Butler County Human Service System Guide - 2017

Where to go for more information

Parent to Parent of Pennsylvania (P2P of PA)
888-727-2706 (toll free)
Email: [email protected]
www.parenttoparent.org

Parent to Parent of Pennsylvania links families of children and adults with disabilities or
special needs on a one-to-one basis with a peer supporter for purposes of support and
information. Services are free and confidential.

Competence and Confidence Partners in Hands and Voices Guide By Your Side (GBYS)
Policymaking Early Intervention (C2P2EI) 800-360-7282 x3908 (PA Only)
215-204-3031 Email: [email protected]
Email: [email protected] www.paearlyhearing.org/gbys.php
http://disabilities.temple.edu/programs/
leadership/c2p2ei.shtml GBYS is a specialized parent support program
that links families of infants and toddlers identi-
C2P2EI is an innovative leadership training fied with deafness and hearing loss with trained
program for parents of children in early and experienced parent guides. Parent guides
intervention. C2P2EI provides up-to-date are other parents of children with deafness and
information on best practices, resources, hearing loss who provide unbiased information
and policy issues. and emotional support. Services are free and
confidential.
Disability Rights Network of Pennsylvania
(DRN) Hispanos Unidos para Niños Excepcionales
800-692-7443 (Harrisburg) (HUNE) (Hispanics United for Exceptional
215-238-8070 (Philadelphia) Children)
412-391-5225 (Pittsburgh) 215-425-6203 (Voice) / 215-425-6204 (Fax)
Email: [email protected] www.huneinc.org
www.drnpa.org
HUNE is a not-for-profit organization that
DRN is a statewide, nonprofit corporation desig- provides free, bilingual English and Spanish
nated as the federally mandated organization training and technical assistance to parents of
to advance and protect the civil rights of adults infants, children, and youth with disabilities and
and children with disabilities. to professionals who work with children.

Education Law Center
215-238-6970 (Philadelphia)
412-258-2120 (Pittsburgh)

The Education Law Center is a nonprofit
legal advocacy and educational organization,
dedicated to ensuring that all of Pennsylvania’s
children have access to a quality public education.

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What Is Adaptive Behav- a Disability Affect ample of a support often needed
ior? Someone’s Life? by a new employee with intellec-
tual disabilities. Supports can be
Adaptive behavior is the collec- The effects of intellectual dis- provided in many settings, and a
tion of conceptual, social and practi- abilities vary considerably among “setting” or location by itself is not
cal skills that have been learned by people who have them, just as the a support.
people in order to function in their range of abilities varies consider-
everyday lives. Significant limitations ably among all people. Children What Is the Definition of
in adaptive behavior impact a per- may take longer to learn to speak, Developmental Disabili-
son’s daily life and affect his or her walk and take care of their per- ties (DD)?
ability to respond to a particular sonal needs, such as dressing or
situation or to the environment. eating. It may take students with According to the Developmen-
Standardized testing aims to mea- intellectual disabilities longer to tal Disabilities Act (Pub. L. 106-
sure the following skills: learn in school. As adults, some 402), the term developmental
• Conceptual skills: receptive and will be able to lead independent disability means a severe, chronic
expressive language, reading and lives in the community without disability that:
writing, money concepts, self- paid supports, while others will 1. is attributable to a mental or
direction. need significant support through- physical impairment or a combina-
• Social skills: interpersonal, out their lives. In fact, a small tion of those impairments;
responsibility, self-esteem, follows percentage of those with intellec- 2. occurs before the individual
rules, obeys laws, is not gullible, tual disabilities will have serious, reaches age 22;
avoids victimization. lifelong limitations in functioning. 3. is likely to continue indefinitely;
• Practical skills: personal activi- However, with early intervention, 4. results in substantial functional
ties of daily living such as eating, appropriate education and sup- limitations in three or more of the
dressing, mobility and toileting; ports as an adult, every person following areas of major life activ-
instrumental activities of daily liv- with an intellectual disability can ity: (i) self care, (ii) receptive and
ing such as preparing meals taking lead a satisfying, meaningful life in expressive language, (iii) learning,
medication, using the telephone, the community. (iv) mobility, (v) self-direction, (vi)
managing money, using transpor- capacity for independent living,
tation and doing housekeeping How Can Supports Help? and (vii) economic self-sufficiency;
activities; occupational skills; main- and
taining a safe environment. Supports include the resources 5. reflects the individual’s need for
A significant deficit in one area and individual strategies necessary a combination and sequence of
impacts individual functioning to promote the development, edu- special, interdisciplinary, or ge-
enough to constitute a gen- cation, interests, and well-being neric services, individualized sup-
eral deficit in adaptive behavior of a person. Supports enhance ports, or other forms of assistance
(AAIDD, 2011). individual functioning. Supports that are of lifelong or extended du-
can come from family, friends ration and are individually planned
How Does Having and community or from a service and coordinated.
system. Job coaching is one ex-

