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					       __________________________________________________________________________




                                FISCAL YEAR 2010

                           (July 1, 2009 – June 30, 2010)



      UNIFORM APPLICATION PROCEDURES AND STANDARDS:

                 LONG TERM CARE SERVICE PROVIDERS




Eff. 7/1/09                                                                         1
                                        TABLE OF CONTENTS

                                                              Page

I.     INTRODUCTORY MATERIAL                                  8

       A.     PCA’s Mission Statement                         9

       B.     Letter from PCA’s President                     10

       C.     Providing Quality Care                          11

       D.     PCA’s Integrated LTC Program                    12

II.    GENERAL INFORMATION FOR APPLICANTS                     14

       A.     Response to Applications                        15

       B.     Unit Prices                                     15

       C.     Areas of Service                                16

       D.     Agreement Period                                16

       E.     Quantity of Services                            16

       F.     Third Party Payor Reimbursable Service          16

       G.     Service Delivery                                17

       H.     Quality Improvement and Consumer Satisfaction   17

       I.     Financial Stability                             17

       J.     Annual Financial Statements                     17

       K.     Transition to a New Provider                    18

       L.     Personnel Policies                              18

       M.     Interrelationship of Providers                  18

       N.     Insurance                                       18

III.   GENERAL OPERATIONAL PROCEDURES
       FOR ALL PROVIDERS                                      22

       A.     Intake                                          23


Eff. 7/1/09                                                          2
       B.     Identification of Field Staff                                       23

       C.     Communication                                                       23

       D.     Emergencies                                                         24

       E.     On Call Procedures                                                  24

       F.     Incidents                                                           24

       G.     Service Orders                                                      25

       H.     Criminal History Reports                                            25

       I.     Legal Residency Status                                              25

       J.     Consumer Signatures                                                 26

       K.     Invoicing                                                           27

       L.     Monitoring of Services                                              28

       M.     Conflict of Interest Policy                                         28

       N.     False Claims Act Policy                                             29

       O.     Service Order Authorization Procedure                               32

       P.     Provider Monitoring – Sanctions                                     35

IV.    SERVICE STANDARDS AND SERVICE SPECIFIC
       OPERATIONAL PROCEDURES                                                     43

       A.     Adult Day Care - Standards                                          44

       B.     Adult Day Care – Service Specific Operational Procedures            45

       C.     Attendant Care – Act 15 – Standards                                 49

       D.     Companion Service - Standards                                       55

       E.     Counseling - Standards                                              57

       F.     Counseling - Service Specific Operational Procedures:               60

       G.     Professional Evaluation - Service Specific Operational Procedures   62




Eff. 7/1/09                                                                            3
              1.     General Information                                                  62

              2.     Medical Physician Services                                           66

              3.     Psychiatric Physician Services                                       68

              4.     Psychological Evaluation                                             70

              5.     OBRA Psychological Evaluation                                        71

       H.     Home Health Care - Standards                                                72

       I.     Home Health Care - Service Specific Operational Procedures                  79

       J.     Home Support - Standards                                                    87

       K.     Home Support - Service Specific Operational Procedures                      91

       L.     Extermination - Service Specific Operational Procedures                     97

       M.     Financial Management – Service Specific Operational Procedures              104

       N.     Personal Care - Standards                                                   107

       O.     Personal Care, Respite, and Home Support - Service Specific
              Operational Procedures                                                      113

       P.     Personal Assistance Service (PAS) – Service Specifications                  123

       Q.     Personal Emergency Response System - Standards                              140

       R.     TeleCare Services                                                           146

              1.     General Information                                                  146

              2.     Health Status Measuring and Monitoring Service                       148

              3.     Activity and Sensor Monitoring Service                               152

              4.     Medication Dispenser and Monitoring Service                          156

       S.     Respite - Standards                                                         160

       T.     Temporary Shelter - Service Specific Operational Procedures                 162

       U.     Specialized Medical Equipment and Supplies - Standards                      166

       V.     Durable Medical Equipment (DME) - Service Specific Operational Procedures   167


Eff. 7/1/09                                                                                     4
       W      Hearing Aids - Service Specific Operational Procedures                   172

       X.     Stair Elevator - Service Specific Operational Procedures                 176

       Y.     Transportation - Standards                                               180

       Z.     Vision Care - Service Specific Operational Procedures                    182

V.     APPLICATION FORMAT AND FORMS                                                    185

       A.     Letter to Applicants                                                     186

       B.     Provider Application – Submission Format/Checklist                       187

       C.     Certification Form/Agency Profile                                        189

       D.     Assurances                                                               192

       E.     Affirmation, Price Certification, and Service Profile Forms              193

              1.     Adult Day Care Centers – Provider Affirmation                     194

              2.     Adult Day Care Centers – Price Certification Form                 196

              3.     Attendant Care – Act 15 – Price Certification Form                197

              4.     Attendant Care / Personal Assistance Service (PAS) Profile        198

              5.     Counseling – Provider Affirmation                                 200

              6.     Counseling – Price Certification Form                             202

              7.     Professional Evaluation Services – Provider Affirmation           203

              8.     Professional Evaluation Services – Price Certification Form (1)   205

              9.     Professional Evaluation Services – Price Certification Form (2)   206

              10.    Home Health Care – Provider Affirmation                           207

              11.    Home Health Services – Price Certification Form                   209

              12.    Home Health Service Profile                                       210

              13.    Home Support – Provider Affirmation                               211

              14.    Home Support – Price Certification Form                           213


Eff. 7/1/09                                                                                  5
              15.    Home Support – Financial Management – Price Certification Form   214

              16.    Personal Care – Provider Affirmation                             215

              17.    Respite Care – Provider Affirmation                              217

              18.    Companion Services – Provider Affirmation                        219

              19.    Personal Care, Respite Care, Companion Services,
                     General Home Support Price Certification Form                    220

              20.    Personal Care Service Profile                                    221

              21.    Personal Assistance Service (PAS) – Provider Affirmation         223

              22.    Personal Assistance Service (PAS) – Price Certification Form     224

              23.    Personal Assistance Service (PAS) Profile                        225

              24.    Respite/Temporary Shelter – Price Certification Form             227

              25.    Transportation – Provider Affirmation                            228

              26.    Transportation – Price Certification Form                        230

              27.    Personal Emergency Response – Provider Affirmation               231

              28.    Personal Emergency Response – Price Certification Form           233

              29.    Health Status Measuring and Monitoring Service
                     Price Certification Form                                         234

              30.    Activity and Sensor Monitoring – Price Certification Form        235

              31.    DME – Hearing Aides – Price Certification Form                   236

              32.    DME – Stair Elevator – Price Certification Form                  237

              33.    Vision Service – Price Certification Form                        238

VI.    ATTACHMENTS                                                                    239

       A.     Procedure Codes for Aging Waiver Services                               240

       B.     DME Supply List                                                         240

       C.     Sample Insurance Certificate                                            240


Eff. 7/1/09                                                                                 6
       D.     Adult Day Care Congregate Meal Requirements   240




Eff. 7/1/09                                                       7
                    SECTION I.


              INTRODUCTORY MATERIAL




Eff. 7/1/09                           8
A.     PCA’s MISSION STATEMENT


       PCA’s mission is to improve the quality of life for older and disabled Philadelphians, assisting these

individuals in achieving maximum levels of health, independence, and productivity. Special consideration

is given to assuring services for those with the greatest social, economic and health needs. Based on the

principle that older persons have the ability and the right to plan and manage their own lives, PCA seeks

ongoing input from the elderly. PCA recognizes the dignity of all older people and respects their racial,

religious, sexual, and cultural differences.

       PCA’s mission is carried out through five major functions: planning, advocacy, program

development, service coordination and provision, and accountable administration of public and private

funds to purchase services. It works with organizations representing and serving older Philadelphians to

develop a comprehensive, coordinated, and accessible system of services responsive to the needs of the

aging population within community and institutional environments.

       PCA is the Area Agency on Aging for Philadelphia, as designated by the Commonwealth of

Pennsylvania in response to the 1973 amendments to the Older Americans Act of 1965. It operates under

the authority of the Pennsylvania Department of Aging.




Eff. 7/1/09                                                                                                 9
B.     LETTER FROM PCA’S PRESIDENT


         As a proud member of Philadelphia’s health care and human services communities, the Philadelphia
Corporation for Aging (PCA) faces the challenge of seeking workable solutions to basic human problems
within a rapidly changing environment. We are grateful for the expertise of the hundreds of agencies with
whom we partner to serve Philadelphia’s large and diverse elderly population a group whose proportional
size is unmatched by other major American cities.

         During its many years of developing, funding, and implementing services and programs that
represent Philadelphia solutions to Philadelphia problems, PCA and its partners have produced a versatile
and unique “network of care”, now touching the lives of an estimated 70,000 people each year. For many,
our aging network offers a caring, helping hand providing guidance, reassurance, and reinforcement. For
some, we fill a definite gap in family support -- allowing them to resume normal family life despite
setbacks caused by functional ability or health. For others, who are without family or informal support, we
are a lifeline assuming essential day-to-day care giving responsibilities.

        As PCA coordinates a local “network of care”, it is a member of a national network that touches
seniors across the nation. We are one of 670 Area Agencies on Aging which derive authority from, the
Older Americans Act of 1965. This Act sets forth a unified set of goals and directions that broadly guide
our nation’s formal support of the aging. Its wisdom proven by the test of time, the Act remains relevant,
versatile, and adaptable in practical application. The 2005 White House Conference on Aging -- attended
by 1,200 delegates representing every state -- issued a resounding endorsement for the Older Americans
Acts, its reauthorization and funding. For those working within the aging network, and for the countless
individuals touched by its network, this is a true statement of success.

       PCA is proud to be linked to the Older Americans Act network and national counterparts through
common purpose and direction. We acknowledge and embrace our responsibility to provide proactive
leadership, as we tackle demographic challenges, which have yet to confront most cities and states.

        Our activities are guided by four central mandates set forth in the Older Americans Act: Facilitating
Independent Living, Empowering Older People Through Community Involvement, Advocating to Protect
Rights, and Targeting and Responding to Priority Needs. These practical themes formulate the core of
PCA’s mission and guide its progress each year. Thanks to our dedicated funding from the Pennsylvania
Lottery and the collaborations we have established with other agencies, we have reached beyond baseline
requirements of the Older Americans Act in developing programs for Philadelphia’s aging community and
non-elderly in need of long-term care services.

        We are proud that PCA’s programs serve as models for other Area Agencies on Aging who derive
benefit from our developmental work as they strive to fortify their own networks.

                                             Sincerely,
                                             Rodney D. Williams




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C.     PROVIDING QUALITY CARE


       PCA is charged with the responsibility for building and improving long-term care towards a goal of
providing a life-long “continuum of care." This goal is being accomplished through PCA’s visible
leadership role as a coordinator of long-term care, provider of information and referral services, and vocal
advocate of public policy that benefits the frail elderly and adults with disabilities.

       Together with its staff and community partners, PCA strives to remain accessible and responsive to
the needs of individuals in their communities. Central to these efforts is an emphasis on diversity -
designing a flexible array of programs that respond to individual and cultural preferences and needs.

       PCA’s perspective is that of an agency committed to consumer choice and to considering
individuals' diversity and personal preferences along with their medical needs.

       Faced with financial constraints, which is the hallmark of this era of health care cost containment,
PCA advocates full use of technological advances, along with thoughtful care decisions. It is hoped that the
influence of PCA’s home and community-based care philosophy will lead to innovative and improved
models of long-term care.

       But foremost on the agenda, as it has been since 1973, is cultivating the practical expertise and
common compassion that are needed to make quality of life a fact of life for older women and men across
the country.

        Chronically ill and disabled adults often need help to live safely and comfortably at home. Some
can afford to pay for services from the burgeoning home-care industry, but most rely on informal support
systems for daily assistance. Since Medicare and Medicaid provide limited care in the home, PCA fills the
service gap for them.

       Since the mid 1980s, PCA has dedicated an increasing percentage of its resources to funding long-
term care services and each year, thousands of Philadelphians (elderly and non-elderly) receive home-based
support services through PCA.




Eff. 7/1/09                                                                                               11
D.     PCA’S INTEGRATED LONG TERM CARE (LTC) PROGRAM

        Since the inception of PCA’s Long Term Care Program (LTC) in 1976, the agency has maintained a
commitment to assuring quality consumer services. In support of its mission “to improve the quality of life
for older and disabled Philadelphians and to assist them in achieving optimum levels of good health,
independence and productivity”, PCA continues to make quality of life a fact of life through its integrated
LTC program.

       Through the use of centralized oversight, common procedures, consumer choice, and common
providers, PCA is able to provide an integrated and seamless service response. This integrated approach
reduces administrative overhead, increases program efficiency, and enhances communication with service
providers. Care management staff carry a programmatically mixed caseload so that as consumers’ needs
change over time, there is minimal disruption in care management and service delivery.

1.     PCA’S LTC DEPARTMENTS

       The Long Term Care (LTC) Program consists of three primary Departments:

        The Long Term Care Assessment (LTCA) Department is responsible for determining, through
performing and assessment, an applicant’s appropriateness for level and locus of care, and makes a referral
to the appropriate program.

        The Long Term Care Options (LTCO) Department is responsible for developing and arranging a
care plan, authorizing services, and providing ongoing care management for those consumers determined
appropriate for home and community based services by LTCA.

        The Community Living Options Department is responsible for two programs. The Domiciliary
Care (Dom Care) Program provides eligible consumers residential and supportive services in a homelike
setting. The Nursing Home Transition Program assists persons residing in nursing homes who are capable
of living independently to move back into the community.




Eff. 7/1/09                                                                                              12
2.     LONG TERM CARE SERVICES

       PCA’s LTC Program includes a wide range of services so that older and disabled adults may live in
the community rather than in a nursing home.

       To receive services, individuals must be 60 years of age or older and, when clinically eligible for
nursing home care (NFCE), they must be in need of assistance with multiple activities of daily living. A
consumer’s care needs are met through care plans developed jointly with a PCA Care Manager. Consumers
choose the providers they wish to use for services from a list provided by the Care Manager. Over 8,000
individuals receive services at any one time. The range of services offered includes:

Adult Day Care                                      Major Cleaning and Extermination
Personal Care                                       Housing Services and Home Modifications
Counseling                                          In-home or Institutional Respite
Home Delivered Meals                                Medical Equipment and Supplies
Hearing Aids                                        Stair Elevators
Specialized Evaluations                             TeleCare Services
Nursing                                             Transportation
Physical, Occupational and Speech Therapy           Emergency Response Systems

        The primary sources of funding for LTC services are Medical Assistance dollars from the
Pennsylvania Department of Public Welfare (DPW) and Pennsylvania Lottery dollars through the
Pennsylvania Department of Aging (PDA). It is PCA’s goal to use the same providers to deliver services
under both funding sources. The same Service Standards, Service Specific Operational Procedures, unit
costs, reporting requirements, consumer selection options, and other operational aspects apply to all
services and providers, regardless of the source of funding.

3.     COMMUNITY CHOICE PROCESS/AGING WAIVER PROGRAM – MEDICAL
       ASSISTANCE FUNDS

        DPW received a waiver from the Centers for Medicare and Medicaid Serivces (CMS) to use
Medical Assistance funds to pay for consumer services. There currently is an aggregate cost cap of 80% of
the average nursing home rate and consumers must be financially eligible for Medical Assistance and
clinically eligible for nursing home care. PCA certifies all Aging Waiver Program service providers for
participation in the Medical Assistance Program and Aging Waiver Program providers are paid directly by
the Department of Public Welfare through the PROMISe system for services authorized by the PCA staff.

4.     OPTIONS PROGRAM - LOTTERY DOLLARS

         Care plans with an individual cap of up to 80% of the average nursing home rate in Philadelphia are
paid for with Pennsylvania Lottery dollars for those consumers with incomes and/or resources above
Medical Assistance allowable limits, or who, although requiring assistance with ADLs, are nursing facility
clinically eligible (NFI). The provision of Options services is through a contract with PCA, which pays
providers directly. Services provided under the Options Program are identical to those provided under the
Aging Waiver Program. Persons with income above 125% of poverty are required to participate in the cost
of all services paid for with Lottery dollars and are billed directly by PCA.




Eff. 7/1/09                                                                                               13
                          SECTION II.




              GENERAL INFORMATION FOR APPLICANTS




Eff. 7/1/09                                        14
                           GENERAL INFORMATION FOR APPLICANTS

       This application packet provides interested service providers with information to prepare and submit
applications for consideration by the Philadelphia Corporation for Aging’s (PCA) Business Administration
Department, to provide services to homebound elderly residents of Philadelphia participating in PCA’s
Long Term Care programs.

A.     Response to Applications

       Applications may be submitted to PCA at any time, however the required information must be
submitted in the order and format detailed in the forms packet.

        Though applicants may choose to apply to be an Aging Waiver Provider only, in order to assure
consistency and continuity in service delivery, they are strongly encouraged to apply to be a provider for
both programs, the Options Program and the Aging Waiver Program. Providers wishing to be an Options
Program provider must be willing to participate in the Aging Waiver Program as well.

         NOTE: Applications to be an Options Program provider will be processed twice yearly, at the
start of the fiscal year – July 1, 2009 - and at mid-year – January 1, 2010. Applications to be an
Aging Waiver Provider will be processed at any time during the fiscal year.

        If any of the required information and forms are missing or are incomplete, the applicant will be
given 30 days to provide the additional material. Additional time may be granted in special circumstances.
All “Assurance” forms must be signed in the affirmative by an official authorized to commit the applicant
to the requirements stated therein. If an application cannot be processed in a reasonable period of time, as
determined by PCA, the provider may resubmit all material at a later date.

       PCA reserves the right to verify any information that appears inconsistent, unclear, or erroneous.
Any applicant that willfully provides false information, as verified by PCA, shall be immediately
disqualified from consideration for a period of up to one year. However, PCA reserves the right to waive
minor errors or irregularities. PCA reserves the right to request best and final price quotes from applicants
and acceptance of a final price quote rests solely with PCA.

        NOTE: Because of PCA’s on-site monitoring and audit requirements, PCA will only consider
applicants that have a local office (i.e., an office located within a reasonable distance of Philadelphia),
so as to facilitate access to all required provider records. While it is recognized that certain services
can be delivered through electronic and/or mail service, PCA must still be able to access provider
records and documentation related to both the due diligence process for provider certification, as
well as the delivery of authorized service.

B.     Unit Prices

        Reimbursement for services provided will be based on unit prices. The unit prices stated on the
Price Certification Forms shall apply to both the Options Program and the Aging Waiver Program. The
unit prices will remain firm for the fiscal year.




Eff. 7/1/09                                                                                                  15
       NOTE: It is requested that providers offer the same unit price(s) to PCA consumers who wish
to purchase additional service on their own.

C.     Areas of Service

        All applicants must have the capacity to deliver service to one or more PCA defined geographic
areas of Philadelphia. Identification of areas to be served shall be made as part of the application process
and the areas identified will determine on which Consumer Selections List(s) the provider is included.
Given consumer choice, applicants should select only those areas they are confident they can comfortably
serve.

      NOTE: In order to provide service in another county in Pennsylvania, an application must be
submitted to that county.

D.     Agreement Period

        Subject to the availability of funds, PCA intends, through this process, to certify and contract with
providers to provide service for the fiscal year period, July 1, 2009 through June 30, 20010. New applicants
for a PCA contract will only be processed at the start of fiscal year – July 1, 2009, and again in mid-year –
January 1, 2010. Applications for certification in the Aging Waiver program will be accepted on a rolling
basis.

E.     Quantity of Service

       PCA does not guarantee any minimum or maximum volume of service for the fiscal year. PCA
assures providers that the availability of all providers will be made known on PCA’s Consumer Selection
Lists.

        The dollar amount of any contract does not represent intent, either expressed or implied, to purchase
service at any level, and shall not be construed as a guarantee of payment beyond service specifically
ordered through an official PCA Service Order form and delivered by the provider.

F.     Third Party Payor Reimbursable Service

The LTC Program is mandated by the Pennsylvania Department of Aging to pursue reimbursement through
other sources, such as Medical Assistance and Medicare and other third party payors. Any provider
offering a service covered by Medicare or Medical Assistance must be enrolled to provide that service
before certification or contracting through this application process. Any consumer who is eligible and
meets the requirements for Medical Assistance or Medicare must receive service paid for by the third party
source. For such a consumer, service will be ordered and paid for by PCA only if it cannot be provided by
Medical Assistance or Medicare or other third party payor. PCA expects each applicant to be
knowledgeable about third party reimbursement; therefore, PCA will not retroactively reimburse a provider
if the claim is rejected by Medical Assistance, Medicare, or other third party payor. A large number of PCA
consumers meet the requirements for billing to Medical Assistance and Medicare.

       Concerning Medicare billable services, PCA requires that services be billed directly to Medicare
and not to PCA or the consumer.




Eff. 7/1/09                                                                                                    16
       The applicant must be knowledgeable about the billing requirements for Medicare and Medical
Assistance in Pennsylvania, and must process all required forms, including having the forms completed by
the consumer’s physician. NOTE: The provider must inform the PCA Care Manager every time a
service can be billed to Medical Assistance or Medicare. PCA will provide the necessary insurance
information and the name and telephone number of the consumer’s physician at the time the service is
ordered. The Care Manager will assist the provider in contacting the physician and in facilitating the
completion of forms only in exceptional situations (e.g., when the provider’s repeated attempts to contact
the physician have been unsuccessful).

G.     Service Delivery

        The provider must have the capacity to start service within 3 business days after receiving the
service order, or within the times frames defined in the individual Service Specific Operational Procedures.
 There may be instances where a PCA Care Manager requests next day delivery in order to meet a
consumer’s urgent needs.

        PCA requires that providers obtain consumer signatures for all services provided to PCA
consumers. No request for payment shall be made without a signed receipt for each unit of service. Any
Options service billed based on unsigned or forged verification forms will be deducted from the provider’s
next payment. Similarly, any Aging Waiver service billed without proper consumer verification will
require that the provider submit a claim adjustment to reimburse DPW. NOTE: Falsification of invoices
will result in the immediate termination of the provider’s contract and the possible termination or
suspension from the Medical Assistance Program.

       PCA requires that providers deliver service on the days and at the time(s) requested. If PCA’s
request cannot be met or an exception occurs once service has started, the consumer and the consumer’s
Care Manager must be notified. Any alternate plan must be approved by the consumer and the PCA Care
Manager.

H.     Quality Improvement and Consumer Satisfaction

      PCA recommends that providers periodically review and analyze their services focusing on quality
improvement and the identification of problems. It is also recommended that providers periodically survey
consumers to gauge their satisfaction.

I.     Financial Stability

       Providers making application to PCA must be financially solvent and able to demonstrate an ability
to meet daily operational and payroll expenses. Should a provider enter into bankruptcy proceedings, the
PCA Contract Manager must be notified immediately.

J.     Annual Financial Statements

        All providers are required to submit a copy of their annual financial statements to their PCA
Contract Managers. These annual financial reports will be due no later than ninety (90) days after the end
of the provider’s fiscal year.




Eff. 7/1/09                                                                                               17
K.     Transition to a New Provider

       In the event that a consumer selects a new service provider or the current provider terminates
services, the current provider must participate in any plan to transition services. Participation shall include
providing a copy of the consumer’s record including a service summary, and attending an orientation
meeting with the new provider and any additional meetings needed to successfully transfer the consumer.

L.     Personnel Policies

         The provider is required to submit a copy of their personnel policies as part of their application.
The policies must cover hiring practices, employee benefits, supervision procedures, and employee training
as it relates to the services covered by the application.

M.     Interrelationship of Providers (Excerpted and modified from the “Medical Assistance
       Handbook, Chapter 1101, Responsibilities")

       Providers are prohibited from making the following arrangements with other providers:

       1.      The referral of consumers directly or indirectly to other practitioners or providers for
               financial consideration or the solicitation of consumers from other providers.

       2.      The offering of, or paying of, or the acceptance of, remuneration to, or from, other providers
               for the referral of consumers for services or supplies.

N.     Insurance

        Providers must provide evidence that they meet PCA’s insurance requirements in order to be
certified for the Aging Waiver Program and in order to participate in the Options Program.

       It is advised that before completing an application, providers verify with their insurance
carriers that they are able to meet PCA’s insurance requirements.

       The insurance requirements are provided below.




Eff. 7/1/09                                                                                                  18
                               PCA’s INSURANCE REQUIREMENTS


Provider shall, at its sole cost and expense, procure and maintain in full force and effect, throughout the
term of the Agreement, the following insurance from companies licensed or approved to do business in the
Commonwealth of Pennsylvania, or through a qualified self-insurance program approved or registered by or
with the Commonwealth and acceptable to PCA, in the forms and on the terms and conditions specified
herein. All insurance companies must maintain a Best’s Insurance Guide rating of at least “A-” and a
financial size of at least Class VII for companies licensed in the Commonwealth or Class X for companies
approved but unlicensed in the Commonwealth. Except as specifically provided herein, all such insurance
shall be written on an occurrence basis.

       1.     General liability insurance (including coverage for physical abuse and sexual molestation
              with sublimits of at least $500,000 per occurrence and 2,000,000 per annual aggregate) with
              no self-insured retention, and with no endorsements excluding or limiting coverage,
              including, but not limited to, contractual liability coverage, naming PCA and the
              Commonwealth of Pennsylvania and their directors, officers, employees and agents as
              additional insureds, with an endorsement stating that the coverage afforded the additional
              insureds shall be primary and non-contributory to any other coverage available. Such
              coverage shall have limits of coverage, on a stand-alone basis or in combination with excess
              or umbrella coverage, of not less than $1,000,000 combined bodily injury and property
              damage per occurrence and $3,000,000 per annual aggregate.

       2.     Automobile liability insurance written on the current Insurance Services Office’s
              commercial auto form or its equivalent, with no self-insured retention, naming PCA and the
              Commonwealth of Pennsylvania and their directors, officers, employees and agents as
              additional insureds, with an endorsement stating that the coverage afforded the additional
              insureds shall be primary and non-contributory to any other coverage available, and with
              limits of coverage, on a stand-alone basis or in combination with excess or umbrella
              coverage, of not less than $1,000,000 per occurrence combined single limit for bodily injury
              and property damage, covering owned, non-owned and hired vehicles;

       3.     Workers compensation insurance (with statutory limits of coverage and no deductible) and
              employers liability insurance (with limits of coverage of not less than $100,000 per accident,
              $100,000 per employee by disease and $500,000 policy limit by disease and no deductible)
              endorsed for all states in which work is to be performed under the Agreement (including,
              without limitation, Pennsylvania).

       4.     Professional liability insurance naming PCA and the Commonwealth of Pennsylvania and
              their directors, officers, employees and agents as additional insureds (except with respect to
              Health Care Providers under the Medical Care Availability and Reduction of Error
              (MCARE) Act), with an endorsement stating that the coverage afforded the additional
              insureds shall be primary and non-contributory to any other coverage available, and with no
              endorsements excluding or limiting coverage, as follows:

              a.      “Participating Health Care Providers” under the MCARE Act must have statutory
                      limits and must participate in the MCARE Fund;



Eff. 7/1/09                                                                                               19
              b.     “Non-participating Health Care Providers” under the MCARE Act and other
                     providers of professional services (including, but not limited to, social and legal
                     services providers and those health care providers who are not “Health Care
                     Providers” under the MCARE Act) must have limits of coverage of not less than
                     $1,000,000 per occurrence and $2,000,000 per annual aggregate and no-self insured
                     retention.

              c.     Professional liability insurance may be written on a claims-made basis, provided,
                     however, that the policy permits Provider to purchase extended reporting period
                     coverage (“Tail Coverage”) upon termination of the policy.

                     (1.)   In the event that insurance is written on a claims-made basis, Provider hereby
                            agrees to maintain, following termination of such coverage or of the
                            Agreement (whichever is earlier), professional liability insurance, covering
                            claims arising out of occurrences during the term of the Agreement, whether
                            by (i) purchasing additional policies of insurance with no exclusion for prior
                            occurrences and the option of purchasing appropriate Tail Coverage, or (ii)
                            purchasing the appropriate Tail Coverage. Tail Coverage for medical
                            professional liability coverage shall be of unlimited duration. All other Tail
                            Coverage shall be maintained for a period of not less than the greater of six
                            years or as required by law, following termination of the Agreement or of such
                            claims-made coverage (whichever is earlier). In no event shall any such Tail
                            Coverage provide limits of coverage lower than the limits of coverage required
                            herein for professional liability.

                     (2.)    In the event that Provider elects to maintain insurance written on a claims-
                             made basis, these undertakings (and the provision of certificates or policies of
                             insurance evidencing compliance with same, as further specified below) shall
                             survive termination of the Agreement.

       5.     All-risk or special form property damage insurance, naming PCA and the Commonwealth of
              Pennsylvania as additional insureds and loss payees, insuring as they may appear the
              interests of Provider, PCA and the Commonwealth of Pennsylvania in all personal property,
              fixtures and improvements to real estate funded or supplied by PCA, whether titled to
              Provider or to PCA. Such coverage shall be written for the full replacement value of the
              property in question without penalty or deduction for coinsurance or deductible greater than
              $500.00, and shall be amended as necessary to reflect changes in inventory.

              If Provider has contracted with PCA for any prior period(s) and has in force general liability
              or, if applicable, excess insurance, written on a claims-made basis, covering claims arising in
              connection with its performance under contract with PCA during such period(s), Provider
              shall maintain said insurance during and for a period of not less than the greater of six years
              or as required by law, following the term of the Agreement (whether by (i) purchasing
              additional policies of insurance with no exclusion for prior occurrences and the option of
              purchasing Tail Coverage, or (ii) purchasing the appropriate Tail Coverage); provided,
              however, that all other terms and conditions contained in this Exhibit “C” are otherwise met.
               In the event that Provider elects to maintain insurance written on a claims-made basis, as


Eff. 7/1/09                                                                                               20
              provided in this paragraph, this undertaking (and the provision of certificates or policies of
              insurance evidencing compliance with same, as further specified below) shall survive
              termination of the Agreement.

              Provider shall provide PCA with certificates of insurance evidencing compliance with the
              requirements of this Exhibit “C” prior to performance under the Agreement in substantially
              the form attached hereto as Appendix 1 to this Exhibit “C”. All certificates shall evidence
              the agreement on the part of the insurer to provide PCA with 30 days prior written notice of
              any non-renewal, cancellation or modification of coverage, or of any impairment of the
              aggregate insurance exceeding $100,000, except in the case of coverage for physical abuse
              and sexual molestation where written notice shall evidence any impairment of the aggregate
              insurance available as a result of loss. Any language on the certificate which states that the
              insurer will “endeavor to” mail such notice and any language stating “but failure to do so
              shall impose no obligation or liability of any kind upon the insurer affording coverage, its
              agents or representatives, or the issuer of this certificate” shall be deleted. PCA shall have
              the right, in its sole discretion, to pay any premium necessary to maintain in force the
              coverages required hereunder, and to recover the amount of such payment, whether by set-
              off against amounts due to Provider under the Agreement, or otherwise. PCA shall have the
              right to require Provider to submit certified copies of policies of insurance required
              hereunder upon reasonable notice.

              The insurance requirements set forth, and shall not be construed, to limit or reduce (or be
              limited or reduced by) any other insurance obligation of Provider under the Agreement; nor
              to limit Provider’s liability under the Agreement to the limits of coverage required or
              procured.




Eff. 7/1/09                                                                                                21
                       SECTION III.



     GENERAL OPERATIONAL PROCEDURES FOR ALL SERVICE

                       PROVIDERS




Eff. 7/1/09                                           22
GENERAL OPERATIONAL PROCEDURES FOR ALL SERVICE PROVIDERS

This document is a supplement to the Options and Aging Waiver Standards and Service Specific
Operational Procedures. It sets forth the operational procedures that ALL Providers offering care to
PCA consumers of the LTC Department programs, must follow, regardless of the payment source for
service provision.

A.     INTAKE

       The LTC Assessor or LTCO Care Manager develops a care plan in conjunction with the consumer
       and/or caregiver. In cases where a need for specialized services exists, the Assessor or Care
       Manager contacts the provider selected by the consumer to make the initial referral.

       The provider agency will be given information necessary to authorize service by way of a Service
       Order from the Assessor or Care Manager. The type of service and time frame in which the service
       is to be provided will be specified. If the provider is not able to meet the request, the Assessor or
       Care Manager will refer the consumer to another agency of his/her choice. Note: for Aging Waiver
       consumers, DPW regulations require providers confirm consumer eligibility prior to the
       delivery of service. Eligibility can be confirmed via DPW’s Eligibility Verification System
       (EVS) and/or through DPW’s Provider Reimbursement and Operations Management Information
       System (PROMISe).

       Even if a service order is based on payment by PCA or Aging Waiver funds, the State of
       Pennsylvania mandates that all other third party payers be billed before PCA or Aging
       Waiver funds are invoiced.

B.     IDENTIFICATION OF FIELD STAFF

       All staff persons in contact with LTC consumers are required to wear attire appropriate to the
       industry and function being carried out. All field staff shall be given provider issued photo
       identification cards.

C.     COMMUNICATION

       Communication by phone, voice mail, fax, and e-mail, as well as face-to-face meetings, when
       necessary, between the LTC staff and the Provider, and between Providers, are at the core of
       responsive service to consumers. The points in time when communication is necessary between the
       Provider and PCA, fall into seven primary categories:

       1.     If required, or if concerns arise, following initiation of service;
       2.     When a change in the consumer’s functioning is observed;
       3.     When collaboration between Providers is necessary;
       4.     When there are changes in the plan of treatment;
       5.     When there are consumer complaints;
       6.     When emergencies occur;
       7.     At the time of discharge or suspension of service.



Eff. 7/1/09                                                                                               23
D.     EMERGENCIES

       1.     CONSUMER - All Providers for all services shall develop and follow written
              policies and procedures regarding the handling of medical emergencies that
              consumers may experience during service provision. The written policies and
              procedures will be reviewed as part of regular monitoring.

       2.     PCA STAFF - Providers shall notify designated staff immediately in the
              event an emergency occurs while providing service, and shall submit an
              incident report (see Item F below) to PCA.

       3.     WEATHER EMERGENCIES/DISASTERS - Providers shall have written policies and
              procedures describing the actions to be taken to ensure continued service to LTC consumers
              in the event of a weather emergency or a disaster. The policies and procedures must
              especially note the actions to be taken to ensure continued service to those consumers
              identified by the Provider and/or LTC staff as most at risk. The written policies and
              procedures will be reviewed as part of regular monitoring.

E.     ON CALL PROCEDURES

       1.     The Provider shall provide PCA consumers with written procedures for how to contact a
              staff person to discuss problems or concerns that require attention during non-business hours
              (weekdays after 5:00 PM and week-ends).

       2.     If the provider agrees to accept referrals for service to start within 24 to 72 hours, staff shall
              be available after normal business hours and on the weekends to receive referrals. In
              addition, the provider shall have the capacity to commit over the telephone when called to
              start service. It is anticipated that this need for extended-hours of coverage will apply
              primarily to home health and personal care service providers. Providers of other types of
              services who may utilize answering machines or answering services, are expected to respond
              to such referrals on the next business day.

       3.     The On Call Procedures will be reviewed as part of regular monitoring.

F.     INCIDENTS

       1.     Incidents of injury or threat to the consumer, an unsafe environment, alleged theft and
              damage to the consumer’s property.

              a.     All incidents must be reported immediately to the Care Manager (or the Care
                     Manager Supervisor or the Nurse Consultant) and be followed by submission of a
                     written Incident Report within 24 hours to the LTC Care Manager and the Contract
                     Manager in the Business Administration Department

              b.     A representative of the Provider shall visit the consumer to discuss the incident,
                     prepare a written statement that describes the incident from the consumer’s
                     perspective, ask the consumer to sign the statement, and submit the statement along




Eff. 7/1/09                                                                                                  24
                      with the Incident Report. The consumer should be encouraged to file a police report
                      if appropriate.

              c.      Irrespective of the willingness of a consumer to sign a statement and/or file a police
                      report, the Provider must resolve the situation consistent with industry standards and
                      consistent with consumer preferences. The Provider shall advise the PCA Care
                      Manager and Contract Manager of the results of these efforts.

G.     SERVICE ORDERS

       1.     All service orders will be sent by Philadelphia Corporation for Aging personnel only.

LTC Care Management staff (Assessors, Care Managers, Care Manager Supervisors, Nurse Consultants, or
PCA administrative staff) are the only staff authorized to place service orders. The Provider must receive
the service order before service delivery can begin.



       3.     If the service order is unclear or erroneous, the PCA Care Manager or Care Manager
              Supervisor must be contacted immediately to discuss the concern. A corrected service order
              must be received before initiating or continuing service. The PCA Care Manager or Care
              Manager Supervisor will make any needed corrections in the care plan and forward a new
              service order, as indicated.

       4.     Please see the Service Order Procedures in Section IV, noting especially PCA’s
              requirements for Web based accessing of referrals by providers.

H.     CRIMINAL HISTORY REPORTS

       Without in any way limiting providers’ duties under any other term or condition of any agreement
       between providers and Philadelphia Corporation for Aging and/or providers and the Commonwealth
       of Pennsylvania Department of Public Welfare, providers shall comply with any federal, state, or
       local law pertaining to mandatory use of criminal history record information, including but not
       limited to the Older Adults Protective Services Act, 35 P.S. Section 10225.101 et seq., and the
       regulations promulgated pursuant thereto, 6 Pa. Code Chapter 15 (commonly referred to as “Act
       13”). In the event that Provider is not otherwise required by applicable law to review criminal
       history record information, Provider shall obtain criminal history record information for all
       employees having contact with PCA consumers and shall exercise discretion in making employment
       decisions based thereon.

I.     LEGAL RESIDENCY STATUS

       Without in any way limiting a provider’s duties under any other term or condition of any agreement
       between providers and Philadelphia Corporation for Aging and/or providers and the Commonwealth
       of Pennsylvania Department of Public Welfare, providers shall comply with the Immigration
       Reform and Control Act of 1986, 29 U.S.C. Section 1802 et seq.




Eff. 7/1/09                                                                                               25
J.     CONSUMER SIGNATURES

       1.     The Provider shall obtain the consumer’s signature, or the signature of an authorized
              representative, on a standardized form or time-slip, each time a service is delivered to a PCA
              consumer. Use of an authorized representative is permissible when the consumer is unable to
              sign due to either physical and/or cognitive limitations. The consumer’s PCA Care Manager
              must confirm the approval and designation of an authorized representative. Providers must
              maintain proof of that designation in their consumer records.

              NOTE: The Provider’s use of electronic / telephony systems in place of the consumer
              signature process, described throughout this section, is possible only with PCA’s prior
              written approval.

       2.     The consumer or the consumer’s authorized representative must be given a copy of the
              signed time-slip or comparable form as a confirmation of delivery of service. It is
              recommended that providers utilize multi-part forms to facilitate this acknowledgement of
              the receipt of service on the given day.

       3.     For those services authorized and ordered in time increments (e.g. ¼ hour), the service
              verification form or time-slip must clearly identify the consumer served, the worker
              providing service, the time service started and ended, including whether A.M. or P.M., for
              each date of service, and must be signed by the consumer and the worker for each day and/or
              instance of service in a given day (e.g. split shift of personal care service, etc.).

              When service is delivered at an adult day service center, the verification of attendance by a
              single consumer signature must indicate the arrival and departure time. In those instances
              where a consumer is unable to sign on a given day because of an acute health condition or
              episode, the signature of a designated center representative will be acceptable, but the event
              must be documented in the consumer’s record.

              For those services where the unit of service is defined as either a visit, an installation, the
              delivery of an item(s), a one way ride, or a repair, the service verification form or time-slip
              must identify the consumer served, and the date of service, and must be signed by the
              provider of the service (e.g. nurse, counselor, driver, etc.) and the consumer, or the
              consumer’s authorized representative.

              The Service Specific Operational Procedures for each service need to be referenced for
              further guidance related to service delivery or time-slip requirements.

       4.     For those services that are to be delivered on a recurrent basis within the consumer’s care
              plan (e.g. personal care, companion services, adult day service, etc.) the Provider must
              obtain a sample of the consumer’s signature at the time service is initiated, for verification
              purposes, using a staff member other than the person providing the service. If the consumer
              cannot sign, the signature of a person authorized to sign is to be obtained. The authorized
              person must sign their own name each time and indicate they are signing for the consumer


Eff. 7/1/09                                                                                                 26
              Exceptions to obtaining the sample signature include services that are provided on a one-
              time basis and/or entail a monthly rental cost for equipment. In such instances, the signature
              of the consumer or the consumer’s authorized representative at the point of service or the
              time of installation will suffice.

       5.     The signed service verifications or time slips are to be cross-checked with the sample
              signature and be kept in the consumer’s files or with the billing documents at the Provider’s
              office. The documentation shall be made available, as needed, for PCA’s monitoring or
              audits.

              No payment claim is to be submitted to PCA or MA without a signed receipt for each
              individual item or service. Any questionable or missing signatures during an audit by PCA
              or other authorized agent will result in a deduction of the amount billed from the next
              invoicing period. The mailing of copies of signed time slips to PCA is NOT required, unless
              specified by PCA. Documentation verifying service provision, as invoiced and reimbursed,
              must be made available for purposes of PCA monitoring and auditing.

       6.     NOTE: Personal Care providers are required to use a scheduling system for each field
              worker visiting PCA consumers. That schedule shall identify the worker’s name, each
              consumer to be visited, the date, starting and ending time, travel time between visits,
              and break time. Each worker’s schedule, combined with the daily time slips, must
              back-up that worker’s payroll records and the hours billed to PCA and/or MA.

              Just as careful scheduling of times of service is important to assure the most responsive and
              efficient level of service to our consumers, PCA expects that the scheduling of visits for
              workers be done with an eye to a reasonable visit pattern, including the overall work-load,
              breaks, and travel time. PCA’s monitoring, in consumers’ homes and in the Provider’s
              office, includes an evaluation of worker visit patterns and the number of hours per week
              scheduled, with an eye to: allowing travel time, no overlapping schedules (including staff
              working for more than one provider), realistic working hours, and rate of pay. Rescheduling
              of service shall occur only with consideration of the consumer’s needs, the plan of care, and
              with LTC Care Management approval.

K.     INVOICING

       1.     Invoices to PCA or MA are to be submitted on a monthly basis, based on prices agreed
              upon through the provider application process and the presence of consumer signatures on
              time slips. For the Options Program, invoices are to be submitted according to the schedule
              of dates provided by PCA and via the web-based Automated Billing System (ABS)
              procedures. For the Aging Waiver Program, PCA recommends the submission of claims to
              MA (via the PROMISe system) on a monthly basis, but recognizes that MA allows providers
              to submit claims on a more frequent basis.

              Questions regarding billing are to be directed to the Provider’s PCA Contract Manager.




Eff. 7/1/09                                                                                               27
       2.     For Options, all services must be billed for the month that they are delivered to a LTC
              consumer. PCA does not allow any back billing for an individual consumer once an Options
              invoice has been submitted for a month.

              Care managers must be notified of any service that is not delivered in the month it was
              ordered, so that corrections can be made to care plans.

       3.     Travel time – providers may not invoice for staff travel time to and from a consumer’s
              home.

L.     MONITORING OF SERVICES

       1.     Each consumer is given the opportunity to monitor the quality of the services they receive, to
              select their service provider(s), and to approve the staff serving him or her. In order to
              measure the quality of care consumers receive, PCA tracks changes in providers and requests
              that consumers answer a Consumer Satisfaction Survey for each service they receive each
              year.

       2.     As a second method of tracking the quality of services consumers receive, Care Managers
              and administrative staff record based on telephone, in the office, and in the home contacts,
              their observations regarding the level and quality of communication with providers and the
              quality of the services that consumers receive.

       3.     PCA’s Business Administration Department audits the Provider’s records, files, and reports,
              in order to evaluate the quality, completeness, accuracy, and appropriateness of the
              Provider’s record keeping and various procedures, as well as to assess the type, amount,
              scope, and duration of the services provided. The audits pay particular attention to the
              interventions used and the subsequent outcomes in addressing the chronic problems of the
              consumer population.

M.     CONFLICT OF INTEREST POLICY

       1.     It is PCA’s expectation that providers will develop and maintain a Conflict of Interest Policy
              as part of their operating procedures. The policy must be in effect as a condition of
              certification, and will be reviewed during PCA’s monitoring. The policy shall include
              language addressing conflict of interest in the recruitment of staff and consumers, the
              provision of services, the marketing of services, and consumer confidentiality. Specifically,
              in order to minimize risk to the Provider, PCA, and consumers, the policy shall include
              references to:

              a.     Not engaging in any practices that are deemed improper as per DPW Medical
                     Assistance Regulations – Chapter 1101;

              b.     Recruiting staff in a proper and professional manner;

              c.     Respecting the right of all consumers to make a free choice in the selection of
                     providers, without encouragement to change providers through the offering of
                     financial or other enticements, pressure, or threats. This applies to consumers


Eff. 7/1/09                                                                                              28
                      receiving services from another provider and when an employee leaves the
                      Provider’s employment;

              d.      Receiving prior written approval from PCA before using PCA’s proprietary material
                      and marketing services in a way that respects the right of all consumers to make a
                      free choice in their selection of providers, without encouragement to change
                      providers through the offering of financial or other enticements, pressure, or threats;

              e.      Protecting consumer confidentiality, including not revealing that a PCA consumer is
                      known to the Provider or revealing any information about any PCA consumer,
                      assuring that employees during and after employment will never reveal the names of
                      consumers served by the provider or any other information about the consumers.
                      Providers are encouraged to have employees sign a form, as a condition of
                      employment, assuring that no consumer information will ever be revealed.

              f.      Not engaging in any activity or conduct that conflicts with, or appears to conflict
                      with, the interests of PCA or its consumers.

N.     FALSE CLAIMS ACT POLICY

              Introduction: On February 8, 2006, President George W. Bush signed into law the Deficit
Reduction Act of 2005 (“DRA”). The DRA reduces federal Medicare and Medicaid spending; funds
programs benefiting certain individuals and families; and, significantly, addresses Medicaid fraud and
abuse.

               Specifically, Section 6032 of the DRA, entitled “Employee Education About False Claims
Recovery,” mandates the amendment of Medicaid State Plans to require certain entities, including PCA, to
implement written policies that describe: (1) the prevention and detection of fraud, waste and abuse; (2)
false claims laws; and (3) whistleblower protection. Accordingly, without in any way limiting any other
policy, procedure or other requirement, including any requirement dealing with related matters, the
following shall apply:

               Policy: The purpose of this policy is to comply with requirements set forth in Section 6032
of the DRA regarding federal and state false claims laws. Entities covered under this provision of the DRA
must ensure that all employees, including management, and their contractors and agents, are educated
regarding federal and state false claims laws and the role of these laws in preventing and detecting fraud,
waste, and abuse in federal health care programs, including Medicaid.

                Because PCA arranges for health care services and provides social services funded by
federal health care programs, it is important to assure that the PCA Workforce understands and complies
with the compliance requirements for such programs.

               False Claims Laws: False claims laws are intended to combat fraud and abuse against the
government, including fraud and abuse in federal health care programs. The laws allow the government,
and in some cases, private individuals, to bring civil actions against healthcare providers to recover
damages and penalties when providers submit fraudulent or false claims to the government. There are
many different types of false claims. Examples include:

                     overcharging the government program


Eff. 7/1/09                                                                                                 29
                      charging for services that were never performed
                      providing less than what was promised
                      providing unnecessary services
                      misrepresenting the services provided
                      billing for services provided by an unlicensed or unqualified provider

                Federal Laws: There are both federal laws and Pennsylvania laws that address false claims
and protections for individuals who report fraud and waste to the government (commonly referred to as
“whistleblowers”). The Federal False Claims Act prohibits any person or entity from knowingly submitting
or causing the submission of a false or fraudulent claim for payment to the federal government. For
purposes of the Act, the term “knowingly” means having actual knowledge or acting in reckless disregard
or deliberate ignorance of the truth or falsity of the information. Violators of the Act may be liable for up to
three times the amount of the fraud, plus a civil penalty of not less than $5,500 and not more than $11,000
for each claim. The Federal False Claims Act authorizes private individuals to bring false claims actions on
behalf of the government, for which the individual may receive between 15 and 30 percent of any recovery
depending in part upon whether the government intervenes in the action. The Act applies to federally
funded programs, including Medicare and Medicaid.

                 The Federal False Claims Act also prohibits an employer from retaliating against an
employee for attempting to uncover or report fraud on the federal government. Any employee who is
discharged, demoted, suspended, threatened, harassed or in any other way discriminated against in his or
her employment as a result of the employee’s lawful acts in furtherance of a false claims suit may bring an
action against the employer in federal district court. An employee who is retaliated against as set forth in
the Act is entitled to reinstatement at the same level, two times the amount of back pay plus interest, and
compensation for any special damages sustained as a result of the discrimination, such as litigation costs
and reasonable attorneys’ fees.

