PA To End Pandemic-Era Flexibilities for Community HealthChoices and OBRA Waivers

Effective May 11, 2023, the Office of Long-Term Living (OLTL) is planning to end temporary pandemic-related flexibilities and resume normal waiver operations for the CHC and OBRA waiver programs. While many participants will not notice any change, the end of these flexibilities could impact consumers who have been opting for telephone assessments or getting paid care from a spouse, legal guardian, power of attorney or representative payee.

Since March 2020, OLTL’s programs have been operating under Appendix K waiver amendments authorized by the Centers for Medicare and Medicaid Services (CMS). OLTL’s Appendix K waivers allowed temporary changes to the CHC and OBRA waiver program to give these programs more flexibility to respond to the COVID-19 pandemic. Most of these changes, which were also extended to the Act 150 program where applicable, were aimed at expanding the settings where HCBS services could be provided, or allowing more flexibility in who could provide those services. The end of the Appendix K flexibilities means OLTL will begin enforcing the pre-COVID rules again. OLTL selected the May 11 end-date to coincide with the end of the federal COVID-19 Public Health Emergency.

OLTL presented an update on the end of the Appendix K flexibilities at the recent Medical Assistance Advisory Committee (MAAC) on February 23. Below is a summary of some of the major changes announced by OLTL:

Return of Face-to-Face Assessments and Service Coordination

Initial level of care assessments using the functional eligibility determination (FED) must be conducted face-to-face; this includes level of care assessments for nursing facility residents.

For participants already in the CHC or OBRA Waivers, annual comprehensive needs assessments and reassessments must also be conducted face-to-face. Service coordinators will no longer be permitted to do telephonic assessments and will also have to resume in-person monitoring visits.

As a reminder, the CHC Waiver requires participants to have an in-person comprehensive needs assessment at least once a year, as well as within 14 days of a triggering event (such as a hospitalization, change in caregiver status, or a request for an assessment). PHLP wants to hear from participants who experience service reductions or denials after May 11 without going through a face-to-face assessment! Please call our Helpline at 1-800-274-3258 for assistance!

The CHC Waiver also requires service coordinators to meet with participants every 3 months to make sure their service plan is meeting their needs. At least two of these quarterly visits must be in-person; the other two can be by phone.  These are meant to be short check-ins, not a full assessment, although the full annual assessment can be done as part of one of the quarterly visits. In other words, participants should be seeing their service coordinators face-to-face at minimum twice a year – once for a full comprehensive needs assessment, and once for a shorter quarterly check-in visit.  

Return of Prohibitions on Paid Care by Spouses and Others

Spouses, legal guardians, representative payees, and those holding power of attorney will no longer be allowed to serve as paid caregivers. This was the rule before the pandemic, but under the Appendix K amendments, OLTL had allowed a small number of these individuals to be paid caregivers on a case-by-case basis. Those previously approved as direct care workers will no longer be paid for hours worked after May 11, 2023. OLTL is not expected to make any exceptions to this rule. Participants and families who are impacted by this return to pre-COVID restrictions should start working with their CHC plans and service coordinators to identify a qualified paid caregiver.

Return of Usual Settings Rules for Certain Services

Effective May 11, residential habilitation, structured day habilitation, and adult daily living services may no longer be provided in private homes. Additionally, adult daily living services, structured day habilitation, cognitive rehabilitation, and counseling services may no longer be provided remotely using phone or video conferencing. The Appendix K Amendments had given more flexibility for these services to be provided by staff in private homes, or to be provided remotely using phone or video conferencing.