Penalty Period Guide

Participants that were eligible for HCBS, but that have entered into a Penalty Period with the County Assistance Office, continue receiving Service Coordination while their other services are on hold.  Below are the steps the SC should follow for participants in a Penalty Period:

• SC receives a task that the participant is in a penalty period
  • The task will have a due date of 2 weeks prior to the end of the penalty period
• SC assesses as usual during the penalty period
  • For trigger events or any other type of visit due (ie. Annual, NPO)
    • If the participant is able to pay for the assessed services (or part of them), then they can pay out of pocket
    • If the participant is not able to pay for services, then the SC should be looking for resources to assist the participant till the end of the penalty period, for any needs that arise
• SC uploads documentation and includes penalty period information in all the assessments
• QA ensures the inclusion of penalty period information in the SRT
• Assessment information will be sent to PHW for review and PHW completes their internal review process
• Approximately 2 weeks before the penalty period is over (when the task is due), the SC reaches out to the participant to determine if there is a need for reassessment (ie. decline in health, hospitalization, change in informal supports, etc.) and if the originally assessed services are still appropriate.
  • If there is a need for reassessment, SC schedules the trigger and continues the process as usual
  • If there is no need for reassessment, PHW is notified and services are authorized to begin the day after the penalty period is over.