ATTACHMENT 1 1 3/31/2016 Click to add footer text GLOSSARY - - PDF document

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ATTACHMENT 1

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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]
• r 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.

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GLOSSARY

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• 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.

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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.

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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.

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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

• ther 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.

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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.

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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.

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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.

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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.

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• 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

• r feasible (i.e. when the participant is not learning, enhancing, or maintaining a

skill). This service can be used for asleep hours

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• 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

• f 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

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• LICENSED DAY HABILITATION

Licensed Day Habilitation consists of supervision, training, and supports in general areas of self-care, communication, community participation, and socialization. This service is facility-based and is licensed under Chapter 2380.

• PREVOCATIONAL

Prevocational services are provided to assist individuals in developing skills necessary for competitive employment. This service is facility-based and is licensed under Chapter 2390.

• RESIDENTIAL HABILITATION

Residential Habilitation protects the health and welfare of participants by acquiring and maintaining skills necessary to reside successfully in the community. Skills include self-care, communication, mobility, socialization and motor skills.

• RESPITE

Respite is a service provided on a short-term basis to relieve those persons normally providing care to reduce stress, address personal crisis or provide care to the individual due to the caregiver’s absence or need for relief. Individual’s can receive two categories of respite services: 24-hour respite and 15- minute respite.

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• SUPPORTED EMPLOYMENT

Supported Employment Services are direct and indirect services that are provided in a variety of community employment work sites with co-workers who do not have disabilities for the purposes of finding and supporting participants in competitive jobs

• f their choice.

Supported Employment Services are categorized as either job finding or job support services.

• SUPPORT BROKERS

The Supports Broker service is available to participants who elect to self-direct their

• wn services utilizing one of the participant directed options of the waiver. The

Supports Broker service is designed to assist participants or their designated surrogate with employer-related functions in order to be successful in self-directing some or all

• f the participants needed services
• SUPPORTS COORDINATION

Supports Coordination is a critical service that involves the primary functions of locating, coordinating, and monitoring needed services and supports for waiver participants . Supports Coordinators assist individuals in developing their Individual Support Plans, choosing providers and informal supports

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• THERAPY SERVICES

Therapy services are direct services provided by health care and other professionals that enable individuals and families to increase or maintain their ability to perform activities of daily living. These include physical therapy, occupational therapy, speech and language therapy, visual and mobility therapy, behavioral therapy and nursing services.

• TRANSITIONAL WORK

Transitional work services offer work experience in a real work environment that is integrated and supervised. These environments are often known as mobile work force, work station in industry, affirmative industry and enclave

• TRANSPORTATION

Transportation services are offered to enable individuals to access services and activities specified in their approved ISP. Transportation may also be funded and provided through another waiver service. Transportation services include those delivered by:

• providers,
• family or other licensed drivers on a mile by mile basis,
• public transportation to promote self-determination,
• transportation on a trip-basis.

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GLOSSARY

• Waiver - The Consolidated and Person/Family Directed

Support Home and Community-Based Waivers approved by the Centers for Medicare and Medicaid Services under section 1915(c) of the Social Security Act.

• Waiver Assurance - CMS requirements for performance

which states must meet when addressing the unique challenges of assuring the quality of services for individuals in the waivers.