Service Category

SERVICE NAME AND DESCRIPTION

Service Levels (Base Rates and Modifiers

SERVICE DEFINITION

Home and Community Services
Health and Community Services

Home and Community Habilitation
Services to help people gain, maintain, and improve skills that allow them to live and participate in their local community

Home and Community Services

Direct service and services to meet regulatory requirements and/or contract conditions provided in home and community settings to assist individuals in acquiring, retaining, and improving self-help, socialization and adaptive skills. For the most part, these services differ only with respect to setting or regulatory requirements. This service can only be provided when the county program determines it will prevent institutionalization.

 

Examples of habilitation include supporting someone to participate in a church activity, learning to cook safely, or learning to use public transportation independently.

Rate Base and Modifiers

Modifiers are used to identify individual services and account for differences in service delivery regulations or methods specific to the service setting. Modifiers enable services to be enriched through lower staff to individual ratios and program content. Individuals and families have increased program options from which to choose and levels of service are available to appropriately address individuals' health and safety needs and/or to achieve the purpose of the provision of the service.

   

Home and Community Habilitation

This service may be made available to individuals in their own home or in other residential or community settings not subject to licensing regulations. Recreation is not an eligible service. Camp day or overnight can only be provided under respite/family aid. Entrance fees to events are not covered. Standard of a contiguous state with regional approval in writing.

   

Basic Staff Support

The provision of the service at a staff to individual ratio of  no less than 1:6.

   

Staff Support Level 1

The provision of the service at a staff to individual ratio range of <1:6 - 1:3.5.

   

Staff Support Level 2

The provision of the service at a staff to individual ratio range of <1:3.5 - >1:1.

   

Staff Support Level 3

The provision of the service at a staff to individual ratio of 1:1.

   

Level 3 Enhanced

The provision of the service at a staff to individual ratio of 1:1 with a staff member who has a 4-year degree or is a licensed nurse.

   

Staff Support Level 4

The provision of the service at a staff to individual ratio of 2:1.

   

Level 4 Enhanced

The provision of the service at a staff to individual ratio of 2:1 with staff members who have a 4-year degree or are licensed nurses; this is indicated by a TD or TE.

 


 

Licensed Day Services Community Habilitation (Title 55, Chapter 2380 Adult Training Facilities)
Adult training facilities provide services that assist individuals in meeting personal needs and performing basic daily activities.

Licensed Day Services/Community Habilitation

This service is made available to individuals in an Adult Training Facility and includes Older Adult Daily Living Centers (6 Pa. Code Chapter 11). Services include supervision, training, and support in communication, self-care and socialization.

   

Basic Staff Support

The provision of the service at a staff to individual ratio of no less than 1:6.

   

Staff Support Level 1

The provision of the service at a staff to individual ratio range of <1:6 - 1:3.5.

   

Staff Support Level 2

The provision of the service at a staff to individual ratio range of <1:3.5 - >1:1.

   

Staff Support Level 3

The provision of the service at a staff to individual ratio of 1:1.

   

Level 3 Enhanced

The provision of the service at a staff to individual ratio of 1:1 with a staff member who has at least a 4-year degree or is a licensed nurse.

   

Staff Support Level 4

The provision of the service at a staff to individual ratio of 2:1.

   

Level 4 Enhanced

The provision of the service at a staff to individual ratio of 2:1 with staff members who have at least a 4-year degree or are licensed nurses; indicated by a TD or TE.

Services with code W7072 through W7076 may be made available to individuals by providers in states contiguous to Pennsylvania when services meet comparable standards. Must have regional approval in writing.

 


 

Pre-Vocational Services (Title 55, Chapter 2390 Vocational Facilities)
Prevocational training prepares individuals for paid employment.

Pre-Vocational Services

This service is made available to individuals in a Vocational Facility. "Handicapped employment" as defined in Title 55, Chapter 2390 is not a service that may be funded through the waiver.

   

Basic Staff Support

The provision of the service at a staff to individual ratio of 1:15.

   

Staff Support Level 1

The provision of the service at a staff to individual ratio range of <1:15 - 1:7.5.

   

Staff Support Level 2

The provision of the service at a staff to individual ratio range of <1:7.5 - >1:1.

   

Staff Support Level 3

The provision of the service at a staff to individual ratio of 1:1.

   

Level 3 Enhanced

The provision of the service at a staff to individual ratio of 1:1 with a staff member who has at least a 4-year degree or is a licensed nurse.

   

Staff Support Level 4

The provision of the service at a staff to individual ratio of 2:1.

