Full Range of Services and Supports

Advanced Supported Employment
Advanced Supported Employment is an enhanced version of supported employment services provided by qualified providers. The service includes discovery, job development, systematic instruction to learn the key tasks and responsibilities of the position and intensive job coaching and supports that lead to job stabilization and retention. 

Assistive Technology
An item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve a participant’s functioning or increase a participant’s ability to exercise choice and control. 

Behavioral Support
This is a direct and indirect service that includes a comprehensive assessment; the development of strategies to support the participant based upon the assessment; and the provision of interventions and training to participants, staff, parents and caregivers. Services must be required to meet the current needs of the participant, as documented and authorized in the service plan. 

Benefits Counseling
Benefits Counseling is a direct service designed to inform, and answer questions from, a participant about competitive integrated employment and how and whether it will result in increased economic self-sufficiency and/or net financial benefit through the use of various work incentives. Through an accurate individualized assessment, this service provides information to the participant regarding the full array of available work incentives for essential benefit programs including Supplemental Security Income, SSDI, Medicaid, Medicare, housing subsidies, food stamps, etc. 

Career Planning
The Career Planning service provides support to the participant to identify a career direction; develop a plan for achieving competitive, integrated employment at or above the minimum wage; and obtain a job placement in competitive employment or self-employment. 

Communication Specialist
This is a direct and indirect service that supports participants with nontraditional communication needs by determining the participant’s communication needs, educating the participant and his or her caregivers on the participant’s communication needs and the best way to meet those needs in their daily lives. 

Community Transition Services
Community Transition Services are non-recurring set-up expenses for individuals who are transitioning from an institution to private residence where the person is directly responsible for his or her living expenses. Institutions include ICF/IID, ICF/ORC, nursing facilities, and psychiatric hospitals, including state hospitals, where the participant has resided for at least 90 consecutive days. Allowable expenses are those necessary to enable an individual to establish his or her basic living arrangement that do not constitute room and board. 

Community Participation Support
Community Participation Support (CPS) provides opportunities and support for community inclusion and building interest in and developing skills and potential for competitive integrated employment. CPS should result in active, valued participation in a broad range of integrated activities that build on the participant's interests, preferences, gifts, & strengths while reflecting his or her desired outcomes related to employment, community involvement & membership. To achieve this, each participant must be offered opportunities & needed support to participate in community activities that are consistent with the individual’s preferences, choices and interests.

Companion
Companion services are direct services provided to participants age 18 and older who live in private homes for the limited purposes of providing supervision or assistance that is designed to ensure the participant’s health, safety and welfare and to perform incidental activities of daily living for the participant. This service is intended to assist the individual to participate more meaningfully in home and community life. This service may be provided in home and community settings, including the participant’s competitive employment work place. To the extent that Companion services are provided in community settings, the settings must be inclusive rather than segregated. Companion services shall not be provided in a licensed setting, unlicensed residential setting or camp. This does not preclude this service from being utilized to assist a participant to volunteer in a nursing facility or hospital or occasionally visit a friend or family member in a licensed setting or unlicensed residential setting. 

Consultative Nutritional Services
Consultative Nutritional Services are direct and indirect services that assist unpaid caregivers and/or paid support staff in carrying out participant treatment/service plan, and that are not covered by the Medicaid State Plan, and are necessary to improve or sustain the participant’s health status and improve the participant’s independence and inclusion in their community. The service may include assessment, the development of a home treatment/service plan, training and technical assistance to carry out the plan and monitoring of the participant and the provider in the implementation of the plan. This service may be delivered in the participant’s home or in the community as described in the service plan. This service requires a recommendation by a physician. 

