HR 10 — A Resolution directing the Joint State Government Commission to conduct a study of how Home and Community-Based Services waivers can be improved to meet the needs of individuals with disabilities, including programs administered by the Office of Long-Term Living and Office of Developmental Programs.

PRINTER'S NO.   146

                  THE GENERAL ASSEMBLY OF PENNSYLVANIA



           HOUSE RESOLUTION
              No. 10
                                              Session of
                                                2025

     INTRODUCED BY CERRATO, M. BROWN, HOHENSTEIN, D. MILLER, KHAN,
        GIRAL, HILL-EVANS, SANCHEZ, PROBST, GUENST, SCHLOSSBERG,
        CIRESI, McANDREW, SHUSTERMAN, FREEMAN, BOROWSKI, OTTEN AND
        DALEY, JANUARY 16, 2025

     REFERRED TO COMMITTEE ON HUMAN SERVICES, JANUARY 16, 2025


                               A RESOLUTION
 1   Directing the Joint State Government Commission to conduct a
 2      study of how Home and Community-Based Services waivers can be
 3      improved to meet the needs of individuals with disabilities,
 4      including programs administered by the Office of Long-Term
 5      Living and Office of Developmental Programs.
 6      WHEREAS, More than 2 million Pennsylvanians have a
 7   disability, or approximately one-fourth of Pennsylvanians, which
 8   includes mobility and cognitive disabilities; and
 9      WHEREAS, Adults with disabilities are more likely to
10   experience other health issues, such as obesity, diabetes and
11   heart disease, than the average adult and they face barriers to
12   independent living and employment; and
13      WHEREAS, Home and Community-Based Services waivers offer
14   resources through a variety of Medical Assistance waivers which
15   support the particular needs of residents of this Commonwealth
16   in community settings, enabling recipients to live in their
17   communities rather than seeking care in an institutional
18   setting, such as an intermediate care facility for individuals
 1   with intellectual disabilities or a nursing facility; and
 2         WHEREAS, Home and Community-Based Services waivers were first
 3   created by an act of Congress in 1981 that amended the Social
 4   Security Act to address a bias in the structure of Medicaid
 5   towards providing benefits in institutional settings; and
 6         WHEREAS, Congress created the waiver program to allow states
 7   to apply for waivers that enable the state to target services to
 8   areas of need and particular populations, especially to help
 9   recipients remain in their community, rather than residing in an
10   institution; and
11         WHEREAS, Home and Community-Based Services waivers are
12   required to be cost-neutral and, by providing care equivalent to
13   Medicaid care in the community, costs are often lower than under
14   standard Medicaid; and
15         WHEREAS, There are multiple waivers available for home and
16   community-based services in this Commonwealth that vary in their
17   target population and the benefits provided, with waivers
18   available for residents with conditions, including autism and
19   developmental physical disabilities, and older Pennsylvanians;
20   and
21         WHEREAS, Home and Community-Based Services waivers are
22   administered by the Department of Human Services, and some of
23   the programs, like the Community HealthChoices Waiver and the
24   OBRA Waiver, are administered by the Office of Long-Term Living
25   (OLTL), and other programs, like the Community Living Waiver and
26   the Adult Autism Waiver, are administered by the Office of
27   Developmental Programs (ODP); and
28         WHEREAS, Home and Community-Based Services waivers give the
29   Commonwealth the flexibility to offer care that is not typically
30   available under Medicaid so that vulnerable individuals can