   

Level 3 Enhanced

The provision of the service at a staff to individual ratio of 2:1 with staff members who have at least a 4-year degree or who are licensed nurses.

Services with code W7087 through W7093 may be made available to individuals by providers in states contiguous to Pennsylvania when services meet comparable standards. Must have regional approval in writing.

 


 

Licensed Residential Habilitation Services


Residential Home and Community Habilitation - Licensed Homes 

Direct service and services to meet regulatory requirements and contract conditions provided in licensed community homes to assist individuals in acquiring, retaining, and improving self-help, socialization and adaptive skills. Services under code W6090 through W7040 are residential services that differ in setting and regulatory requirements. All homes must be integrated and dispersed; homes on campuses are not eligible for waiver.

 



Rate Setting Methodology

Rates are based on the individual's needs and are/may be unique to each person in each setting.

 

Child Residential Services (The residential section of Title 55, Chapter 3800 Child Residential and Day Treatment Facilities)

Child Residential Services

The Title 55, Chapter 3800 services that may be funded through the waiver are limited to residential service settings. Child residential services provided in secure settings, detention centers, and residential treatment facilities accredited by JCAHO may not be funded through the waiver.

   

Eligible

Service costs eligible for waiver funding.

   

Ineligible

Service costs not eligible for waiver funding.

 

Community Residential Rehabilitation Services for the Dual-Diagnosed (Title 55, Chapter 5310)

Community Residential Rehabilitation Services for the Dual-Diagnosed

Community residential rehabilitation services (CRRS) are characterized as transitional residential programs in community settings for persons with chronic psychiatric disability. Full-care CRRS for adults. Excludes host homes. This is a service for people with an intellectual disability and mental illness.

   

Eligible

Service costs eligible for waiver funding.

   

Ineligible

Costs not eligible for waiver funding.

 

Community Homes for Individuals with an Intellectual Disability (Title 55, Chapter 6400)

Community Homes for Individuals with Intellectual Disabilities

This service is made available to individuals in Title 55, Chapter 6400 settings.

   

Eligible

Service costs eligible for waiver funding.

   

Ineligible

Costs not eligible for waiver funding.

 

Family Living Homes (Title 55, Chapter 6500)

Family Living Homes (Title 55, Chapter 6500)

A Title 55, Chapter 6500 setting is a private home in which residential care is provided to one or two individuals with an intellectual disability and who are not relatives of the home owner(s).

   

Adults

 
   

Eligible

Service costs eligible for waiver funding and is available for both 1 and 2 individual homes.

   

Ineligible

Costs not eligible for waiver funding and is available for both 1 and 2 individual homes.

   

Children

 
   

Eligible

Service costs eligible for waiver funding and is available for both 1 and 2 individual homes.

   

Ineligible

Costs not eligible for waiver funding and is available for both 1 and 2 individual homes.

 


 

Residential Home and Community Habilitation - Unlicensed Homes


Residential Home and Community Habilitation - Unlicensed Homes

Direct service and services to meet contract conditions provided in agency owned, leased, or rented homes to assist individuals in acquiring, retaining, and improving self-help, socialization and adaptive skills.

 


 

Supplemental Habilitation


 

Service for temporary supplemental licensed habilitation service to meet short term behavioral or medical needs. Maximum 12-month (consecutive) authorization term.

 

Additional Individualized Staffing


 

Service used to supplement licensed residential habilitation service to meet long-term behavioral or medical need. May require more than 12-month (consecutive) staffing period based on level of need.

 

Companion Service


 

Service to provide supervision and assistance focused on health and safety of the individual. Not available to those in licensed residential settings. Limited to 24-hours per day per individual.

   

Basic Staff Support

The provision of the service at a staff to individual ratio of no less than 1:6.

   

Staff Support Level 1

The provision of the service at a staff to individual ratio range of <1:6 to 1:3.5.

   

Staff Support Level 2

The provision of the service at a staff to individual ratio range of <1:3.5 to >1:1.

   

Staff Support Level 3

The provision of the service at a staff to individual ratio of 1:1.





Employment Services (Competitive Employment)
Employment Services

Supported Employment Services


Employment Services

Direct and indirect services that must meet contractual conditions provided in community employment work sites with co-workers who do not have a disability for the purposes of finding and supporting individuals in competitive jobs of their choice. Individuals must receive minimum wage or higher. Code W7235 is the standard for contiguous state with regional approval in writing and encompasses Job Finding and Job Support Services.

 


 

Job Finding Service
Development of skills, outreach to potential employers, training of job tasks and other such tasks to assist individual in acquiring a job. 

