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Office of Developmental Programs

SCO Monitoring Tool: Cycle 4 (2014-2015)

ODP Guidelines for Completing the SCO Monitoring Tool

SCO Monitoring Tool Instructions

I. Overview of SCO Monitoring ToolThis SCO Monitoring Tool is designed to assess an SCO’s structure and practices across a number of measures to ensure compliance with regulations, waiver requirements, Provider Agreement terms, and policies and procedures.

This tool consists of 67 questions (including a comment box) addressing compliance standards divided broadly into 21 Oversight Areas. The “compliance standards” are policy statements taken from the waivers, regulations, the Provider Agreement and bulletins that will be measured and recorded with this tool.

II. Tool UsersThe tool is intended for use by the following users:

A. SCOs: SCOs need to complete and submit this tool once annually. B. ODP Reviewers: ODP Reviewers will validate SCO responses during the on-site monitoring phase.

III. Tool Completion InstructionsThe following guidelines are intended to help a user successfully complete and submit this tool on-line.

A. ODP suggests each SCO print the PDF version of the tool, or download the Word version of the tool and mark answers on one of those documents before transferring final answers to the web-based tool. The web-based tool will allow a user to print a submission once complete.

B. Using the Sample for Record Review: During the SCO reporting phase, each SCO shall conduct required monitoring activities by completing this standardized SCO monitoring tool, based on the sample distribution of records provided to the SCO by ODP. The record review time period is July 1, 2013 to June 30, 2014.

1. For each SCO’s distribution of records, ODP shall identify 2.0% of the total population of waiver participants whose records shall be reviewed as part of the SCO Monitoring review, with a minimum of 10 records. The individuals chosen in the ODP distribution are identified only by the individuals’ MCI numbers. In addition to the initial waiver participants provided in the distribution, ODP also provides an additional alternative 5 waiver participants to be used if there are extenuating circumstances. The SCO must use the initial waiver participants as identified by ODP. The use of the alternative 5 waiver participants is acceptable if the waiver participant has passed away during the review period, transferred to a different SCO or was dis-enrolled from the Waiver during the review period. The alternative participants should NOT be used to replace individuals who enrolled in a waiver during the review period. The review should begin with the start date of the waiver.

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ODP Guidelines for Completing the SCO Monitoring Tool2. If ODP determines the need to review additional records during the ODP on-site review, it may automatically include these

additional alternative 5 waiver participants’ records in the on-site review, as well as other priority records.

B. Completing the Tool:1. All questions must be answered before the tool can be submitted.2. There are two question formats in this tool:

a. Yes/No: Answer these questions by selecting 'yes' or 'no' based on the guidelines provided. ‘N/A’ can only be chosen where indicated in the question. If there is a circumstance where N/A applies but is not an option, choose ‘Yes’ and explain the reason in the Section Comments box at the end of the section.

b. Data entry questions: These questions require text or integer (number) information. Please be sure to enter integer information as numbers (i.e., 10 instead of ten).

3. Instructions for SCOs: When responding to questions in this tool, SCOs must retain all related documentation for the sample group, including policy & procedure documentation, training curricula, training records, etc. This file with supportive or documentary evidence (referred to as “relevant documentation” throughout this tool) must be retained and made available to the ODP reviewers either prior to and during the on-site monitoring.

IV. General instructions1. If you have questions, issues or concerns about the tool questions or technical difficulties, please contact ra-

[email protected].

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mailto:[email protected]



Monitoring Questions Source Document /ODP Guidelines Implementation Guidelines/Suggested Remediation

1)

Question:What is the legal IRS name of the SCO Organization?

1A) – DBA (Doing Business As)

2)Question:What is the MPI# of the SCO Organization?

3)

Question:In which region is the SCO located? Central Northeast Southeast West

• If the SCO serves waiver participants in multiple regions, please designate the region in which the SCO serves the most waiver participants.

4)Question:What is the SCO’s primary Administrative Entity (county) of operations?

• This is the AE in which the SCO serves the most number of waiver participants.

5)

Question:Reviewer contact information (for the person entering this report)

Contact Name (first and last name):

Contact Phone Number (no space or dash):

Contact E-mail Address:

• Reviewer will enter the contact information for the primary contact person in the organization who is responsible for SCO Monitoring. This should be the person who is entering the report.

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Monitoring Questions Source Document / ODP Guidelines Implementation Guidelines / Suggested Remediation

6)

Oversight area: Monitoring requirementsCompliance Standard: The SCO participated in all aspects of SCO Monitoring

Question: Did the SCO submit all supporting documentation identified on the on-site checklist? Did the SCO submit by the submission deadline?

Yes, the SCO submitted all documentation

No, the documentation was not submitted

Source Document(s): Consolidated and P/FDS Waivers

• Reviewer will review the date of submission of the required paperwork to the SCO Monitoring mailbox ([email protected])

Plan of Improvement• The SCO should provide the documentation to the SCO

Monitoring mailbox by the submission deadline in the next SCO Monitoring cycle

7)

Oversight area: StaffingCompliance Standard: The SCO ensures that staff are not on any exclusion lists.

Question: Does the SCO have a policy/procedure for checking whether staff or anyone they contract with is listed on the LEIE (List of Excluded Individuals and Entities), SAM (System for Award Management) and DPW’s Medicheck list and is it implemented?

Yes, the SCO has a policy

No, there is no policy

Source Document(s): MA Bulletin 99-11-05 – Provider Screening of Employees and Contractors for Exclusion from Participation in Federal Health Care Programs and the Effect of Exclusion on Participation; 55 Pa Code Chapter 51 Sections 51.62, 51.141 and 51.152;ODP Announcement 031-13 – Migration of the Excluded Parties List System to the System for Award Management

• Reviewers will review the SCO’s policy/procedure for checking exclusion lists (LEIE, SAM and DPW’s Medicheck).

• The policy must include a process for screening their employees and contractors (individuals and entities) to determine if they have been excluded from participation in Medicare, Medicaid or any other federal health care program. Screening should occur prior to hire and on an ongoing monthly basis after hire.

Remediation:• The SCO will develop/modify a policy/procedure for

checking whether staff or anyone they contract with is listed on LEIE, SAM and DPW’s Medicheck list.

• If the SCO has no process in place, they will immediately check the lists to ensure that no staff or contractors are excluded. If staff or contractors are found to be on one or more of the lists, the SCO will terminate contracts with the staff/contractor and void all SNs associated with the staff/contractor.

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8)

Oversight area: Deaf ServicesCompliance Standard: The SCO has a written protocol for delivery of deaf services.

Question: Does the SCO have a written protocol for how staff will request and obtain the necessary communication assistance for individuals who are deaf or hard of hearing?

Yes, the SCO has a written protocol

No, there is no protocol

Source Document(s): ODP Bulletin # 00-14-04, Accessibility of Intellectual Disability Services for Individuals Who Are Deaf, page 3.

• Reviewers will review the protocol to ensure it contains details on how SCO staff will request and obtain necessary communication assistance.

Remediation:• The SCO should develop a written protocol that meets the

requirement.

9)

Oversight area: The SCO meets the conflict-free requirement in the approved waiversCompliance Standard: The SCO maintains its conflict-free status.

Question: Does the SCO continue to meet the conflict-free requirement?

Yes, the SCO is conflict-free

No, a conflict exists

Source Document(s): 55 Pa. Code Chapter Waiver Regulations,51, 51.33(c), Consolidated and P/FDS Waivers - Qualifications for Supports Coordination Organization, ODP Bulletin, #00-10-06, Supports Coordination Services, page 5 (J).

• Reviewer will review Supports and Services Directory (SSD), PROMISe, and other HCSIS information.

• Conflict free is an independent, separate or self-contained agency that does not provide direct or indirect services to participants.

Remediation:• The SCO should be able to verify conflict free status.• DCAP to develop plan to become conflict free.

10) Oversight area: QM PlanCompliance Standard: The SCO develops and implements a Source Document(s): 55 Pa. Code

• Reviewer will review the QM plan every two years to see if it has been updated.

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Quality Management Plan

Question: Did the SCO update their Quality Management plan within the last two years as per ODP policy?

Yes, the SCO updated their plan as per policy

No, the SCO should have updated their plan and did not

N/A, the SCO updated their plan last year

Chapter 51, Waiver Regulations, 51.13(j), 51.25(d.1-6).

• If the SCO did not update the plan as required, mark N.• If the SCO updated their plan last year, mark N/A.

Remediation:• The SCO should update the QM plan and provide to the

Reviewer.

Plan of Improvement• The SCO should keep track of when they update the QM

plan to show that they did so every two years.

11)

Oversight area: QM PlanCompliance Standard: The SCO develops and implements a Quality Management Plan

Question: Does the SCO Quality Management plan include the following required elements: the goals of the QM plan (which include how they will meet ODP priorities); target objectives that support each goal; performance measures that will be used to evaluate progress in achieving target objectives; data source for each performance measure; person responsible for the QM plan; actions to be taken to meet target objectives?

Yes, all required elements are included in the Quality Management plan

No, required element(s) was missing from the plan

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations, 51.25(d, 1-6).

