PRINTER'S NO. 3515
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE RESOLUTION
No.
499
Session of
2024
INTRODUCED BY CERRATO, M. BROWN, HOHENSTEIN, D. MILLER, KHAN,
GIRAL, PROBST, HANBIDGE, SANCHEZ, OTTEN, HILL-EVANS, KAZEEM,
CEPEDA-FREYTIZ, McNEILL, HOWARD, BOYD, GALLAGHER, WAXMAN,
KENYATTA, BOROWSKI, SHUSTERMAN, PIELLI, GUENST, WEBSTER,
MERSKI, D. WILLIAMS, CIRESI AND DALEY, JULY 17, 2024
REFERRED TO COMMITTEE ON HUMAN SERVICES, JULY 17, 2024
A RESOLUTION
Directing the Joint State Government Commission to conduct a
study of how Home and Community-Based Services waivers can be
improved to meet the needs of individuals with disabilities,
including programs administered by the Office of Long-Term
Living and Office of Developmental Programs.
WHEREAS, More than 2 million Pennsylvanians have a
disability, or approximately one-fourth of Pennsylvanians, which
includes mobility and cognitive disabilities; and
WHEREAS, Adults with disabilities are more likely to
experience other health issues, such as obesity, diabetes and
heart disease, than the average adult and they face barriers to
independent living and employment; and
WHEREAS, Home and Community-Based Services waivers offer
resources through a variety of Medical Assistance waivers which
support the particular needs of residents of this Commonwealth
in community settings, enabling recipients to live in their
communities rather than seeking care in an institutional
setting, such as an intermediate care facility for individuals
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with intellectual disabilities or a nursing facility; and
WHEREAS, Home and Community-Based Services waivers were first
created by an act of Congress in 1981 that amended the Social
Security Act to address a bias in the structure of Medicaid
towards providing benefits in institutional settings; and
WHEREAS, Congress created the waiver program to allow states
to apply for waivers that enable the state to target services to
areas of need and particular populations, especially to help
recipients remain in their community, rather than residing in an
institution; and
WHEREAS, Home and Community-Based Services waivers are
required to be cost-neutral and, by providing care equivalent to
Medicaid but by offering care in the community, costs are often
lower than under standard Medicaid; and
WHEREAS, There are multiple waivers available for home and
community-based services in this Commonwealth that vary in their
target population and the benefits provided, with waivers
available for residents with conditions, including autism and
developmental physical disabilities, and older Pennsylvanians;
and
WHEREAS, Home and Community-Based Services waivers are
administered by the Department of Human Services, and some of
the programs, like the Community HealthChoices Waiver and the
OBRA Waiver, are administered by the Office of Long-Term Living
(OLTL), and other programs, like the Community Living Waiver and
the Adult Autism Waiver, are administered by the Office of
Developmental Programs (ODP); and
WHEREAS, Home and Community-Based Services waivers give the
Commonwealth the flexibility to offer care that is not typically
available under Medicaid so that vulnerable individuals can
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continue to live in the community rather than an institution;
and
WHEREAS, In 1978, the Congress of the United States defined
developmental disability as a severe, chronic disability due to
a physical or mental impairment, manifesting before 22 years of
age, likely to continue indefinitely, and resulting in
substantial functional limitations in three or more major life
activities; and
WHEREAS, This definition was updated in 2000 by the
Developmental Disabilities and Bill of Rights Act of 2000,
emphasizing the need for lifelong, individualized support; and
WHEREAS, Pennsylvania has adopted eligibility criteria for
Home and Community-Based Services waivers that exclude some
individuals who meet the Federal definition of developmental
disability, thus preventing them from receiving the necessary
services; and
WHEREAS, Inadequate service availability and provision can
detrimentally affect an individual's health, ability to live
independently, work and have self-determined lives; and
WHEREAS, Data submitted by the Department of Human Services
to the Employment First Oversight Commission shows that in 2022,
16% of ODP's Home and Community-Based Services waiver
participants 18 to 64 years of age are employed in an integrated
setting and earning a minimum wage or higher; and
WHEREAS, Supporting access to Home and Community-Based
Services waivers, medical assistance and other public assistance
is important to the Commonwealth's commitment to health equality
and equal participation in our communities; and
WHEREAS, The concerns and needs of the individuals who use
these programs should be the foremost priority for legislators
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in delivering assistance to those individuals; therefore be it
RESOLVED, That the House of Representatives direct the Joint
State Government Commission to conduct a study and issue a
report on the programs administered by the Office of Long-Term
Living and the Office of Developmental Programs focused on how
to improve the experience of individuals with disabilities that
receive a Home and Community-Based Services waiver; and be it
further
RESOLVED, That the study:
(1) Report on whether Home and Community-Based Services
waivers meet the medical needs of recipients who have a
disability, and ways in which care under waivers can be
improved to better meet the medical needs of individuals with
disabilities, taking into consideration those differences in
the needs of individuals with physical disabilities and
developmental disabilities.
