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ODP Announcement 21-090
The purpose of this announcement is to provide guidance to licensees that operate Community Homes for Individuals with an Intellectual Disability or Autism, licensees that operate Life Sharing Homes, ODP-enrolled providers of licensed or unlicensed Residential Habilitation, ODP-enrolled providers of licensed or unlicensed Life Sharing, and/or ODP-enrolled Supported Living providers (“Providers”) about the use of assistive technology and remote supports to achieve individual’s goals and outcomes while balancing the benefits of technology use with the requirement to protect each individual’s right to privacy.
The use of assistive technology and remote supports in residential settings can be beneficial in helping individuals achieve their goals and outcomes including:
Assistive Technology and remote supports in residential settings can only be used when an individual makes an informed choice to do so based on person-centered planning processes. Assistive Technology and remote supports should not be used solely for the convenience of the provider.
ODP has seen a significant increase in the use of assistive technology and remote supports in residential service provision in recent years, and fully supports the use of technology to maximize individuals’ independence and to improve health and safety protections. At the same time, residential providers must ensure that technology used meets regulatory and applicable waiver requirements, including but not limited to an individual’s right to privacy.
WHAT IS THE DIFFERENCE BETWEEN ASSISTIVE TECHNOLOGY AND REMOTE SUPPORTS IN RESIDENTIAL SETTINGS?
The basic difference between Assistive Technology and Remote Supports is:
Assistive Technology in residential service delivery generally means 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 an individual’s functioning or increase an individual’s ability to exercise choice and control.
Assistive technology devices range in complexity from low-tech to high-tech and include, but are not limited to:
Remote Supports involve the use of high-tech devices that use two-way, real-time communication in the individual’s home or community which allows a professional (e.g., an employee, contractor, or consultant) who is offsite to monitor and respond to the individual’s needs. Interaction with the professional who is monitoring and responding occurs as needed as part of remote supports but is not the main function of the service. The purpose of remote supports is to assist individuals to obtain and/or maintain their independence and safety within their home and community and decrease their need for assistance from others. Remote Supports are not recommended for individuals under the age of 16.
REMOTE SUPPORTS REQUIREMENTS FOR ALL RESIDENTIAL PROVIDERS
Remote supports are fully integrated into the individual’s overall system of support using person-centered planning. Prior to implementing remote supports as part of the residential service, the residential provider must discuss the following with the individual, persons designated by the individual, and other service plan team members to determine the appropriateness of this service delivery method:
Recommendations regarding person-centered planning; including back-up plans and factors to consider regarding the individual’s privacy and control over the devices or equipment, are contained in the Residential Technology Evaluation Tool (Attachment 1).
The residential provider is required via licensing and program-operational regulations to actively provide each individual the necessary support to make choice and understand their rights under the regulations, including the right to choose or decline remote supports.
Residential providers are also responsible for ensuring that any professionals rendering remote supports receive orientation and annual training on topical areas outlined in regulations (55 Pa. Code §§6100.142 (b), 6100.143(c), 6400.51(b), 6400.52(c), 6500.47(b). and 6500.48(b)). Professionals rendering remote supports do not have to complete any specific number of orientation or annual training hours on these topical areas. The residential provider must ensure that the orientation and annual training enables professionals to render remote supports in a manner that protects each individual’s health and safety and meets all applicable regulatory and programmatic requirements.
ADDITIONAL REQUIREMENTS FOR RESIDENTIAL SERVICES PROVIDED THROUGH THE CONSOLIDATED WAIVER, COMMUNITY LIVING WAIVER, ADULT AUTISM WAIVER OR BASE FUNDING
Providers that use assistive technology or remote supports as part of Residential Habilitation, Life Sharing, and/or Supported Living services must continue to meet all requirements in the waivers and in 55 Pa. Code Chapter 6100 (relating to Services for Individuals with and Intellectual Disability or Autism). The method of service delivery is not related to waiver or regulatory compliance; the responsibility to comply is the same regardless of whether the service is rendered in-person or through the use of technology.
Remote supports rendered as part of Residential Habilitation, Life Sharing, or Supported Living services must enhance or increase the individual’s independence, reduce the participant’s need for direct support, and comply with 42 CFR 442.301(c)(4)(vi)(A) through (D) related to privacy, control of schedule and activities and access to visitors. Remote supports are intended to reduce the individual’s need for direct support that is available as part of the residential service. As such, remote supports are an alternative to in-person staffing that is built into the residential service rates and cannot be authorized as a discrete service. However, the assistive technology needed to render remote supports to a specific individual as part of the residential service may be authorized as a discrete service under the Assistive Technology service definition. In other words, providers of Residential Habilitation, Life Sharing, and/or Supported Living services:
When a provider contracts with a separate entity to render remote supports as part of the residential service, the residential provider is responsible for ensuring that the contracted entity meets qualification, waiver, and regulatory requirements for the delivery of residential services. The Consolidated and Community Living Waivers include the following qualification requirements when rendering remote supports to participants:
DETERMINING IMPACTS OF ASSISTIVE TECHNOLOGY OR REMOTE SUPPORTS ON INDIVIDUAL’S PRIVACY IN ALL RESIDENTIAL SETTINGS
Any assistive technology utilized, or remote supports provided must ensure each individual’s right to privacy of person and possession2. There is no single answer that will definitively determine whether an individual’s privacy will or may be violated because each situation where privacy could be violated is unique. The only way to know whether a violation of privacy will or may occur is to collect information on a variety of factors specific to each situation and analyze them as a collective whole.
In general, the factors to be considered include:
Other factors to consider include whether the device:
ODP has developed a Residential Technology Evaluation Tool to assist providers in determining whether a privacy violation will or may occur. The tool is not a required form although ODP strongly recommends its use. Providers may develop their own tool to determine whether a privacy violation will or may occur. The Residential Technology Evaluation Tool is attached to this announcement as Attachment 1.
SUPPORT AND ASSISTANCE
Providers are encouraged to contact ODP for support and assistance in determining whether a situation or device may constitute a violation of an individual’s privacy. Questions may be directed to the ODP Regulatory Administration Unit at RA-PW6100REGADMIN@pa.gov or to the appropriate ODP Regional Office.
ODP is holding a webinar to discuss requirements and best practices for the use of Assistive Technology and Remote Supports in residential settings. The date, time, and link for registration to attend the webinar are as follows:
January 18, 2022
10:00 AM to 11:00 AM