Day Habilitation
Day Habilitation is provided in adult training facilities licensed under 55 PA Code Chapter 2380, which are settings other than the participant’s private residence, and meet the federal requirements for HCBS settings. This service also includes day habilitation activities in general public community settings, which are non-disability specific settings and meet the federal requirements for HCBS settings. When provided in community locations, this service does not take place in licensed facilities, or any type of facility owned, leased or operated by a provider of other ODP services. Day Habilitation provides individualized assistance with acquiring, retaining, and improving communication, socialization, self-direction, self-help, and adaptive skills necessary to reside in the community. The service is expected to help the participant develop and sustain a range of valued social roles and relationships; build natural supports; increase independence; and experience meaningful community participation and inclusion. 

Education Support Services
Education Support consists of education and related services as defined in Sections (22) and (25) of the Individuals with Disabilities Education Act (IDEA) to the extent that they are not available under a program funded by IDEA or available for funding by the Office of Vocational Rehabilitation (OVR). To receive Education Support services through the waiver, students attending eligible institutions and who are eligible for Federal Student Aid and/or PA State Grant funding must apply. 

Family/Caregiver Training and Support
This service provides training and counseling services for unpaid family members or caregivers who provide support to a participant. For purposes of this service an unpaid family member or caregiver is defined as any person, such as a family member, spouse, neighbor, friend, partner, companion, or coworker, who provides uncompensated care, training, guidance, companionship or support to the participant. 

Home Accessibility Adaptations
Home accessibility adaptations are an outcome based vendor service that consists of certain modifications to the private home of the participant (including homes owned or leased by parents/relatives/friends with whom the participant resides and Life Sharing homes that are privately owned, rented, or leased by the host family or participant). The modification(s) must be necessary due to the participant’s disability, to ensure the health, security of, and accessibility for the participant, or which enable the participant to function with greater independence in the home. This service may only be used to adapt the participant's primary residence, may not be furnished to adapt homes that are owned, rented, leased, or operated by providers except when there is a needed adaptation for participants residing in a Life Sharing setting and the life sharing host home is owned, rented or leased by the host and not the Life Sharing provider agency. 

Homemaker/Chore
Homemaker services enable the participant or the family member(s) or friend(s) with whom the participant resides to maintain their primary private home. This service can only be provided when a household member is temporarily absent or unable to manage the home, or when no landlord or provider agency staff is responsible to perform the homemaker activities. Homemaker Services include cleaning and laundry, meal preparation, and other general household care. Chore services consist of services needed to maintain the home in a clean, sanitary, and safe condition. Chore services consist of heavy household activities such as washing floors, windows, and walls; tacking down loose rugs and tiles; moving heavy items of furniture in order to provide safe access and egress; ice, snow, and/or leaf removal; and yard maintenance. In the case of rental property, the responsibility of the landlord, pursuant to the lease agreement, will be examined prior to any authorization of service. Maintenance in the form of upkeep and improvements to the participant’s home is excluded from federal financial participation. 

Housing Transition and Tenancy Sustaining Services
This service includes pre-tenancy and housing sustaining supports to assist participants in being successful tenants in private homes owned, rented or leased by the participants. 

In-Home and Community Support
In-Home and Community Support is a direct service provided in home and community settings to assist participants in acquiring, maintaining and improving the skills necessary to live in the community, to live more independently, and to participate meaningfully in community life. To the extent that In-Home and Community Support is provided in community settings, the settings must be inclusive rather than segregated. This service is built on the principle that every participant has the capacity to engage in lifelong learning. As such, through the provision of this service, participants will acquire, maintain, or improve skills necessary to live in the community, to live more independently, and to participate meaningfully in community life. To the extent that Life Sharing is provided in community settings outside of the residence, the settings must be inclusive rather than segregated. Services consist of assistance, support and guidance (physical assistance, instruction, prompting, modeling, and reinforcement) in the general areas of self-care, health maintenance, decision making, home management, managing personal resources, communication, mobility and transportation, relationship development and socialization, personal adjustment, participating in community functions and activities and use of community resources. 