               The Program Fraud Civil Remedies Act of 1986 (“PFCRA”) is another federal law that
provides administrative remedies for the knowing submission of false claims and false statements. For
purposes of the PFCRA, a false claim or false statement includes a claim or written statement submitted to
the federal government which asserts a material fact that is false, omits a material fact, or is for services that
were not provided. Penalties for a violation of the PFCRA include a civil penalty of up to $5,000 per claim,
plus an assessment of up to twice the amount of each false claim.

                Pennsylvania Laws: The Commonwealth of Pennsylvania has not yet enacted a false
claims statute like the Federal False Claims Act. However, it does have anti-fraud laws that impose
criminal and civil penalties for false claims and false statements. The law applicable to Medicaid providers
prohibits the submission of false or fraudulent claims to Pennsylvania’s medical assistance programs as
well as the payment of kickbacks in connection with services paid in whole or in part by a medical
assistance program. A violation of the law is a criminal felony offense that carries with it penalties of
imprisonment of up to 7 years, fines, and mandatory exclusion from Pennsylvania’s medical assistance
programs for five years. Beyond criminal penalties, the law authorizes the Pennsylvania Department of
Public Welfare to institute a civil action against a provider for two times the amount of excess benefits or
payments paid plus interest.

               Pennsylvania has another anti-fraud law that prohibits beneficiaries of medical assistance
programs from making false claims or false statements in connection with an application for medical
assistance benefits or payments. Depending upon the nature of the violation, criminal penalties range from



Eff. 7/1/09                                                                                                    30
felony to misdemeanor offenses. In addition, the Department of Public Welfare may institute a civil action
against a beneficiary.

                Pennsylvania also has a Whistleblower Law that prohibits an employer from discharging,
threatening or otherwise discriminating or retaliating against an employee of a public body because the
employee in good faith reports or is about to report wrongdoing or waste to the employer or appropriate
authority. While the Law applies only to employees of a “public body,” Pennsylvania courts have
interpreted the phrase “public body” to refer to entities that receive money from the Commonwealth. This
includes Medicaid providers.

                How to Report Concerns Regarding Fraud, Abuse, and False Claims: PCA is
committed to conducting its business in a lawful and ethical manner. The PCA Workforce must comply
with all applicable laws, regulations, policies, procedures, and other requirements. PCA requires all PCA
Workforce members to identify and report immediately any issues regarding fraud, waste, abuse and false
claims, including any suspected issues or concerns, to PCA’s Manager of Auditing Services or Vice
President of Business and Finance. Any questions about this policy should be directed to PCA’s
Compliance Officer, the Vice President of Business and Finance.

                Reports may be made on an anonymous basis. Any reported matters that suggest substantial
violations of applicable laws, regulations, policies, procedures and other requirements shall be documented
and investigated promptly.

References:    Deficit Reduction Act of 2005, §§ 6031 and 6032
               Federal False Claims Act, 31 U.S.C. §§ 3729-3733
               Program Fraud Civil Remedies Act of 1986, 31 U.S.C. §§ 3801-3812
               Pennsylvania Whistleblower Law, 43 P.S. §§ 1422-23
               Pennsylvania Public Welfare Fraud and Abuse Control Laws, 62 P.S. § 1407, § 1408




Eff. 7/1/09                                                                                                 31
O.     SERVICE ORDER AUTHORIZATION PROCEDURE


       1.     No service is to be initiated, changed, or terminated prior to care plan expiration, or included
              on an invoice without receipt of a service order. Providing service without a service order is
              not allowed and will not be reimbursed.

       2.     Upon development of the PCA care plan, a service order will be forwarded to the provider.
              If the provider identifies an error on the service order, or has a question, they are to call the
              LTC staff person immediately to clarify any concerns.

       3.     Only the lesser of the amount of service ordered or the service amount that is delivered will
              be paid. The amount invoiced for each consumer is not to exceed the authorized amount in
              the care plan. Any amounts invoiced by the provider that exceed PCA authorized amounts
              will not be paid and reported back to the provider as discrepancies.

       4.     With the implementation of web-based service orders, it is absolutely essential that providers
              log in to the PCA site and download service orders daily.

       5.     If a provider is expecting a service order to start service and the service order is not received
              in sufficient time to initiate service, the provider must contact the Care Manager (or his/her
              direct Supervisor or RN Consultant, if unavailable) to verify the current status of the request.
              6.      Service orders are labeled (I) Initial, for all new consumers and those care plans that
              are renewed six month care plans; (M) Modified, for changes to a service during the six-
              month care plan period; or (T) Terminated, to terminate specific services. Services put on
              hold are reflected on a Modified service order, (refer to attached codes). All service types,
              which are re-ordered, will show as Duplicates.

       7.     It is important that particular attention be paid to the dates on the service order and the
              monthly totals. If a provider is not able to start a service as specified, the provider must
              notify the Care Manager (or his/her direct Supervisor) to assure the service is still needed
              and remains appropriate and to assure it is re-entered for the next month. All rescheduled
              service or additional months or units must be authorized through a service order.

       8.     If the days of the week that service is provided differ from those indicated on the service
              order, the total amount of service projected for the month in PCA’s system may be less. If
              this happens, the excess service during the month delivered by the provider will not be paid
              and the full amount reflected on the provider invoice will not be reimbursed. Each service
              order specifies the total units and/or cost for each month. It is each provider’s responsibility
              to assure the service being billed is equal to, or less than that specified on the service order.
              It is important that providers notify the Care Manager of all delivery patterns, especially if
              there is a change, so that PCA and provider records are identical.

       9.     Please note that although the LTC Program may authorize provision of service by a service
              order, payment remains contingent upon fulfilling any related reporting requirements, as
              delineated by PCA for the Options consumers and DPW for the Aging Waiver program. For
              the Aging Waiver program, providers must confirm consumer eligibility utilizing the
              Eligibility Verification System (EVS) and/or PROMISE system, prior to the delivery of


Eff. 7/1/09                                                                                                   32
              service, as stipulated by DPW regulations.

       10.    Care plans typically are ordered for a six-month or one year period. It is suggested each
              provider set controls to track all consumer care plans to assure service orders are received
              prior to expiration of the previous care plans. If a new service order is not received in a
              timely manner (received before the next period begins), the provider must contact the Care
              Manager or his/her direct Supervisor and obtain a copy before continuing service. Providers
              must not continue to provide service without an updated service order.

       11.    The reason codes that follow are used to explain the basis for revising care plans.




Eff. 7/1/09                                                                                             33
       CODE                                   TERMINATIONS

         01   Consumer deceased.

         04   Nursing Home placement.

         05   Closure - (moved out of area, withdrew, situation resolved, etc.).

         15   Internal transfer. Service/case transferred to another PCA Department.

         19   Consumer is clinically ineligible.

         29   Consumer is financially ineligible.

       CODE                                HOLDS / EXCEPTIONS

         16   Temporary hold -( Hospitalized, vacation, etc.)

         30   Provider no show. Worker did not show up or call to cancel visit.

         36   Temporary hold - skilled care/ Medicare. Consumer receiving third party
              reimbursed services.

         66   Temporary hold - Housing service not performed yet.




Eff. 7/1/09                                                                             34
P.     PROVIDER MONITORING: SANCTIONS

       A provider’s PCA contract for Long Term Care (LTC) and/or enrollment in the Aging Waiver
       Program is contingent on a provider meeting the appropriate Long Term Care (LTC) service and
       clinical care standards, program requirements, and applicable State licensing standards. Provider
       compliance to such standards is measured by PCA on an ongoing basis through formal monitoring
       procedures, as well as the day-to-day experiences of consumers and care managers.

       The purpose of this procedure is to set forth a system for addressing compliance issues or
       documented deficiencies in a provider’s performance and to delineate the subsequent actions
       leading to suspension of referrals, removal of consumers, contract termination, or decertification
       recommendation.

       1.     Findings of non-compliance to program standards, service delivery problems, and/or
              deficiencies may be identified by PCA in one of the following methods:

              a.      Results of formal monitoring site visits, such as the Administrative, Clinical, and or
                      fiscal audits. Where applicable, the Clinical audit will also measure compliance with
                      Clinical Audit Guidelines issued to providers.

              b.      The experiences and/or observations of LTC Department staff -care managers, nurse
                      consultants, etc., documented through Problem or Contact Logs, incident reports, or
                      care managers provider performance evaluations.

              c.      Consumer or caregiver complaints made directly to the care managers of LTC, the
                      Business Administration Department, through community ombudsman, and/or
                      concerns identified in consumer satisfaction surveys.

       2.     Requests for corrective actions to address deficiencies, with a time frame for
              implementation, are communicated to the provider in one of the following ways:

                      -      As a result of clinical care discussions or incidents reports;
                      -      Documented discussions of case conferences;
                      -      At an exit interview following all monitoring visits and in writing via the
                             monitoring/audit reports;
                      -      Monitoring follow-up meetings.

              a.      Plans of correction, in response to monitoring/audit findings, are required to be
                      submitted to PCA within 30 days of the date the monitoring report is mailed to the
                      provider. The acceptance of the plans of corrections will be confirmed to the
                      provider, in writing. The provider will be required to submit, within a reasonable
                      period of time, any revisions/corrections to plans of corrections deemed
                      unacceptable, in whole or part. Proof of implementation will be verified through
                      follow-up site visits, as needed.

              b.      Requests for immediate corrective actions may be made based on the severity of the
                      identified problems, e.g. clinical care issues- (see clinical audit section D.), incident
                      reports, direct care manager observations, unacceptable plans of corrections, etc.


Eff. 7/1/09                                                                                                   35
              c.     Provider meetings are scheduled periodically, and as needed, to provide a forum for
                     mutual discussions related to service issues, problem solving activities, and/or
                     monitoring results.

              d.     Notification of all adverse actions will be confirmed to the Providers, in writing.
                     Providers will be afforded the right to appeal adverse actions to terminate contracts,
                     certification, and decertification actions - see PCA Appeal Procedures.

       3.     Administrative Audits

              Providers’ compliance with PCA service standards are initially determined through a formal
              evaluation in a competitive bidding process (RFP) and/or certification process. An on-site
              Administrative audit is intended to gauge/verify a provider’s continued compliance with
              service standards as delineated in the contract or provider agreement. Those areas reviewed
              include:

                     -      Appropriate licenses, e.g. Medicare, MA, PDA, etc.;
                     -      Insurance coverage;
                     -      Verification of usual and customary rates;
                     -      Agency’s administrative procedures, including: record keeping, billing,
                            personnel records, training, etc.;
                     -      Time slip audit.

              a.     Verification of loss of appropriate licenses or a change in status of ownership,
                     provider name, or affiliation can affect the contract or certification status of a
                     provider.

                     (1.)   A provider’s loss of licensure - Medicare, MA, or PDA (adult day care) will,
                            in turn, result in contract termination or decertification action. Note: in
                            instances where a provisional license is issued, the provider will be placed on
                            “hold for new referrals” pending full licensure. The following actions will be
                            taken for a provider’s loss of license:

                            (a.)      Consumers served by that provider will be asked to select another
                                      provider.

                            (b.)      The PCA contract will be terminated and decertification action will be
                                      initiated - (see Aging Waiver Decertification Procedures).

                     (2.)   Merger with or acquisition of another provider may/will require a change in
                            the contract. Such changes may also result in new Medicare and MA
                            numbers being assigned to the new or changed entity. In such instances PCA
                            will assign a new provider number to be used in building consumer care
                            plans.

                            (a.)      Depending on the type of change, PCA may place a temporary “hold”
                                      on new consumer referrals, pending the assignment of new Medicare


Eff. 7/1/09                                                                                               36
                                  or MA numbers, as well as new PCA number.

                          (b.)    If such action results in structural and/or operational changes, which
                                  adversely impact on the quality of service delivered by the provider,
                                  consumers will be removed and asked to select another provider. The
                                  provider will remain on hold pending the implementation of
                                  appropriate corrective actions.

              b.   Providers must demonstrate proof of the types of and amount of insurances required
                   by PCA as a condition for contract or certification.

                   (1.)   Providers are required to submit updated certificates of insurance as needed.
                          Failure of a provider to submit updated certificates within a reasonable period
                          of time after it is identified as a deficiency, either as a result of an on-site
                          audit or through tracking of expiration dates, may result in PCA withholding
                          payment for current invoices, pending the corrective action.

                   (2.)   Refusal or failure to comply with insurance requirements, unless given a
                          waiver, can result in a provider’s contract termination or decertification
                          action. In such instances, the following steps will be implemented:

                          (a.)    Consumers will be asked to select another provider.

                          (b.)    PCA contract will be terminated and decertification action initiated.

              c.   Providers must have in place the appropriate administrative procedures and
                   organizational structure to meet LTC service standards relative to: staffing, training,
                   record keeping, billing, and care manager communication.

                   (1.)   Staffing must meet the specified levels of education, training, experience
                          indicated in the service standards and be approved by PCA; e.g. skilled
                          services, supervisory positions, etc. Only approved staff will be allowed to
                          provide service to PCA consumers. Failure to utilize approved qualified staff
                          can result in the provider being placed on “hold” for new referrals. (See
                          Clinical Audit, section D.)

                   (2.)   Failure to have in place or follow required training curriculum can result in a
                          provider being placed on “hold” for new referrals, pending corrective actions.

                   (3.)   Record keeping procedures, inclusive of personnel and consumer records,
                          must comply with all service and contract requirements.

                   (4.)   The provider is expected to maintain consistent, ongoing communication with
                          the appropriate PCA staff and comply with all service reporting requirements.

                   (5.)   The following corrective actions will be required when deficiencies are
                          identified in those provider service requirements identified in a. through d.,
                          above:


Eff. 7/1/09                                                                                                37
                          (a.)   A hold for new referrals to the provider will be initiated, pending the
                                 receipt and approval of a plan of correction.

                          (b.)   In instances where the identified deficiency(s), through its impact on
                                 the quality of services delivered, presents a risk to consumers, those
                                 consumers will be immediately removed and will be asked to select
                                 another provider; see Clinical Audit section for additional
                                 clarification.

                          (c.)   Implementation of corrective actions will be verified as needed,
                                 including through an on-site “retest”. Failure to implement corrective
                                 actions, as verified through this retest, will result in consumers being
                                 removed and asked to select another provider.

                          (d.)   Failure to implement corrective actions may also result in contract
                                 termination and initiation of decertification action.

              d.   Time-Slip Audit

                   (1.)   Service providers are required to maintain fiscal records and procedures that
                          fully disclose the nature and extent of services rendered to consumers, as
                          authorized by Care Managers. These procedures must include provisions for
                          obtaining a consumer’s or family/caregiver’s signature that confirm delivery
                          of service using time-slips, encounter forms - (e.g., MA 91), or a comparable
                          format.

                          Providers may only invoice for delivered services confirmed by such
                          signatures. PCA auditors must be able to trace a clear audit trail from
                          workers’ field schedules, visits, signed documents and specified reports, PCA
                          Service Orders, to billed units related to a consumer file.

                          There may be some limited situations when a consumer is unable to sign due
                          to physical and/or cognitive limitations. This may be evident in Adult Day
                          Care centers, where obtaining a consumer’s signature may not be possible, in
                          some instances, due to clinical reasons. In those instances, the center can
                          utilize daily attendance logs, which are signed by a designated staff person.
                          The attendance log must document date of service, time of arrival and
                          departure, and that the consumer is unable to sign.

                   (2.)   Time-slip audits will be conducted, at a minimum, yearly by the Contract
                          Managers and/or designated auditor(s) from PCA. This review will verify
                          invoiced units of service through documentation of signatures on time-slips
                          or attendance logs for a designated invoice/reporting period(s).

                   (3.)   Over-billing (for service not delivered) or invoiced units of service that are
                          not verified by an acceptable consumer or other PCA approved signature (on
                          time slips, or other comparable formats) will be disallowed and the provider


Eff. 7/1/09                                                                                             38
                             will be denied payment for those units of service:

                             (a.)   Disallowed units of service for the LTC Options program will be
                                    adjusted in the provider’s next payment.

                             (b.)   Disallowed units of service for the Aging Waiver Program will
                                    require the provider to submit an invoice adjustment to MA, giving
                                    back any overpayment. A copy of the invoice adjustment must be
                                    submitted to PCA.

                             (c.)   The degree of such billing errors may also require a more detailed
                                    review and testing by auditors from the Fiscal Department.

                             (d.)   A “hold” for new referrals will be initiated when the billing
                                    discrepancies are extensive, as confirmed by either the routine or
                                    special audits.

                             (e.)   Billing of a fraudulent nature may result in contract termination,
                                    initiation of decertification, and other legal actions.

                     (4.)    Providers will be expected to implement appropriate and timely corrective
                             actions for all discrepancies, including those attributable to entry errors,
                             incorrect filing, etc.

4.     Nursing Quality Assurance

       Provider compliance with PCA clinical standards initially is determined through a confirmation of
       Medicare and Medical Assistance licensure/certification and review of formal procedures and record
       keeping. Two primary activities are employed to ascertain ongoing compliance: clinical audits and
       internal reporting mechanisms by PCA staff.

       a.     Clinical audits are performed in order to gauge/verify a provider’s actual nursing/clinical
              practice and record keeping procedures to identify any potential situations of consumer risk.
               From the broader perspective, PCA staff looks for continued compliance with professional
              clinical standards related to the Nurse Practice Act, CMS regulations, State licensure, and/or
              PCA standards. Those areas reviewed include:

              -      Referral forms (for timeliness of response);
              -      Initial assessments (including CMS 485 and OASIS);
              -      Interventions;
              -      Documentation of agency case management compliance.

              The results of the audit are formally communicated to the provider, as follows:

              -      Clinical audit results, including those that demonstrate inappropriate clinical practice,
                     are verbally presented and discussed at an exit interview;
              -      Audit results, including those that demonstrate inappropriate clinical practice, are
                     spelled out by PCA in a written report to the provider,


Eff. 7/1/09                                                                                                 39
              -      Corrective actions, delineated in a Plan of Correction accepted and approved by
                     PCA, are required from the provider in response to PCA audit results that
                     demonstrate inappropriate clinical practice either in one or more “at risk” situations
                     or one or more clinical audit scores below 70%. Response is required whether the
                     results relate to one nurse or involve the entire agency.
              -      Based on PCA findings, the provider may be required to complete a new assessment
                     of the consumer, which may involve a joint visit with PCA staff.

              Serious “at risk” violation(s), flagrant disregard for PCA expectations, failure to submit a
              Plan of Correction within the acceptable time frame established by PCA, failure to act on a
              Plan of Correction, multiple audit scores substantially below 70%, or repeated scores below
              70% without signs that activity is being taken to correct, will result in one or more of the
              PCA actions, that follow. The specific action initiated will depend on the severity of the
              situation.

                     (1.)    The Program Review Nurse(s), in collaboration with the Contract Manager,
                             will immediately place the agency on hold for referrals. Depending on the
                             severity of the practice issues, the provider will be required to demonstrate
                             appropriate changes in practice before reinstatement.

                     (2.)    Program Review Nurses will re-orient the agency and all staff to PCA
                             philosophy, care management principles, and expected nursing practices, if
                             determined that a lack of understanding is the cause of the deficit.

                     (3.)    Where indicated, consumer(s) will be asked to select another provider.
                             Depending on the severity of the practice issues, the provider will be required
                             to demonstrate appropriate changes in practice before reinstatement.

                     (4.)    The PCA contract will be terminated and decertification action initiated.

       b.     Specific actions, based on substantiation that there is an inability on the provider’s part to
              safely serve a consumer, will be taken based on various internal PCA reporting mechanisms.
              Some of the major processes in place are PCA Problem Logs, Consumer Satisfaction
              Surveys, Incident Reports, LTC team meetings, ongoing review of Progress Notes, case
              conferences between Program Review Nurses and LTC program staff, and ongoing
              discussion with providers. The determination that a provider does not have the ability to
              respond to service requests to ensure a safe care plan will result in an on-site record audit
              and the potential of an evaluation home visit by PCA staff. Possible responses to clinical
              concerns include:

                     (1.)    Program Review Nurses will re-orient the agency and all staff to PCA
                             philosophy, care management principles, and expected nursing practices, if
                             determined that a lack of understanding is the cause of the deficit.

                     (2.)    The Program Review Nurse, in collaboration with the Contract Manager, will
                             place the agency on hold. Depending on the severity of the practice issues,
                             the provider will be required to demonstrate appropriate changes in practice
                             before reinstatement.


Eff. 7/1/09                                                                                               40
                      (3.)    Where indicated, consumer(s) will be asked to select another provider.
                              Depending on the severity of the practice issues, the provider will be required
                              to demonstrate appropriate changes in practice before reinstatement.

                      (4.)    The PCA contract will be terminated and decertification action initiated.

       c.      Where a case conference is the source of reporting an “at risk” event, it will be the
               responsibility of the Nurse Consultant, Care Management Supervisor and Care Manager to
               document an accurate and timely report of the incident through a PCA Problem Log entry.
               The time frame for resolution of such incidents will be from immediate, for a life threatening
               situation, to within one month of the nurse or therapist’s last visit. Further activity will
               provide an immediate pathway for decisions, which may result in the actions above. Further
               incidents during a contract year can result in the termination of part or all referrals or
               termination as per this sanctions policy.

5.     Other

       a.      Providers are expected to adhere to and support the foremost principle of consumer
               autonomy in the selection of service providers. This includes the use of generally accepted
               marketing practices of their industry and/or as defined by the Philadelphia Corporation for
               Aging, Medical Assistance, Medicare, or JCAHO. Instances of violations will be addressed
               as follows:

               (1.)   Written notification to the provider and/or meeting to discuss violation.

               (2.)   Failure to comply after written notification can result in the provider being placed on
                      “hold” for new referrals.

               (3.)   Repeated violations or a refusal to comply can result in contract termination and/or
                      initiation of decertification actions.

       b.      Based on PCA Problem Logs, Incident Reports, complaints, Consumer Satisfaction survey
               results, and/or case conferences among Contract Managers and Care Managers, Care
               Management Supervisors, Nurse Consultants, and Assistant Directors of the LTC program
               and ongoing discussion with the provider that substantiate illegal or inappropriate provider
               activity, or inability to meet the requirements of the care plan or safely serve a consumer, the
               specific actions that follow will be taken by PCA:

               (1.)   Contract Managers will re-orient the agency to PCA philosophy, care management
                      principles, and expected performance, if determined that a lack of understanding is
                      the cause of the deficit.

               (2.)   The Contract Manager, will immediately place the agency on hold. Depending on the
                      severity of the issues, the provider will be required to demonstrate appropriate
                      changes in performance before reinstatement.

               (3.)   Where indicated, consumer(s) will be asked to select another provider. Depending on


Eff. 7/1/09                                                                                                  41
                      the severity of the issues, the provider will be required to demonstrate appropriate
                      changes in performance before reinstatement.

              (4.)    The PCA contract will be terminated and decertification action initiated.

c.     Where a case conference is the source of reporting a serious situation, it will be the responsibility of
       LTC staff to document an accurate and timely report of the incident through a PCA Problem Log
       entry. The time frame for resolution of such incidents will be from immediate, for a life threatening
       situation, to within one month of the reported incident for all others. Provider response to PCA
       decisions will determine further action by PCA, including hold status. Further incidents during a
       contract year may result in the termination of part or all referrals or termination as per this sanctions
       policy.




Eff. 7/1/09                                                                                                   42
                            SECTION IV.



                       SERVICE STANDARDS &

              SERVICE SPECIFIC OPERATIONAL PROCEDURES




Eff. 7/1/09                                             43
A.     ADULT DAY CARE: STANDARDS


THE PROVIDER MUST BE LICENSED BY THE PENNSYLVANIA DEPARTMENT OF AGING,
PURSUANT TO PENNSYLVANIA CODE,
“TITLE 6. AGING, CHAPTER 11", AS AMENDED.

       1.     Service Reporting

              Persons providing Older Adult Daily Living services must comply with all reporting
              requirements as specified by the AAA.

       2.     Scheduling

              Days and times schedules for Older Adult Daily Living services must be consistent with the
              Care Plan provided by AAA.

       3.     Confidentiality

              All agencies that provide Older Adult Daily Living services must comply with all federal,
              state, and local laws relating to research on human subjects and consumer confidentiality.

              Agencies must provide all Care Managers with consent forms and approval from all
              appropriate review boards for those consumers who wish to be part of a research study.




Eff. 7/1/09                                                                                                44
B.     ADULT DAY CARE - SERVICE SPECIFIC OPERATIONAL PROCEDURES

These operational procedures set forth requirements for facilities providing Adult Day Care service
to Philadelphia Corporation for Aging (PCA) consumers, of the Long Term Care (LTC) program
which encompass the Options and Aging Waiver payment sources. The operational procedures are
in addition to the Adult Day Care Standards, as well as those as delineated by the Pennsylvania
Department of Aging license standards pursuant to Pennsylvania code, “Title 6, Aging, Chapter 11”,
as amended.

       1.     License

              All providers must have demonstrated experience in the delivery of adult day care service to
              consumers and be in operation with all the necessary components, prior to being placed on a
              consumer selection list. All adult day care providers must have, as a minimum, a
              “Provisional” license from the Pennsylvania Department of Aging.

       2.     General Requirements

              a.     Administrative Structure and Organization

                     (1.)   The adult day care center shall have clearly delineated lines of authority and
                            supervisory structure.

                     (2.)   The adult day care center shall have a full-time administrator/program
                            director with the authority and responsibility to direct and manage the
                            operations of the center.

                     (3.)   The legal entity operating the adult day care center will furnish proof of
                            ownership by person, society, corporation, governing authority, or partnership
                            legally responsible for the administration and operation of a center. Such
                            proof shall include:

                            -       Indication of legal business structure and type of control. If the legal
                                    entity is a corporation, it shall submit a copy of the articles of
                                    incorporation. If a partnership, a copy of the partnership agreement.
                                    Copies of a fictitious name approval and a charter approval, if
                                    applicable.

                            -       Listing of all directors, board members, and share holders; preferably
                                    documented via a “certificate of incumbency” signed by the secretary
                                    of the corporation;

                            -       Copy of an IRS tax identification number, e.g. IRS notification letter
                                    or tax label.
              b.     Staffing

                     (1.)   The adult day care center staff will have experience working with older adults
                            with functional and/or cognitive impairments and meet the specific education,


Eff. 7/1/09                                                                                                45
                          experience, and skill requirements for the following positions, as defined by
                          the PDA License requirements:

                          -       Program director/administrator;
                          -       Social Worker;
                          -       Registered Nurse or Licensed Practical Nurse;
                          -       Activities coordinator;
                          -       Program aides.

                   (2.)   Use of volunteers to supplement staff is encouraged however they cannot be
                          used to fulfill minimum staffing requirements.

                   (3.)   Staff persons may simultaneously perform the duties and responsibilities of
                          more than one position. In such instances, the staff person shall meet the
                          licensure requirement for each of the positions held, and at least the minimum
                          education or equivalent experience requirements for each of the positions
                          held.

              c.   Nutrition – adult day care centers may prepare food onsite or arrange for service
                   from outside sources. In all instances, all meals served shall be based on the
                   following:

                   (1.)   Each meal shall conform to the requirements of the Nutrition Services
                          Incentive Program (NISP), Title III of the Older Americans Act as amended
                          (2000). Specifically, each meal shall provide at least one-third of the current
                          Dietary Allowances for persons aged 51 years and older, as established by the
                          Food and Nutrition Board of the National Academy of Science. Each meal
                          must also adhere to The Dietary Guidelines for American, Fifth Edition.

                   (2.)   Each meal shall conform to the Philadelphia Corporation for Aging (PCA)
                          Congregate Meal Program Standards, which include the submission and
                          approval of two, six month, 20-day menu cycles.

                   (3.)   All onsite and offsite meal preparation and serving areas must be inspected
                          and approved to assure compliance with local Health Department food
                          handling and serving regulations.

              d.   Unit of Service Defined

                   (1.)   A full day of adult day care is defined as a consumer participating at a center
                          for duration of over 4 hours. A half-day of service is defined as consisting of
                          consumer participation of 4 hours or less.

                   (2.)   Authorization for full day or half day of service is a function of a consumer
                          and/or caregiver needs as reflected in the plan of care and confirmed by a
                          service order.




Eff. 7/1/09                                                                                               46
              e.   Referral Process

                   (1.)   The PCA Care Manager will utilize the Adult Day Service Care Planning
                          Tool for all new referrals for adult day care service.

                   (2.)   After confirming with the provider that a referral is being made, the PCA
                          Care Manager will fax a copy of the Tool in which the Care Manager will
                          have indicated/completed the PCA Assessment and Need sections, along
                          with brief explanations – as needed – in the Impairment section.

                   (3.)   The adult day care provider will conduct their assessment of the consumer
                          and complete the Need and Impairment columns in the ADS Assessment
                          section. The completed form will be faxed back to the referring Care
                          Manager. Additional discussions and/or request for clarification can occur, as
                          needed.

                   (4.)   If the consumer is determined appropriate for the program – by the center,
                          Care Manager, and if consumer is in agreement, service will be authorized
                          through the issuing of a Service Order.

              f.   Service Authorization and Days of Service Policy

                   Adult Day Care service cannot be provided without prior written authorization by the
                   LTC Care Manager, in accordance to the PCA Service Authorization Procedures

                   Providers may accept consumer and/or caregiver initiated rescheduling of day of
                   service within the same week. Approval by the Care Manager is not required in such
                   instance nor is a new Service Order. However, it is imperative that the provider
                   remind the consumer that adjustments in other scheduled services may also be
                   required, e.g. personal care. When CCT-Shared Ride is involved, any rescheduling
                   of days of service will require the provider to make the requisite arrangements with
                   the CCT-Shared Ride Coordinator.

                   On occasions where the length of an authorized unit of service is inadvertently
                   affected by factors such as transportation problems through the CCT-Shared Ride
                   vendor, inclement weather, and/or illness the adult day care provider will be paid for
                   delivered service at the authorized unit of service level. However, the Care Manager
                   needs to be notified of such instances or changes in the consumer’s circumstance so
                   that, if needed, the consumer care plan can be adjusted.

                   In addition, when making such schedule changes, consideration must be given to
                   days at the beginning or end of the month, as the change may affect the total days
                   billed for that period. When rescheduling within the same week results in an increase
                   of total authorized units within a month, it is imperative for the provider to contact
                   the Care Manager immediately so as to obtain a revised Service Order, confirming
                   the change in authorization totals for both adult day care and meals.




Eff. 7/1/09                                                                                            47
              g.     Reporting Requirements

                     (1.)   Adult Day Care providers are required to send a copy of the formal plan of
                            care for each consumer to the PCA Care Manager within thirty (30) days
                            from the start of service.

                     (2.)   Adult day care staff must communicate with the Care Manager to keep
                            him/her informed of any changes in the status of the consumer’s health and
                            overall well being, attendance, and incidents. Adult Day Care providers are
                            required to forward written progress reports to the Care Manager when
                            requested.

                     (3.)   The adult day care will comply with all reporting requirements specified by
                            PCA, including the reporting of Shared Ride transportation service.

              h.     The provider shall obtain the consumer’s signature on a standardized form
                     (attendance log, etc.) for each day the service is delivered to a PCA consumer.
                     Confirmation of attendance can be made by an authorized representative in
                     those documented instances where the consumer cannot sign due to physical
                     and/or cognitive limitations. If or when requested, consumers and/or caregivers
                     must be given a copy of the signed form as a confirmation of delivery of service.
                     Providers can utilize multi-part forms to facilitate this acknowledgement of the
                     receipt of service on a given day.

3.     Communicable Diseases

       a.     Adult day care providers are expected to follow procedures recommended in the Center of
              Disease Control (CDC) Guidelines and OSHA Regulations when caring for consumers with
              communicable diseases. Adult day care centers are responsible to provide appropriate in-
              services regarding these universal precautions.

       b.     The adult day care shall notify the PCA care manager upon determining or learning from
              another source, that a consumer has a communicable disease.

       c.     The provider must follow CDC and OSHA Guidelines regarding the disposal of
              contaminated needles.

       d.     All consumer-contact employees shall have a Mantoux Interacutaneous PPD Test
              according to CDC recommendations and, if the results are positive, it will be followed by
              appropriate physician directed treatment.

              In order to continue employment, the employee must be free of active TB. Verification by a
              physician that the employee is free of TB must be in the personnel file and updated every 2
              years, minimum. Chest X-rays are required based on physician’s advice.

       e.     All employees must be offered and/or received the Hepatitis B Vaccine designated by
              OSHA Regulations.




Eff. 7/1/09                                                                                               48
C.     ATTENDANT CARE / ACT 150: SERVICE SPECIFICATIONS


       *NOTE: Applicable for only the designated Attendant Care/Act 150 Providers.


       1.     ATTENDANT CARE SERVICES – Transition of Services for Consumers Turning
              Age 60

              The Department of Public Welfare (DPW) Attendant Care Program is intended to enable
              mentally alert, physically disabled persons who cannot perform activities of daily living
              tasks by themselves to remain independent in their own homes. There are two distinct
              consumer categories within the Attendant Care Program: Attendant Care Waiver (where
              consumers are MA eligible), and Attendant Care Act 150, (where consumers are not MA
              eligible). Consumers in both categories of the DPW Attendant Care Program have the right
              to direct their own service. DPW Attendant Care consumers may also direct their attendant
              to perform certain health maintenance activities, which the consumer would elect to do if
              he/she were physically able. Note: the Commonwealth of Pennsylvania Department of
              Public Welfare Office of Social Program’s Revised Attendant Care Program Requirements,
              published April 1, 2002, inclusive of all subsequent policy changes, are hereby included by
              reference.

              When DPW Attendant Care Program – Act 150 consumers in Philadelphia County reach the
              age of 60, the Philadelphia Corporation for Aging (PCA) – as the designated local Area
              Agency on Aging (AAA), is required to ensure uninterrupted, appropriate levels of attendant
              care services to those consumers. The transition of services is governed by the Pennsylvania
              Department of Aging (PDA) Attendant Care policy – hereby included by reference. This
              policy allows DPW Attendant Care Program consumers to continue to receive attendant care
              services in the manner in which they are accustomed while also enabling these consumers
              entry into the aging services system.

              DPW Attendant Care consumers can continue to receive attendant care services from the
              same DPW Attendant Care service provider. PCA will enter into written agreements
              directly with the Attendant Care service providers to ensure the continuity of service for the
              Act 150 consumers. PDA will provide information regarding rate structure, based on DPW’s
              published rate guidelines.

              a.     Service Models

                     Attendant Care is “hands-on” and “hands-off” service provided to persons who are
                     unable to independently meet some or all of their needs relative to personal hygiene,
                     activities of daily living and managing their home, and where no resource (or only
                     partial) exists in the family or community. Attendant care may be provided up to
                     seven days per week. It shall be available during normal working hours, as well as
                     before and after working hours. Scheduling of service shall respond – to the extent
                     feasible, to the special needs of the individual.




Eff. 7/1/09                                                                                              49
                   “Hands-on” personal care assistance can include:

                   -      Getting in and out of bed, wheelchair or motor vehicle;
                   -      Assistance with ambulation – with or without mechanical aids, inside the
                          home;
                   -      Routine bodily functions such as eating or feeding, meal preparation, and
                          toileting;
                   -      Assistance with bathing dressing, personal hygiene; and
                   -      Assistance with health maintenance activities.

                   Consumer will receive attendant care service based on one of the following:

                   (1.)   Consumer-Employer Model - The consumer is responsible for managing all
                          aspects of his/her attendant care service, such as: recruitment, hiring and
                          firing attendants, training, supervising, filing and paying all applicable taxes,
                          purchasing liability insurance, and arranging for back-up service. The
                          consumer is the employer of the attendant.

                   (2.)   Combination Model - The consumer chooses certain aspects of their
                          attendant care service to manage, and the attendant care provider agency
                          and/or PCA is responsible for the remaining aspects of care. For example: the
                          consumer elects to recruit, hire, train and supervise the attendant, but not the
                          recording, filing and paying of employee taxes, etc.

                   (3.)   Agency Model - The consumer is not responsible for the management of any
                          aspect of their care. PCA or the subcontracted attendant care provider would
                          employ the attendant and manage all aspects of the consumer’s care.

              b.   Role of the AAA in the Transition of Service

                   DPW Attendant Care providers shall notify PCA at intervals of 18 months, 12
                   months, and four months prior to a consumer’s 60th birthday, and provide copies of
                   the notifications to the DPW Office of Social Programs and the consumer. As the
                   local AAA, PCA will be responsible for the provision of Attendant Care services
                   when the Act 150 consumers turn age 60.

                   PCA, in its role as the purchaser of services for DPW Attendant Care Program
                   consumers who turn age 60, shall be responsible for the following:

                   (1.)   PCA is responsible to contact each Attendant Care Program consumer –
                          Waiver and Act 150, prior to their 60th birthday to schedule a “confirmation”
                          visit to acquaint the consumer with Aging services. Note: If an Attendant
                          Care Waiver consumer chooses to stay with that program, the PCA Care
                          Manager will inform the Attendant Care provider of that consumer decision.

                   (2.)   Ensuring that the existing DPW cost- sharing arrangement (sliding fee scale)
                          continues as part of the Attendant Care provider’s care plan. Consumers
                          eligible for co-payment in the DPW Act 150 Attendant Care program will be


Eff. 7/1/09                                                                                             50
                          re-assessed upon their transition to PCA services. Consumer fee assessments
                          will be determined as per DPW Attendant Care Program and Pennsylvania
                          Department of Aging requirements.

                          PCA will confirm to the Attendant Care providers, as well as the consumers,
                          the co-pay determination. The providers will be responsible for the collection
                          of and the reporting of their designated consumers’ co-payments. The
                          providers will “net out” those co-payments when submitting their invoices for
                          services to PCA. The existing DPW Attendant Care Program penalties for
                          failure to pay fees shall continue to apply.

                   (3.)   PCA is in control of the care plan. Any changes to the consumer's original
                          Attendant Care provider care plan must receive prior approval by PCA and
                          Office of Long Term Living.

                   (4.)   Situations may arise in which PCA determines that it would be more cost
                          effective to serve the consumer directly and not contract with the Attendant
                          Care provider. If the consumer's Attendant Care provider care plan remains
                          the same (same attendant, same hours, etc.) and the consumer agrees to the
                          change in service delivery, then the PCA shall contact PDA and request a
                          waiver to this policy.

                   (5.)   Establishing time intervals to conduct "Progress Interviews" with the
                          consumer. The purpose of conducting periodic progress interviews is to
                          solicit input from the consumer regarding his or her continued satisfaction
                          with the existing service and to evaluate any changing needs of the consumer,
                          which may warrant PCA intervention.

                   (6.)   Conducting an assessment of the consumer using the LOCA only when:

                          (a.)   It has first been discussed with the consumer and the consumer has
                                 been educated regarding what the LOCA is and how and why it is
                                 used; and

                          (b.)   It is requested by the consumer; or PCA determines that the
                                 consumer's cognitive condition has declined to the point where only
                                 PCA services are warranted; or the Attendant Care service provider
                                 can no longer serve the consumer because the consumer is no longer
                                 mentally alert or for some other reason AND the consumer is referred
                                 to PCA by the Attendant Care provider to provide all services.

              c.   Supports Coordination and Financial Management Service

                   (1.)   Support Coordination are those activities performed by the Attendant Care
                          providers to support those consumers who self direct their care through the
                          selection of the Consumer Employer or the Combination Model of service.
                          Support coordination activities can include, but is not limited to:




Eff. 7/1/09                                                                                             51
                     (a.)   Assisting consumers to recruit, supervise, manage and train their
                            attendants;
                     (b.)   Credentialing all attendants hired by the consumer, to ensure
                            compliance with all PDA worker specifications and regulations;
                     (c.)   Performing criminal record check on all attendants hired by the
                            consumer, including emergency back-up workers, as well as
                            processing all I-9 forms and related Homeland Security compliant
                            forms.
                     (d.)   Providing training to consumers regarding all aspects of being an
                            employer, developing job descriptions, etc.

                     Note: Attendant Care providers will receive a monthly coordination fee for
                     those in the consumer directed Consumer Employed or Combination Model
                     of service.

              (2.)   Financial Management Services (FMS) are supportive services provided only
                     to participants (consumers) who use consumer-employer model services for
                     some or all of their individual service plan hours. When FMS is provided, the
                     participant is the common law employer of the direct care worker employed
                     under the consumer-employer model. FMS agencies reduce the employer-
                     related burden of participants using the consumer-employer model of services
                     through the provision of appropriate fiscal and supportive services. FMS
                     agencies must have a separate Employer Identification Number (EIN) for
                     FMS.

                     FMS includes performing the following tasks with the participant’s
                     authorization:

                     (a.)   On behalf of the participant employer, enrollment of the participant
                            into all applicable taxing authorities;
                     (b.)   Assisting participant to understand their responsibilities as an
                            employer;
                     (c.)   On behalf of the participant employer, processing employment
                            application package and documentation for prospective individual to
                            be employed (including verifying their workers’ qualifications and
                            clearances);
                     (d.)   On behalf of the participant employer, establishing and maintaining a
                            record for each individual employed and process all employment
                            records;
                     (e.)   On behalf of the participant employer, preparing and disbursing
                            payroll;
                     (f.)   On behalf of the participant employer, securing workers’
                            compensation or other forms of insurance and managing the claims;
                     (g.)   On behalf of the participant employer, withholding, filing, reporting
                            and depositing federal, state, and local income taxes in accordance
                            with federal IRS, state Department of Revenue Services, and local tax
                            bureaus rules and regulations;
                     (h.)   On behalf of the participant employer, withholding, filing, reporting,


Eff. 7/1/09                                                                                     52
                                  depositing and maintaining compliance with the claims and appeals
                                  with the Pennsylvania and Federal Unemployment Compensation
                                  Bureaus rules and regulations;
                          (i.)    On behalf of the participant employer, generating and distributing IRS
                                  W-2’s, wage and tax statements and related documentation annually
                                  to all member-employed caregivers who meet the statutory threshold
                                  earnings amounts during the tax year by January 31st;
                          (j.)    On behalf of the participant employer, acting on behalf of the
                                  participant receiving supports and services for the purpose of payroll
                                  reporting;
                          (k.)    On behalf of the participant employer, distributing, collecting and
                                  processing provider time sheets and attendance data as summarized on
                                  payroll summary sheets completed by the participants;
                          (l.)    On behalf of the participant employer, securing business agreements
                                  with any individual or entity that will be reimbursed with waiver
                                  funding;
                          (m.)    On behalf of the participant employer, establishing and maintaining
                                  all FMS related participant records with confidentiality, accuracy, and
                                  appropriate safeguards;
                          (n.)    Participating in the Commonwealth of Pennsylvania’s quality
                                  management strategy;
                          (o.)    On behalf of the participant employer, purchasing other forms of
                                  insurance, including healthcare, as appropriate;
                          (p.)    On behalf of the participant employer, verifying weekly service hours
                                  in relationship to payroll in order to ensure correct billing, problem
                                  resolution, and alternate billing procedures;
                          (q.)    On behalf of the participant employer, processing judgments and
                                  wage garnishments and requests for employee wage information;
                          (r.)    Rescinding or revoking all authorizations when a participant leaves
                                  the program;
                          (s.)    Maintaining compliance with all applicable regulations and statutes,
                                  such as the Bureau of Program Integrity’s (BPI) fraud and abuse
                                  policies;
                          (t.)    Collecting co-pays from applicable Act 150 consumer employers; and
                          (u.)    Providing reports and documentation to the Department as requested.

                          Note: effective August 1, 2007, Attendant Care providers will receive a
                          separate fee -in addition to the monthly coordination fee, for the Financial
                          Management Services (FMS) detailed above. The additional FMS fee is
                          limited to those in the consumer directed Consumer Employed or
                          Combination Model of service.

              d.   Personal Emergency Response Systems (PERS)

                   Personal Emergency Response Systems (PERS) is an electronic device which
                   enables certain high-risk consumers to secure help in an emergency; see PERS
                   standards included in the PCA Contract, Exhibit “A” attachment. PERS service is
                   limited to those consumers who live alone or who are alone for significant parts of


Eff. 7/1/09                                                                                              53
              the day, have no regular caregiver for extended periods of time, and who would
              otherwise require extensive routine supervision.

              Service authorization for PERS is coordinated by the Attendant Care provider with
              the PCA Care Manager. The Attendant Care provider should establish PERS vendor
              agreements for equipment installation and monthly monitoring cost for the Attendant
              Care consumers. Note: effective 10/1/07, the monthly monitoring cost for PERS
              service is inclusive of installation costs.




Eff. 7/1/09                                                                                    54
D.     COMPANION SERVICES: STANDARDS


       1.     DESCRIPTION OF ACTIVITIES

              Companion Services are provided in accordance with a therapeutic goal in the care plan and
              are not merely diversional in nature.

              Activities may include, but are not limited to the following:

              a.     Accompanying consumer on daily walks.

              b.     Reminding consumer to begin or finish meals.

              c.     Accompanying consumer to appointments, errands, etc.

              d.     Socialization activities, such as reading books, writing letters, etc.

              e.     Casual physical assistance, such as assisting the consumer in putting on a coat, etc.

       2.     STANDARDS FOR COMPANIONS

              a.     Ability to read, write and follow instructions.

              b.     Understanding and knowledge of the special needs of older chronically ill
                     individuals.

              c.     Good personal grooming habits.

       3.     COMMUNICABLE DISEASES

              a.     Providers are expected to follow procedures recommended in the Center for Disease
                     Control (CDC) guidelines and OSHA regulations. Providers are responsible to take
                     appropriate action and provide in-services regarding these universal precautions.
                     (CDC toll free number is 1-800-342-2437.)

                     Providers are also required to provide appropriate protective articles such as, but not
                     limited to, aprons, gloves, and masks.

              b.     Based on CDC guidelines, the provider shall develop a written policy regarding
                     communicable diseases.

              c.     The Provider shall notify the Care Manager, or supervisor, upon determining, or
                     learning from another source, that one of their workers or a consumer has a
                     communicable disease.




Eff. 7/1/09                                                                                                  55
              d.     PPD Test - A Mantoux Intracutaneous PPD test using the two-step procedure (the
                     tine test is not an acceptable alternative), shall be administered to all consumer-
                     contact employees before assigning to a work, and yearly, thereafter. If the results of
                     the PPD test are positive at any time, it shall be followed by an examination by a
                     physician and chest x-ray (if indicated) and any appropriate treatment prescribed.

                     An infected worker shall receive follow-up care as required by a physician and shall
                     not begin or resume work to consumers until discharged by the physician as no
                     longer contagious.

       4.     TRAINING STANDARDS

              Must be oriented to the purpose and background of the Home and Community Based
              Waiver.

       5.     RECORDS AND DOCUMENTATION

              a.     Provider must maintain service records that include a service order for tasks to be
                     performed.

              b.     Report form for the companion to document changes or other observed consumer
                     problems.

              c.     Individual time slips must be signed by the consumer or family member/caregiver
                     and the companion to document each unit of service billed.

       6.     SERVICE REPORTING

              Persons providing Companion services must comply with all reporting requirements as
              specified by the Area Agency on Aging.

       6.     SCHEDULING

              Days and times scheduled for companion services must be consistent with the Care Plan
              provided by the AAA.

       8.     CONFIDENTIALITY

              All agencies that provide Companion services must comply with all federal, state and local
              laws relating to research on human subjects and consumer confidentiality.

              Agencies must provide all Care Managers with consent forms and approval from all
              appropriate review boards for those consumers who wish to be part of a research study.




Eff. 7/1/09                                                                                                56
E.     COUNSELING: STANDARDS

       1.     DEFINITION

              A broad array of health and mental health related counseling services to include but not
              limited to the following:

                  problem solving and coping skills,

                  nutrition education, counseling and/or diet instruction,

                  music therapy,

                  alcoholism,

                  drug dependency,

                  individual/marital/family stress,

                  family problems including situations of abuse or neglect,

                  detection and treatment of depression and other mental health conditions.

       2.     EDUCATIONAL QUALIFICATIONS

              All in-home counselors enrolled in the Medicaid Waiver program will have the appropriate
              credentials as deemed valid by experts in their specialized areas. Examples include:

                  Masters Degree or Ph.D. in Counseling; Social Work; Clinical Psychology; Educational
                   Psychology or Music Therapy;

                  Nursing Masters Degree in Psychiatric Adult Mental Health;

                  Registration with the American Dietetic Association;

                  License as required by that profession/discipline, i.e. PA license for MSW, etc.

       3.     SERVICE ACTIVITIES

                  Individual counseling
                  Marital/couple counseling
                  Family counseling
                  Group counseling

       4.     UNIT OF SERVICE SPECIFICATION

              a.     Visits will consist of approximately one hour spent with the consumer.



Eff. 7/1/09                                                                                              57
              b.     The consumer assessment should include the counselor’s problem
                     identification, goal setting, time frame, treatment techniques and recommendation.

              c.     Every assessment and every visit will be documented by the counselor in a clinical
                     progress note.

