​DHS COVID-19 PROVIDER RESOURCES // ODP​

ODP Announcement 20-052 Update:
Home and Community-Based Services (HCBS)
in Counties Designated by the Governor as Yellow Phase

Updated: May 13, 2020

Audience

All stakeholders

Purpose

To provide updated guidance to stakeholders about Governor Wolf’s announcement of counties that are moving to the “yellow phase” and provide service-specific guidance to ODP stakeholders.

Discussion

Individuals who are COVID-19 positive or suspected positive should continue to selfisolate regardless of the color designation of the county where they reside. Individuals who are COVID-19 positive or suspected positive should not be engaging in community activities.

During the yellow phase some face-to-face and community activities may resume. This updated communication provides guidance for services rendered face-to-face and in the community in counties which are in the yellow phase. Please note for any HCBS that are occurring in counties remaining in the red phase, screening protocols and mask use described at the end of this document should be followed.

On May 8, 2020, 24 counties from the northwest and north-central regions of the state moved from red phase to yellow phase, which is part of the administration’s Process toRe-Open Pennsylvania. On May 15, thirteen additional counties in the southwest region will move to the yellow phase. This marks a reduction in restrictions on work and social settings.

These counties were deemed ready to move to the yellow phase because of low percapita case counts, the ability to conduct contact tracing and testing, and a population density that will allow for the containment of community spread. For more information about how this decision was made, stakeholders can review the Risk-Based DecisionSupport Tool which was developed in partnership with Carnegie Mellon University (CMU) to strike a balance between economic concerns and public health risks.

The Planning Process

It is highly encouraged that the Individual Support Plan (ISP) teams use the ODP Individual Transition Guide (issued May 11th) in conjunction with the probe guidance in the annotated ISP to assess risk associated with COVID-19 and determine for each individual who resides in a county which is in the yellow phase which services and/or community activities may be resumed or started and what supports the individual must receive in order to be able to safely resume activities or engage in new activities. In situations where the ISP team has not met, activities in the community and necessary supports for those activities should be established by the individual, family, and currently authorized service providers using the ODP Individual Transition Guide. All conditions outlined in the Intellectual Disabilities/Autism Waivers Operational Guidance (version 1.0 or any published revisions) and the Adult Autism Waiver Operational Guidance (version 1.0 or any published revisions) continue to apply.

To assist with this transition, ODP is providing the following service-specific guidance for stakeholders in counties moving to the yellow phase beginning May 8, 2020.

For all HCBSs, the screening protocols, the use of masks, and information on handwashing discussed at the end of this announcement should be followed.

Screening Guidance

Providers must screen the following: 

• Direct service professionals or other staff, contractors or consultants that render face-to-face services to individuals. 
• Family or friends with whom the individual will have face-to-face visits.
• Individuals receiving services. Screening of individuals is not required if they are currently diagnosed with COVID-19.
  

Screening Questions: 

1. Do you have a fever equal to or higher than 100.0 degrees or respiratory symptoms such as new or worsening cough, shortness of breath, or sore throat? 

2. In the past 14 days, have you had a potential exposure to COVID-19? A potential exposure means a household contact or having close contact within 6 feet of an individual with confirmed or suspected COVID-19 for at least 10 minutes. The timeframe for having contact with an individual includes the period of time of 48 hours before the individual became symptomatic. 

3. Are you currently diagnosed with COVID-19, have a test pending for COVID-19, or been told by a medical provider that you may or do have COVID-19?

Additional screening considerations for individuals with ID/A: 

• In addition to the typical symptoms of COVID-19 as identified by the Centers for Disease Control (CDC), ODP providers have noted that for individuals with ID/A, COVID-19 infection has caused muscle aches, weakness or a change in baseline behavior without or prior to respiratory symptoms emerging. Providers should closely observe individuals for weakness or other changes in behavior that may be indicative of illness.
  

Screening Guidance for Residential Settings

• Residential providers should continue to follow the Long Term Care Guidance for Screening and Infection Control established by the CDC and found at www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-carestrategies.html.
  

