Provider Applicant Orientation for the Office of

>www.dpw.state.pa.us >www.dhs.pa.gov

OFFICE OF DEVELOPMENTAL PROGRAMS

Provider Applicant Orientation for the Office of Developmental Programs

Pre-Registration Module 6: Becoming a Provider

Hello, my name is Frank Schweigert with the Columbus Organization. Welcome to Pre‐Registration Module 6 of the Office of Developmental Programs’ Provider Applicant Orientation.

This module is the sixth and final in a series of modules to ensure that Applicants seeking to provide services to people with an Intellectual Disability (ID) and/or Autism Spectrum Disorder (ASD) obtain a basic understanding of how the Office of Developmental Programs (ODP) system works. The information in this module is about becoming a provider. The information will be further explained during the face‐to‐face session. It does not substitute for additional research using the resource materials available in this course.

This material is presented so that you may learn as much about how the system works as possible to prepare for attending an in‐person Provider Applicant Orientation session and/or Bureau of Autism Services (BAS) enrollment.

Revised 3-25-2020 1

PA Dept. of Human Services, Office of Developmental Programs - Provider Applicant Orientation Pre-Registration Module 6


Step 1:

Review the material for each of the pre-registration modules and successfully pass the test after each module.

Step 2:

Register for and participate in a full-day in-person session.

Step 3:

Successfully pass a post-test following the in-person session.

Introduction

This module is part of Step 1 shown on the slide. This is the last of six Modules that must be completed before an Applicant can register for an in‐person session.

Revised 3-25-2020 2



Applicants intending to provide services through the Adult Autism Waiver (AAW) only: You are not required to complete this module and are not required to register for a face-to face session. If you have completed modules 1-5, then contact the Bureau of Support for Autism and Special Populations (BSASP) at 1-866-539-7689 or [email protected] for further enrollment steps.

Applicants who intend to provide services through Consolidated, Community Living, Person/Family Directed Support and Adult Autism Waiver: Complete this module, pass the post-test, and continue to the next module.

Applicants who intend to provide services only through the Adult Autism Waiver (AAW) are required to complete this module but are not required to register for a face‐to‐face session. After completing modules 1‐5 (including passing the post‐tests), contact the Bureau of Support for Autism and Special Populations (BSASP) using the information on the slide for further enrollment steps.

If you intend to provide services through the other Office of Developmental Programs’ Waivers, the Consolidated, Community Living, Person/Family Directed Support (or P/FDS) and Adult Autism Waiver, you must continue with this Module, pass the post‐test, and continue to the next module.

Revised 3-25-2020 3



Introduction

Step 1:

The CEO/Executive Director must review the material for each module and successfully pass the test for the module.

Introduction, ODP Service System, and ODP Mission, Vision, and Values

Person-Centered Planning and the ISP

Rules and Regulations, the ID/A Waivers, and Monitoring of Providers

Incident and Risk Management

Financial Management, Quality Management, and Provider Training

Becoming a Provider

Remember that only the CEO/Executive Director is permitted to take the test that follows each module.

Revised 3-25-2020 4



Becoming a Provider

You are applying to be a Medicaid provider. The enrollment process is to assure that only qualified providers may provide waiver services. People with an Intellectual Disability and/or Autism require assurances that they get the services they need, that they are free from harm and receive supports that promote their independence.

The process is complex. The Applicant is responsible to submit all required materials in accordance with expected timeframes. Attending this Orientation training and accessing the various references should be helpful to guide you.

Revised 3-25-2020 5



Becoming A Provider Process Steps

Licensed

LicensingFlowchart

Unlicensed

In the Resources for Pre‐Registration Module 6 are links for the documents on the slide. You should have them to refer to while viewing this Module. You will also need to print and bring them with you to the face‐to‐face session (it is acceptable to save them to the laptop you will bring with you to the session instead of printing.)