Music Therapy, Art Therapy and Equine Assisted Therapy
Direct therapy services provided to a participant who may or may not have a primary diagnosis of mental illness, but who could benefit by the provision of therapy to maintain, improve or prevent regression of the participant’s condition and assist in the acquisition, retention or improvement of skills necessary for the participant to live and work in the community. Services and intended benefit must be documented in the service plan. Therapy services consist of the following individual therapies that are not primarily recreational or diversionary:

  • Art Therapy;
  • Music Therapy; and
  • Equine Assisted Therapy. 

Participant-Directed Goods and Services
Participant-Directed Goods and Services are services, equipment or supplies not otherwise provided through other services offered in this waiver, the Medicaid State Plan, or a responsible third-party. Participant-Directed Goods and Services must address an identified need in the participant’s service plan and must achieve one or more of the following objectives:

  • Decrease the need for other Medicaid services.
  • Promote or maintain inclusion in the community.
  • Promote the independence of the participant.
  • Increase the participant’s health and safety in the home environment.
  • Develop or maintain personal, social, physical or work-related skills.
  • Items and services must be used primarily for the benefit of the participant.

Participant-directed Goods and Services may not be used for any of the following:

  • Personal items and services not related to the participant’s intellectual disability or autism;
  • Experimental or prohibited treatments;
  • Entertainment activities, including vacation expenses, lottery tickets, alcoholic beverages, tobacco/nicotine products, movie tickets, televisions and related equipment, and other items as determined by the Department; or
  • Expenses related to routine daily living, including groceries, rent or mortgage payments, utility payments, home maintenance, gifts, pets (excluding service animals), and other items as determined by the Department.
  • Items and services that are excluded from receiving Federal Financial Participation, including but not limited to: room and board payments which include the purchase of furnishings and services provided while a participant is an inpatient of a hospital, nursing facility, or ICF/ID. 

Residential Habilitation
Residential Habilitation services are direct and indirect services provided to participants who live in licensed and unlicensed provider owned, rented or leased residential settings. This service is built on the principle that every participant has the capacity to engage in lifelong learning. As such, through the provision of this service, participants will acquire, maintain, or improve skills necessary to live in the community, to live more independently, and to participate meaningfully in community life. To the extent that Residential Habilitation is provided in community settings outside of the residence, the settings must be inclusive rather than segregated. 

Respite
Respite services are direct services that are provided to supervise and support participants living in private homes on a short-term basis for planned or emergency situations, giving the person(s) normally providing care a period of relief that may be scheduled or due to an emergency. Respite services do not cover the care provided to a minor child when the primary caregiver or legally responsible individual is absent due to work. 

Shift Nursing
Shift Nursing is a direct service that can be provided either part-time or full-time in accordance with 49 Pa. Code Chapter 21 (State Board of Nursing) which provides the following service definition for the practice of professional nursing: "Diagnosing and treating human responses to actual or potential health problems through such services as case finding, health teaching, health counseling, provision of care supportive to or restorative of life and well-being, and executing medical regimens as prescribed by a licensed physician or dentist. The term does not include acts of medical diagnosis or prescription of medical, therapeutic or corrective measures, except as may be authorized by rules and regulations jointly promulgated by the State Board of Medicine and the Board, which rules and regulations will be implemented by the Board." 

Small Group Employment
Small Group Employment services are direct services that consist of supporting participants in transitioning to competitive integrated employment through work that occurs in a location other than a facility subject to 55 Pa. Code Chapter 2380 or Chapter 2390 regulations. The goal of Small Group Employment services is competitive integrated employment. Participants receiving this service must have a competitive integrated employment outcome included in their service plan, and it must be documented in the service plan how and when the provision of this service is expected to lead to competitive integrated employment. Work that participants perform during the provision of Small Group Employment services must be paid at least minimum wage and the compensation must be similar to compensation earned by workers without disabilities performing the same work. 

Specialized Skill Development
Specialized Skill Development (SSD) is used to address challenges participants may have because of limited social skills, perseverative behaviors, rigid thinking, difficulty interpreting cues in the natural environment, limited communication skills, impaired sensory systems, or other reasons. SSD uses specialized interventions to increase adaptive skills for greater independence, enhance community participation, increase self-sufficiency and replace or modify challenging behaviors. The intent of SSD is also to reduce the need for direct personal assistance by improving the participant’s capacity to perform tasks independently. 

