PDD-29-14-00005-P HCBS Waiver Community Habilitation Services

7/23/14 N.Y. St. Reg. PDD-29-14-00005-P

NEW YORK STATE REGISTER

VOLUME XXXVI, ISSUE 29

July 23, 2014

RULE MAKING ACTIVITIES

OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

PROPOSED RULE MAKING

NO HEARING(S) SCHEDULED

 

I.D No. PDD-29-14-00005-P

HCBS Waiver Community Habilitation Services

PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following proposed rule:

Proposed Action:

Amendment of sections 635-10.1, 635-10.4(b)(4) and 635-10.5 of Title 14 NYCRR.

Statutory authority:

Mental Hygiene Law, sections 13.07, 13.09(b) and 16.00

Subject:

HCBS Waiver Community Habilitation Services.

Purpose:

To make revisions to HCBS Waiver Community Habilitation services.

Text of proposed rule:

Subdivision 635-10.1(e) is amended as follows:

(e) [Only section 635-10.4(b)(2) and (c)-(f) of this Subpart are applicable to eligible persons receiving waiver community residential habilitation services in facilities operated by providers of services pursuant to Part 671 of this Title.] The allowable activities for waiver community residential habilitation services provided in accordance with Part 671 of this Title are not subject to the provisions of paragraph 635-10.4(b)(1).

• Paragraph 635-10.4(b)(4) is amended as follows:

(4) Community habilitation phase II (CH II) services were delivered between October 1, 2012 and September 30, 2013 and are no longer available. CH II services are … CH II services.)

(Note: rest of paragraph is unchanged.)

• Paragraph 635-10.5(c)(7) is amended as follows:

(7) Billing limits for group day habilitation, [and] supplemental group day habilitation, and prevocational services (see subdivision (e) of this section).

(i) Limit of one full unit or two half units.

(a) This limit applies to an individual who, on a given day:

(1) does not receive supplemental group day habilitation; and

(2) if the individual lives in an Individualized Residential Alternative (IRA), Community Residence (CR), or family care home (FCH), the individual also does not receive community habilitation (CH) services. [On a given day, for an individual who does not receive supplemental group day habilitation on that day,]

(b) On a given day, a maximum of the following may be reimbursed:

[(a)](1) one full unit of group day habilitation; or

[(b)](2) one full unit of a blended service which includes group day habilitation (a blended service is a combination of day habilitation, prevocational services [(see subdivision (e) of this section)] and/or supported employment services); or

[(c)](3) one full unit of prevocational services; or

(4) any combination of two half units of: group day habilitation, prevocational services or blended services.

(Note: current subparagraphs (ii) and (iii) are deleted.)

(ii) Limit of one and a half units or three half units.

(a) This limit applies to an individual who receives supplemental group day habilitation on a given day.

(b) On a given day, a maximum of the following may be reimbursed:

(1) one full unit of group day habilitation, supplemental group day habilitation, prevocational services or blended services and one half unit of any of these services; or

(2) three half units of any of these services.

(iii) For individuals who live in an IRA, CR or FCH and receive community habilitation on a given day, additional billing limits are described in paragraphs (11) and (12) of subdivision (ab) of this section.

(iv) Where more than one agency delivers services on a given day to the same individual, the total number of units and/or hours of CH services billed for that day by all agencies may not exceed the maximum allowed daily units and/or hours described in subparagraphs (i) [, (ii) and (iii)] – (iv) of this paragraph.

(v) Exceptions. The following applies only to requests made prior to the effective date of these amendments.

(Note: clauses (a) – (c) are unchanged.)

• Paragraph 635-10.5(e)(9) is amended as follows:

(9) Billing limits for prevocational services, group day habilitation, and supplemental group day habilitation (see subdivision (c) of this section).

(Note: current subparagraphs (i) – (iii) are deleted.)

(i) Limit of one full unit or two half units.

(a) This limit applies to an individual who, on a given day:

(1) does not receive supplemental group day habilitation; and

(2) if the individual lives in an Individualized Residential Alternative (IRA), Community Residence (CR), or family care home (FCH), the individual also does not receive community habilitation (CH) services.

(b) On a given day, a maximum of the following may be reimbursed:

(1) one full unit of group day habilitation; or

(2) one full unit of a blended service which includes group day habilitation (a blended service is a combination of day habilitation, prevocational services and/or supported employment services); or

(3) one full unit of prevocational services; or

(4) any combination of two half units of: group day habilitation, prevocational services or blended services.