1. Licensing FLOWCHART2. Licensed PROCESS (steps)3. Unlicensed FLOWCHART4. Unlicensed PROCESS (steps)5. Bureau of Human Services Licensing Flowchart

Important notes: • Many of these steps will be completed after you have completed the Orientation and enter the

Qualification phase. Any steps you can take are outlined in the Getting Started document. If the step is not included in the Getting Started Document, please hold your question until the face‐to‐face session.

• Print or save these documents to your computer and have them nearby so you can refer to them in this section. You will also need to bring printed copies of these five documents with you to the face‐to‐face session.

These flow charts and documents portray the process of getting enrolled for ODP services and the process for becoming a licensed provider. The licensed and unlicensed versions of the flowchart and Word document with steps were included in the materials available for download with the PowerPoint.

The flowchart covers the enrollment process as it is today from first contact to PROMISe™ enrollment. In this section, we are going to review each step in the process related to Applicants’ responsibility. If you carefully read the chart, you will note that it includes activities by other entities, such as ODP and Administrative Entities in response to the Applicant’s status in the process.

Revised 3-25-2020 6


Revised 3-25-2020


6


These are the steps you’ve already taken as a provider Applicant:

Expressed interest in rendering Consolidated, Community Living Waiver, P/FDS Waiver, or Adult Autism Waiver (AAW) services within ODP.

Received the Provider Applicant (aka Getting Started) e-mail from ODP or AE.

After completing the post-test for this Module, you will be able to register for a face-to-face session.

Provider Applicant Orientation

This slide corresponds to steps 1 and 2 on the Licensed and Unlicensed Process documents.

When Applicants make their first inquiry, typically to ODP or an AE, they receive an e‐mail that directs them to the MyODP Provider Applicant Orientation Welcome course.

At this point, you will have reviewed the first five (5) Pre‐Registration Modules. This is the final Pre‐Registration Module. After completing the post‐test for this Module, you will be given the opportunity to register for an available face‐to‐face session.

Revised 3-25-2020 7



After completing all Pre-Registration requirements, an Applicant registers for and attends a face-to-face Provider Applicant Orientation session.

The CEO/Executive Director must attend the full-day session.

While waiting for the face-to-face session, Applicants should review the Getting Started Materials. These materials are available after registration is complete.


After completing all Pre‐Registration requirements, you will register for an all‐day, face‐to‐face session. The CEO/Executive Director must attend the full‐day session.

Only the CEO/Executive Director is permitted to attend the face‐to‐face session. As of May 1, 2019, guests are no longer permitted. The CEO/Executive Director must bring a photo ID to the session and present it in order to participate.

While waiting to attend the face‐to‐face session, you should review and begin completing the Getting Started materials. The Getting Started materials will be available after you have completed registration.

Revised 3-25-2020 8



Applicants take a post-test after the face-to-face session.

Applicants who pass the post-test will be able to download and print a Certificate and Next Steps document.

Next Steps

Applicants who do not pass the post-test after two attempts will need to attend a second face-to-face session.

Applicants may attend a maximum of two face-to-face sessions per calendar year.


Applicants who do not pass the post-test after a second face-to-face session must wait one year (365 days) before registering for a session again.

Following the face‐to‐face session, Applicants will take a post‐test. Immediately after submitting the post‐test, Applicants will receive feedback on their score. Specific instructions about the post‐test will be given at the session.

• If Applicants pass the post‐test, they will receive a Certificate and next steps.

• If Applicants do not pass the post‐test on the first attempt, they will receive a message stating the score and how to attempt the test a second time.

• If Applicants do not pass the post‐test after two (2) attempts, they will need to attend anotherface‐to‐face Applicant Orientation session.

• If the Applicant does not pass the post‐test after attending the second face‐to‐face session, the Applicant will have to wait one year before taking the Applicant Orientation again.

• Applicants may attend a maximum of two (2) face‐to‐face sessions per calendar year.

