The Office of the Secretary of the U.S. Department of Transportation (DOT) has issued guidance to public transportation and emergency management agencies to emphasize the needs of individuals with disabilities following a disaster. The DOT document responds to a request by the Interagency Coordinating Council on Emergency Preparedness and Individuals with Disabilities (ICC). To access the ICC’s 2009 report, and for more information regarding the ICC, please visit www.DisabilityPreparedness.gov. Applicable regulatory provisions underlying this guidance can be found in 49 CFR Part 37, Transportation Services for Individuals with Disabilities, at http://www.fta.dot.gov/civilrights/ada/civil_rights_3906.html. The Federal Transit Administration has published a guide: Disaster Response and Recovery Resource for Transit Agencies that provides additional information for transit agencies and communities on planning for and meeting the needs of people with disabilities following a disaster. That report is available at http://go.usa.gov/N8U.
The U.S. Substance Abuse Mental Health Services Administration (SAMHSA) recently announced a new working definition of recovery from mental disorders and substance use disorders. The new working definition of Recovery from Mental Disorders and Substance Use Disorders is as follows: A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Through the Recovery Support Strategic Initiative, SAMHSA also has delineated four major dimensions that support a life in recovery: Health: Overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way. Home: A stable and safe place to live. Purpose: Meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society. Community: Relationships and social networks that provide support, friendship, love, and hope. The definition is the product of a year-long effort by SAMHSA and a wide range of partners in the behavioral health care community and other fields to develop a working definition of recovery that captures the essential, common experiences of those recovering from mental disorders and substance use disorders. SAMHSA led this effort as part of its Recovery Support Strategic Initiative. Read the full press release at http://www.samhsa.gov/newsroom/advisories/1112223420.aspx. Learn more about the SAMHSA Recovery Support Initiative at http://www.samhsa.gov/recovery/.
An amended Independence Waiver that has been approved by the Centers for Medicare and Medicaid Services (CMS) has been posted to the PA Office of Long-Term Living (OLTL) website. See http://www.portal.state.pa.us/portal/server.pt?open=514&objID=733698&mode=2. On its website OLTL indicates that the services provided through the Independence Waiver may be able to help adults with physical disabilities to live or remain in the community and remain as independent as possible. To be eligible for the Independence Waiver you must be a Pennsylvania resident between the ages of 18 and 60. Individuals who are currently in the waiver and were enrolled prior to July 1, 2006 will age in place. FMI: View the 2011 Independence Waiver (an accessible version of this document is available upon request) http://www.portal.state.pa.us/portal/server.pt?open=514&objID=733698&mode=2. The 2011 OLTL Global Corrective Action Work Plan is also at http://www.portal.state.pa.us/portal/server.pt?open=514&objID=733698&mode=2.
On December 29, Department of Public Welfare (DPW) Office of Developmental Programs (ODP) issued ODP Informational Memo 180-11 with a Uniform Construction Code Clarification for Licensed Providers. ODP Memo 180-11is directed to providers with sites licensed or may be licensed under 55 Pa Code § 2380, 2390, 6400, and 6500 regulations. The memo was issued to clarify the application of the Fire and Panic Regulation (F&P) and Uniform Construction Code (UCC) for sites that require licensure by ODP in order to comply with regulation 55 Pa Code §2380.14, 55 Pa Code §2390.14, 55 Pa Code §6400.14(a), 55 Pa Code §6500.16 and 55 Pa Code §20.35(a).The memo says that effective immediately, the Department of Public Welfare (DPW) is requiring that all providers include a copy of their Certificate of Occupancy, as applicable, along with their initial application packet, addendum for all new sites, and renewal applications if the certificate of occupancy has changed. ODP says that the provider may reference the link below or contact their local municipality to determine if their municipality has decided to take on the responsibility (“opted in”) to enforce the Pennsylvania Uniform Construction of Code. If so, the provider is responsible to contact the municipality where the home is located in order to obtain the certificate of occupancy. If the municipality decided not to apply the Uniform Construction of Code (“opted out”), the Department of Labor and Industry is responsible for all commercial code enforcement in that municipality. For a complete list of Pennsylvania’s municipalities and their decisions regarding local enforcement of the UCC can be accessed at http://www.portal.state.pa.us/portal/server.pt/community/uniform_construction_code/10524/local_enforcement/596334. FMI: See www.odpconsulting.net.
On December 29 the PA Department of Public Welfare (DPW) Office of Developmental Programs (ODP) issued newly corrected cover letters and policy bulletins related to five (5) public notices recently published in the Pennsylvania Bulletin announcing the rate setting methodology and fee schedule rates for specific time periods covered in FY 2011/2012 DPW ODP said that the corrections were minor and do not affect the content of the bulletins. The bulletins were: Office of Developmental Programs (ODP) Bulletin #00-11-08, “Rate Setting Methodology for Consolidated and Person/Family Directed Support Waivers and Base-Funded Services for Individuals Participating in the Office of Developmental Programs Service System from July 1, 2011 through November 14, 2011”; Office of Developmental Programs (ODP) Bulletin #00-11-09, “Medical Assistance Program Fee Schedule for select Services in the Consolidated and Person/Family Directed Support Waivers and Community Mental Retardation Base Program Effective July 1, 2011 through November 14, 2011”; Office of Developmental Programs (ODP) Bulletin #00-11-10, “Rate Setting Methodology for Consolidated and Person/Family Directed Support Waivers and Base-Funded Services for Individuals Participating in the Office of Developmental Programs Service System from November 15, 2011 through June 30, 2012”. Office of Developmental Programs (ODP) Bulletin #00-11-11, “Medical Assistance Program Fee Schedule for select Services in the Consolidated and Person/Family Directed Support Waivers and Community Mental Retardation Base Program Effective November 15, 2011 through June 30, 2012”; Office of Developmental Programs (ODP) Bulletin # 00-11-12, “Adult Autism Waiver, FY 2011-2012 Service Rates”. FMI: See www.odpconsulting.net.
In the December 31 edition of the Pennsylvania Bulletin, the PA Insurance Department and the PA Department of Health published a joint notice to Pennsylvania insurers, including managed care plans, concerning external review under the Affordable Care Act. The notice said that the Departments were responding to a determination issued on July 29, 2011 by the U.S. Department of Health and Human Services that the Commonwealth of Pennsylvania does not meet federal requirements for external review under the Affordable Care Act (ACA) and a letter sent on November 22, 2011 by the Centers for Medicare and Medicaid Services (CMS) requiring issuers of health insurance in the Commonwealth to make good faith efforts to come into compliance with Federal law and to be fully participating in a Federally-administered external review process on January 1, 2012. The Departments said that they are reminding managed care plans that the requirements of PA Act 68 remain in effect after January 1, 2012, except to the extent that federal law has replaced those requirements. Thus, issues of network adequacy, contract review, credentialing, which are dealt with by the Department of Health, and prompt pay, which is dealt with by the Insurance Department, among other matters, will still be reviewed by the relevant department. The Departments said that they will continue to review as complaints matters that are not considered adverse benefit determinations as defined by the ACA and its regulations in the same manner as before the passage of the ACA. Complaints relating to contract exclusions, and issues relating to co-payments, formulary changes, out-of-network benefits, and services beyond the contractual limitation should continue going to the PA Departments and not go to HHS. However, adverse benefit determinations, as defined by the ACA, will be subject to Federal review. Adverse benefit determinations include issues that relate to denials, reductions, terminations or failures to provide or make payment in whole or in part for a benefit. FMI: See www.pabulletin.com