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 1   continue to live in the community rather than an institution;
 2   and
 3         WHEREAS, In 1978, the Congress of the United States defined
 4   developmental disability as a severe, chronic disability due to
 5   a physical or mental impairment, manifesting before 22 years of
 6   age, likely to continue indefinitely, and resulting in
 7   substantial functional limitations in three or more major life
 8   activities; and
 9         WHEREAS, This definition was updated in 2000 by the
10   Developmental Disabilities and Bill of Rights Act of 2000,
11   emphasizing the need for lifelong, individualized support; and
12         WHEREAS, Pennsylvania has adopted eligibility criteria for
13   Home and Community-Based Services waivers that exclude some
14   individuals who meet the Federal definition of developmental
15   disability, thus preventing them from receiving the necessary
16   services; and
17         WHEREAS, Inadequate service availability and provision can
18   detrimentally affect an individual's health, ability to live
19   independently, work and have self-determined lives; and
20         WHEREAS, Data submitted by the Department of Human Services
21   to the Employment First Oversight Commission shows that in 2022,
22   16% of ODP's Home and Community-Based Services waiver
23   participants 18 to 64 years of age are employed in an integrated
24   setting and earning a minimum wage or higher; and
25         WHEREAS, Supporting access to Home and Community-Based
26   Services waivers, medical assistance and other public assistance
27   is important to the Commonwealth's commitment to health equality
28   and equal participation in our communities; and
29         WHEREAS, The concerns and needs of the individuals who use
30   these programs should be the foremost priority for legislators

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 1   in delivering assistance to those individuals; therefore be it
 2      RESOLVED, That the House of Representatives direct the Joint
 3   State Government Commission to conduct a study and issue a
 4   report on the programs administered by the Office of Long-Term
 5   Living and the Office of Developmental Programs focused on how
 6   to improve the experience of individuals with disabilities that
 7   receive a Home and Community-Based Services waiver; and be it
 8   further
 9      RESOLVED, That the study:
10             (1)   Report on whether Home and Community-Based Services
11      waivers meet the medical needs of recipients who have a
12      disability, and ways in which care under waivers can be
13      improved to better meet the medical needs of individuals with
14      disabilities, taking into consideration those differences in
15      the needs of individuals with physical disabilities and
16      developmental disabilities.
17             (2)   Examine and compare the rates being paid by the
18      OLTL's waivers and programs such as Community HealthChoices,
19      OBRA and Act 150 Services, and ODP's waivers for caregiver
20      services, employment support services and participant-driven
21      services.
22             (3)   Examine the service menus in the OLTL versus those
23      in ODP, recognizing that the needs of individuals in both
24      programs may be the same or similar.
25             (4)   Examine challenges faced by waiver participants to
26      avoid institutionalization and to be supported to remain
27      actively engaged in their community.
28             (5)   Examine the root causes of the percentages of OLTL
29      participants in competitive integrated employment being one-
30      tenth of those served by ODP's waivers.

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 1        (6)    Compare pay rates, benefits, training, recruitment
 2    and retention policies and career advancement opportunities
 3    for direct care workers in OLTL's OBRA waiver and the
 4    Attendant Care Services Act (Act 150) to those for direct
 5    support professionals in the ODP's waivers.
 6        (7)    Report on ways in which Home and Community-Based
 7    Services waivers administrative processes could be improved
 8    to address the challenges facing individuals with
 9    disabilities to access Home and Community-Based Services
10    waivers.
11        (8)    Provide recommendations on how the administrative
12    processes may be improved, including the application process
13    and eligibility determinations.
14        (9)    Evaluate ways in which other states have
15    accommodated the diverse needs of individuals with
16    disabilities and altered their public assistance programs as
17    a result, including the utilization of the Federal definition
18    of "developmental disabilities."
19        (10)    Report on access to primary, secondary and tertiary
20    prevention health care for individuals with disabilities on
21    Home and Community-Based Services waivers and whether the
22    access adequately meets the needs of individuals with
23    disabilities.
24        (11)    Report on barriers and facilitators to obtaining
25    medical supplies for individuals with disabilities on Home
26    and Community-Based Services waivers and the effect this has
27    on health outcomes.
28        (12)    Report on barriers and facilitators to accessing
29    nursing services for individuals with disabilities on Home
30    and Community-Based Services waivers, including the differing