(2) Examine and compare the rates being paid by the
OLTL's waivers and programs such as Community HealthChoices,
OBRA and Act 150 Services, and ODP's waivers for caregiver
services, employment support services and participant-driven
services.
(3) Examine the service menus in the OLTL versus those
in ODP, recognizing that the needs of individuals in both
programs may be the same or similar.
(4) Examine challenges faced by waiver participants to
avoid institutionalization and to be supported to remain
actively engaged in their community.
(5) Examine the root causes of the percentages of OLTL
participants in competitive integrated employment being one-
tenth of those served by ODP's waivers.
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(6) Compare pay rates, benefits, training, recruitment
and retention policies and career advancement opportunities
for direct care workers in OLTL's OBRA waiver and the
Attendant Care Services Act (Act 150) to those for direct
support professionals in the ODP's waivers.
(7) Report on ways in which Home and Community-Based
Services waivers administrative processes could be improved
to address the challenges facing individuals with
disabilities to access Home and Community-Based Services
waivers.
(8) Provide recommendations on how the administrative
processes may be improved, including the application process
and eligibility determinations.
(9) Evaluate ways in which other states have
accommodated the diverse needs of individuals with
disabilities and altered their public assistance programs as
a result, including the utilization of the Federal definition
of "developmental disabilities."
(10) Report on access to primary, secondary and tertiary
prevention health care for individuals with disabilities on
Home and Community-Based Services waivers and whether the
access adequately meets the needs of individuals with
disabilities.
(11) Report on barriers and facilitators to obtaining
medical supplies for individuals with disabilities on Home
and Community-Based Services waivers and the effect this has
on health outcomes.
(12) Report on barriers and facilitators to accessing
nursing services for individuals with disabilities on Home
and Community-Based Services waivers, including the differing
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standards for authorizing nursing services among different
waivers.
(13) Report on barriers and facilitators to accessing
direct care services for individuals with disabilities on
Home and Community-Based Services waivers, including the
differing standards for authorizing direct care services
among different waivers.
(14) Report on barriers and facilitators to individuals
with disabilities on Home and Community-Based Services
waivers receiving medically related supports, such as tube
feedings or catheter changing and the social determinants of
health.
(15) Report on the barriers and facilitators to hiring
an attendant or direct care worker to be able to provide
these supports when a nurse is not available under these
waivers.
(16) Report on cases where health or administrative
challenges with waivers lead an individual with a disability
to seek care in an institution instead.
(17) Report on any quality-of-life differences for Home
and Community-Based Services waiver recipients living in the
community compared to individuals with comparable
disabilities who are in an institution.
(18) Report on the circumstances of dual eligibility for
Medicare and Medicaid for an individual with disabilities,
and any issues that this raises for the recipient in
coordinating provider networks and benefits.
(19) Evaluate possible cost savings associated with
changes to waivers, including the costs of changes that would
address barriers to access.
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(20) Make recommendations on actions that the Department
of Human Services, Department of Health or other State
agencies could take to better meet the needs of people
receiving waivers.
(21) Make legislative recommendations on actions that
the General Assembly could take to improve access to Home and
Community-Based Services waivers.
(22) Collect and evaluate data, including satisfaction
surveys, interviews with waiver recipients and interviews
with staff who administer Home and Community-Based Services
waivers;
and be it further
RESOLVED, That the Joint State Government Commission convene
an advisory committee which contains the following members:
(1) The Secretary of Health or a designee.
(2) The Secretary of Human Services or a designee.
(3) A representative from the Office of Medical
Assistance Programs.
(4) A representative from ODP.
(5) A representative from OLTL.
(6) A representative of a county assistance office or a
designee.
(7) A representative of an association of community
providers of long-term care living services in this
Commonwealth.
(8) A representative from two separate disability
advocacy groups in this Commonwealth.
(9) A representative of an organization representing
members of a union that provide services to individuals
receiving a Home and Community-Based Services waiver.
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(10) A representative of a health plan.
(11) A representative of a hospital.
(12) A member of the Statewide Independent Living
Council.
(13) A consumer representative from the Long-Term
Services and Supports subcommittee of the Medical Assistance
Advisory Committee.
(14) A representative of the Long-Term Care Council.
(15) A family member of an individual who receives a
Home and Community-Based Services waiver.
(16) An individual receiving services from a Home and
Community-Based Services waiver administered by ODP.
(17) An individual receiving services from home and
community-based services administered by OLTL.
(18) A representative of the Employment First Oversight
Commission.
(19) A representative of an organization that offers
personal assistance services or attendant care.
(20) A representative who is a service coordinator who
serves the OBRA waiver population.
(21) A representative who is a service coordinator who
serves the Community HealthChoices Waiver population.
(22) Any other representatives who are deemed
appropriate by the Joint State Government Commission;
and be it further
RESOLVED, That the advisory committee be dissolved no later
than six months after the reporting of findings concludes; and
be it further
RESOLVED, That the Joint State Government Commission report
its findings and recommendations to the House of Representatives
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no later than 24 months after the adoption of this resolution.
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