For more information on this and other topics, visit www.thearc.org 124

Before the age of ten, an infant neurological conditions that can References:
or child with developmental delays result in impairment of general American Association on Intel-
may be considered to have an in- intellectual functioning or adaptive
tellectual or developmental disabil- behavior similar to that of a person lectual & Developmental Disabilities.
ity if his or her disabilities are likely with intellectual disabilities. (2011). Intellectual Disability: Defini-
to meet the above criteria without tion, Classification, and Systems of
intervention. Why Do Some People Still Supports, 11th Edition. Washington,
Use the Term “Mental DC: American Association on Intellec-
How Does the DD Defini- Retardation”? tual & Developmental Disabilities.
tion Compare with the
AAIDD Definition of In- The term “mental retardation” Developmental Disabilities Assis-
tellectual Disability? is an out-dated term that may tance and Bill of Rights Act of 2000.
offer special protections in some PL106-402. http://www.acf.hhs.gov/
The major differences are in states, however, with the passage programs/add/DDACT2.htm
the age of onset, the severity of of Rosa’s Law in 2010, many states
limitations, and the fact that the have replaced all terminology from Larson, S.L. et al. (2000). Preva-
developmental disability defini- mental retardation to intellectual lence of mental retardation and/or
tion does not refer to an IQ re- disability. Although some still use developmental disabilities: Analysis of
quirement. Many individuals with the term “mental retardation” to the 1994/1995 NHIS-D. MR/DD Data
intellectual disability will also meet be eligible for some services in a Brief. Minneapolis, MN: Institute on
the definition of developmental few states, in no case does having Community Integration, University of
disability. However, it is estimated the label guarantee that supports Minnesota.
that at least half of individuals with will be available. The Arc does not
intellectual disability will not meet encourage the use of nor promote
the functional limitation require- the term mental retardation. The
ment in the DD definition. The general public, including families,
DD definition requires substantial individuals, funders, administra-
functional limitations in three or tors, and public policymakers at
more areas of major life activity. local, state and federal levels, are
The intellectual disability defini- becoming aware of how offensive
tion requires significant limitations this term is and The Arc is actively
in one area of adaptive behavior. working to make sure the public at
Those with developmental disabili- large now use the preferred term
ties include individuals with cere- of intellectual or developmental
bral palsy, epilepsy, developmental disability.
delay, autism and autism spectrum
disorders, fetal alcohol spectrum
disorder (or FASD) or any of hun-
dreds of specific syndromes and

For more information on this and other topics, visit www.thearc.org 125

Intellectual Disabilities (ID) Services

Supports Coordination Services - Supports coordination services are received by all
individuals enrolled in the ID system. Supports Coordinators help individuals develop
their individual support plans, choose providers and informal supports, and monitor the
administration of services. Supports coordination services may be provided either by a
county or by an outside agency that contracts with the county to provide these services.

Home and Community Services - These services are for individuals who need
assistance in acquiring, retaining, or improving skills related to living and working in the
community. There are a number of services under this category, including the following:

 Home and Community Habilitation - This service is provided in home and
community settings to assist individuals in gaining, maintaining, and improving
self-help, domestic, socialization, and adaptive skills. Through this service,
individuals learn, maintain, or improve skills through their participation in a
variety of everyday life activities of interest to them.