Revised 3-25-2020 9



Certificates cannot be issued without a unique identifying number. Most Applicants use the Federal Employer Identification Number (FEIN). You may have supplied this number when you completed demographic information.

Applicants who do not have an FEIN may use the last four digits of the CEO’s social security number or another four digits.

If you did not provide a number when you registered, send it to [email protected]. If you do not provide an identifying number, it may result in a delay in the qualification process.

There is more information about the FEIN on the IRS.gov website.


#12-3456789

Important:

If you pass the post‐test, ODP must have a unique identifying number to place on the Certificate. You may have already supplied this number when you completed the Demographic information. If you did not, bring the number to the face‐to‐face session.

Please note: If you do not enter a unique identifying number, there will be a delay in receiving your Certificate if you pass the post‐test. This may further delay your application and enrollment process.

To learn more, follow the link on this slide.

Revised 3-25-2020 10



Certificate for Licensed Services

Information on licensing services can be found on the DHS website (www.dhs.pa.gov)Providers > Human Services Licensing > Developmental Programs Licensing

2380 – Adult Training Facilities

2390 – Vocational Facilities

6400 – Residential Habilitation

6500 – Family Living Homes(Lifesharing)

Providers seeking to become qualified for such licensed services will need to earn a Certificate of Compliance for the relevant licensed Chapter i.e. Chapter 6400, 6500, 2380, 2390, etc.

Above is an image of a Certificate of Compliance for licensed services. Providers seeking qualification for a licensed service must have at least one Certificate of Compliance in the appropriate Chapter. On the back of the Certificate will be listed the service or services for which the provider is licensed.

Information on licensing services can be found on the Department of Human Services (DHS) website.

Revised 3-25-2020 11



Requirements for Residential Providers

Meeting this requirement can take time. Begin the coursework as soon as possible.

Those intending to provide Residential Habilitation Services must complete Dual Diagnosis training.

Step 3

Over the next several slides, make sure you have a copy of the Process Steps document discussed earlier in the webcast. Use the document – licensed or unlicensed – that corresponds to the service you are applying to provide. The step will be shown in the green box on the slide.

The link for the ODP Communication shown on this slide is included in the Resource list for Pre‐Registration Module 6.

ODP requires agencies intending to provide Residential Habilitation services to complete the ODP approved Dual Diagnosis Training curriculum. Please refer to ODP Announcement 076‐18 “Required Dual Diagnosis Training for Providers Newly Enrolling to Provide Residential Habilitation Services.”

Completing this requirement may take time. Therefore, providers intending to provide residential service (as outlined in the ODP Communication) are urged to begin completing the coursework as soon as possible in order to avoid delays later in the process.

Revised 3-25-2020 12



Additional Requirements and Resources

Applicants seeking to provide licensed Residential Habilitation in a Community Home must complete the webcast series Providing Residential Habilitation in a Community Home for Individuals with an Intellectual Disability and Autism and earn a certificate as part of the licensing process.

The ODP Regulatory Administration Unit will send instructions after the licensing application has been approved.

Applicants seeking to provide licensed or unlicensed Residential Habilitation Service must complete a review of the ISP Residential Staffing and the Health Risk Screening webinars and earn a certificate. Information on these webinars is available in the Provider Applicant Orientation Pre-Registration course.

This requirement can be met at any time. A certificate must be included in qualification documentation sent to the Assigned Administrative Entity.

A webcast outlining Licensing Application requirements is available to Applicants seeking to provide any licensed service. The webcast is not required. The ODP Regulatory Administration Unit will provide information on the webcast after the licensing application has been approved.

Information on the licensing application process is available to Applicants intending to provide any licensed service. This webcast is not required but may provide guidance on required documentation and the licensing inspection process. Applicants who intend to provide a licensed service will receive information on the Licensing Application webcast from the ODP Regulatory Administration Unit after the license application has been approved.

For those intending to provide Residential Services, there are additional requirements.