• Reviewer will review the QM plan for all elements.• Reviewer will use ODP Communication 107-12 to assure that

priorities listed in the Communication are included in the QM Plan (*Note – the Communication does not require that all priorities be in the QM Plan)

Remediation:• The SCO should update their QM plan to include all

elements.

12)Oversight area: TrainingCompliance Standard: The SCO has a process to validate that new SCs meet the minimum education and experience

Source Document(s): ODP Bulletin # 00-10-06, Supports Coordination Services, page 8 (Q.6).

• All new SCs hired since ODP’s last on-site review will be audited, even the ones who are no longer employed with the agency. Exclude discreet base caseloads.

• Reviewer will search service notes from the date of hire to the August 2014 6



requirements.

Question: Did all new SCs hired since the last date of ODP’s on-site monitoring complete the required orientation prior to working independently with waiver participants?

Please enter the number of SCs hired since the last date of on-site monitoring in the first text box and the number of staff that completed the required ODP SC orientation prior to working independently with waiver participants in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there were no new hires from the last date of on-site monitoring, please put 0 (zero) in both text boxes.

# of staff SCs hired since the date of the last ODP on-site monitoring:

# of staff that completed the required orientation prior to working independently with waiver participants:

date of orientation completed (per the SC Orientation certificate).Utilizing the SN Search, Advanced Search, the reviewer will search Comment Author Last Name and First Name.

• Reviewer will search for billable face-to-face service notes. Any billable face-to-face meetings shall have evidence that the SC did not attend these meetings independently (i.e. documenting supervisor or co-workers attendance).

• If there are no new hires since ODP’s last on-site review, mark “0” (zero).

Remediation:• The SCO should provide proof of Supervisor or other SC’s

presence (i.e. signature sheet) to the Reviewer.• The SCO should void any Service Notes that indicate

billable face-to-face activity when there is not clear documentation that the SC was with a Supervisor or other SC.

Plan of Improvement• The SCO should ensure Service Notes identify that SC was

not working independently.

13)Oversight area: TrainingCompliance Standard: The SCO has a process to validate that new SCs meet the minimum education and experience requirements.

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations, 51.17(k), 51.23, ODP Bulletin # 6000-04-01, Incident Management.

• Reviewer will review that all new SCs hired since last on-site have been trained.


• Staff initialing the SC Orientation checklist is not an acceptable

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Question: Did all new SCs hired since the date of the last ODP on-site monitoring receive the SCO incident management training?

Please enter the number of SCs hired since the last date of the on-site monitoring in the first text box and the number of staff who received the incident management training in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If the SCO has not hired any new staff from the last date of on-site monitoring, please put 0 (zero) in both text boxes.


# of staff that completed the required SCO incident management:

form of documentation.• Reviewer will accept the SCO Incident Management training• OR , Reviewer will accept the ODP Incident Management

trainings “Foundations of Incident Management (IM)/Risk

Management (RM)” “Understanding IM” “SC Role in IM”

*Note all 3 ODP IM trainings must be completed in order to meet the requirement

Remediation:• The SCO should ensure that staff receive the incident

management training.

14)Oversight area: HiringCompliance Standard: The SCO has a process to verify upon hiring a new SC that the individual has the licenses, certifications, and qualifications required of a waiver supports coordinator.

Source Document(s): Consolidated and P/FDS Waivers - Qualifications for Supports Coordination Organization.

• Reviewer will review certifications and qualifications of all new SCs hired since last on-site.

• If the SCO utilizes civil service employees, mark N/A.• If there are no new hires since ODP’s last on-site review, mark

“0” (zero).• A bachelor’s degree, which includes or is supplemented by at

least 12 college credits in sociology, social welfare, psychology, August 2014 8



Question: Does the SCO maintain certifications and qualifications for all new SCs hired since the last ODP on-site monitoring?

Please enter the number of SC/SCS hired since the last date of on-site monitoring in the first text box and the number of staff that have certifications and qualifications in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there were no new hires from the last date of on-site monitoring or the SCO utilizes civil service employees, please put 0 (zero) in both text boxes.


# of staff whose certifications and qualification are present:

gerontology, criminal justice, or other related social science; or• Two years’ experience as a County Social Service Aide 3 and

two years of college level course work, which include at least 12 college credits in sociology, social welfare, psychology, gerontology, criminal justice, or other related social service; or

• Any equivalent combination of experience and training which includes 12 college credits in sociology, social welfare, psychology, gerontology, criminal justice, or other related social service and one year of experience as a County Social Services Aide 3 or similar position performing paraprofessional case management functions.

• “Other related social service”: Sociology, Social Welfare, Social Work, Anthropology, Psychology, Counseling, Gerontology, Administration of Justice, Criminal Justice, Criminology, Human Behavior, Human Services, Human Development, Special Education, Economics, Geography, History, Political Science.

Remediation:• The SCO should ensure that they have all documentation

to certifications and qualifications.• SCs billing shall be voided for those staff that do not meet

the requirements and they shall not be allowed to bill for activity until 12 credits are obtained.

15)Oversight area: TrainingCompliance Standard: The SCO ensures that all new SCs/SCS meet ODP's SC Training requirements

Question: Did all new SCs with a caseload (exclude any

Source Document(s): ODP Bulletin # 00-10-06, Supports Coordination Services, page 6 (N), ODP Bulletin 00-10-13, Supports Coordination Training Waiver Requirements.

• Reviewer will review all new SCs with a caseload and all new SC Supervisors to assure that they completed ODP mandatory training after the date of hire. Exclude discreet base caseloads.

• Reviewer will use the training certificates.• Training must be taken within the timeframes as defined by

ODP. Required training taken as Professional Development (PD) will be considered non-compliant.

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SC with a discrete base caseload) and all SC Supervisors hired since the last ODP on-site monitoring attend/take all ODP sponsored trainings since the date of hire (calendar year 2014)?

Please enter the number of new SCs with a caseload and all new SC Supervisors hired since the last date of on-site monitoring in the first text box and the number of staff trained as required in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there were no new hires from the date of the last monitoring, please put 0 (zero) in both text boxes.


# of staff where all training requirements can be verified:

• Reviewer will not look at new SCs who were reviewed during Cycle 3.


Remediation:• The SCO should ensure that records are up to date.• The SCO should ensure that SCs take the required training

as Professional Development.

Plan of Improvement:• The SCO should develop a plan to ensure that training is

taken as required moving forward.

16)Oversight area: TrainingCompliance Standard: The SCO ensures that all new SCs/SCS meet ODP's SC Training requirements

Question: Did all new SCs and SC Supervisors with a


• Reviewer will review all new SC/SC Supervisors with a caseload to assure that they completed the required number of training hours, prorated based on the date of hire. Exclude discreet base caseloads.

• SC orientation counts as 12 hours of training.• Reviewer will not look at new SCs who were reviewed during

Cycle 3.

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caseload (exclude any SC with a discrete base caseload) complete the required number of annual training hours, pro-rated based on the date of hire (calendar year 2014)?

Please enter the number of new SC/SC Supervisors with a caseload hired since the last date of on-site monitoring in the first text box and the number of staff trained as required in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there were no new hires from the date of the last monitoring, please put 0 (zero) in both text boxes.




Remediation:• The SCO should ensure that records are up to date.



17) Oversight area: TrainingCompliance Standard: The SCO ensures that all SCs/SCS meet ODP's SC Training requirements

Question: Did all SCs with a caseload (exclude any SC with a discrete base caseload) attend/take all ODP sponsored trainings in the calendar year 2013 (January-December)?

Please enter the number of SCs with a caseload reviewed in the


• Reviewer will review all 25% of SCs, but no less that 5 SCs.• Reviewer will review records to assure that SCs with a caseload

completed ODP mandatory training after the date of hire. Exclude discreet base caseloads.




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first text box and the number of staff trained as required in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).

# of staff reviewed:


• The SCO should ensure that SCs take the required training as Professional Development.



18)

Oversight area: TrainingCompliance Standard: The SCO ensures that all SCs/SCS meet ODP's SC Training requirements

Question: Did all SC Supervisors attend/take all ODP sponsored trainings in the calendar year 2013 (January-December)?

Please enter the number of SC Supervisors reviewed in the first text box and the number of staff trained as required in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).




• Reviewer will review all SC Supervisors.• Reviewer will review records to assure that all SC Supervisors

completed ODP mandatory training after the date of hire. Exclude discreet base caseloads.



Remediation:• The SCO should ensure that records are up to date.• The SCO should ensure that SCs take the required training

as Professional Development.



19)Oversight area: TrainingCompliance Standard: The SCO ensures that all SCs meet ODP's SC Training requirements.

Question: Did all SCs (exclude any SC with a discrete base caseload) complete the required number of training hours (a total of 40 hours of training per year) in the calendar year 2013 (January – December)?

Source Document(s): ODP Bulletin # 00-10-06, Supports Coordination Services, page 6 (N), Qualifications for Supports Coordination Organization.