 Community Habilitation (Adult Training Facilities) - This service, provided by
Adult Training Facilities (ATF), is to assist individuals in gaining, maintaining, and
improving self-help, domestic, socialization and adaptive skills.

 Pre-Vocational Services - This service prepares people for paid employment.
Individuals are taught concepts such as task completion, safety, problem solving,
following direction, and dependability.

 Older Adult Day Services - Services are provided to individuals to assist in
meeting their personal care and social needs.

 Personal Supports

 Residential Home and Community Habilitation-Licensed Homes - Housing is a
part of the residential service and includes Community Homes for Individuals
with Intellectual Disabilities and Family Living.

 Child Residential Services - Child Residential and Day Treatment Facilities.

 Residential Home and Community Habilitation-Unlicensed Homes - Housing is a
part of the residential service. These are homes that do not require licensure
because they serve 3 or fewer individuals who are 18 years of age or older and
who need a yearly average of 30 hours or less of direct habilitation service per
week per home.

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Supported Employment Services - These services support individuals in obtaining
and maintaining integrated, competitive employment.

 Job Support Service / Job Finding Service - The service may include but is not
limited to: interview skill training, resume preparation, job searching, preparation
for job tasks, and employer outreach and orientation. The service includes
training individuals in job assignments, periodic follow-up, and/or ongoing support
with individuals and their employers. The service must be necessary for
individuals to maintain acceptable job performance and work habits including
assistance in learning new work assignments, maintaining job skills, and
achieving performance expectations of the employer.

Transitional Work – This service offers work experience in a real work environment
that is highly supervised. These environments are often known as enclaves, mobile
work force, affirmative industry, work station in industry, and transitional employment.

Specialized Therapies and Related Clinical Services - Specialized support services
are services provided by health care and other professionals that enable individuals and
families to increase or maintain their ability to perform activities of daily living. Examples
of such services are:

o Physical Therapy
o Occupational Therapy
o Speech and Language Therapy
o Visual and Mobility therapy
o Behavioral Therapy
o Visiting Nurse Services.

Respite Services - Respite is a service provided on a short-term, emergency basis to
relieve the primary caregivers. There is an annual 4-week limit for respite services.
Respite Services may be provided by a specialized agency in the person’s home, the
home of a family member or friend, or in an agency licensed respite home. Respite
services may also be provided by someone that the person and family already knows
who is qualified and willing to provide assistance either in the person’s home, the home
of a family member, or a friend’s home.

Transportation Services - Transportation services are offered to enable individuals to
gain access to their community including both services and informal supports.
Transportation covers emergency transportation in certain circumstances.

Intermediate Service Organizations – An Intermediate Service Organization (ISO)
provides a service to help people hire, pay, and manage their own individual providers
of service.

Environmental Accessibility Adaptations - This service is provided to improve
individuals’ independence in activities of daily living in their homes and communities
and/or to make possible their continued care and support in their homes or the homes

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of family members. This is made possible through physical adaptations to
individuals’/families’ private properties and vehicles. Also included are the following:

 Homemaker - Allows for temporary general household activities such as meal
preparation and routine house cleaning when the person(s) regularly responsible
for these activities is incapacitated and no other paid or unpaid assistance is
available.

 Chore - Chore services are more extensive services than homemaker. This
temporary service would be needed to maintain the home in a clean, sanitary
and safe condition.

 Education Support Services - Support for education courses and training not
funded by the Individuals with Disabilities Education Act (IDEA).

Family Support Services (non-waiver services)
 Family Aide - Provides for the care and supervision of family members other than
the family member with intellectual disabilities.
 Special Diet Preparation - Assistance in the planning or preparation of meals for
medically involved clients who require significant modification to a routine diet.
 Recreation/Leisure Time Activities - This service is designed to provide for the
individual to participate and experience regular community leisure-time activities
and to increase his or her physical or psycho-social development. Participation in
activities with non-related people within the community is encouraged.
 Home Rehabilitation - The home rehabilitation service includes the minor
renovation to a family’s home to provide for continued care of the individual with
mental retardation in their own home.

The following sources of information were used for this section:
PA Department of Human Services website, http://www.dhs.state.pa.us/

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What You Should Know About
Mediation and Appeals

NOTE: In addition to the person needing supports, "you" also refers to the family
member or friend who will assist him or her to get the needed supports and services.

