The Bureau of Autism Service’s Adult Autism Waiver
Public Comments
Notice was published in the Pennsylvania Bulletin on December 20, 2014 informing stakeholders that
the Adult Autism Waiver was making an amendment and accompanying transition plan available for
public review and comment. This notice also informed stakeholders that comments would be accepted
regarding the waiver amendment and accompanying transition plan from December 20, 2014 through
February 2, 2015. The public was given three different methods for submitting comments: Verbally
during two webinars held, electronically via the email address (RA-odpcomment@pa.gov) or written
submission by mail.
This document reflects summaries of the comments received during the public notice period, reasons
why comments were not adopted, and any modifications to the amendment based upon those
comments. Multiple comments that convey the same meaning were consolidated.
Helpful definitions of acronyms used in this document:
BAS – The Bureau of Autism Services
CMS – The Centers for Medicare and Medicaid Services, the federal agency that approves and funds
Pennsylvania’s 1915(c) Waivers
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Summary of Comment
Several comments were received that
recommended a substantive change be made
to the AAW. Some of these suggestions
included, adding participant-directed services,
and adding a service definition that includes
Smart Home Technology, Telecare and Personal
Emergency Response Systems.
It was recommended by one commenter that
the AAW include the term “abandonment” to
reserved capacity to reflect the Adult Protective
Services Act.
It was recommended by one commenter that
the AAW allow an individual who meets criteria
for reserved capacity to enroll if he or she is in
another program (including a waiver program)
that is not sufficient to meet his or her needs.
Response
This is a retroactive amendment. Any
substantive change cannot be considered for a
retroactive amendment. Per CMS guidance, each
of these would be considered a substantive
change.
BAS agrees with this recommendation and has
revised the amendment accordingly.
If the individual is already being served in
another waiver, Adult Protective Services would
give the Report of Need (RON) automatically to
the office that is currently serving the individual.
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Numerous comments were received requesting
that the AAW substantially increase the waiver
enrollment in this amendment, as well as
reserved capacity.
One comment was received recommending
that the AAW provide enough funding to serve
all individuals on the waiting list, regardless of
Priority.
One commenter recommended that the AAW
allow for enrollment into the waiver based on
need.
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One commenter recommended that the AAW
should not exclude individuals who live in
institutions from receiving AAW services.
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One commenter recommended that each
service definition should contain a statement
that all settings must comply with
42 C.F.R. § 401.301(c)(4)-(5).
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One commenter recommended that the
supports coordination service definition include
all person-centered planning requirements and
conflict-free rules from the new federal
regulations for waivers,
42 C.F.R. §441.301(c)(1)-(3).
One commenter recommended that the AAW
should require provider training on how to
minimize and avoid the use of restraints,
seclusion, and other restrictive interventions
and how to use proactive, positive measures
instead.
One commenter suggested, in response to
Appendix G-2-a-I and Appendix G-2-c, providers
who use restraints or seclusion should not be
able to bill for services when restraints or
seclusion are used.
One commenter questioned “why it takes 120
days to enroll new people into the waiver.” The
commenter recommended that eligibility
determinations and enrollment should be more
expeditious.
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The current amendment reflects the number of
individuals the Waiver is funded to serve.
The current amendment reflects the number of
individuals that the Waiver is funded to serve.
This amendment is a retroactive amendment.
Any substantive change cannot be considered
for a retroactive amendment. Per CMS guidance,
this would be considered a substantive change.
The Bureau of Autism Services will keep this
comment under consideration.
The Adult Autism Waiver does not exclude
individuals who live in institutions from receiving
services. A person who lives in an institution
would be placed on the Priority 2 interest list.
The current transition plan states that waiver
service definitions will be reviewed to determine
which changes will be necessary. This
recommendation will be considered during this
process.
Appendix D of the Waiver reflects the
Participant-Centered Planning and Service
Delivery of the Waiver. BAS will keep this
comment under consideration when revising
service definitions in the future.
This amendment is a retroactive amendment.
Any substantive change cannot be considered
for a retroactive amendment. Per CMS guidance,
this would be considered a substantive change.
BAS will keep this comment under consideration.
Appendix G of the Adult Autism Waiver
addresses the use of restraints and seclusion.
This change is due to a CMS format change in
Appendix G. The content of these sections are
not changed, only the format.
The Bureau of Autism Services has and will
continue to design improvement projects to
reduce the time frame of enrollment. Please
note that the Adult Autism Waiver does not
determine a person’s eligibility for the Waiver
until after the application has been sent. This
differs greatly than other Waivers and impacts
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Several comments were received regarding
concerns of a lack of accessible and affordable
housing.
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One comment was received questioning “why
some kids who desperately need a waiver are
not getting approved and other people are
getting waivers approved who underutilize
their waiver.”
One comment was received wanting more
information available to the public.
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Two comments were received suggesting that
the Adult Autism Waiver allow funding for
individuals under 21 years of age
the amount of time it takes for a person to be
enrolled and begin receiving services in the
Waiver.
While waiver funds may not be used for housing,
the need for affordable housing in Pennsylvania
is a concern the Bureau of Autism Services has as
well. BAS continues to seek and share housing
resources for participants and Supports
Coordinators. Unfortunately, this is a concern
that the Waiver itself cannot address.
Every participant enrolled in the Adult Autism
Waiver has been deemed eligible and
determined to need services.
We understand this comment to refer to
information about the final rule.
BAS agrees that more information should be
made available for participants and family
members. BAS is currently working on
documents that will provide an overview of the
CMS Home and Community-Based Services
(HCBS) Final Rule that will be made publicly
available. BAS is working with the Office of
Developmental Programs to develop webinars
that will provide general information on the CMS
HCBS Final Rule to Supports Coordination
Agencies. While these are examples of some
initial projects BAS is engaged in, BAS is
committed to ongoing engagement and
education of all stakeholders impacted by any
changes made.
This amendment is a retroactive amendment.
Any substantive change cannot be considered
for a retroactive amendment. Per CMS guidance,
this would be considered a substantive change.
The Bureau of Autism Services will keep this
comment under consideration.
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