Applicants who want to provide licensed or unlicensed Residential Habilitation services must complete a review of two webinars:• Residential ISP Staffing: It's About the Person, Not the Numbers and• Health Risk Screening Tool (HRST) Orientation.

This requirement can be completed at any time, but a certificate must be part of the qualification documentation the Applicant sends to the Administrative Entity during the qualification and enrollment period following the Orientation.

Applicants who intend to provide Residential Habilitation Services in a Community Home must also complete the webcast series Providing Residential Habilitation in a Community

Revised 3-25-2020 13


Home for Individuals with an Intellectual Disability and Autism. This webcast series is not directly available to Applicants on the MyODP website. Information on how to complete the series will be sent to Applicants by the ODP Regulatory Administration after the Applicants’ license application has been approved.

Revised 3-25-2020


13


Provider Registration

For those applying to provide licensed service only: Licensed Steps 5 and 6

ODP Licensed Providers will be required to register with the Certification and Licensing System (CLS).

To become an ODP provider of a licensed waiver service, you must register through the provider self‐service button, located on the Welcome to HCSIS home page. When the Welcome to Provider Self‐Service (PSS) page opens, click the create account button to register your b‐(NAME) user ID (the username you chose during registration will have “b‐” before it.) At the end of this process, a b‐(NAME) user ID will be sent to you via the e‐mail account you used during registration.

Once you have your b‐user ID, log in to the Certification Licensing System to complete the licensing process. The process to earn a license or Certificate of Compliance is quite complex and is a process separate from the ODP qualification and enrollment process (although licensing and qualification should be completed concurrently.) There is a separate flowchart that describes the licensing process for provider Applicants in the "Getting Started Materials" that are available in the Pre‐Registration course in the Resources link for Module 6.

Once complete, you will receive your license along with your PROMISe ID number. The PROMISe ID number is a 13 digit number broken into two parts, the Master Patient Index (MPI) 9 digits plus Service Location 4 digits.

Links to the websites shown on this page are on the Licensed and Unlicensed Steps documents.

Revised 3-25-2020 14



Licensing

Licensed Providers (2380, 2390, 6400, 6500) must email the ODP Regional Waiver Capacity Manager for site clearance.

Providers will receive an approval letter if the site meets requirements.

Step 5

The link to the ODP Announcement shown on this page is included in the Resource document list for Pre‐Registration Module 6.

All licensed settings and unlicensed residential settings must be integrated and dispersed in the community in noncontiguous locations and may not be located on campus settings. Licensed services and Unlicensed Residential services should be located in the community and surrounded by the general public. The provider will contact the appropriate Regional ODP Waiver Capacity Manager to obtain Site Clearance assuring compliance with these requirements prior to their application for licensure.

Providers need to follow the steps outlined in ODP Communication 19‐138 to seek and receive approval from the Regional Waiver Capacity Manager that the site is cleared and meets approval as a non‐contiguous site. The provider will receive an e‐mail confirming approval of the site as non‐contiguous.

Once a licensed provider (2380, 2390, 6400, 6500) has received the e‐mail obtaining site clearance, they must contact licensing to have the site licensed. After the site is licensed and the provider has received a certificate of compliance, it must again contact the Regional Waiver Capacity Manager to request Approved Program Capacity. The provider will then receive a letter that includes the approved Licensed Capacity and the Approved Program Capacity. This letter will need to be submitted as part of the PROMISe enrollment application at the end of this process.

Revised 3-25-2020 15



Provider Applicant to complete ODP Provider Agreement

Provider Agreement

ODP Waiver Provider Instructions and Agreement

Licensed Step 8Unlicensed Step 6

All waiver provider Applicants must complete and sign the ODP Waiver Provider Agreement. The Provider Agreement is the contract between the Provider and ODP.