What is Mediation?

Mediation is a way to resolve disputes between you and your County Intellectual
Disabilities Program concerning the identification, evaluation or the provision of
appropriate waiver services or supports. Your county is responsible for informing you of
your right to mediation when the above conditions apply. Mediation is through an
independent mediation entity, which is currently the Office for Dispute Resolution
(ODR). An ODR mediator is available on the request of and at no charge to your County
MH/ID Program or to you. The address and phone number for ODR is:

Office for Dispute Resolution
6340 Flank Drive, Suite 600
Harrisburg, Pennsylvania 17112
Telephone: 1-800-992-4334

In mediation, everyone agrees to work together with an impartial mediator. The
mediator is a person trained to help people work out an agreement, without taking
sides.

What is the Mediation Process?

You can make a request for mediation either orally or in writing to MH/EI/ID Department
of Butler County Human Services or directly to the Office for Dispute Resolution (ODR).
If you make the request to your county, the county shall immediately notify ODR in
writing and send a copy of the notification to you.

The independent mediator is responsible for scheduling the mediation process within 10
days of notification.

Discussions that occur during the mediation process are confidential and may not be
used as evidence in any later due process hearings. You and other people participating
in the process may be required to sign a statement of confidentiality.

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Mediation is to take place in a location that is convenient for you and the other parties
who are part of the process. It also is to be completed in a timely fashion. The result of
the mediation process is everyone involved coming to an agreement which is then put
into writing. The written mediation agreement includes time frames for implementing
changes and also includes any outstanding issues. You will receive a written copy of
this report.

Your county is responsible to participate in the mediation process and to cooperate with
the independent mediator in all aspects of the process. Your county also is responsible
for ensuring that actions or changes are carried out according to the conditions and time
frame that are in the mediation agreement.

The mediator will discuss with you who should participate in the mediation process. If
you do not want someone (for example a provider) included in the process, then the
mediator will respect your desire. However, if part of your problem is concerning the
provider, then the mediator will explain why it is important to have the provider involved
so that an agreement can be reached by everyone.

Lawyers are not permitted to participate in mediation meetings or request mediation on
your behalf.

Copies of the mediation agreement and status reports shall be kept by your county for
three years and be available to representatives of the Department of Human Services
and the Department of Health and Human Services upon their request.
Your county may offer mediation to you before you file an appeal. You may use both the
mediation and appeal process at the same time.

What is an Appeal?

An appeal is a formal process that you can use when you have a problem concerning
the Infants, Toddlers, and Families Waiver, Person/Family Directed Support (P/FDS)
Waiver or Consolidated Waiver services that you cannot resolve with your County Office
of Intellectual Disabilities. It is an opportunity to present your side of the disagreement to
a group that is independent from your county and the Office of Developmental
Programs, formerly the Office of Mental Retardation.

For problems concerning the above, you file an appeal with your County MH/ID Office.
They will send it on to the Department of Human Services (DHS), Bureau of Hearings
and Appeals within three days. See the section, "What is the Appeal Process?"

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When Should I Be Told About Appeals?

When you ask for information about Intellectual Disabilites Medicaid Waivers, you
should be given a copy of the appeals form entitled, "Fair Hearing Request Form" and
instructions. The instructions should include the name of the person the county
designates to assist you, address and telephone number.

You do not have to be enrolled in a waiver to get these documents. All Supports
Coordinators have copies of the instructions and forms and should give them to you
when you ask for information about appeals or when you indicate a desire to file an
appeal.

When you are having a problem with the waiver and you have tried other things, then
your Supports Coordinator should remind you about the appeals process that is
available for you to use.

When Can I Use the Appeal Process for Medicaid Services?

If you are enrolled in any one of the intellectual disabilities waivers and you are not
getting services you need, you or your legal representative, have the right to appeal.
You may also appeal if:

 You have not been given the opportunity to choose either home and community
waiver funded services that are provided in your home and community or
services provided in an Intermediate Care Facility (ICF) that are provided in an
institution.