• Reviewer will review all 25% of SCs, but no less that 5 SCs.• Reviewer will review records to assure that SCs with a caseload

completed a total of 40 hours of training for the prior calendar year. Exclude discreet base caseloads.


Plan of Improvement:• The SCO should develop a plan to ensure that all 40 hours

of training are taken as required moving forward.

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Please enter the number of SCs reviewed in the first text box and the number of staff trained as required in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).



20) Oversight area: TrainingCompliance Standard: The SCO ensures that all SCs meet ODP's SC Training requirements.

Question: Did any SC Supervisor with a caseload (or who submitted billable Service Notes) complete the required number of training hours (a total of 40 hours of training per year) in the calendar year 2013 (January – December)?

Please enter the number of SC Supervisors with a caseload or


• Reviewer will check to see if there is a caseload associated with the supervisor. If there is a caseload, the training requirement will be reviewed. If there is no caseload, billable Service Notes will be reviewed.

• Reviewer will review HCSIS (Service Notes > Advance Search) to see if a supervisor is billing. If there are billable Service Notes, the training requirement will be reviewed. If there are not billable Service Notes, the training for the supervisor will be N/A

• Reviewer will review records to assure that SC Supervisors with a caseload or who submitted billable Service Notes completed a total of 40 hours of training for the prior calendar year. Exclude

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who submitted billable Service Notes reviewed in the first text box and the number of staff trained as required in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).



discreet base caseloads.


Plan of Improvement:• The SCO should develop a plan to ensure that all 40 hours

of training are taken as required moving forward.

21)

Oversight area: TrainingCompliance Standard: The SCO ensures that all SCs meet ODP's SC training requirements

Question: Did the SCO maintain training records, training curricula, attendance records and orientation materials for all non-ODP sponsored trainings?

Yes, training materials are present

No, the SCO does not have training materials


• Reviewer will determine if the SCO maintains training curricula for all non-ODP sponsored training for which training credit was given.

• Entire curriculum is not necessary, just what documents its relevancy and attendance.

• Certificates are acceptable as verification.

Remediation:• The SCO should obtain the training curricula for the

training taken and submit to the Reviewer.

Plan of Improvement:• The SCO should develop a plan to ensure that all training

hours are documented correctly in the future.22)

Oversight area: TrainingCompliance Standard: The SCO ensures that all SCs/SCS meet ODP's SC Training requirements

Question: Did all SCs and all SC Supervisors (exclude any SC with a discrete base caseload) attend/take the following standard annual trainings: Department policy on intellectual disability principles and values; training to meet the needs of a participant as identified in the ISP; QM plan; identification and prevention of abuse, neglect and exploitation of a

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations, 51.23(a)(1-8).

• Reviewer will review 25% of SCs and SC Supervisors, but no less that 5 SCs.

• Reviewer will review to assure that all 8 topics were addressed.• Reviewer will review records to assure that SCs and all SC

Supervisors completed the standard annual trainings after the date of hire. Exclude discreet base caseloads.

Remediation:• The SCO should ensure that records are up to date.• The SCO should ensure that SCs and SC Supervisor

attend/take the standard annual training.


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participant; recognizing, reporting and investigating an incident; participant grievance resolution; department issues policies or procedures; accurate billing and documentation of HCBS delivery?

Please enter the number of SC/SC Supervisor reviewed in the first text box and the number of staff that took the standard annual trainings in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).


# of staff where training requirements can be verified:

provided to all SCs and SC Supervisors annual as required moving forward.

23) Oversight area: QualificationsCompliance Standard: The SCO has a process to verify upon hiring a new SC, and annually thereafter, that the individual has the licenses, certifications, and qualifications required of a waiver supports coordinator.

Question: Does the SCO maintain an updated listing of all SC and SC Supervisors’ drivers’ licenses?

Please enter the number of SC/SC Supervisor reviewed in the first text box and the number of staff that maintained current driver’s licenses in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If the SCs and SC Supervisors do not use a vehicle to provide supports coordination services, please put 0 (zero) in both text boxes.

Source Document(s): Consolidated and P/FDS Waivers - Qualifications for Supports Coordination Organization.

• Reviewer will use the list of current SCs and SC Supervisor.• This is only necessary for SCOs if the operation of a vehicle is

necessary to provide Supports Coordination services.

Remediation:• The SCO should get current licenses to the Reviewer.

Plan of Improvement:• The SCO should develop a tracking mechanism to ensure

that information is kept current.

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# of staff with current driver’s licenses:

24)

Oversight area: Incident ManagementCompliance Standard: The SCO maintains the ability to investigate incidents, or have incidents investigated, when the reported incident is related to the delivery of supports coordination services.

Question: Does the SCO maintain a certified investigator on the staff of their agency or have a written agreement with another entity to obtain the services of a certified investigator to investigate incidents directly related to SC Services?

Yes, the SCO has a certified investigator available to investigate reported incidents related to SC services

No, there is no ability to investigate reported incidents related to SC services

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations, 51.13(l), 51.17, 51.19, ODP Bulletin # 00-10-06, Supports Coordination Services, page 8 (7.a), ODP Bulletin # 6000-04-01, Incident Management.

• Reviewer will review if there is a certified investigator or an agreement.

• Investigations of incidents directly related to SC services NOT SCO reportable incidents (such as abuse, neglect or death).

Remediation:• The SCO should provide verification to the Reviewer.

Plan if Improvement:• The SCO should develop an agreement.• The SCO should maintain their CI certification if applicable.

25)

Oversight area: Incident ManagementCompliance Standard: The SCO complies with the requirements of the Incident Management Bulletin.

Question: Did the SCO review and analyze incidents at least quarterly?

This question will be N/A for all SCOs in Cycle 4.

Source Document(s): ODP Bulletin # 00-10-06, Supports Coordination Services, page 8 (7), ODP Bulletin # 6000-04-01, Incident Management, ODP Informational Memo 031-14.

• Reviewer will review to see if the SCO reviews and analyzes incidents at least quarterly.

• This question will be N/A until ODP provides further instructions as per 031-14

Plan of Improvement:• The SCO should develop a plan to review and analyze

incidents as required.

26) Oversight area: Grievance ProcedureCompliance Standard: The SCO complies with the requirements of the Regulations, Grievance Procedure.

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations, 51.26.

• Reviewer will review whether there were any grievances filed.• Grievance (as per Chap 51 regulations) is the formal expression

of dissatisfaction with the provision of a waiver service or a provider's delivery of a waiver service.

• A request for a new Supports Coordinator is considered a August 2014 16



Question: Did the SCO have any grievances filed since the last ODP on-site monitoring?

Yes, grievances were filed

No, there weren’t any grievances filed

grievance.• The SCO should ensure that all information related to any

grievance is available for on-site review.• If there was a grievance, the SCO must provide their grievance

policy to the reviewer.

27)

Oversight area: Grievance ProcedureCompliance Standard: The SCO complies with the requirements of the Regulations, Grievance Procedure.

Question: If any grievances were filed, is there documentation that they were resolved within the 21 day timeframe?

Yes, the grievance was resolved within 21 days

No, the grievance was not resolved within 21 days

N/A, there were no grievances

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations, 51.26.

• Reviewer will review whether grievances were resolved within 21 days.

• If there were no grievances filed, mark N/A.

Remediation:• The SCO should provide evidence that all grievances that

did not meet the 21 day timeframe were resolved.

Plan of Improvement:• The SCO should develop a plan to ensure that all

grievances are resolved within the appropriate timeframe.

28) Oversight area: PUNSCompliance Standard: The SCO complies with the requirements of the Chapter 51 Waiver regs

Question: Did the SCO update active PUNS in HCSIS as per ODP policy?

Utilizing the PUNS reports for the review period of FY 2013-2014, SCOs should calculate their overall percentage of compliance with this question and enter the percent into the text box.

Percentage of PUNS updated in HCSIS as per ODP policy during review period:

Source Document(s): Consolidated and PFDS waivers, ODP Bulletin # 00-10-06, Supports Coordination Services, page 9 (J), PUNS Manual.

• Reviewer will review the Performance Review Reports.• Reviewer will check to see if PUNS with a status of “Not

Reviewed” have been remediated.• Reviewer will look for plans of improvement for PUNS with a

status of “Late”.• PUNS should be updated annually and when there is a needed

for service that cannot be immediately authorized in the ISP.• This will be a percentage measure.• The SCO should utilize the PUNS timeliness Performance

Review Reports to get an annual compliance score.

Remediation:• The SCO should ensure that the “Not Reviewed” PUNS

have been updated.

August 2014 17



Plan of Improvement:• The SCO should ensure that PUNS is updated as per ODP

policy.• The SCO should develop a plan to track PUNS to ensure

timeliness using the Performance Review Reports.

29)

Oversight area: PUNSCompliance Standard: The SCO complies with the requirements of the Chapter 51 Waiver regs.

Question: Did the SCO exhibit an increase in PUNS 365 day review compliance rate since the last cycle?

Utilizing the PUNS reports for the review period of FY 2013-2014, SCOs should calculate their overall percentage of compliance with this question and compare it to last monitoring cycle’s percentage.