The ODP Provider Agreement must be on file with ODP before ODP will process an Applicant’s PROMISe™ enrollment application. The AE or BSASP must also verify that the ODP Provider Agreement has been signed so that the provider Applicant can be qualified. The Agreement must be signed by the Provider CEO. The provider's ODP Provider Agreement must be stamped by ODP in the upper right‐hand corner for the AE to utilize it toward the provider's qualification.

The ODP Waiver Provider Agreement and instructions are available on‐line via HCSIS under the ODP Program Links section and is titled “ODP Waiver Provider Instructions and Agreement.” An endorsed ODP agreement will be sent back to the provider Applicant to use with the qualification and enrollment applications.

Revised 3-25-2020 16



Quality Assessment & Improvement Contact Information


Complete the Quality Assessment & Improvement (QA&I) Contact Information Questionnaire.

Send the confirmation to the AE in which you intend to initially provide services.

Complete the ODP QA&I contact information form on Question Pro, then send the confirmation e‐mail to the assigned AE in which you intend to provide the majority of services.

The link is found on your process flow chart.

Revised 3-25-2020 17



Provider Qualification


These three documents are available in the Resources link for Pre‐Registration Module 6. Please review them to become familiar with all the documents. More information on completion of these documents will be discussed in the face‐to‐face session.

The Applicant completes the Provider Qualification Documentation Record, Form DP 1059 and the New Provider Self‐Assessment and submits them with supporting documentation to the AE in which they intend to provide the most service. The AE will review the information, correspond with the Applicant and if approved, will forward an approved copy of the Form PQ Form DP 1059 back to the provider Applicant.

Links to the following documents can be found in the Resources list for Pre‐Registration Module 6.

• DP 1059• ODP Provider Qualification Documentation Record (note: for reference only. We do not recommend

printing this document at this time)• PQ Doc Record ‐ Documentation Requirements Tab (note: this is one tab of the Provider Qualification

Documentation Record noted above. This is one document that you will be asked to print and bring with you to the face‐to‐face session. If you choose to print the document here, keep it in your folder of materials to take with you to the face‐to‐face session).

• New Provider Self‐Assessment and Guidelines 2019.

Revised 3-25-2020 18



Provider Applicant applies for services for which they are qualified.

ODP Provider Enrollment Unit will review application and if approved, enroll in PROMISeTM.

Medical Assistance (MA) Program Enrollment

Licensed Steps 11 & 12Unlicensed Steps 9 & 10

Approved DP FORM 1059License (if required)ODP Agreement

Approved APC letter

Now you are ready to go to the DHS Electronic Provider Enrollment Application website and apply for the Provider Types and Specialties that you are qualified for. You will need to provide supporting documentation including Approved APC letter (if needed), and DP FORM 1059 to ODP Enrollment for each site. Other forms may be required depending on the specialty of service.

If done successfully, you will receive an automated letter generated by the Office of Medical Assistance Programs (OMAP) sent through US mail confirming site enrollment details. You will also receive notification from the HCSIS helpdesk that you have an ODP role to access HCSIS.

Revised 3-25-2020 19



Provider Applicant logs into HCSIS to add services.

Notification is received from the HCSIS Help Desk that the provider Applicant may add services for which they are qualified in HCSIS.

Provider Adds Service

Licensed Steps 13 & 14 Unlicensed Step 10 & 11

The HCSIS Help Desk staff will notify the provider Applicant once the roles have been added to their user id to access HCSIS.

When the notification is received from the HCSIS Helpdesk, the provider Applicant can move forward with adding services they are qualified for in HCSIS.

Job aids on how to add services will be available once you log in.

Revised 3-25-2020 20



Rates loaded into PROMISeTM and contracts created in HCSIS within 5-7 business days.

If participants choose the provider’s services, the Supports Coordinator can add the services to the ISP.

The Supports Coordinator submits the ISPto the Administrative Entity for review.

The Administrative Entity authorizes services and the provider may begin to provide services.