 You are denied your choice of waiver funded services that are part of your
individual support plan including the amount, length of time, and frequency of
services. Agreeing to services in your individual support plan does not prevent
you from filing for a fair hearing regarding these services.

 You are denied your choice of a qualified waiver service provider or choice of an
ICF provider to meet your needs that are included in your individual plan.

 You are dissatisfied with a decision or action taken to refuse, suspend, reduce or
terminate a waiver-funded service after your county has authorized the service.

 Your application for waiver services is not acted upon with reasonable
promptness—45 days to determine your eligibility if you are already Medicaid
approved; and 90 days if you are not approved for Medicaid.

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What Steps in Problem Solving Should I Try Before Using the Appeal
Process of the Department of Human Services (DHS)?

First it is best to try to solve your problem by contacting your Supports Coordinator. If
that doesn’t work, then you should contact the Supports Coordination Supervisor at your
County MH/ID Office.

If your problem is not resolved, contact the County MH/ID Administrator. If your problem
still is not resolved, contact the Regional Program Manager of the Office of
Developmental Programs. The telephone numbers are as follows:

 Northeast Regional Office, 570-963-4391
 Southeast Regional Office, 215-560-2247
 Central Regional Office, 717-772-6507
 Western Regional Office, 412-565-5144

If you still need assistance after going through the County and Regional offices, contact
the Department of Human Services, Office of Developmental Programs. The telephone
number is 717-787-3700. The Toll Free telephone number is 1-888-565-9435.

What is the Appeal Process?

One of the first things you can do is request to have a conference with your county to
discuss your concerns. You may also request independent mediation. If you are
interested in either of these options, write or telephone your County MH/ID Program to
let them know what you want to do.

Your County MH/ID program must offer a pre-hearing conference to you (this does not
involve the Bureau of Hearings and Appeals) but you may choose to decline the offer.
The pre-hearing conference gives you an opportunity to settle the matter prior to the
hearing but neither party is required to change its position at the conference. If the issue
is resolved with the pre-hearing conference, your County Office of MH/ID will notify the
Bureau of Hearings and Appeals.

If you choose to have a conference or to use mediation with the County MH/ID
Program, you may do so without losing your appeal rights with the following provisions:
1) You must contact your County MH/ID Program within 10 days of when you receive
notification of the action with which you disagree. Two examples would be plans to
reduce or to terminate your services. 2) You must agree to meet with the County in an
attempt to resolve the matter outside the Department of Human Services appeal and
fair hearing process. Filing within 10 days provides the right for you to continue in
services that are in dispute.

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If you are not satisfied with the results of the conference or mediation, you may appeal
to the Department of Human Services, Bureau of Hearings and Appeals by filing the
appeal with your County MH/ID Office who will notify the Bureau. You must appeal
within 30 days of your being notified of the county’s decision. However, you do not have
to wait for the results of the mediation before filing an appeal since you may use both
mediation and the appeal process at the same time.

You do not have to have a conference with your county or use mediation if you want to
go directly to an appeal.

Appeals must be filed in writing by you or your legal representative using the form
entitled, "Fair Hearing Request Form" (MR-458) sent to your County Office of MH/ID
with a copy sent to your Regional Office of Developmental Programs. You can get this
form from your Supports Coordinator.

Regional Offices of Developmental Programs addresses are as follows:

Southeast Regional Office of Developmental Programs
801 Market Street, Suite 5071, Philadelphia, PA 19107

Northeast Regional Office of Developmental Programs
100 Lackawanna Avenue, Scranton, PA 18503

Central Regional Office of Developmental Programs
Room 430, Willow Oak Building
Harrisburg State Hospital
Harrisburg, PA 17120

Western Regional Office of Developmental Programs
Piatt Place
301 Fifth Avenue, Room 490
Pittsburgh, PA 15222

At your request, a designated person in your County Office of MH/MR will help you in
filing for an appeal before the Department of Human Services, Bureau of Hearings and
Appeals.

When a hearing date is scheduled, the Bureau of Hearings and Appeals will send of
copy of the "Notice of Hearing Date and Time" form to you and to your County MH/ID
Program.

At the hearing, you can present to the hearing officer the reasons you disagree with the
action or decision and present information and/or witnesses to support your case. You
have the right to represent yourself or to have someone else represent you. You have
the right to bring advocates to the hearing with you.