 

Services directed towards supporting individuals in transition to integrated competitive employment through work that occurs in a location other than a facility subject to Title 55, Chapter 2390. The provision of 1:1 services by a staff member with the training and experience to appropriately address the needs of an individual.

 


 

Job Support Service
Follow-up with an individual who is working in competitive employment and their employer to support them in maintaining employment in the community.  This helps identify and solve any problems as they arise to prevent the person from losing the job. 

 

The provision 1:1 services by a staff member with the training and experience to appropriately address the needs of an individual.





Transitional Work Services
Transitional Work Services

Transitional Work Services


Transitional Work Services

Services directed towards supporting individuals in transition to integrated, competitive employment through work that occurs in a location other than a facility subject to Title 55, Chapter 2380 or Chapter 2390. Transitional work service options include, but are not limited to: mobile work force, work station in industry, affirmative industry, and enclave.

   

Basic Staff Support

The provision of the service at a staff to individual ratio range of <1:10 - >1:6.

   

Staff Support Level 1

The provision of the service at a staff to individual ratio range of <1:6 - 1:3.5.

   

Staff Support Level 2

The provision of the service at a staff to individual ratio range of <1:3.5 - >1:1.

   

Staff Support Level 3

The provision of the service at a staff to individual ratio of 1:1.





Specialized Therapies and Related Clinical Services
Specialized Supports

Physical Therapy

 

Waiver service not otherwise specified. Service delivered by a licensed physical therapist based on a prescription by a physician. A denial letter from medical assistance fee for service or managed care must be received prior to any healthcare related services being provided.

 


 

Occupational Therapy


Waiver service not otherwise specified. Service delivered by a registered occupational therapist based on a prescription by a physician. A denial letter from medical assistance fee for service or managed care must be received prior to any healthcare related service being provided.

 


 

Speech and Language Therapy


Waiver service not otherwise specified. Service delivered by an American Speech-Language-Hearing Association certified and state licensed speech-language pathologist. Requires an evaluation and recommendation by such a pathologist or other physician. Includes counseling, evaluation habilitation and rehabilitation of participants as well as examination for assistive technology. A denial letter from medical assistance fee for service or managed care must be received prior to any healthcare related service being provided.

 


 

Nursing Service


Waiver service not otherwise specified. Consultation and training within scope of practice. A denial letter from medical assistance fee for service or managed care must be received prior to any healthcare related service being provided.

 


 

Specialized Supplies


Supplies consisting of incontinence supplies that are not available through insurance and have a yearly financial limit.

 


 

Behavior Support


Services include functional assessment, development of strategies to support the individual based upon assessment, and the provision of training individuals, staff, relatives and caregivers. Completed on 1:1 basis between individual and behavior support professional with a Master's Degree or under the direction of someone with a Master's Degree.

 


 

Visual/Mobility Therapy

 

Evaluation and consultation for individuals who are blind or have visual impairments and is completed by a trained visual or mobility specialist/instructor based on an evaluation/recommendation by a trained visual/mobility instructor or physician.





Respite Services
Respite Services

Respite Services


Respite Services

Direct service and services to meet regulatory requirements and/or contractual conditions that are provided to supervise/support individuals on a short term basis because of the absence or need for relief of those persons normally providing care. 24 hour respite care is limited to 30 days per fiscal year. Respite that is less than 24 hours is limited to a recommended maximum of 480 (15 minute) units. Both may be adjusted by the County MH/MR Office based on individual need. Waivers of these limitations may be approved on an individual basis by the Regional Offices in accordance with Title 55, Chapter 6350, Family Resource Services, Section 6350.16. Waiver option. These limitations also apply to the respite services in camp settings.

 



Rate Base and Modifiers

Modifiers enable services to be enriched through lower staff to individual ratios and program content. Individuals and families have increased program options from which to choose and levels of service are available to appropriately address individuals' health and safety needs.

 


 

Respite - In Home - 24 Hours
Provide relief for the primary care givers in their absence in an emergency situation. This is provided in their family's home.

Respite - In Home - 24 Hours

This service is provided in the private homes of individuals or the homes of their family or friends. The service may also be provided in other unlicensed homes acceptable to individuals/families.

   

Basic Staff Support

The provision of the service at a staff to individual ratio of 1:4.

   

Staff Support Level 1

The provision of the service at staff to individual ratio range of <1:4 - >1:1.

   

Staff Support Level 2

The provision of the service at a staff to individual ratio range of 1:1.

   

Level 2 Enhanced

The provision of the service at a staff to individual ratio of 1:1 with a staff member who has at least a 4-year degree or is a licensed nurse.