       5.     SERVICE AUTHORIZATION

              a.     AAA Care Managers will assess the need for mental health assessment and/or
                     intervention and refer the consumer/caregiver to the counselor/agency as part of the
                     consumer's comprehensive care plan.

              b.     The counselor will discuss the case with the Care Manager and make an appointment
                     to assess the consumer’s situation.

              c.     After the assessment, the counselor will write up the assessment, and propose a
                     preliminary plan for treatment, should it seem appropriate, to the Care Manager.

              d.     Together they will project units of service.

              e.     The counselor will keep a case record on each consumer served, containing pertinent
                     clinical information.

              f.     The counselor will keep a monthly log, listing consumers' names and dates of actual
                     visits, and recording supervisory conferences, as they are completed. Individual time
                     slips must be signed by the consumer or family member/caregiver and the counselor
                     to document each unit of service billed.

       6.     SERVICE REPORTING

              Persons providing counseling services must comply with all reporting requirements as
              specified by the Area Agency on Aging.

       7.     SCHEDULING

              Days and times scheduled for counseling must be consistent with the care plan provided by
              the AAA.

       8.     INSURANCE

              Agencies who wish to provide Companion services will be required to attest to having the
              following types of insurance in amounts consistent in the industry:

              a.     General liability;
              b.     Professional liability;
              c.     Automobile liability covering owned, non-owned and hired vehicles;
              d.     Workman Compensation as required by law;
              e.     Employer’s liability of accident and disease.


Eff. 7/1/09                                                                                               58
       9.     CONFIDENTIALITY

              All agencies who provide counseling services must comply with all federal, state and local
              laws relating to research on human subjects and consumer confidentiality.

              Agencies must provide all Care Managers with consent forms and approval from all
              appropriate review boards for those consumers who wish to be part of a research study.




Eff. 7/1/09                                                                                                59
F.     COUNSELING SERVICE: SPECIFIC OPERATIONAL PROCEDURES

These Operational Procedures are in addition to the Counseling Standards. They delineate further
expectations for providers delivering service to Philadelphia Corporation for Aging (PCA)
consumers in the Long Term Care (LTC) Program, which encompass the Options and Aging Waiver
payment sources.

       1.     Definition and Operating Principles

              a.     The primary objective of in-the-home mental health counseling service is the
                     provision of short term, goal oriented counseling for consumers and/or their
                     caregivers in order to restore, remediate or rehabilitate in order to improve
                     functioning and independence.

              b.     In addition to the array counseling services identified in the Counseling Standards,
                     counseling includes:

                     -      Telephone supportive therapy;
                     -      Music Therapy.

              c.     When applicable, service providers must be Medicare certified and have a
                     provider number for counseling service.

              d.     PCA / LTC program shall be the payers of last resort. Providers shall bill
                     counseling service to third party payers – ( Medicare, MA fee schedule, managed
                     care), when eligible and indicated.

       2.     Staffing

              a.     Providers will utilize staff that has the appropriate credentials as deemed valid by
                     experts in the industry. Exceptions to staffing requirements may only be made
                     with prior written approval by PCA.

              b.     Supervisors must have a Master’s Degree, minimum, and a reasonable length of
                     clearly delineated experience in therapeutic counseling and supervision of clinicians.

              c.     Providers shall make available the services of a psychiatrist, when needed, for the
                     purpose of consultation and clinical support to counselors and supervisors.

       3.     Service Authorization and Reporting

              a.     No service may be provided without prior written authorization by the LTC Care
                     Manager, in accordance to the PCA Service Authorization Procedures.

              b.     An initial assessment shall be completed within ten (10) working days of the receipt
                     of a service order. The initial assessment evaluation results will be forwarded to the
                     referring care manager within ten (10) working days of the evaluation visit. The
                     initial evaluation shall include:


Eff. 7/1/09                                                                                                 60
                   -   Diagnosis;
                   -   Therapeutic goals;
                   -   Plan of treatment.

              c.   Clinical progress notes that will contain sufficient clinical content regarding the
                   treatment process and visit, must be maintained in individual consumer records. A
                   clinical progress report that includes goals and progress towards achieving those
                   goals will be forwarded to the LTC Care Manager on a monthly basis.

              d.   The provider shall obtain the consumer’s signature (or that of other authorized
                   representative) on a time slip or other standardized form each time a service is
                   delivered to a PCA consumer. Consumers must be given a copy of the signed form
                   as a confirmation of delivery of service. It is recommended that providers utilize
                   multi-part forms so that the consumer can receive their copy as an acknowledgement
                   of the receipt of service on the given day.




Eff. 7/1/09                                                                                              61
G.     PROFESSIONAL EVALUATION: SERVICE SPECIFIC OPERATIONAL PROCEDURES

       1.     General Information

              These Operational Procedures delineate further contractual requirements for
              Providers of Medical, Psychiatric, Psychological and OBRA Psychological
              consultations and evaluations. The following services may be ordered by
              representatives of PCA’s LTC Program: (Options), LTCA (Long Term Care Access)
              or OAPS (Older Adult Protective Services) Departments:

              -     Medical Physician Services

                    Provide medical consultations, case reviews and training to PCA programs;
                    participate at court hearings or appeals, and provide home visits when requested.
                    Refer to 2. below Medical Physician Services for a detailed description of services
                    required.

              -     Psychiatric Physician Services

                    Provide psychiatric evaluations, case reviews and training to PCA programs;
                    participate in court proceedings and appeals; and perform home visits.
                    Refer to 3. below Psychiatric Physician Services for a detailed description of services
                    required.

              -     Psychological Evaluation

                    Provide psychological evaluations, case reviews and training to PCA programs;
                    participate in court proceedings and appeals; and perform home visits. Refer to 4.
                    below for a detailed description of services required.

              -     OBRA Psychological Evaluations

                    Provide specialized consultative, training and evaluation services relating to Mental
                    Retardation or a Related Condition as required under OBRA at the request of PCA’s
                    LTCA Department. Refer to 5. below for a detailed description of services required.

              a.    INTAKE

                    (1.)   When the need for professional consultation or evaluation is identified, the
                           care manager, assessor, investigator or supervisor (“PCA Representative”)
                           will contact the Provider, selected by the consumer when appropriate, to
                           make the initial referral and to arrange for a home visit (if required) or other
                           service, which shall be performed by Provider within five (5) working days,
                           or within 24 hours in the event of an emergency.

                    (2.)   Upon confirmation of a date for the evaluation, the Care Manager will
                           forward a Service Order to the Provider authorizing service.




Eff. 7/1/09                                                                                               62
                   (3.)   To the extent that the above is at variance with the specific requirements of
                          the Attachment directly applicable to the services ordered, the requirements
                          of that Attachment shall control.

              b.   SERVICE DELIVERY

                   (1.)   Upon receipt of the service order, the Provider will confirm the scheduled
                          date of evaluation with the PCA Representative. If indicated after initial
                          consultation with the Provider, a joint visit may be made with the PCA
                          Representative and any other providers involved in the consumer’s plan of
                          care.

                   (2.)   Provider staff needs to communicate with the PCA Representative to keep
                          PCA informed of any changes in the consumer’s health status.

                   (3.)   Provider staff shall communicate with the PCA Representative as follows:

                          (a.)   Within 24 hours of the initial contact with consumer, consumer
                                 records or other provider involved in the consumer’s plan of care, the
                                 results of the visit, review or contact shall be provided by phone to the
                                 PCA Representative. The Provider will advise the PCA
                                 Representative of any diagnosis and recommended plan of care. No
                                 additional visits are to be made without a further service order.

                                 (b.)    When there is a professional conflict regarding the delivery of
                                 care between the Provider and other professionals.

                                 (c.)  When the consumer is hospitalized or experiences a health
                                 emergency.

              c.   REPORTING REQUIREMENTS

                   (1.)   A written report of the evaluation findings will be forwarded to the PCA
                          Representative by the fifth (5th) working day following the visit or other
                          consultative activity. Evaluation findings for emergency request will be
                          submitted to the PCA Representative within 24 hours after the visit or other
                          consultative activity.

                   (2.)   A telephone report of the evaluation will be provided to the PCA
                          Representative within 24 hours of the assessment visit.

                   (3.)   To the extent that the above is at variance with the specific requirements of
                          the Attachment directly applicable to the services ordered, the requirements
                          of that Attachment shall control.




Eff. 7/1/09                                                                                               63
              d.   STAFF QUALIFICATIONS

                   (1.)   Providers will assign staff that has the following qualifications:

                          (a.)   Medical Physicians - must be board certified in internal medicine (and
                                 preferably with added qualification in geriatric internal medicine);
                                 have current Pennsylvania license; have experience in aging and
                                 community-based care; and have experience in working with social
                                 workers, nurses, and other health and social service professionals.

                          (b.)   Psychiatric Physicians - must be board certified or board eligible in
                                 psychiatry (and preferably with added qualification in geriatric
                                 psychiatry); have current Pennsylvania license; and have admitting
                                 privileges at a local hospital.

                          (c.)   Psychologists - must have a Ph.D. level degree and be Pennsylvania
                                 licensed clinical psychologists.

                   (2.)   Provider shall submit for review and approval any exceptions to the above
                          staff requirements, in writing, addressed to the Contract Manager in PCA’s
                          Business Administration Department.

                   (3.)   Provider shall notify the Contract Manager in the Business Administration
                          Department if there is any change in the roster of professionals assigned to
                          perform work under the Agreement.

                   (4.)   To the extent that the above is at variance with the specific requirements of
                          the Attachment directly applicable to the services ordered, the requirements
                          of that Attachment shall control.

              e.   COMMUNICABLE DISEASES

                   (1.)   When performing services under the Agreement, Provider shall comply with
                          all applicable law and adhere to all generally recognized professional
                          standards relating to communicable diseases, including but not limited to
                          Center for Disease Control (CDC) guidelines and OSHA regulations.
                          Provider shall provide its staff with appropriate training and supervision in
                          these areas, including in the use of universal precautions. (A training tape is
                          available from CDC upon request; the CDC toll-free number is 1-800-232-
                          4636).

                          Provider shall also provide to its staff appropriate protective articles
                          including, but not limited to, aprons, gloves, masks, and gowns as needed.

                   (2.)   Provider shall develop written policies regarding communicable diseases
                          consistent with CDC guidelines, OSHA requirements and generally
                          recognized professional standards, and shall submit copies of these to the
                          PCA Contract Manager.


Eff. 7/1/09                                                                                               64
              (3.)   Provider shall notify the PCA Representative upon determining that a
                     consumer has a communicable disease.

              (4.)   Provider shall adhere to applicable law, including but not limited to CDC and
                     OSHA guidelines and generally recognized professional standards, regarding
                     the disposal of medical waste.

              (5.)   To the extent that the above is at variance with the specific requirements of
                     the Attachment directly applicable to the services ordered, the requirements
                     of that Attachment shall control.




Eff. 7/1/09                                                                                          65
2.     Medical Physician Services

       a.     Scope of Services:

              (1.)   The use of Physician evaluations or consultations are intended to:

                     (a.)   Evaluate at-risk consumers who do not currently have a primary physician or
                            those whose primary physicians are not responsive to the consumers’ needs;
                     (b.)   Complete MA51 for those consumers who do not have an identified primary
                            physician;
                     (c.)   Provide consultation in those difficult or borderline level of care and/or locus
                            of care decisions;
                     (d.)   Provide evaluations and/or consultations in those instances where there is
                            anticipation of a formal appeal of level and/or locus of care decisions.

              (2.)   The consumer population will include adults age 18 and over. However, the majority
                     of consumers will be over the age of 65.

              (3.)   Upon request, the physician consultant will make home visits.

       b.     Provider Responsibilities:

              (1.)   Review completed assessments and/or care plans of consumers selected by PCA with
                     Nurse Consultants, Supervisors and other PCA Representatives.

              (2.)   Consult with consumer’s physician and/or other health and social service
                     professionals regarding consumer’s recommended LOC and/or community based
                     home health care needs. If necessary, visit consumers at their home for final
                     recommendations.

              (3.)   Recommend a LOC determination when there is a disagreement among PCA
                     supervisors regarding the most appropriate LOC.

              (4.)   Review care plans of community based consumers from a quality assurance
                     perspective and make such recommendations, as the consultant deems appropriate.

              (5.)   Provide documentation of case review and recommendation within the case file of
                     consumers selected for consultation.

              (6.)   Participate when requested by PCA in supervisory or team conferences regarding
                     selected consumers for Long-Term Care programs.

              (7.)   Provide training requested by PCA through in-service training sessions.

              (8.)   Attend staff meetings as requested by PCA to review program implementations,
                     procedures and policies.




Eff. 7/1/09                                                                                               66
                 (9.)    Participate as requested by PCA in fair hearings or appeals processes or as witness in
                         court proceedings.

                 (10.)   Provide medical information for consumers who do not have a physician relative to
                         the MA-51 form.

                 (11.)   Provide home visits for Older Adults Protective Services consumers.

                 (12.)   Coordinate with PCA and hospital or geriatric practice on use of students and
                         residents.

                 (13.)   Be available up to six (6) hours per week, fifty (50) weeks per year, to provide the
                         above services.

                 (14.)   Be available for emergencies on 24 hours notice.

              If these services are unavailable during vacation periods, backup telephone consultation,
              at a minimum, and other services mutually agreeable to the parties shall be provided by a
              member of the Provider’s internal medicine medical staff.




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3.     Psychiatric Physician Services

       a.     Scope of Service

              The primary objective of a Psychiatric Evaluation is the physical, functional, and mental
              health assessment of homebound elderly consumers who are referred by either the Options,
              OAPS, or LTCA Departments. The psychiatric evaluation is used in assisting PCA in the
              development of a consumer’s plan of care and/or the need for protective service or other
              (including emergency) intervention. On occasion, the psychiatrist may also be needed to
              give testimony in legal proceedings regarding a consumer’s mental status.

              Evaluations are to be provided by a Board certified or Board eligible psychiatrist licensed to
              practice in the state of Pennsylvania. Certain aspects of evaluations may also be conducted
              by gero-psychiatric nurses under the supervision of a licensed psychiatrist.

              (1.)   Psychiatric Evaluation - the psychiatrist or psychiatric nurse shall perform an
                     assessment of mental status, history, and need for treatment of referred consumers.
                     In emergency situations, the psychiatrist shall focus on evaluating the consumer’s
                     ability to receive and evaluate information effectively and communicate decisions
                     essential to the health and safety and the management of finances. Unless otherwise
                     specified, evaluations will be conducted in the person’s home. Consumer
                     evaluations shall be coordinated with the referring PCA Representative, within 5
                     working days from the date of the referral. Emergency evaluation requests shall be
                     conducted within 24 hours. If appropriate, the psychiatrist shall develop a
                     recommended treatment plan, which may include medication, outpatient psychiatric
                     services, supportive services, or in-patient psychiatric treatment. When
                     hospitalization is needed, the psychiatrist shall facilitate admission to the appropriate
                     licensed hospital. All medical treatment and/or hospital admissions shall be
                     coordinated with the consumer’s physician.

              (2.)   Participation in Legal Proceedings - As needed, the psychiatrist shall participate in
                     legal proceedings that may include:

                     (a.)    Petition for a 302 involuntary commitment for psychiatric evaluation;

                     (b.)    Testifying at hearings for a 303 or 304 commitment;

                     (c.)    Testifying in court as to consumer competency in guardianship hearings;

                     (d.)    Providing testimony as to consumer mental capacity in court petitions for
                             emergency orders under the Older Adults Protective Services Act. Such
                             testimony may be made orally or in writing at PCA’s direction.

              (3.)   Documentation of evaluations is to be reported as follows:

                     (a.)    If requested, a verbal/telephone report of the evaluation shall be provided to
                             PCA within 24 hours of the assessment visit.




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              (b.)   A written report of the evaluation findings shall be forwarded to PCA by the
                     5th working day following the assessment visit.

              (c.)   Evaluation findings for emergency requests shall be submitted to PCA within
                     24 hours after the assessment visit.




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4.     Psychological Evaluations

       a.     Scope of Service

              The primary objective of a Psychological Evaluation is the functional and mental health
              assessment of homebound elderly consumers who are referred by the Options, OAPS, or
              LTCA Departments. The psychological evaluation is used in assisting PCA in the
              development of a consumer’s plan of care and/or the need for protective service or other
              (including emergency) intervention. On occasion, the psychologist may also be needed to
              give testimony in legal proceedings regarding a consumer’s mental status.

              Evaluations are to be provided by a Ph.D. level psychologist licensed to practice in the state
              of Pennsylvania.

              (1.)   Psychological Evaluation - the psychologist shall perform an assessment of mental
                     status, history, and functional capacity of referred consumers. In emergency
                     situations, the psychologist shall focus on evaluating the consumer’s ability to
                     receive and evaluate information effectively and communicate decisions essential to
                     the health and safety and the management of finances. Unless otherwise specified,
                     evaluations will be conducted in the person’s home. Consumer evaluations shall be
                     coordinated with the referring PCA Representative, within 5 working days from the
                     date of the referral. Emergency evaluation requests shall be conducted within 24
                     hours.

              (2.)   Participation in Legal Proceedings - As needed, the psychologist shall participate in
                     legal proceedings that may include:

                     (a.)    Petition for a 302 involuntary commitment for psychiatric evaluation;

                     (b.)    Testifying at hearings for a 303 or 304 commitment;

                     (c.)    Testifying in court as to consumer competency in guardianship hearings;

                     (d.)    Providing testimony as to consumer mental capacity in court petitions for
                             emergency orders under the Older Adults Protective Services Act. Such
                             testimony shall be given orally or in writing at PCA’s direction.

              (3.)   Documentation of evaluations is to be reported as follows:

                     (a.)    If requested, a verbal/telephone report of the evaluation shall be provided to
                             PCA within 24 hours of the assessment visit.

                     (b.)    A written report of the evaluation findings shall be forwarded to PCA by the
                             5th working day following the assessment visit.

                     (c.)    Evaluation findings for emergency requests shall be submitted to PCA within
                             24 hours after the assessment visit.




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5.     Responsibilities of the OBRA qualified Mental Retardation Provider


       a.     Provider shall make available the services of a licensed, Ph.D. level, clinical psychologist
              with special training and experience in the evaluation of mental retardation for the purpose
              of assessing an applicant’s need for active treatment as required under OBRA. These
              services must be available at least two (2) hours per week, Monday through Friday, between
              8:30 am and 5:00 pm. Services shall include record review, telephone consultation in fifteen
              (15) minute minimum blocks of time, in-home evaluation, and other related activities
              appropriate and necessary to the individual case. Travel time is allowable at the hourly rate.
              Home visits are required when the individual applicant has not been evaluated previously by
              a qualified professional for the purpose of determining mental retardation or a related
              condition and measuring IQ.

       b.     The psychologist shall:

              (1.)    Identify the applicant’s intellectual functioning measurement;
              (2.)    Validate that the applicant has “mental retardation or a related condition”; and
              (3.)    Assess whether the applicant needs active treatment in order to function.

       c.     The psychologist may be required to provide one or more in-service training sessions to
              LTCA staff in the area of Mental Retardation or Other Related Conditions. In-service
              training sessions shall be one (1) to two (2) hours. A maximum of two (2) hours of
              preparation time is allowable at the hourly rate for each in-service training session.

       d.     The psychologist shall provide information to the Department of Public Welfare that
              identifies the extent to which an applicant compares with each of the following
              characteristics, commonly associated with the need for active treatment:

              (1.)    Inability to take care of most personal care needs;
              (2.)    Inability to understand simple commands;
              (3.)    Inability to communicate basic needs and wants;
              (4.)    Inability to be employed at a productive wage level without systematic long term
                      supervision or support;
              (5.)    Inability to learn new skills without aggressive and consistent training;
              (6.)    Inability to apply skills without aggressive and consistent training;
              (7.)    Without direct supervision, inability to demonstrate behavior appropriate to the time,
                      situation or place;
              (8.)    Demonstration of severe maladaptive behavior(s) which place the person or others in
                      jeopardy to health and safety;
              (9.)    Inability or extreme difficulty in making decisions requiring informed consent; and
              (10.)   Presence of other skill deficits or specialized training needs which necessitates the
                      availability of trained Mental Retardation personnel, 24 hours per day, to teach the
                      person to learn functional skills.




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H.     HOME HEALTH CARE: STANDARDS

Home health services include home health aide, nursing care, occupational therapy, physical therapy, and
speech therapy provided to an individual to enable them to remain in the community. These professionals
may be required to work as a team in their approach to the consumer’s care. Duration and scope of the
services are limited only by the care plan.

1.     SPECIAL ELIGIBILITY CRITERIA

       a.     Eligibility for Home Health Care service is established on the basis of a comprehensive
              needs assessment conducted by the AAA Care Management Unit.

       b.     The need for Home Health Care service must be confirmed by the nurse consultant and the
              Care Manager.

              (1.)    The nurse consultant will review the Care Management Assessment and other
                      pertinent medical information, including information obtained by contracting health
                      care providers who have cared for the consumer, to assure the appropriateness of the
                      service.

              (2.)    The nurse consultant may perform elements of a nursing evaluation, including
                      examining the consumer to assess a particular problem if there is a question of the
                      need or the kind of home care.

              (3.)    The nurse consultant may not carry out any treatments or clinical interventions.

              (4.)    The nurse consultant assists in the development of the care plan as it relates to Home
                      Health Care service.

       c.     Home Health Care service must be ordered by a primary physician.

              (1.)    The order must reflect the consumer’s medical condition and/or disability.

              (2.)    The order must include the specific nursing and/or therapeutic service required.

              (3.)    The order must be obtained by the Home Health service provider prior to service
                      authorization.

              (4.)    The order for continuation of service must be obtained every sixty days.

       d.     The registered nurse and therapist, if therapy service is being rendered, must evaluate the
              consumer to determine the consumer’s potential for rehabilitation and to enable the therapist
              to develop or modify a plan of care for him/her prior to service and every 60 days. This plan
              and recommendation for service must be submitted to the Care Management Unit prior to
              service authorization.

              If skilled care is not required, the services of the home health aide will be provided only as
              long as the need for supportive service continues. This necessitates that the registered nurse


Eff. 7/1/09                                                                                                 72
              or therapist performs a sixty-day evaluation to monitor the consumer’s improvement or
              regression. With each evaluation, instructions must be written for the home health aide
              including any changes in how supportive activities are to be rendered.

2.     ACTIVITIES FOR HOME HEALTH AIDE

       a.     Home Health Aide services are provided by a supervised aide who may be a trained home
              health aide or a license practical nurse. In addition to personal care, home health activities
              include:

              (1.)    Performing simple measurements and tests to monitor the consumer’s medical
                      condition including vital signs, simple urine checks for sugar and albumin and
                      measuring intake and output.

              (2.)    Assisting with ambulation when the consumer also uses an ambulation aide.

              (3.)    Assisting with other medical equipment use.

              (4.)    Assisting with exercises taught by a nurse or physical therapist.

              (5.)    Changing and/or reinforcing simple dressings on stable surface wounds.

              (6.)    Low level care of decubitus ulcers (as directed by a registered nurse).

              (7.)    Caring for well-healed normal functioning colostomy.

              (8.)    Assisting with changing of a colostomy bag (as directed by a registered nurse).

              (9.)    Monitoring of dietary habits and preparing special diet meals.

              (10.)   Assisting in retraining the consumer in self-help skills.

              (11.)   Reporting changes in the consumer’s condition and needs to the registered nurse
                      supervisor.

3.     STANDARDS FOR HOME HEALTH AIDE

       a.     Appropriately trained (see training standard).

       b.     Supervised by a licensed practitioner.

4.     TRAINING STANDARDS FOR HOME HEALTH AIDE

       Basic training of a minimum of 60 hours must be completed during the first 3 months of
       employment. (Suggested curriculum example: National Homecaring Council, "Instructions of the
       Homemaker-Home Health Aide" using at a minimum the 60 hour classroom modules including an
       Add-on Module dealing with Aging in place of the units covering Children, Mothers and Babies.)
       This may be waived if the Home Health Aide worker provides documentation of completion of


Eff. 7/1/09                                                                                                    73
       related training and/or is able to demonstrate competency in all skilled areas required in the basic
       training. In-service training shall be ongoing and home health aide workers must have demonstrated
       competency in procedures and activities they are asked to perform.

5.     SUPERVISION STANDARDS

       a.     Home Health Aide services must be supervised by a registered nurse and are provided under
              physician’s orders. Home Health aides are supervised by the subcontract agency's registered
              nurse and/or the therapist if they are assisting with therapeutic activities.

       b.     The supervision must occur in the consumer’s residence every two weeks with the
              supervisor reassessing the consumer’s situation, monitoring and assessing the home health
              aide job performance. It is not required that the home health aide be present every two
              weeks during the supervisory visit in the consumer’s home, but it encouraged that he/she is
              present during these visits as often as possible.

              It is required, however, that included in the supervisory notes there be documented
              communication between the registered nurse supervisor and the home health aide at least
              every two weeks, regarding the consumer’s condition, response to service and satisfaction,
              the home health aide’s job performance, re-evaluation of the care plan meeting consumer’s
              needs, etc., and any other pertinent information regarding the consumer’s condition, aide job
              performance or care plan implications.

6.     RECORDS AND DOCUMENTATION

       a.     The Home Health Care provider must maintain a standardized record keeping system. The
              system must ensure uniformity and consistency in documentation of the service provision,
              the consumer’s response to the service, and other observations made of the consumer.

       b.     Consumer information must be maintained in a confidential manner.

       c.     A separate record must be maintained for each consumer. The record must include:

              (1.)   the physician order;

              (2.)   AAA Service Authorization Form;

              (3.)   the plan of care established by the nurse and/or therapist;

              (4.)   the nurse or therapist assignment to the home health aide;

              (5.)   a record of supervisory visits for the home health aide;

              (6.)   documentation of each visit made to the consumer (to include changes in a
                     consumer’s condition) through a report to the Care Management Unit;




Eff. 7/1/09                                                                                              74
              (7.)   Pertinent consumer information obtained during the supervisory visits and home
                     health provider contact must be included in agency reports shared with the AAA
                     Care Manager and physician of record;

              (8.)   Individual time slips signed by the consumer or family member/caregiver and the
                     field staff worker to document each unit of service billed.

7.     ACTIVITIES FOR NURSING CARE

       a.     Providing either a basic general nursing evaluation or a specialty nursing evaluation of the
              consumer (by a registered nurse only).

              (1.)   Basic General Nursing Evaluation: a basic general nursing evaluation completed by
                     the Medicaid provider’s registered nurse to evaluate and monitor the general health
                     and medical needs of the consumer in order to make recommendations and develop a
                     nursing care plan for the registered nurse, licensed practical nurse, and/or home
                     health aide to carry out the physician’s recommended health care plan, and to carry
                     out teaching for implementation of the health care plan. This nursing evaluation
                     includes but not limited to: living conditions, health history, current health status
                     (including taking of vital signs and any other "hands-on necessary to complete the
                     evaluation), medication review, review of systems, etc. This general nursing
                     evaluation is usually completed initially and then on an on-going basis, as needed, as
                     part of the home health and is considered an integral part of the unit of service
                     provided by the home health workers. The information obtained from the nursing
                     evaluation is documented and shared with the AAA Care Manager and the physician
                     of record.

              (2.)   Specialty Nursing Evaluation: a specialty nursing evaluation completed by a
                     registered nurse with specialty training, education, experience and knowledge to
                     make specialty recommendations and develop a nursing care plan to carry out the
                     physician’s approved plan of care or to carry out intensive teaching in a special area
                     (e.g., incontinence training, ostomy care, wound care). This nursing evaluation
                     includes, but not limited to the above areas, including any "hands-on” with
                     concentration on specific areas related to the reason for the request, and the specialty
                     nurse contracted to perform this type of evaluation, would generally make only one
                     or two visits and the evaluation is contracted for at the discretion of the AAA site.
                     Again, the information obtained from the evaluation is documented and shared with
                     the AAA Care Manager and physician of record.

       b.     Developing a nursing care plan (by a registered nurse only). Licensed practical nurses may
              assist and participate in the development and planning of nursing care.

       c.     Implementing a nursing care plan.

       d.     Administering of physician’s prescribed medications.




Eff. 7/1/09                                                                                                  75
       e.     Teaching and training activities which require the skills and knowledge of a nurse, e.g.,
              special diet, medication management, insulin administration, enteral or parenteral feeding,
              decubitus care, ostomy care, and catheter care.

       f.     Performing medical treatments as order by the physician.

       g.     Performing nursing skills and procedures which are usual, customary practice as permitted
              by the "Professional Nursing Law” for licensed nurses and for which the nurse assigned can
              demonstrate educational preparation, experience and knowledge.

       h.     Maintaining clinical documentation of all nursing activities and visits.

       i.     Obtaining new medical orders (by a registered nurse only) from the consumer’s physician as
              indicated.

       j.     Monitoring of consumer’s physical and mental status in order to prevent hospitalization and
              regression of consumer status and to report any changes in condition of needs to the AAA
              Care Manager and physician of record.

8.     NURSING STANDARDS

       a.     Nursing Care is provided by an individual currently licensed to practice in Pennsylvania as a
              registered nurse or a licensed practical nurse under the direction of a registered nurse.

9.     RECORDS AND DOCUMENTATION

        (Same as Home Health Aide)

10.    ACTIVITIES FOR OCCUPATIONAL THERAPY

       a.     Develop a restorative and/or maintenance therapy plan of treatment with physician approval.

       b.     Implement therapeutic tasks and activities to restore sensory-integration functions
              (perceptual problems due to loss of vision, touch, hearing, etc.).

       c.     Teach consumers ways to protect joints from injury while doing activities of daily living and
              instrumental activities of daily living.

       d.     Design, fabrication, and application of splints not including orthotic devices or prostheses.

       e.     Teach compensatory techniques to improve the level of independence in activities of daily
              living and instrumental activities of daily living.

11.    OCCUPATIONAL THERAPIST STANDARDS

       a.     Occupational therapy is provided by a therapist currently licensed to practice in the
              Commonwealth. The occupational therapist is responsible for consulting, evaluation,




Eff. 7/1/09                                                                                                   76
              teaching and providing occupational therapy procedures to consumers under physician
              direction.

12.    RECORDS AND DOCUMENTATION

       (Same as Home Health Aide).

13.    PHYSICAL THERAPY ACTIVITIES

       a.     Develop a restorative and/or maintenance therapy plan of treatment (common treatment
              procedures include hot packs, paraffin baths, gait training, ultra-sound, range of motion
              testing, therapeutic exercises, etc.) with physician approval.

       b.     Teach positioning and proper body mechanics for lifting and transferring consumers.

14.    PHYSICAL THERAPISTS STANDARDS

       a.     Physical therapy is provided by an individual currently licensed as a physical therapist by the
              Commonwealth. The physical therapist is responsible for consulting, evaluating, teaching,
              and providing physical therapy procedures to consumers under physician direction.

15.    RECORDS AND DOCUMENTATION

       (Same as Home Health Aide).

16.    ACTIVITIES FOR SPEECH THERAPY

       a.     Develop a restorative and/or maintenance therapy plan of treatment with physician approval.

       b.     Evaluate and develop a treatment program for speech problems.

       c.     Evaluate and develop a treatment program to address problems of dysphagia (difficulty
              swallowing).

17.    SPEECH THERAPIST STANDARDS

       a.     Speech therapy is provided by a individual currently licensed in speech and language therapy
              by the Commonwealth. The therapist is responsible for consulting, evaluating, teaching and
              providing speech therapy procedures to consumers under physician direction.

18.    RECORDS AND DOCUMENTATIONS

       (Same as Home Health Aide)

19.    SERVICE REPORTING

       Persons providing Home Health Care services must comply with all reporting requirements as
       specified by the Area Agency on Aging.


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20.    SCHEDULING

       Days and times schedules for Home Health Care must be consistent with the Care Plan provided by
       the AAA.

21.    INSURANCE

       Agencies who wish to provide Home Health Care services will be required to attest to having the
       following types of insurance in amounts consistent in the industry:

              a.     General liability;
              b.     Professional liability;
              c.     Automobile liability covering owned, non-owned and hired vehicles;
              d.     Workman Compensation as required by law;
              e.     Employer’s liability of accident and disease.

22.    CONFIDENTIALITY

       All agencies who provide Home Health Care services and comply with all federal, state and local
       laws relating to research on home subjects and consumer confidentiality.

       Agencies must provide all Care Managers with consent forms and approval from all appropriate
       review boards for those consumers who wish to be part of a research study.




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I.     HOME HEALTH CARE: SERVICE SPECIFIC OPERATIONAL PROCEDURES


These Operational Procedures are a supplement to the Home Health Care Standards, and as such
they delineate further clinical expectations for Home Health Providers giving skilled home health
care to PCA consumers of the LTC Programs which encompass the Options and Aging Waiver
payment sources. When there is a difference between the Home Health Care Standards and these
Service Specific Operational Procedures, the more stringent requirement prevails.

NOTE: Home Health Agency (HHA) refers to skilled Medicare certified Home Health Provider

1.     INTAKE

       a.     When making a referral, the LTC staff will indicate the type of service and time frame in
              which the visit is to be made. The PCA Care Manager will be responsible to identify their
              Registered Nurse Consultant (RNC) on the referral and/or indicate it in the “special
              instructions” section of the Service Order.

              If the Home Health Agency is not able to meet the request, the LTC staff person will refer
              the consumer to another Home Health Agency of his/her choice.

       b.     The LTC staff will discuss with the HHA intake staff the source of payment for the visit(s).
              Pennsylvania Department of Aging (PDA) and Department of Public Welfare (DPW)
              mandate providers to exhaust all other insurance, including Medicare and Medicaid
              (MA), before payment can be authorized through Options or Aging Waiver programs.
              Note: providers must obtain prior authorization from MA for all medically necessary
              home health visits for eligible consumers.

              In cases where the LTC staff requests a skilled evaluation visit and it is agreed that the
              consumer services will not be covered by third party payers, PCA will reimburse for the
              visit. The LTC staff person will take under advisement a request by a nurse for a second visit
              to assess a consumer fully, consistent with CMS regulations.

       c.     Skilled care visits paid by PCA may occur only after the skilled home health agency
              has received a service order. The date this service order is received becomes the
              referral date for all skilled services. Care managers may note in the special instructions
              the time frame within which the visit must occur. If a visit is needed within twenty-four
              hours the service order will be preceded with a telephone call to the provider and the visit
              made prior to receiving the service order. All providers MUST comply with DPW process
              regulations before initiating services, e.g. the completion of the Eligibility Verification
              System (EVS) check and prior authorization.

       d.     PCA service orders constitute payment authorization for services delivered.

2.     COORDINATION & DELIVERY OF CARE

       a.     The LTC Programs expect all of the skilled home health evaluations to follow


Eff. 7/1/09                                                                                                  79
              CMS/OASIS/PPS regulations and PCA specifications. This includes a thorough
              assessment, plan of treatment, and nursing care plan. The skilled services will follow a care
              plan or critical pathway, which meets consumer goals. Since LTC consumers have both
              acute and chronic illnesses PCA expects that the HHA staff will be knowledgeable and
              skilled in defining, monitoring and intervening with any health issues or concerns that
              impact on LTC consumers. Such health issues may include the following: incontinence,
              nutrition, depression, polypharmacy, pressure ulcer management and impaired mobility.
              RNs will discuss all of these areas of need and any other needs which impact on or cause an
              improvement or deterioration in the consumer's health status with the Care Manager. The
              HHA’s RN and the PCA Care Manager, together with the PCA Registered Nurse
              Consultant (RNC), will attempt to jointly resolve and/or problem solve all issues of a
              clinical or payment nature. PCA staff will make the final decision in any disputes.

       b.     The LTC programs expect that care will be provided to consumers using an interdisciplinary
              team approach. HHA staff needs to communicate with the Care Manager and their RNC to
              keep him/her informed of any changes in the consumer’s health status. The HHA is
              expected to communicate with the PCA Registered Nurse Consultant (RNC) at the
              following times:

              (1.)   Within one business day after completion of the initial assessment, the HHA’s RN
                     must contact the RNC to establish the payer of service and the recommended visit
                     pattern.
              (2.)   When the agency completes an episode of care and recertifies the consumer for a
                     second episode of care or discharges the consumer from skilled home health care.
                     (Please note this change from previous requirements).
              (3.)   When there is a significant change in the consumer’s health condition.
              (4.)   When there are any consumer complaints regarding health-related aspects of their
                     care.
              (5.)   When other agencies are not performing or delivering requested care such as
                     personal care, transportation, meals, or adult day care. This primarily is the
                     consumer’s responsibility, except when dementia or caregiver absence exists and non
                     performance impacts on consumer’s safety or health status.
              (6.)   When the consumer is hospitalized or experiences a health emergency.
              (7.)   When there is a professional conflict regarding the delivery of care between HHA's
                     and other professionals.
              (8.)   When the HHA expects to discharge the consumer from third party payer services or
                     resume PCA paid services.
              (9.)   Reports from HHA’s RN are to be given to the RNC regarding all clinical issues. In
                     the RNC is not available, voice mails messages can be left, and in an emergency the
                     PCA Care Manager or the Care Manager Supervisor can be contacted.

       c.     LTC programs have a Supervisor on-call from 8:30-5:00 Monday through Friday to address
              any problems or concerns that may arise in the Care Manager or RNC’s absence.

       d.     There may be situations that arise when a consumer’s needs are complex and require the
              LTC Care Manager to request consultations from various specialists, for example: wound
              care, psychiatrist, psychiatric nurse, or mental health counselors. The LTC Programs expect
              that HHA staff be available to discuss consumer situations with the consultants and to follow


Eff. 7/1/09                                                                                              80
              their recommendations and coordinate care, when indicated. If HHA staff should disagree
              with their recommendations they need to contact the LTC RN Consultant and explain their
              concerns.

       e.     The LTC programs expect that there may be times when conferencing either in person or by
              phone with all health team members and/or family members may need to occur.

3.     PLAN OF TREATMENT

       a.     All care given by Home Health Agency staff will be under the direction of the
              consumer’s physician.

       b.     It is expected that the Home Health Agency will be responsible for obtaining the physician’s
              orders and signature on the plan of treatment (CMS form 485 and 487) and submit a copy to
              the LTC Care Manager.

       c.     It is expected that the Home Health Agency will follow all the Medicare Regulations in
              providing care to LTC consumers under third party payer conditions of participation. This
              includes the need for CMS defined homebound status.

4.     REPORTING/PROGRESS NOTES.

       a.     The Home Health Agency is required to keep records on each consumer according to CMS
              Guidelines and the Home Health Care Standards. Reporting requirements remain the
              same for all LTC skilled nursing and physical therapy consumers authorized to a PCA
              provider, irrespective of reimbursement source. The LTC Program needs to receive
              copies of the initial assessment from all disciplines, initial plan of treatment (485), and
              discharge summary no later than one week after care was delivered. The following
              Reporting Guidelines must be followed for Skilled Nursing and PT visits:

              (1.)   The reports to PCA shall contain:
                     (a.)   Initial (485) Plan of Treatment;
                     (b.)   Initial Skilled Progress Note or last page of OASIS with summary of
                            findings;
                     (c.)   Discharge Summaries for PCA and third party payers.

                     Please Note: All PCA RNC or Care Manager initiated transfers or discharges
                     must allow the home health agency an appropriate visit for closure under that
                     episode of care.

                     Contents of verbal reports to the RNC should include the following:

                            (i.)     Consumer name;
                            (ii.)    Name of RN making the visit;
                            (iii.)   RN’s agency name;
                            (iv.)    Date of most recent visit;
                            (v.)     Vital signs and changes of any significance based on ranges being
                                     reported per 485;


Eff. 7/1/09                                                                                               81
                              (vi.)   A summary of diagnoses and treatments as they relate to the current
                                      episode of care. This summary will include any observation noted in
                                      the Summary, along with Care Plan interventions.

               (2.)    Review of payer sources:
                       (a.)  Current visit pattern;
                       (b.)  Type of payer source (potential third party);
                       (c.)  Primary diagnosis for episode of care;
                       (d.)  Goals of episode of care and were the goals achieved;
                       (e.)  Anticipated date of discharge from episode of care and anticipated number of
                             recertification under any payer source.

               (3.)    Upon request, all agencies will forward copies of documentation (other than those in
                       #1. above) for review by the PCA Nurse Consultant.

               (4.)    Reports are required for the one visit paid by PCA (Options or Aging Waiver) and all
                       third party billed visits under Medicare, MA, and any HMO. Additional reports
                       may be requested when warranted due to any significant changes in the
                       consumer’s status. Reports may be made by e-mail, phone or fax to RNC.

          b.   The Home Health Agency is required to keep written documentation on each visit with the
               PCA consumer in the form of progress notes. Progress notes and OASIS reassessment notes
               will include the following:

               (1.)    All required OASIS and agency conforming PPS documentation.

               (2.)    Consumer’s name, Care Manager’s name, date and time of visit.

               (3.)    Observation and documentation of the consumer’s physical, mental, and cognitive
                       status.

               (4.)    Teaching and treatments given including consumer’s response with regards to
                       understanding of instructions.

               (5.)    Evaluation of progression/regression based on measurable/observable data with a
                       modification of goals.

               (6.)    Contact with the physician, RNC, Care Manager or other agencies providing care.

               (7.)    Home health aide supervisory visits per third-party payer guidelines established by
                       CMS .

               (8.)    Explanation of treatment goals and consumer/caregiver agreement with stated goals.

               (9.)    Specific plan for subsequent visit and date of the next projected visit.

               (10.)   Reasons why staff is unable to provide authorized service, if applicable.




Eff. 7/1/09                                                                                                  82
               (11.)   Signed verification by the consumer or caregiver that the visit was made. A
                       signature is required for each visit made by a RN, OT, PT, ST, ET, and home
                       health aide.

                       *The provider shall obtain the consumer’s signature (or that of other authorized
                       representative) on a time slip or other standardized form each time a service is
                       delivered to a PCA consumer. Consumers must be given a copy of the signed
                       time slip or form as a confirmation of delivery of service. It is recommended that
                       providers utilize multi-part forms so that the consumer can receive their copy as
                       an acknowledgement of the receipt of service on the given day.

          c.   Verbal reports to the designated care management team’s RNC for all Physical Therapy,
               Occupational Therapy, and/or Speech Therapy consumer visits, which must include the
               following, where applicable:

               (1.)    Therapeutic rehabilitative goals based on a thorough and complete functional
                       assessment.

               (2.)    An assessment of any potential third party payer reimbursable diagnoses and
                       treatments.

                       (a.)   Anticipated outcomes of your therapeutic interventions.
                       (b.)   DME equipment needs of the consumer (both PCA and those paid by third
                              party payer).
                       (c.)   Anticipated safety check follow-up visit for all equipment ordered and/or
                              installed.
                       (d.)   Anticipated discharge date whether by PCA or third party payers.

          d.   Documentation must be available to the PCA RNC, Care Managers and their supervisors
               upon request. The request will include the current episode of care only.

          e.   The Home Health Agency staff will submit a discharge summary, by discipline, which
               outlines the following:

               (1.)    Admission and discharge dates.
               (2.)    Summary of care that was provided listing initial goals and final outcome.
               (3.)    Consumer’s condition at discharge including medications, vital sign range, activity
                       level, and cognitive status.
               (4.)    Signature of the consumer verifying that he/she has been advised of discharge.

          f.   The Home Health Aide will keep a dated record of each contact with the consumer and
               record services provided observations of consumer and supervisory visit when it is made by
               the home health agency staff. This record is to be dated and signed by the consumer and
               home health aide.




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5.     STAFF QUALIFICATIONS

       The Home Health agency will select staff to deliver care to LTC consumers who have to attend
       PCA’s orientation to its programs. The staff must meet the qualifications delineated below in
       section A. PCA’s experience has shown that relationships and communications are enhanced when
       a core group of provider staff are assigned to work with the LTC consumers.

       a.     The Home Health Agency will assign field staff who have the following qualifications as
              listed below:

              (1.)   Registered Nurses - have a minimum of two years of nursing experience.

              (2.)   Psychiatric Nursing- Qualifications for Psychiatric nurses providing Evaluation and
                     Therapy in the home are those mandated by the Medicare Intermediary as part of
                     their medical policy manual.

                     Note: These requirements may change at any time based on the intermediary’s
                     decision. Please review www.myhomehealth.com or the CAHABA Web site for
                     updated information.

              (3.)   Enterostomal Therapy Nurses (ET) - must have two years of nursing experience in
                     enterostomal therapy.

                     The ET nurse must have graduated from an accredited school of nursing and
                     graduated from an accredited Enterostomal Therapy Nurse Education Program
                     approved by the International Association for Enterostomal Therapy and be board
                     certified or board eligible.

                     The ET nurse shall sit for and pass the board certification examination within one
                     year of employment by subcontractor.

                     For the purpose of this service, PCA requires that enterostomal nurses providing care
                     have the CETN (Enterostomal Therapy Nurse Certification) or CWOCN (Wound
                     Ostomy Continence Nurse Certification) certification. PCA will only utilize
                     enterostomal nurses who are CETN or CWOCN certified for ostomy and wound
                     care. PCA expects ET nurses to sit for boards every 5 years to ensure that the care
                     provided will be according to the latest standards of care.

              (4.)   Home Health Aides - have completed a 75 hour approved Medicare Training
                     Program, have a high school diploma or General Equivalency Diploma (GED).

              (5.)   Physical Therapists - have a minimum of two years of physical therapy experience.

              (6.)   Occupational Therapists - have a minimum of two years of occupational therapy
                     experience.

              (7.)   Speech Therapists - have a minimum of one-year experience in speech therapy.




Eff. 7/1/09                                                                                               84
       b.     All RN staff, including both agency administrators and subcontracted professional
              staff, are required to attend a PCA Orientation before they can serve any PCA
              consumers, unless a waiver certificate is granted by the Program Review Nurses.
              Resumés for all professional staff need to be submitted to the Contract Manager and
              Program Review Nurses, prior to attending the Orientation. Requests for a waiver must be
              made in writing, accompanied by the resumé and license.

       c.     The Philadelphia Corporation for Aging reserves the right to request the Home Health
              Agency to remove individual staff from providing care to specific consumers or from seeing
              any PCA consumers.

       d.     The Home Health Agency will notify the Contract Manager in the Business
              Administration Department in the event of any resignation of a staff member who
              administers the program or provides care to our consumers.

       e.     The Home Health Agency will assume responsibility for the supervision of its staff as well
              as subcontracted specialists to assure the delivery of quality care. The RN will provide
              supervision of the Home Health Aide according to CMS Guidelines.

6.     COMMUNICABLE DISEASES

       a.     When caring for consumers with communicable diseases, PCA expects provider agencies to
              follow procedures recommended in the Center for Disease Control (CDC) guidelines and
              OSHA regulations. Agencies are responsible to provide appropriate In-services regarding
              these universal precautions. (A training tape is available from CDC upon request. The CDC
              toll-free number is 1-800-232-4636).

              Home Health agencies are also required to provide appropriate protective articles such as,
              but not limited to, aprons, gloves, masks, and gowns as needed.

       b.     Based on CDC guidelines, the provider shall develop a written policy regarding
              communicable diseases. That policy must meet State/Federal requirements.

       c.     The provider shall notify the PCA RNC or Care Manager upon determining or learning from
              another source that a consumer has a communicable disease. If this knowledge is from
              another source, they must still notify the PCA RNC and/or Care Manager that the consumer
              has a communicable disease.

       d.     The provider must follow CDC and OSHA Guidelines regarding the disposal of
              contaminated needles.

       e.     Before being assigned to a case, and annually, all consumer-contact employees shall have a
              Mantoux Intracutaneous PPD test according to CDC recommendations and, if the results are
              positive, it will be followed by appropriate physician directed treatment.

              In order to continue employment, the employee must be free of active TB. Verification by a
              physician that the employee is free of TB must be in the personnel file and updated annually.
              Chest X-rays are required based on physician’s advice.


Eff. 7/1/09                                                                                                85
       f.     All employees must be offered and/or receive the Hepatitis B Vaccine as designated by
              OSHA regulations.

7.     CERTIFICATION AND QUALITY OF CARE STANDARDS.

       a.     It is expected that the Home Health Agency will be currently certified by Medicare to deliver
              home health care services and will provide PCA with its current Medicare Survey results.
              Verification of CHAPS or JCAHO survey accreditation shall be provided to PCA, if
              applicable.

       b.     The LTC Program will use the Clinical Practice Guidelines as published by U.S. Department
              of Health and Human Services under the Agency for Health Care Policy and Research
              (AHCPR) and any professional Standards of Practice for care of the older adult, as
              guidelines while auditing.

       c.     The Home Health Agency will adhere to all of the following Federal Guidelines: CMS,
              OSHA, PPS and CHAPS or JCAHO if applicable.