Yes, the percentage increased

No, the percentage stayed the same or decreased

Source Document(s): Consolidated and PFDS waivers, ODP Bulletin # 00-10-06, Supports Coordination Services, page 9 (J), PUNS Manual.

• Reviewer will review the Performance Review Reports from the current and previous cycles.

• The SCO should utilize the PUNS timeliness Performance Review Reports to get an annual compliance score.

Plan of Improvement:• The SCO should develop a plan to track PUNS to ensure

timeliness using the Performance Review Reports.• The SCO should develop training to ensure that all SCs

understand the PUNS timeliness requirements

30)Oversight area: Delivery of Supports CoordinationCompliance Standard: The SC uses HCSIS to document compliance with all requirements of supports coordination services.

Question: Were all SC individual monitoring tools entered into HCSIS within 14 calendar days of the date of monitoring?

Utilizing the Monitoring in 14 Days reports for the review period of FY 2013-2014, SCOs should calculate their overall percentage of compliance with this question and enter the percent into the text box.

Source Document(s): ODP Bulletin # 00-10-06, Supports Coordination Services, page 11 (5).

• Reviewer will review the Monitoring Performance Review Reports and ensure that SC individual monitoring tools were entered into HCSIS within 14 days of monitoring.

• This will be a percentage measure.

Plan of Improvement:• The SCO should develop a plan to ensure that all SC

individual monitoring tools are entered into HCSIS within 14 days of monitoring.

• The SCO should utilize the Performance Review Reports to track compliance.

August 2014 18



Percentage of individual monitoring tools entered into HCSIS as per ODP policy during review period:

31)Oversight area: External MonitoringsCompliance Standard: The SCO ensures that IM4Q considerations are addressed.

Question: For the identified sample of waiver records, if there was an IM4Q consideration response documented in HCSIS, is the response appropriate (i.e., did the team meet to discuss the consideration, does the response address the consideration, is the response based on Everyday Lives principles)?

Please enter the number of individuals in the sample who had an IM4Q consideration requiring response in the first text box and the number of individuals where the SCO addressed the

Source Document(s): ODP Bulletin # 00-10-06, Supports Coordination Services, page 6 (P), IM4Q Considerations Manual (www.odpconsulting.net = ODP Consulting System >Topic Info > Independent Monitoring for Quality (IM4Q) > IM4Q Considerations Manual).

• Reviewer will review IM4Q consideration reports in HCSIS to see if there were any resolved IM4Q considerations.

• Reviewer will ensure that the SC response is appropriate based on information in the Service Notes and ISP.

• Reviewers will use the HCSIS path – M4Q > IM4Q > Considerations > Search

• If there are no considerations, mark “0” (zero).

Remediation:• The SCO should ensure that all resolved IM4Q

considerations were appropriate.

Plan of Improvement: The SCO should develop a plan to ensure that all IM4Q

considerations appropriate and there is team agreement.

August 2014 19

http://www.odpconsulting.net/



consideration using the “closing the loop” plan with an appropriate response in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there were no IM4Q considerations in the sample please put 0 (zero) in both text boxes.

# of individuals in the sample who had an IM4Q consideration requiring response:

# of individuals where the SCO responded to the consideration per ODP policy:

32)

Oversight area: Delivery of Supports CoordinationCompliance Standard: The SC uses HCSIS to document compliance with all requirements of supports coordination services.

Question: For the identified sample of waiver records, were the Service Notes entered within 7 calendar days of the date of contact?

Utilizing the individuals in the sample for the review period of FY 2013-2014, SCOs should calculate their overall percentage of compliance with this question and enter their overall percent into the text box.

Percentage of Service Notes entered into HCSIS as per ODP policy during review period:

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations, 51.28(l)(m), ODP Bulletin # 00-10-06, Supports Coordination Services, page 10 (2).

• Reviewer will utilize the Service Note Spreadsheet to calculate the days between contact and SN entry.

• This will be a percentage measure for each record in the final report, with an overall score for the SCO.

Plan of Improvement:• The SCO should develop a plan to ensure that all Service

Notes are entered within 7 days of contact.

August 2014 20



33)

Oversight area: Delivery of Supports CoordinationCompliance Standard: The SCO uses HCSIS to document compliance with all requirements of supports coordination services.

Question: For the identified sample of waiver records, did all Service Notes marked as billable represent a billable SC activity?

Please enter the number of individuals in the sample in the first text box and the number of individual records found to be billable in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).

Note: The ODP reviewer must make a note of the non-billable Service Note date and MCI number, as a list of non-billable activity will be given to the SCO with the final report.

# of individuals in the sample:

# of individual records whose service notes were found to be a billable activity:

Source Document(s): Consolidated and PFDS waivers, ODP Bulletin #00-07-01, Provider Billing Documentation Requirements for Waiver Services, ODP Informational Packet 035-14.

• Reviewer will review the Service Note in HCSIS and ensure that all billable notes represent billable activity as per the Consolidated and PFDS waivers.

• Reviewer will make note of the name of the individual(s) and the date(s) of the non-billable service note so that a list can be provided with the final report.

• Reviewer will review the services notes to ensure they support the claims for services.

• Examples of non-billable activity include: activity for recertification for MA or Waivers, administrative tasks such as SC Supervisory review of ISPs or peer reviews of ISPs and SN, etc.

• Waiver Supports Coordination services are billed at a rate of 15 minutes per unit.

Remediation:• The SCO should void Service Notes that do not represent

billable activity.• The SCO has to provide evidence that Service Notes were

voided to the Reviewer.

Plan of Improvement:• The SCO should develop a plan to ensure that all Services

Notes marked billable are billable activity.

August 2014 21



34)Oversight area: Delivery of Supports CoordinationCompliance Standard: The SC uses HCSIS to document compliance with all requirements of supports coordination services.

Question: For the identified sample of waiver records, do the Service Notes meet quality standards (i.e., person centered, clear and concise, objective, include Who, What, When and Where, detailed, describe actions taken and actions needed)?

Please enter the number of individuals in the sample in the first text box and the number of individual records with Service Notes that meet the quality standards in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).


# of individual records whose Service Notes meet quality standards:

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations, 51.28(l)(m), ODP Bulletin # 00-10-06, Supports Coordination Services, page 14 (E), ODP Training “Service Notes Basics 2013 – Part 1”.

• Reviewer will review Service Notes for quality based on Required Service Note training – Basic Service Notes.

• Reviewer will look at SNs from 1/1/2014-6/30/2014 to answer this question ONLY

Remediation:• The SCO should review Service Notes and edit as

appropriate.

Plan of Improvement:• The SCO should develop a plan to ensure that all Service

Notes meet quality standards.• The SCO should develop a plan to re-train SCs where

Service Notes do not meet standards

August 2014 22



35)Oversight area: Individual Support PlanCompliance Standard: The SC documents as per ODP expectations

Question: For the identified sample of waiver records, did the SC document a change of need indicated by the individual or the team?

Please enter the number of individuals in the sample in the first text box and the number of individual records with a documented change in need in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there were no documented change in need in the sample please put 0 (zero) in both text boxes.


# of individual records with documented change in need:

Source Document(s):ISP Manual• Reviewer will review Service Notes and Individual Monitoring

Tools to see if a change in need was indicated by the individual or any team members.

Plan of Improvement• The SCO should develop a plan to ensure that training is

provided to all SCs on appropriate documentation of changes in need

August 2014 23



36)

Oversight area: Individual Support PlanCompliance Standard: The SC documents as per ODP expectations

Question: For the identified sample of waiver records, if the SC documented that a change was needed, was the ISP updated (via General Update or Critical Revision)?

Please enter the number of individual records with a documented change in need in the first text box and the number of individual records with an updated ISP in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there were no documented change in need in the sample please put 0 (zero) in both text boxes.


# of individual records whose ISP was updated:

Source Document(s):ISP Manual• If a change in need was identified in Service Notes or Individual

Monitoring Tools, the Reviewer will review ISP Plan Comments and Plan History to determine if the need was addressed.


provided to all SCs on appropriate documentation of changes in need

August 2014 24



37)

Oversight area: Delivery of Supports CoordinationCompliance Standard: The SCO ensures monitorings occur as per ODP requirements.

Question: For the identified sample of waiver records, did all monitorings occur at the required frequency?

Please enter the number of individuals in the sample in the first text box and the number of individual records with monitorings that meet the required frequency of each Waiver in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).


# of individual records with monitorings that meet the required frequency:

Source Document(s): Consolidated and PFDS waivers, ODP Bulletin # 00-10-06, Supports Coordination Services, page 5 (M).

• Reviewer will review the Monitoring Performance Review Reports and ensure that monitorings occurred at the required frequency.

• Reviewer will look in HCSIS at monitoring tools if there are missing dates from the Performance Review Report.

• For Consolidated Waiver – Frequency is 3 face to face monitorings every 3 months*.

• For Consolidated Waiver – if an individual is not at the day program for an extended time period due to health reasons, no non-compliance will be marked as long as the reason for no SC monitoring at the day program is documented in the Service Notes.

• For PFDS, an individual living with a family member - Frequency of contact is at least 1 time every 3 months* and face-to-face at least every 6 months.