(ii) Limit of one and a half units or three half units.

(a) This limit applies to an individual who receives supplemental group day habilitation on a given day.

(b) On a given day, a maximum of the following may be reimbursed:

(1) one full unit of group day habilitation, supplemental group day habilitation, prevocational services or blended services and one half unit of any of these services; or

(2) three half units of any of these services.

(iii) For individuals who live in an IRA, CR or FCH and receive community habilitation on a given day, additional billing limits are described in paragraphs (11) and (12) of subdivision (ab) of this section.

(iv) On a given day, a maximum of one full unit per individual, either one full unit or two half units, may be reimbursed for supplemental group day habilitation.

(v) Where more than one agency delivers services on a given day to the same individual, the total number of units and/or hours of CH services billed for that day by all agencies may not exceed the maximum allowed daily units and/or hours described in subparagraphs (i) – (iv) of this paragraph.

[(iv)] (vi) Exceptions. The following applies only to requests made prior to the effective date of these amendments.

(Note: clauses (a) – (c) are unchanged)

• Subdivision 635-10.5(ab) is amended as follows

(ab) Hourly community habilitation (CH) services. The following shall apply to CH services (see section 635-10.4(b)(3) of this Subpart).

(1) [Individuals who live in a residence which is operated or certified by OPWDD (including family care homes)] are not eligible to receive CH services.]

Eligibility for CH services.

(i) The following individuals are eligible to receive CH services:

(a) Individuals who do not live in a setting certified or operated by OPWDD (e.g. a private home); and

(b) Individuals who live in the following residences certified by OPWDD: Individualized Residential Alternative (IRA), Community Residence (CR) and Family Care Home (FCH).

(ii) Prior to the effective date of these amendments, no individual who lived in a residence certified or operated by OPWDD (including a family care home) was eligible to receive CH services.

(2) Reimbursement shall be contingent upon prior OPWDD approval of the person's need for CH services. [OPWDD shall approve persons for CH services based on the need for services to protect the health or safety of the person or of his or her caregiver, the compatibility of the individual with available CH services, and the individual’s relative need for supports for daily living.]

(i) For all individuals (except for those who live in an Individualized Residential Alternative (IRA), a Community Residence (CR), or a family care home (FCH)), OPWDD shall approve persons for CH services based on the individual’s relative need for supports for daily living and the individual’s need for community-based activities.

(ii) For individuals who live in an IRA, CR or FCH, OPWDD shall approve persons for CH services based on the individual’s need for community-based activities.

(Note: paragraphs (3) – (5) are unchanged.)

(6) In order to be billable, CH services may not be delivered at a site certified by OPWDD or at a site operated by OPWDD which would be required to be certified if it were operated by another provider. Examples of such sites include but are not limited to a certified day habilitation site, a family care home, a supportive or supervised IRA, and a free-standing respite center certified as an IRA. However, an exception to this rule is that CH services are billable if the services are delivered at clinic treatment facilities certified in accordance with Part 679 of this Title (also known as "article 16 clinics") and the services delivered are in accordance with the exception in clause (7)(i)(e) of this subdivision.

(7) Time spent receiving another Medicaid service cannot be counted toward the CH billable service time, except as follows:

(i) If the individual lives in a setting which is not certified or operated by OPWDD (e.g. a private home) or a FCH:

(Note: current subparagraphs (i) – (iv) are renumbered as clauses (a) – (d) and are unchanged. Current subparagraph (v) is renumbered as clause (e) and clauses (v)(a) – (d) are renumbered as subclauses (e)(1) – (4) and are unchanged except for the amendment of subclause (e)(4).)

(4) Notwithstanding any other provision of this subdivision, CH services delivered in accordance with this [subparagraph] clause are billable regardless of location (even if the clinical service is delivered at a facility certified by OPWDD).

(ii) For individuals who live in an IRA or CR:

(a) The individual may concurrently receive hospice and CH services.

(b) Time when the Medicaid service coordination (MSC) service coordinator is conducting the face-to-face MSC visit with the individual may be counted toward the CH billing as long as the CH staff is present. This concurrent billing is allowed in order to promote the coordination of services.