   

Staff Support Level 3

The provision of the service at a staff to individual ratio of 2:1.

   

Level 3 Enhanced

The provision of the service at a staff to individual ratio of 2:1 with staff members who have at least a 4-year degree or who are licensed nurses. Indicated by a TD or TE.

 


 

Respite - In Home - 15 minutes 


Respite - In Home - 15 minutes

This service is provided in the private homes of individuals or the homes of their family or friends. The service may also be provided in other unlicensed homes acceptable to individuals/families.

   

Basic Staff Support

The provision of the service at a staff to individual ratio of 1:4.

   

Staff Support Level 1

The provision of the service at staff to individual ratio of <1:4 - >1:1.

   

Staff Support Level 2

The provision of the service at a staff to individual ratio range of 1:1.

   

Level 2 Enhanced

The provision of the service at a staff to individual ratio of 1:1 with a staff member who has at least a 4-year degree or is a licensed nurse.

   

Staff Support Level 3

The provision of the service at a staff to individual ratio of 2:1.

   

Level 3 Enhanced

The provision of the service at a staff to individual ratio of 2:1 with staff members who have at least a 4-year degree or are licensed nurses. Indicated by a TD or TE.

 


 

Respite - Out of Home - 24 hours
Provide relief for the primary care givers in their absence in an emergency situation. This is provided in a licensed home.

Respite - Out of Home - 24 hours

This service is provided in licensed (6400 and 6500) homes.

   

Basic Staff Support

The provision of the service at a staff to individual ratio of 1:4.

   

Staff Support Level 1

The provision of the service at staff to individual ratio of <1:4 - >1:1.

   

Staff Support Level 2

The provision of the service at a staff to individual ratio range of 1:1.

   

Level 2 Enhanced

The provision of the service at a staff to individual ratio of 1:1 with a staff member who has at least a 4-year degree or is a licensed nurse.

   

Staff Support Level 3

The provision of the service at a staff to individual ratio of 2:1.

   

Level 3 Enhanced

The provision of the service at a staff to individual ratio of 2:1 with staff members who have at least a 4-year degree or are licensed nurses. Indicated by a TD or TE.

   

Respite-Emergency

Emergency Respite rendered in a licensed Waiver-funded 6400 home in which ODP permitted the provision of respite services beyond the approved program capacity of the home.

 


 

Respite - Out of Home - < 15 minutes


Respite - Out of Home - < 15 minutes

This service is provided in licensed (6400 and 6500) homes.

   

Basic Staff Support

The provision of the service at a staff to individual ratio of 1:4.

   

Staff Support Level 1

The provision of the service at a staff to individual ratio of <1:4 - >1:1.

   

Staff Support Level 2

The provision of the service at a staff to individual ratio range of 1:1.

   

Level 2 Enhanced

The provision of the service at a staff to individual ratio of 1:1 with a staff member who has at least a 4-year degree or is a licensed nurse.

   

Staff Support Level 3

The provision of the service at a staff to individual ratio of 2:1.

   

Level 3 Enhanced

The provision of the service at a staff to individual ratio of 2:1 with staff members who have at least a 4-year degree or are licensed nurses.





Transportation Services
Transportation Services

Transportation Service


 

Direct service and services to meet regulatory requirements and/or contractual conditions to provide transportation for individuals enabling them access to services/activities in accordance with their ISPs.

 


 

Transportation (Mile)
Enables individuals to gain access to their community. 

 

Transportation by providers, family members, surrogates who are the employer or managing employer, and other qualified licensed drivers. When transportation is provided to more than one individual at a time, the total number of units of service provided are equitably divided among the individuals for whom transportation is provided. The mileage cost may not exceed the state rate.

 


 

Public Transportation

 

Public transportation for individuals enabling access to services/resources in accordance with their ISPs to promote self-determination in a cost-effective manner.

 


 

Transportation (Trip)

 

Transportation by a provider agency (excluding transportation for residential services) for which costs are determined on a per trip basis.

 

 

Zone 1

A defined geographical area that is the shortest distance from the program site. For Zone 1, procedure code W7274 is used and includes trips that are > 0 miles and up to 20 miles.

 

 

Zone 2

A defined geographical area that represents a middle distance from the program site. For Zone 2, procedure code W7275 is used and includes trips that are > 20 miles and up to 40 miles.

 

 

Zone 3

A defined geographical area that is the longest distance from the program site. From Zone 3, procedure code W7276 is used and includes trips that are > 40 miles and up to 60 miles.





