheet F- How many sign off sheets will be needed? Is there a separate review signature sheet that is specified that needs to be used with the team? What does the review with the Individual of the ISP mean? Can it count to be at the meeting OR when the ISP comes out you need to re-review the information with the individual? One sign off sheet would be required for each ISP meeting (i.e. annual update, review, etc.) There is no standard ODP review signature sheet needed for compliance with (b). However, ODP has issued a standard ISP meeting signature sheet form that can be used. An individual s attendance at the meeting and receipt of a copy of the plan can satisfy one of the ISP review meetings. The program specialist must still review the ISP with the individual every three months following the ISP meeting or more frequently if the individual's needs change as per (a), (a), (a) and (a). 2/4/11 13 of 14

14 Small Agencies and ISP Meeting Attendance Requirements In regard to Direct Care Staff attending ISP meetings. What do smaller agencies do where the Program Specialist also serves in the direct care capacity? Can the PS also count as the direct care staff? ( ) The intent of the regulation was to have as many people as possible who work with the individual to be present at the meeting. As per (b)(4), (b)(4), (b)(4) and (d)(4) the program specialist or family living specialist as applicable, is required to attend the ISP meeting. As per (b), (b), (b) and (b) at least three plan team members, in addition to the individual, if the individual chooses to attend, shall be present for the ISP, annual update and ISP revision meeting. One person fullfilling two roles cannot count as two people attending the meeting. Supervision (a) Does this effect outcomes? Why is there outcome when there is a supervision section to the ISP? What if the person is at, for example, a status quo of 4 hours and the team has agreed it is not going to increase or decrease? As per (a) an individual may be left unsupervised for specified periods of time if the absence of direct supervision is consistent with the individual's assessment and is part of the individual's ISP as an outcome which requires the achievement of a higher level of independence. Therefore, if the assessment states the individual can be without direct supervision, and the individual wants to work towards a higher level of independence, then there should be an outcome developed to support what the individual needs to obtain. Unlicensed Settings/ Licensed by Another Program Office Does it make a difference if the person is in an unlicensed program such as Transitional Work Services vs. a licensed program in regard to the submission of documents to the SC? This question would also apply to persons in Older Adult Daily Living Centers. Transitional Work Services and Older Adult Daily Living Centers are not covered by these regulations. Transitional work services occur in a location other than a facility subject to 55 Pa.Code Chapter 2380 or Chapter Older adult Daily Living Centers are covered by 6 Pa.Code Chapter 11. Water Safety and Day Services Why is it necessary for Adult Day Training and Vocational Habilitation providers to address an individual s knowledge of water safety in regard to pools and bodies of water. Per regulation (e)(4) and (e)(4), it is necessary because to ensure an individual's health and safety, it is important to know and record information about the individual s ability to understand water safety and temperature safety. 2/4/11 14 of 14