(c) Nursing services may be provided concurrently with CH services, but only in cases where the CH plan describes supports and services that are distinct and separate from the supports and services being provided by the nursing staff.

(8) CH services are not billable while an individual is in a hospital, nursing home, rehabilitation facility, or [intermediate care facility for persons with developmental disabilities (ICF/DD, see Part 681 of this Title)] ICF/DD. CH services are billable on the day of admission to or discharge from one of these settings so long as the services are not provided in the hospital, nursing home, rehabilitation facility or ICF/DD.

(9) For each continuous service delivery period or session, the CH provider must document:

(i) the service start time and the service stop time [, the ratio of individuals to staff at the time of service delivery, and];

(ii) the provision of at least one service/staff action delivered in accordance with the individual's CH plan;

(iii) for individuals who do not live in an IRA, CR or FCH; the ratio of individuals to staff at the time of service delivery; and

(iv) for individuals who live in an IRA, CR or FCH; whether the CH service is delivered on an individual or group basis.

(10) The unit of service for CH services shall be one hour equaling 60 minutes and is reimbursed in 15 minute increments. When there is a break in the service delivery during a single day, the provider may combine, for billing purposes, the duration of each continuous period of service provision (or session) that is provided during the day. [that has the same individual to staff ratio] In order to be combined, each session must have the same individual to staff ratio (for individuals who do not live in a residence certified by OPWDD). For individuals who live in an IRA, CR or FCH, all sessions being combined must be either “individual” or “group” but the individual to staff ratio in the group CH may vary.

(11) Billing limits for individuals who live in a supervised IRA or supervised CR.

(i) Community habilitation services may only be reimbursed if the services are delivered on weekdays and have a service start time prior to 3:00 p.m.

(ii) CH services may not be reimbursed on a given day that the individual receives:

(a) one full unit of group day habilitation services; or

(b) one full unit of prevocational services; or

(c) one full unit of a blended service (which is a combination of day habilitation and prevocational services); or

(d) any combination of two half units of: group day habilitation, prevocational services or blended services.

(iii) On a given day, a maximum of the following may be reimbursed:

(a) six hours of CH services; or

(b) the combination of:

(1) one half unit of: group day habilitation, prevocational services or blended services; and

(2) four hours of CH services.

(12) Billing limits for individuals who live in a supportive IRA, supportive CR or FCH: On a given day, a maximum of the following may be reimbursed:

(i) eight hours of CH services; or

(ii) the combination of:

(a) one half unit of: group day habilitation services, supplemental group day habilitation services, prevocational services or blended services; and

(b) six hours of CH services; or

(iii) the combination of:

(a) one full unit or two half units of: group day habilitation services, supplemental group day habilitation services, prevocational services or blended services; and

(b) four hours of CH services; or

(iv) the combination of:

(a) one full unit and one half unit or three half units of: group day habilitation services, supplemental group day habilitation services, prevocational services or blended services (one half or one full unit of these must be supplemental group day habilitation services); and

(b) two hours of CH services.

(13) Where more than one agency delivers services on a given day to the same individual who lives in an IRA, CR, or family care home the total number of units and/or hours of CH services billed for that day by all agencies may not exceed the maximum allowed daily units and/or hours described in paragraphs (11) and (12) of this subdivision.

[(11)](14) CH which is self-directed or family-directed. The following requirements apply to CH services which are self-directed or family-directed, and are in addition to [the] all other provisions [of paragraphs (1)-(10)] of this subdivision.

(Note: rest of paragraph is unchanged.)

[(12)](15) Community habilitation fee setting.

(Note: rest of paragraph is unchanged except for the addition of a new clause (iii)(d))

(d) Effective on the effective date of these amendments, the fees for CH delivered to an individual who lives in a CR, IRA or FCH are as follows:

Fee is hourly per person
	Individual	Group
	Serving 1	Serving 2-4
Region I	$37.05	$23.16
Region II	$38.39	$23.99
Region III	$37.51	$23.44

(Note: paragraphs (13) – (15) are renumbered as (16) – (18) and are unchanged.)

• Subdivision 635-10.5(ac) is amended as follows:

(ac) Community habilitation phase II (CH II) services. The following [shall apply] applied to CH II services (see section 635-10.4(b)(4) of this Subpart), which were delivered between October 1, 2012 and September 30, 2013 and are no longer available.