Medical Assistance (MA) Program Enrollment

Licensed Steps 14 & 15 Unlicensed Step 11 & 12

After you have added services in HCSIS, rates are loaded into PROMISeTM and contracts are created in HCSIS within 5‐7 business days. At this point, Supports Coordinators will be able to add services to an individual’s ISP and then submit the ISP for the Administrative Entity to review.

A rate for a service cannot be applied until the entire enrollment process is complete and you are qualified to provide that service.

Additional information can be found on MyODP to help you through the enrollment process.

Revised 3-25-2020 21



Scenario

Phil owns an empty house. He is considering using this home to support people with disabilities. He has asked how he may get paid. The answer to this is not easy.

• Phil could simply lease or sell the home to an individual or a provider. In this case, he is a landlord and does not need to be enrolled in the system.

• If Phil wants to ‘rent rooms’ but not provide any waiver services, this is not eligible for ODP funding.

• Phil can establish a community home for people with an Intellectual Disability. He must complete the registration and enrollment process, become qualified for Residential Habilitation services, and complete the Provider Applicant Orientation.

• Get licensed, obtain ODP approval for site size, enroll in PROMISe™ and if Phil’s agency is the provider of choice for an individual enrolled in the Consolidated Waiver, begin services.

Read this scenario and reflect on the following.

This is one of the most frequently asked questions from potential Applicants who are considering offering services. Although not all potential Applicants want to provide residential habilitation, it is the most complicated of waiver services to initiate.

There are additional requirements in regulation and the waiver regarding the location, space requirements and building codes of community homes. Waiver sites must be geographically dispersed, meaning within a certain distance and configuration of another group home to prevent the clustering of homes, diminishing the community nature of the home.

There are limited start‐up funds that are subject to the availability of funds. A new Provider will need a plan to sustain their cash flow to include average days taken to identify and begin services to new residents and additional time for payment for at least three weeks due to prudent pay.

Revised 3-25-2020 22



Becoming A Provider

What does this mean for you as a prospective provider?

Registration, orientation, licensure (if applicable), qualifications, and PROMISe™ enrollment are completed before approval to begin offering services.

ODP registration and PROMISe™ enrollment can take from 30-90 days to complete.

Applicants must be prepared to assure compliance with all federal and state regulations.

Think about the services you intend to provide and consider the following:

• Registration, orientation, licensure (if applicable), qualifications and PROMISe™ enrollment are all pre‐requisites to the final approval for the Applicant to begin to offer services.

• Due to the complexity of the process and depending on departmental priorities and provider responsiveness, ODP registration and PROMISe™ enrollment can take from 30‐90 days to complete.

• Applicants must be aware of the complexity of the ODP system and be prepared to assure compliance with all federal and state regulations.

Revised 3-25-2020 23



Next Steps

Return to the Provider Applicant Orientation Welcome course and follow these steps:• Complete the training confirmation.• If you are ready, click the link to open the test for Module 1.• Answer all questions, then click “submit” then “submit all and finish.”

This concludes Pre-Registration Module 6 of the ProviderApplicant Orientation.

After you submit your answers, you will receive feedback on your score and next steps.

Thank you for reviewing Module 6.

Return to the Provider Applicant Orientation Course:

* Complete the training confirmation.

* If you affirmed that you have reviewed the information and are ready to take the test, you will see a link for Module 6: Test.

* Click the link to open the test. Answer all the questions, then click the “submit” button and then “submit all and finish”.

After you submit your test responses, you will receive a score and feedback on next steps. If you passed all Module tests, you will be able to proceed to register for an available face‐to‐face session.

Revised 3-25-2020 24



25

Music courtesy of www.essasmusic.com

Developed and produced by

Pennsylvania Department of Human ServicesOffice of Developmental Programs

In partnership with

This webcast has been developed and produced by the Pennsylvania Department of Human Services, Office of Developmental Programs in partnership with The Columbus Organization.

Thank you for participating in this lesson.

Revised 3-25-2020 25


Documents

Provider Applicant Orientation for the Office of