Screening Guidance for the Provision of Transportation Trip Services

Based on the answers to the screening questions, transportation trip providers should take the following steps: 

A. If the answer to all three questions above is “no,” then the individual can use transportation trip services. Transportation trip services should be arranged in a manner that limits the driver’s physical contact with the individual and allows for social distancing. This may require fewer people in a common vehicle or more individual rides. 

B. If the answer is “yes” to just one of either question 1 or 2 above, the individual can use transportation trip services under the following circumstances: 

• The individual is transported as an individual ride; 
  
• The individual, if able, should wear a mask prior to entering the vehicle. 
  
• The driver must wear a mask. 
  

C. If the answers to both questions 1 and 2 above are “yes” or the answer to question 3 is “yes,” then in addition to complying with guidance in “B” above, transportation trip services should only be used for medical care or medical appointments under the direction of the individual’s health care practitioner.

Screening Process for Other HCBS Services

• Providers (including Agency with Choice Financial Management Services organizations) must have a protocol to ensure that staff and individuals have been screened using the above screening questions prior to services being delivered. 
• Common law employers in the Vendor Fiscal/Employer Agent model are responsible for establishing how screening will be completed. ODP will release additional guidance to assist common law employers with establishing this process soon. 
• When a direct support professional answers “yes” to any of the above screening questions, the direct support professional should not render face-to-face services and back-up plans should be implemented. 
• When an individual receiving services answers “yes” to any of the screening questions, the individual should not participate in any community activities and appropriate steps should be taken to ensure follow-up if COVID-19 is suspected as a result of the screening. The individual’s health care professional will provide additional guidance on the appropriate timeframe to return community activities.
  

Masks: Cloth Face Coverings and Surgical Face Masks 

Wearing a face mask has been recommended by the Secretary of Health to stop the spread of COVID-19. It is expected that staff who provide services wear a face covering or a mask during the entirety of service provision. The only exception is if the staff person lives with the individual. Masks should be worn by staff and individuals during activities in the community. Please note: Cloth face coverings are not considered personal protective equipment (PPE) and should not be worn in place of a surgical face mask when caring for an individual with COVID-19.

Masks should be worn by staff and individuals during activities in the community.

In accordance with current CDC guidance, cloth face coverings should: 

• Fit snugly but comfortably against the side of the face 
• Be secured with ties or ear loops 
• Include multiple layers of fabric 
• Allow for breathing without restriction 
• Be able to be laundered and machine dried without damage or change to shape.
  

Masks should not be placed on children younger than 2 years of age. f an individual has trouble breathing or other medical conditions that may be worsened with wearing a mask, seek clarification with the health care practitioner regarding mask use. 

It is important to keep in mind that some individuals may not be able to tolerate a mask or may be afraid or unsettled when others wear masks. The ODP Individual Transition Guide contains some questions that address the use of face masks. In addition, the following may help an individual adjust to wearing a mask:

• Using the Wearing a Mask Social Story on the ASERT website: https://paautism.org/resource/wearing-mask-social-story/. There is also an animated version available here. 
• Ensure that the individual knows that the individual will be able to breathe while wearing a mask if that is a concern. 
• While wearing masks, look in the mirror and talk about what it is like to wear a mask.
• Decorate a mask so the mask is personalized and fun to wear. 
• Show the individual pictures of other people wearing masks. 
• Use masks with a clear window where staff/caregivers mouths can be seen such as these. 
• Pin a picture without a mask of staff or caregivers on the staff or caregivers shirt.

Handwashing 

Handwashing prevents the spread of infection. The following information should be provided to all staff: 

The CDC recommends washing your hands frequently and avoiding touching your face. Always put on and take off your mask with clean hands. Use hand sanitizer that contains at least 60% alcohol if you cannot use soap and water to wash your hands. 

Follow these five steps every time.

 1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap. 
2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
4. Rinse your hands well under clean, running water.
5. Dry your hands using a clean towel or air dry them.