Base-Funded Services
Respite Services

   

Services provided through County base funding program based on the needs of the individual and the availability of funding to enable the individual to remain with his/her family in a community setting or to maintain independence in a community setting.

 

Family Support Services

Family Support Services

Indirect service to allow cash and/or voucher payments to individuals and families for Family Support Services including employment and management of providers for non-waiver services.

 


 

Respite Care-24 Hours- Out of Home


Respite Care-24 Hours- Out of Home

This service is the same as in home respite services, with one exception related to sites in which the service may be provided. The Family Resource Services Program permits respite care in a general hospital or nursing home when there is documented medical need and the County MH/MR Administrator approves the person's placement in a medical facility. Limited to 4 weeks (28 days) per year or by exception from the County Program.

   

Basic Staff Support

The provision of the service at a staff to individual ratio of 1:4.

   

Staff Support Level 1

The provision of the service at a staff to individual ratio of <1:4 - >1:1.

   

Staff Support Level 2

The provision of the service at a staff to individual ratio range of 1:1.

   

Staff Support Level 3

The provision of the service with a staff to individual ratio of 2:1.

   

Respite-Emergency

Service rendered in a licensed Waiver- funded 6400 home in which the provision of respite services is approved beyond the approved program capacity of the home.

 


 

Respite Care-Out of Home- 15 minutes


Respite Care-Out of Home- 15 minutes

This service is the same as in home respite services, with one exception related to sites in which the service may be provided. The Family Resource Services Program permits respite care in a general hospital or nursing home when there is documented medical need and the County MH/ID Administrator approves the person's placement in a medical facility.

   

Basic Staff Support

The provision of the service at a staff to individual ratio of 1:4.

   

Staff Support Level 1

The provision of the service at a staff to individual ratio of <1:4 - >1:1.

   

Staff Support Level 2

The provision of the service at a staff to individual ratio range of 1:1.

   

Staff Support Level 2 Enhanced

The provision of the service with a staff member who has had the training and experience to appropriately address the exceptional needs of an individual. This also includes service at a staff to individual ratio of 2:1.

 


 

Family Aide

Family Aide

Direct service in segments of less than 24-hours for short-term basis due to the absence or need for relief of those normally providing care. The family aide may be responsible for the care and supervision of family members other than the family member with an intellectual disability.

   

Basic Staff Support

The provision of the service at a staff to individual ratio of no less than 1:6.

   

Staff Support Level 1

The provision of the service at a staff to individual ratio range of <1:6 - 1:3.5.

   

Staff Support Level 2

The provision of the service at a staff to individual ratio range of <1:3.5 - >1:1.

   

Staff Support Level 3

The provision of the service at a staff to individual ratio of 1:1.

   

Staff Support Level 4

The provision of the service at a staff to individual ratio of 2:1.

 


 

Special Diet Preparation

 

This service is assistance in the planning or preparation of meals for individuals who require significant modification to a routine diet.

 


 

Recreation/Leisure Time Activities

 

This service is to enable individuals to participate in regular community activities that are recreational in nature.

 


 

Home Rehabilitation

 

This service is the minor renovation to an individual's or family's home to enable the continued care and support of the individual with an intellectual disability in the home.





Other Services
Personal Support

Environmental Accessibility Adaptations

Vehicle

Adaptations to vehicles for improved access and/or safety with a limit of $20,000 per individual for a 10-year period.

   

Home

Adaptations to homes for improved access and/or safety with a limit of $10,000 every 5 years.

 


 

Assistive Technology/Equipment


 

The purchase or modification of assistive technology for increased functional involvement by individuals in their activities of daily living. Both medical and non-medical technology available.

 


 

Homemaker/Chore Services


 

Indirect services including household cleaning/maintenance and homemaker activities such as meal preparation, laundry or services to keep the home clean and in a safe condition. This service is limited to 40 hours per year and may only be provided when the individual or anyone else in the household is temporarily incapable of physically performing needed tasks.

 


 

Education Support Services


 

Support, in the form of payment, for continuing education courses not available under a program funded by IDEA or through OVR including college-level courses and assistance towards apprenticeships.

 


 

Respite - 24-hour


 

The temporary support/supervision of individuals in residential camp settings. Respite in a residential camp is not contingent upon an emergency situation. Service limits for respite camp are included in the 30-unit limit per year under Waiver-funded Respite.

 


 

Respite - 15-minute


 

The temporary support/supervision of individuals in a day camp setting. Respite in a day camp setting is not contingent upon an emergency situation. Service limits for temporary respite camp are included in the 48-unit limit per year under Waiver-funded Respite.