(Note: rest of subdivision is unchanged.)

Text of proposed rule and any required statements and analyses may be obtained from:

Regulatory Affairs Unit, OPWDD, 44 Holland Avenue, 3rd Floor, Albany, NY 12229, [phone], email: [e-mail]

Data, views or arguments may be submitted to:

Same as above.

Public comment will be received until:

45 days after publication of this notice.

Additional matter required by statute:

Pursuant to the requirements of the State Environmental Quality Review Act, OPWDD, as lead agency, has determined that the action described herein will have no effect on the environment, and an E.I.S. is not needed.

Regulatory Impact Statement

1. Statutory authority:

a. OPWDD has the statutory responsibility to provide and encourage the provision of appropriate programs and services in the area of care, treatment, rehabilitation, education and training of persons with developmental disabilities, as stated in the New York State (NYS) Mental Hygiene Law Section 13.07.

b. OPWDD has the authority to adopt rules and regulations necessary and proper to implement any matter under its jurisdiction as stated in the NYS Mental Hygiene Law Section 13.09(b).

c. OPWDD has the statutory authority to adopt regulations concerning the operation of programs, provision of services and facilities pursuant to the NYS Mental Hygiene Law Section 16.00.

2. Legislative objectives: The proposed amendments further the legislative objectives embodied in sections 13.07, 13.09, and 16.00 of the Mental Hygiene Law. The proposed amendments establish revised standards for the provision of HCBS Waiver Community Habilitation Services.

3. Needs and benefits: As part of its ongoing efforts to increase the availability of self-directed services within the system, OPWDD is modifying the HCBS Waiver service, Community Habilitation (CH), to allow individuals residing in certified settings appropriate for HCBS Waiver enrollment to access the service in lieu of traditional day services.

It is expected that this change will allow individuals more service options, and will increase the ability of individuals residing in certified settings appropriate for HCBS Waiver enrollment to receive a highly individualized service and to more readily participate in activities in the community in lieu of more traditional day services. In addition, it is also expected that this change will impact several hundred individuals initially, and may grow over time.

4. Costs:

a. Costs to the Agency and to the State and its local governments:

OPWDD considers that the fiscal effect of these amendments will be minimal. Some individuals who live in IRAs, CRs and family care homes will be newly eligible to receive CH services and may begin to receive CH services – generally in lieu of other Medicaid-funded services in the OPWDD system such as day habilitation or prevocational services. OPWDD therefore expects that the expenditure of Medicaid funds for CH will increase as a result of these amendments, but that there will be a commensurate decrease in expenditures for other Medicaid-funded services. The overall expenditure of Medicaid funds as a result of these amendments is therefore expected to remain roughly equivalent.

For similar reasons, the effect on revenues and costs incurred by OPWDD as a provider of services is expected to be about the same.

Even if Medicaid expenditures changed as a result of these amendments, there would be no impact on local governments. There are no costs to local governments as a result of amendments that change Medicaid expenditures because Chapter 58 of the Laws of 2005 places a cap on the local share of Medicaid costs.

b. Costs to private regulated parties: There are no initial capital costs. As noted above, the amendments are expected to result in an increase in the provision of CH services and a commensurate decrease in the provision of other Medicaid-funded services. Overall revenue to private regulated parties is expected to remain roughly equivalent.

5. Local government mandates: There are no new requirements imposed by the rule on any county, city, town, village; or school, fire, or other special district.

6. Paperwork: Agencies providing CH services will have to develop a CH service delivery plan for each person new to CH services and will need to document the delivery of the CH services. However, there will be a commensurate decrease in paperwork associated with the receipt of other Medicaid-funded services which will no longer be received by these individuals, which typically have equivalent requirements for Habilitation Plans and for service documentation. In addition, there may be some initial paperwork associated with the need to revise Individualized Service Plans to include the receipt of CH services.

7. Duplication: The proposed amendments do not duplicate any existing State or Federal requirements that are applicable to these services.

8. Alternatives: The regulations contain limits on the receipt of CH services for individuals who reside in residential facilities certified or operated by OPWDD. These provisions limit the number of hours of CH services that may be provided and limit the receipt of day habilitation and prevocational services. OPWDD considered not imposing limits on the receipt of CH services for these individuals. However, since these individuals also receive residential habilitation for significant periods of time, OPWDD decided to impose limits on the receipt of CH services to avoid inappropriate duplication of services.

