72016 2 dec e[1lv 12-27-16 … · kroh,karen3”° from: mochon, julie sent: tuesday, december 20,...

Kroh,Karen3”°

From: Mochon, JulieSent: Tuesday, December 20, 2016 12:12 PMTo: Kroh, KarenSubject: FW: 6100 draft comments-Mainstay Life ServicesAttachments: 6100 comments-Mainstay Life Services.docx

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From: Dana Schutte Lmailto:[email protected]] DEC 2 72016Sent: Tuesday, December 20, 2016 11:34 AMTo: Mochon, Julie <[email protected]> Independent Regu’atorY

Subject: 6100 draft comments-Mainstay Life Services

Dear Ms. Mochon,

The comments for the 6100 draft regulations are attached for Mainstay Life Services. The other chapters would need

adapted accordingly.

Thankyou,

Dana Schutte I Chief Operating OfficerMainstay Life Services200 Roessler Road I Pittsburgh, PA 15220Tel: 412344.3640 Fax: 412.344.5486Email: [email protected]: www.mainstaylifeservices.org

This e-mail message, including any attachments, is far the sole use of the intended recipient(s) and may contain confidential and

privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient,

please contact the sender by reply e-mail and destroy all copies of the original message.

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Mainstay Life ServicesComments Template

Chapter 6100

Citation: 6100.1. Purpose (a)

Discussion:

Recommendation:

Citation: 6100.2. Applicability

Discussion:

Recommendation:

Citation: 6100.3. Definitions

Discussion:

Recommendation:

Citation: 6100.41. Appeals

Discussion:

Recommendation:

Citation: 6100.42. Monitoring compliance

Discussion:

Recommendation:

Comments on Chapter 6100— Support for Individuals with an Intellectual Disability orAutismDatePage 2 of 29

Citation: 6100A3. Regulatory waiver

Discussion:

Recommendation:

Citation: 6100.44. Innovation project

Discussion:

Recommendation:

Citation: 6100.45. Quality management

Discussion:

Recommendation:

Citation: 6100.46. Protective services

Discussion: Unclear if ElM satisfies the dept. and county reporting requirement

Recommendation: Clarify if additional reporting beyond electronic systemreporting will be required.

Citation: 6100.47. Criminal history checks

Discussion:

Recommendation:

Citation: 6100.48. Funding, hiring, retention and utilization

Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 3 of 29

Discussion:

Recommendation:

Citation: 6100.49. Child abuse history certification

Discussion:

Recommendation:

Citation: 6100.50. Communication

Discussion:

Recommendation:

Citation: 6100.51. Grievances

Discussion: It’s unclear at what point a phone call with a concern becomes agrievance.

Recommendation: Define grievance.

Citation: 6100.52. Rights team

Discussion: Redundant.. .no value added. These issues are addressed throughElM and Investigation Peer review committee. Counties couldn’t manage to attendthese for all providers.

Recommendation: Roll the review of rights violations and abuse as arequirement of the Restrictive ProcedurelHuman Rights Committee (dualcommittee). Require invitation to attend specific portion of the meeting forindividualslfamilies of any effected person.


Citation: 6100.53. Conflict of interest

Discussion:

Recommendation:

Citation: 6100.54. Recordkeeping

Discussion:

Recommendation:

Citation: 6100.55. Reserved capacity

Discussion: Costly if not funded.

Recommendation: Fund vacancies held for individuals while out of aresidential program.

Citation: 6100.81. HCBS provider requirements

Discussion:

Recommendation:

Citation: 6100.82. HCBS documentation

Discussion:

Recommendation:

Citation: 6100.83. Submission of HCBS qualification documentation


Discussion:

Recommendation:

Citation: 6100.84. Provision, update and verification of information

Discussion:

Recommendation:

Citation: 6100.85. Ongoing HCBS provider qualifications

Discussion:

Recommendation:

Citation: 6100.86. Delivery of HCBS

Discussion:

Recommendation:

Citation: 61 00.141. Annual training plan

Discussion: Training requirement for administrative and ancillary staff is too long.While these employees should be trained on the philosophy, the 8 of required and 12total hour requirement is beyond what would be necessary. Job skill training foradministrative staff should not be mandated.