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If you need a lawyer, you can ask your County MH/ID contact person to refer you to free
legal counsel and advocates. (A County may make a referral to a family regarding full
free legal counsel; however, this is not a policy.)

If you need some other accommodation (for example, an interpreter or a handicapped
accessible location) to attend or participate in the hearing, you may request help in
getting the accommodation by contacting your County contact person. Since you must
make this request before the date of the hearing, it would be good to clearly state your
accommodation needs when you file the appeal.

The Bureau of Hearings and Appeals will hold a hearing for you either over the
telephone or face-to-face. You may choose which type you prefer. If you do not have a
telephone, you can use one at your County MH/ID program or the telephone of a friend,
relative or neighbor. You will indicate whether you want a telephone or face-to-face
hearing by checking a box on the "Fair Hearing Request Form."

If you do not agree with the decision from the Department of Human Services, Bureau
of Hearings and Appeals, you can request reconsideration by the Secretary for the
Department of Human Services. To do this you must send a written request to the
Secretary within 15 days. The request must be sent to the Bureau of Hearings and
Appeals who will forward it to the Secretary. Your request must detail the reasons for
the requested reconsideration and the Secretary can decide to disapprove the reasons
for reconsideration or send it back to the Director of the Bureau of Hearings and
Appeals for further review.

If you still are not satisfied, you can appeal through the Court of Common Pleas. You
will want to have legal counsel to assist you with this process.

Are Mediation and Appeals Available to Me?

You have the right to mediation and appeals if you have applied for or receive services
funded through the Infants, Toddlers and Families Waiver, Person/Family Directed
Support Waiver or the Consolidated Waiver for Individuals with Intellectual Disabilities.

You also have the right to appeal through the Court of Common Pleas if you are an
applicant or recipient of non-waiver services. Local Agency Law gives you this right
when services are denied, reduced significantly or terminated. Nason v.
Commonwealth, 533 A.2d 435 (PA 1987).

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During the Mediation and/or Appeal Processes, Will My Services
Continue?

If you choose to have a county conference or to use mediation, services should not
change until a decision on the conference or independent mediation is made, unless
that change is based solely on federal or state law, regulation or policy.
If your appeal is about a change in services that are already provided to you, and if you
appeal to the Department within 10 days of the county’s decision, your services will
generally continue without change until the Department’s hearing officer makes a
decision. Services will not continue if the action is based only on a change in federal or
state requirements.
This information was created by a work group of the Pennsylvania Self Determination
Consumer and Family Group and the Pennsylvania Office of Developmental Programs,
formerly the Office of Mental Retardation. For more information or other assistance from
the PA Self Determination Consumer and Family Group, call 1-800-459-1838.

Source: PA Department of Human Services http://www.dpw.state.pa.us/

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The Pennsylv F requently ies and Families
A sked
Q uestions

ania Training Partnership for People with Disabilit

FAQ # 4 / WORKBOOK

How Do I Choose a
Provider for the
Supports I Need?

Fall 2014

136

How do i choose a provider of supports through the
Intellectual Disability system?

Anyone who needs support through the ID system will eventually decide
on a provider and/or model of support. This decision may be difficult.

Designed to assist people who have chosen Home and Community-
Based services, this booklet offers helpful steps for those who will
choose a provider of services and supports.

To simplify, we used the term “you” throughout this booklet. The “you”
refers to the person receiving services, though we recognize that it is
often family members assisting with choosing a provider.

Where do i even start to figure out how my supports should
be provided and who can provide them?

STEP 1 The place to start is with your vision
of how you want to live your life.

It is important to know what you want and need before you begin looking
for the right type of service and the right provider for you.

Knowing the answers to the questions below is an important first step.

What do I want my life to look like in 5 years? 10 years?

Here are some questions to think about :
• Where do you want to live?
• Who do you want to live with?
• Who are your friends?
• What is your relationship with your family and extended family?
• What activities do you like to do for fun?

HOW DO I CHOOSE A PROVIDER FOR THE SUPPORTS I NEED? • FAQ # 4 / PAGE 1

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