9. Federal standards: The proposed amendments do not exceed any minimum standards of the federal government for the same or similar subject areas.

10. Compliance schedule: OPWDD is planning to adopt the proposed amendments effective October 1, 2014.

OPWDD will provide all necessary information, training, and guidance to providers regarding the revisions before they become effective.

Regulatory Flexibility Analysis

1. Effect on small businesses and local governments: These proposed regulatory amendments will apply to agencies which provide HCBS Waiver Community Habilitation (CH) services to persons with developmental disabilities. Most CH services are expected to be delivered by voluntary provider agencies which employ more than 100 people overall and would therefore not be classified as small businesses. Some smaller agencies do, however, employ fewer than 100 employees overall and would, therefore, be considered to be small businesses. OPWDD estimates that approximately 252 provider agencies would be affected by the proposed amendments. OPWDD is unable to estimate the number of these provider agencies which would be considered to be small businesses.

The proposed amendments have been reviewed by OPWDD in light of their impact on these small businesses and on local governments. OPWDD has determined that these amendments will not have any negative effects on these small business providers of CH services.

The amendments to CH services offer another option to participants who live in residential facilities who wish to have their habilitation services available in a variety of community settings. The service is designed to promote independence and community integration by offering skills training and supports which take place only in non-certified settings.

OPWDD expects that the overall provision of services by specific providers will be roughly equivalent. The amendments will therefore have minimal impacts on service providers.

The amendments will have no effect on local governments.

2. Compliance requirements: As noted, for individuals transitioning to CH services, the individual’s ISP will need to be revised and a CH service delivery plan developed. In general, the revision of the ISP can take place during the course of regular ISP reviews. The amendments contain minor changes in service documentation requirements for CH services which do not increase overall service documentation requirements. Providers will also need to monitor the receipt of specified day services and CH services to ensure that an individual’s receipt of services does not exceed billing limits specified in the regulation.

3. Professional services: No additional professional services are required as a result of these amendments. The amendments will not add to the professional service needs of local governments.

4. Compliance costs: There may be minor costs to small business providers associated with the revision of ISPs, development of new CH plans and training staff to deliver, document and bill CH services. There are no additional compliance costs to small business providers or local governments associated with the continued compliance with these proposed amendments. As noted above, individuals newly receiving CH services as a result of these amendments are expected to experience a commensurate decrease in the receipt of other Medicaid-funded services with similar requirements for plans and service documentation so that there will be no overall increase in costs for service delivery, documentation or billing.

5. Economic and technological feasibility: The proposed amendments do not impose on regulated parties the use of any new technological processes.

6. Minimizing adverse economic impact: OPWDD has given sufficient advance notice of these amendments so that providers can generally make the necessary changes to the individual’s ISP during the regular review process. OPWDD plans to provide sufficient guidance and training to providers to streamline the changes in service delivery that will result from these amendments.

OPWDD has reviewed and considered the approaches for minimizing adverse economic impact as suggested in section 202-b(1) of the State Administrative Procedure Act (SAPA). In the event that small business providers choose to provide CH services to residents of IRAs, CRs and family care homes, the providers must comply with the same requirements as all providers of CH services in order to ensure the provision of quality services and to document the delivery of services to safeguard the expenditure of Medicaid funds. Small business providers of CH services are not required to serve new individuals in the event that they are unable or unwilling to comply with the requirements.

7. Small business and local government participation: OPWDD has reached out to stakeholders regarding the service change, largely in concert with its redesign of the Consolidated Supports and Services that was requested by the Centers for Medicaid and Medicare Services (CMS). OPWDD conducted two statewide informational videoconferences in April, 2014 with individuals and families, as well as a videoconference with agencies affected by the changes to the service and a question and answer session with Provider Association representatives. OPWDD continues to receive input on the eventual design of self directed services, including CH, from stakeholders through stakeholder workgroups meetings which have individual, family, and agency representation.