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 1    standards for authorizing nursing services among different
 2    waivers.
 3        (13)   Report on barriers and facilitators to accessing
 4    direct care services for individuals with disabilities on
 5    Home and Community-Based Services waivers, including the
 6    differing standards for authorizing direct care services
 7    among different waivers.
 8        (14)   Report on barriers and facilitators to individuals
 9    with disabilities on Home and Community-Based Services
10    waivers receiving medically related supports, such as tube
11    feedings or catheter changing and the social determinants of
12    health.
13        (15)   Report on the barriers and facilitators to hiring
14    an attendant or direct care worker to be able to provide
15    these supports when a nurse is not available under these
16    waivers.
17        (16)   Report on cases where health or administrative
18    challenges with waivers lead an individual with a disability
19    to seek care in an institution instead.
20        (17)   Report on any quality-of-life differences for Home
21    and Community-Based Services waiver recipients living in the
22    community compared to individuals with comparable
23    disabilities who are in an institution.
24        (18)   Report on the circumstances of dual eligibility for
25    Medicare and Medicaid for an individual with disabilities,
26    and any issues that this raises for the recipient in
27    coordinating provider networks and benefits.
28        (19)   Evaluate possible cost savings associated with
29    changes to waivers, including the costs of changes that would
30    address barriers to access.

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 1          (20)     Make recommendations on actions that the Department
 2      of Human Services, Department of Health or other State
 3      agencies could take to better meet the needs of people
 4      receiving waivers.
 5          (21)     Make legislative recommendations on actions that
 6      the General Assembly could take to improve access to Home and
 7      Community-Based Services waivers.
 8          (22)     Collect and evaluate data, including satisfaction
 9      surveys, interviews with waiver recipients and interviews
10      with staff who administer Home and Community-Based Services
11      waivers;
12   and be it further
13      RESOLVED, That the Joint State Government Commission convene
14   an advisory committee which contains the following members:
15          (1)     The Secretary of Health or a designee.
16          (2)     The Secretary of Human Services or a designee.
17          (3)     A representative from the Office of Medical
18      Assistance Programs.
19          (4)     A representative from ODP.
20          (5)     A representative from OLTL.
21          (6)     A representative of a county assistance office or a
22      designee.
23          (7)     A representative of an association of community
24      providers of long-term care living services in this
25      Commonwealth.
26          (8)     A representative from two separate disability
27      advocacy groups in this Commonwealth.
28          (9)     A representative of an organization representing
29      members of a union that provide services to individuals
30      receiving a Home and Community-Based Services waiver.

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 1        (10)   A representative of a health plan.
 2        (11)   A representative of a hospital.
 3        (12)   A member of the Statewide Independent Living
 4    Council.
 5        (13)   A consumer representative from the Long-Term
 6    Services and Supports subcommittee of the Medical Assistance
 7    Advisory Committee.
 8        (14)   A representative of the Long-Term Care Council.
 9        (15)   A family member of an individual who receives a
10    Home and Community-Based Services waiver.
11        (16)   An individual receiving services from a Home and
12    Community-Based Services waiver administered by ODP.
13        (17)   An individual receiving services from home and
14    community-based services administered by OLTL.
15        (18)   A representative of the Employment First Oversight
16    Commission.
17        (19)   A representative of an organization that offers
18    personal assistance services or attendant care.
19        (20)   A representative who is a service coordinator who
20    serves the OBRA waiver population.
21        (21)   A representative who is a service coordinator who
22    serves the Community HealthChoices Waiver population.
23        (22)   One member of the Senate designated by the
24    President pro tempore of the Senate.
25        (23)   One member of the Senate designated by the Minority
26    Leader of the Senate.
27        (24)   One member of the House of Representatives
28    designated by the Speaker of the House of Representatives.
29        (25)   One member of the House of Representatives
30    designated by the Minority Leader of the House of

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 1      Representatives.
 2          (26)     Any other representatives who are deemed
 3      appropriate by the Joint State Government Commission;
 4   and be it further
 5      RESOLVED, That the advisory committee be dissolved no later
 6   than six months after the reporting of findings concludes; and
 7   be it further
 8      RESOLVED, That the Joint State Government Commission report
 9   its findings and recommendations to the House of Representatives
10   no later than 24 months after the adoption of this resolution.




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