March 25, 2020 Update
1135 Waiver Request
DHS and the Department of Health submitted our request for an 1135 Waiver on March 24. The application letter and checklist are available on DHS’ COVID-19 Provider Resources page. As of March 25, we are still waiting for a response from the federal government.
When the president declares a disaster or emergency under the Stafford or National Emergencies Act and the Secretary of Health and Human Services (HHS) declares a public health emergency under Section 319 of the Public Health Service Act, the HHS Secretary is granted additional authority. Under section 1135 of the Social Security Act, this authority permits changes to Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) to ensure needs of people covered by these programs are met during an emergency.
DHS and the DOH submitted an 1135 waiver request to the federal government seeking temporary changes to our Medicaid Fee-for-Service Program, the HealthChoices managed care programs for both physical and behavioral health services, Community HealthChoices (CHC), Home and Community Based Services (HCBS) waivers, the Section 1115 Demonstration waiver for Former Foster Care Youth and
Substance Use Disorder, and Children’s Health Insurance Program (CHIP). If granted, this waiver request would allow us to:
- Enhance provider access by expediting provider enrollment, permitting services from providers not yet enrolled in the Medicaid program, permitting services from providers enrolled in another states’ Medicaid program, and permit payment for services provided in alternate sites of care;
- Enhance benefit access by suspending some prior authorization requirements, permitting non-physician directed services by physician assistants and certified registered nurse practitioners, reducing limitations on institutions serving people with mental illness, reducing need for face-to-face visits for durable medical equipment prescriptions, reducing limitations on service locations, and reducing acute care hospital space demand;
- Enhance benefit access in eligibility by extending continuous eligibility periods and suspending the Pre-Admission Screening and Annual Resident Review (PASRR) assessment for 30 days;
- Ease state administrative burdens by permitting eligibility determinations to exceed typical timeframes, extending grievance and appeal timeframes, and implementing a lock-in period for CHC participants.
Now that the waiver has been submitted, we will keep you all informed of its progress and, ideally, when our request is granted.
Child Care Updates
Child care centers and group child care homes outside of a residence were closed under the Governor’s order to close non-life-sustaining businesses, but waivers are being granted to continue operation recognizing that these services are necessary to allow essential personnel like health care workers, first responders, home care workers, and grocery and food service staff to keep doing the critical work they provide. We continue to receive and process waiver requests for child care centers and group child care homes seeking to continue to operate during this time, and as of March 25, more than 690 child care providers continue to operate with a waiver.
As the non-life-sustaining business closure order is being enforced around Pennsylvania, we are working closely with law enforcement agencies so they know that some child care providers may continue to operate. Child care providers operating with a waiver should be prepared to present this waiver if contacted regarding how or why they are operating during this time. The Office of Child Development and Early Learning (OCDEL) also recently issued guidance to operating child care providers on keeping children, their families, and staff safe during this public health emergency. We encourage all providers to take this guidance seriously.
We are also urging these essential services personnel to consider their options if their child care provider chooses to close even if they are operating with a waiver. If families are able to make alternative child care arrangements at home, we are encouraging them to allow vacancies to be used for those who do not have other options, and begin to make an actionable contingency plan if their child care arrangement has to change.
We centralized a list of open child care facilities if families working in essential jobs need to contact a new provider. This is now available on DHS’ COVID-19 resources section on the resources for citizens page. We are updating it regularly as new providers request waivers and as some may choose to close.
Early Intervention Guidance
OCDEL continues to develop guidance responsive to child care and early learning providers’ needs. Guidance was recently issued for early intervention providers and is available here.
County Assistance Office Updates
Our county assistance offices (CAOs) continue to operate as closed to the public during this time. We are working closely with the unions and the commonwealth’s labor relations staff to ensure both continued operations and safe workspaces for our staff doing this essential work.
We are monitoring this situation hour-by-hour and actively working to address employee concerns and implement strategies that mitigate the risk of exposure to the coronavirus while maintaining these essential functions. For example:
- CAOs with large staff complements are implementing staggered shifts – two days on, two days off – rotated between total staff. The Office of Income Maintenance (OIM) is also actively evaluating the use of alternative office locations so that employees will have more space to work and reduced contact with each other. Although the initial focus is on the larger CAOs, 50 or more staff, we will extend mitigation efforts to all CAOs as soon as feasible.
- The Department of General Services, which manages leases with the owners of many CAO offices, is in communication with landlords across the commonwealth about proper cleaning and CDC guidelines. All of these leases include requirements for regular cleaning;
- We have ordered additional sanitation supplies and CAOs have been provided the ability to purchase these items as they become available;
- DHS is also actively evaluating the feasibility of and options to facilitate telework for CAO staff.
