3/31/2016 ATTACHMENT 1 1 3/31/2016 Click to add footer text GLOSSARY • Administrative Entity [AE] - A county/joinder or non-governmental entity with an agreement or contract with the Department of Human Services to perform operational and administrative functions delegated by the Department, related to the Department’s approved Consolidated and Person/Family Directed Support (P/FDS) Waivers. The ‘lead’ AE and ‘qualifying’ AE is the AE where a provider serves the majority of its service recipients • Applicant - An individual provider, Service Support Worker [SSW] or agency provider in the process of enrolling as an Home and Community Based Service [HCBS] provider with the Department. • Consolidated Waiver -A Federally-approved 1915(c) waiver under section 1915(c) of the Social Security Act designed to help participants with an intellectual disability 3 years of age older with an ICF/ID level of care to live more independently in their homes and communities. 3/31/2016 2 Click to add footer text 1
3/31/2016 GLOSSARY • Center For Medicare and Medicaid Services [CMS] The Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (DHHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children's Health Insurance Program (SCHIP), and health insurance portability standards. 3/31/2016 3 Click to add footer text GLOSSARY • Everyday Lives - Everyday Lives is the core philosophy and framework of the Commonwealth of Pennsylvania’s Office of Developmental Programs (ODP). The fundamental concept of Everyday Lives is that, with the support of family and friends, individuals with disabilities decide how to live their lives and what supports they need. It also means that they are responsible for their decisions and actions. HCBS - Home and Community-Based Services — An array of • medical, financial and social services or goods not covered by third-party medical resources or other funding sources that are necessary and paid for by the Department to assist a participant to live in the community. 4 3/31/2016 Click to add footer text 2
3/31/2016 GLOSSARY • Home and Community Services Information System [ HCSIS] — A secure web enabled information system which manages information regarding participants and providers of waiver services. [HCSIS is being replaced with alternative platforms over the coming years] • Health Care Quality Unit [HCQU] – The 8 HCQUs are geographically dispersed contracted entities that work to support and improve the health information and knowledge for the intellectual disability community service system by building capacity and competency within the physical and behavioral health care systems as well as the stakeholders of the ID system. 5 3/31/2016 Click to add footer text GLOSSARY • Health Insurance Portability and Accountability Act of 1996 HIPAA – Federal privacy regulations commonly known as the HIPAA Privacy Rule. HIPAA requires most doctors, nurses, pharmacies, hospitals, nursing homes, and other health care providers to protect the privacy of health information. • Intellectual Disability [ID] - Documented sub average general intellectual functioning that occurs prior to the participant’s 22nd birthday and is accompanied by significant limitations in adaptive functioning in at least two areas. 6 3/31/2016 Click to add footer text 3
3/31/2016 GLOSSARY • Individual Support Plan [ISP] — The plan for each individual supported by ODP developed with the Individual and the Individual’s team. The team includes the Individual and Supports Coordinator, and may also include family members, surrogates, advocates, providers of services, and others the Participant chooses. • The ISP must include at a minimum the estimated frequency, duration and scope of each Waiver-eligible service. The ISP is approved and authorized by the AE. The Provider then furnishes each service in accordance with the plan. 7 3/31/2016 Click to add footer text GLOSSARY • PA Plus – The PA Plus is an assessment tool used concurrently with the Supports Intensity Scale™. It consists of a set of nine questions to provide additional planning information not covered in the Supports Intensity Scale™ assessment. Topics include supports needed for mobility, transfers, vision, hearing, communication, and safety, as well as assistive technology, treatments, medications and behavioral health. • Participant – Individual determined eligible for waiver services and choosing to enroll, or is enrolled, in the ODP waivers. • Person/Family Directed Support Waiver [P/FDSW] – A Federally- approved 1915(c) waiver under section 1915(c) of the Social Security Act designed to support participants with an intellectual disability 3 years of age or older to live more independently in their homes and communities. 8 3/31/2016 Click to add footer text 4
3/31/2016 GLOSSARY • Positive Approaches - Positive Approaches is a worldview in which all individuals are treated with dignity and respect, and all are entitled to the core values identified in “Everyday Lives”. • PROMISe ™ - Provider Reimbursement and Operations Management Information System in electronic format - Providers of waiver and base services submit claim transactions through the Commonwealth’s Medicaid Management Information System, PROMISe ™ • Provider Monitoring – a statewide, standardized methodology to evaluate waiver provider’s compliance with the waivers and 55 PA Code Chapter 51 regulations. 9 3/31/2016 Click to add footer text GLOSSARY • Provider Agreement for Participation in Pennsylvania’s Consolidated and Person/Family Directed Support Waivers or Waiver Provider Agreement – The agreement established between the Department, as the state Medicaid agency and a service Provider as per 42 CFR 431.107, under which the Provider or organization agrees to furnish services to Medicaid Waiver Participants in compliance with state and federal requirements, including Waiver requirements approved by CMS. • Provider Qualification – A bi-ennual process by which all Consolidated and P/FDS Waiver providers must be deemed qualified to provide their applicable services. 10 3/31/2016 Click to add footer text 5
3/31/2016 GLOSSARY • SERVICE DEFINITIONS • ASSISTIVE TECHNOLOGY Assistive technology that can be used to increase, maintain or improve functioning can also be funded including training and software. An evaluation and recommendation with a letter of medical necessity Must be completed for eligibility. • BEHAVIOR SUPPORT This is a service that includes functional assessment; the development of strategies to support the participant based upon assessment; and the provision of training to participants, staff, parents and caregivers. Services must be required to meet the current needs of the participant, as documented and authorized in the ISP • COMPANION Companion services are provided to participants living in private homes for the limited purposes of providing supervision and assistance that is focused solely on the health and safety of the adult participant with an intellectual disability. Companion Services are used in lieu of Home and Community Habilitation Services to protect the health and welfare of the participant when a habilitative outcome is not appropriate or feasible (i.e. when the participant is not learning, enhancing, or maintaining a skill). This service can be used for asleep hours 3/31/2016 11 3/31/2016 Click to add footer text GLOSSARY • HOME AND COMMUNITY HABILITATION Home and Community Habilitation is provided in home and community settings to assist individuals in acquiring, maintaining, and improving self-help, domestic, socialization, and adaptive skills necessary to reside successfully in home and community-based settings. • HOME AND VEHICLE ADAPTATIONS Home accessibility adaptations consist of certain modifications to the private home of the participant (including homes owned or leased by parents/relatives with whom the participant resides and family living homes that are privately owned, rented, or leased by the host family) which are necessary due to the participant’s disability, to ensure the health, security of, and accessibility for the participant, or which enable the participant to function with greater independence in the home. Vehicle accessibility adaptations consist of certain modifications to the vehicle that the participant uses as his or her primary means of transportation to meet his or her needs. The modifications must be necessary due to the participant’s disability. • HOMEMAKER CHORE SERVICES Homemaker/Chore services enable an individual to remain in their private residence by providing physical assistance in areas including meal preparation, cleaning and household care and maintenance 12 3/31/2016 Click to add footer text 6
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