Eff. 7/1/09                                                                                             86
J.     HOME SUPPORT SERVICE STANDARDS

       1.     DESCRIPTION OF ACTIVITIES

              Home Support Services include instruction on managing the household as well as hands-on
              assistance. Allowable activities include:

              a.     Basic housekeeping and home management necessary to ensure safe and sanitary
                     conditions;

              b.     Instructions in home management. Home management includes such things as
                     maintaining an orderly environment, proper food storage, preparation of shopping
                     lists, maintaining appliances in safe working conditions;

              c.     Shopping assistance with or without the consumer;

              d.     Personal laundry and mending of clothing;

              e.     Transportation of the consumer by a Home Support worker to complete chores or
                     keep appointments. This should occur when Transportation services are
                     inappropriate or unavailable;

              f.     Labor intensive low cost home repair. Chores necessary for reasons of a consumer’s
                     health and safety;

              g.     Ground maintenance when necessary to maintain a consumer in his/her home;

              h.     Meal planning and preparation;

              i.     Escort to medical facilities;

              j.     Observing and communicating health and other problems to a supervisor;

              k.     Extermination services - extermination services should only occur to ensure the
                     consumer’s health or welfare;

              l.     Dumpster rental - Dumpster rental may be required on a temporary job specific basis
                     for the purposes of intensive home repair, ground maintenance, or major clean up.
                     Monthly maintenance fees would not be covered;

              m.     Financial management - financial management includes routine financial transactions
                     for consumer’s unable to conduct their day-to-day affairs without some assistance,
                     e.g. paying bills and checkbook balancing.




Eff. 7/1/09                                                                                             87
       2.     STANDARDS FOR HOME SUPPORT WORKERS

              a.   Qualifications and selection of Home Support Workers must follow personnel
                   policies that include:

                   (1.)   Home Support Workers must have the ability to understand and carry out
                          simple instructions.

                   (2.)   A personal interview and follow-up of references provided by the workers.
                          Documentation of follow up must be incorporated into the worker’s
                          personnel file. Appropriate references include:

                          (a.)   one verifiable work reference indicating a minimal length of
                                 employment of two years or,

                          (b.)   one verifiable work reference if employed less than two years plus one
                                 verifiable personal reference,

                          (c.)   two verifiable personal references.

                   (3.)   In recruiting, there must be assurance of compliance with Title VI of the Civil
                          Rights Act of 1964.

                   (4.)   Agencies that provide Home Support services must assure that home support
                          workers comply with federal, state and local health requirements related to
                          communicable diseases. All field staff must receive a PPD test - the results
                          of which are maintained in their files.

                   (5.)   There must be documentation that any worker who transports consumers in
                          the line of duty possesses a currently valid driver’s license and appropriate
                          insurance.

                   (6.)   Workers must receive a copy of a job description, personnel policies and
                          wage scale for the position.

                   (7.)   These tasks are provided by paraprofessionals with supervision. Supervision
                          by a Registered Nurse is not required.

       3.     TRAINING STANDARDS

              a.   Home Support Workers must be oriented to the purpose and background of AAA
                   Programs.

              b.   No specific pre-service training is required of Home Support Workers, however, they
                   must demonstrate knowledge and ability to perform the activities assigned. Methods
                   for determining this include but are not limited to:

                   (1.)   previous job experience,


Eff. 7/1/09                                                                                               88
                      (2.)   verification by previous employer,
                      (3.)   of a questionnaire testing the worker’s knowledge.

               c.     Providers must establish regular in-service training for Homemaker staff. Topic
                      areas must include:

                      (1.)   principles of cleanliness and home safety,
                      (2.)   communication with older persons,
                      (3.)   understanding aging and functionally impaired persons,
                      (4.)   observing, appraising and reporting changes in consumers’ situations.

               d.     Documentation of demonstrated skill and in-service training must be maintained as
                      part of the worker’s personnel record.

       4.      RECORDS AND DOCUMENTATION

              a.      Provider must maintain service records that include a service order for tasks to be
                      performed and a report form requiring a consumer’s signature verifying the length of
                      time spent and satisfactory completion of the service.

              b.      Report form for the Home Support Workers to document changes or other observed
                      consumer problems.

              c.      AAA must maintain records required by the Department of Aging for program and
                      financial reporting.

              d.      AAA (or its subcontractor) must maintain service records that include a service order
                      for tasks to be performed and a report form requiring a consumer’s signature
                      verifying the length of time spent and satisfactory completion of the service.

       5.      SERVICE REPORTING

               Persons providing Home Support services must comply with all reporting requirements as
               specified by the Area Agency on Aging.

       6.      SCHEDULING

               Days and times scheduled for Home Support must be consistent with the Care Plan provided
               by the AAA.

       7.      INSURANCE

               Agencies who wish to provide Home Support services will be required to attest to having the
               following types of insurance in amounts consistent in the industry:

               a.     General liability;
               b.     Professional liability;
               c.     Automobile liability covering owned, non-owned and hired vehicles;


Eff. 7/1/09                                                                                             89
              d.     Workman Compensation as required by law;
              e.     Employer’s liability of accident and disease.

       8.     CONFIDENTIALITY

              All agencies who provide Home Support services must comply with all federal, state and
              local laws relating to research on human subjects and consumer confidentiality.

              Agencies must provide all Care Managers with consent forms and approval from all
              appropriate review boards for those consumers who wish to be part of a research study.




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K.     HOME SUPPORT: SERVICE SPECIFIC OPERATIONAL PROCEDURES


These Operational Procedures are in addition to the Home Support Service Standards related to
heavy cleaning. They delineate further expectations for providers administering care to Philadelphia
Corporation for Aging (PCA) consumers, of the Long Term Care (LTC) Program which encompass
the Options and Aging Waiver payment sources. For other home support tasks, refer to the Personal
Care, Respite and Home Support Service Specific Operational Procedures.

       1.     SCHEDULING

              a.    Once the referral is made, the provider must contact the Care Manager within 24
                    hours if unable to meet the request for service. After accepting a referral, completion
                    of the service is expected within fifteen working days maximum of receipt of a
                    service order. Any anticipated delay will be immediately communicated to the Care
                    Manager.

              b.    The specific time and day for which service is scheduled shall be at the consumer’s
                    convenience. There is no restriction on providing service on Saturdays and Sundays,
                    assuming full consumer agreement; however, PCA will not reimburse at a higher unit
                    cost for such service.

              c.    The provider must contact the Care Manager: 1) to inform him/her of the
                    scheduled date for service once determined and 2) when work is completed.

              d.    Any problems in contacting, scheduling or tasks should be reported to the
                    appropriate Care Manager promptly, and noted on a Chore Service activity report.

       2.     DESCRIPTION OF SERVICES

              a.    Work Estimate

                    (1.)   An appointment with the consumer shall be made by phone prior to making
                           the estimate visit and prior to scheduling work to be done. The PCA Care
                           Manager will help with any special arrangements needed, such as the
                           consumer leaving for a period of time, preparation of the consumer for
                           expected disruption, arrangements for others to be there during the job,
                           arrangements to get into the home, etc.

                    (2.)   A home visit to the consumer, within three (3) days of the initial referral,
                           shall be made by an identified person from the provider agency to finalize the
                           request, to estimate the time needed to perform the work requested, and to lay
                           any needed groundwork in preparation for the job. These findings must be
                           communicated to the PCA Care Manager, and a service order will be
                           generated authorizing the estimated hours.

                    (3.)   If, during the estimate visit, the provider agency observes work needed, but
                           not requested by PCA, they will contact PCA’s Care Manager to discuss the


Eff. 7/1/09                                                                                              91
                          observations. All changes to the original request must be approved by the
                          Care Manager prior to provision of service.

              b.   Heavy Cleaning

                   (1.)   Heavy cleaning is cleaning requiring substantial effort. Generally, moderate
                          to severe dirt has accumulated in normally used living areas, and extremely
                          uncomfortable conditions and/or extraordinary filth may be present. Such
                          conditions may be due to uncontrolled pets, lice or fleas, and/or waste or
                          debris build-up. Window cleaning and/or a severe rug problem may also
                          exist. Heavy cleaning is done for persons who have been unable to meet
                          independently the cleaning needs relating to a sanitary environment and
                          where no resource in the family or community exists. The tasks requested by
                          PCA will vary from case to case.

                          Note: general outside cleaning may include collection and disposal of
                          trash and window cleaning. It does not include gardening or snow
                          removal.

                   (2.)   Needed cleaning supplies shall be provided by the provider agency, unless
                          during the estimate visit, it has been determined and agreed that the consumer
                          would prefer to provide these supplies. If a consumer cannot be removed
                          during cleaning, the provider shall have available a range of cleaning
                          materials. Special consideration is to be given to the type of supplies used in
                          relation to their potential for causing allergic or other reactions.

              c.   Hauling

                   (1.)   Hauling is requested only with Heavy Cleaning and is to be billed separately,
                          at a prior approved, individualized price, based on prices quoted as part of
                          price negotiations.

                   (2.)   Hauling is only considered appropriate when it requires the use of a
                          dumpster/special truck for removal of extreme accumulations of trash. When
                          requesting approval, the nature of the material to be removed shall be
                          specified as substantiation for the size of the dumpster/truck indicated.

              d.   Hours of Service

                   (1.)   Ordering - PCA will order heavy cleaning and indicate whether a dumpster
                          (or hauling) is needed. The provider is expected to provide and schedule
                          the ordered service based on the exact requests. Any difference of
                          opinion should be communicated immediately to the appropriate PCA
                          staff person, as any deviation in service or billing, not approved by PCA,
                          will result in non-payment of the invoiced hours.

                   (2.)   21-Hour Limit - Any job estimate that exceeds 21 hours (22 hours or more)
                          must be approved by the LTCO Care Manager Supervisor before work is


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                          begun.

                   (3.)   Hourly Rate Computation - The estimated hours represents person hours.
                          For example, three people working together for eight hours would be 24
                          person hours for a 24-hour estimate. The hourly rate is the charge per person,
                          per hour. Actual person-hours are to be documented through the use of time-
                          slips.

                          Note: Hourly costs for estimating and inspection shall be included
                          (loaded) in computing the hourly rate and shall not be billed as hours
                          worked.

              e.   Work Inspection

                   (1.)   A home visit to the consumer after completion of the work shall be made by
                          an identified person from the cleaning provider to inspect and certify that the
                          work performed meets the original plan, has corrected the initial conditions
                          and is of high quality. Any variances from the requested plan found at
                          inspection shall be corrected prior to final certification by the provider
                          agency.

                   (2.)   It is expected that if, at the time of the inspection, the work does not meet
                          quality standards, the provider will take action immediately to correct the
                          situation. If the desired level of correction has not been met through
                          extenuating circumstances, not related to the provider, the chore provider will
                          communicate the observations to the consumer’s Care Manager.

              f.   Work Completion Notification

                   (1.)   The consumer’s PCA Care Manager shall be called to report that the work
                          has been completed, including any other appropriate observations, within 24
                          hours of verifying that the work performed meets the quality standards of the
                          chore provider.

                   (2.)   If direct contact cannot be made, the PCA Care Manager’s Supervisor shall
                          be notified. If suitable contact cannot be made within the required time frame,
                          a written message shall be sent immediately to the Care Manager.

              g.   Follow-up

                   (1.)   The Care Manager is expected to visit, or contact when appropriate, the
                          consumer within 5 days of completion of the job to verify the results and
                          determine if the work requested satisfies the purposes defined in the
                          consumer’s care plan. If the results are unsatisfactory, the Care Manager will
                          contact the provider directly and work out a resolution.

                   (2.)   If tasks not originally requested are identified, a follow up service order will
                          be arranged with the provider, following normal procedures.


Eff. 7/1/09                                                                                              93
       3.     REPORTING REQUIREMENTS

              a.     Service Activity Reports

                     (1.)    A consumer-by-consumer listing of all cases referred for service, estimated
                             for service, or completed during the week, shall be completed by the provider.

                     (2.)    The report is to be kept on file at the agency for review by PCA during
                             regular monitoring, or it may be reviewed as a separate audit. Should there
                             be a concern or specific issue observed at the consumer’s home, it is to be
                             reported to the Care Manager.

                     (3.)    Issues requiring immediate follow up should be communicated to the PCA
                             Care Manager. In their absence, the Care Manager Supervisor, the Nurse
                             Consultant or the Supervisor on call should be contacted. It is expected that
                             reporting requirements will be strictly adhered to.

                     (4.)    The Service Activity Reports shall be the basis for invoicing submitted by the
                             provider agency. Figures on the Service Activity Report are to be based on
                             dated time slips signed by the consumers and workers, which show actual
                             hours of work provided to each consumer, as indicated on the service order.
                             Appropriate information, including time slips, is to be maintained in the
                             provider agency’s records for justification of the reports submitted, and is
                             subject to periodic review by PCA staff.

                     (5.)    The provider shall obtain the consumer’s signature (or that of other
                             authorized representative) on a time slip or other standardized form
                             each time a service is delivered to a PCA consumer. Consumers must be
                             given a copy of the signed form as a confirmation of delivery of service.
                             It is recommended that providers utilize multi-part forms so that the
                             consumer can receive their copy as an acknowledgement of the receipt of
                             service on the given day.

              b.     The provider agency is encouraged to report any concerns it may have about a
                     consumer based on worker/supervisor observations. The report may be verbal or
                     written, and is to be submitted to Care Managers and the PCA Contract Manager.

       4.     IDENTIFICATION OF CHORE WORKERS

              All field workers will be given provider issued photo identification cards. Photo
              identification must be shown prior to entry into consumers’ homes and must be visible at all
              times when in consumer’s homes.

       5.     SUPERVISION AND JOB PERFORMANCE

              a.     Every job shall be staffed by an identified Supervisor, Foreman or Team Leader.
                     Every employee used for a PCA consumer shall be trained prior to his/her service


Eff. 7/1/09                                                                                                94
                   being rendered.

              b.   Any employee used to perform a job alone shall also have been monitored and
                   witnessed on the job at least three times by a management level employee
                   (Supervisor, Foreman) and shall be monitored periodically, but no less than once
                   each quarter.

              c.   Documentation of employee skill level, of persons providing service monitoring
                   visits and training, must be maintained by the provider agency and available for
                   reporting and inspection.


              d.   Field supervision shall be performed by a competent professional with demonstrated
                   experience in the cleaning field.

              e.   When changes occur on the administrative level, the PCA Contract Manager is to be
                   notified in writing, in advance, if known; or immediately upon such change. When
                   the change involves a change in administrative or supervisory personnel, a resume
                   for the new employee shall be included with the written notification.

       6.     RECRUITMENT OF STAFF

              a.   When recruiting workers, the following applicants, who meet the requirements, shall
                   be given priority: public assistance recipients, individuals of minority groups and
                   elderly persons.

              b.   Cleaning workers may be recruited for either full or part-time service in accordance
                   with the demands on the agency, and the ability of the person to meet full or part-
                   time job assignments.

              c.   Individuals with special knowledge, such as different cultural backgrounds,
                   languages or experience with various groups of older or chronically ill persons shall
                   be sought by the provider in order to make available a variety of competencies to
                   meet special situations.

              d.   The provider agency shall maintain sound, accepted personnel policies to minimize
                   personnel turnover, which would adversely affect the delivery of service

       7.     COMMUNICABLE DISEASES

              a.   PCA expects provider agencies to follow procedures recommended in the Center for
                   Disease Control (CDC) guidelines and OSHA regulations. Agencies are responsible
                   to provide appropriate In-services regarding universal precautions. (A training tape
                   is available from CDC upon request. The CDC toll-free number is 1-800-232-4636.)

                   Provider agencies are also required to provide appropriate protective articles such as,
                   but not limited to, aprons, gloves, masks, and gowns as needed.




Eff. 7/1/09                                                                                             95
              b.   Based on CDC Guidelines, the provider shall develop a written policy regarding
                   communicable diseases. That policy must meet State/ Federal requirements.

              c.   The provider must follow CDC and OSHA Guidelines regarding the disposal of
                   contaminated needles.

              d.   Before being assigned to a case, and annually, all consumer-contact employees shall
                   have a Mantoux Intracutaneous PPD test according to CDC recommendations,
                   and, if the results are positive, it will be followed by appropriate Physician directed
                   treatment.

                   In order to continue employment, the employee must be free of active TB.
                   Verification by a Physician that the employee is free of TB must be in the personnel
                   file and updated annually. Chest X-rays are required based on a physician’s advice.

              e.   All employees must be offered and/or receive the Hepatitis B Vaccine as designated
                   by OSHA Regulations.




Eff. 7/1/09                                                                                             96
L.     HOME SUPPORT EXTERMINATION: SERVICE SPECIFIC OPERATIONAL
       PROCEDURES


These Operational Procedures are in addition to the Home Support Service Standards as they relate
to extermination service. They delineate further expectations for providers serving Philadelphia
Corporation for Aging (PCA) consumers, of the Long Term Care (LTC) Program which encompass
the Options and the Aging Waiver payment sources. For other home support tasks, refer to the
Personal Care, Respite and Home Support Service Specific Operational Procedures.

Note: Extermination service will not be provided to LTC consumers residing in public housing,
subsidized housing, etc. as these entities are responsible for providing this service for their residents.

       1.     SCHEDULING

              a.      Once the extermination referral is made, the provider must contact the Care Manager
                      within 24 hours if unable to meet the request. In such instances, the Care Manager
                      will refer the consumer to another agency of their choice.

              b.      PCA expects prompt and courteous service to be provided to consumers.
                      Completion of the service is to be within five (5) working days, of receipt of the
                      service order. The provider will notify the Care Manager of the date that the job is to
                      be performed at the consumer’s residence. The PCA Care Manager must be notified
                      immediately if performance will be delayed.

              c.      No extermination service is to be performed by the provider without the service
                      order. Immediate requests for service may be referred to a provider through a verbal
                      authorization; however, a service order must be initiated.

              d.      The specific time and day for which service is scheduled shall be at the consumer’s
                      convenience. There is no restriction on providing service on Saturdays and Sundays,
                      assuming full consumer agreement; however, PCA will not reimburse at a higher unit
                      cost for such service.

              e.      Providers are required to notify the Care Manager and document when a consumer
                      has refused service, not available for service, or when access to the property has been
                      denied.

              f.      Should the provider not adhere to the follow-up schedule, PCA may deny payment
                      for follow-up units invoiced by the provider that is not consistent with the authorized
                      service delivery pattern.

       2.     IDENTIFICATION OF EXTERMINATION WORKERS

              All extermination workers will be given provider issued photo identification cards. Photo
              identification must be shown prior to entry into consumers’ homes and must be visible at all
              times when in consumers’ homes.


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       3.     ASSESSMENT/ESTIMATE

              a.     Provider must complete an initial assessment of the problem area and provide an
                     estimate for correction of the pest infestation. The assessment/estimate visit must
                     occur within three (3) working days of the referral. Provider’s assessment must
                     include: identification of the problem, the proposed plan of treatment, and the
                     expected duration of treatment. The provider will follow up with the Care Manager
                     within three (3) working days of the assessment/estimate visit to discuss their
                     findings. The Care Manager will generate a service order based on an agreed upon
                     course of action based on the findings of the estimate visit. The Care Manager will
                     help with any special arrangements needed, such as the consumer leaving for a period
                     of time, preparation of the consumer for expected disruption, arrangements for others
                     to be there during the job, arrangements to get into the home, etc.

              b.     Special consideration is to be given to the type of supplies used in relation to their
                     potential for causing allergic or other reactions. If a consumer cannot be removed
                     during the extermination, the provider shall have alternate treatments available.

              c.     If, during the assessment visit, the provider observes work needed, but not requested
                     by PCA, they will contact the Care Manager to discuss the observations. The Care
                     Manager, prior to the provision of service, must approve any deviation from the
                     plan outlined during the evaluative visit by subsequently issuing a modified
                     service order.

              d.     Extermination supplies, and any other usual equipment needed, shall be the
                     responsibility of the provider agency and shall be reflected in the unit price
                     negotiated with the Business Administration Department of PCA.

       4.     EXTERMINATION SERVICE

              Extermination service is defined as an intervention required to eliminate infestation of
              roaches and related household insects, fleas, lice, mites, maggots, termites, and rodents.
              Extermination is a service that can be provided directly by a provider or through a
              subcontractor. Extermination may be requested exclusively or along with other chore
              services such as moderate or heavy cleaning. Extermination service consists of several
              categories of treatment identified as follows:

              a.     Assessment/Estimate: An overall estimate and assessment of the pest infestation, to
                     be completed prior to any authorized extermination service. An assessment
                     report (form) must be completed, identifying the problem, the proposed plan of
                     treatment, the expected duration of treatment, and outcomes leading to the problem’s
                     resolution.

              b.     Initial Extermination - Authorized intervention based on the plan of treatment
                     proposed as a result of the assessment that can include:




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              c.   Baseboard / Crack and Crevise Treatment – spray application of liquid type, low
                   odor insecticide, usually of a non-petroleum base, in all rooms in household.

              d.   Gel Application - Consists of thick brown gel, with a sweet odor that roaches find
                   appetizing. Gel bait advantages:

                   -      Food and dishes do not have to be removed from cabinets.
                   -      Odorless application is used so that consumer does not need to leave
                          premises.
                   -      Gel has a longer residual effect than a liquid application.

              e.   Rodents

                   (1.)   Treatment to place baits and glue traps in rodent pathways.
                   (2.)   Seal rodent entry holes with a foam sealant, mesh, or plugs.

              f.   Baiting – Baiting for roaches, water bugs, ants, etc, used when a consumer cannot
                   leave the house for a fogging/bombing, or has a respiratory problem.

              g.   Gnats and flies – require special catcher traps and different surface applications.

                   PCA expects extermination providers to treat the entire home in order to
                   maximize effectiveness of the intervention.

              h.   Follow up Extermination: An authorized repeat of the extermination treatment, on a
                   pattern basis, until the problem is resolved.

              i.   Special Extermination: Special extermination is a prior approved intervention to be
                   used when a severe infestation of the types of pests identified under the Initial
                   Extermination (B. above) is present. Note: a Special extermination service is
                   defined as an intervention that requires a completion time of between three (3)
                   and eight (8) hours. The provider will document the start and stop time of this
                   service through the use of time-slips or work logs. Special extermination is
                   authorized only after the completion of an assessment, which identifies the problem,
                   the proposed plan of treatment, and is subject to LTC’s policy and procedures
                   regarding the ordering of the service. Special extermination services should consist
                   of a different form of treatment and/or a different type of application.

                   Special Extermination Problems and Treatments

                   (1.)   Fogging/bombing – Fogging and bombing treatments, used especially in
                          such instances of severe infestation of roaches, fleas, mites, etc. The fogging
                          chemical is used to saturate and cover the area being treated. Consumer
                          precautions with this intervention include:

                          (a.)    Removal of foods and dishes from cabinets and cupboards.
                          (b.)    Close all windows and extinguish all pilot flames.
                          (c.)    Cover any fish tanks; remove all pets and clear baseboards for


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                                  application.
                          (d.)    Remain out of premises for three (3) to four (4) hours.
                          (e.)    Upon entering, ventilate household before re-entering.
                          (f.)    In the treatment of fleas, the following additional actions must be
                                  taken:
                                  (i.)     All floors must be swept or vacuumed.
                                  (ii.)    All carpets and furniture must be sprayed.
                                  (iii.) For maximum results, two treatments, seven to ten days apart,
                                           are recommended.
                          Note: treatment for flea infestation also requires the consumer and/or
                          caregiver to make arrangements for “dipping” all household pets, however
                          this would not be the responsibility of the extermination provider.

              2.   Termites: Wood destroying insects require putting a chemical barrier around the
                   premises, both interior and exterior. This process involves both drilling and
                   trenching, and any other intervention as deemed appropriate in the industry’s
                   certification standards. Provider must detail all proposed activity of the
                   intervention/treatment.

              j.   LTCO Policy and Procedures for Special Extermination

                   (1.)   In all cases Care Managers are to seek supervisory approval prior to
                          ordering/authorizing special exterminations (CHXS & CHXT). If the Care
                          Manager Supervisor or Registered Nurse Consultant is not immediately
                          available, the Care Manager must secure approval from the Assistant Director
                          prior to ordering/authorizing the service.

                   (2.)   Prior to ordering this service, Care Managers are to verbally verify with the
                          provider that the procedure will, in fact, take 3 – 8 hours to complete, per
                          contractual agreement.

                   (3.)   If unable to verify this required timeframe, Care Managers are not to order the
                          service. This outcome is to be reported to the immediate supervisor, who is
                          to communicate this via e-mail to the Assistant Director with a copy to the
                          Director. The Director is to e-mail all such reported instances to the Business
                          Administration Department, with a copy to the Deputy Director.

                   (4.)   Care Managers are to document all activity related to the above in the contact
                   log.

                   (5.)   To monitor compliance with this policy, billing information is to be
                          distributed to the supervisory/management personnel on a monthly basis.

       5.     REPORTING REQUIREMENTS

              a.   Service Activity Reports

                   (1.)   A consumer-by-consumer listing of all cases referred for service, estimated


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                          for service, or completed during the week, shall be completed by the provider.

                   (2.)   The report is to be kept on file at the agency for review by PCA during
                          regular monitoring, or it may be reviewed as a separate audit. Should there
                          be a concern or specific issue observed at the consumer’s home, it may be
                          indicated on the service report, and the provider may forward it to the LTC
                          Care Manager.

                   (3.)   Issues requiring immediate follow up should be communicated to the PCA
                          Care Manager. In their absence, the Care Manager Supervisor, the Nurse
                          Consultant or the Supervisor on call should be contacted. It is expected that
                          reporting requirements will be strictly adhered to.

                   (4.)   Service Activity Reports shall be the basis for invoicing submitted by the
                          provider agency. Figures on the Chore Service Activity Report are to be
                          based on dated time slips signed by the consumers and workers, which show
                          actual hours of work provided to each consumer, as indicated on the service
                          order. Appropriate information, including time slips, is to be maintained in
                          the provider agency’s records for justification of the reports submitted, and is
                          subject to periodic review by PCA staff.

              b.   The provider shall obtain the consumer’s signature (or that of other authorized
                   representative) on a time slip or other standardized form each time a service is
                   delivered to a PCA consumer. Consumers must be given a copy of the signed
                   form as a confirmation of delivery of service. It is recommended that providers
                   utilize multi-part forms so that the consumer can receive their copy as an
                   acknowledgement of the receipt of service on the given day.

       6.     STAFF QUALIFICATIONS

              a.   Exterminators:

                   (1.)   All Exterminators must pass the required state exam, possess a state license
                          with the category identified, i.e. commercial, pest control and/or termite, and
                          possess State registration. Exterminators must maintain Environmental
                          Protection Agency (EPA) tickets on file for all work done.

                   (2.)   Good physical and mental health, sensitivity to feelings and needs of others,
                          and maturity of attitude toward work assignment.

                   (3.)   Ability to work under supervision as an employee of the agency.

                   (4.)   Ability to communicate orally with the consumer.

                   (5.)   Honesty and good personal grooming habits.

                   (6.)   Assurance that there is no communicable disease.




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              b.     Administrative Staff:

                     (1.)   All of the above qualifications for Exterminators.

                     (2.)   Ability to complete required assessment forms, estimates and ancillary forms
                            accurately.

                     (3.)   Ability to give direction and training to assure compliance with PCA
                            standards, procedures, etc.

                     (4.)   Ability to organize and track the scheduling and completion of work.

       7.     TRAINING

              The extermination provider is expected to provide orientation for new workers before
              assignment to a PCA case. This may be done on a one-to-one basis, or in a group session.
              The orientation must include a description of the policies of the provider agency, and an
              introduction to the LTCO Program. Particular emphasis must be provided on the role of the
              Care Manager in developing the care plan and managing the consumer’s services. Ongoing
              communication with the Care Manager must also be highlighted.

       8.     ADMINISTRATIVE CHANGES

              When changes occur on the administrative level, the PCA Contract Manager is to be notified
              in writing, in advance, if known, or immediately upon such change.

       9.     COMMUNICABLE DISEASES

              a.     When caring for consumers with communicable diseases, PCA expects providers to
                     follow procedures recommended in the Center for Disease Control (CDC) guidelines
                     and OSHA Regulations. Agencies are responsible to provide appropriate in-services
                     regarding universal precautions. (A training tape is available from CDC upon
                     request. The CDC toll-free number is 1-800-232-4636.)

                     Provider is also required to provide appropriate protective articles such as, but not
                     limited to aprons, gloves, masks, and gowns as needed.

              b.     Based on CDC guidelines, the provider shall develop a written policy regarding
                     communicable diseases. That policy must meet State/Federal requirements.

              c.     The provider shall notify the PCA Nurse Consultant or Care Manager upon
                     determining or learning from another source, that a consumer has a communicable
                     disease.

              d.     Before being assigned to a case, and annually, all consumer-contact employees shall
                     have a Mantoux Intracutaneous PPD test according to CDC recommendations, and
                     if the results are positive, it will be followed by the appropriate Physician directed
                     treatment.


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                   In order to continue employment, the employee must be free of active TB.
                   Verification by a Physician that the employee is free of TB must be in the personnel
                   file and updated annually. Chest X-rays are required based on Physician advice.

              e.   All employees must be offered and/or receive the Hepatitis B Vaccine as designated
                   by OSHA Regulations.




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M.     HOME SUPPORT FINANCIAL MANAGEMENT: SERVICE SPECIFIC OPERATIONAL
       PROCEDURES

These Operational Procedures are in addition to the Home Support Service Standards as they relate
to financial management tasks. They delineate further expectations for providers serving
Philadelphia Corporation for Aging (PCA) consumers, of the Long Term Care (LTC) Program
which encompass the Options and the Aging Waiver payment sources. For other home support
tasks, refer to the Personal Care, Respite and Home Support Specific Operational Procedures along
with Home Support-Chore and Extermination Services.

       1.     SERVICE DEFINITION

              Home Support financial management service provides consumers with professional
              assistance in money management. Consumers will authorize Social Security and/or other
              income checks to be deposited directly into a financial institution via Durable Power of
              Attorney or Representative Payee relationship. Through this relationship, the service
              provider will facilitate the day-to-day money management and accurate bill paying. (NOTE:
              the scope of this service is not to be mistaken with that of the Financial Management
              Services (FMS), which was added to the Aging Waiver as part of the approved
              reapplication to CMS).

              The need for financial management services may be identified initially during the assessment
              process, through interviews between the care manager and the consumer/caregiver, or
              through observation by another service already in the consumer’s home. Consumers must
              have “capacity” to designate a Durable Power of Attorney. If a consumer’s capacity is
              uncertain, a psychiatric evaluation must be secured to assess capacity.

       2.     INTAKE

              a.     The care manager will request the consumer to select a provider from the Certified
                     Provider list.

              b.     The care manager will contact the chosen agency and make a financial management
                     service referral, detailing the consumer’s circumstances, needs resources, etc. After
                     reviewing the referral, the service provider will schedule and initial
                     assessment/enrollment interview in the consumer’s home.

              c.     Upon confirmation of Initial Evaluation visit, the care manager will generate a
                     service order, which will indicate the authorization for an initial visit. Note: Initial
                     Evaluations are not required for consumer transferred from Options to Aging Waiver,
                     who may be already receiving financial management services from the provider.

              d.     With the consumer’s acceptance of the service, the provider will proceed with
                     completion of the required authorization forms and/or documents needed for
                     enrollment. While all efforts will be made by the provider to complete the
                     enrollment during the initial assessment visit, additional contacts or visits may be
                     needed. Authorization for these additional visits is not required since they are


Eff. 7/1/09                                                                                                 104
                   factored into the initial assessment.

              e.   Upon the development and finalization of a financial management plan for the
                   consumer, the care manager will authorize a monthly management fee for the length
                   (or remaining months) of the six (6) month care plan. The care plan will be updated
                   and a service order generated.

       3.     SERVICE DELIVERY AND INVOICING

              a.   The provider will schedule the initial assessment authorized by the care manager and
                   develop a financial management plan. The initial assessment interview is to be
                   conducted at the consumer’s residence, within ten working days of the receipt of the
                   service order. The provider will forward to the care manager a copy of the proposed
                   financial management plan, within ten working days of the initial assessment visit.
                   Bill paying activity cannot begin until the direct deposit of the various sources of
                   income begins.

              b.   The provider will reconcile the individual consumer’s monthly statements from the
                   financial institution with the various activities delineated in the financial
                   management plan. A copy of the monthly statements will be forwarded to the
                   consumer.

              c.   The provider will furnish the care manager with semi-annual updates or progress
                   reports. Progress notes should include complete reassessment materials, care plans,
                   and projected budget of finances being managed. The Provider will forward a copy
                   of the Reassessment to the care manager within ten days after the Reassessment visit.

              d.   The provider will keep a case record on each consumer being served. It should
                   contain ongoing, chronological, dated record of all contact about or with the
                   consumer. The contact logs will document telephone calls, interviews, mail receipt,
                   and all contact with and/or about the consumer. The consumer file will include:

                   (1.)   Referral information;
                   (2.)   Initial assessment information, including: financial institution account
                          documents, consent and release forms, direct deposit arrangement records,
                          etc.;
                   (3.)   Financial institution material, including: monthly statements, payment
                          instructions, and automatic payment authorization;
                   (4.)   Copies of all bills;
                   (5.)   Fax documentation, correspondence, and contact logs;
                   (6.)   Account charges.

              e.   The provider should make monthly contact, by telephone, with the consumer or
                   consumer’s designee to assess any problems and/or respond to any questions.

              f.   The provider will invoice DPW (Aging Waiver) or PCA (Options) for an initial
                   assessment and management fee for the subsequent months.




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              g.   Providers are required to verbally report all incidents and follow up with a written
                   incident report; copies must be maintained in the consumer’s file.




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N.     PERSONAL CARE: STANDARDS

       1.     ACTIVITIES

              Personal Care is the provision in a consumer’s home of “hands-on” care related to a personal
              hygiene or functional activity of daily living that an individual cannot meet independently.
              Personal Care may only be provided in accordance with the care plan developed. The
              following list of activities can be considered in provision of this service:

              a.     Bathing - assistance to the consumer with bathing in the tub, shower or bed. (Totally
                     dependent, bedridden consumers who are unable to direct the bathing activity by the
                     Personal Care worker, and/or are unable to provide any assistance in washing
                     themselves or are unable to move independently in bed are not appropriate for
                     bathing by a Personal Care worker. However, when care is under nurse management,
                     a Personal Care worker can augment the medically supervised care as long as the
                     Personal Care tasks are limited to those allowed under the Personal Care definition.)

              b.     Skin Care - the routine application of lotion to unbroken, uninfected, undiseased skin
                     surface.

              c.     Mouth Care - assistance in care of teeth and mouth including care of dentures.

              d.     Dressing - includes assistance with clothing as well as application of previously self-
                     applied prostheses.

              e.     Grooming - includes hair care, shaving, cleaning and filing of nails. (The diabetic
                     consumer’s toe nails may not be cared for by the Personal Care workers.)

              f.     Toileting - includes assistance with transfers on and off commode or toilet, emptying
                     commodes and catheter bags.

              g.     Ambulation and Transfer - includes steady support and supervision to assist a
                     consumer with walking and transferring.

              h.     Change of Position or Turning Consumer - does not include range of motion
                     exercises, except when such care is under nurse management.

              i.     Feeding - which may also include mashing of food for easier management and/or
                     assistance in preparation and serving a meal.

              j.     Medication - assistance with self-administered medication. Assistance is limited to
                     reminding the consumer to take medications, placing medication within consumer’s
                     reach, obtaining the necessary equipment, pouring water for oral medication, opening
                     bottle caps, checking dosage, storing the medication and reassuring the consumer
                     that he/she has obtained and taken the correct dosage.

              k.     Observation - reporting of changes in consumer conditions and needs as observed
                     during performance of personal care.


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              l.     Instruction to Informal Caregivers - in the delivery of the above-listed activities.

                     Personal Care service may also include provision of supplemental housekeeping
                     service as long as the primary service rendered is for personal care. These activities
                     may include:

                     (1.)   washing dishes and clean-up after meal preparation,
                     (2.)   making beds and linen change for the consumer,
                     (3.)   shopping for the consumer,
                     (4.)   washing the consumer’s personal laundry,
                     (5.)   light housekeeping essential to maintaining a healthful living environment for
                            the consumer,
                     (6.)   preparing and serving nutritious meals,
                     (7.)   assistance with home and simple money management.

       2.     STANDARDS FOR PERSONAL CARE PROVIDERS

              Persons providing Personal Care services are usually Personal Care Aides, but can be Home
              Support Workers, who have been properly trained, Home Health Aides or Licensed Practical
              Nurses.

              a.     Qualifications and selection of Personal Care workers shall follow personnel policies
                     that include:

                     (1.)   A personal interview and required follow-up of personal and employment
                            references must be completed.

                     (2.)   Recruited workers must provide appropriate references:

                            a.      one verifiable work reference indicating a minimal length of
                                    employment of two years;

                            b.      one verifiable work reference if employed less than two years plus one
                                    verifiable personal reference;

                            c.      two references from instructors and/or supervisors from an acceptable
                                    homemaker training program;

                            d.      two verifiable personal references.

                     (3.)   There must be assurance of compliance with Title VI of the Civil Rights Act
                            of 1964, as amended, in recruiting.

                     (4.)   There must be assurance of applicant’s ability to read, write and follow
                            simple instructions.




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                     (5.)    In order to make available a variety of competencies, efforts should be made
                             to recruit Personal Care workers with knowledge of language and/or skills
                             which address the special needs of older chronically ill individuals.

                     (6.)    Agencies that provide Personal Care services must assure that Personal Care
                             workers comply with federal, state and local health requirements related to
                             communicable diseases. All field staff must receive a PPD test - the results
                             of which are maintained in their files.

                     (7.)    Personal Care workers shall receive a copy of a job description, personnel
                             policies and wage scale for workers at the time of their employment and when
                             there is a revision or change in these policies.

                     (8.)    Wage scale shall be in conformity with applicable minimum wage laws.
                             Compensation for overtime work shall be provided in accordance with
                             current federal and state law.

                     (9.)    The AAA is responsible for assuring that provider agencies will schedule and
                             serve all consumers authorized for service without regard to race, religion,
                             national origin, age, physical condition, functional limitations or medical
                             diagnosis.

       3.     TRAINING STANDARDS

              Each person providing Personal Care service shall be trained for all services to be
              performed.

              a.     Such training shall be given in an organized course and include content related to:

                     (1.)    orientation to the service,
                     (2.)    interpersonal skills and understanding family relationships,
                     (3.)    working with older persons,
                     (4.)    personal care and rehabilitative care skills,
                     (5.)    care of the home and personal belongings,
                     (6.)    safety and accident prevention,
                     (7.)    home, time and money management,
                     (8.)    food nutrition and meal planning.

              b.     For each broad area of the training and appropriate professional shall provide
                     instructions. A registered nurse (RN) must provide the skills training in personal
                     care techniques.

              c.     Evidence of proficiency in skills and completion of training course shall be
                     documented in the Personal Care worker’s personnel file.

              d.     No Personal Care service may be rendered by a Personal Care worker prior to
                     demonstration of his/her competency in performing the specific service assigned.




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              e.     The requirement for completion of the 40-hour training requirement may be waived
                     if the Personal Care worker:

                     (1.)    Provides documentation of completion of related training that includes
                             demonstrated competency in all skill areas.

                     (2.)    Is able to demonstrate to the provider agency competency in all skill areas
                             included in the basic training and that observation of the competency is
                             documented.

              f.     AAA shall ensure that each individual Personal Care worker is in compliance with
                     basic training, competency and in-service requirements. Methods may include:

                     (1.)    Required submission by the trainer of documentation for each worker
                             attesting to proficiency in required skills.

                     (2.)    Required submission by Personal Care worker of a certificate of course
                             completion.

                     (3.)    Periodic review of personnel records of contracted agencies to verify
                             documentation of training and/or skill proficiency.

       4.     SUPERVISION STANDARDS

              A Registered Nurse must be included in the supervision of all Personal Care workers. A
              nurse supervisory review visit is made to the consumer’s home, on assignment of the
              Personal Care Aide to the consumer, then every ninety days thereafter. If the Case Manager
              determines that the consumer needs more frequent nurse supervisory review visits because
              of a fragile or unpredictable medical or functional condition, the Case Manager has the
              flexibility to require that the visits occur more often than the 90 day interval. This decision
              must be reflected in the consumer’s care plan.

              The purpose of the on-site, in-person nursing supervisory review visit is to review the status
              of the consumer, to review the services recommended by the site, to identify special care
              instructions or training requirements for the aide assigned to the case, to be able to establish
              schedules and give assignments to the aide, to monitor aide performance, to provide for
              continuity of care with other involved caregivers and to review specific consumer needs with
              service implications. Although not required, it is encouraged that if convenient and feasible,
              Registered Nurse supervisory review visits be made to the consumer’s home with the
              Personal Care Aide present.

              As part of the nurse supervisory review visit, the R.N. is responsible for identifying changes
              in the consumer’s status and/or needs and a review of the Provider's plan of service to
              include a professional recommendation on the appropriateness of the service rendered. This
              portion of the report should be shared with the Care Manager and the physician of record.
              The report should also include a Personal Care worker daily log of service which indicates
              arrival and departure time, specific services provided and tasks performed and comments




Eff. 7/1/09                                                                                                110
              and observations about the consumer’s response to service. This portion of the report should
              also be shared with the Care Manager.

              When there is more than one agency involved in providing care to the consumer, combined
              supervisory visits with the Home Health Agency Registered Nurse may be made with the
              aide(s) to provide for coordination of care.

       5.     RECORDS AND DOCUMENTATION

              Records shall be maintained for each individual for whom the service is provided and shall
              be maintained in a confidential manner. All entries by the Personal Care worker and the
              supervisor shall be signed and dated. Individual time slips must be signed by the consumer
              or family member/caregiver and the personal care worker to document each unit of service
              billed.

              a.     The record should contain:

                     (1.)    data that identify the consumer,

                     (2.)    current care plan,

                     (3.)    the written assignment to the worker,

                     (4.)    Personal Care worker daily log of service which indicates arrival and
                             departure time and specific services provided,

                     (5.)    worker's comments and observations concerning the consumer’s condition
                             and his/her response to service including the reporting of changes and/or
                             problems to the supervisor,

                     (6.)    a record of supervisory visits,

                     (7.)    statements of any change in consumer’s condition as observed and reported
                             by the Personal Care Workers and acknowledged by the supervisor;

                      (8.)   statements of follow up taken by the supervisor, including reporting to the
                             Care Management Unit of the AAA.

       6.     SERVICE REPORTING

              Persons providing Personal Care services must comply with all reporting requirements as
              specified by the Area Agency on Aging.

       7.     SCHEDULING

              Days and times scheduled for Personal Care services must be consistent with the Care Plan
              provided by the AAA.




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        8.    INSURANCE

              Agencies who wish to provide Personal Care services will be required to attest to having the
              following types of insurance in amounts consistent in the industry:

              a.     General liability;
              b.     Professional liability;
              c.     Automobile liability covering owned, non-owned and hired vehicles;
              d.     Workman Compensation as required by law;
              e.     Employer’s liability of accident and disease.

       9.     CONFIDENTIALITY

              All agencies who provide Personal Care services must comply with all federal, state and
              local laws relating to research on human subjects and consumer confidentiality.

              Agencies must provide all Care Managers with consent forms and approval from all
              appropriate review boards for those consumers who wish to be part of a research study.




Eff. 7/1/09                                                                                             112
O.     PERSONAL CARE, RESPITE, COMPANION, AND HOME SUPPORT: SERVICE
       SPECIFIC OPERATIONAL PROCEDURES


These Operational Procedures are a supplement to the Personal Care, Respite, Companion and
Home Support Standards. They delineate further expectations for providers administering care to
Philadelphia Corporation for Aging (PCA) consumers, of the Long Term Care (LTC) Program
which encompass the Options and Aging Waiver payment sources. When there is a difference
between Personal Care, Respite, Companion or Home Support Standards and the PCA’s Service
Specific Operational Procedures, the more stringent requirement prevails. (For consistency, the
providers’ Personal Care, Respite, Companion and Home Support workers are herein referred to as
“aides”).

Personal Care Agencies must be licensed/registered by the Pennsylvania Department of Health under
Act 69 of 2006 and Title 28 Pa. Code Chapter 51.

       1.     INTAKE

              a.    The Care Manager contacts the provider, selected by the consumer, to make the
                    initial referral. The request for service will be based on a plan of care developed by
                    the LTC Care Manager in conjunction with the consumer and/or caregiver. The plan
                    will identify tasks to be performed and specific days and times for service. Once a
                    referral is made, provider must contact the Care Manager within two (2)
                    business days if unable to meet the request. If a Community Choice referral
                    requires immediate service start-up, the provider is to be able to give the Care
                    Manager a response within that day.

                    NOTE: Providers must keep the PCA Contract Manager current on their
                    capacity to provide services. They must notify the PCA Contract Manager
                    immediately when having difficulty providing service in their designated service
                    area(s), experiencing staffing problems, or when experiencing any other
                    problems that impact their ability to accept referrals and/or deliver service to
                    PCA consumers.

              b.    LTC staff will telephone personal care providers to make the initial referral. A
                    service authorization – Service Order, will be forwarded to the provider upon
                    acceptance of the referral.

              c.    A copy of the LTC Personal and Home Management Care Plan will be left in the
                    consumer’s home, and a copy will be forwarded to the provider electronically, with
                    the service order, via the PCA website. This plan includes the tasks to be performed
                    and the specific days and times for the visit. Any errors or questions regarding the
                    information on both the Service Order and the Personal and Home Management Care
                    Plan must be immediately brought to the attention of the PCA care manager. Please
                    note: care plans will only be sent with the initial or modified Service Orders. Also,
                    Personal care services cannot be provided at the same time as Personal Assistance
                    Service, Home Support Service, Home Health Aide Service, or Companion Service.


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              d.   PCA will order service for specific blocks of time, i.e. number of hours and number
                   of days per week, to provide specific personal care tasks. Generally, it is expected
                   that service will be provided in one, two, three, or four hours blocks of time,
                   depending on the actual needs of the consumer. Service will usually be requested
                   between the hours of 8:00 a.m. and 6:00 p.m.; however, on occasion, service will be
                   requested before or after the latter times, and PCA expects the provider agency to
                   have the capacity to meet this need.

              e.   For consumers who are authorized to receive Home Support only, the frequency for
                   the ongoing support activities should not (in most cases) be more than once or twice
                   per month.

       2.     SCHEDULING

              a.   If the provider cannot meet the service request within 5 working days from receipt of
                   the service order or earlier for those Community Choice cases that require service to
                   start within 24 to 72 hours, the Care Manager will refer the consumer to another
                   personal care or home support agency of the consumer’s choice.

              b.   It is expected that service will be provided on Saturdays, Sundays, holidays, and
                   evenings if requested. Reimbursement is at the same rate as daily service. Service
                   must be rendered to consumers in accordance with the care plan and service order.

              c.   The initial visit must occur within a maximum of five working days from receipt of
                   the service order. The provider agency will notify the Care Manager of the start date
                   and the name of the worker. In cases where the initial visit will be delayed,
                   notification of the delay shall be reported to PCA immediately. Providers must
                   check eligibility for all newly assigned Aging Waiver consumers prior to the
                   initiation of service. Any problems with eligibility must be communicated to the
                   PCA Care Manager and service should not begin until the issue is resolved. Should
                   PCA become aware of a change in the consumer’s eligibility, it will be
                   communicated to the provider.

              d.   Aides must continue on the same case at the days and times ordered. Should the aide
                   fail to provide service at the assigned time, the provider agency is expected to
                   provide a substitute worker on the day, and at the approximate time scheduled.
                   When changes are made, both the consumer and the Care Manager must be
                   notified.

              e.   Should additional time be needed than what is authorized, the provider must call the
                   Care Manager for authorization and an updated service order. Provider will only be
                   reimbursed for authorized delivered service. Providers may not invoice for
                   staff travel time to and from a consumer’s home.

              f.   Aides must not be assigned to relatives and friends in the provision of service to
                   PCA consumers. Service cannot be provided by a legally responsible person,
                   relative, or legal guardian.




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              g.   No scheduling arrangements are to be negotiated between aides and
                   consumers/caregivers. It is expected that all modifications to the schedule be
                   done by the appropriate administrative personnel.

       3.     IDENTIFICATION AND CONDUCT OF STAFF

              a.   All field staff is required to wear professional attire, and be given provider
                   issued photo identification cards. Photo identification must be shown prior to
                   entry into consumers’ homes.

              b.   Aides are not permitted to bring family members or friends to the consumer’s home.

              c.   Aides are not permitted to disseminate neither the consumer’s telephone number nor
                   any other personal information.

              d.   Aides are not permitted to eat consumers’ food, use toiletries, or use other personal
                   items. Use of consumers’ phones must be restricted to business use only, with
                   permission from consumer, and used sparingly. No personal calls are allowed.

              e.   Aides are not permitted, under any circumstances, to reside with PCA consumers.

              f.   Transportation: aides are not permitted to transport a consumer in either the worker's
                   car or a consumer's car. When it is necessary for an aide to use public transportation
                   or her/his own car to perform required duties, and it is agreed upon by the consumer,
                   the consumer is responsible for paying the transportation costs, if additional expense
                   is incurred. (Those costs shall not exceed SEPTA's current round trip bus fare, and
                   the trip must be within a 10-block radius.)