We are in constant contact with employee unions to address concerns and collaborate on solutions that protect employees and maintain these essential functions.
SNAP and Food Security Efforts
Maintaining access to food – one of our most basic needs – continues to be a top priority for DHS during this period.
The federal government approved our request to extend the time that people are eligible to receive benefits. This will allow us to continue benefits during this crisis. We also continue to engage with Food and Nutrition Services regarding additional SNAP benefits that may be issued to eligible households during this crisis. We hope to have guidance soon so we can offer additional SNAP assistance to all the SNAP eligible households.
We are also submitting a waiver request to waive restrictions preventing most college students from receiving SNAP. The waiver will allow for low-income households with a student who is attending an institution of higher education to receive additional SNAP benefits to feed the whole family during the COVID-19 emergency.
Federal regulations state that an individual who is enrolled at least half-time in an institution of higher education shall be ineligible to participate in SNAP unless they qualify for an exemption or are employed for a minimum of 20 hours per week. The Wolf Administration’s waiver request seeks to give DHS the ability to waive these regulations for students that meet the income thresholds for SNAP benefits until COVID-19 health emergency has ended.
Current federal regulations also state that students not meeting additional eligibility criteria are not included in their household’s SNAP eligibility. For example, in a household of three where one member is a student, the household would only receive SNAP benefits for two of the members, despite the student still residing and eating meals with that household. Now that students are home, these families may not have the resources, either monetarily or in food supply, to support the additional person now residing with them.
We know that this pandemic has caused many people and families to find that they are suddenly food insecure and require assistance. The Feeding Task Force has been operationalized to support Pennsylvanians and charitable food networks during this time. The task force is comprised of public, private, and non-profit partners from across the state, including, among others, the Governor’s Food Security Partnership state agencies, the Salvation Army, Feeding PA, and the Pennsylvania Food Merchants Association. This centralized hub allows us to determine where our needs are, how many meals are needed, how we are getting food to people, and how we are getting volunteers to help charitable food networks across Pennsylvania.
If you know of other businesses with resources to share, the task force is collecting this information. Companies can share information about resources available with the Feeding Task Force here.
The Feeding task force has also created a second survey that’ll attempt to capture where people who are suddenly food insecure are so we can operationalize and allocate resources appropriately. If people suddenly find themselves needing help keeping food on the table due to COVID-19 mitigation efforts, we are encouraging them to fill out this survey to help the task force meet food needs around Pennsylvania. If people are in immediate need of food assistance, Feeding Pennsylvania and Hunger-Free Pennsylvania are hubs of information for where people can get assistance locally in their communities.
We know that this time is also creating an incredible strain on charitable organizations, so if organizations need volunteers or resources, they may visit the United Way of Pennsylvania’s 211 website. We are also encouraging anyone who is healthy and able to consider taking some time to volunteer with their local food bank. Their operations are seriously altered because of this situation, but their services are and will continue to be incredibly needed as COVID-19 continues to disrupt daily lives. We need to be sure our charitable food networks are able to continue their daily operations and meet the needs of their communities, so we will continue to encourage healthy and able people to contact their local food bank to get involved and help their neighbors and community during this time of great need. To find a food bank or pantry in your community, visit Feeding Pennsylvania and Hunger-Free Pennsylvania.
We’ve made adjustments to ensure continuity for ChildLine and Adult Protective Services, but these critical outlets are not effective if potential abuse or neglect is not being reported.
People who are mandated reporters under the Child Protective Services Law should report online at www.KeepKidsSafe.pa.gov, but ChildLine is also available to anyone wishing to report, 24/7 at 1-800-932-0313.
Adult Protective Services protects adults who are 18 to 59 and have a physical or intellectual disability. Reports can be made 24/7 to 1-800-490-8505. Reports submitted are still fielded and directed to the appropriate parties to investigate. We appreciate you continuing to lift these resources so we can keep Pennsylvanians safe.
In addition, domestic violence programs and rape crisis centers continue to provide services to victims and survivors. If you need to find rape crisis services, please call 1-888-772-7227 or visit www.pcar.org to be connected with your local rape crisis center. For domestic violence services, please visit www.pcadv.org or call the National Domestic Violence Hotline at 1-800-799-7233 (SAFE), 1-800-787-3224 (TTY for people who are deaf). If you are unable to speak safely, you can also log onto www.thehotline.org or text LOVEIS to 22522.