Recommendation: 4 annually training hours for admin staff on EverydayLives, abuse, etc. No job skills training requirement is necessary.

Citation: 61 00.142. Orientation program

Discussion:

Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage6of29

Recommendation:

Citation: 6100.143. Annual training

Discussion: Training requirement for administrative and ancillary staff is too long.While these employees should be trained on the philosophy, the 8 of required and 12total hour requirement is beyond what would be necessary. Job skill trainingrequirement should not be mandated

Recommendation: 4 hours annually on Everyday Lives, abuse, etc. No jobskills training requirement should be mandated for administrativelancillarystaff.

Citation: 6100.144. Natural supports

Discussion:

Recommendation:

Citation: 6100.181. Exercise of rights

Discussion:

Recommendation:

Citation: 6100.182. Rights of the individual

Discussion:

Recommendation:

Citation: 61 00.183. Additional rights of the individual in a residential facility

Discussion:

Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 7of29

Recommendation:

Citation: 6100.184. Negotiation of choices

Discussion:

Recommendation:

Citation: 6100.185. Informing of rights

Discussion:

Recommendation:

Citation: 6100.186. Role of family and friends

Discussion:

Recommendation:

Citation: 6100.221. Development of the PSP

Discussion:

Recommendation:

Citation: 6100.222. The PSP process

Discussion:


Recommendation:

Citation: 61 00.223. Content of the PSP

Discussion:

Recommendation:

Citation: 6100.224. Implementation of the PSP

Discussion:

Recommendation:

Citation: 61 00.225. Support coordination and TSM

Discussion:

Recommendation:

Citation: 6100.226. Documentation of support delivery

Discussion:

Recommendation:

Citation: 61 00.261. Access to the community

Discussion:

Recommendation:

Comments on Chapter 6100 — Support for Individuals with an Intellectual Disability or AutismDatePage 9 of 29

Citation: 6100.262. Employment

Discussion:

Recommendation:

Citation: 6100.263. Education

Discussion:

Recommendation:

Citation: 6100.301. Individual choice

Discussion:

Recommendation:

Citation: 6100.302. Transition to a new provider

Discussion:

Recommendation:

Citation: 6100.303. Reasons for a transfer or a change in a provider

Discussion: Discharge may be necessary if an individual’s behavior causes unduestress or extreme disruption to the other individuals in the home.

Recommendation: Add language that would allow for the rights of the others inthe home in the case of someone who may be causing an unhealthy, stressfulenvironment.


Citation: 6100.304. Written notice

Discussion:

Recommendation:

CitatIon: 6100.305. Continuation of support

Discussion: This can be an incredible burden when no willing provider is locatedwithin a reasonable time. We supported an individual for two years post dischargenotice (his request). This was detrimental to his happiness as well as for hishousemates.

Recommendation: Provide an alternative for individuals who are unable tofind a willing provider within a designated time period.

Citation: 6100.306. Transition planning

Discussion:

Recommendation:

Citation: 61 00.307. Transfer of records

Discussion:

Recommendation:

Citation: 6100.341. Use of a positive intervention

Discussion: Support. Good change of title from “Safe Behavior Managemeiit”

Recommendation:

Comments on Chapter 6100— Support for Individuals with an Intellectual Disability orAutismDatePage 11 of 29

Citation: 6100.342. PSP

Discussion:

Recommendation:

Citation: 6100.343. Prohibition of restraints

Discussion: Title can be misleading to appear that no restraints are allowed, ever

Recommendation: Change title to “Prohibition of certain types of restraints.”