       4.     SUPERVISION

              a.   Supervision of the aides shall be performed directly by a Registered Nurse (RN)
                   Field Supervisor, who is capable of demonstrating and teaching all personal care,
                   respite, companion or home support activities, as ordered on the care plan. The RN
                   must have two years of professional work experience in a health care related
                   capacity. If less than two years, the RN must provide one work reference and one
                   personal reference.

                   Note: in those instances where the consumer is receiving Home Support Services
                   only, field supervision can be provided by a designated person with appropriate
                   training and work experience related to the service being provided.

              b.   The RN or designated Field Supervisor is required to visit each new consumer’s
                   home on the first day of service to review the care plan and to observe the
                   worker providing care. A new consumer is one who is new to the provider agency,
                   and/or to the aide.

                   PCA requires supervision of the aide, with the worker present during
                   supervision, at a minimum of every 90 days; this is also applicable for those


Eff. 7/1/09                                                                                           115
                   receiving Respite, Companion or Home Support Services only. The RN Field
                   Supervisor or designated field supervisory staff visits each consumer to determine
                   the effectiveness of service given, including:

                   (1.)   Assuring the worker arrives at and leaves the consumer’s home as scheduled;
                   (2.)   Making sure the worker satisfactorily accomplishes the tasks outlined in the
                          care plan;
                   (3.)   Being aware of changes in the consumer’s needs/and or circumstances, and
                          reporting these changes promptly to the provider agency and the Care
                          Manager.

                          (a.)    In instances where the RN or designated Field Supervisor is
                                  unavailable to supervise the aide on the first day of service, and
                                  the aide is available to staff the case, the provider may accept the
                                  referral. However, the RN or designated Field Supervisor must be
                                  present during one of the first three visits to supervise the aide.
                                  Both the aide and the RN or designated Field Supervisor must be
                                  present during that supervisory visit.

                          (b.)    Supervisory requirements are waived for cases receiving escort
                                  service only.

              c.   Home Health providers involved in the provision of personal care service are
                   expected to continue supervising aides in a manner consistent with the Centers for
                   Medicare and Medicaid Service guidelines, as well as any other regulatory guidelines
                   governing Home Health agencies. In such instances, supervision of ides is expected
                   every 60 days.

                   A report must be completed by the RN or designated Field Supervisor for each
                   consumer, on the effectiveness of activities carried out by the personal care worker
                   (aide). The report includes changes noted by the aide and observed by the Field
                   Supervisor in the consumer’s home. It is expected that the consumer or caregiver,
                   the RN and the aide sign the report. This report will be used to ascertain provider
                   agency compliance with each care plan, monitor consumer progress, and document
                   that the Supervisor visited each consumer. The report must be kept on file at the
                   agency for review by PCA during regular monitoring, or it may be reviewed as a
                   separate audit. Should there be a concern or specific issue observed at the
                   consumer’s home, it may be indicated on a Personal Care Supervisory Report, and
                   the provider may forward it to the PCA Nurse Consultant. Items requiring
                   immediate follow up should be communicated to the PCA Care Manager. In
                   their absence, the Care Manager Supervisor, the Nurse Consultant or the Supervisor
                   on call should be contacted. The Supervisor on call is available from 8:30 a.m. -
                   5:00 p.m. Monday through Friday, to address any concerns that may arise in the Care
                   Manager's absence.

              d.   Collaboration between the RN or designated Field Supervisor and PCA Care
                   Manager is expected, to assure quality care. Communication is expected when there
                   is a significant change in the consumer’s condition, as well as in the following


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                     conditions:

                     (1.)    When there are complaints;
                     (2.)    When other services such as meals, transportation, etc. are not received;
                     (3.)    When the consumer is hospitalized; or
                     (4.)    When there is an incident.

              e.     PCA requires supervision of Home Support and Respite workers at a minimum of
                     every 90 days, with the worker present, as indicated above for aides.

              f.     Care Management staff reserves the right to request that a provider conduct more
                     frequent supervision of staff, on a case by case basis, as needed.

              g.     Each provider is expected to have established clear policies related to the supervision
                     of staff. The above supervisory requirements are in no way intended to waive a
                     provider’s responsibility for supervision of staff and being accountable for its staff.

       5.     PERSONAL CARE TASKS (Activities of Daily Living - ADLS)

              a.     Before assigning an aide to perform tasks, their competency and judgment to perform
                     the tasks safely, effectively, and completely must be evaluated and affirmed by their
                     RN Field Supervisor. An RN evaluation of an aide’s competency and judgment prior
                     to assignment is not necessary for licensed CNS staff.

              b.     For a detailed listing of allowable tasks, please refer to the Personal Care, Respite,
                     Companion and Home Support Standards.

       6.     HOME SUPPORT TASKS

              Personal Care or Home Support service may also include provision of supplemental
              housekeeping service, as long as the primary service rendered is for personal care. These
              tasks are provided to persons who are unable to perform some or all of the tasks needed to
              manage their home, where no resource (or only partial help) in the family or community
              exists, or where respite is needed. As with personal care tasks, these tasks will vary from
              case to case, as indicated on the care plan, and can include:

              a.     Meal preparation and serving;
              b.     Housekeeping - maintenance of areas used by consumer, to keep the environment in
                     state of cleanliness and safety;
              c.     Damp-mopping floors;
              d.     Dusting and sweeping;
              e.     Vacuuming;
              f.     Changing bed linens;
              g.     Day-to-day cleaning of the refrigerator (including routine defrosting and assisting the
                     consumer in discarding spoiled food), stove, oven and other appliances;
              h.     Cleaning of kitchen and bathroom (including portable commodes);
              i.     Trash and garbage disposal;




Eff. 7/1/09                                                                                               117
              j.   Personal laundry, including bed linens and towels, washed in the most efficient way,
                   at the closest suitable location for the aide, if there is no washer/dryer;
              k.   Marketing, in the most suitable location with consideration to economy and
                   efficiency;
              l.   Local errands and/or assistance with food shopping within the neighborhood;
              m.   PCA does not expect the worker to assist consumers with financial management.
                   Aides are not permitted to cash, write, or deposit checks for consumers,
                   purchase money orders, use consumer credit/debit cards for purchases, or be
                   given more than $50.00 at one time to market or assist with local errands. Receipts
                   must be presented to consumers for any purchase made.
              n.   Escort, as identified and/or arranged by the Care Manager. Note: aides are not
                   permitted to transport a consumer in either the worker's car or a consumer's
                   car.

       7.     SERVICE VERIFICATION

              a.   PCA requires that subcontractors obtain a sample, for verification purposes, using a
                   staff member other than the person providing service, of each consumer’s signature
                   at the time service is initiated. If the consumer cannot sign, the signature of a person
                   authorized to sign is to be obtained. The authorized person must sign their own
                   name each time and indicate they are signing for the consumer. An aide signing the
                   consumer’s name to a slip will be considered fraud and is strictly prohibited.

              b.   The provider shall obtain the consumer’s signature (or that of other authorized
                   representative) on a time slip or other standardized form each time a service is
                   delivered to a PCA consumer. Consumers must be given a copy of the signed
                   time slip or form as a confirmation of delivery of service. It is recommended
                   that providers utilize multi-part forms so that the consumer can receive their
                   copy as an acknowledgement of the receipt of service on the given day.

                   Note: provider use of electronic / telephony systems in place of the consumer
                   signature process, described throughout this section, is possible only with PCA
                   prior written approval.

              c.   These signed receipts are to be cross-checked with the sample signature and be kept
                   in consumer files or with the billing documents at the subcontractor’s office as this
                   requirement will be audited by PCA’s internal and external auditors. No payment
                   claim is to be submitted to PCA or MA without a signed receipt for each individual
                   item or service. Any questionable or missing signatures during an audit by PCA or
                   other authorized agent will result in a deduction in the amount billed from the next
                   invoicing period.

              d.   The time slip must clearly identify the consumer served, the worker providing the
                   service, the time service started and ended, including whether A.M. or P.M., the
                   dates of service, and consumer’s signature each time service was rendered. Time
                   slips for consumers receiving multiple services must clearly indicate service time for
                   the specific service provided; e.g. personal care hours versus companion hours, etc.




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              e.   Providers are required to use a scheduling system for each aide visiting PCA
                   consumers. That schedule shall identify the aide’s name, each consumer to be
                   visited, date, starting and ending time, travel time between visits and break
                   time. Each aide’s schedule, combined with the daily time sheets, must back-up
                   that worker’s payroll records and hours billed to PCA and/or MA.

       8.     STAFF QUALIFICATIONS AND TRAINING

              a.   All aides must have good physical and mental health, as evidenced by a Statement of
                   Good Health, from a Physician, which will be made part of the personnel file; and
                   they must demonstrate maturity of attitude toward work assignment.

              b.   Orientation: Personal Care workers (aides) assigned to PCA consumers must
                   meet State standards of certification and have experience with the elderly. The
                   provider agency is expected to provide orientation for new aides before
                   assignment to a case. This may be done on a one-to-one basis, or in a group
                   session. The orientation must include a description of policies of the provider
                   agency, and an introduction to the PCA LTC Program, with particular
                   emphasis on the care plan and the need for strict adherence to
                   tasks/days/hours/and role of the Care Manager.

                   Please note: training requirements are subject to, and superseded by, those
                   regulatory requirements stipulated in Act 69 for Home Care Agencies.

              c.   Certificate Training

                   (1.)   To assure the highest quality of service possible, prior to assignment to PCA
                          cases, all aides must:

                          (a.)   Receive a certified training of at least forty (40) hours from the
                                 provider agency; or
                          (b.)   Possess a training certificate comparable to the training content
                                 outlined; or
                          (c.)   Be listed in good standing on the Nursing Home Aide Registry.

                   (2.)   On- the-job training is not to be included in meeting the forty (40) hours
                          requirement, but specific practice in performing tasks is to be included. In
                          order to assure the validity and consistency of the training, PCA has elected
                          to require that “National Home Care Aide Certification Program", developed
                          by the National Association of Homecare be used by all provider agencies.
                          The curriculum can be obtained by contacting the Home Care University, 228
                          Seventh Street SE, Washington, DC 20003. As an alternative, provider
                          agencies who provide Home Health Aides to Medicare certified Home Health
                          Agencies may substitute a training program, approved by the Home Health
                          Agency, that meets the “Personnel Qualifications" specified in the Medicare
                          Regulations for Home Health Agencies, Federal Register/Vol. 56, No. 138,
                          section 484.4 and the “Conditions of Participation: Home Health Aides
                          Services" specified in the Medicare Regulations for Home Health Agencies,


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                          Federal Register/Vol.54, No. 153, section 484.36 (a).

                          Please note: training requirements are subject to, and superseded by,
                          those regulatory requirements stipulated in Act 69 for Home Care
                          Agencies

                   (3.)   Agency records must include documentation of the certificate training
                          program, which the aide has completed.

                   (4.)   Current Employees -In order to be allowed to continue to serve PCA
                          consumers, all aides, currently employed by the provider agency, who do not
                          possess a training certificate consistent with c. above, must be enrolled in and
                          complete no later than 6 months following signing of a contract with PCA for
                          the then current fiscal year, a certified training course consistent with the
                          requirements in this section. Until such training is completed, aides cannot
                          care for PCA consumers.

                   (5.)   In-Service Training

                          (a.)    In-service training sessions must be offered to all aides at least
                                  quarterly. The training curriculum should be kept on file and will be
                                  reviewed by PCA during regular monitoring.

                          (b.)    In-service training should include:

                                  (i.)     Follow-up in content areas introduced in certificate training;
                                  (ii.)    Relevant trends in service delivery;
                                  (iii.)   Content areas based on identified problems of aides in
                                           providing service;
                                  (iv.)    Programs on agency policies and procedures are necessary but
                                           should not constitute the majority of the sessions.

                          (c.)    In-service sessions may be conducted by the agency or may
                                  include attendance at outside seminars.

       9.     ADMINISTRATIVE STAFF QUALIFICATIONS

              a.   Sufficient administrative staff shall be employed to insure the efficient and effective
                   provision of service. Experience has shown that a ratio of 100 to 125 consumers per
                   Office Coordinator (and Field Supervisor) allows for provision of adequate service.

              b.   Coordinators and Field Supervisors are expected to be familiar with the aged and
                   chronically ill, and be sensitive to consumer needs and living situations; thus
                   assuring awareness and ability to match aide with consumer needs. Specific
                   requirements for the RN Field Supervisor are listed under “Supervision” on page 3.




Eff. 7/1/09                                                                                            120
       10.    STAFFING

              a.   When a change occurs on the administrative level, the PCA Contract Manager is to
                   be notified in writing, in advance if known, or immediately upon such change. When
                   the change involves a change in administrative or supervisory personnel, curriculum
                   vitae for the new employee shall be included with the written notification.

              b.   The provider agency shall maintain sound personnel policies to minimize personnel
                   turnover, which would adversely affect the delivery of service. Experience has
                   shown that turnover may be minimized by providing competitive wages
                   commensurate with the required job skills, as well as incentives (in the form of
                   bonuses and/or fringe benefits) for workers who have given continuous and
                   satisfactory performance.

              c.   Providers must submit any exceptions to PCA staff requirements to the
                   Contract Manager in the Business Administration Department for review.
                   Submissions may be done by mail, e-mail, or fax. Staff is not to be assigned to
                   provide services to PCA consumers until an exception has been reviewed and
                   approved.

              d.   RN Field Nurses and administrative staff with contract oversight responsibility
                   must attend a PCA Orientation. While the nurse is encouraged to attend the
                   orientation before serving a PCA consumer, some flexibility is permitted. If provider
                   can demonstrate that the nurse will be closely supervised while waiting to attend the
                   orientation, the nurse may serve PCA consumers and attend the next scheduled PCA
                   training. Their resume must be submitted to the PCA Contract Manager and/or the
                   Program Review Nurse prior to attending the Orientation.

              e.   PCA reserves the right to request the provider to remove individual staff from
                   providing care to specific consumers, or from seeing any PCA consumers.

       11.    RECRUITMENT OF STAFF

              a.   Providers shall establish an effective ongoing program of staff recruitment
                   procedures. Experience has shown that face-to-face involvement between the
                   Scheduling Coordinator and aide, during the recruitment process, facilitates the best
                   provision of service.

              b.   When recruiting staff, applicants who meet the following requirements, shall be
                   given priority: public assistance recipients and individuals of minority groups,
                   including men and elderly persons.

              c.   Aides may be recruited for either full or part-time service in accordance with the
                   demands of the agency, and the ability of the aide to meet full or part-time
                   assignments.

              d.   Individuals with special knowledge, such as different cultural backgrounds,
                   languages, or experience with various groups of older or chronically ill persons, shall


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                   be sought by the provider in order to make available a variety of competencies to
                   meet special situations.

       12.    COMMUNICABLE DISEASES

              a.   When caring for consumers with communicable diseases, PCA expects provider
                   agencies follow procedures recommended in the Center for Disease Control (CDC)
                   guidelines and OSHA regulations. Agencies are responsible to provide appropriate
                   In-services regarding universal precautions. (A training tape is available from CDC
                   upon request. The CDC toll-free number is 1-800-232-4636.)

                   Provider agencies are also required to provide appropriate protective articles such as,
                   but not limited to, aprons, gloves, masks, and gowns as needed.

              b.   Based on CDC Guidelines, the provider shall develop a written policy regarding
                   communicable diseases. That policy must meet State/Federal requirements.

              c.   The provider shall notify the PCA Nurse Consultant or Care Manager upon
                   determining or learning from another source, that a consumer has a communicable
                   disease.

              d.   The provider must follow CDC and OSHA Guidelines regarding the disposal of
                   contaminated needles.

              e.   Before being assigned to a case, and annually, all consumer-contact employees shall
                   have a Mantoux Intracutaneous PPD test according to CDC recommendations.
                   If the results are positive, it must be followed by appropriate physician directed
                   treatment.

                   In order to continue employment, the employee must be free of active TB.
                   Verification by a Physician that the employee is free of TB must be in the personnel
                   file and updated annually. Chest X-rays are required based on physician's advice.

              f.   All employees must be offered and/or receive the Hepatitis B Vaccine as designated
                   by OSHA Regulations.




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P.     PERSONAL ASSISTANCE SERVICE (PAS): SERVICE SPECIFICATIONS


       1.     Definition

              Personal Assistance Service (PAS) is in-home personal care and other approved support
              activities for consumers with functional disabilities who need assistance to accomplish daily
              living tasks. The service consists of those basic and ancillary services, which enable eligible
              consumers to live in their own homes and communities rather than institutions and to carry-
              out functions of daily living, self-care, and mobility. Primarily, the consumer if he/she were
              physically able, or family/friends, if available, would carry out these activities.

              Personal Assistance Service is available for eligible consumers in both the Aging Waiver
              and Options programs.

       2.     Aging Waiver PAS Standards

              An individual with an assessed need for PAS shall have a choice of directing a portion of
              his/her care or having an agency direct the care.

              Individuals who are assessed as being cognitively able to direct a portion of their own care
              and are willing to do so may manage certain aspects of their care or choose to have a
              caregiver direct the care. The caregiver may not be a paid personal assistance worker.

              An individual who is assessed as being cognitively impaired must not direct his/her own
              care. Such an individual may have a caregiver or legally authorized surrogate who is willing
              to direct the care. The caregiver or legally authorized surrogate may not be a paid personal
              assistant.

              a.     Services

                     Personal assistance services shall include primarily “hands-on” personal care
                     assistance with one or more of the following basic activities in order to maintain the
                     personal care of one’s self, regardless of who provides the assistance:

                     (1.)    Getting in and out of bed, wheelchair, or motor vehicle;
                     (2.)    Ambulating, with or without mechanical aids, inside the home;
                     (3.)    Routine bodily functions, including eating or feeding (including meal
                             preparation and clean-up) and toileting;
                     (4.)    Bathing, dressing, personal hygiene and grooming; and
                     (5.)    Health maintenance activities (i.e. insulin injections, medication
                             administration -and skin care).

              b.     Health maintenance activities are activities that are necessary to maintain the
                     consumer’s optimum health, as directed by the physician responsible for the
                     consumer’s medical/health plan of care.

                     Unless determined otherwise by the assessment and agreed to in the care plan, the


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                   consumer will direct and supervise the PAS worker in the specified health
                   maintenance activities under the following conditions:

                   (1.)   The consumer has indicated that he/she has been adequately instructed by the
                          appropriate health professionals and is thereby qualified and able to instruct
                          and supervise his/her PAS worker in health maintenance activities. A
                          statement to this effect is included in the care plan.

                   (2.)   At the consumer’s request, the PAS worker will be instructed in health
                          maintenance activities by health professionals as arranged by the provider
                          agency or PCA.

                   (3.)   The PAS worker is instructed and monitored in health maintenance activities
                          by the consumer, the consumer’s physician, and/or health professional as
                          appropriate.

                   (4.)   The provider or PCA, as appropriate, will monitor the PAS worker’s
                          performance of health maintenance activities during monitoring visits and
                          through consultation and input from the consumer regarding his/her
                          satisfaction with the service.

                   (5.)   The consumer has appropriate arrangements in place to respond to health
                          emergencies and back-up services; a statement to this effect is included in the
                          care plan. Information on the arrangements for health emergencies is also
                          made available to the PAS worker(s) either by the consumer, provider, or
                          PCA, as appropriate.

                   (6.)   The consumer, the PAS worker(s) and others who have committed to provide
                          health maintenance activities must sign the care plan. Copies of the care plan
                          should be given to all persons providing health maintenance activities.

                   (7.)   If at any time there is an indication that the health maintenance activities are
                          not being carried out adequately by the PAS worker or not being adequately
                          supervised by the consumer, the provider or PCA has the right and
                          responsibility to intervene and recommend appropriate corrective measures.

              c.   Supplemental Services

                   Home support services, including but not limited to, shopping, laundry, cleaning and
                   seasonal chores.

                   Companion-type services including, but not limited to, assistance with transportation,
                   reading, and letter writing.

              d.   Backup Services

                   For those consumers who choose to direct their care and not opt for the agency model
                   (see Service Delivery Options below), PCA shall require the consumer to take


Eff. 7/1/09                                                                                             124
                   primary responsibility for arranging backup services. The use of family, friends and
                   neighbors shall be encouraged since these sources are dependable and usually
                   available on short notice. In the event the consumer is unable to arrange for backup
                   services, PCA or its subcontractor will be responsible to provide basic services, as
                   defined in the definitions section of this policy, to the consumer until the regular
                   personal assistance worker returns. A written statement describing the consumer's
                   arrangement of backup services must be included in the care plan.

                   The consumer shall take primary responsibility for arranging back-up services,
                   especially in priority-care situations/conditions. (Priority care is defined as care
                   needed by consumers to fulfill their basic service needs. Priority care does not
                   include supplemental services.) The use of family, friends and neighbors shall be
                   encouraged since these sources are dependable and usually available on short notice.

                   The provider remains ultimately responsible for ensuring that basic services are
                   provided when a consumer’s back up fails. Consumers are responsible for notifying
                   the provider promptly when back-up and priority situations arise or when the
                   consumer’s back-up system changes. Provider response to these situations should be
                   within a reasonable time frame (one to three hours).

                   The scheduling of PAS will be responsive to the special needs of consumers as
                   appropriate and is to be made available on weekends and after normal working hours.

              e.   Personal Assistance Worker Specifications

                   PAS workers are usually neither licensed nor registered nurses. A PAS worker is
                   someone chosen by the consumer or legally authorized surrogate to meet his or her
                   individualized service needs. PAS workers may be friends and/or relatives of the
                   consumer, but may not be spouses (including common-law spouse), minor children,
                   legal guardian, or power of attorney. All PAS workers, including friends and
                   relatives, must meet the following qualifications:

                   (1.)   Be 18 years of age or older;
                   (2.)   Have the required skills to perform personal assistance services as specified
                          in the consumer’s service plan;
                   (3.)   Possess basic math, reading, and writing skills;
                   (4.)   Possess a valid Social Security number; and,
                   (5.)   Be willing to submit to and pass a criminal record check.
                   (6.)   When required by the consumer, the personal assistance (attendant care)
                          worker must be able to demonstrate the capability to perform health
                          maintenance activities specified in the consumer’s service plan or be willing
                          to receive training.

              f.   Service Delivery Options

                   Based upon their assessed ability and competency, consumers should be given the
                   option of choosing a service delivery model which best meets their needs. At a
                   minimum, PCA is required to offer consumers one of the PAS service delivery


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              models described below and are encouraged to develop the capacity to implement the
              combination model. The service delivery option must be described in the consumer’s
              care plan.

              (1.)   Combination Model

                     (a.)   The consumer chooses to manage certain aspects of his/her PAS,
                            including:

                            (i.)     Recruiting, hiring and training personal assistance workers.
                            (ii.)    Defining personal assistance workers’ duties and work
                                     schedules.
                            (iii.)   Supervising personal assistance workers regarding how and
                                     when specific tasks are to be completed.
                            (iv.)    Disciplining and discharging personal assistance workers.

                     (b.)   Support Coordination

                            The provider agency or PCA will be responsible for managing all
                            aspects of the PAS not assumed by the consumer.

                            When requested by a personal assistance consumer and determined
                            appropriate through the assessment process, PCA will be responsible
                            for making available (either directly or arranged through another
                            source) the elements necessary to support a consumer who chooses
                            the combination service delivery model. These elements include but
                            are not limited to assistance with the following: recruiting and
                            screening attendants; training consumers and PAS workers;
                            supervising PAS workers. If requested by the consumer, PCA or a
                            subcontractor will also be responsible to assist those consumers who
                            choose the combination model service delivery model for a period of
                            time until the consumer acquires the skill necessary to perform the
                            requisite employer functions independently.

                            NOTE: The Aging Waiver Program does not allow consumers to be
                            paid directly. This should in no way diminish the ability of the
                            consumer to direct his/her care.

                            Example: A consumer choosing this model has previously secured or
                            will secure a PAS worker who meets all definitions and qualifications
                            and will assume some or all responsibility for employee management
                            related tasks. The payroll management and disbursement activities
                            will be completed by an MA certified fiscal agent (see below). The
                            fiscal agency may be a private payroll company, PCA, an MA service
                            provider, or a DPW Attendant Care provider currently providing this
                            service to DPW Attendant Care Waiver consumers.




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              (c.)   Financial Management Services (FMS)

                     Financial Management Services (FMS) are supportive services
                     provided only to participants (consumers) who use Combination
                     Model services for some or all of their individual service plan hours.
                     When FMS is provided, the participant is the common law employer
                     of the direct care worker employed under the consumer-employer
                     model. FMS agencies reduce the employer-related burden of
                     participants using the consumer-employer model of services through
                     the provision of appropriate fiscal and supportive services. FMS
                     agencies must have a separate Employer Identification Number (EIN)
                     for FMS.

                     FMS includes performing the following tasks with the participant’s
                     authorization:

                     (i.)    On behalf of the participant employer, enrollment of the
                             participant into all applicable taxing authorities;
                     (ii.)   Assisting participant to understand their responsibilities as an
                             employer;
                     (iii.) On behalf of the participant employer, processing employment
                             application package and documentation for prospective
                             individual to be employed (including verifying their workers’
                             qualifications and clearances);
                     (iv,) On behalf of the participant employer, establishing and
                             maintaining a record for each individual employed and process
                             all employment records;
                     (v.)    On behalf of the participant employer, preparing and
                             disbursing payroll;
                     (vi.) On behalf of the participant employer, securing workers’
                             compensation or other forms of insurance and managing the
                             claims;
                     (vii.) On behalf of the participant employer, withholding, filing,
                             reporting and depositing federal, state, and local income taxes
                             in accordance with federal IRS, state Department of Revenue
                             Services, and local tax bureaus rules and regulations;
                     (viii.) On behalf of the participant employer, withholding, filing,
                             reporting, depositing and maintaining compliance with the
                             claims and appeals with the Pennsylvania and Federal
                             Unemployment Compensation Bureaus rules and regulations;
                     (ix.) On behalf of the participant employer, generating and
                             distributing IRS W-2’s, wage and tax statements and related
                             documentation annually to all member-employed caregivers
                             who meet the statutory threshold earnings amounts during the
                             tax year by January 31st;
                     (x.)    On behalf of the participant employer, acting on behalf of the
                             participant receiving supports and services for the purpose of
                             payroll reporting;


Eff. 7/1/09                                                                              127
                            (xi.)    On behalf of the participant employer, distributing, collecting
                                     and processing provider time sheets and attendance data as
                                     summarized on payroll summary sheets completed by the
                                     participants;
                            (xii.) On behalf of the participant employer, securing business
                                     agreements with any individual or entity that will be
                                     reimbursed with waiver funding;
                            (xiii.) On behalf of the participant employer, establishing and
                                     maintaining all FMS related participant records with
                                     confidentiality, accuracy, and appropriate safeguards;
                            (xiv.) Participating in the Commonwealth of Pennsylvania’s quality
                                     management strategy;
                            (xv.) On behalf of the participant employer, purchasing other forms
                                     of insurance, including healthcare, as appropriate;
                                     On behalf of the participant employer, verifying weekly
                                     service hours in relationship to payroll in order to ensure
                                     correct billing, problem resolution, and alternate billing
                                     procedures;
                            (xvi.) On behalf of the participant employer, processing judgments
                                     and wage garnishments and requests for employee wage
                                     information;
                            (xvii.) Rescinding or revoking all authorizations when a participant
                                     leaves the program;
                            (xviii.) Maintaining compliance with all applicable regulations and
                                     statutes, such as the Bureau of Program Integrity’s (BPI) fraud
                                     and abuse policies; and
                            (xix.) Providing reports and documentation to the Department as
                                     requested.

                            The following DPW Attendant Care forms can be used/modified for
                            these and other PAS related activities: Fiscal Agent Function, Fiscal
                            Agent and Employment Related Forms, Consumer Selection
                            Option, Service Agreement Between Consumer and
                            Contractor/Provider, Consumer Designation of Primary
                            Responsibility, Consumer/Employer Appointment of Agent, List
                            of Services Agreed to be Provided by Fiscal Agent, Application
                            for Employment, Criminal Record Check Policy for
                            Consumers/Employers, Agreement Between Consumer and
                            Attendant, Time Sheet, Payroll Form, Status Form, Notice of
                            Discontinued Employment, Taxing Agency Forms.

                            NOTE: The Fiscal Agent duties described above are currently
                            included in the Monthly Coordination fee for those in the consumer
                            directed Combination Model of service.

              (2.)   Agency Model - The consumer is not responsible for managing any aspect of
                     his/her PAS. The provider agency will employ the PAS worker, or through a
                     subcontractor, and manage all aspects of the consumer’s PAS.


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                          Supervision and oversight of the PAS worker is required and must be
                          provided as outlined in the standards for Aging Waiver Personal Care
                          Services, hereby included by reference. In addition, providers and their
                          subcontractors will adhere to those additional supervisory requirements as
                          outlined in PCA’s Service Specific Operational Requirements for Personal
                          Care, Respite, Companion and Home Support, hereby included by reference.

                          In both service delivery options, a registered nurse, on staff of the provider or
                          its subcontractor, or in a consultant role, must be available as needed by
                          consumers and/or by PCA or provider agency responsible for delivering the
                          PAS and for ensuring the health and safety of the consumer.

                          Appropriate professional staff must be available to provider staff and to
                          consumers to assist in training and to provide consultative support in PAS
                          service delivery.

              g.   Supervision

                   Supervision of PAS workers in the Combination Model is to be performed directly
                   by the consumer. It shall be the responsibility of the consumer to supervise the PAS
                   worker in regards to the specified tasks. That responsibility also extends to decisions
                   to discharge the PAS worker, when deemed appropriate.

                   Note: in those instances where the consumer lacks the necessary skills to properly
                   supervise the PAS worker, PCA or the contract provider will be responsible until the
                   consumer can perform the requisite employer functions independently.

                   Supervision of the PAS worker in the Agency Model is not the responsibility of the
                   consumer. The contract provider or their designated subcontractor will employ the
                   PAS worker and manage all aspects of the consumer’s PAS service. Supervision of
                   the PAS worker must be provided as outlined in the standards for Aging Waiver
                   Personal Care Services, hereby included by reference. In addition, providers and their
                   subcontractors will adhere to those additional supervisory requirements as outlined in
                   PCA’s Service Specific Operational Requirements for Personal Care, Respite,
                   Companion and Home Support, hereby included by reference.

              h.   Provider Agency Requirements

                   In order to serve Aging Waiver consumers, each provider agency will have a
                   provider agreement directly with the Department of Public Welfare (DPW) Office of
                   Medical Assistance Programs.

                   Under the terms of the DPW provider agreement, all full-time and part-time
                   employees of the provider agency or individuals delivering services through personal
                   assistance services agreements with a provider agency, including subcontractors,
                   must meet the qualifications for safeguarding the health and welfare of the recipients,
                   specified in the provider requirements for Aging Waiver personal assistance


Eff. 7/1/09                                                                                            129
              services.

              (1.)   For Aging Waiver consumers, provider agencies must be certified Medicaid
                     Providers of Service as documented by a completed Provider of Service
                     agreement with the Commonwealth of Pennsylvania, Department of Public
                     Welfare and must meet all stipulated fiscal, Medical Assistance Program, and
                     AGING Waiver personal assistance service requirements.

              (2.)   Provider agencies can have subcontracting arrangements in place.

              (3.)   Provider agencies must provide, either directly or by sub-contract, the full
                     range of personal assistance services. Personal assistance service provider
                     agencies under the waiver and subcontractors must be capable of providing a
                     continuum of services that enable the consumer to choose the level of
                     consumer control most suitable to individual needs. The consumer always
                     has the choice of directing his or her own care. In addition, provider agencies
                     must be capable of providing 24-hour service availability. The range of
                     options must be made available to each consumer. The option chosen is in
                     conformance with the consumer’s care plan.

              (4.)   The provider agency must agree to assist the consumer in all employer-related
                     activities that are needed.

              (5.)   For Aging Waiver consumers, provider agencies must be willing to accept the
                     Department of Public Welfare’s reimbursement rate for provision of personal
                     assistance services as payment in full. Reimbursement is for personal
                     assistance services provided, including the direct provision of personal
                     assistance services to consumers, service coordination, support activities,
                     program monitoring activities, and administrative requirements stipulated by
                     the Department of Public Welfare. Provider agencies may not balance bill
                     consumers or seek any additional reimbursement other than any minimal co-
                     payment stipulated by the Department of Public Welfare.

              (6.)   Provider agencies must meet the following staffing requirements:

                     (a.)   The agency must have sufficient professional staff to perform the
                            needed service coordination and support activities as required by
                            AGING Waiver personal assistance services requirements.

                     (b.)   The Medicaid Waiver and PCA provider agency must have registered
                            nurse (RN) consulting services available, either by a staffing
                            arrangement or through a contracted consulting arrangement to
                            provide support as needed to ensure the health, welfare and safety of
                            consumers. The responsibilities of the provider agency RN consultant
                            include the following:

                            (i.)    Provide training, as needed, to consumers, personal assistance
                                    workers, and provider agency staff, on issues related to health


Eff. 7/1/09                                                                                     130
                                     maintenance activities and/or other health, welfare and safety
                                     issues.

                            (ii.)    Provide consultation, as needed, on service delivery problem
                                     solving related to health maintenance activities and/or to the
                                     health, welfare, and safety of consumers including
                                     consultation services to consumers and to provider agency
                                     staff on issues related to supervision of personal assistance
                                     worker basic services and ancillary activities.

                            (iii.)   To the extent specified in the consumer’s care (service) plan,
                                     supervision of personal assistance workers’ basic and ancillary
                                     service activities is by the consumer. Provider RN consulting
                                     services shall be available as needed by consumers and/or by
                                     the provider agency staff supervising personal assistance
                                     service delivery.

              (7.)   Qualified provider agencies will provide personal assistance services
                     consistent with the following requirements:

                     (a.)   Provider agencies will have the capability to provide, either directly or
                            under purchase arrangements, an array of support activities that will
                            assist consumers in managing their personal assistance service and in
                            other aspects of independent living. These activities include: payroll
                            services related to personal assistance service, management and
                            assistance in linking consumers to services such as transportation,
                            income maintenance, housing, medical and related services, and
                            general assistance with the direct provision of personal assistance
                            service.

                     (b.)   Provider agencies will also coordinate with the Office of Vocational
                            Rehabilitation, county governments and other sources of support
                            services, including family and friends, who are available to provide
                            back-up services according to the consumer’s care plan to avoid
                            duplication and to integrate service.

                     (c.)   Provider agencies will offer consumers a continuum of consumer
                            control options, ranging from consumer management of the personal
                            assistance service, to provider agency management. Provider agencies
                            will offer consumers the option of recruiting, managing, training,
                            hiring, and approving time sheets of their personal assistance workers.
                             Consumers have the right to choose and perform any or all of these
                            tasks in conformance with their own needs and requirements. The
                            consumers will determine which level of control is desired.

                     (d.)   Provider agencies that provide services through a subcontract or any
                            other purchase arrangement are responsible for ensuring that services
                            rendered under these contractual or purchase arrangements are in


Eff. 7/1/09                                                                                      131
                                     compliance with the Medical Assistance and AGING Waiver
                                     Programs and quality of care requirements to the same extent that
                                     services are provided by direct employees of the provider agency.

                     (8.)    All providers of services to PCA consumers are to comply with federal, state
                             and local health requirements related to communicable disease and to follow
                             procedures recommended in the Centers for Disease Control (CDC)
                             Guidelines and OSHA regulations, including provision of protective articles
                             to staff and in-service on universal precautions.

       3.     Options Program PAS Standards

              Personal Assistance Service is in-home personal care and other approved support activities
              for consumers with functional disabilities who need assistance to accomplish daily living
              tasks. The service consists of those basic and ancillary services, which enable eligible
              consumers to live in their own homes and communities rather than in institutions and to
              carry out functions of daily living, self-care and mobility. Primarily, the consumer if he/she
              were physically able, or family/friends, if available, would carry out these activities.

              Personal assistance service is consumer directed care, in which a consumer chooses a service
              delivery model and is given the opportunity to control the delivery of service prescribed in
              the care plan.

              a.     Standards:

                     (1.)    An individual with an assessed need for personal assistance service shall have
                             a choice of directing a portion of his or her care or having an agency direct his
                             or her care.

                     (2.)    Individuals who are assessed as being cognitively capable to direct a portion
                             of their own care, and are willing to do so, may manage certain aspects of
                             their care or choose to have a caregiver direct their care.

                     (3.)    An individual who is assessed as being cognitively impaired must not direct
                             his or her care. Such an individual who is assessed as being cognitively
                             impaired may have a caregiver who is willing and able to direct his or her
                             care. Consumers who have objections to being assessed as cognitively
                             impaired shall have immediate and full access to the PCA and PDA hearings
                             and appeals process.

                     (4.)    An individual consumer, or legally authorized surrogate, may direct the care.
                             “Legally authorized surrogate” is defined as an individual legally appointed to
                             speak, act, and make decisions for the consumer; i.e., power of attorney and
                             /or guardian. The legally-authorized surrogate may not be a paid personal
                             assistance worker.




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              b.   Services

                   (1.)   The individual must currently experience functional disabilities, which result
                          in a substantial loss of capability to perform one or more of the following
                          basic activities associated with the personal care of one's self, and require
                          "hands-on" assistance to fulfill these needs:

                          (a.)    Getting in and out of bed, wheelchair, or motor vehicle;
                          (b.)    Ambulating, with or without mechanical aids, inside the home;
                          (c.)    Routine bodily functions, including eating or feeding (including meal
                                  preparation and clean-up) and toileting;
                          (d.)    Bathing, dressing, personal hygiene and grooming; and
                          (e.)    Health maintenance activities.

                   NOTE: The need for "hands-on" assistance in completing these basic activities must
                   be the individual's primary need for formal services in order for personal assistance
                   to be the appropriate service response.

                   The individual must reside in a private home or apartment or be able to reside in a
                   private home or apartment if personal assistance is provided.

                   (2.)   In addition, personal assistance services may include the following activities,
                          if these activities are ancillary to the above "hands-on" activities which
                          establish the primary need for personal assistance service:

                          (a.)    Home Support services including, but not limited to, shopping,
                                  laundry, cleaning and seasonal chores.
                          (b.)    Companion-type services including, but not limited to, assistance with
                                  transportation, letter writing, reading mail and escort.
                          (c.)    At the direction of the consumer, assistance with household
                                  management tasks.

                   (3.)   Backup Services - For those consumers who choose to direct their care and
                          not opt for the Agency Employed Model, PCA shall require the consumer to
                          take primary responsibility for arranging backup services. The use of family,
                          friends, and neighbors shall be encouraged since these sources are dependable
                          and usually available on short notice. In the event the consumer is unable to
                          arrange for backup services, PCA or its subcontractor will only be responsible
                          to provide basic services, as defined earlier in the definitions section of this
                          policy, to the consumer until the regular attendant returns. A written
                          statement describing the consumer's arrangement of backup services must be
                          included in the care plan.

                   (4.)   Supplemental Services - Supplemental services necessary to support personal
                          assistance assessments and service delivery may be appropriate in specific
                          situations. When the services listed below are not otherwise available, PCA
                          may provide them as follows:




Eff. 7/1/09                                                                                           133
                          (a.)    Home Health Services, other than those performed by a PAS worker
                                  pursuant to the definition of Health Maintenance Activities in this
                                  document.

                          (b.)    Rehabilitative Therapy for disabled persons, when medically
                                  prescribed for a specific consumer's needs, if PCA has have
                                  exhausted all possibilities for obtaining such therapy under other
                                  community or third party resources.

                   (5.)   In addition to being made available during normal weekday working hours,
                          services will be made available to meet individual needs on weekends and
                          before or after normal working hours.

                   (6.)   The scheduling of personal assistance services shall, to the extent feasible,
                          respond to the special needs of the individual for personal assistance at
                          specific times.

              c.   PAS Worker Specifications

                   Personal assistance workers are usually neither licensed nor registered nurses. A
                   personal assistance worker is someone chosen by the consumer or appropriate
                   caregiver to meet his/her individualized service needs. Personal assistance workers
                   may be friends and/or relatives of the consumer, but may not be spouses (including
                   common-law spouse), minor children, legal guardian, or power of attorney. All
                   personal assistance workers, including friends and relatives, must meet the
                   qualifications outlined below:

                   (1.)   Be 18 years of age or older;
                   (2.)   Have the required skills to perform personal assistance (attendant care)
                          services as specified in the consumer’s service plan;
                   (3.)   Possess a valid Social Security number;
                   (4.)   Be willing to submit to and pass a criminal record check; and
                   (5.)   When required by the consumer, must be able to demonstrate the capability to
                          perform health maintenance activities specified in the consumer’s service
                          plan or be willing to receive training.

              d.   Service Delivery Options

                   Based upon their assessed ability and competency, personal assistance consumers
                   should be given the option of choosing a service delivery model which best meets
                   their needs.

                   (1.)   Combination Model:

                          (a.)    The consumer chooses certain aspects of his/her personal assistance
                                  service to manage and PCA or a subcontractor of PCA is responsible
                                  for providing the consumer with the remaining aspects of care.




Eff. 7/1/09                                                                                            134
              (b.)   Support Coordination:

                     When requested by a personal assistance consumer and determined
                     appropriate through the assessment process, PCA will be responsible
                     for making available (either directly or arranged through another
                     source) the elements necessary to support a consumer who chooses
                     the combination service delivery model. These elements include but
                     are not limited to assistance in performing the following: recruiting
                     and screening attendants; training consumers and personal assistance
                     workers; managing and supervising personal assistance workers. If
                     requested by the consumer, PCA or a subcontractor of PCA will also
                     be responsible to assist those consumers who choose the combination
                     service delivery model for a period of time until the consumer
                     acquires the skills necessary to perform the requisite employer
                     functions independently.

              (c.)   Financial Management Services (FMS)

                     Financial Management Services (FMS) are supportive services
                     provided only to participants (consumers) who use Combination
                     Model services for some or all of their individual service plan hours.
                     When FMS is provided, the participant is the common law employer
                     of the direct care worker employed under the consumer-employer
                     model. FMS agencies reduce the employer-related burden of
                     participants using the consumer-employer model of services through
                     the provision of appropriate fiscal and supportive services. FMS
                     agencies must have a separate Employer Identification Number (EIN)
                     for FMS.

                     FMS includes performing the following tasks with the participant’s
                     authorization:

                     (1.)   On behalf of the participant employer, enrollment of the
                            participant into all applicable taxing authorities;
                     (2.)   Assisting participant to understand their responsibilities as an
                            employer;
                     (3.)   On behalf of the participant employer, processing employment
                            application package and documentation for prospective
                            individual to be employed (including verifying their workers’
                            qualifications and clearances);
                     (4.)   On behalf of the participant employer, establishing and
                            maintaining a record for each individual employed and process
                            all employment records;
                     (5.)   On behalf of the participant employer, preparing and
                            disbursing payroll;
                     (6.)   On behalf of the participant employer, securing workers’
                            compensation or other forms of insurance and managing the
                            claims;


Eff. 7/1/09                                                                             135
                     (7.)   On behalf of the participant employer, withholding, filing,
                            reporting and depositing federal, state, and local income taxes
                            in accordance with federal IRS, state Department of Revenue
                            Services, and local tax bureaus rules and regulations;
                     (8.)   On behalf of the participant employer, withholding, filing,
                            reporting, depositing and maintaining compliance with the
                            claims and appeals with the Pennsylvania and Federal
                            Unemployment Compensation Bureaus rules and regulations;
                     (9.)   On behalf of the participant employer, generating and
                            distributing IRS W-2’s, wage and tax statements and related
                            documentation annually to all member-employed caregivers
                            who meet the statutory threshold earnings amounts during the
                            tax year by January 31st;
                     (10.) On behalf of the participant employer, acting on behalf of the
                            participant receiving supports and services for the purpose of
                            payroll reporting;
                     (11.) On behalf of the participant employer, distributing, collecting
                            and processing provider time sheets and attendance data as
                            summarized on payroll summary sheets completed by the
                            participants;
                     (12.) On behalf of the participant employer, securing business
                            agreements with any individual or entity that will be
                            reimbursed with waiver funding;
                     (13.) On behalf of the participant employer, establishing and
                            maintaining all FMS related participant records with
                            confidentiality, accuracy, and appropriate safeguards;
                     (14.) Participating in the Commonwealth of Pennsylvania’s quality
                            management strategy;
                     (15.) On behalf of the participant employer, purchasing other forms
                            of insurance, including healthcare, as appropriate;
                            On behalf of the participant employer, verifying weekly
                            service hours In relationship to payroll in order to ensure
                            correct billing, problem resolution, and alternate billing
                            procedures;
                     (16.) On behalf of the participant employer, processing judgments
                            and wage garnishments and requests for employee wage
                            information;
                     (17.) Rescinding or revoking all authorizations when a participant
                            leaves the program;
                     (18.) Maintaining compliance with all applicable regulations and
                            statutes, such as the Bureau of Program Integrity’s (BPI) fraud
                            and abuse policies; and
                     (19.) Providing reports and documentation to the Department as
                     requested.

              The following DPW Attendant Care Program forms can be used/modified for
              these and other related PAS activities: Fiscal Agent Function, Fiscal Agent
              and Employment Related Forms, Consumer Selection Option, Service


Eff. 7/1/09                                                                            136
                          Agreement Between Consumer and Contractor/Provider, Consumer
                          Designation of Primary Responsibility, Consumer/Employer
                          Appointment of Agent, List of Services Agreed to be Provided by Fiscal
                          Agent, Application for Employment, Criminal Record Check Policy for
                          Consumers/Employers, Agreement Between Consumer and Attendant,
                          Time Sheet, Payroll Form, Status Form, Notice of Discontinued
                          Employment, Taxing Agency Forms.

                          NOTE: The Fiscal Agent duties described above are currently included in the
                          Monthly Coordination fee for those in the consumer directed Combination
                          Model of service.

                   (2.)   Agency Model - The consumer is not responsible for managing any aspects
                          of his or her personal assistance service. PCA or a subcontractor of PCA
                          would employ the attendant and manage all aspects of the consumer's
                          personal assistance service.

                          Supervisory visits must be made to the consumer's home to monitor the
                          performance of the PAS worker. This includes the requirement for the
                          frequency of supervisory visits to be made at a minimum of 90-day intervals.
                          In addition, providers and their subcontractors will adhere to those additional
                          supervisory requirements as outlined in PCA’s Service Specific Operational
                          Requirements for Personal Care, Respite, Companion and Home Support,
                          hereby included by reference.

                          The selected service delivery option will be described in the consumer’s plan
                          of care. Supervision of personal assistance worker basic and ancillary
                          activities is controlled by the consumer to the extent specified in the
                          consumer’s plan of care. A registered nurse, on staff or in a consultant
                          arrangement with a provider agency, must be available as needed by
                          consumers and/or by the provider agency responsible for delivering the
                          personal assistance service and for ensuring the health and safety of the
                          consumer. Appropriate professional staff must be available to provider
                          agency staff and to consumers to assist in training and to provide consultative
                          support in personal assistance service delivery as needed to ensure the health,
                          welfare, and safety of consumers.

                          The personal assistance service is necessary to prevent institutionalization
                          and to provide optimum conditions for participating consumers to live as
                          integrated members of society.

              e.   Health Maintenance Activities

                   Health Maintenance Activities are those activities which are necessary to maintain
                   the consumer's optimum health, as directed by the physician responsible for the
                   consumer's medical/health plan of care. These activities would be carried out
                   primarily by the consumer if he/she were physically able, or family members if
                   available. These activities include, but are not limited to:


Eff. 7/1/09                                                                                              137
                   (1.)   Catheter irrigations;
                   (2.)   Administration of medication, enemas, and suppositories; and
                   (3.)   Wound Care.

              f.   Supervision

                   Supervision of PAS workers in the Combination Model is to be performed directly
                   by the consumer. It shall be the responsibility of the consumer to supervise the PAS
                   worker in regards to the specified tasks. That responsibility also extends to decisions
                   to discharge the PAS worker, when deemed appropriate.

                   Note: in those instances where the consumer lacks the necessary skills to properly
                   supervise the PAS worker, PCA or the contract provider will be responsible until the
                   consumer can perform the requisite employer functions independently.

                   Supervision of the PAS worker in the Agency Model is not the responsibility of the
                   consumer. The contract provider or their designated subcontractor will employ the
                   PAS worker and manage all aspects of the consumer’s PAS service. Supervision of
                   the PAS worker must be provided as outlined in the standards for Aging Waiver
                   Personal Care Services, hereby included by reference. In addition, providers and their
                   subcontractors will adhere to those additional supervisory requirements as outlined in
                   PCA’s Service Specific Operational Requirements for Personal Care, Respite,
                   Companion and Home Support, hereby included by reference.

              g.   Special Program and Cost Concerns

                   Health Maintenance Activities - In cases where the personal assistance service (PAS)
                   worker will be assisting the consumer with health maintenance activities, it is
                   required that the consumer have a "medical home"; i.e., that the consumer is enrolled
                   and being seen regularly by a primary care physician in a clinic, HMO or a primary
                   care center responsible for the consumer's medical/health plan of care.