• For PFDS, an individual living on their own or any other setting – Frequency is face-to-face contact every 3 months* and contact every month

• If the individual has approved non-statutory frequency, identify them in the comments section by MCI#.


individual monitorings occur at the correct frequency.• The SCO should utilize the Performance Review Reports to

track compliance.*3 months is calculated as calendar months, and not interpreted per quarter

August 2014 25



38)


Question: For the identified sample of waiver records, did all monitorings occur at the required locations?

Please enter the number of individuals in the sample in the first text box and the number of individual records with monitorings that meet the required location of each Waiver in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).


# of individual records with monitorings that meet the required location:

Source Document(s): Consolidated and PFDS waivers, ODP Bulletin # 00-10-06, Supports Coordination Services, page 5 (M).

• Reviewer will review the Monitoring Performance Review Reports and ensure that monitorings occurred at the required location.

• For Consolidated Waiver – Location is 1 in the residence, 1 at the day program and 1 where the individual chooses.

• For Consolidated Waiver – if an individual is not at the day program for an extended time period due to health reasons, no non-compliance will be marked as long as the reason for no SC monitoring at the day program is documented in the Service Notes.

• For PFDS, an individual living with a family member - Location is in the home at least 1 time per calendar year.

• For PFDS, an individual living on their own or any other setting – Location is in the home at least 1 time every 6 months.

• If the individual has approved non-statutory frequency, identify them in the comments section by MCI#.


individual monitorings occur at the correct frequency.• The SCO should utilize the Performance Review Reports to

track compliance.

August 2014 26



39)

Oversight area: Delivery of Supports CoordinationCompliance Standard: The SC uses HCSIS to document compliance with all requirements of supports coordination services.

Question: For the identified sample of waiver records, do the Individual Monitoring Tools meet quality standards (i.e., person centered, checks whether services are meeting needs as per the ISP, if the person has access to services, if services are being delivered according to the ISP and describe what actions are needed)?

Please enter the number of individuals in the sample in the first text box and the number of individual records with Individual Monitoring Tools that meet the quality standards in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).


# of individual records with Individual Monitoring Tools that meet the quality standards:

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations, 51.28(l)(m), ODP Bulletin # 00-10-06, Supports Coordination Services, page 11 (4 & 5)& page 12 (6 & 7), ODP Training “Introduction to Individual Support Plan (ISP) Monitoring”.

• Reviewer will review Individual Monitoring Tools for quality based on the required Monitoring Tool training.

• Reviewer will look at monitoring tools from 1/1/2014-6/30/2014 to answer this question ONLY


Monitoring Tools meet quality standards.• The SCO should develop a plan to re-train SCs where

Monitoring Tools do not meet standards

August 2014 27



40)


Question: For the identified sample of waiver records, did the SCO/SC maintain documentation in HCSIS that each monitoring visit included a review of progress towards outcomes in the ISP?

Please enter the number of individuals in the sample in the first text box and the number of individual records where HCSIS was used to record monitoring activities, including a review of progress towards the outcomes in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).


# of individual records where HCSIS was used to record a review of progress towards outcomes:

Source Document(s): Consolidated and PFDS waivers, ODP Bulletin # 00-10-06, Supports Coordination Services, page 12 (6).

• Reviewer will review records to see if HCSIS (Service Notes and Individual Monitoring Tools) was utilized to document progress towards outcomes listed in the ISP.

• Progress towards each outcome should be reviewed, although not every outcome must be reviewed during every monitoring.

Plan of Improvement:• The SCO should develop a plan to ensure documentation in

HCSIS of review of progress on outcomes.

August 2014 28



41)

Oversight area: ISP implementationCompliance Standard: The approved ISP is implemented.

Question: For the identified sample, did the SC review utilization of all services that are authorized in the approved ISP?

Please enter the number of individuals in the sample in the first text box and the number of individual records where service utilization was reviewed in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).


# of individual records where service utilization was reviewed:

Source Document(s):ISP Manual• Reviewer will review Service Notes and monitoring tools to look

for documentation that review of the utilization of all authorized services was completed.

• Reviewer should look for documentation of conversations about service utilization the SC had with the individual, family and ISP team and document those conversations in the individual’s service notes and monitoring tools in HCSIS. Documentation should include the reason(s) for the under or over utilization that has occurred. This information should also be discussed and documented during the annual review ISP meeting.

• Service being utilized per the frequency and duration in the ISP as well as the total authorized units.


provided to all SCs on appropriate documentation of utilization of services.

August 2014 29



42)

Oversight area: MonitoringCompliance Standard: The SCO ensures that monitoring information is maintained in HCSIS.

Question: For the identified sample of waiver records, is there documentation that the SCO/SC notified the AE of any identified issues that were unresolved within the agreed upon timeframe by the provider?

Please enter the number of individuals in the sample whose HCSIS record identifies issues that remain unresolved in the first text box and the number of individual records that have documentation of notification to the AE in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there were no unresolved issues, please put 0 (zero) in both text boxes.

# of individuals in the sample whose HCSIS record identifies issues that remain unresolved:

# of individual records with documentation of notification to the AE:

Source Document(s): ODP Bulletin # 00-10-06, Supports Coordination Services, page 8 (5.b).

• Reviewer will review records to ensure notification of the AE of identified issues that were unresolved by the provider.

• Reviewer will use both SC individual monitoring tools and Service Notes.

• Reviewer will also accept emails and letters as verification.• If there were no issues, mark “0” (zero).

Remediation:• The SCO should provide verification of notification to the

AE.

Plan of Improvement:• The SCO should develop a plan to track notification of the

AE of unresolved issues.

August 2014 30



43)

Oversight area: Delivery of Supports CoordinationCompliance Standard: The SCO ensures Residential Habilitation review as per ODP requirements.

Question: For the identified sample of waiver records did the SC review the ISP Checklist at the annual review ISP meeting? (Residential Habilitation, Licensed One Person Home, Day Program 1:1 or more, HCH 16 hours or more daily)?

Please enter the number of individuals in the sample in the first text box and the number of individuals who had an ISP Checklist review in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).

# of individuals in the sample who require an ISP Checklist:

# of individual records where the ISP Checklist was completed at the annual review ISP meeting:

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations, 51.28(d)(e), ODP Informational Packet 020-13.

• Reviewer will review the ISP Checklist to ensure it was completed.


individuals have an ISP Checklist reviewed during the annual review ISP meeting after 4/1/2013.

44)


Question: For the identified sample of waiver records, do any individuals receive service(s) that require a 6 month review (Residential Habilitation, Licensed One Person Home, Pre-Vocational, and Job Finding)?

Please enter the number of individuals in the sample who have service(s) that require a 6 month review in the text box.

# of individuals in the sample who have services that require a 6 month review:

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations, 51.28(d)(e), ODP Informational Packet 020-13.

• Non-scored question

August 2014 31



45)


Question: For the identified sample of waiver records, if any individuals are receiving service(s) that require a 6 month review (Residential Habilitation, Licensed One Person Home, Pre-Vocational, and Job Finding), did the SC complete a bi-annual ISP update? And did the SC document a summary of the team meeting discussion in the bi-annual ISP?

Please enter the number of individuals in the sample who have service(s) that require a 6 month review in the first text box and the number of individuals who had a bi-annual ISP in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there are no individuals with services that require 6 month review please put 0 (zero) in both text boxes.

# of individuals in the sample who have services that require a 6 month review:

# of individual records where the bi-annual ISP was completed as per ODP policy:

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations, 51.28(d)(e); ODP Informational Packet 020-13.

• Reviewer will review all records for individuals who receive services that require a 6 month review.

• Reviewer will review ISP (Plan) History to ensure a bi-annual ISP update was completed.

• If an individual does not receive any of the services that require a 6 month review, do not count them in the sample number.

• If there are no individuals’ services that require a 6 month review, mark “0” (zero).

• The content and outcome of the six-month review shall be documented in Home and Community Supports Information System (HCSIS) using the Biannual Review ISP format in the sections of the ISP identified in the Checklist.

• Document the summary of the team discussion as well as the date of the discussion in the “Outcome Actions: How will you know that progress is being made toward the outcome?” section of the ISP.

Plan of Improvement:• The SCO should develop a plan to ensure that a review of

services is conducted for all individuals receiving services that require a 6 month review after 4/1/2013.

August 2014 32



46)


Question: For the identified sample of waiver records, if any individuals are receiving service(s) that require a 6 month review (Residential Habilitation, Licensed One Person Home, Pre-Vocational, and Job Finding), and the individual does not continue to meet the criteria, was the ISP updated to include the action plan?

Please enter the number of individuals in the sample whose 6 month review identifies that they do not currently meet the criteria for the service in the first text box and the number of individuals who had an updated ISP that includes the action plan in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there are no individuals with services that require 6 month review or who continue to meet the criteria please put 0 (zero) in both text boxes.

# of individuals in the sample who had a 6 month review and they do not continue to meet criteria of the service:

# of individual records who did not meet the criteria and whose ISP was updated to include the action plan:

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations, 51.28(d)(e); ODP Informational Packet 020-13.