Citation: 61 00.344. Permitted interventions

Discussion:

Recommendation:

Citation: 6100.345. Access to or the use of an individual’s personal property

Discussion:

Recommendation:

Citation: 6100.401. Types of incidents and timelines for reporting

Discussion:#16 Moving medication errors to a 24 hour reporting requirement createsyet another reason for direct care staff to contact managers during their personal time(weekends/holidays). This is an unnecessary burden since serious errors wouldresult in an emergency room visit which would then be reportable in ElM within 24hours. Lesser errors should continue to be reportable within 72 hours.#17 is too nebulous. “A critical health and safety event” is open to interpretationleaving providers vulnerable to the whims of monitors.


Recommendation:#16 Medication errors should not be on the 24 hour list.. .72 hours is sufficient.#17 “Critical health and safety event” should be removed.

Citation: 6100.402. Incident investigation

Discussion: It appears that all reportable incidents require an investigation.

Recommendation: Clarify which incidents require investigating or specifywhere to find such information.

Citation: 6100.403. Individual needs

Discussion:

Recommendation:

Citation: 61 00.404. Final incident report

Discussion:

Recommendation:

Citation: 61 00.405. Incident analysis

Discussion:

Recommendation:

Citation: 6100.441. Request for and approval of changes

Discussion: V

Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 13 of29

Recommendation:

Citation: 6100.442. Physical accessibility

Discussion:

Recommendation:

Citation: 6100.443. Access to the bedroom and the home

Discussion:What about fire emergencies? While the regulation states thatemergency access should be immediate, I’m not sure how that’s possible. Staff aresometimes evacuating multiple people and don’t need to be unlocking more doorsthan necessary---they’re already dealing with hoards of keys and some individualswho need physical assistance to evacuate. If an individual chooses to not use thelock, they shouldn’t be required to have the key.. .although they can choose to havethe key. Requiring permission for each access unless it’s a life threateningemergency is unrealistic. What about changing linens or entering because of a leakin the ceiling while the individual is out of the home?

Recommendation: Change to “lockable” doors on bedrooms for individualswho choose to lock their door. Staff will wait for permission to enter (nonemergency) when the individual is home. Written consent for necessaryaccess while the individual is away.

Citation: 6100.444. Lease or ownership

Discussion:

Recommendation:

Citation: 6100A45. Integration

Discussion:


Recommendation:

Citation: 6100.446. Facility characteristics relating to size of facility

Discussion: I think this regulation may catch in its net the VERY INTEGRATED semiindependent, unlicensed apartment programs of some providers. It also violates therights of individuals who want to live near their friends and staff. It shouldn’t matterhow many apartments are in a building as long as the building is well integrated in acommunity that serves a mostly non-disabled population (non-campus setting—fewerthan 10% of units). These individuals navigate the community on their own and arecompetitively employed. They come and go as they please. Having the group withinclose proximity allows for a level of oversight that maximizes these opportunities forindependence. Some of these individuals may lose independence if they are forced tolive further away from their support circle. I’m not clear on the definition of facility. Ifeach apartment is billed separately (2 person unlicensed) is it a different “facility” thanthe apartment across the hall?

Recommendation: Carve out semi-independent unlicensed apartmentprograms within a larger integrated complexlcommunity (non-campus setting).Clarify what constitutes a facility.

Citation: 6100.447. Facility characteristics relating to location of facility

Discussion:

Recommendation:

Citation: 6100.461. Self-administration

Discussion:

Recommendation:

Citation: 6100.462. Medication administration

Discussion: Including life sharing providers seems excessive. The life sharingmodel is the most inclusive, natural model offered. Having these providers adhere to


storage and documentation requirements is counterproductive to this most naturalsupport

Recommendation: Define some less stringent medication training for lifesharing providers.