                   If the consumer chooses to direct his/her health maintenance activities and his/her
                   primary care physician makes a determination that the consumer is capable of
                   directing his/her health maintenance activities, then the PAS worker may perform
                   health maintenance activities under the conditions listed below:

                   (1.)   The consumer has indicated that he/she has been adequately instructed by the
                          appropriate health professionals and is thereby qualified and able to instruct
                          and supervise his/her attendant in Health Maintenance Activities. A written
                          statement to this effect must be included in the care plan. This statement
                          must be signed by the appropriate health professional (preferably the
                          consumer's physician).

                   (2.)   The PAS worker is instructed and monitored in Health Maintenance
                          Activities by the consumer, the consumer's physician and/or a health
                          professional (usually a nurse or therapist) as appropriate.


Eff. 7/1/09                                                                                              138
                   (3.)   The PCA care manager will monitor Health Maintenance Activities which are
                          part of the care plan to assure that the services are being provided as ordered
                          by the physician. The care manager will also monitor the consumer's
                          satisfaction with the PAS worker’s performance of Health Maintenance
                          Activities, either through routine monitoring visits or through periodic
                          consultation and input from the consumer regarding his/her satisfaction with
                          the service. The PCA care manager will not monitor the PAS worker’s
                          performance of the health maintenance activity. This is the consumer's,
                          consumer's physician and/or health professional's responsibility as
                          appropriate.

                   (4.)   Disposable items or devices are used in caring for the consumer whenever
                          they are obtainable.

                   (5.)   The PAS worker’s prior experience and work history do not indicate unsafe
                          performance of such activities.

                   (6.)   The consumer has appropriate arrangements in place to respond to health
                          emergencies; a statement to this effect is included in the care plan.
                          Information on the arrangements for health emergencies is also made
                          available to the PAS worker(s) either by PCA, its delegate or by the
                          consumer.

                   (7.)   PCA and consumer must document in the Care Plan who is responsible for
                          providing Health Maintenance Activities and that these persons, if PAS
                          workers, have been trained in the performance of these activities as approved
                          by the consumer's physician.

                   (8.)   When there is an indication that the Health Maintenance Activities are not
                          being carried out as ordered by the physician, PCA has the right and
                          responsibility to intervene and provide appropriate corrective measures.
                          Corrective measures could involve contacting the physician to make him or
                          her aware of the problem and requesting additional training and/or direction.

              h.   Care Management

                   Consumers receiving personal assistance service must receive care management in
                   accordance with the program instructions contained in the Options Program policy.




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Q.     PERSONAL EMERGENCY RESPONSE SYSTEM: STANDARDS

       1.     SERVICES TO BE PURCHASED

              PCA’s Options and Aging Waiver Program will lease Personal Emergency Response System
              (PERS) from an emergency medical response system manufacturer (herein called vendor).
              Units leased will be maintained and guaranteed by the vendor, and will be updated, at no
              cost to the Options or Aging Waiver Program, as technology improves performance.

              Each PERS shall include:

              a.     Installation, in the consumer’s home, including any needed phone jack modifications
                     and devices;
              b.     Two way voice communication;
              c.     Fire and smoke detector;
              d.     Inactivity timer;
              e.     Average range, water proof, portable help button, with a five year battery;
              f.     Ability to self-test on-line status of all functions;
              g.     UL listed/certified.

              Included as a part of the monthly charge, the vendor shall, either directly or through
              subcontract, provide for ongoing provision of on-line emergency response center services for
              each consumer authorized. This shall include response to consumer self-testing, as well as
              daily provider testing, self auditing and quality control, repair, replacement, and staff
              training.

              The vendor will insure 24-hour staffing, by trained operators, of the emergency response
              center, 365 days per day.

       2.     CERTIFICATION, STANDARDS AND SAFETY

              All PERS installed, shall be certified as meeting standards for safety and use, as may be
              promulgated by any governing body, including any electrical, communications, consumer or
              other standards, rules or regulations that may apply.

       3.     INSTALLATION

              It shall be the vendor's responsibility to deliver and install each Personal Emergency
              Response System unit that is leased. The vendor agrees to complete installation within five
              working days of receipt of the service order. Services will be billed in the month that PERS
              units are ordered and installed.

              a.     The PCA Care Manager will notify the vendor by phone of a request for installation.
                     The vendor shall arrange with the consumer for a mutually convenient appointment
                     within five working days of the vendor's notification by the Care Manager.

              b.     The vendor shall notify the Care Manager of the installation appointment and shall
                     notify the Care Manager to confirm that installation has been completed.


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              c.   The vendor immediately shall notify the Care Manager if it is unable to schedule or
                   complete an installation within the required time frame.

              d.   The vendor shall provide all parts and equipment necessary for installing an
                   emergency medical response system unit, whether purchased or leased, into a
                   functioning telephone system.

              e.   The vendor shall instruct the consumer in the use and maintenance of the PERS and
                   shall provide the consumer with simple written instructions, including how to report
                   a malfunction of the PERS.

              f.   The vendor shall, upon request of the consumer or Care Manager, provide additional
                   follow-up instructions to the consumer on operating and maintaining the PERS.

              g.   The vendor shall forward to the Care Manager, within five working days of the
                   installation either by mail or by facsimile, a form signed by a vendor representative
                   or employee and by the consumer or consumer’s representative confirming the date
                   of the installation and the consumer’s understanding of the use and maintenance of
                   the PERS.

              h.   The vendor shall provide the Care Manager, consumers, and other persons (as needed
                   to assure care), instructional materials and orientation in the operation of the PERS,
                   stated in simple and understandable language.

              i.   If any applicable regulatory, industry, or manufacturer standards are changed,
                   resulting in improvements or updating of equipment, the Care Manager shall be
                   notified and each on-line consumer with leased equipment immediately shall be
                   provided with said new equipment.

       4.     MAINTENANCE OF EQUIPMENT AND SERVICE

              a.   Vendor shall maintain all installed PERS in proper working order.

                   (1.)   The vendor shall make provision to insure that each installed PERS is
                          operating properly at least once every 24 hours.

                   (2.)   Provision for the daily testing will preferable be automated and cause the
                          least possible inconvenience for the consumer.

                   (3.)   The vendor shall follow up with the consumer and notify the Care Manager
                          within 24 hours, or the next business day of any PERS that is not operating
                          properly. Malfunctioning equipment shall be repaired or replaced within 24
                          hours of notification or identification.




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       5.     PROVISION OF SERVICE

              Vendor shall maintain, either directly or through subcontract, a 24-hour Emergency
              Response Center staffed with trained emergency response operators. The Emergency
              Response Center shall perform the activities that follow:

              a.     Receive, acknowledge, and establish immediate two-way communication in
                     responding to emergency signals from consumers. The vendor immediately upon
                     receiving a signal from a consumer’s PERS, will retrieve the consumer’s automated
                     data records, establish immediate two-way voice contact directly with the consumer
                     via the incoming signal, and contact the consumer’s representative, or take other
                     emergency action as prescribed in the consumer’s record.

              b.     Be capable of responding to multiple emergency signals simultaneously.

              c.     Respond immediately to any and all signals from consumer’s PERS and maintain
                     appropriate contact until termination of the emergency situation.

              d.     Notify a third party, consumer-designated representative, (e.g. neighbor, police,
                     Emergency Medical System (EMS), etc.), to respond to an emergency via immediate
                     telephone contact and without interrupting or terminating direct voice contact with
                     the consumer.

              e.     The Emergency Response Operator will monitor the provision of emergency service
                     to verify that it has been provided and that the emergency situation no longer exists at
                     the consumer’s residence.

              f.     Verify resolution of the emergency situation, document the incident, as below, for
                     future reference, and notify the Care Manager of the incident within 24 hours or the
                     next business day.

       6.     SUSPENSION AND TERMINATION OF SERVICE

              The decision to remove a PERS is at the sole discretion of the Care Manager. For all PERS
              removals, notification will be by telephone from the authorized Care Manager. Written
              authorization to terminate PERS service will be sent to the vendor on the same day as the
              telephone notification. If the vendor is notified directly by a consumer’s family or other
              representative to remove the PERS, authorization must first be obtained from the Care
              Manager.

              a.     When a consumer with a PERS no longer requires such services, regardless of the
                     reason, the Care Manager will discuss with appropriate staff, as needed, and contact
                     the vendor, so that the PERS may be transferred or removed.

              b.     When a consumer’s services are suspended because of the consumer’s admission to
                     the hospital, the Care Manager will notify and/or authorize the vendor to take the unit
                     off line. Services will be resumed to the consumer, only after the Care Manager




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                     notifies the vendor. Payment for leased equipment will be made at the standard unit
                     price as long as a unit remains in the home of a consumer.

              c.     The vendor shall disconnect/remove a PERS from a consumer’s residence within five
                     working days of notification by the Care Manager.

       7.     SUPERVISION

              The vendor shall supervise all staff providing services covered by this contract, at a
              minimum of once a month. It is expected that there will be a supervisor available during
              working hours.

       8.     STAFFING AND QUALIFICATIONS

              a.     Line Staff Employees Shall Possess:

                     (1.)   Ability to work under supervision as an employee of the agency;

                     (2.)   Ability to communicate orally with the consumer and resource personnel with
                            whom they must work, and both orally and in writing with their supervisor;

                     (3.)   Ability to read, write, follow written instructions, and to converse easily on
                            the telephone;

                     (4.)   Training and/or paid or volunteer experience of one year or more, specifically
                            related to the skills required to perform as an Emergency Response Center
                            employee;

                     (5.)   Ability to provide references as follows:

                            (a.)    Two verifiable work references, or

                            (b.)    One verifiable work reference indicating a minimum length of
                                    employment of one year, or

                            (c.)    Two references, total, from a supervisor and/or instructors from an
                                    acceptable training program.

                     (6.)   A written test shall be administered to all consumer contact employees, by the
                            vendor, pertaining to proper operation of the system and response to
                            emergencies, or installation and repair of equipment, prior to being assigned
                            on the job.

              b.     Supervisors

                     (1.)   Supervisors shall be capable of demonstrating and teaching all job skills
                            needed to perform all aspects of the jobs of their employees.




Eff. 7/1/09                                                                                               143
                     (2.)   Supervisors shall receive regular supervision by a designated administrative
                            staff person.

              c.     Administrative Staff

                     Sufficient administrative staff shall be employed to insure the efficient and effective
                     provision of service under the contract.

              d.     Consultant Staff

                     Appropriate other staff shall be available for consultation regarding response,
                     operation, training, or other matters requiring professional input

              e.     General

                     The vendor will maintain sound personnel policies to minimize personnel turnover
                     which would adversely affect the delivery of service.

       9.     TRAINING

              a.     In-service training sessions must be offered to all direct consumer contact employees.
                      Subject areas covered should relate to relevant aspects of service delivery, trends or
                     advances in the field, or identified problems or gaps in knowledge. Programs on
                     vendor policies and procedures are necessary but should not constitute the majority
                     of any session.

              b.     The vendor will use and have on file, written training materials and procedures.

              c.     For staff with demonstrated personal characteristics and abilities, training in how to
                     work with consumers having special mental health or other complex needs, is
                     encouraged.

       10.    SERVICE REPORTING

              Persons providing Personal Emergency Response services must comply with all reporting
              requirements as specified by the AAA.

       11.    SCHEDULING

              Days and times schedules for Personal Emergency Response services must be consistent
              with the care plan provided by the AAA.

       12.    INSURANCE

              Agencies who wish to provide Personal Emergency Response services will be required to
              attest to having the following types of insurance in amounts consistent in the industry:




Eff. 7/1/09                                                                                              144
              a.     General liability;
              b.     Professional liability;
              c.     Automobile liability covering owned, non-owned and hired vehicles;
              d.     Workman Compensation as required by law;
              e.     Employer’s liability of accident and disease.

       13.    CONFIDENTIALITY

              All agencies who provide Personal Emergency Response services must comply with all
              federal, state, and local laws relating to research on human subjects and consumer
              confidentiality.

              Agencies must provide all Care Managers with consent forms and approval from all
              appropriate review boards for those consumers who wish to be part of a research study.




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R.     TELECARE SERVICES

       1.     GENERAL INFORMATION

              a.   TeleCare is a model of care, which integrates social and healthcare services that are
                   supported by innovative technologies to sustain and promote independence, quality
                   of life and reduce the need for nursing home placement. By utilizing in-home
                   technology, Pennsylvania will have more options to assist and support individuals so
                   that they can remain in their own homes. TeleCare complements home and
                   community based services by facilitating timely visits based on patient needs and
                   enables healthcare providers to allocate resources by allowing nurses and other
                   homecare professionals to work more efficiently.

              b.   Types of TeleCare Services:

                   (1.)   Health Status Measuring and Monitoring
                   (2.)   Activity and Sensor Monitoring
                   (3.)   Medication Monitoring System

                   Note: All other medical equipment and supplies that will be of value to the
                   individual to maintain them safely in the home can be purchased using medical
                   equipment and supplies in the Aging Waiver. (Examples include but are not limited
                   to: blood pressure cuff, weigh scale, light movement sensors, etc.)

              c.   TeleCare Services will be utilized for participants where there is a demonstrated
                   medical need for the services and it has been determined that the services are not
                   covered under Medicare, State Plan or other third party resources. In instances where
                   Medicare or other third party payer services are in place TeleCare services will not be
                   approved by the care manager and AAA nursing staff. TeleCare Services are
                   provided in an efficient manner, preventing duplication of services, unnecessary
                   costs and unnecessary administrative tasks. TeleCare Services attempt to use
                   resources efficiently to maximize the benefits and services available to all individuals
                   enrolled in the AGING 60+ Waiver Program.

              d.   The participant’s home must be evaluated to ensure that there is an adequate living
                   environment with sufficient utilities to meet the manufacturers’ specifications for
                   equipment, which allows for the adaptation of the TeleCare equipment. TeleCare
                   Services which are web based services must be HIPAA compliant. The
                   documentation collected from the use of TeleCare services must be available upon
                   request. All reports and data must be maintained and made available for at least 1
                   year past removal of the equipment. All TeleCare service providers must be enrolled
                   in the Medical Assistance program and are required to comply with other applicable
                   statutes, state and federal regulations and policies and procedures. Providers shall
                   ensures that individuals providing services meet service qualifications and standards
                   and equipment meet all manufacturers’ qualifications and standards for the
                   appropriate type of TeleCare Services.




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              e.   Participant care plans including TeleCare Services must adhere to PDA policies for
                   Care Plan review as outlined in APD #06-01-03. TeleCare Services are not to be
                   used as a onetime emergency service.

              f.   Special Eligibility Criteria for All TeleCare Services

                   (1.)   The participant must be assessed and determined to be clinically eligible for
                          nursing facility level of care (NFCE); as defined in the approved Waiver and
                          Aging Program Directive #07-01-01 (Chapter 1 of the Home and
                          Community-Based Services Manual).

                   (2.)   The participants must have at least three of the following
                          conditions/situations:

                          (a.)   Three (3) or more hospitalizations in the past year.
                          (b.)   Frequent, recurrent, repeated or regular use of the emergency room.
                          (c.)   Poor adherence with physician orders or medication.
                          (d.)   Formal or informal support systems are limited or absent.
                          (e.)   Documented history of falls within the last six months that results in
                                 an injury that required medical or emergent care.
                          (f.)   Lives alone or is at home for extended periods of time or care access
                                 challenges (for example, RN shortage, rural access issues, etc.)

                   (3.)   The participant must be sufficiently cognitively intact and be able to
                          physically operate the equipment (i.e. able to see the monitor or put on the
                          blood pressure cuff) or has a caregiver willing and able to assist with the
                          equipment, unless the service does not require active participation of the
                          participant.

                   (4.)   The participant’s home must be evaluated to ensure that the TeleCare
                          equipment can work. Adequate utilities to meet the manufacturer’s
                          specifications for equipment, if applicable and the living
                          situation/environment must allow for adequate adaptation of the TeleCare
                          equipment.

                   (5.)   A determination has been made that the participant’s needs are not covered
                          under third party resources, Medicare, or the Medicaid State Plan.




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       2.     HEALTH STATUS MEASURING AND MONITORING SERVICE

              a.   Health Status Measuring and Monitoring Service is beneficial to participants with
                   chronic medical conditions such as congestive heart failure, diabetes or pulmonary
                   disease that could benefit from frequent monitoring and evaluation. Examples of
                   Health Status Measuring and Monitoring Service may include but are not limited to
                   weight, pulse oximetry, and vital sign monitoring. Providers of health Status
                   Measuring and Monitoring Services must be Medicare certified Home health Agency
                   (HHA) enrolled in the Medical Assistance program. Any peripheral equipment must
                   be capable of interfacing with Health Status Measuring and Monitoring Service
                   equipment. All equipment and any peripheral equipment for Health Status
                   Measuring and Monitoring Services must be certified by the FDA and be UL
                   listed/certified.

              b.   Reimbursement for Health Status Measuring and Monitoring Service includes an RN
                   visit as part of the service fee. When additional services are required due to changes
                   in participant’s condition the care manager must be informed and services approved
                   in consultation with the AAA RN. When the change in condition requires a skilled
                   level of care the HHA should access Medicare and other third party payers for those
                   services. If the participant is receiving an approved skilled Medicare 60 day episode
                   TeleCare cannot be authorized.

              c.   The use of Health Status Measuring and Monitoring Services will be authorized
                   when all other care methods such as informal care givers, RN availability, physician
                   monitoring, and other technology have been demonstrated to be ineffective or
                   unavailability, physician monitoring, and other technology have been demonstrated
                   to be infective or unavailable for the individual’s safety and monitoring.

              d.   The reimbursement fee for this service will include:

                   (1.)   The installation, removal of equipment and monthly equipment rental.

                   (2.)   The training of the participant and/or their representative in the use of the
                          equipment and health status monitoring.

                   (3.)   Health Status Measuring and Monitoring Service by the home health agency
                          and all data collected.

                   (4.)   One monthly face to face visit by the Medicare certified Home Health
                          Agency and includes any other contact with the participant (such as telephone
                          contact).

              e.   Roles and Responsibilities of the Area Agency on Aging (AAA)

                   (1.)   Determine the need for Health Status Measuring and Monitoring service
                          based on the completion of the Care Management Instrument (CMI) and
                          applying the special eligibility criteria for TeleCare Services.




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                   (2.)    The need for Health Status Measuring and Monitoring service must be
                           approved by consultation with the AAA nurse and the care manager
                           Supervisor.

                   (3.)    The AAA nurse will review the Care Management Instrument and all other
                           pertinent information, including but not limited to information obtained by
                           contacting health care providers who have cared for the client, to assure the
                           appropriateness of the service.

                   (4.)    If there is a question regarding the need for health status measuring and
                           monitoring, the AAA nurse should perform a nursing evaluation, which could
                           include examining the client to assess a particular problem. However, the
                           AAA RN may not carry out any treatments or clinical interventions.

                   (5.)    The AAA nurse assists in the development of the care plan.

                   (6.)    Care Manager Supervisor must concur and approve with the recommendation
                           for TeleCare Services.

                   (7.)    Health Status Measuring and Monitoring service must be ordered by a
                           primary physician.

                   (8.)    The AAA must follow PDA requirements for Care Plan Review as outlined
                           in APD # 06-01-03.

                   (9.)    Notify PDA and DPW of critical events related to the Health Status
                           Measuring and Monitoring Services.

                   (10.)   On a monthly basis provide a face to face assessment to evaluate the
                           participant’s FDA certified, UL Listed/certified of the technology in the home
                           and assess whether the continued use of the TeleCare services is warranted.

                   (11.)   The AAA must provide the HHA with a copy of the participants current care
                           plan (which includes the care plan worksheet and service plan.)

              f.   Roles and Responsibilities for Health Status Measuring and Monitoring Service
                   Providers:

                   (1.)    Must be Medicare Certified, Medicaid enrolled HHA provider and meet all
                           the standards in the approved waiver.

                   (2.)    Must document Health Status Measuring and Monitoring Services including
                           the type, mode, and frequency in the participants care plan.

                   (3.)    Must provide teaching and training of the peripheral, video or non-video
                           equipment.




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                   (4.)    Must review all data collection of peripheral devices (blood pressure, weight,
                           glucometer readings, etc.) and follow-up with appropriate interventions.

                   (5.)    Must assure that all equipment meet service standards.

                   (6.)    Must ensure that the Health Status Measuring and Monitoring service is
                           ordered by a primary physician.

                           (a.)   The order must be obtained by the HHA prior to service authorization.

                           (b.)   The order must include the specific nursing and/or therapeutic service
                                  required.

                           (c.)   The order must reflect the client’s medical condition as it relates to
                                  the special medical eligibility requirements.

                           (d.)   The order must be obtained every sixty days for continuation of
                                  service.

                   (7.)    HHA must inform the care manager and contact the physician for approval of
                           additional services and obtain new medical orders when additional services
                           are required due to changes in participant’s condition. When the change in
                           condition requires a skilled level of care the HHA should access Medicare
                           and other third party payers for those services.

                   (8.)    Must maintain clinical documentation of all Home Health activities, Health
                           Status Measuring and Monitoring Service data and all participant contacts.
                           Documentation must be available upon request

                   (9.)    HHA must submit to the AAA the care plan and recommendation for service
                           when plan of care is updated or modified or at least every 60 days prior to
                           service authorization.

                   (10.)   The HHA must provide the AAA with a copy of the participants current care
                           plan.

              g.   Health Status Measuring and Monitoring Service Standards

                   (1.)    Persons providing and evaluating Health Status Measuring and Monitoring
                           Services must be licensed Registered Nurses.

                   (2.)    The reimbursement fee for Health Status Measuring and Monitoring Services
                           includes one monthly face to face visit by the RN from the Medicare Certified
                           Home Health Agency and any other contact with the participant (such as
                           telephone contact).

                   (3.)    Providers of Health Status Measuring and Monitoring Service must be
                           Medicare certified Medicaid enrolled HHA.


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                   (4.)   Providers are required to comply with other applicable statutes, state and
                          federal regulations and policies and procedures.

                   (5.)   Providers shall assure that individuals providing Health Status Measuring and
                          Monitoring Services meet service qualifications.

                   (6.)   All equipment and any peripheral equipment for Health Status Measuring and
                          Monitoring Services must be FDA certified and/or UL listed/certified.

                   (7.)   All web based services must be HIPAA compliant.

              h.   Health Status Measuring and Monitoring Service Reporting:

                   (1.)   Reporting for Health Status Measuring and Monitoring Services includes:
                          documentation and care plan requirements, data analysis with tracking and
                          trending and any other state and federal requirements (e.g. communicable
                          diseases, abuse and neglect, incident reporting, etc.)

              i.   Health Status Measuring and Monitoring Service confidentiality:

                   (1.)   All information must be kept confidential and HIPAA compliant.




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       3.     ACTIVITY AND SENSOR MONITORING SERVICE

              a.   A service that employs sensor based technology on a 24 hr./7 day basis by remotely
                   tracking the participant’s activities of daily living. These activities may include but
                   are not limited to total activity in the house and environmental temperature
                   monitoring. Data is then transmitted to the caregiver and/or healthcare provider
                   depending on the activity and sensor monitoring system employed. Activity and
                   Sensor Monitoring Service equipment must be UL listed/certified. Activity and
                   Sensor Monitoring Services can be provided by a Home Health Agencies, DME
                   providers or MA enrolled provider of Activity and Sensor Monitoring Services.

              b.   The use of Activity and Sensor Monitoring Services will be authorized by the AAA
                   when all other methods such as informal care givers, PERS systems, infant
                   monitoring systems, and other less restrictive technology have been demonstrated
                   and documented to be ineffective or unavailable for individual safety and monitoring.

              c.   The reimbursement fee for this service will include:

                   (1.)   The installation and removal of the equipment and any additional
                          repositioning of sensor equipment,

                   (2.)   Training of the participant and/or their caregivers,

                   (3.)   Monthly rental of equipment,

                   (4.)   Appropriate monitoring and documentation of the activities to maximize
                          technology capability,

                   (5.)   The repair or replacement of malfunctioning equipment,

                   (6.)   The provider shall provide ongoing provision of web based data collection for
                          each individual, as appropriate. This shall include response to participant
                          self-testing, as well as manufacture’s specified provider testing, self-auditing
                          and quality control.

              d.   As appropriate, included as part of the monthly charge, the provider shall, either
                   directly or through subcontractor provide for ongoing provision of on-line emergency
                   response services for each individual authorized. This shall include response to
                   participant self testing as well as daily provider testing, self auditing and quality
                   control.

              e.   Roles and Responsibilities of the Area Agency on Aging (AAA):

                   (1.)   Determine the need for Activity and Sensor Monitoring Service based on the
                          completion of the Care Management Instrument (CMI) and applying the
                          special eligibility criteria for TeleCare Services.




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                   (2.)    The AAA nurse will review the Care Management Instrument and all other
                           pertinent information, including but not limited to information obtained by
                           contacting health care providers who have cared for the client, to assure the
                           appropriateness of the service.

                   (3.)    If there is a question of need for Activity and Sensor Monitoring Services, the
                           nurse should perform elements of a nursing evaluation, including examining
                           the client to assess a particular problem however, the AAA nurse may not
                           carry out any treatments or clinical interventions.

                   (4.)    Care Manager Supervisor must concur and approve with the recommendation
                           for TeleCare services.

                   (5.)    The AAA must follow PDA requirements for Care Plan Review as outlined
                           in APD # 06-01-03.

                   (6.)    Activity and Sensor Monitoring Service must be ordered by a primary
                           physician.

                   (7.)    The AAA must provide the Activity and Sensor Monitoring Service provider
                           with a copy of the participants current care plan (which includes the care plan
                           worksheet and service plan).

                   (8.)    Notify PDA and DPW of critical events related to the Activity and Sensor
                           and Monitoring Services.

                   (9.)    The decision to remove an Activity and Sensor Monitoring Service is at the
                           sole discretion of the participant/representative and the Care Manager. The
                           Care Manager will provide written documentation to terminate Activity and
                           Sensor Monitoring Services.

                   (10.)   On a monthly basis provide a face to face assessment to evaluate the
                           participant’s UL Listed/certified of the technology in the home and assess
                           whether the continued use of the TeleCare services is warranted.

                   (11.)   The Care manager will investigate the damage or misuse of the Activity and
                           Sensor Monitoring Service equipment with the participant/representative and
                           provider to determine the continued use 9of the Activity and Sensor
                           Monitoring Service.

              f.   Roles and Responsibilities for Activity and Sensor Monitoring Providers:

                   (1.)    Must be MA enrolled provider and meet all the Medicaid enrolled provider
                           requirements as defined in the approved waiver.

                   (2.)    Must ensure that the Activity and Sensor Monitoring Service is ordered by a
                           primary physician.




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                   (3.)    The order must be obtained by service provider prior to service authorization.

                           (a.)   The order must include the specific service required.

                           (b.)   The order must reflect the client’s medical condition as it relates to
                                  the need for the Activity and Sensor Monitoring Services.

                   (4.)    Must develop and implement a service plan indicating the type, mode and
                           frequency for Activity and Sensor.

                   (5.)    Must provide the AAA with a copy of the participant’s current service plan
                           documenting the individual who will provide the Activity and Sensor
                           Monitoring.

                   (6.)    Must provide training for the Activity and Sensor Monitoring Services to the
                           individual and representatives.

                   (7.)    Must review the data collected and monitor activity with follow-up and
                           appropriate interventions as applicable to the type of technology in the home.

                   (8.)    Must ensure that Activity and Sensor Monitoring Service equipment is UL
                           listed/certified.

                   (9.)    Must inform the care manager and contact the physician for approval of
                           additional services and obtain new medical orders due to changes in
                           participant’s condition prior to additional service authorization.

                   (10.)   Must maintain all Activity and Sensor Monitoring Service date and all
                           documented participant contacts. As data is collected utilizing technology
                           and the Activity and Sensor Monitoring service provider will provide tracking
                           and trending reports on participant’s activity.

                   (11.)   Must disconnect/remove an Activity and Sensor Monitoring Service
                           equipment from a participant’s residence within 5 working days of
                           notification by the Care Manager.

              g.   Provider Standards for Activity and Sensor Monitoring Service

                   (1.)    Activity and Sensor Monitoring Service providers must be enrolled in the
                           Medical Assistance program and are required to comply with other applicable
                           statutes, state and federal regulations and policies and procedures.

                   (2.)    Activity and Sensor Monitoring Service must install and maintain services in
                           proper working order and guaranteed by the provider.

                   (3.)    Activity and Sensor Monitoring Service provider must deliver and install
                           Activity and Sensor Monitoring Services within 5 working days of receipt of
                           the service order.


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                   (4.)    Activity and Sensor Monitoring Service providers must notify the Care
                           Manager of the installation of Activity and Sensor Monitoring Service
                           equipment.

                   (5.)    Activity and Sensor Monitoring Services provider must instruct the
                           participant/representative in the use, maintenance and safety of the Activity
                           and Sensor Monitoring Service.

                   (6.)    Activity and Sensor Monitoring Service provider must have a system in place
                           for notification of emergency events to designated individuals.

                   (7.)    Activity and Sensor Monitoring Service provider must update equipment
                           when necessary, at no cost to the Aging Waiver Program, as technology
                           improves performance.

                   (8.)    The Activity and Sensor Monitoring Service provider must assure that
                           Activity and Sensor Monitoring Service equipment is UL listed/certified.

                   (9.)    The Activity and Sensor Monitoring Service provider must repair or replace
                           malfunctioning Activity and Sensor Monitoring Service equipment within 24
                           hours or next business day of notification or identification.

                   (10.)   Activity and Sensor Monitoring Service provider’s data collected must be
                           available at least 90% of the time to designated individuals when web based
                           systems are used.

                   (11.)   Activity and Sensor Monitoring Services provider must offer to all direct
                           participant contact employees training. The provider must verify that all
                           employees completing installation are adequately trained.

                   (12.)   Activity and Sensor Monitoring Service provider must use, and have on file,
                           written training materials and procedures for Activity and Sensor Monitoring
                           Services.

                   (13.)   Activity and Sensor Monitoring Service provider must be HIPAA compliant.

              h.   Activity and Sensor Monitoring Services Confidentiality:

                   (1.)    All information must be kept confidential and HIPAA compliant.




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       4.     MEDICATION DISPENSING AND MONITORING SERVICES

              a.     A remote Medication Dispensing and Monitoring Service is pre-programmed based
                     on the needs of the participant to dispense and monitor medication compliance. A
                     system will be in place to notify the provider or caregiver of missed does or non-
                     compliance with medication administration. This service may be used with
                     individuals that demonstrate a cognitive deficit, need assistance with medication, and
                     have demonstrated and documented past non-compliance with medication
                     administration.

              b.     Medication Dispensing and Monitoring service equipment must be UL
                     listed/certified. The provider agency shall assure that all equipment meet service
                     standards. Medication Dispensing and Monitoring Services can be obtained from
                     MA enrolled providers which may include any MA enrolled provider that meets the
                     standards of Medication Dispensing and Monitoring Services.

              c.     The reimbursement fee will include:

                     (1.)   The installation, removal, repair or replacement of equipment;
                     (2.)   Rental of the equipment;
                     (3.)   Training of the participant and/or their caregivers;
                     (4.)   Monitoring of the Medication Dispensing service activities by a trained
                            professional with appropriate and documented interventions.

              NOTE: included as part of the monthly charge, the provider shall, either directly or
              through subcontractor, provide for ongoing provision of on-line emergency response
              services for each individual authorized. This shall include response to participant self
              testing, as well as daily provider testing, self auditing and quality control.

              d.     Roles and Responsibilities of the Area Agency on Aging (AAA):

                     (1.)   Determine the need for Medication Dispensing and Monitoring Service based
                            on the completion of the Care Management Instrument (CMI) and applying
                            the special criteria for TeleCare Services.

                     (2.)   The need for Medication Dispensing and Monitoring Service must be
                            approved by consultation with the AAA.

                     (3.)   The AAA nurse will review the Care Management Assessment and other
                            pertinent medical information, including information obtained by contacting
                            health care providers who have cared for the client, to assure the
                            appropriateness of the service.

                     (4.)   The Care Manager Supervisor must concur and approve with the
                            recommendation for Medication Dispensing and Monitoring Services.

                     (5.)   The AAA must follow PDA requirements for Care Plan Review as outlined
                            in APD#06-01-03.


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                   (6.)    Medication Dispensing and Monitoring Service must be ordered by a primary
                           physician.

                   (7.)    The AAA must provide the service provider with a copy of the participants
                           current care plan (which includes the care plan worksheet and service plan).

                   (8.)    The decision to remove the Medication Dispensing and Monitoring Service is
                           at the sole discretion of the participant/representative and the Care Manager.
                           The Care Manager will provide written documentation to terminate.

                   (9.)    Notify PDA and DPW of critical events related to the Medication Dispensing
                           and Monitoring Service.

                   (10.)   The Care Manager will investigate the damage or misuse of the Medication
                           Dispensing and Monitoring Service with the participant/representative and
                           provider to determine the continued use of the Medication Dispensing and
                           Monitoring Service.

              e.   Roles and Responsibilities for Medication Dispensing and Monitoring Service
                   Providers:

                   (1.)    Must be MA enrolled provider and meet all the Medicaid enrolled provider
                           requirements as defined in the approved waiver.

                   (2.)    Medication Dispensing and Monitoring Service must be ordered by a primary
                           physician.

                           (a.)   The order must be obtained by the service provider prior to service
                                  authorization.

                           (b.)   The order must reflect the client’s medical condition as it related to
                                  the need for the Medication Dispensing and Monitoring System.

                   (3.)    Must provide training to the participant/representative on the Medication
                           Dispensing and Monitoring Services.

                   (4.)    Must review the data collected and monitor activity with follow-up and
                           appropriate intervention as applicable to the type of technology in the home.
                           Documentation must be available upon request.

                   (5.)    The provider must maintain an up to date event notification system. Notify
                           the Care Manager of critical events that occur in the home related to the use
                           of Medication Dispensing and Monitoring Services.

                   (6.)    The provider must disconnect/remove Medication Dispensing and Monitoring
                           Service equipment from a participant’s residence within 5 working days of
                           notification by the Care Manager.


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                   (7.)    The provider must update the Medication Dispensing and Monitoring Service
                           equipment when necessary, at no cost to the AGING Waiver Program, as
                           technology improves performance.

              f.   Provider Standards for Medication Dispensing and Monitoring Services:

                   (1.)    Medication Dispensing and Monitoring Service providers must be enrolled in
                           the Medical Assistance program and are required to comply with other
                           applicable statutes, state and federal regulations, and policies and procedures.

                   (2.)    Medication Dispensing and Monitoring Service equipment must be UL
                           listed/certified and shall assure that all equipment meet manufacturer service
                           standards.

                   (3.)    It shall be the provider’s responsibility to deliver and install each Medication
                           Dispensing and Monitoring Service. The provider agrees to complete
                           installation within 5 working days of receipt of service order.

                   (4.)    The provider shall notify the Care Manager of the installation of Medication
                           Dispensing and Monitoring Services.

                   (5.)    The provider shall instruct the participant/representative in the use,
                           maintenance and safety of the Medication Dispensing and Monitoring
                           Services.

                   (6.)    Medication Dispensing and Monitoring Service provider must have a system
                           in place for notification of emergency events to designated individuals.

                   (7.)    The repair or replacement of malfunctioning Medication Dispensing and
                           Monitoring Service equipment shall be completed within 24 hours or next
                           business day of notification or identification.

                   (8.)    Data collection from Medication Dispensing and Monitoring Service must be
                           available to designated individuals, participant representative, care managers,
                           PDA staff or State Medicaid staff.

                   (9.)    Medication Dispensing and Monitoring Service reports which provide an
                           analysis of the medication monitoring activities must be made available to
                           designated individuals.

                   (10.)   Training sessions must be offered to all direct participant contact employees.
                           The provider must verify that all employees completing installation are
                           adequately trained.

                   (11.)   The provider will use, and have on file, written training materials and
                           procedures.




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                   (12.)   Units will be maintained and guaranteed by the provider, updated at no cost
                           to the Aging Waiver Program as technology improves performance.

              g.   Medication Dispensing and Monitoring Service Confidentiality:

                   (1.)    All information must be kept confidential and HIPAA compliant.




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S.     RESPITE SERVICE: STANDARDS

       1.     GENERAL INFORMATION

              a.     Respite services consist of temporary and emergency residential services offered to
                     recipients to relieve family members or primary caregivers who normally provide
                     care.

              b.     Respite services may be provided in the recipient's home or in other approved
                     settings.

              c.     Eligible residents may receive two categories of Respite Service: Twenty-four hour
                     overnight Respite and temporary or emergency Respite. Twenty-four hour overnight
                     Respite is provided in segments of 24 hours and includes overnight care. Temporary
                     or emergency assistance means Respite Services which are provided less than 24
                     hours.

              d.     All Respite Service providers are trained in the following areas prior to rendering
                     services:

                     (1.)    Consumer Rights
                     (2.)    Respite Service Provider Responsibilities
                     (3.)    Fire and Safety
                     (4.)    First Aid
                     (5.)    Basic Nutrition/Medication Training
                     (6.)    Program Philosophy/Mission

       2.     STAFF QUALIFICATION

              Agencies that provide Respite Care services must assure that Respite Care workers comply
              with federal, state and local health requirements related to communicable diseases. All field
              staff must receive a PPD test, the results of which are maintained in their files.

       3.     RECORDS AND DOCUMENTATION

              Individual time slips must be signed by the consumer or family member/caregiver and the
              Respite Care worker to document each unit of service.

       4.     SERVICE REPORTING

              Persons providing Respite Care services must comply with all reporting requirements as
              specified by the Area Agency on Aging.

       5.     SCHEDULING

              Days and times scheduled for Respite Care must be consistent with the care plan provided by
              the AAA.




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       6.     INSURANCE

              Agencies who wish to provide Respite Care services will be required to attest to having the
              following types of insurance in amounts consistent in the industry:

              a.     General liability;
              b.     Professional liability;
              c.     Automobile liability covering owned, non-owned and hired vehicles;
              d.     Workman Compensation as required by law;
              e.     Employer’s liability of accident and disease.

       7.     CONFIDENTIALITY

              All agencies who provide Respite Care services must comply with all federal, state and local
              laws relating to research on human subjects and consumer confidentiality.

              Agencies must provide all Care Managers with consent forms and approval from all
              appropriate review boards for those consumers who wish to be part of a research study.

       8.     EXCLUSIONS FROM FFP

              Room and Board

              (1.)   Pursuant to 42 CFR 441.10 (a) (3), the department shall only reimburse service
                     providers for room and board costs when Respite Services are provided in the
                     following facilities:

                     (a.)    Medicaid Certified Hospitals and Nursing Facilities;

                     (b.)    Foster Homes and Community and Residential Facilities that meet
                             appropriate state standards;

              (2.)   Reimbursement for room and board costs when Respite Services are provided in
                     private residences shall be excluded under the Waiver.




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S.     TEMPORARY SHELTER: SERVICE SPECIFIC OPERATIONAL PROCEDURES

These Operational Procedures delineate further expectations for providers delivering services to
Philadelphia Corporation for Aging (PCA) consumers of the Long Term Care Program (LTC) which
encompass the Options and Aging Waiver payment sources. Where there are differences between these
procedures and Pennsylvania Department of Health license and/or Department of Public Welfare provider
enrollment requirements and regulations, the more stringent requirement prevails.

       1      Temporary Shelter / Respite - Defined

              a.     Temporary Shelter is the intermittent provision of room, board, supervisory and
                     supportive care in a protective setting outside of the consumer’s usual place of
                     residence which is necessary to maintain the health and safety of the individual when
                     the primary caregiver needs respite from the responsibility of caring and/or is not
                     available to provide such care, or when a temporary emergency living
                     arrangement is necessary to maintain the health and safety of the consumer.

              b      Such care may be provided in an institutional - Nursing Facility (NF) or a
                     non-institutional setting, reflecting the needs of the individual and the regulatory
                     requirements of the setting.

              c.     The availability of temporary shelter arrangements are based on individual
                     agreements with service providers, based on a contracted daily rate. While every
                     effort should be made to utilize existing reimbursement sources, such as Medical
                     Assistance, Medicare, and third party payors, PCA can authorize private payment for
                     such stays up to a maximum of 2 weeks (14 days).

       2.     Service Authorization

              The need for temporary shelter arrangements may be identified on a planned basis or
              precipitated by an emergency; such circumstances can include:

              a.     The provision of respite for a primary caregiver who will be absent for at least eight
                     (8) hours a day, due to health needs of the caregiver and/or pre-scheduled relief;

              b.     The need for a temporary living arrangement, on an emergency basis, to maintain the
                     health and safety of the consumer;

              c.     The need to identify permanent housing.

                     The LTC Care Manager or Protective Services Investigator can facilitate placement
                     of a consumer in a temporary shelter arrangement based on the availability of beds at
                     a given facility. Placement can occur during regular work hours, at night, or on
                     weekends. The care manager will remain actively involved with the consumer, the
                     family, and the facility throughout the placement so as to assure a timely transfer out
                     of the placement and appropriate resolution of the consumer’s circumstances.
                     Supervisory approval is required for use of this service, and can be provided up to a
                     total of fourteen days per fiscal year per client. Individual consumer exceptions may


Eff. 7/1/09                                                                                                 162
                     be made on a case by case basis.

       3.     Facility Specifications

              a.     License - PCA will seek temporary shelter arrangements only with those facilities
                     which are fully licensed by their respective licensing authority:

                     (1.)   Nursing Homes - such facilities must have current license from the
                            Commonwealth of Pennsylvania Department of Health (DOH),

              b.     Standards of Care

                     PCA expects that facilities make available to consumers in temporary shelter
                     arrangements the same type and quality of services offered to permanent residents
                     consistent with Federal and State regulatory requirements.

                     * Subject to a facility's regulatory requirements, the placement of a stable consumer
                     into a temporary shelter arrangement - under 14 days, may not require the extensive
                     care planning of a regular admission. The evaluation of nursing, medical, social
                     work, dietary, activities, therapies, etc. can be facilitated with and in collaboration
                     with the referring care manager. It is expected that third party reimbursement will be
                     secured for eligible services and individuals.

              c.     Admission Agreements

                     (1.)   PCA - Facility

                            PCA's intent is to establish admission agreements with any and all licensed
                            facilities that are willing to provide temporary shelter arrangements, based of
                            course on the availability of beds, for appropriate LTC consumers. In order
                            to facilitate appropriate referrals, facilities will need to clearly indicate
                            admission criteria, limitations, ability to accept placements during normal
                            business hours and week-ends, and any other limitations.

                            In instances where the temporary shelter arrangement requires nursing home
                            care, PCA will attempt whenever possible to assure that all individuals
                            referred will have been examined and diagnosed free of an acute mental
                            health disorder, as a primary diagnosis, and be free of tuberculosis or other
                            communicable diseases. Moreover, in all instances, PCA will attempt
                            whenever possible to assure individuals needing psychiatric interventions or
                            care will have been directed into appropriate mental health facilities.
                            Whenever possible individuals will also be screened by health care providers
                            and certified that they are not in need of admission to an acute care facility.

                     PLEASE NOTE: There may be occasions where the Older Adults Protective
                     Services (OAPS) will not have immediate or complete consumer assessment
                     information as described above, e.g. emergency interventions to alleviate immediate
                     risk to a consumer. In such instances, these departments will work with the facility


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                     where the placement is being requested to secure appropriate and timely consumer
                     assessment/diagnostic information.

              (2.)   Facility - Consumer

                     PCA recognizes that every facility has its own admission procedure, which may
                     include a formal admission agreement. Such admission agreements should stipulate
                     the terms of the stay in the facility, and contain a list of those services included in the
                     daily rate and those services for which there are additional charges. Unless informed
                     otherwise by the PCA care manager at the time of a consumer placement, facilities
                     are not to seek "Financial Guarantee" agreements with consumers, families or
                     caregivers.

                     ** There may be occasions when the consumer and/or family/caregiver will be
                     sharing in the cost of the Temporary Shelter placement. In such instances, the PCA
                     care manager will advise the facility at the time of placement and identify those costs
                     that are to be assumed by each party; e.g. PCA could be responsible for specific
                     number of days of service and the remainder to be borne by the consumer and/or
                     family. When such a placement is requested, the facility can seek "Financial
                     Guarantee" agreements with the client and/or family/caregiver.

       3.     Payment Provisions/Invoicing

              It is anticipated that most temporary shelter arrangements will be private pay. However,
              PCA will request the cooperation of facilities to make every effort to utilize existing
              reimbursement sources such as, Medicare, Medical Assistance, and other third party payors.

              a.     Service Orders

                     When a client has been placed in a facility, PCA will forward to that facility a
                     Service Order which represents a written authorization for payment for the
                     anticipated number of days of service. For those Medical Assistance or Medicare
                     eligible consumers, it is expected that the facility or its providers will bill Medicare
                     or MA for any covered services.

              b.     Invoices

                     Units of service are invoiced on a monthly basis. Claims for Options consumers will
                     be submitted to PCA via the Automated Billing System (ABS).The invoice will
                     indicate units of service delivered. The daily reimbursement is an all-inclusive rate;
                     no miscellaneous or ancillary charges will paid without prior approval by the care
                     manager. Any such approved charges must be supported by appropriate
                     documentation, e.g. receipts, vendor invoices, etc. NOTE: all co-pay billing of
                     services reimbursable by Medicare or Medical Assistance or other insurances must
                     be done through the monthly invoice, unless otherwise noted by the care manager.
                     Service for AGING Waiver consumers will be billed directly to MA at the
                     established rate for that facility.




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       4.     Financial Statement

              Providers entering into contracts with PCA must be financially solvent and able to
              demonstrate an ability to meet daily operational expenses. Should a provider enter into
              bankruptcy proceedings, the Contract Manager must be notified immediately.




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U.     SPECIALIZED MEDICAL EQUIPMENT AND SUPPLIES: STANDARDS

       1.     Conditions

              The equipment and/or supply provided is above and beyond those already supplied under the
              approved state plan.

       2.     Fiscal Management

              Procurement of durable medical equipment, medical supplies and adaptive devices must be
              achieved by the Care Manager in the most cost effective manner available. The decision to
              rent or purchase equipment from an enrolled provider may vary greatly, depending on types
              of equipment and consumers.




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V.     DURABLE AND CONSUMABLE MEDICAL EQUIPMENT (DME): SERVICE SPECIFIC
       OPERATIONAL PROCEDURES

The following procedures are a supplement to the Durable Medical Equipment and Supplies (DME) service
standards. They delineate further general expectations for providers serving consumers in PCA’s Long
Term Care (LTC) Program which encompass the Options and Aging Waiver payment sources.

       1.     Provider Eligibility

              a.     The Philadelphia Corporation for Aging (PCA) will certify and contract with only
                     DME providers who are enrolled providers in both the Medicare and Medical
                     Assistance programs. Participation as a service provider is contingent on the
                     following:

              b.     Willingness to provide MA/Medicare covered items at the lower of either the
                     provider’s charge to the self-paying public or the respective MA or Medicare fee
                     schedule prices and, when applicable, to use the MA/Medicare prior approval
                     process.

              c.     Willingness to provide several non-MA or Medicare covered items at the established
                     prices on the PCA DME list.

       2.     DME List

              a.     Selected items, only, from the Medical Assistance (MA) Program, Medical Supplier
                     Fee Schedule product list will be utilized by PCA’s LTC program. Consumers,
                     independent of the PCA care manager, may wish to purchase, on their own or
                     covered by MA, Medicare, or a third party payment source, items needed as part
                     of their care by a skilled provider or to increase their safety.

              b.     The Philadelphia Corporation for Aging’s DME List establishes a limited range of
                     non-MA/Medicare covered equipment (hand held showers, grab bars, air
                     conditioners, a microwave, a fan) that may be ordered for consumers to enable them
                     to remain in their homes. The items on the list are identified by their PCA item
                     number, manufacturer code - where applicable, the item description, and designated
                     price. The list also includes those commonly used MA Fee Schedule items,
                     identified by their PCA number, HCPCS code, and MA rate.

              c.     Occasionally a consumer may wish to privately pay for items not on the PCA DME
                     list. In such instance, providers are requested to provide the item at the MA rate or a
                     fair market price and to install it for the same price as indicated in our DME price
                     list. Items not on the PCA DME price list may not be billed to PCA.

