6. Service Plan
All Services that the participant receives (regardless of payor) should be entered into the Service plan.
PA Health and wellness will make the final determination for hours. Participant will be notified via determination letter from PHW.
Entries for common services
| Service | Service Type | Amount | Frequency | Specific details |
|---|---|---|---|---|
| PAS | Personal Assistance Services | Amount currently authorized | Weekly | Must list provider name, phone#, and NPI# |
| PERS | Personal Emergency Response System | 1 | Monthly | – State “Monthly Maintenance” or “One-time installation” depending on request (new requests require 2 separate requests, one of each; existing requests only require monthly maintenance). – Refer to guide above for new PERS requests. |
| HDM | Home Delivered Meals | Amount needed per week (max 14) | Weekly | – If the participant has specific diet requirements they should be stated. – Max 14 meals per week. |
| ADC | Adult Daily Living | Number of times attended per week | Weekly | None |
| Home mod | Home Adaptations | 1 | One time | – Do NOT state specific item being requested. – State “Home adaptations evaluation is needed…” then state the barrier. – Ex. “Home adaptations evaluation is needed, the participant cannot maneuver up and down the stairs to the second floor when bedroom and bathroom are located.” – Refer to Home Adaptations/DME/SME guide for more assistance |
| DME | Exceptional DME | 1 | One time | – State the item needed in the Service Details – State size (if applicable) – If item is covered by Medicare, state “This item is being covered by Medicare” in the Provider Section. – Refer to Home Adaptations/DME/SME guide for more assistance |
| SME | Specialized Medical Equipment and Supplies | Average amount needed per day | Daily | – State “participant uses ___ amount of ____ item per day on average” – State size (if applicable) – If item is covered by Medicare, state “This item is being covered by Medicare” in the Provider Section. – Refer to Home Adaptations/DME/SME guide for more assistance |
| TRANS (MTM rides) | Non-Medical Transportation | Amount needed per month. | Monthly | – State the type of transportation in the service details. – To calculate amount need per month, ask how many round trips are needed per week, then multiply by 2, then multiply by 4. – Refer to Septa and Transportation Services guide for more assistance |
| TRANS (Septa, CCT, MATP) | Non-Medical Transportation | 1 | Monthly | – State the type of transportation in the service details. – Transpass – State the zone needed in service details. CCT – State “Zone 2” and CCT in service details. – Refer to Septa and Transportation Services guide for more assistance |
Service Format based on scenarios
Services Staying the same as prior Service Plan
- If SC has completed an assessment with a participant and services and providers are all staying the same as last assessment, then the Service Plan in the PCSP should reflect the following:
- Start Date: date of assessment/visit
- Amount: Current hours approved are listed (this does not have to match the SPG tool)
- If PHW makes a change to the hours that will be approved moving forward (e.g. increase or decrease), at the next visit with the participant the SC will update the PCSP Service plan to reflect what is currently approved.
- End date: one year from the date of visit minus 1 day
Increase/Decrease Procedure
For PAS
- If SC has completed an assessment with a participant and the hours for PAS indicated by the new assessment are either an increase or a decrease from what the participant has currently, then the Service Plan in the PCSP should reflect the following:
- Start Date: date that SC completed assessment with participant
- Amount: Current hours approved are listed (this does not have to match the SPG tool)
- If PHW makes a change to the hours that will be approved moving forward (e.g. increase or decrease), at the next visit with the participant the SC will update the PCSP Service plan to reflect what is currently approved.
- End date: one year from the date of your visit minus 1 day
For non-PAS
This will result in two separate entries on the PCSP for the same type of service
- If SC has completed an assessment with a participant and an increase or decrease in a Non-PAS service are being requested, then the Service Plan in the PCSP should reflect the following:
- 1st Entry
- Start date: first date in current year that participant began receiving this service (eg. if participant had HDM for this entire year then 1/1/20 is listed, if participant started receiving HDM on 3/2/20 then 3/2/20 is listed). You will need to look at the authorizations in FP to determine the appropriate start date.
- Amount: Current amount of service approved
- End date: Day of current visit with participant
- 2nd Entry
- Start date: Day after your current visit with participant
- Amount: Increase/decrease amount being requested
- End date: one year from the date of your visit minus 1 day
- 1st Entry
New service request
For PAS
- If SC completes an assessment with the participant and a request is made for PAS and the participant does not currently have PAS hours, then the Service plan in the PCSP should reflect the following:
- Start date: Day of visit with the participant
- End date: one year from date of visit, minus one day
- Amount will be left blank, as PA Health and Wellness will make the final determination of hours.
- At next visit with the participant SC will update assessment to reflect currently authorized PAS hours
For PERS
- For a PERS installation, you need to also make two separate services.
- First service: PERS installation
- Start Date: Date of Visit
- End Date: One year from date of visit, minus one day
- Amount: 1
- Frequency: One time
- Second Service: PERS Monthly Monitoring
- Start Date: Date of Visit
- End Date: One year from date of visit, minus one day
- Amount: 1
- Frequency: Monthly
- First service: PERS installation
For every other service
- If SC completes an assessment with the participant and a request is made for a Non-PAS service (e.g. HDM’s, transportation, etc) and the participant does not currently have that service, then the Service plan in the PCSP should reflect the following:
- Start date: Day of visit with the participant
- End date: one year from date of visit, minus one day
- Amount will be filled in for what is being requested (e.g. Amount= 1 for one trail pass, Amount = 7 for seven HDM’s)
Ending a Current Service
DO NOT just leave the service off of the service plan
- If SC has completed an assessment with a participant and it has resulted in a request to end a service that is already in place.
- Start date: first date in current year that participant began receiving this service (eg. if participant had HDM for this entire year then 1/1/20 is listed, if participant started receiving HDM on 3/2/20 then 3/2/20 is listed). You will need to look at the authorizations in FP to determine the appropriate start date.
- Amount: Current amount of service approved
- End Date: Date that service is requested to be terminated
- DO NOT just leave the service off of the service plan
Change in Provider
This will result in two separate entries on the PCSP for the same type of service
- If SC has completed an assessment with a participant and a change in any type of provider is being requested, then the Service Plan in the PCSP should reflect the following:
- 1st Entry
- Start date: first date in current year that participant began receiving this service (eg. if participant had HDM for this entire year then 1/1/20 is listed, if participant started receiving HDM on 3/2/20 then 3/2/20 is listed). You will need to look at the authorizations in FP to determine the appropriate start date.
- Amount: Current amount of service approved
- End date: Future date that new provider can begin, minus 1 day (SC may need to confirm this with new provider)
- 2nd Entry
- Start date: Future day that new provider can begin (SC may need to confirm this with new provider)
- Amount: Current amount of service approved
- End date: one year from the date of your visit minus 1 day
- 1st Entry
Home Adaptations Request
- If the SC has completed an assessment with the participant and a modification to the home has been requested it should be documented as follows.
- Start Date: Date of Visit
- End Date: 6 months from visit date to allow for evaluation
- Amount: 1 evaluation
- Frequency: one time
- Service Details: Ingress and egress is noted (do NOT list the specific item ie. stair glide)
Ex. Participant requesting stair glide at 8/12/20 assessment