• Reviewer will review records of the individuals identified in Q.44 to see if a required team meeting was held.

• If an individual does not receive any of the services that require a 6 month review, do not count them in the sample number.

• If there are no individuals’ services that require a 6 month review, mark “0” (zero).

Plan of Improvement:• The SCO should develop a plan to ensure that if an

individual does not continue to meet the criteria for services that require a 6 month review, a team meeting is held to create an action plan after 4/1/2013.

August 2014 33



47)

Oversight area: Deaf ServicesCompliance Standard: The SCO ensures that communication assistance is offered.

Question: For the identified sample of waiver records, is an individual identified as being deaf or hard of hearing?

Please enter the number of individuals in the sample who are identified as being deaf or hard of hearing in the text box.

# of individuals in the sample who are identified as being deaf or hard of hearing:

Source Document(s): ODP Bulletin # 00-14-04, Accessibility of Intellectual Disability Services for Individuals Who Are Deaf.


48)

Oversight area: Deaf ServicesCompliance Standard: The SCO ensures that communication assistance is offered.

Question: For the identified sample of waiver records, if there is an individual who is deaf or hard of hearing, did the SC provide communication assistance when providing supports coordination services?Please enter the number of individuals in the sample who are identified as deaf or hard of hearing in the first text box and the number of individuals who were provided communication assistance in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there are no individuals who are identified as being deaf or hard of hearing please put 0 (zero) in both text boxes.

# of individuals in the sample who are identified as being deaf or hard of hearing:

# of individual records that were provided communication assistance:

Source Document(s): ODP Bulletin # 00-14-04, Accessibility of Intellectual Disability Services for Individuals Who Are Deaf, page 5.

• Reviewer will review ISP to determine what communication assistance is identified.

• Reviewer will review Service Notes to see if assistance was offered whenever supports coordination services are provided.

• Examples of communication assistance:- Access to video phone equipment- Assistive Technology (such as adaptive telephones)- Communication Access Realtime Translation (CART)- Video Remote Interpreting- Closed caption decoders- Highly visual communication tools, checklists, etc.- Open and closed captioning on TV- Staff or interpreters proficient in sign language- Sign Language Interpreters- Transliteration- Exchange of written notes

• Looking at 4/8/2014 going forward


provided to all SCs on how to offer communication assistance and appropriate documentation in HCSIS.

August 2014 34



49)

Oversight area: The SCO will ensure that SCs perform required monitoring of participant services.Compliance Standard: The SCO ensures that monitoring information is maintained in HCSIS.

Question: For the identified sample of waiver records, was there documentation in SC monitoring tools and/or Service Notes in HCSIS that identified imminent risk to the health and welfare of the individual?

Please enter the number of individuals in the sample whose HCSIS record identifies imminent risk to the health and welfare of the individual in the first text box and the number of individual records that have documentation in HCSIS in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there was no imminent risk to the health and welfare of the individual, please put 0 (zero) in both text boxes.

# of individuals in the sample whose HCSIS record identifies imminent risk to the health and welfare of the individual:

# of individual records with documentation of notification in HCSIS:

Source Document(s): ODP Bulletin # 00-10-06, Supports Coordination Services, page 8 (5a-c).

• Reviewer will review records to see if HCSIS was utilized to document issues with imminent health and welfare discovered during monitoring.

• Reviewer will use both SC individual monitoring tools and Service Notes.

• If there were no issues, mark “0” (zero).• Imminent Risk is an immediate risk of abuse, neglect,

exploitation or death as identified in the Annex A of the Incident Management bulletin.

• Verify the individual is safe.

Plan of Improvement:• The SCO should develop a plan to ensure documentation in

HCSIS of imminent risk to health and welfare.

50) Oversight area: The SCO will ensure that SCs perform required monitoring of participant services.

Source Document(s): ODP Bulletin # 00-10-06, Supports Coordination

• Reviewer will review records of the individuals identified in Q.50 to see if the SCO notified the AE and RPM of imminent risk.

August 2014 35



Compliance Standard: The SCO ensures that monitoring information is maintained in HCSIS.

Question: For the identified sample of waiver records, if there was imminent risk to the health and welfare of the individual (as identified in Q.49), did the SCO/SC maintain records that they notified the AE and Regional Program Manager (RPM) as required?

Please enter the number of individuals in the sample whose HCSIS record identifies imminent risk to the health and welfare of the individual (as identified in Q. 49) in the first text box and the number of individual records that have documentation of notification of AE and/or RPM in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there was no imminent risk to the health and welfare of the individual, please put 0 (zero) in both text boxes.

# of individuals in the sample whose HCSIS record identifies imminent risk to the health and welfare of the individual:

# of individual records with documentation of notification of AE and RPM:

Services, page 8 (5.a). • Reviewer will use both SC individual monitoring tools and Service Notes. Reviewer will also accept emails and letters as verification.

• If there were no issues, mark “0” (zero).• Imminent Risk is an immediate risk of abuse, neglect,

exploitation or death as identified in the Annex A of the Incident Management bulletin.

• Verify the individual is safe.

Remediation:• The SCO should provide documentation/records of their

notification of the AE and RPM of imminent risk.

Plan of Improvement:• The SCO should develop a plan for tracking notification of

the AE and RPM.

August 2014 36



51)

Oversight area: Incident ManagementCompliance Standard: The SCO ensures that incident management functions are maintained in HCSIS.

Question: For the identified sample of waiver records, did the SC describe in a Service Note a reportable incident that should be reported by the SCO as per ODP policy?Please enter the number of individuals in the sample who had a reportable incident that should be reported by the SCO in the text box.

# of individuals in the sample who had a reportable incident described:

Source Document(s): ODP Bulletin # 6000-04-01, Incident Management; ODP Informational Packet 072-13


52)


Question: For the identified sample of waiver records, if an SC describes a reportable incident that should be reported by the SCO, was an incident report created in HCSIS?Please enter the number of individuals in the sample who had a reportable incident that should be reported by the SCO in the first text box and the number of individual records who had an incident report created in HCSIS in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there are no individuals who had an incident that needed reported, please put 0 (zero) in both text boxes.

# of individuals in the sample who had an incident that needed reported:

# of individual records with an incident report created in HCSIS:


• Reviewer will review Service Notes or Individual Monitoring Tool for any incidents that the SC must report. These include:

Incidents that occur while only Supports Coordination Services are being provided (does not include medication error or restraint)

Incidents that occur during PDS services (using the VF/EA model) and are reported to the SC (does NOT include diseases reportable to DOH, emergency closure and individual to individual abuse)

Incidents of abuse, neglect, misuse of funds, rights violation and death that are reported to a SC and not associated with the provision of a provider delivered service

**Unreported incidents that are required to be entered by the provider, the SCO should be assuring that the incident is entered

Remediation• The SCO should enter any incidents that were not entered.


provided to all SCs and SC Supervisors on incident reporting and ODP requirements

August 2014 37



53)


Question: For the identified sample of waiver records, if an SC describes a reportable incident that should be reported by the SCO, (as identified in Q. 52), was an incident report created in HCSIS within 24 hours of knowledge of the incident?

Please enter the number of individuals in the sample who had a reportable incident that should be reported by the SCO in the first text box and the number of individual records who had an incident report created in HCSIS within 24 hours in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there are no individuals who had an incident that needed reported, please put 0 (zero) in both text boxes.

# of individuals in the sample who had an incident that needed reported:

# of individual records with an incident report created in HCSIS within 24 hours:


• Reviewer will review Service Notes and Individual Monitoring Tool for any incidents that the SC must report.

• Reviewer will ensure that the incident was created within 24 hours of being informed of, or seeing, an incident.


provided to all SCs and SC Supervisors on incident reporting and ODP requirements

August 2014 38



54)

Oversight area: Incident ManagementCompliance Standard: Providers take prompt action to protect individual’s health, safety and rights.

Question: For the identified sample, did initial incident reports done by the SC include evidence that the SC ensured the individual’s health, safety and rights?

Please enter the number of individuals in the sample who had an initial incident report done by an SC in the first text box and the number of individual records where evidence exists that the SC ensure the individual’s health, safety and rights in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there are no individuals who had an initial incident report created by an SC, please put 0 (zero) in both text boxes.

# of individuals in the sample who had an initial incident report created by an SC:

# of individual records with evidence that the individual’s health, safety and rights were ensured:

Source Document(s):55 Pa. Code Chapter 51, Waiver Regulations, 51.17 (b); 55 Pa Code Chapter 6000 subchapter Q – Incident Management; ODP Informational Packet 072-13

• Reviewer will review incidents and Service Notes in HCSIS to ensure proper actions have been taken to ensure the immediate health, safety and rights of the individual.

Plan of Improvement:• The SCO should develop and implement a process that

ensures that the health, safety and rights of the individuals are immediately protected

August 2014 39



55)

Oversight area: Individual Support PlanCompliance Standard: The SC uses HCSIS to document compliance with all requirements of supports coordination services.