       3.     Service Orders

              a.     All orders on the PCA DME list will be placed through PCA personnel, only, subject
                     to an established medical necessity and will have been prescribed or ordered by the
                     consumer’s primary physician or other health professional designated by PCA,


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                    within the scope of their practice.

              b.    If the consumer is eligible to receive the item under Medical Assistance or Medicare,
                    the provider must bill that third party source, using the designated prior approval
                    process – when applicable.

              c.    The provider must have the service order before a delivery can be made or, if
                    applicable, the required authorization under the prior approval process. In the
                    event the service order is unclear or erroneous, the care manager must be contacted
                    immediately to discuss the problem. The care manager will make any needed
                    corrections in the care plan and generate a new service order.

       4.     Third Party Billing

              a.    PCA is mandated by the Pennsylvania Department of Aging to pursue all other
                    payment sources for consumers such as Medicare, Medical Assistance, and other
                    third party payers. Therefore, providers must be knowledgeable about third
                    party billing requirements and are expected to process the necessary forms,
                    including the prior approval process for items whose individual cost is over
                    $100.00, and contacting the consumer’s physician, as needed.

                    (1.)   Upon the initial contact by the PCA care manager, the provider must inform
                           them if the item requested can be billed to a third party such as Medicare or
                           Medical Assistance.

                    (2.)   Care managers will provide the necessary insurance information and name of
                           the physician, including license number, at the time the order is placed. PCA
                           will not retroactively reimburse a provider if the claim is rejected by such
                           third party payers.

                    (3.)   If an item is needed in amounts greater than those allowed or covered by third
                           party, (e.g., MA fee schedule), the excess amount may be ordered by the PCA
                           care manager and billed to PCA or Aging Waiver, at the established
                           MA/Medicare fee schedule rate.

              b.    It is expected that providers will accept third party reimbursement as full payment for
                    the item delivered, except as mandated for copayment requirements.

       5.     Delivery

              a.    The provider must have the capacity to deliver, within 3 business days, to the homes
                    of PCA consumers citywide after receiving prior approval and/or the service order
                    from the Options or Aging Waiver Program. The Options or Aging Waiver Program
                    may request next day delivery on a regular basis for certain items, such as
                    incontinence products. PCA requires that subcontractors receive a signed receipt
                    for every item delivered to a PCA consumer. No payment will be made without a
                    signed receipt for each individual item. Delivery charges are included in the prices
                    for all items on the LTC - DME SUPPLY LISTS.


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              b.     If a provider is temporarily out of stock of a particular item, the PCA staff person
                     ordering the item(s) must be notified by the provider within 2 hours of receipt of the
                     request or service order issued from PCA. The provider may substitute a comparable
                     item of the same or higher quality for the same price, but must discuss this first with
                     the PCA staff person placing the order. If the item ordered is covered by Medical
                     Assistance or Medicare, the substituted item may NOT be billed to PCA.

              c.     PCA requires that providers make NO partial deliveries. Since a follow up visit for
                     medical equipment is often made to instruct the consumers in the use of the
                     equipment, the entire order must be delivered at the same time. If this requirement
                     cannot be met for any reason, the care manager needs to be contacted immediately to
                     weigh the consequences of the delay, make any changes needed in the order, make
                     any necessary changes in the consumer’s care plan, and issue a new service order.

              d.     Delivery of the item shall be inside delivery to the client's home and to a specific
                     location inside the home if warranted (for instance assemblage of toilet seat onto
                     toilet).

              e.     If the equipment is delivered and the consumer refuses it, PCA needs to know why
                     the equipment was refused (for instance cosmetic reason, consumer no longer wants
                     item, etc.).

              f.     Certain items from List C (Incontinence items like diapers or chux) may be delivered
                     by UPS where indicated. The provider must get the care manager’s approval in
                     all cases where UPS delivery is considered.

       6.     Installation and Assembly of Equipment

              All providers must agree to install and assemble medical equipment, when necessary, in
              consumers’ homes throughout the city of Philadelphia. The Philadelphia Corporation for
              Aging (PCA) defines installation and assembly as follows:

              a.     Installation - This refers to the installing of air conditioners, microwaves, and wall
                     mounted grab bars and hand held shower hoses. Separate fixed prices for installation
                     of the grab bars and shower hoses are included on page 1, List A. Non-Consumable
                     Medical Supplies..

                     (1.)   Air Conditioners and Microwaves:

                            (a.)    Air conditioners will be securely installed in the consumers window,
                                    as identified by the Care Manager. Packing material will be removed
                                    from the consumer’s home

                            (b.)    Microwaves will be unpacked, placed in a suitable location – as
                                    identified by the consumer or Care Manager. Packing material will be
                                    removed from the consumer’s home.


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                    (2.)   Grab Bars: The Options and Aging Waiver Programs require installing of
                           grab bars or shower hoses. PCA relies on the judgment of the installer to
                           determine if an installation can safely be made. If the installer feels that it is
                           structurally unsafe to install wall mounted grab bars where marked by a PCA
                           subcontract therapist, the provider must notify the care manager immediately.
                           For safety reasons, PCA asks providers not to install any wall grab bars on
                           encased shower stalls or bathtub enclosures that are made of fiberglass.

                    (3.)   Shower Hoses: PCA asks that providers install shower hoses into the wall and
                           not use the adhesive backing. We also ask the provider to carry washers and
                           adapters on the truck at the time of doing such installations. Whenever an
                           order for a shower hose is placed, the provider must also take along the
                           Portable hand held shower which fits over faucet because the ordered hose
                           may not fit or the shower head cannot be removed. Please read the third
                           paragraph under “Assembling” concerning the process for billing such an
                           installation charge.

              b.    Assembly

                    (1.)   Assembling of equipment means putting together any parts of an item and
                           placing it in the designated area where it is to be used (e.g. the raised toilet
                           seat is to be assembled and placed over the toilet per the instructions of the
                           specific order).

                    (2.)   Assembly of equipment must be provided at no extra charge to PCA or the
                           consumer. If wall mounting of grab bars or shower hoses for consumers is
                           requested, it will be reimbursed according to the LTCO DME Supply List, on
                           page 1 of List A Non-Consumable Medical Supplies (Item A-01-0010 for the
                           first grab bar/shower hose installation at a visit, and item A-01-0020 for each
                           additional grab bar/shower hose installation at the same visit).

                    (3.)   In the process of assembling an item, it sometimes turns out that it does not
                           fit. In that case, the assembler is not to leave the item at the consumer's
                           home, but to take it back to the provider. The provider must call the PCA
                           care manager who placed the order, and discuss the nature of the problem and
                           recommend a substitute. In these instances, the consumer’s care plan will
                           need to be changed and a new service order with the new price will be faxed
                           to the provider.
       7.     Invoicing

              a.    Specific billing instructions and information will be provided by PCA.

              b.    All orders must be billed in the month they are delivered to a consumer. No
                    payment will be made for any item for which the provider does not have a
                    service order. Any back billing beyond the normal invoice period is not allowed.
                    The care manager must be notified about any item that was not delivered in the
                    month it was ordered, as this must be corrected in the consumer’s care plan. PCA


Eff. 7/1/09                                                                                               170
                    will then generate a new service order to the provider. It is very important that the
                    provider notifies the care manager of these changes as they affect invoicing and
                    payment to the provider.

              c.    PCA requires that providers receive a signed receipt for every item delivered,
                    regardless of payer source, to a PCA consumer. These signed receipts are to be
                    kept in consumer files or with the billing documents at the provider’s office as
                    this requirement will be audited by PCA’s external auditors. No payment will
                    be made without a signed receipt for each individual item. The mailing of copies
                    of signed delivery slips to PCA is NOT required; however, they must be
                    retained in the provider’s records for audit purposes.

       8.     Warranty and Repairs

              a.    The provider must warrant all equipment for satisfactory performance for the period
                    of the manufacturer's warranty, from date of installation. Defective equipment under
                    warranty must be replaced and installed at no cost to PCA or the consumer.

              b.    Prior to repair requests, the PCA Care Manager will attempt to identify which DME
                    provider supplied the item(s) in question, and direct the repair request accordingly to
                    that provider. Whether the repair request is directed to the original DME provider or
                    another (because the original provider is not known or available), the PCA Care
                    Manager will authorize the evaluation for repairs via an initial Service Order that will
                    indicate one unit of the RPAR service code at a cost of $1.00.

                    Providers will evaluate the DME item in question for repairs, including a
                    confirmation for warranty coverage – when applicable, and will notify the PCA Care
                    Manger with the estimate of the repair costs. Third party payor sources for repair
                    costs are to be exhausted prior to billing PCA or DPW. The cost of replacement
                    parts, not covered under warranty, will be based on MA Fee schedule rates, when
                    applicable. As needed, the authorization for the repair cost will be forwarded by the
                    PCA Care Manager via a modified Service Order. Labor costs for repairs will be
                    based on the rate established by MA Fee schedule.




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W.     HEARING AID SERVICES: SERVICE SPECIFIC OPERATIONAL PROCEDURES

       1.     GENERAL INFORMATION

              a.    These Operational Procedures delineate requirements for agencies providing
                    Hearing Aids to Philadelphia Corporation for Aging (PCA) consumers, of the
                    Long Term Care Options (LTCO) Program which encompass the Options and
                    Aging Waiver payment sources. The following requirements apply:

                    (1.)   The evaluation for a hearing instrument will be conducted as a result of and
                           following a comprehensive diagnostic hearing evaluation to determine the
                           consumer’s hearing ability and possible rehabilitation potential that can be
                           corrected with a hearing device(s). Note: Audiology examinations can be
                           covered by Medicare or managed care insurance plans when prescribed by the
                           primary physician and conducted by an Ear, Nose and Throat (ENT)
                           specialist or a licensed audiologist.

                    (2.)   In making appropriate cost effective treatment recommendations, generic
                           products must be considered first if applicable.

                    (3.)   The provision of hearing aid(s), if required, to the PCA consumer in his/her
                           home or provider’s office. Hearing aids will be fitted by the provider.

       2.     DEFINITION OF SERVICE

              a.    Diagnostic Evaluation - a comprehensive examination by an ENT or licensed clinical
                    audiologist, which will include, but is not limited to the following:

                    (1.)   Determination of hearing threshold;

                    (2.)   Differential testing to provide information regarding medical diagnosis and
                           treatment;

                    (3.)   Assessment of communication and handicapping effects of hearing loss;

                    (4.)   Evaluation of aural rehabilitation.

              * Diagnostic evaluations can be covered by Medicare or managed care insurance plans,
              when prescribed by a physician.

              b.    Aural Rehabilitation (Hearing Aid Evaluation) - Procedure to choose suitable
                    amplification for the consumer, which shall be based upon history, test findings,
                    observations and other considerations.

                    (1.)   Hearing Aid evaluation – selection of behind-the-ear, in-the-ear, or in-the-
                           canal hearing aids.




Eff. 7/1/09                                                                                               172
                   (2.)   Taking a mold of the consumer’s ear.

                   (3.)   Initial fitting and adjustment of the hearing aid.

                   (4.)   Hearing aid counseling; inclusive of:

                          (a.)    Instructions regarding use and care of the hearing aid.

                          (b.)    Evaluation of the consumer’s hearing aid to ensure appropriate
                                  amplification.

                          (c.)    Assisting the consumer to adjust the amplification and develop
                                  effective strategies to enhance their communication ability.

       3.     STAFF QUALIFICATIONS

              a.   Providers, enrolled in the Long Term Care Program will use staff that has the
                   appropriate credentials as deemed valid by experts in the industry. A copy of their
                   resume must be forwarded to the Contract Manager for review.

              b.   At a minimum, a Clinical Audiologist should be used. The Audiologist must hold a
                   Master’s Degree from an accredited university and hold a Certification of Clinical
                   Competence from the American Speech Language and Hearing Association. The
                   staff person must hold a license to practice audiology and dispense hearing aids, and
                   have adequate liability insurance. Note: a hearing aid fitter cannot be used in place of
                   a Clinical Audiologist. A fitter can only be used in conjunction with a Clinical
                   Audiologist for tasks such as: taking a mold of the consumer’s ear, an initial fitting,
                   and/or adjustment of the hearing aid.

              c.   All staff servicing PCA consumers must receive an orientation on PCA programming
                   and the goals and philosophy of the Long Term Care Program prior to servicing PCA
                   consumers.

       4.     DELIVERY OF SERVICE

              a.   When the need for service has been determined as a result of a diagnostic hearing
                   evaluation, the LTC Care Manager will make a referral to the provider selected by
                   the consumer. The provider will schedule the in-the-home hearing instrument
                   examination within five (5) working days of the receipt of the referral.

                   The information provided in the referral will include the consumer’s insurance
                   information, which the provider will utilize to determine whether there is third party
                   coverage – prior to the delivery of service. PCA and/or Aging Waiver shall be the
                   payor of last resort. Please note: there will be no care manager authorization of
                   partial payments for insurance deductibles and co-payments.

              b.   Within 48 hours of the hearing examination, the results of the exam will be phoned
                   to the Care Manager, identifying the type and quantity of hearing aids, if applicable.


Eff. 7/1/09                                                                                            173
              c.   The Care Manager will authorize hearing aids by forwarding a service order to the
                   provider. Note: Unless counter-indicated with clearly documented clinical reasons,
                   Care Managers will order the “generic” hearing aids.

              d.   The provider will deliver and properly fit the hearing aid(s) to the consumer.

       5.     REPORTING REQUIREMENTS

              a.   The provider is required to keep records on each consumer. Reporting requirements
                   remain the same for all LTC consumers irrespective of reimbursement source.

              b.   The provider is required to keep written documentation on each contact with the
                   consumer. The consumer record must include:

                   (1.)   Consumer’s name, Care Managers’ name, date and time of visits;
                   (2.)   Results of a diagnostic hearing evaluation;
                   (3.)   Hearing aid evaluation test results;
                   (4.)   Documentation of the hearing aid counseling and instructions in the proper
                          use of the new hearing system;
                   (5.)   Contact with the physician, Care Manager or other agencies providing care;
                   (6.)   Signed verification by the consumer or caregiver that the visit was made.

         6.   ADMINISTRATIVE REQUIREMENTS

              a.   The provider will notify the Contract Manager in writing if there is a resignation of a
                   staff member who administers the program or provides direct service to our
                   consumers.

              b.   The provider will assume responsibility for the supervision of their staff to assure the
                   delivery of quality care.

         7.   COMMUNICABLE DISEASES

              a.   When caring for consumers with communicable diseases, PCA expects provider
                   agencies to follow procedures recommended in the Center for Disease Control
                   (CDC) guidelines and OSHA regulations. Agencies are responsible to provide
                   appropriate In-services regarding these universal precautions.

              b.   Based on CDC guidelines, the provider shall develop a written policy regarding
                   communicable diseases. That policy must meet State/Federal requirements.

              c.   The provider shall notify the PCA nurse consultant or Care Manager upon
                   determining or learning from another source, that a consumer has a communicable
                   disease.

              d.   The provider must follow CDC and OSHA Guidelines regarding the disposal of
                   contaminated needles.


Eff. 7/1/09                                                                                            174
              e.   Before being assigned to a case, and annually, all consumer-contact employees shall
                   have a Mantoux Intracutaneous PPD test according o CDC recommendations and,
                   if the results are positive, it will be followed by appropriate physician directed
                   treatment.

              f.   In order to continue employment, the employee must be free of active TB.
                   Verification by a physician that the employee is free of TB must be in the personnel
                   file and updated annually. Chest X-rays are required based on physician’ advice.

              g.   All employees must be offered and/or receive the Hepatitis B Vaccine as designated
                   by OSHA Regulations.




Eff. 7/1/09                                                                                          175
X.      STAIR ELEVATOR: SERVICE SPECIFIC OPERATIONAL PROCEDURES

These Operational Procedures delineate specifications for vendors of stair elevators provided to Philadelphia
Corporation for Aging (PCA) consumers in the Long Term Care (LTC) program which encompass the Options
and Aging Waiver payment sources.

       1.      Services to be Purchased:

               a.     PCA will lease a stair elevator unit from a stair elevator manufacturer or supplier (herein
                      called Vendor). Units leased will be maintained and guaranteed by Vendor. Vendor will
                      provide installation, removal, service and repairs for each leased unit in all areas of
                      Philadelphia.

               b.     Vendor shall service a stair elevator that is reported by a consumer to be non-operating
                      within 24 hours of the earliest call provided such call is received between 8 a.m.
                      Monday and 4 p.m. Saturday; calls received between 4 p.m. Saturday and 8 a.m.
                      Monday shall be serviced no later than 12 p.m. Monday. Vendor shall make all other
                      service calls within 48 hours of the call to Vendor.

       2.      Certification Standards and Safety

               All installed stair elevators shall be certified by Vendor as meeting standards for safety and use,
               as may be promulgated by any governing body, including any electrical, manufacturing,
               consumer or other standards, rules or regulations that may apply.

       3.      Service Tasks

               PCA will be responsible for referring all consumers to be served under the contract, and will
               retain complete control of consumer eligibility determination and service authorization. PCA
               will also be responsible for monitoring and evaluating Vendor's performance.

       4.      Consumer Screening and Referral

               a.     PCA is responsible for screening and referring any consumer for leasing a stair elevator.
                      PCA will refer consumers to Vendor who have been determined by PCA to be eligible
                      and who elect to participate in leasing a stair elevator unit for their residence. However,
                      Vendor reserves the right to refuse installation in cases where its own assessment reveals
                      that the consumer and/or caregiver would be at undue risk.

               b.     Before the care manager can make the referral, the supervisor or nurse consultant in
                      LTC must approve the referral based on the consumer information on the “Stair Elevator
                      Order/Removal Form”. PCA will provide Vendor with pertinent data for each consumer
                      who is referred; data shall include the consumer's name, address, telephone number, and
                      other pertinent information that may impact on serving, including medical condition and
                      diagnoses if deemed necessary. After Vendor has completed its evaluation in Subsection
                      4.c., d., e. below, an Occupational Therapist (OT) will document the assessment for a
                      stair elevator.




Eff. 7/1/09                                                                                                   176
              c.     LTC staff will fax a “Stair Elevator Order/Removal Form” requesting Vendor to
                     evaluate the consumer's home to determine if the home is suitable for a stair elevator.
                     Vendor shall arrange with the consumer for a mutually convenient appointment within
                     five (5) working days of PCA's request to evaluate the home, and if the home is suitable
                     for a stair elevator, Vendor will arrange for an installation date and time with the
                     consumer. Vendor agrees to complete installation within ten days following the home
                     evaluation if the home is suitable for a stair elevator or within ten days following the
                     time the home has been made suitable for a stair elevator.

              d.     Vendor shall notify PCA within three (3) days after the evaluation whether a home is
                     suitable for a stair elevator and whether an installation date has been scheduled. If
                     additional work is recommended in order to make the home suitable for a stair elevator,
                     Vendor will inform PCA of its recommendations for making the home suitable for a
                     stair elevator.

              e.     The eligibility screening by PCA under Section 4.a. above relates only to clinical and
                     fiscal matters, not construction, manufacture, design, installation, and safety and use
                     matters. Without limiting the responsibility of Vendor under Section B above and
                     elsewhere in the agreement between PCA and Vendors as to Vendor’s responsibility for
                     compliance with all applicable law, and without limiting the right of Vendor to refuse an
                     installation under Section 4.a. above, in connection with Vendor’s evaluation of whether
                     a particular home is suitable for a stair elevator as required above in this section 4.,
                     Vendor shall not install any stair elevator in any particular home if the installation,
                     following any additional work or modifications recommended by the Vendor, will not
                     meet all standards for construction, manufacture, design, installation, safety and use,
                     whether promulgated by governing authorities or independent bodies, such as but not
                     limited to model building code developers and standards-developing organizations,
                     including but not limited to electrical, mechanical, engineering, manufacturing,
                     consumer and other industry standards, requirements of insurance companies and
                     underwriters, and other reasonable standards. Vendor will not recommend or install a lift
                     if it does not meet such standards. Further, all work performed shall be in good and
                     workmanlike manner, exercising Vendor’s professional expertise, being fully informed
                     by legal requirements, such standards, warranty and manufacturers’ certification
                     requirements. PCA may withdraw any Stair Elevator Order/Removal Form, or fail to
                     issue a Service Order, for any or no reason at any time. However, during the evaluation,
                     installation, and promptly after the installation is completed, and at any time thereafter
                     when Vendor visits the consumer’s home or becomes aware of a problem with the lift or
                     the consumer’s use of it, notwithstanding any evaluation by the OT, care manager, nurse
                     or others at any time, Vendor shall have the responsibility to determine not only whether
                     a particular home is suitable, but whether a particular consumer or other user is able to
                     operate the lift safely and the lift is appropriate for the consumer.

       5.     Installation

              a.     When the home is ready to accept the stair elevator and there is a confirmed installation
                     date, PCA will generate written authorization called a Service Order. The order details
                     the date of installation, the type of stair elevator, and other appropriate information.
                     Vendor will receive a service order for each consumer when the service is initiated.


Eff. 7/1/09                                                                                                177
              b.    It shall be Vendor's responsibility to deliver and install each stair elevator. Vendor
                    agrees to complete installation at the date specified. Vendor will obtain consumer
                    signature on Client Lease Agreement form at time of installation.

              c.    Vendor shall immediately notify PCA if it is unable to schedule or complete an
                    installation within the required time frame.

              d.    Vendor shall instruct the consumer in the use of the stair elevator and shall provide the
                    consumer with simple written instructions, including how to report a malfunction of the
                    stair elevator.

              e.    The Client Lease Agreement/Acknowledgement Form is dated and signed by the
                    consumer or consumer's representative at time of installation, and a copy shall be left
                    with the consumer. The Vendor retains a copy in their files.

       6.     Termination of Service

              a.    The decision to remove a stair elevator is at the discretion of PCA. For all removals,
                    notification will be by telephone from authorized PCA staff. Written authorization to
                    terminate service will be provided to the Vendor on the same day as the telephone
                    notification.

              b.    If the Vendor is notified directly by a consumer's family or other representative to
                    remove the stair elevator, the Vendor must contact PCA for approval.

              c.    When an LTC consumer with a stair elevator no longer requires such services,
                    regardless of the reason, the designated LTC staff member will discuss the
                    circumstances with appropriate staff, as needed, and contact the Vendor, so that the stair
                    elevator can be removed.

              d.    The Vendor shall, upon instruction by PCA, arrange with the consumer or consumer's
                    representative for a mutually convenient appointment to remove the stair elevator within
                    five (5) working days of notification by PCA.

              e.    The Vendor will verify to PCA by telephone and in writing that the stair elevator has
                    been removed.

              f.    Upon removal of the equipment, Vendor shall plug or patch the holes made at the time
                    the equipment was installed. PCA is aware that this is not intended to restore the
                    property to its original condition or color.

       7.     Reimbursement and Billing

              a.    PCA will reimburse Vendor for all authorized service for Options consumers. Provider
                    will submit claims to DPW for all AGING Waiver consumers.




Eff. 7/1/09                                                                                               178
              b.     No payment will be made for any service for which the Vendor does not have a service
                     order.

              c.     PCA will require Vendor to submit invoices electronically to PCA for Options
                     consumers.

       8.     Financial Statement

              Providers entering into contracts with PCA must be financially solvent and able to
              demonstrate an ability to meet daily operational and payroll expenses. Should a provider
              enter into bankruptcy proceedings, the Contract Manager must be notified immediately.




Eff. 7/1/09                                                                                              179
Y.     TRANSPORTATION: STANDARDS

The provider of transportation services may be the coordinated transportation system or other transportation
agencies which meet the following criteria:

       1.      AGENCY

               a.     Must have a back-up capacity if a vehicle is unable to or does not show.

               b.     Must have coordinated, consistent, and comprehensive safety and emergency
                      policies.

               c.     Must be licensed by the P.U.C. and/or be a Public Transit Authority, a Community

               d.     Transportation Provider, or a Community Transportation Subcontractor.

               e.     Must have drivers/personnel trained on how to relate to the needs of the elderly.

               f.     Ambulance companies who are enrolled in the Medical Assistance Program may also
                      provide non-emergency transportation services as indicated in the plan of care.

       2.      DRIVERS

               a.     Must be 18 years of age or older.

               b.     Must be properly licensed by the Commonwealth of Pennsylvania.

               c.     Must have training in handling emergency situations and accidents.

               d.     Must receive a physical examination, including a vision test, at the time of hire. In
                      addition, it is strongly encouraged that drivers continue to receive physical exams,
                      including vision tests, at least every two years after the initial exam, at the time of
                      hire.

               e.     Must be trained in passenger assistance techniques.

               f.     Must be willing to provide door-to-door service to consumers as necessary.

       3.      VEHICLES

               a.     Must be able to accommodate people with disabilities and be in compliance with the
                      Americans with Disabilities Act requirements and relevant federal regulations.

               b.     Must have capacity to accommodate attendants and escorts.

               c.     Must be maintained in a safe operating condition through a systematic preventive
                      maintenance program which at a minimum meets the recommendations of the
                      vehicle manufacturer.


Eff. 7/1/09                                                                                                 180
              d.     Procure and maintain adequate fleet, general and property liability insurance.

              e.     Drivers will identify MA waiver riders by their log book and/or MA identification
                     card.

       4.     SERVICE REPORTING

              Persons providing transportation services must comply with all reporting requirements as
              specified by the AAA.

       5.     SCHEDULING

              Days and times scheduled for transportation must be consistent with the care plan provided
              by the AAA.




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Z.     VISION CARE SERVICES: SERVICE SPECIFIC OPERATIONAL PROCEDURES

These Operational Procedures delineate requirements for agencies providing Vision Care Services to
Philadelphia Corporation for Aging (PCA) consumers, of the Long Term Care (LTC) Program
which encompass the Options and Aging Waiver payment sources. The following requirements
apply:

       1.     SERVICES TO BE PURCHASED

              PCA will purchase vision examinations, refraction and eyeglasses. These examinations will
              be performed in the homes of identified PCA consumers. In some instances, consumers may
              choose to travel to the provider for the eye examinations. The LTC care manager will
              identify these consumers and the provider will schedule appointments at their
              location/facility. Transportation will be arranged by the referring care manager. The
              services will include:

              a.     A comprehensive vision examination to determine eye condition and the need for a
                     new or change in prescription.

              b.     Making appropriate cost effective treatment recommendations.

              c.     Documentation and communication of those findings to the referring LTC care
                     manager.

              d.     The provision and fitting of new glasses, if required, to the PCA consumer in his/her
                     home.

              e.     Communication with the consumer’s physician when necessary.

       2.     STAFF QUALIFICATIONS

              a.     The staff optometrist must have a Doctor of Optometry degree from an accredited
                     optometric educational institution, Board certified and be licensed to practice
                     optometry in the Commonwealth of Pennsylvania.

              b.     All providers must receive an orientation on PCA’s Long Term Care Program prior
                     to serving consumers.

       3.     DELIVERY OF SERVICES

              a.     The LTC care manager will make a referral to the provider and relay the following
                     information regarding the home visit:

                     (1.)   Consumer name, address, zip code and telephone number;
                     (2.)   Pertinent history relating to vision problem, e.g. cataract surgery, history of
                            glaucoma, etc.;
                     (3.)   Pertinent information which may affect home visit arrangements (hard of
                            hearing, client’s ability to answer phone); and


Eff. 7/1/09                                                                                               182
                   (4.)   Whether or not a care manager or another formal/informal support needs to
                          be present during the examination.

              b.   The vision care provider will schedule the home visit and, if necessary, notify (by
                   phone) the LTC care manager prior to the scheduled visit.

              c.   Coordination of care and conferencing will occur for all PCA consumers irrespective
                   of reimbursement source (either Medicare, Medicaid or PCA payment.)

       4.     REPORTING REQUIREMENTS

              a.   The provider is required to keep records on each consumer. Reporting requirements
                   remain the same for all LTC consumers irrespective of reimbursement source.

              b.   The provider is required to keep written documentation on each contact with
                   the consumer. The consumer record must include:

                   (1.)   Consumer’s name, care manager’s name, date and time of visit;
                   (2.)   Diagnosis, treatment plan, and recommendation for follow-up;
                   (3.)   Services and interventions given, including consumers/family reception and
                          understanding of instruction;
                   (4.)   Contact with the consumer’s physician or other providers of care to PCA
                          consumers, when appropriate.

              c.   If the Vision Care provider is unable to arrange a home visit because the consumer
                   refuses service or cannot be reached by phone, the LTC care manager must be
                   notified.

       5.     INVOICING PROCEDURE

              a.   All service must be billed for the month in which they are provided. No payment
                   will be made for any service for which the provider does not have a service order.

              b.   The LTC care manager must be notified of any change in the timing of in service
                   delivery, as this must be corrected in the consumers care plan and an updated service
                   order generated.

              c.   Service will be invoiced on a Reporting Period basis according to the schedule
                   provided by PCA. Invoicing for all LTC consumers must be done via PCA’s
                   Automated Billing System.

              d.   PCA will not pay for units of service that were ordered but not delivered due to
                   consumer cancellation, no-shows, inclement weather, etc.

              e.   Services must be billed to third party payers first, if the consumer is eligible.
                   Therefore, the provider will bill third party payers, including, but not limited to,
                   Medicare, Medical Assistance and private insurance. The provider must submit to
                   PCA information detailing those services billed to third party payers for PCA


Eff. 7/1/09                                                                                              183
                   consumers. PCA will authorize payment for co-pay and/or unmet deductible when
                   applicable.

       6.     ADMINISTRATIVE REQUIREMENTS

              a.   The provider will notify the contract manager in writing if there is a resignation of a
                   staff member who administers the program or provides direct service to our
                   consumers.

              b.   The provider will assume responsibility for the supervision of their staff to assure the
                   delivery of quality care.




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                       SECTION V.



              APPLICATION FORMAT AND FORMS




Eff. 7/1/09                                  185
A.     LETTER TO APPLICANTS




Dear Applicant:

     Thank you for your interest in providing services to PCA’s Long Term Care consumers. Please refer to
the enclosed Uniform Application Procedures and Standards for background information requirements.
Following this cover letter, you will find all the forms necessary to apply for Aging Waiver certification and
to initiate contract material from PCA to become a provider of specific services funded through the LTC
Program for the fiscal year effective July 1, 2009 to June 30, 2010.

        In order to apply for a PCA Options contract and/or certification as an Aging Waiver provider for
any one of the specified services, you must submit a completed application packet that consists of all the
required provider information and in format/order referenced on the check-off list. For additional
information regarding Pennsylvania Department of Public Welfare (DPW) rules and regulations governing
AGING Waiver provider enrollment, please refer to their website:
http://www.dpw.state.pa.us/omap/omapprovmain.asp

        Upon receipt of your completed application package, we will review all of the material submitted.
If your application is incomplete in any way, a PCA Contract Manager will contact you to clarify or work
out plans to obtain any missing information. You may withdraw or modify your application at any time
during this process.

       If you are certified as an Aging Waiver provider, your application will be sent to the Department of
Public Welfare with a recommendation for enrollment.

       If you are not approved for a PCA contract and/or certified to be a provider for the Aging Waiver
program, you will be notified of any appeal options available to you.




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B.     PROVIDER APPLICATION


                              SUBMISSION FORMAT / CHECK LIST

       NOTE: Application must be submitted in the format order listed below:

       SECTION                      REQUIRED INFORMATION

       1. ____       Complete organization description, organizational structure and
                     procedures, service capabilities, internal controls, and fee schedules.

       2. ____       Copy of Personnel Manual detailing agency’s recruitment, hiring, supervision
                     policies/procedures, copy of job descriptions and salary structure.

       3. ____       Copy of all forms that consumers are typically asked to sign, including time-sheets
                     or other comparable formats used to verify delivery of service.

       4. ___        Resumes of Professional staff (e.g. RNs, etc.)

       5. ____       Signed Certification/Agency Profile Form(s)

       6. ____       Operating officers and Board Members

       7. ____       Most recent annual Financial Statement/Report

       8. ____       IRS Tax Label; Articles of Incorporation; Licenses

       9. ____       PROMISE (DPW) Provider Enrollment Base Application

       10. ____      Aging Waiver Addendum

       11.____       DPW Provider Agreement for AGING Waiver Services

       12.____       DPW Provider Agreement

       13.____       Signed Assurances form

       14.____       Signed Price Certification Form(s)

       15.____       Signed Affirmation Form(s) for each service applied for

       16.____       Required Insurance Certificates




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PROMISe™ Provider Enrollment Information and Application
In order for providers to participate with the Department of Public Welfare, they must first enroll. To be
eligible to enroll, practitioners in Pennsylvania must be licensed and currently registered by the appropriate
State agency. Out-of-state practitioners must be licensed and currently registered by the appropriate agency
in their state and they must provide documentation that they participate in that state's Medicaid program.
Other providers must be approved, licensed, issued a permit or certified by the appropriate state agency, and
if applicable certified under Medicare. To enroll, providers must complete a base provider enrollment form
and any applicable addenda documents dependent on the provider type.

The links indicated below are applicable for provider type 55 – Vendor. Please see the following link
www.dpw.state.pa.us/omap/promise/enroll/omappromiseenroll.asp for other PROMISe provider types
enrollment information.

        Enrollment Application / Provider Agreement

        Requirements / Additional Information / FormsRequirements / Additional Information / Forms

        PDA Provider Enrollment Application/Provider Agreement/Requirements/Additional Information/Forms




PROMISe (DPW) Provider Enrollment Service Change Request

PROMISe™ Service Location Change Request and Instructions




Eff. 7/1/09                                                                                                 188
C.     CERTIFICATION FORM/AGENCY PROFILE

                                  (Include one form for each applicant office)

LOCAL OFFICE: (complete Operating Officers & Board Members forms as applicable) Attachments? Y / N
1.  Contact Person Name and Title: ____________________________________________
2.  Telephone Numbers Office: ( )                 Fax: ( ) ______ E-Mail _____________
3.  Local Administrator Name and Title: _________________________________________
4.  Office Name: ___________________________________________________________
5.  Street Address:__________________________________________________________
6.  City State and Zip Code:     _________________________________________________

 7.                                                                  Provider Number                  Date of Action
      IRS Number
      Medicare Certification
      DPW/MA Enrollment, Certification
      AGING Waiver Program Certification
      Joint Commission Accreditation (JCHO)

PARENT COMPANY: (complete Operating Officers & Board Members forms as applicable) Attachments? Y / N

 8.    Company Name:___________________________________________________
 9.    Street Address: ______________________________________________________
10.    City, State and Zip Code:_______________________________________________
11.    Agency Status (circle all that apply)
               A.     (1) Profit             (2)     Non-Profit   (3) Public
               B.     (1) Corporation        (2) Privately Owned  (3) Publicly Traded

12.    Agency Type (circle one):
             (1) Educational Institution                     (2) Product Vendor
             (3) Organization/Agency                         (4) Other Institution

13.    Agency Data:                               _________________                      _______________
                         (Company Founded)              (Initiation of this office)       (Number of Offices)

14.    Total Unduplicated Persons served
       by this office during the last calendar year: ____________                        ____________
                                                                         (Year)          (Number for year)
15.    Total Number of Current Staff (This office Only):
       ___________________       ___________ _____________                            ___________
       (Administrative/Supervisory)         (Service)          (Other)                  (Total)

16.    Total IRS Gross Revenue:                              $_________________                   $_______________
       Filing Year: ___________                                     (Total Company)                    (This Office)

17.    _________________________________                ___________________                       __________________
       (Signature of Authorized Representative)              (Title)                                     (Date)


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                     OPERATING OFFICERS (Photocopy, as needed)

A. NAME __________________________________________________________

TITLE _____________________________________________________________

ADDRESS                                  ZIP CODE             PHONE____________

ETHNICITY (CIRCLE)                             SEX             AGE
1. BLACK               4. AMERICAN INDIAN      1. MALE        1. UNDER 60
2. HISPANIC            5. WHITE                2. FEMALE      2. OVER 60
3. ASIAN AMERICAN      6. OTHER

B. NAME_____________________________________________________

TITLE ____________________________________________________________

ADDRESS                                ZIP CODE          PHONE ___________

ETHNICITY (CIRCLE)                 SEX           AGE
1. BLACK               4. AMERICAN INDIAN      1. MALE         1. UNDER 60
2. HISPANIC            5. WHITE                2. FEMALE       2. OVER 60
3. ASIAN AMERICAN      6. OTHER

C. NAME____________________________________________________

TITLE ____________________________________________________________

ADDRESS __________________________ZIP CODE         PHONE_________________

ETHNICITY (CIRCLE)                                SEX          AGE
1. BLACK               4. AMERICAN INDIAN         1. MALE     1. UNDER 60
2. HISPANIC            5. WHITE                   2. FEMALE   2. OVER 60
3. ASIAN AMERICAN      6. OTHER

D. NAME _____________________________________________________________

TITLE _______________________________________________________________

ADDRESS                                   ZIP CODE            PHONE_______________

ETHNICITY (CIRCLE)                             SEX             AGE
1. BLACK               4. AMERICAN INDIAN      1. MALE   1. UNDER 60
2. HISPANIC            5. WHITE                2. FEMALE 2. OVER 60
3. ASIAN AMERICAN      6. OTHER




Eff. 7/1/09                                                                          190
                       BOARD MEMBERS (Photocopy, as needed)

A. NAME __________________________________________________________

TITLE _____________________________________________________________

ADDRESS                                  ZIP CODE          PHONE ________

ETHNICITY (CIRCLE)                             SEX           AGE
1. BLACK               4. AMERICAN INDIAN      1. MALE      1. UNDER 60
2. HISPANIC            5. WHITE                2. FEMALE    2. OVER 60
3. ASIAN AMERICAN      6. OTHER

B. NAME __________________________________________________________

TITLE _____________________________________________________________

ADDRESS                                  ZIP CODE          PHONE _________

ETHNICITY (CIRCLE)                             SEX           AGE
1. BLACK               4. AMERICAN INDIAN      1. MALE      1. UNDER 60
2. HISPANIC            5. WHITE                2. FEMALE    2. OVER 60
3. ASIAN AMERICAN      6. OTHER

C. NAME __________________________________________________________

TITLE _____________________________________________________________

ADDRESS                                  ZIP CODE          PHONE __________

ETHNICITY (CIRCLE)                             SEX           AGE
1. BLACK               4. AMERICAN INDIAN      1. MALE      1. UNDER 60
2. HISPANIC            5. WHITE                2. FEMALE    2. OVER 60
3. ASIAN AMERICAN      6. OTHER

D. NAME __________________________________________________________

TITLE _____________________________________________________________

ADDRESS                                  ZIP CODE          PHONE _________

ETHNICITY (CIRCLE)                             SEX           AGE
1. BLACK               4. AMERICAN INDIAN      1. MALE      1. UNDER 60
2. HISPANIC            5. WHITE                2. FEMALE    2. OVER 60
3. ASIAN AMERICAN      6. OTHER




Eff. 7/1/09                                                                   191
D.     ASSURANCES

       By my initials next to each statement that follows and my signature below, I certify that:

           I have the capacity to deliver all service orders accepted and will commit the resources at my
       disposal to assure provision of all services applied for.

            I understand that PCA does not guarantee any minimum or maximum volume of service and
       that the total amount of actual reimbursement will be based on consumer choice, service orders
       placed by PCA, and actual service delivered and verified by consumer signatures.

              I will carry and keep current insurance and provide evidence of such insurance, upon request.

           I agree to maintain for 4 years and make available, for purposes of PCA monitoring and audit,
       documentation to verify service provision as invoiced and reimbursed.

           I recognize the particular need for sensitivity in serving the elderly, and am committed to
       providing honest, thorough and responsive staff service in order to minimize consumer disruption
       and upset.




NAME: _______________________                               _________________________
              (Signature)                                           (Print name)

TITLE: _______________________________________________________________

Name of organization: ___________________________________________________

Address: _____________________________________________________________

City/State:                          Zip:          Phone:                 Date: _______




Eff. 7/1/09                                                                                               192
E.     PROVIDER AFFIRMATION, PRICE CERTIFICATION, AND PROFILE FORMS


Following are copies of price certification forms to record the unit price(s) you are requesting for the
services you are seeking to provide. The same prices will apply to both funding sources under LTC:
Options and Aging Waiver. As part of this process, a best and final price quote process may be necessary
depending upon prices offered. An Affirmation and Service Profile form (where included), must be
submitted with each Price Certification Form submitted. Please make sure that your agency/organization is
enrolled in MA as the correct Provider Type for the services/ Procedure Codes you are applying for and
offering prices.

Should you have any questions regarding the price negotiation process, please contact your Contract
Manager in the Business Administration Department.




Eff. 7/1/09                                                                                           193
1.     ADULT DAY CARE CENTERS: PROVIDER AFFIRMATION

I, the undersigned, affirm that:

       1.      STANDARDS: I will comply with all Pennsylvania Department of Aging licensing
               requirements and the requirements related to the Older Adult Daily Living Centers
               Standards and Service Specific Operational Procedures (SSOP).

       2.      STAFF QUALIFICATIONS: I will assure that all consumer contact staff receives an
               annual PPD test and that documents of the results are maintained in their files along
               with other verification of compliance with federal, state and local health requirements
               related to communicable disease. I will follow procedures recommended in the Center
               for Disease Control (CDC) Guidelines and OSHA regulations, including provision of
               protective articles to staff.

               I will assure that a criminal history record check for compliance with Act 169 will be
               completed on all staff servicing PCA consumers.

       3.      TRAINING: All Older Adult Day Care Staff serving LTC consumers will meet the
               training requirements established by the Pennsylvania Department of Aging.

       4.      SERVICE REPORTING: I will comply with all reporting requirements as specified
               by the AAA.

       5.      SCHEDULING: I understand that the specific days for which service is scheduled shall
               be in conformance with the consumer’s needs and consistent with the Care Plan
               provided by the AAA.

       6.      INSURANCE: I agree to carry, verified by a current certificate of coverage in the
               amounts specified by PCA




Eff. 7/1/09                                                                                              194
       7.     CONFIDENTIALITY - RESEARCH PROTOCOLS: I will comply with all federal,
              state and local laws relating to research on human subjects; and all federal, state and
              local laws and agreements with AAA’s, regarding consumer confidentiality. I agree and
              warrant that any research in which consumers receiving services under the Aging
              Waiver program will be asked to participate, shall have been reviewed and approved by
              a Department of Health and Human Services (DHHS) or Federal Drug Administration
              (FDA) approved Institutional Review Board (IRB) unless exempt from IRB review. I
              will inform the appropriate (PDA, MA and AAA) staff of research involving said
              consumers and will provide all appropriate parties with copies of IRB approvals and
              consent forms. I, upon request, will provide all parties with any additional information
              and copies of research protocols.


PROVIDER NAME:          ________________________________________

PROVIDER ADDRESS: ___________________________________________

CITY, STATE AND ZIP CODE: ______________________________________

                                                          ______________
(Signature of Authorized Representative)                   (Date)




Eff. 7/1/09                                                                                              195
2.     PRICE CERTIFICATION FORM: ADULT DAY CARE CENTERS

Provider Name: _______________________________County: _____________________


                                   REIMBURSEMENT RATES
                                        CUSTOMARY AND                     RATE REQUESTED
                                        USUAL CHARGE                      FROM LTC
 PROCEDURE CODE
                                        YEAR: _________                   PROGRAM


 FULL DAY, including meal and 2
 snacks.
  (unit = day)  S5102      DAYC

 FULL DAY, including meal, 2 snacks,
 and bath.
  (unit = day) S5102-32 DAYB

 HALF-DAY, including meal and one
 snack
  (unit = 1/2 day) S5101   DAYH

 HALF-DAY, including meal, one
 Snack, and bath.
 (unit = ½ day) S5101- 32   WATB


 MEAL COST (included above as part
 of daily charge)        DCML


 BATH COST (included above as part
 of daily charge)

                                                              North
                                    South        West         Central       Northwest      Northeast

 Service Areas Requested

I understand the rates above will be used to determine the actual reimbursement rate for the provider named
herein for both LTC funding sources, subject to the price ceiling for each Procedure Code. I affirm the
price information provided above is true, correct, and complete to the best of my knowledge. I
Understand The Rate Requested From The LTC Program May Not Exceed My Customary And
Usual Rate.
________________________________                      __________________              ___________
Signature of Authorized Representative                         Title                      Date




Eff. 7/1/09                                                                                                   196
3.       ATTENDANT CARE (ACT 150 – Transitional Service): PRICE CERTIFICATION FORM


Provider Name:           ________________________ County: _________________________________


                                           REIMBURSEMENT RATES

                PROCEDURE CODE                          ATTENDANT CARE                    STARTING HOURLY
                                                        FEE SCHEDULE,                       RATE PAID TO
                                                        EFFECTIVE 7/1/08:                     WORKERS


     Combination Model – (unit = hour)                             15.64
     ATCO

     Agency Directed Model – (unit = hour)                         18.84
     ATAO

     Monthly Coordination Fee (unit = 1 month fee)                 154.26

     ATMC

     Monthly Financial Management Service – for
     Consumer and Combination Model only–                          75.00
     (unit= 1 monthly fee) ,
     ATFM       (*W7341 - effective 8/1/07)




                                                                    North
                                      South          West          Central           Northwest          Northeast

     Service Areas

I understand the rates above will be used to determine the actual reimbursement rate for the provider named herein for
both LTC funding sources, subject to the price ceiling for each Procedure Code. I affirm the price information provided
above is true, correct, and complete to the best of my knowledge.


                               __                         ______________                   ___________
Signature of Authorized Representative                          Title                          Date




Eff. 7/1/09                                                                                                         197
4.        ATTENDANT CARE / PERSONAL ASSISTANCE SERVICE (PAS) PROFILE

As an adjunct to the enclosed Price Certification Form, the following statistical data is being
requested for informational purposes.

It is expected that data presented will relate to Attendant Care or Personal Assistance Service.

APPLICANT                                                       FISCAL YEAR ________

I. Agency Status

     A.     Are you a Medicare Certified Home Health Agency?

                 Yes            No

     B.     Are you applying for, or intending to obtain Medicare Certification?

                 Yes            No

     C.     Information presented below relates to:     (check one)

                 Personal Assistance Service
                 Attendant Care

II. Agency Information

     A. Training

            Do you currently have the following:
            Certificate Training Yes             No             If yes, hrs./mo.
            In-Service Training Yes              No             If yes, hrs./mo.
            Orientation          Yes             No             If yes, hrs./mo.


     B. Attendant Care / Personal Assistance Service Level; last calendar year: _________

            1.     Average number of consumers served on a weekly basis:           ______
            2.     Average number of hours delivered on a weekly basis:            ______
            3.     Total number of hours delivered last year:                      ______




Eff. 7/1/09                                                                                        198
   C. Attendant Care / Personal Assistance Service Workers

           1. Number of attendant care / personal assistance attendants:


   Length of providing service         # Attendants           # of Field Supervisors

   24 months & longer

   12 through 23 months

   6 through 11 months

   Less than 6 months

   Total number


           2.        What is your current starting salary for attendants?                _________

           3.        What is the current average salary paid to these workers?          _________

           4.        What are the Fringe costs (% basis)?                              __________

           5.        Number of hours per week worked by attendant care / personal assistance workers and
                     field supervisors:


    Hours Per Week        Under 9       10-19         20-29            30-39           40-49         50+

     # Attendants


      # of Field
     Supervisors




Eff. 7/1/09                                                                                                199
5.     COUNSELING: PROVIDER AFFIRMATION


I am applying to provide the Counseling services I have checked below:

        1.             Problem-solving and coping skills
        2.             Drug Dependency
        3.             Alcoholism
        4.             Individual stress
        5.             Marital/family stress
        6.             Family problems involving abuse or neglect
        7.             Detection and treatment of depression and other mental health conditions
        8.             Nutrition education, counseling and/or diet instruction
        9.             Music therapy
       10.             Other (specify):

I, the undersigned, affirm that:

       1.      STANDARDS: I will comply with all the requirements stated in the Long Term Care
               (LTC) Program Counseling Standards and Service Specific Operational Procedures
               (SSOP).

       2.      STAFF QUALIFICATIONS: I will assure that documentation of the credentials of all
               counseling staff is maintained in their files along with other verification of compliance with
               any federal, state and local health requirements related to communicable disease. Where
               they apply, I will follow procedures recommended in the Center for Disease Control (CDC)
               Guidelines and OSHA regulations, including provision of protective articles to staff.

               I will assure that a criminal history record check for compliance with Act 169 will be
               completed on all staff servicing PCA consumers.

       3.      SUPERVISION: All counselors providing service to LTC Program consumers will be
               supervised or have access to consultation.

               Supervision will be provided based on the normal and customary clinical practice in the
               industry. Such supervision will include, but not be limited to, review of assessments and
               other clinical activities, clinical guidance and support regarding therapeutic techniques.

       4.      SERVICE REPORTING: I will comply with all reporting requirements as specified by
               the AAA.

       5.      SCHEDULING: I understand that the specific days and times for which service is
               scheduled shall be in conformance with the consumer’s needs.

