Section 51.98. Residential habilitation vacancy

(a) From July 1, 2011, through November 14, 2011, the Department’s residential habilitation vacancy policy consists of the following:

(1) Payments to residential habilitation service providers operating waiver service locations for an unlimited number of medical leave days per participant each fiscal year are as follows:

(i) The first day of absence for medical leave is the date the participant is admitted to the medical facility regardless of the length of the absence.

(ii) The last day of the medical leave is the day before the date of discharge from the medical facility.

(iii) On the date of discharge, the HCBS is considered a residential habilitation service day, not a medical leave day, regardless of the number of hours the residential habilitation service is provided on that day.

(2) Payments to residential habilitation service providers operating waiver HCBS locations for up to 48 days of therapeutic leave per participant each State fiscal year. The first day of absence for therapeutic leave is defined as 12 to 24 hours of continuous absence within a 24-hour period between 12:00 a.m. and 11:59 p.m. when the participant is not accompanied by or receiving HCBS from the residential habilitation service provider.

(3) Payments to licensed residential habilitation providers under Chapters 3800, 5310 and 6400 (relating to child residential and day treatment facilities; community residential rehabilitation services for the mentally ill; and community homes for individuals with mental retardation) will be made for permanent vacancies for participants enrolled in the Consolidated Waiver up to 60 days unless the provider uses the permanent vacancy for an alternative purpose.

(b) From November 15, 2011, through June 30, 2012, the Department will make payments to residential habilitation service providers for therapeutic and medical leave days up to a combined maximum of 60 days per participant, per fiscal year.

(c) From November 15, 2011, through June 30, 2012, the Department will provide payments to licensed residential habilitation service providers under Chapters 3800, 5310 and 6400 up to a maximum of 30 days per participant per State fiscal year for a permanent vacancy that occurs in the licensed residential habilitation community home.

(d) The Department will establish a vacancy factor for all waiver residential habilitation services by publication of a notice in the Pennsylvania Bulletin.

(e) The vacancy factor for residential habilitation services shall be managed by the provider across all the provider’s residential habilitation service locations.

(f) A provider may submit a request for a waiver to the Department under § 51.34 (relating to waiver of a provision of this chapter) for exception to the vacancy factor when a provider’s total vacancy amount for waiver residential HCBS locations exceeds the vacancy factor.

(g) To submit a request for a waiver under § 51.34 to the Department for exception to the vacancy factor, the provider shall do the following:

(1) Demonstrate that without being granted an exception to the vacancy factor the provider’s continued operation is jeopardized. This demonstration shall be based on actual utilization data from the provider’s waiver residential habilitation service locations to show that leave days resulting from hospital and rehabilitation care for all residential sites the provider operates falls below the vacancy factor set by the Department.

(2) Describe the financial impact to the provider if a vacancy exception is not approved. The financial impact must include:

(i) The information related to personnel expenses.

(ii) The need for borrowing above historic numbers.

(iii) The impacts on a provider’s ability to fulfill ISP requirements.

(3) Explain the circumstances related to vacancies and revenue the provider has received for rendering another service in the vacancies.

(h) Approval of the request for a waiver under § 51.34 to the Department for exception to the vacancy factor will be at the sole discretion of the Department.

(i) A provider may not have a policy that limits the leave days to a participant.

(j) A provider may not discuss the vacancy factor with a participant or the participant’s family.

(k) A provider may not initiate a discharge of a participant due to the participant’s vacancy from the program until after the provider has contacted the Department to discuss and resolve the provider’s concern related to the vacancy.

(l) A provider shall comply with reserved capacity requirements in the approved applicable waiver, including approved waiver amendments.

(m) A provider shall cooperate with the Department or the Department’s designee when a participant is identified in reserved capacity to ensure the participant can return to the waiver residential habilitation service location in accordance with the reserved capacity timelines in the approved applicable waiver, including approved waiver amendments.

The provisions of this § 51.98(d) effective July 1, 2012, 43 Pa.B. 588. Immediately preceding text appears at serial pages (361322) to (361323).

Notation

Cross References

This section cited in 55 Pa. Code § 51.48 (relating to provider in the Adult Autism Waiver).