Rural Area Flexibility Analysis

1. Description of the types and estimation of the number of rural areas in which the rule will apply: OPWDD services are provided in every county in New York State. 43 counties have a population of less than 200,000: Allegany, Cattaraugus, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Cortland, Delaware, Essex, Franklin, Fulton, Genesee, Greene, Hamilton, Herkimer, Jefferson, Lewis, Livingston, Madison, Montgomery, Ontario, Orleans, Oswego, Otsego, Putnam, Rensselaer, St. Lawrence, Schenectady, Schoharie, Schuyler, Seneca, Steuben, Sullivan, Tioga, Tompkins, Ulster, Warren, Washington, Wayne, Wyoming and Yates. Additionally, 10 counties with certain townships have a population density of 150 persons or less per square mile: Albany, Broome, Dutchess, Erie, Monroe, Niagara, Oneida, Onondaga, Orange, and Saratoga.

The proposed amendments have been reviewed by OPWDD in light of their impact on rural areas.

The amendments to CH services offer another option to participants who live in residential facilities who wish to have their habilitation services available in a variety of community settings. The service is designed to promote independence and community integration by offering skills training and supports which take place only in non-certified settings.

OPWDD expects that the overall provision of services by specific providers will be roughly equivalent. The amendments will therefore have minimal impacts on service providers in rural areas.

The amendments will have no impact on local governments in rural areas.

2. Compliance requirements: For individuals transitioning to CH services, the individual’s ISP will need to be revised and a CH service delivery plan developed. In general, the revision of the ISP can take place during the course of regular ISP reviews. The amendments contain minor changes in service documentation requirements for CH services which do not increase overall service documentation requirements. Agencies will also need to monitor the receipt of specified day services and CH services to ensure that an individual’s receipt of services does not exceed billing limits specified in the regulation.

OPWDD expects that the compliance requirements are necessary to ensure the proper use of federal and state public funds and that they are not burdensome as they are consistent with requirements for other HCBS waiver services with which the agencies are very familiar.

The amendments do not impose any compliance requirements on local governments in rural areas.

3. Professional services: There are no additional professional services required as a result of these amendments and the amendments will not add to the professional service needs of local governments.

4. Compliance costs: There may be minor costs to providers in rural areas associated with the revision of ISPs, development of new CH plans and training staff to deliver, document and bill CH services. There are no additional compliance costs to providers of CH services located in rural areas associated with the continued compliance with these proposed amendments. As noted above, individuals newly receiving CH services as a result of these amendments are expected to experience a commensurate decrease in the receipt of other Medicaid-funded services with similar requirements for plans and service documentation so that there will be no overall increase in costs for service delivery, documentation or billing.

5. Minimizing adverse economic impact: OPWDD has given sufficient advance notice of these amendments so that providers can generally make the necessary changes to the individual’s ISP during the regular review process. OPWDD plans to provide sufficient guidance and training to providers to streamline the changes in service delivery that will result from these amendments.

OPWDD has reviewed and considered the approaches for minimizing adverse impact as suggested in 202-bb(2)(b) of the State Administrative Procedure Act (SAPA). In the event that providers in rural areas choose to provide CH services to residents of IRAs, CRs and family care homes, the providers must comply with the same requirements as all providers of CH services in order to ensure the provision of quality services and to document the delivery of services to safeguard the expenditure of Medicaid funds. Providers of CH services in rural areas are not required to serve new individuals in the event that they are unable or unwilling to comply with the requirements.

6. Participation of public and private interests in rural areas: OPWDD has reached out to stakeholders regarding the service change, largely in concert with its redesign of the Consolidated Supports and Services that was requested by the Centers for Medicaid and Medicare Services (CMS). OPWDD conducted two statewide informational videoconferences in April, 2014 with individuals and families, as well as a videoconference with agencies affected by the changes to the service and a question and answer session with Provider Association representatives, including representatives of providers in rural areas. Some of these informational sessions were attended by rural providers of CH services. OPWDD continues to receive input on the eventual design of self directed services, including CH, from stakeholders through stakeholder workgroups meetings which have individual, family, and agency, including rural agency, representation.

Job Impact Statement

OPWDD is not submitting a Job Impact Statement for this proposed rulemaking because this rulemaking will not have a substantial adverse impact on jobs or employment opportunities.

As noted, OPWDD expects the overall provision of services to individuals as a result of these amendments to be roughly equivalent. OPWDD expects that the amendments will result in an increase in CH services and that there will be a commensurate decrease in other services. This means that the overall number of jobs involved with the provision of services will be about the same.

Thus, the proposed amendments will not have any substantial adverse impact on jobs or employment opportunities.