       6.      INSURANCE: I agree to carry, verified by a current certificate of coverage in the amounts
               specified by PCA




Eff. 7/1/09                                                                                                 200
       7.     CONFIDENTIALITY - RESEARCH PROTOCOLS: I will comply with all federal,
              state and local laws relating to research on human subjects; and all federal, state and local
              laws and agreements with AAA’s, regarding consumer confidentiality. I agree and warrant
              that any research in which consumers receiving services under the LTO program will be
              asked to participate, shall have been reviewed and approved by a Department of Health and
              Human Services (DHHS) or Federal Drug Administration (FDA) approved Institutional
              Review Board (IRB) unless exempt from IRB review. I will inform the appropriate (PDA,
              MA and AAA) staff of research involving said consumers and will provide all appropriate
              parties with copies of IRB approvals and consent forms. I, upon request, will provide all
              parties with any additional information and copies of research protocols.


PROVIDER NAME:          __________________________________________________

PROVIDER ADDRESS: _________________________________________________

CITY, STATE AND ZIP CODE:__________________________________________

                                                                      _____________
 (Signature of Authorized Representative)                                 (Date)




Eff. 7/1/09                                                                                             201
6.     COUNSELING SERVICE: PRICE CERTIFICATION FORM


Provider Name: _______________________________County: ___________________


                                      REIMBURSEMENT RATES

                                 MEDICARE          MA RATE:           CUSTOMARY           RATE
 PROCEDURE CODE                  RATE:             YEAR:              AND USUAL           REQUESTED
                                 YEAR:             ______             CHARGE              FROM LTC
                                                                      YEAR:               PROGRAM

 INITIAL
 EVALUATION(unit = visit
  T2025 -HH         CNEV
 PROBLEM SOLVING &
 COPING SKILLS (unit =
 visit)
 T2025 -HH         CNIT
 MUSIC THERAPY(unit =
 visit)
 T2025 -HH        WMUS
 TELEPHONE SUPPORT
 GROUP(unit = session)
  T2025 -HH        CNOG




                                                            North
                                  South        West         Central        Northwest      Northeast

 Service Areas Requested

I understand the rates above will be used to determine the actual reimbursement rate for the provider
named herein for both LTC funding sources, subject to the price ceiling for each Procedure Code. I affirm
the price information provided above is true, correct, and complete to the best of my knowledge. I
Understand The Rate Requested From The LTC Program May Not Exceed My Customary And
Usual Rate.

                                                                                    _________
Signature of Authorized Representative                        Title                     Date




Eff. 7/1/09                                                                                                 202
   7.      PROFESSIONAL EVALUATION SERVICES: PROVIDER AFFIRMATION


I, the undersigned, affirm that:

           1.     STANDARDS: I will comply with all the procedures stated in the Long Term Care (LTC)
                  Program Service Specific Operational Procedures.

           2.     STAFF QUALIFICATIONS: I will assure that all consumer contact staff receive an
                  annual PPD test and that documents of the results are maintained in their files along with
                  other verification of compliance with federal, state and local health requirements related to
                  communicable disease. I will follow procedures recommended in the Center for Disease
                  Control (CDC) Guidelines and OSHA regulations, including provision of protective
                  articles to staff.

                  I will assure that a criminal history record check for compliance with Act 169 will be
                  completed on all staff servicing PCA consumers.

           3.     TRAINING: All staff serving LTC consumers will meet the education and requirements
                  specified and demonstrate competency in the skill areas licensure included in the Service
                  Specific Operational Procedures.

           4.     CARE PLAN COMPLIANCE: I agree that a care plan will be developed jointly
                  between my staff and the LTC care manager and primary physician and will be subject to
                  interdisciplinary review and coordination.

           5.     CARE PLAN COORDINATION: I agree staff will make joint visits, as needed, in the
                  care needed. and will maintain ongoing records and make necessary communication to
                  provide instruction, discuss the consumer’s progress, and review treatment
                  recommendations. I agree staff will assess the consumer and family’s ability to participate

           6.     SERVICE REPORTING: I will comply with all reporting requirements as specified by
                  the AAA.

           7.     SCHEDULING: I understand that the specific days and times for which service is
                  scheduled shall be in conformance with the consumer’s needs.

           8.     INSURANCE: I agree to carry, verified by a current certificate of coverage in
                  the amounts specified by PCA.




   Eff. 7/1/09                                                                                                203
         9.     CONFIDENTIALITY-RESEARCH PROTOCOLS: I will comply with all federal,
                state and local laws relating to research on human subjects; and all federal, state and local
                laws and agreements with AAA’s, regarding consumer confidentiality. I agree and
                warrant that any research in which consumers receiving services under the LTC program
                will be asked to participate, shall have been reviewed and approved by a Department of
                Health and Human Services (DHHS) or Federal Drug Administration (FDA) approved
                Institutional Review Board (IRB) unless exempt from IRB review. I will inform the
                appropriate ( PDA, MA and AAA) staff of research involving said consumers and will
                provide all appropriate parties with copies of IRB approvals and consent forms. I, upon
                request, will provide all parties with any additional information and copies of research
                protocols.



PROVIDER NAME:_____________________________________________________

  PROVIDER ADDRESS: _________________________________________________

  CITY, STATE AND ZIP CODE: _________________________________________

                                                                      ___________________

(Signature of Authorized Representative)                                 (Date)




  Eff. 7/1/09                                                                                               204
8.       PROFESSIONAL EVALUATION SERVICES: PRICE CERTIFICATION FORM (1)


Provider name: _____________________________ County: ____________________


                                      REIMBURSEMENT RATES

                                       MEDICARE          MA          CUSTOMARY           RATE
     PROCEDURE CODE                    RATE:             RATE:       AND USUAL           REQUESTED
                                       YEAR:             YEAR:       CHARGE              FROM LTC
                                                                     YEAR:               PROGRAM

     PSYCHIATRIC EVALUATION
     (unit = hour) PSYC

     MEDICAL EVALUATION (unit
     = hour)      PHYS




                                      South     West       North Central     Northwest     Northeast

     Service Areas Requested

I understand the rates above will be used to determine the actual reimbursement rate for the provider
named herein for both LTC funding sources, subject to the price ceiling for each Procedure Code. I
affirm the price information provided above is true, correct, and complete to the best of my
knowledge. I Understand The Rate Requested From The LTC Program May Not Exceed My
Customary And Usual Rate.

                                                                                   ___________
Signature of Authorized Representative                       Title                   Date




Eff. 7/1/09                                                                                             205
9.       PROFESSIONAL EVALUATION SERVICES: PRICE CERTIFICATION FORM (2)


Provider name: ___________________________ County: ____________________________


                                      REIMBURSEMENT RATES

                                       MEDICARE          MA          CUSTOMARY           RATE
     PROCEDURE CODE                    RATE:             RATE:       AND USUAL           REQUESTED
                                       YEAR:             YEAR:       CHARGE              FROM LTC
                                                                     YEAR:               PROGRAM
     PSYCHOLOGICAL
     EVALUATION
     (unit = hour) PSGY

     OBRA PSYCHOLOGICAL
     EVALUATION
     (unit = hour) OBAS




                                      South     West       North Central     Northwest     Northeast

     Service Areas Requested

I understand the rates above will be used to determine the actual reimbursement rate for the provider
named herein for both LTC funding sources, subject to the price ceiling for each Procedure Code. I
affirm the price information provided above is true, correct, and complete to the best of my
knowledge. I Understand The Rate Requested From The LTC Program May Not Exceed My
Customary And Usual Rate.

                                                                                     ___________
Signature of Authorized Representative                       Title                        Date




Eff. 7/1/09                                                                                             206
10.    HOME HEALTH CARE: PROVIDER AFFIRMATION



I, the undersigned, affirm that:

       1.     STANDARDS: I will comply with all the requirements stated in the Long Term Care
              (LTC) Program Home Health Care Standards and Service Specific Operational Procedures
              (SSOP).

       2.     STAFF QUALIFICATIONS: I will assure that all consumer contact staff receive an
              annual PPD test and that documents of the results are maintained in their files along with
              other verification of compliance with federal, state and local health requirements related to
              communicable disease. I will follow procedures recommended in the Center for Disease
              Control (CDC) Guidelines and OSHA regulations, including provision of protective
              articles to staff.

              I will assure that a criminal history record check for compliance with Act 169 will be
              completed on all staff servicing PCA consumers.

              All Enterostomal nurses serving LTC consumers will have graduated from an accredited
              Enterostomal Therapy Nurse Education Program approved by the International
              Association for Enterostomal Therapy and be board certified or board eligible. If board
              eligible, the ET nurse shall sit for and pass the board certification examination within one
              year of employment by provider.

       3.     TRAINING: All Home Health Aides serving LTC consumers will demonstrate
              competency in the skill areas included in the Home Health Standards. Observation of
              competency will be documented in each Home Health Aide’s Personnel file.

       4.     CARE PLAN COMPLIANCE: After joint development by the RN, PT, OT, ST, ET,
              Psych Nurse, with the LTC care manager and physician, each home health care plan will
              be maintained in the home of the LTC consumer as well as in the consumer’s file, for
              interdisciplinary review and coordination. The professional involved also will develop a
              care plan for the home health aide to follow in the consumer’s home. The home health
              aide will perform only those tasks approved by AAA staff.

       5.     CARE PLAN COORDINATION: I agree the Enterostomal Nurse and the Registered
              Nurse will make joint visits, as needed, and will maintain ongoing communication to
              provide instruction, discuss the consumer’s progress, and review treatment
              recommendations. I agree the Enterostomal Nurse will assess the consumer and family’s
              ability to participate in the care needed.

       6.     SERVICE REPORTING: I will comply with all reporting requirements as specified by
              the AAA.




Eff. 7/1/09                                                                                              207
       7.     SCHEDULING: I understand that the specific days and times for which service is
              scheduled shall be in conformance with the consumer’s needs.

       8.     INSURANCE: I agree to carry, verified by a current certificate of coverage in the
              amounts specified by PCA.

       9.     CONFIDENTIALITY-RESEARCH PROTOCOLS: I will comply with all federal, state
              and local laws relating to research on human subjects; and all federal, state and local laws
              and agreements with AAA’s, regarding consumer confidentiality. I agree and warrant that
              any research in which consumers receiving services under the LTC program will be asked
              to participate, shall have been reviewed and approved by a Department of Health and
              Human Services (DHHS) or Federal Drug Administration (FDA) approved Institutional
              Review Board (IRB) unless exempt from IRB review. I will inform the appropriate ( PDA,
              MA and AAA) staff of research involving said consumers and will provide all appropriate
              parties with copies of IRB approvals and consent forms. I, upon request, will provide all
              parties with any additional information and copies of research protocols.


PROVIDER NAME:____________________________________________________

PROVIDER ADDRESS:_________________________________________________

CITY, STATE AND ZIP CODE:__________________________________________

                                                           _________________
 (Signature of Authorized Representative)                        (Date)




Eff. 7/1/09                                                                                            208
   11.     HOME HEALTH SERVICES: PRICE CERTIFICATION FORM

   Provider Name:_______________________________ County: ______________

                                               REIMBURSEMENT RATES

  PROCEDURE CODE                      MEDICARE       MA                     CUSTOMARY AND       RATE
                                      RATE:          RATE:                  USUAL CHARGE        ESTABLISHED
                                      YEAR: ____     YEAR: ____             YEAR:               FOR LTC
                                                                                                PROGRAM
  NURSING (unit = visit)
                                                                                                      88.00
  T2025-TD              NURS
  PHYSICAL THERAPY (unit =
  visit)                                                                                              88.00
  T2025-GP         HHPT
  OCCUPATIONAL THERAPY
  (unit = visit)                                                                                      88.00
  T2025-GO              HHOT
  SPEECH THERAPY
  (unit = visit)                                                                                      88.00
  T2025-GN              HHST
  PSYCHIATRIC NURSING
  (unit = visit                                                                                       88.00
  T2025-TD PSNR
  ENTEROSTOMAL THERAPY
  (unit = visit)                                                                                      88.00
   T2025 - TD           ENST
  HIGH TECH NURSING (unit =
  visit)                                                                                              88.00
  T2025-TD       NRHT
  HOME HEALTH AIDE
  (unit = visit)
                                                                                                      46.00
  T2025 HHHA
  Health Status Measuring and
  Monitoring Service (unit = 1/day)                                                                   10.00
  T2025-GT              HSMM
                                                                   North
                                       South       West           Central        Northwest          Northeast

  Service Areas Requested
I understand the rates above will be used to determine the actual reimbursement rate for the provider named
herein for both LTC funding sources, subject to the price ceiling for each Procedure Code. I affirm the price
information provided above is true, correct, and complete to the best of my knowledge. I Understand The
Rate Requested From The LTC Program May Not Exceed My Customary And Usual Rate.

                                                                                             ___________
Signature of Authorized Representative                    Title                                  Date




   Eff. 7/1/09                                                                                                  209
12.     HOME HEALTH SERVICE PROFILE

As an adjunct to the enclosed Price Certification Form, the following statistical data is being
requested for informational purposes.

APPLICANT                                                  YEAR: ________________
Agency Information

   A. Home Health Service Level Last Calendar Year: __________

           1.   Average number of patients served on a weekly basis: _______
           2.   Average number of visits made on a weekly basis: __________
           3.   Total number of visits made last year: __________

   B. Skilled Workers

           1. Number of contracted skilled workers used by you at this time: _________
           2. Number of skilled workers employed by you at this time: ___________
           3. Please break down in the chart below, the total included in 1 and 2: ________


      Length of Employment      Registered     Physical     Occupational   Enterostomal       Psychiatric
            and Status           Nurses       Therapists     Therapists       Nurses            Nurses

      24 months & longer

      12 through 23 months

      6 through 11 months

      Less than 6 months

      Total number

      Employed Full Time

      Employed Part Time

      Contracted




Eff. 7/1/09                                                                                                 210
13.    HOME SUPPORT: PROVIDER AFFIRMATION



Provider may offer one or more of the services that follow:

       1.      Basic housekeeping.
       2.      Labor-intensive, low-cost home repair.
       3.      Chores necessary for reasons of a consumer’s health and safety, which requires availability
               of heavy cleaning in the home, extermination and hauling of debris.
       4.      Grounds Maintenance.
       5.      Extermination
       6.      Dumpster Rental/Hauling
       7.      Home Management necessary to ensure safe and sanitary condition
       8.      Instruction in home management.
       9.      Personal laundry and mending of clothing.
       10.     Meal planning and preparation.
       11.     Financial management.
       12.     The escorting of consumer by a Home Support worker to complete chores or to keep
               medical appointments, through the use of the coordinated transportation system.
       13.     Shopping Assistance with or without the consumer.

I, the undersigned, affirm that:

       1.      STANDARDS: I will comply with all the requirements stated in the Long Term Care
               (LTC) Program Home Support Service Standards and Service Specific Operational
               Procedures (SSOP).

       2.      STAFF QUALIFICATIONS: I will assure that all consumer contact staff receive an
               annual PPD test and that documents of the results are maintained in their files along with
               other verification of compliance with federal, state and local health requirements related to
               communicable disease. I will follow procedures recommended in the Center for Disease
               Control (CDC) Guidelines and OSHA regulations, including provision of protective articles
               to staff.

               I will assure that a criminal history record check for compliance with Act 169 will be
               completed on all staff servicing PCA consumers.

       3.      SERVICE REPORTING: I will comply with all reporting requirements as specified by
               the AAA.

       4.      SCHEDULING: I understand that the specific tasks and days and times for which service
               is scheduled shall be in conformance with the consumer’s needs.

       5.      INSURANCE: I agree to carry, verified by a current certificate of coverage in the amounts
               specified by PCA




Eff. 7/1/09                                                                                              211
       6.     CONFIDENTIALITY - RESEARCH PROTOCOLS: I will comply with all federal,
              state and local laws relating to research on human subjects, and all federal, state and local
              laws and agreements with AAA’s, regarding consumer confidentiality. I agree and warrant
              that any research in which consumers receiving services under the LTC program will be
              asked to participate, shall have been reviewed and approved by a Department of Health and
              Human Services (DHHS) or Federal Drug Administration (FDA) approved Institutional
              Review Board (IRB) unless exempt from IRB review. I will inform the appropriate (PDA,
              MA and AAA) staff of research involving said consumers and will provide all appropriate
              parties with copies of IRB approvals and consent forms. I, upon request, will provide all
              parties with any additional information and copies of research protocols.


PROVIDER NAME: __________________________________________________

PROVIDER ADDRESS: _______________________________________________

CITY, STATE AND ZIP CODE: __________________________________________

_______________________________________                    __________________
Signature of Authorized Representative)                          (Date)




Eff. 7/1/09                                                                                             212
14.     HOME SUPPORT: PRICE CERTIFICATION FORM

Provider Name: _____________________________ County: __________________________

                                            REIMBURSEMENT RATES

           PROCEDURE CODE                       CUSTOMARY AND USUAL                      RATE REQUESTED
                                                CHARGE, YEAR:                           FROM LTC PROGRAM


 HEAVY CLEANING
 (unit = 1/4 hour) W1729            CHHC

 INITIAL EXTERMINATION
 (unit = visit) W1732               CHEX

 FOLLOW-UP EXTERMINATION
 (unit = visit) W1733  CHXF

 SPECIAL EXTERMINATION
 (unit = visit) W1733  CHXS

 RENTAL DUMPSTER
 (unit = daily fee) W1758           CHDR
                                                                     North
                                      South          West           Central          Northwest           Northeast

 Service Areas Requested

I understand the rates above will be used to determine the actual reimbursement rate for the provider named herein for
both LTC funding sources, subject to the price ceiling for each Procedure Code. I affirm the price information provided
above is true, correct, and complete to the best of my knowledge. I Understand The Rate Requested From The LTC
Program May Not Exceed My Customary And Usual Rate.

                               __                         ________________                 ____________
Signature of Authorized Representative                          Title                          Date

                               HOME SUPPORT/CHORE - VENDOR PROFILE

                                Types of cleaning performed last calendar year
                            Restoration       Domestic
Type                                                        Store     Office    Industrial      Extermination visits
                             (fire, etc)      Services
Enter unduplicated
number cleaned
2008-09




Eff. 7/1/09                                                                                                        213
15.     HOME SUPPORT- FINANCIAL MANAGEMENT: PRICE CERTIFICATION FORM

Provider Name: ___________________________ County: ______________________

                                           REIMBURSEMENT RATES

           PROCEDURE CODE                       CUSTOMARY AND USUAL                      RATE REQUESTED
                                                CHARGE, YEAR:                           FROM LTC PROGRAM


 INITIAL EVALUATION
 (unit = ¼ hour – Aging Waiver;
  unit = hour – Options)
  W1729                      WFIM

 MONTHLY MANAGEMENT
 (unit = ¼ hour – Aging Waiver;
  unit = hour - Options)
 W1729                       WFIM




                                                                    North
                                      South          West          Central           Northwest           Northeast

 Service Areas Requested

I understand the rates above will be used to determine the actual reimbursement rate for the provider named herein for
both LTC funding sources, subject to the price ceiling for each Procedure Code. I affirm the price information provided
above is true, correct, and complete to the best of my knowledge. I Understand The Rate Requested From The LTC
Program May Not Exceed My Customary And Usual Rate.

                               __                         ________________                 ____________
Signature of Authorized Representative                          Title                          Date




Eff. 7/1/09                                                                                                        214
16.    PERSONAL CARE: PROVIDER AFFIRMATION

I, the undersigned, affirm that:

       1.      STANDARDS: I will comply with all the requirements stated in the Long Term Care
               (LTC) Program Personal Care Standards and Service Specific Operations Procedures
               (SSOP).

       2.      STAFF QUALIFICATIONS: I will assure that all consumer contact staff receives an
               annual PPD test and that documents of the results are maintained in their files along with
               other verification of compliance with federal, state and local health requirements related to
               communicable disease. I will follow procedures recommended in the Center for Disease
               Control (CDC) Guidelines and OSHA regulations, including provision of protective articles
               to staff.

               I will assure that a criminal history record check for compliance with Act 169 will be
               completed on all staff servicing PCA consumers.

       3.      TRAINING: All personal care workers serving LTC consumers will demonstrate
               competency in the skill areas included in the LTC Program Personal Care Standards and
               SSOP. Observation of competency will be documented in each personal care worker’s
               personnel file.

       4.      SERVICE REPORTING: I will comply with all reporting requirements as specified by the
               AAA.

       5.      SCHEDULING: I understand that the specific days and times for which service is
               scheduled shall be in conformance with the consumer’s needs.

       6.      INSURANCE: I agree to carry, verified by a current certificate of coverage in the amounts
               specified by PCA.

       7.      CONFIDENTIALITY - RESEARCH PROTOCOLS: I will comply with all federal, state
               and local laws relating to research on human subjects, as well as all federal, state and local
               laws and agreements with AAA’s regarding consumer confidentiality. I agree and warrant
               that any research in which consumers receiving services under the LTC program will be
               asked to participate shall have been reviewed and approved by a Department of Health and
               Human Services (DHHS) or Federal Drug Administration (FDA) approved Institutional
               Review Board (IRB), unless exempt from IRB review. I will inform the appropriate (PDA,
               MA and AAA) staff of research involving said consumers and will provide all appropriate
               parties with copies of IRB approvals and consent forms. I, upon request, will provide all
               parties with any additional information and copies of research protocols.




Eff. 7/1/09                                                                                              215
PROVIDER NAME:_____________________________________________________

PROVIDER ADDRESS: _________________________________________________

CITY, STATE AND ZIP CODE: ___________________________________________

                                                   ___________
  (Signature of Authorized Representative)           (Date)




Eff. 7/1/09                                                             216
17.    RESPITE CARE: PROVIDER AFFIRMATION

I, the undersigned, affirm that:

       1.      STANDARDS: I will comply with all the requirements stated in the Long Term Care
               (LTC) Program Respite Service Standards and Service Specific Operational Procedures
               (SSOP).

       2.      STAFF QUALIFICATIONS: I will assure that all consumer contact staff will be used
               who have received an annual PPD test that is documented in their files, along with other
               verification of compliance with federal, state and local health requirements related to
               communicable disease. I will follow procedures recommended in the Center for Disease
               Control (CDC) Guidelines and OSHA regulations, including provision of protective articles
               to staff.

               I will assure that a criminal history record check for compliance with Act 169 will be
               completed on all staff servicing PCA consumers.

       3.      TRAINING: All respite workers serving LTC consumers will demonstrate competency,
               that is documented in their files, in the areas for training included in the Long Term Care
               Options Program Respite Standards.

       4.      SERVICE REPORTING: I will comply with all reporting requirements as specified by
               the AAA.

       5.      SCHEDULING: I understand that the specific days and times for which service is
               scheduled shall be in conformance with the consumer’s needs.

       6.      INSURANCE: I agree to carry, verified by a current certificate of coverage in the amounts
               specified by PCA.

       7.      CONFIDENTIALITY - RESEARCH PROTOCOLS: I will comply with all federal,
               state and local laws relating to research on human subjects; and all federal, state and local
               laws, and agreements with AAA’s, regarding consumer confidentiality. I agree and warrant
               that any research in which consumers receiving services under the LTC program will be
               asked to participate, shall have been reviewed and approved by a Department of Health and
               Human Services (DHHS) or Federal Drug Administration (FDA) approved Institutional
               Review Board (IRB), unless exempt from IRB review. I will inform the appropriate (PDA,
               MA and AAA) staff of research involving said consumers and will provide all appropriate
               parties with copies of IRB approvals and consent forms. I, upon request, will provide all
               parties with any additional information and copies of research protocols.




Eff. 7/1/09                                                                                                  217
PROVIDER NAME:_______________________________________________________

PROVIDER ADDRESS: ___________________________________________________

CITY, STATE AND ZIP CODE:______________________________________________

                                              ______________________
  (Signature of Authorized Representative)                (Date)




Eff. 7/1/09                                                               218
18.    COMPANION SERVICES: PROVIDER AFFIRMATION

I, the undersigned, affirm that:

       1.      STANDARDS: I will comply with all the requirements stated in the Long Term Care
               (LTC) Program Companion Services Standards and Service Specific Operational Procedures
               (SSOP).

       2.      STAFF QUALIFICATIONS: I will assure that all consumer staff will be used who have
               received an annual PPD test that is documented in their files, along with other verification of
               compliance with federal, state and local health requirements related to communicable
               disease. I will follow procedures recommended in the Center for Disease Control (CDC)
               Guidelines and OSHA regulations, including provision of protective articles to staff.

               I will assure that a criminal history record check for compliance with Act 169 will be
               completed on all staff servicing PCA consumers.

       3.      TRAINING: All Companions serving LTC consumers will demonstrate competency in the
               skill areas included in the LTC Program Companion Standards.

       4.      SERVICE REPORTING: I will comply with all reporting requirements as specified by the
               AAA.

       5.      SCHEDULING: I understand that the specific days and times for which service is
               scheduled shall be in conformance with the consumer’s needs.

       6.      INSURANCE: I agree to carry, verified by a current certificate of coverage the amounts
               specified by PCA.

       7.      CONFIDENTIALITY - RESEARCH PROTOCOLS: I will comply with all federal,
               state and local laws relating to research on human subjects; and all federal, state and local
               laws, and agreements with AAA’s, regarding consumer confidentiality. I agree and warrant
               that any research in which consumers receiving services under the LTC program will be
               asked to participate, shall have been reviewed and approved by a Department of Health and
               Human Services (DHHS) or Federal Drug Administration (FDA) approved Institutional
               Review Board (IRB), unless exempt from IRB review. I will inform the appropriate (PDA,
               MA and AAA) staff of research involving said consumers and will provide all appropriate
               parties with copies of IRB approvals and consent forms. I, upon request, will provide all
               parties with any additional information and copies of research protocols.

PROVIDER NAME: _________________________________________________

PROVIDER ADDRESS:______________________________________________

CITY, STATE AND ZIP CODE: ________________________________________

                                                                    _______________
 (Signature of Authorized Representative)                                 (Date)



Eff. 7/1/09                                                                                               219
19.    PERSONAL CARE, RESPITE, COMPANION, GENERAL HOME SUPPORT:
       PRICE CERTIFICATION FORM

Provider Name: ___________________________                 County: ____________________


                                       REIMBURSEMENT RATES
                                        CUSTOMARY
                                        AND USUAL     RATE ESTABLISHED                 AVE. HOURLY
PROCEDURE CODE                          CHARGE,       FOR LTC PROGRAM                  RATE PAID TO
                                        YEAR:                                          WORKERS

PERSONAL CARE
(unit = ¼ hour) W1700         PERS                                    3.94

RESPITE CARE – 24 HOURS
( unit = 24 hours of service)                                        222.66
                   W1703      WRSD
COMPANION SERVICE
(unit = ¼ hour) W1723         COMP                                    2.47

ESCORT OF CONSUMER TO
COMPLETE CHORES (ERRANDS) OR
 APPOINTMENT                                                          3.94
(unit = ¼ hr) W1729   WEMV

HOUSEKEEPING & HOME MGT
(unit = ¼ hour) W1729 CHHK                                            3.94

                                                           North
                                     South     West       Central        Northwest       Northeast

  Service Areas Requested

I understand the rates above will be used to determine the actual reimbursement rate for the provider
named herein for both LTC funding sources, subject to the price ceiling for each Procedure Code. I affirm
the price information provided above is true, correct, and complete to the best of my knowledge. I
Understand The Rate Requested From The LTC Program May Not Exceed My Customary And
Usual Rate.

                                                                          ________________
Signature of Authorized Representative                     Title                      Date




Eff. 7/1/09                                                                                            220
20.    PERSONAL CARE SERVICE PROFILE

As an adjunct to the enclosed Price Certification Form, the following statistical data is being
requested for informational purposes.

It is expected that data presented will relate to Personal Care Service only. If you are a Medicare
Certified Home Health Agency, you may include information for comparable Home Health Aide
services, but not OT, PT, Nursing, etc.

APPLICANT                                                             YEAR:_____________________

I.     Agency Status

       A.       Are you a Medicare Certified Home Health Agency?

                 Yes         No

       B.       Are you applying for, or intending to obtain Medicare Certification?

                 Yes         No

       C.       Information presented below relates to: (check one)

                 Personal Care Service only
                 Personal Care/Home Health Aide Service

II.    Agency Information

       A. Training

            Do you currently have the following:
            Certificate Training       Yes           No               If yes, hrs./mo. ______
            In-Service Training        Yes           No               If yes, hrs./mo. ______
            Orientation                Yes           No               If yes, hrs./mo. ______




Eff. 7/1/09                                                                                           221
   B. Personal Care Service Level Last Calendar Year: ___________

         1. Average number of consumers served on a weekly basis: _____________
         2. Average number of hours delivered on a weekly basis: _____________
         3. Total number of hours delivered last year: ______________
   C. Personal Care Workers

          1. Number of personal care/home health aides employed:


   Length of Employment        # of Personal Care        # of Home Health            # of Field
                                    Workers                    Aides                Supervisors

   24 months & longer

   12 through 23 months

   6 through 11 months

   Less than 6 months

   Total number

          2.   How many personal care/home health aides currently employed, meet the training
               requirements detailed in the standards?                        ___________

          3.   What is your current starting salary for personal care workers       $___________

          4.   What is the current average salary paid to these workers?            $___________

          5.   If awarded a contract at the price requested, what would your starting salary be for personal
               care workers assigned to PCA cases?                  $___________

          6.   Number of hours per week worked by personal care workers/home health aides and field
               supervisors:

     Hours Per
       Week          Under 9        10-19        20-29         30-39            40-49       50+
   # of Personal
     Care/HH
       Aides
     # of Field
       Staff




Eff. 7/1/09                                                                                               222
21.    PERSONAL ASSISTANCE SERVICE (PAS): PROVIDER AFFIRMATION

I, the undersigned, affirm that:

       1.      STANDARDS: I will comply with all the requirements stated in the Long Term Care
               Options (LTCO) Program Personal Assistance Service (PAS) standards.

       2.      STAFF QUALIFICATIONS: I will comply with federal, state, and local health
               requirements related to communicable disease and to follow procedures recommended in the
               Center for Disease Control (CDC) Guidelines and OSHA regulations, including provision of
               protective articles to staff and in-service on universal precautions.

               I will assure that a criminal history record check for compliance with Act 169 will be
               completed on all staff servicing PCA consumers.

       3.      TRAINING: All personal care workers serving LTCO consumers will demonstrate
               competency in the skill areas included in the LTCO Program Personal Assistance Service
               Standards. Observation of competency will be documented in each personal assistance
               worker’s personnel file.

       4.      SERVICE REPORTING: I will comply with all reporting requirements as specified by the
               AAA.

       5.      SCHEDULING: I understand that the specific days and times for which service is
               scheduled shall be in conformance with the consumer’s needs.

       6.      INSURANCE: I agree to carry, verified by a current certificate of coverage in the amounts
               specified by PCA.

       7.      CONFIDENTIALITY - RESEARCH PROTOCOLS: I will comply with all federal, state
               and local laws relating to research on human subjects, as well as all federal, state and local
               laws and agreements with AAA’s regarding consumer confidentiality. I agree and warrant
               that any research in which consumers receiving services under the LTCO program will be
               asked to participate shall have been reviewed and approved by a Department of Health and
               Human Services (DHHS) or Federal Drug Administration (FDA) approved Institutional
               Review Board (IRB), unless exempt from IRB review. I will inform the appropriate (PDA,
               MA and AAA) staff of research involving said consumers and will provide all appropriate
               parties with copies of IRB approvals and consent forms. I, upon request, will provide all
               parties with any additional information and copies of research protocols.

PROVIDER NAME:_____________________________________________________


PROVIDER ADDRESS: _________________________________________________


CITY, STATE AND ZIP CODE: __________________________________________



Eff. 7/1/09                                                                                              223
22.     PERSONAL ASSISTANCE SERVICE (PAS): PRICE CERTIFICATION FORM


Provider Name: ______________________________________ County: _______________________


                                            REIMBURSEMENT RATES

                PROCEDURE CODE                          PAS ( +Attendant Care)           AVE. HOURLY RATE
                                                        FEE SCHEDULE,                    PAID TO WORKERS
                                                        EFFECTIVE 7/1/08:


                                                                   3.91
  Combination Model – (unit = ¼ hour)
  W1792           PACO
                                                                  (15.64)

                                                                   4.71
  Agency Directed Model – (unit = ¼ hour)
  W1793            PAAO
                                                                  (18.84)

  Monthly Coordination Fee                                         154.26
  (unit = 1 month ) , for Combination Model only
  W7341                 PAMC




                                                                   North
                                     South          West          Central           Northwest            Northeast

  Service Areas

I understand the rates above will be used to determine the actual reimbursement rate for the provider named herein for
both LTC funding sources, subject to the price ceiling for each Procedure Code. I affirm the price information provided
above is true, correct, and complete to the best of my knowledge.

                               __                          ________________                ____________
Signature of Authorized Representative                           Title                         Date




Eff. 7/1/09                                                                                                          224
23.     PERSONAL ASSISTANCE SERVICE (PAS) PROFILE

As an adjunct to the enclosed Price Certification Form, the following statistical data is being
requested for informational purposes.

It is expected that data presented will relate to Personal Assistance Service.

APPLICANT                                                             FISCAL YEAR ________


I. Agency Status

   A.     Are you a Medicare Certified Home Health Agency?

               Yes            No

   B.     Are you applying for, or intending to obtain Medicare Certification?

               Yes            No

   C.     Information presented below relates to:     (check one)

               Personal Assistance Service
               Attendant Care

II. Agency Information

   A. Training

          Do you currently have the following:
          Certificate Training Yes             No             If yes, hrs./mo.
          In-Service Training Yes              No             If yes, hrs./mo.
          Orientation          Yes             No             If yes, hrs./mo.


   B. Personal Assistance Service Level; last calendar year: _________

          1.     Average number of consumers served on a weekly basis:           ______
          2.     Average number of hours delivered on a weekly basis:            ______
          3.     Total number of hours delivered last year:                      ______




Eff. 7/1/09                                                                                       225
   C. Personal Assistance Service Workers

           1. Number of attendant care / personal assistance attendants:


   Length of providing service         # Attendants           # of Field Supervisors

   24 months & longer

   12 through 23 months

   6 through 11 months

   Less than 6 months

   Total number


           2.        What is your current starting salary for attendants?       _________

           3.        What is the current average salary paid to these workers?         __________

           4.        Number of hours per week worked by personal assistance workers and field supervisors:


    Hours Per Week        Under 9       10-19         20-29            30-39           40-49        50+

     # Attendants


      # of Field
     Supervisors




Eff. 7/1/09                                                                                               226
24.    RESPITE/TEMPORARY SHELTER: PRICE CERTIFICATION FORM



Provider name                                             County: ________________________



                                  REIMBURSEMENT RATES

                                            MA / MEDICARE                RATE
 PROCEDURE CODE                             RATE                         ESTABLISHED FOR
                                            YEAR:                        LTC PROGRAM

 Respite/Temporary Shelter – Nursing
 Facility           S5151    WRIN
 (unit = day, all inclusive)




I understand the rates above will be used to determine the actual reimbursement rate for the provider named
herein for both LTC funding sources, subject to the price ceiling for each Procedure Code. I affirm the price
information provided above is true, correct, and complete to the best of my knowledge. I understand the rate
requested from the LTC Program may not exceed my M.A. rate and subject to quarterly adjustments as
issued by DPW.

___________________________________ ____________________                    _________________
Signature of Authorized Representative           Title                            Date




Eff. 7/1/09                                                                                               227
25.       TRANSPORTATION: PROVIDER AFFIRMATION

I the undersigned, affirm that:

          1.      STANDARDS: I will comply with all the requirements stated in the Long Term Care (LTC)
                  Program Transportation Standards and Service Specific Operational Procedures (SSOP).

          2.      STAFF QUALIFICATIONS: I will assure that all consumer contact staff receives an
                  annual PPD test and that documents of the results are maintained in their files along with
                  other verification of compliance with the Federal, state and local health requirements related
                  to communicable disease. I will follow procedures recommended in the Center for Disease
                  Control (CDC) Guidelines and OSHA regulations, including provision of protective articles
                  to staff.

                  I will assure that a criminal history record check for compliance with Act 169 will be
                  completed on all staff servicing PCA consumers.

          3.      TRAINING: All transportation workers serving LTC consumers will demonstrate
                  competency in the skill areas included in the LTC Program Transportation Standards,
                  documented in each worker’s personnel file.

          4.      SERVICE REPORTING: I will comply with all reporting requirements as specified by the
                  AAA..

          5.      SCHEDULING: I understand that the specific days and times for which service is scheduled
                  shall be in conformance with the consumer’s needs.

          6.      INSURANCE: I agree to carry, verified by a current certificate of coverage in the amounts
                  specified by PCA

          7.      CONFIDENTIALITY: I will comply with all federal, state and local laws relating to
                  research on human subjects; and all federal, state and local laws and agreements with AAA’s,
                  regarding consumer confidentiality. I agree and warrant that any research in which
                  consumers receiving services under the LTC program will be asked to participate, shall have
                  been reviewed and approved by a Department of Health and Human Services (DHHS) or
                  Federal Drug Administration (FDA) approved Institutional Review Board (IRB) unless
                  exempt from IRB review. I will inform the appropriate ( PDA, MA and AAA) staff of
                  research involving said consumers and will provide all appropriate parties with copies of IRB
                  approvals and consent forms. I, upon request, will provide all parties with any additional
                  information and copies of research protocols.




   Eff. 7/1/09                                                                                               228
PROVIDER NAME: _____________________________________________________

PROVIDER ADDRESS:____________________________________________________

CITY, STATE AND ZIP CODE:______________________________________________

                                                           ______________
  (Signature of Authorized Representative)                   (Date)




  Eff. 7/1/09                                                               229
  26.     TRANSPORTATION: PRICE CERTIFICATION FORM


Provider Name:                                                County:     _______________________________



                                       REIMBURSEMENT RATES

                                          CUSTOMARY AND                    RATE ESTABLISHED FOR
 PROCEDURE CODE                           USUAL CHARGE,                    LTC PROGRAM
                                          YEAR:

 AMBULANCE – non emergency
 service, not covered by Medicare or
 MA (unit = one way ride)                                                               120.00
 W1712                     WTRA




                               South        West       North Central        Northwest       Northeast

Service Areas Requested

   I understand the rates above will be used to determine the actual reimbursement rate for the provider named
   herein for both LTC funding sources, subject to the price ceiling for each Procedure Code. I affirm the price
   information provided above is true, correct, and complete to the best of my knowledge. I Understand The
   Rate Requested From The LTC Program May Not Exceed My Customary And Usual Rate.

   ________________________________                         ______________             ___________
  Signature of Authorized Representative                       Title                         Date




  Eff. 7/1/09                                                                                                230
   27.     PERSONAL EMERGENCY RESPONSE: PROVIDER AFFIRMATION

I, the undersigned, affirm that:

           1.     STANDARDS: I will comply with all the requirements stated in the Long Term Care
                  (LTC) Program Personal Emergency Response Standards and Service Specific
                  Operational Procedures (SSOP).

           2.     STAFF QUALIFICATIONS: I will assure that all consumer contact staff receives an
                  annual PPD test and that documents of the results are maintained in their files along with
                  other verification of compliance with the Federal, state and local health requirements
                  related to communicable disease. I will follow procedures recommended in the Center for
                  Disease Control (CDC) Guidelines and OSHA regulations, including provision of
                  protective articles to staff.

                  I will assure that a criminal history record check for compliance with Act 169 will be
                  completed on all staff servicing PCA consumers.

           3.     SERVICE REPORTING: I will comply with all reporting requirements as specified by
                  the AAA.

           4.     TRAINING: All employees will demonstrate competency in the skill areas included in
                  the LTC Program Personal Emergency Response Systems Standards, documented in each
                  worker’s personnel file.

           5.     SCHEDULING: I understand that the installation and removal of equipment shall be in
                  conformance with the consumer’s needs.

           6.     INSURANCE: I agree to carry, verified by a current certificate of coverage in the
                  amounts specified by PCA

           7.     CONFIDENTIALITY- RESEARCH PROTOCOLS: I will comply with all federal,
                  state and local laws relating to research on human subjects; and all federal, state and local
                  laws and agreements with AAA’s, regarding consumer confidentiality. I agree and
                  warrant that any research in which consumers receiving services under the LTC program
                  will be asked to participate, shall have been reviewed and approved by a Department of
                  Health and Human Services (DHHS) or Federal Drug Administration (FDA) approved
                  Institutional Review Board (IRB) unless exempt from IRB review. I will inform the
                  appropriate (PDA, MA and AAA) staff of research involving said consumers and will
                  provide all appropriate parties with copies of IRB approvals and consent forms. I, upon
                  request, will provide all parties with any additional information and copies of research
                  protocols.




   Eff. 7/1/09                                                                                                231
PROVIDER NAME:___________________________________________________

PROVIDER ADDRESS:_______________________________________________

CITY, STATE AND ZIP CODE: _________________________________________

                                                   ___________
 (Signature of Authorized Representative)               (Date)




Eff. 7/1/09                                                           232
28.        PERSONAL EMERGENCY RESPONSE SYSTEM: PRICE CERTIFICATION FORM


   Provider Name: _____________________________________County: ________________________

                                                 REIMBURSEMENT RATES
                                                         CUSTOMARY AND                         ESTABLISHED RATE
                                                         USUAL CHARGE.                         FOR LTC PROGRAM
      PROCEDURE CODE                                     YEAR:
      Personal Emergency Response System; monthly
      monitoring , inclusive of installation and
      repair/replacement cost (unit = monthly fee)

      W1720                             MEMN                                                              30.00




                                                  South       West        North Central      Northwest       Northeast

      Service Areas Requested

I understand the rates above will be used to determine the actual reimbursement rate for the provider named herein for both
LTC funding sources, subject to the price ceiling for each Procedure Code. I affirm the price information provided above is
true, correct, and complete to the best of my knowledge. I Understand The Rate Requested From The LTC Program
May Not Exceed My Customary And Usual Rate.

__________________________________                            _________________                 ____________
Signature of Authorized Representative                         Title                            Date




   Eff. 7/1/09                                                                                                           233
29.        HEALTH STATUS MEASURING AND MONITORING SERVICE:
           PRICE CERTIFICATION FORM


   Provider Name: _____________________________________County: ________________________

                                                REIMBURSEMENT RATES
                                                        CUSTOMARY AND                          ESTABLISHED RATE
                                                        USUAL CHARGE.                          OR MA FEE
      PROCEDURE CODE                                    YEAR:                                  SCHEDULE RATE

      Specialized supplies/Health Monitoring equipment
      – not listed on MA fee schedule or in excess of
      state plan limits; (unit = one purchase)
      T2028- GT                      SUHM
      Specialized DME/Health Monitoring equipment –
      not listed on MA fee schedule or in excess of
      state plan limit; (unit = one purchase)
      T2029-GT                       DMHM
      Health Status Measuring and Monitoring of chronic
      conditions; includes equipment installation,
      training, monthly consumer visit, and any other
      contacts. Home Health providers only.
      (unit = 1/day)                                                                                      10.00
      T2025-GT                       HSMM
      Medication Dispenser Monthly Fee, inclusive of
      installation and repair/replacement cost
       (unit = monthly fee)
       S5185 -32                           WMRP                                                           50.00
      Medication Set-Up – by a Pharmacist, for
      consumers not receiving any skilled services. (unit=
      monthly fee)                                                                                        50.00
      S5185                                MEST

                                                  South       West        North Central      Northwest       Northeast

      Service Areas Requested

I understand the rates above will be used to determine the actual reimbursement rate for the provider named herein for both
LTC funding sources, subject to the price ceiling for each Procedure Code. I affirm the price information provided above is
true, correct, and complete to the best of my knowledge. I Understand The Rate Requested From The LTC Program
May Not Exceed My Customary And Usual Rate.

__________________________________                            _________________                 ____________
Signature of Authorized Representative                         Title                            Date




   Eff. 7/1/09                                                                                                           234
30.        ACTIVITY AND SENSOR MONITORING: PRICE CERTIFICATION FORM


   Provider Name: _____________________________________County: ________________________

                                                REIMBURSEMENT RATES
                                                        CUSTOMARY AND                          RATE ESTABLISHED
                                                        USUAL CHARGE.                          FOR LTC PROGRAM
      PROCEDURE CODE                                    YEAR:
      Activity and Sensor Monitor – installation
      (unit = one time fee)
      W2025                    ASMO                                                                      200.00
      Monthly Monitoring of Activity Sensor equipment
      (unit = monthly fee)
      W9006                   MDMS                                                                        79.95




                                                   South      West        North Central      Northwest       Northeast

      Service Areas Requested

I understand the rates above will be used to determine the actual reimbursement rate for the provider named herein for both
LTC funding sources, subject to the price ceiling for each Procedure Code. I affirm the price information provided above is
true, correct, and complete to the best of my knowledge. I Understand The Rate Requested From The LTC Program
May Not Exceed My Customary And Usual Rate.

__________________________________                            _________________                 ____________
Signature of Authorized Representative                         Title                            Date




   Eff. 7/1/09                                                                                                           235
31.    DME - HEARING AIDS: PRICE CERTIFICATION FORM


Provider name                                               County: ________________________


                                      REIMBURSEMENT RATES
 PROCEDURE CODE                          CUSTOMARY AND
                                         USUAL CHARGE,                   RATE REQUESTED FROM
                                         YEAR:                           LTC PROGRAM
 Hearing Aid/Behind the ear unit
 (unit = 1 )
  T2029                        ORBE
 Hearing Aid/In the ear unit
 (unit = 1)
  T2029                         ORIE
 Hearing Aid/Canal ear unit
 (unit = 1)
  T2029                       ORCE
 Hearing Aid, Digital, Monaural, CIC,
 ITC, ITE, BTE (unit = 1)
 T2029                        GRDM
 Hearing Aid, Digital, Binaural, CIC,
 ITC, ITE, BTE (unit = 2)
 T2029                        GRDB
 Hearing Aid/ Service or repair of
 unit(unit = variable cost)
  T2029                         ORSR

                                           South       West        North Central    Northwest    Northeast

 Service Areas Requested

I understand the rates above will be used to determine the actual reimbursement rate for the provider named
herein for both LTC funding sources, subject to the price ceiling for each Procedure Code. I affirm the price
information provided above is true, correct, and complete to the best of my knowledge. I Understand The
Rate Requested From The LTC Program May Not Exceed My Customary And Usual Rate.

_________________________________            ____________________           ____________________
Signature of Authorized Representative                    Title                          Date




Eff. 7/1/09                                                                                               236
32.    DME – STAIR ELEVATOR: PRICE CERTIFICATION FORM



Provider Name:                                               County: ____________________

                                  REIMBURSEMENT RATES

                                            USUAL AND                    RATE REQUESTED
 SERVICE DESCRIPTION                        CUSTOMARY RATE;              FROM LTC
 (Procedure code)                           YEAR:                        PROGRAM

 Installation – all models
 W1758              SROC
 Front Rider – monthly rent
 T2029              WFRR
 Front Rider – daily rental
 T2029
 Side Rider – fixed seat – monthly rent
 T2029               WFRR
 Side Rider – fixed seat – daily rent
 T2029
 Side Rider – swivel seat – monthly rent
 T2029               WFRR
 Side Rider – swivel seat – daily rent
 T2029
 Repairs – hourly rate
 T2029               RPAR




I understand the rates above will be used to determine the actual reimbursement rate for the provider named
herein for both LTC funding sources, subject to the price ceiling for each Procedure Code. I affirm the price
information provided above is true, correct, and complete to the best of my knowledge.
 __________________________________ ________________________                        ______________
Signature of Authorized Representative               Title                          Date




Eff. 7/1/09                                                                                               237
33.     VISION SERVICES: PRICE CERTIFICATION FORM


Provider name:________________________________________ County: _________________________

                                      REIMBURSEMENT RATES
                                                                           CUSTOMARY
                                                                                              RATE
                                    MEDICARE           MA RATE:            AND USUAL
                                                                                              REQUESTED
 PROCEDURE CODE                     RATE: _____        YEAR: ______        CHARGE
                                                                                              FROM LTC
                                    YEAR: _____                            YEAR: ____
                                                                                              PROGRAM


 VISION SCREEN
 (unit = visit) HEYN

 REFRACTION
 (unit = visit)       REFR


 GLASSES
 (unit = visit)       WEGL

 CO-PAY NOT COVERED
 (unit = visit) COPY

 MEDICARE DEDUCTIBLE
 NOT MET
 (unit = visit) DEDT

 XACT MEDICARE
 (unit = visit) HEYM

                                     South        West            North Central   Northwest    Northeast

 Service Areas Requested


I understand the rates above will be used to determine the actual reimbursement rate for the provider named herein for
both LTC funding sources, subject to the price ceiling for each Procedure Code. I affirm the price information
provided above is true, correct, and complete to the best of my knowledge. I Understand The Rate Requested
From The LTC Program May Not Exceed My Customary And Usual Rate.


                                                                                   _________
Signature of Authorized Representative                    Title                      Date




Eff. 7/1/09                                                                                                       238
               SECTION VI.



              ATTACHMENTS




Eff. 7/1/09                  239
A.     Procedure codes for Aging Waiver:


B.     DME Supply List:


C.     Sample Insurance Certificate:


D.     Adult Day Care Congregate Meal Requirements:




Eff. 7/1/09                                           240

				
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