Citation: 6100.463. Storage and disposal of medications

Discussion:

Recommendation:

Citation: 6100.464. Labeling of medications

Discussion:

Recommendation:

Citation: 6100.465. Prescription medications

Discussion:

I Recommendation:

Citation: 6100.466. Medication records

Discussion:

Recommendation:

Citation: 6 100.467. Medical errors


Discussion:

Recommendation:

Citation: 6100.468. Adverse reaction

Discussion:

Recommendation:

Citation: 6100.469. Medication administration training

Discussion:

Recommendation:

Citation: 61 00.470. Exception for family members

Discussion: Support this.. ..include life sharing providers.

Recommendation: Include Life sharing providers in this section.

Citation: 6100.481. Department rates and classifications

Discussion:

Recommendation:

Citation: 6100.482. Payment

Discussion:


Recommendation:

Citation: 6100A83. Title of a residential building

Discussion:

Recommendation:

Citation: 6100.484. Provider billing

Discussion:

Recommendation:

Citation: 6100.485. Audits

Discussion:

Recommendation:

Citation: 6100.486. Bidding

Discussion:

Recommendation:

Citation: 6100.487. Loss or damage to property

Discussion:

Recommendation:


Citation: 61 00.571. Fee schedule rates

Discussion: More of a commitment needs to be made to keeping fees in line withrising costs. (b) The Department will refresh the market-based data used in subsection (a) toestablish fee schedule rates at least every 3 years.

Recommendation: Adhere to methodology that utilizes Medicare Home HealthMarket Basket Index to adjust fees every year.

Citation: 6100.641. Cost-based rate

Discussion:

Recommendation:

Citation: 6100.642. Assignment of rate

Discussion:

Recommendation:

Citation: 61 00.643. Submission of cost report

Discussion:

Recommendation:

Citation: 6100.644. Cost report

Discussion:


Recommendation:

Citation: 6100.645. Rate setting

Discussion:

Recommendation:

Citation: 6100.646. Cost-based rates for residential habilitation

Discussion:

Recommendation:

Citation: 6100.647. Allowable costs

Discussion:

Recommendation:

Citation: 6100.648. Donations

Discussion:

Recommendation:

Citation: 6100.649. Management fees

Discussion:

Recommendation:


Citation: 6100.650. Consultants

Discussion:

Recommendation:

Citation: 6100.651. Governing board

Discussion:

Recommendation:

Citation: 6100.652. Compensation

Discussion: (b) A bonus or severance payment, that is part of a separation package, is not anallowable cost.This is a cost of doing business and should be allowable. However, under a fee based system, thesecosts are irrelevant to the state.

Recommendation: Change bonus or severance packages to “aIIowabe”.

Citation: 6100.653. Training

Discussion:

Recommendation:

Citation: 6100.654. Staff recruitment

Discussion:

Recommendation:


Citation: 6100.655. Travel

Discussion:

Recommendation:

Citation: 61 00.656. Supplies

Discussion:

Recommendation:

Citation: 6100.657. Rental equipment and furnishing

Discussion:

Recommendation:

Citation: 61 00.658. Communication

Discussion:

Recommendation:

Citation: 6100.659. Rental of administrative space

Discussion:

Recommendation:

Citation: 6100.660. Occupancy expenses for administrative buildings

Discussion:


Recommendation:

Citation: 6100.661. Fixed assets

Discussion:

Recommendation:

Citation: 6100.662. Motor vehicles

Discussion: (2) The provider shall keep a daily log detailing the use, maintenance and servicesactivities of vehicles.The “maintenance and services activities” is onerous to providers. Other oversight (state inspection,etc.) assure the safety of vehicles in PA.

Recommendation: Change to include only usage.

Citation: 6100.663. Fixed assets of administrative buildings

Discussion: (c) The provider shall receive prior written approval from the Department for a plannedmajor renovation of an administrative building with a cost above 25% of the original cost of theadministrative building being renovated.The “prior written approval” for “25% of the original cost” does not factor in real estate appreciationfor buildings held for decades and adds to the administrative burden of providers.

Recommendation: Remove or change to 25% of current building value.