Question: For the identified sample of waiver records, did the SC distribute invitations to all ISP team members at least 30 days prior to the annual review ISP meeting?ON-SITE

Please enter the number of individuals in the sample in the first text box and the number of individuals who’s SCs sent out the invitations at least 30 days prior to the annual review ISP meeting in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).


# of individual records with the invitations sent out at least 30 days prior:

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations, 51.28(c)(3), ODP Bulletin # 00-10-06, Supports Coordination Services, page 10 (1), ISP Manual.

• Reviewer will note date of invitation letter sent.• If the ISP was rescheduled, the reviewer will use the date of the

initial letter.• Reviewer will identify if the invitation letter was sent at least 30

days in advance of the meeting for an Annual Review Update Date that is within the review period of 7/1/2013-6/30/2014.

Remediation:• The SCO should provide verification that the letter was

sent out according to ODP requirements.

Plan of Improvement:• The SCO should develop a plan to ensure that invitation

letters are sent according to required timeframes.• The SCO should provide training to ensure that all SCs

understand the ODP requirements.

August 2014 40



56)

Oversight area: Offering Provider ChoiceCompliance Standard: The SC informs individuals at the initial ISP meeting, and at least annually thereafter, of the right to choose a willing and qualified waiver provider, including choice of SCO.

Question: For the identified sample of waiver records, does the ISP Signature Form contain documentation that choice of provider, including choice of SCO, was offered?ON-SITE

Please enter the number of individuals in the sample in the first text box and the number of individual records with documented provider choice, including choice of SCO, in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).


# of individual records with documented choice of provider:

Source Document(s): Consolidated and PFDS waivers, ODP Bulletin # 00-10-06, Supports Coordination Services, page 4 (A).

• Reviewer will review documentation on the ISP Signature Form (Q.4).

• Reviewer will only accept signature pages dated 8/12 (issued 10/12).

Remediation:• The SCO should provide the ISP Signature Page to prove

that choice of provider, including choice of SCO, was offered.

Plan of Improvement:• The SCO should develop a plan to track the completion of

the ISP Signature Page and ensure that it is completed correctly before filing.

August 2014 41



57)

Oversight area: Individual Support PlanCompliance Standard: The SC documents as per ODP expectations

Question: For the identified sample of waiver records, if the individual was not present for the ISP meeting, were the results of the meeting reviewed with the individual and the ISP Signature Form completed?ON-SITE

Please enter the number of individuals in the sample who were not present for the ISP meeting in the first text box and the number of individual records with documentation of the ISP being reviewed on the ISP Signature Form in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there are no individuals who had to have the ISP reviewed with them after the meeting, please put 0 (zero) in both text boxes.

# of individuals in the sample who were not present at the ISP Meeting:

# of individual records with documentation of the ISP being reviewed on the ISP Signature form:

Source Document(s):ISP Manual; ODP Bulletin # 00-12-05, Individual Supports Plans (ISPs) – Attachment #3 (Revised ISP Signature Form)

• Reviewer will review the current ISP Signature Form to see if the individual attended the ISP Meeting.

• If the individual did not attend the ISP Meeting, ensure that the ISP Signature Form contains the individual’s signature and date of when the results of the meeting were reviewed.


provided to all SCs on appropriate documentation of ISP meetings with individuals who are not present at the meeting.

August 2014 42



58)


Question: For the identified sample of waiver records, did the SC facilitate the annual review ISP meeting at least 60 days prior to the Annual Review Update Date?

Please enter the number of individuals in the sample in the first text box and the number of individuals whose annual review ISP meeting was held at least 60 days prior to the Annual Review Update Date in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).


# of individual records with the annual review ISP meeting held at least 60 days prior:

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations,51.28(c)(4), ODP Bulletin # 00-10-06, Supports Coordination Services, page 10 (1), ISP Manual.

• Reviewer will review ISP records to ensure documentation of annual Review ISP activity.

• Reviewer will review ISP Meeting date in the ISP and compare to Annual Review Update Date that is within the review period of 7/1/2013-6/30/2014 to identify if the meeting was held at least 60 days in advance.

• Reviewer will use the actual date of the ISP Meeting (regardless of whether it was rescheduled or not)

• Reviewer will use either HCSIS or the ISP Signature Form.

Remediation:• The SCO should provide verification that the meeting was

held according to ODP requirements.

Plan of Improvement:• The SCO should develop a plan to ensure that ISP meetings

are held according to required timeframes.• The SCO should provide training to ensure that all SCs


August 2014 43



59)


Question: For the identified sample of waiver records, did the SC submit the annual review ISP for approval and authorization at least 30 days prior to the Annual Review Update Date?

Please enter the number of individuals in the sample in the first text box and the number of individuals whose annual review ISP was submitted for approval and authorization at least 30 days prior to the Annual Review Update Date in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).


# of individual records with the annual review ISP submitted for approval at least 30 days prior:

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations, 51.28(c)(5), ODP Bulletin # 00-10-06, Supports Coordination Services, page 10 (1), ISP Manual.


• Reviewer will review date ISP was submitted (Pending Approval status) and compare to Annual Review Update Date to identify if the ISP was submitted at least 30 days in advance of Annual Review Update Date that is within the review period of 7/1/2013-6/30/2014.

Plan of Improvement:• The SCO should develop a plan to ensure all ISP activity is

being done in a timely manner and documented in HCSIS.• The SCO should provide training to ensure that all SCs


August 2014 44



60)


Question: For the identified sample of waiver records, did the SC re-submit the Annual Review ISP for approval and authorization within 7 days of date it was returned for revision?

Please enter the number of individuals in the sample whose Annual Review ISP was returned for revision in the first text box and the number of individuals whose annual review ISP was re-submitted for approval and authorization within 7 days in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there are no individuals whose annual review ISP was returned for revision, please put 0 (zero) in both text boxes.

# of individuals in the sample whose Annual Review ISP was returned for revision:

# of individual records whose ISP was re-submitted within 7 days:

Source Document(s): 55 Pa. Code Chapter 51, Waiver Regulations, 51.28(c)(6),ISP Manual.


• Reviewer will note the date Annual Review ISP was returned by AE for revision (Pending Revision status) and compare to the date ISP Revision was submitted (Pending Approval status) and determine if the ISP Revision was submitted within 7 days.

• Based on Annual Review Update Date that is within the review period of 7/1/2013-6/30/2014.

Plan of Improvement:• The SCO should develop a plan to ensure all ISP activity is

being done in a timely manner and documented in HCSIS.• The SCO should provide training to ensure that all SCs


August 2014 45



61)

Oversight area: ISP implementationCompliance Standard: The approved ISP is implemented.

Question: For the identified sample, do the descriptions of the services in the ISP and Service Notes match the service definitions for the services that are authorized in the approved ISP?

Please enter the number of individuals in the sample in the first text box and the number of individuals whose authorized services match the service definitions in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).


# of individual records whose authorized services match the service definitions:

Source Document(s):55 Pa. Code Chapter 51, Waiver Regulations, 51.4; Waiver Assurance on Qualified Providers (Appendix C); ISP Manual

• Reviewers will review ISPs and Service Notes.• Compare descriptions of services in Service Notes to actions

and outcomes identified in the ISP.• Compliance is indicated if the service descriptions are in

accordance with the outcomes for authorized services.• If the description of services in the ISP matches the outcomes

in the ISP, but are not consistent with the definition of the service in the waivers, the question will be mark N.

Remediation:• The SCO will request a team meeting to discuss ensuring

that the appropriate service is attached and authorized in the ISP


provided to all SCs on appropriate documentation of services.

• The SCO should develop and implement a process to review/assess individuals’ needs and ensure that the appropriate service is included in the ISP.

August 2014 46



62)

Oversight area: Standardized Needs AssessmentCompliance Standard: The SC uses HCSIS to document compliance with all requirements of supports coordination services.

Question: For the identified sample of waiver records, if a SIS has been completed, does the ISP include the results from the SIS?Please enter the number of individuals in the sample who have a SIS completed in the first text box and the number of individuals whose ISPs includes assessed needs as indicated in the SIS in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If no one in the sample meets the meet the age requirement for a SIS, please put 0 (zero) in both text boxes.

# of individuals in the sample who have a SIS:

# of individual records with SIS assessed needs information recorded in the ISP:

Source Document(s): Consolidated and PFDS waivers.

• Reviewer will review HCSIS to see if a SIS has been completed.• If the individual has a SIS, the ISP will be reviewed to see if the

results from the SIS are in the ISP.• Reviewer will look in the ISP for medical needs, behavioral

needs and anything that is mentioned repeatedly in the SIS assessment.

• If an individual does not have a SIS, do not count them in the sample number.

• If individuals do not meet the AAIDD required age range for a SIS (16-72) or do not have a SIS, mark N/A.

• If there are no individuals with a SIS, mark “0” (zero).

Plan if Improvement:• The SCO should ensure that the current ISP is updated to

include all results from the SIS.• The SCO should develop a plan to ensure that SIS results

are included in ISPs.