Specialized Supplies
Specialized Supplies consist of incontinence supplies that are medically necessary and are not a covered service through the MA State Plan, Medicare or private insurance. Supplies are limited to diapers, incontinence pads, cleansing wipes, underpads, and vinyl or latex gloves. 

Supports Broker Services
The Supports Broker service is a direct and indirect service available to participants who elect to self-direct their own services utilizing one of the participant directed options outlined in Appendix E-1 of this Waiver. The Supports Broker service is designed to assist participants or their designated surrogate with employer-related functions in order to be successful in self-directing some or all of the participants needed services. 

Supported Employment
Supported Employment services are direct and indirect services that are provided in a variety of community settings for the purposes of supporting participants in obtaining and sustaining competitive integrated employment. Competitive integrated employment refers to full or part-time work at minimum wage or higher, with wages and benefits similar to workers without disabilities performing the same work, and fully integrated with coworkers without disabilities. 

Supported Living
These are direct and indirect services provided to participants who live in a private home that is owned, leased or rented by the participant or provided for the participant’s use via a Special or Supplemental Needs trust and located in Pennsylvania. Supported Living services are provided to protect the health and welfare of participants by assisting them in the general areas of self-care, health maintenance, wellness activities, meal preparation, decision making, home management, managing personal resources, communication, mobility and transportation, relationship development and socialization, personal adjustment, participating in community functions and activities and use of community resources. Through the provision of this service participants will be supported to live in their own home in the community and to acquire, maintain or improve skills necessary to live more independently and be more productive and participatory in community life. 

Supports Broker Service
The Supports Broker service is a direct and indirect service available to participants who elect to self-direct their own services utilizing one of the participant directed options outlined in Appendix E-1 of the Waiver. The Supports Broker service is designed to assist participants or their designated surrogate with employer-related functions in order to be successful in self-directing some or all of the participant's needed services. 

Temporary Supplemental Services
Temporary Supplemental services provide additional staff in the short term when it has been determined that the participant’s health and welfare is in jeopardy and needed supports and services cannot be provided without additional staff assistance. This service is intended for those unforeseen circumstances which trigger a need for a time limited increase in support. This service is intended for circumstances such as unplanned stressful life events which increase a participant’s risk of a crisis event (such as the recent loss of a family member), or to support a participant to return to baseline following a recent crisis event, which triggered a need for a time-limited increase in support. 

Therapy Services
Therapy services are direct services provided to assist participants in the acquisition, retention, or improvement of skills necessary for the participant to live and work in the community and must be attached to a participant's outcome as documented in his or her service plan. Therapy services may include physical therapy, occupational therapy, speech/language therapy and orientation, mobility and vision. 

Transportation
Transportation is a direct service that enables participants to access services and activities specified in their approved service plan. This service does not include transportation that is an integral part of the provision of another discrete Waiver service. 

Unlicensed Residential Habilitation
Residential Habilitation services are direct and indirect services provided to participants who live in unlicensed provider owned, rented or leased residential settings. This service is built on the principle that every participant has the capacity to engage in lifelong learning. As such, through the provision of this service, participants will acquire, maintain, or improve skills necessary to live in the community, to live more independently, and to participate meaningfully in community life. To the extent that Residential Habilitation is provided in community settings outside of the residence, the settings must be inclusive rather than segregated. 

Vehicle Accessibility Adaptations
Vehicle accessibility adaptations consist of certain modifications to the vehicle that the participant uses as his or her primary means of transportation to meet his or her needs. The modifications must be necessary due to the participant’s disability. The vehicle that is adapted may be owned by the participant, a family member with whom the participant lives, or a non-relative who provides primary support to the participant and is not a paid provider agency of services. This service may also be used to adapt a privately owned vehicle of a life sharing host when the vehicle is not owned by the Life Sharing provider agency.