Citation: 6100.664. Residential habilitation vacancy

Discussion:


Recommendation:

Citation: 6100.665. Indirect costs

Discussion: (d) The provider shall select an allocation method to assign an indirect cost inaccordance with the following: (1) The method is best suited for assigning a cost with a benefitderived. (2) The method has a traceable cause and effect relationship. (3) The cost cannot be directlyattributed to an HCBS. (e) The provider shall allocate a general expense in a cost group that is moregeneral in nature to produce a result that is equitable to both the Department and the provider.Providers are already required to follow the Federal Super Circular and GAAP for indirect costallocation. This section is redundant and not necessary.

Recommendation: Remove section (d).

Citation: 6100.666. Moving expenses

Discussion:

Recommendation:

Citation: 6100.667. Interest expense

Discussion:

Recommendation:

Citation: 6100.668. Insurance

Discussion:

Recommendation:

Citation: 6100.669. Other allowable costs


Discussion:

Recommendation:

Citation: 6100.670. Start-up cost

Discussion:

Recommendation:

Citation: 6100.671. Reporting of start-up cost

Discussion:

Recommendation:

Citation: 6100.672. Cap on start-up cost

Discussion: (a) A cap on start-up cost will be established by the Department.Currently, the state only has $200,000 in a fund to reimburse up to $5,000 per new individual for startup costs on a first come, first serve basis. If the state is not planning to fund every provider’s start upcosts at a high enough amount, this cap will not be an incentive for providers to open new homes.

Recommendation: Increase cap and fund this more realistically.

Citation: 6100.681. Room and board applicability

Discussion:

Recommendation:

Citation: 6100.682. Support to the individual


Discussion:

Recommendation:

Citation: 6100.683. No delegation permitted

Discussion:

Recommendation:

Citation: 6100.684. Actual provider room and board cost

Discussion:

Recommendation:

Citation: 6100.685. Benefits

Discussion:

Recommendation:

Citation: 6100.686. Room and board rate

Discussion:

i Recommendation:

Citation: 6100.687. Documentation

Discussion:


Recommendation:

Citation: 6100.688. Completing and signing the room and board residencyagreement

Discussion:

Recommendation:

Citation: 61 00.689. Modifications to the room and board residency agreement

Discussion:

Recommendation:

Citation: 6100.690. Copy of room and board residency agreement

Discussion:

Recommendation:

Citation: 6100.691. Respite care

Discussion:

Recommendation:

Citation: 6100.692. Hospitalization

Discussion:


Recommendation:

Citation: 61 00.693. Exception

Discussion:

Recommendation:

Citation: 61 00.694. Delay in an individual’s income

Discussion:

Recommendation:

Citation: 61 00.711. Fee for the ineligible portion of residential habilitation

Discussion: (c) The Department will refresh the market-based data used in subsection (a) toestablish Department-established fees at least every 3 years.

I Recommendation: Use Medicare Home Health Market Basket Index and adjustfees annually.

Citation: 6100J41. Sanctions

Discussion:

Recommendation:

Citation: 61 00.742. Array of sanctions

Discussion: If these are not licensing regulations, the language should not be sofocused On corrective action.


Recommendation: Change title to “Remediation.”

Citation: 6100.743. Consideration as to type of sanction utilized

Discussion:

Recommendation:

Citation: 6100.744. Additional conditions and sanctions

Discussion:

Recommendation:

Citation: 6100.801. Adult autism waiver

Discussion:

Recommendation:

Citation: 6100.802. Agency with choice

Discussion:

Recommendation:

Citation: 6100.803. Support coordination, targeted support management andbase-funded support coordination

Discussion:


Recommendation:

Citation: 6100.804. Organized health care delivery system

Discussion:

Recommendation:

Citation: 6100.805. Base-funded support

Discussion:

Recommendation:

Citation: 6100.806. Vendor goods and services

Discussion:

Recommendation:

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72016 2 dec e[1lv 12-27-16 … · kroh,karen3”° from: mochon, julie sent: tuesday, december 20,...

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