63)

Oversight area: Standardized Needs AssessmentCompliance Standard: The SCO ensures participation in standardized needs assessment

Question: For the identified sample of waiver records, if a SIS has been completed in the review period, did the SC participate?Please enter the number of individuals in the sample who have a SIS completed in the review period in the first text box and the number of SCs who participated in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there are no individuals with a SIS completed in the review period, please put 0 (zero) in both text boxes.

# of individuals in the sample who have a SIS:

# of individual records whose SC participated in the SIS:

Source Document(s): 55 Pa. Code Chapter51, Waiver Regulations, 51.13(x).

• Reviewer will review HCSIS to see if a SIS has been completed during the review period of 7/1/2013-6/30/2014.

• If the individual has a SIS, the Assessment Switchboard will be utilized to view the participants.

• If an individual does not have a SIS completed in the review period, do not count them in the sample number.

• If there are no individuals with a SIS completed in the review period, mark “0” (zero).

Plan of Improvement:• The SCO should develop a plan to ensure that SCs

participate in the SIS assessment.

August 2014 47



64)

Oversight area: Individual Support PlanCompliance Standard: The SC documents Outcomes as per ODP expectations

Question: For the identified sample, has the ISP team identified areas of risk for the individual?

Please enter the number of individuals in the sample who have identified areas of risk in the text box.

# of individuals in the sample who have an identified area of risk:

Source Document(s): ISP Manual• Non-scored

65)


Question: For the identified sample, if a risk has been identified, does the ISP identify risk mitigation strategies?

Please enter the number of individuals in the sample who have identified risks in the first text box and the number of individuals whose ISPs includes risk mitigation strategies in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten). If there are no individuals with an identified risk, please put 0 (zero) in both text boxes.

# of individuals in the sample who have an identified risk:

# of individual records whose ISP includes risk mitigation strategies:

Source Document(s): ISP Manual• Reviewer will read the ISP for risk mitigation strategies for the

identify areas of risk (based upon the ISP Health & Safety Focus Areas – general health safety risks, fire safety, and traffic, through meals /eating).

Plan of Improvement• The SCO should ensure that the current ISP is updated to

reflect any risk mitigation strategies identified.• The SCO should review all ISPs and ensure that all risk

mitigation information is included.• The SCO should develop a plan to ensure that training is

provided to all SCs on appropriate documentation of risk mitigation in the ISP.

August 2014 48



66)


Question: For the identified sample, do the outcome statements have any services listed in them?

Please enter the number of individuals in the sample in the first text box and the number of individuals whose ISP outcome statements DO NOT have a service listed in them in the second text box. Please enter your response in integer format only (i.e., 10 instead of ten).

This question will be N/A for all SCOs in Cycle 4.

Source Document(s): ODP Training “Outcome Statements (Slide 20)”.

• Reviewer will review the outcome statements for each individual to ensure they do not have services listed in them.

• This question will be N/A for all SCOs in Cycle 4.

Plan of Improvement• The SCO should review current ISP and remove services

from outcome statements if present.• The SCO should develop a plan to ensure that training is

provided to all SCs on appropriate documentation of services in outcomes as per ODP’s on-going Outcomes Trainings.

67)

Comments Box

• Provide a comment for any questions answered with a zero, No or N/A (please include question number).

• Provide any other comments related to questions.

Appendix C

Billable ActivitiesLocating: Locating services and supports consists of assistance to the participant and his or her family in linking, arranging for, and obtaining services specified in an Individual Support Plan (ISP), including needed medical, social, habilitation,

Participate in the ODP standardized needs assessment process to inform development of the ISP, including any necessary ISP updates;

Facilitate the completion of additional assessments, based on participants’ unique strengths and needs, for planning purposes and ISP development in order to address all areas of needs and the participant’s strengths and preferences;

Locate resources for the development of the ISP; Assist the participant in identifying people to serve as part of the ISP team, and offer support to invite other people who may

August 2014 49

ODP Guidelines for Completing the SCO Monitoring Tooleducation, or other needed community services. Activities included under the locating function include all of the following, as well as the documentation of the activities

contribute valuable information during the planning process; Assist the participant and his or her family in identifying and choosing willing and qualified providers; Inform participants about the use of unpaid, informal, generic, and specialized services and supports that are necessary to

address the identified needs of the participant and to achieve the outcomes specified in the ISP; Provide information to participants on fair hearing rights and assist with fair hearing requests when needed and upon request;

and Assist participants in gaining access to needed services and to exercise their civil rights.

Coordinating: Coordinating consists of development and ongoing management of the ISP in cooperation with the participant, his or her family, members of the ISP team, and providers of service. Activities included under the coordinating function include all of the following, as well as the documentation of the activities:

Use a person centered planning approach and a team process to develop the participant’s ISP to meet the participant’s needs in the least restrictive manner possible;

Use information from the ODP standardized needs assessment, as well as any additional assessments completed based on the unique needs of the participant, to develop the ISP to address all of the participant’s needs;

Periodic review of the ISP with the participant, including update of the ISP at least annually and whenever a participant’s needs change;

Periodic review of the standardized needs assessment through a face-to-face visit with the participant, at least annually or more frequently based on changes in a participant’s needs, to ensure the assessment is current;

Coordinate ISP planning with providers of service to ensure consistency of services; Coordinate with other entities, resources and programs as necessary to ensure all areas of the participant’s needs are

addressed; Contact with family, friends, and other community members to facilitate coordination of the participant’s natural support

network; Facilitate the resolution of barriers to service delivery; and Disseminate information and support to participants and others who are responsible for planning and implementation of

services.

Monitoring: Monitoring consists of ongoing contact with the participant and his or her family, to ensure services are implemented as per the ISP. Activities included under the monitoring function include all of the following, as well as the documentation of the activities:

Monitor the health and welfare of participants through regular contacts at the minimum frequency outlined in Appendix D-2-a of this Waiver;

Monitor ISP implementation through monitoring visits with the participant, at the minimum frequency outlined in Appendix D-2-a of this Waiver;

Visit with the participant’s family, when applicable, and providers of service for monitoring of health and welfare and ISP implementation;

Respond to and assess emergency situations and incidents and assure that appropriate actions are taken to protect the health and welfare of participants;

Review participant progress on outcomes and initiate ISP team discussions or meetings when services are not achieving desired outcomes;

Monitor participant and/or family satisfaction with services; Arrange for modifications in services and service delivery, as necessary to address the needs of the participant, and modify

the ISP accordingly; Ensure that services are identified in the ISP; Work with the authorizing entity regarding the authorization of services on an ongoing basis and when issues are identified

August 2014 50

ODP Guidelines for Completing the SCO Monitoring Toolregarding requested services;

Communicate the authorization status to ISP team members, as appropriate; Validate that service objectives and outcomes are consistent with the participant’s needs and desired outcomes; Advocate for continuity of services, system flexibility and integration, proper utilization of facilities and resources,

accessibility, and participant rights; and Participate in activities related to Independent Monitoring for Quality, such as obtaining consent to participate from the

participant, preparing survey information, and follow up activities (“closing the loop”) and other activities as identified by ODP.

In addition to locating, coordinating, and monitoring, Supports Coordination also includes providing information and assistance in order to help participants transition to the community or decide whether to select participant direction of services, and assistance for participants who opt to direct services. Activities include all of the following, in addition to the documentation of activities:

Provide participants with information on participant direction, including the potential benefits and risks associated with directing services, during the planning process and upon request;

Assist with the transition to the participant direction service delivery model if the participant is interested in this model, and ensure continuity of services during transition;

Assist the participant in designating a surrogate, as desired, as outlined in Appendix E-1-f of this Waiver; and Provide participants with the standard ODP information about participant direction, an explanation of the options and the

contact information for the Financial Management Services provider.

Non-Billable Activities Outreach that occurs before an individual is enrolled in the Waiver; Intake for purposes of determining whether an individual has an intellectual disability and qualifies for Medical Assistance; Direct Prevention Services, which are used to reduce the probability of the occurrence of an intellectual disability resulting from social, emotional, intellectual, or

biological disorders; General information to participants, families, and the public that is not on behalf of a waiver participant, such as school fairs; Travel time incurred by the Supports Coordinator may not be billed as a discrete unit of service; Services otherwise available under the MA State Plan and other programs; Services that constitute the administration of foster care programs; Services that constitute the administration of another non-medical program such as child welfare or child protective services, parole and probation functions, legal

services, public guardianship, and special education; Direct delivery of medical, educational, social, or other services; Delivery of medical treatment and other specialized services including physical or psychological examinations or evaluations; The actual cost of the direct services other than Supports Coordination that the Supports Coordinator links, arranges, or obtains on behalf of the participant; Transportation provided to participants to gain access to medical appointments or direct Waiver services other than Supports Coordination; Representative payee functions;

August 2014 51

ODP Guidelines for Completing the SCO Monitoring Tool Conducting Medicaid eligibility certification or recertification, intake processing, Medicaid pre-admission screening for inpatient care, prior authorization for Medicaid

services, and Medicaid outreach (methods to inform or persuade individuals to enter into care through the Medicaid system); and Assistance in locating and/or coordinating burial or other services for a deceased participant.

August 2014 52

Documents

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