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Authors Posts by Carol Ferenz

Carol Ferenz

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ODP Announcement 24-071 informs stakeholders of the submission of the Performance-Based Contracting (PBC) 1915(b)4 Waiver and 1915(c) Waiver amendments to the Centers for Medicare and Medicaid Services (CMS). The Office of Developmental Programs (ODP) has included with this announcement multiple documents and resources that are essential for understanding and implementing PBC. The documents are:

Submitted amendments for Consolidated and Community Living 1915(c) and 1915(b)(4) Selective Contracting Waiver for Residential Services are available online. All significant changes resulting from public comments can be found in the PBC Implementation Guide under Appendix A, titled, “Significant Changes to Performance-Based Contracting Proposal as a Result of Public Comment April 20-June 4, 2024.”

As a reminder, all residential providers must sign and return the Residential Provider Agreement to ODP by July 31, 2024. Please direct any questions about this information to ODP electronically.

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ODP Bulletin 00-24-01 Performance-Based Standards for Residential Services has been published, providing detailed information regarding the standards that will be utilized to evaluate performance of residential providers in PA. An expected timeline for implementation of residential performance standards and tier assignment and the evaluation standards that will be used to assign tiers to providers have also been published.

ODP submitted waiver amendments for the 1915(c) waiver and the new 1915 (b)(4) waiver to the Centers for Medicare & Medicaid Services (CMS) on July 26, 2024. RCPA anticipates the fee schedule rates will be published in the PA Bulletin on August 31, 2024. Implementation of the new rates will happen October 1, 2024, with an effective date of July 1, 2024.

All non-residential services, including participant directed services, will receive an 8% increase. All residential services will receive a 6% increase. Implementation of PBC will include rate add-ons of:

  • Select Providers: 3%
  • Clinically Enhanced Providers: 5%

Pay for Performance will also be available.

ODP will hold a webinar on Monday, July 29, to provide an overview of these changes. You can register for the meeting here. Please direct any questions about this information to ODP electronically.

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RCPA was honored to have Stacy DiStephano of Consulting for Human Services, LLC and Ross Harper of Limbic AI join us for a discussion regarding the use of clinical AI in behavioral health care. The recording is now available on RCPA’s website; you will need to log in to your RCPA member account to access. If you have any questions regarding the content or recording, please contact Carol Ferenz. You can find more information below on the speakers and their respective organizations.

Speaker Bios:

Stacy DiStefano, Founder and CEO of Consulting for Human Services, LLC, is a passionate and dynamic healthcare and human services executive advisor, strategist, and retained leader. She has worked on high level strategic initiatives for behavioral health provider organizations, private equity firms, state departments, and tech vendors. Stacy is a visionary with a clinical background, enabling growth and mission achievement. She also works as a trusted advisor who easily builds rapport and works in collaboration with key stakeholders. A resilient and creative problem-solver with an eye on efficiency and a track record of improving financial performance, Stacy always strives to solve complex challenges.

Ross Harper, PhD, CEO of Limbic AI, is a distinguished computational neuroscientist with a rich academic background. Holding a PhD in Computational Neuroscience and a Master’s in Mathematical Modeling from University College London as well as a Master’s in Natural Sciences from the University of Cambridge, Ross possesses an intricate understanding of the overlap between mathematics, technology, and the human mind. He launched Limbic AI in 2020 to enable large language models and generative AI to aid and assist processes in the mental health space, supporting clinicians and their patients within the NHS during the pandemic. Used by over 230,000 patients and mental health professionals within the NHS, Ross is leading a company that is improving patient access to mental health resources, speeding up diagnosis, and supporting mental health professionals to avoid burnout as the company prepares to expand into the US.

Limbic AI:

Limbic is a clinically-validated AI copilot to drive quality and efficiency in behavioral healthcare, drastically improving service operating margins while demonstrably improving patient outcomes. Limbic has been proven at scale in the UK, currently working with 40% of the National Health Service, which now implements Limbic as part of routine care (used by 320,000 patients already). In 2024, Limbic has published 3 large-scale clinical studies, showing improved patient outcomes, lower cost-per-recovery, expanded provider capacity, enhanced access for underserved communities, reduced patient wait times, and elevated satisfaction for patients and clinicians (Nature Medicine, JMIR, British Medical Journal). The company is now working with community health providers in the United States to deliver economic and clinical ROI.

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Photo by Markus Winkler on Unsplash

Deputy Secretary Ahrens of the Office of Developmental Programs (ODP) shared a PowerPoint today, July 25, 2024, at the MAAC meeting. Highlights included ODP’s plan to publish several documents. ODP will be submitting waiver amendments for the 1915(c) waiver and the new 1915 (b)(4) waiver to the Centers for Medicare & Medicaid Services (CMS) on July 26, 2024. In addition, ODP Bulletin 00-24-01: Performance-Based Standards for Residential Services and an ODP announcement regarding the waiver submission, including an implementation guide and provider self-assessment, will be released tomorrow, July 26.

RCPA will share these documents with members as soon as they are available.

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Today, ID/A associations met with Secretary Arkoosh and Dep. Secretary Kristin Ahrens to better understand the FY 2024–25 budget. The Secretary expressed gratitude for our collective advocacy over the past year. She relayed that this budget was a hard-fought battle. Although DHS did not receive the proposed amount, $354 million in new funding is a significant investment. The administration is committed to eliminating the emergency waiting list and made it clear Performance-Based Contracting is moving forward. The administration is committed to building a stronger system and wants to continue to work on these priorities together.

Here are a few technical updates regarding the FY 2024–25 budget:

  1. New rates are anticipated to be published on August 31st, to be effective October 1st, and retroactive to July 1st
    1. Non-residential rates expected to go up by 8% across the board
    2. Residential rates expected to go up by 6% across the board
    3. Providers are encouraged to bill at the current rates and expect a gross adjustment sometime after October 1st
  2. Changes to PBC are anticipated to be published on July 26th as follows:
    1. The rate add-on for clinically enhanced providers is expected to be 5%
    2. The rate add-on for select providers is expected to be 3%
    3. Pay for performance is expected to receive more funding, in order to open more categories for select and clinically enhanced providers

For any questions, contact Richard Edley or Carol Ferenz.

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ODP Announcement 24-069 provides an update to all stakeholders about the status of the Performance-Based Contracting (PBC) 1915(b)4 Waiver and 1915(c) Waiver amendment submissions to the Centers for Medicare and Medicaid Services (CMS). The Office of Developmental Programs (ODP) has changed the date for submission of proposed waiver changes to CMS to Friday, July 26, 2024.

Due to the delay in submitting the waivers, ODP has also rescheduled the July 22 webinar for residential providers to Monday, July 29, from 9:00 am – 10:00 am. In this session, ODP will review revisions to the proposed waiver submissions and implementation plan, supporting documents, and instructions for tier determination and provider data submission. Anyone previously registered does not need to re-register and can expect an email notification of the change. If you are unable to attend on July 29, ODP requests that you unregister. This session will be recorded and posted on MyODP at the Performance-Based Contracting – MyODP page.

Register for the webinar here. Please direct any questions about this information electronically.

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Message from the Office of Developmental Programs (ODP):

Dear ODP Licensed Providers,

There is a worldwide Microsoft outage impacting many applications you may rely on for operations. This link will direct you to a Microsoft Forms questionnaire for you to report any impacts to critical functions. We would like you to complete the questionnaire as soon as you receive it, but at the latest by 1:00 pm today, July 19, 2024, or as soon as possible.

We are asking that all licensed providers complete the questionnaire even if you are not currently experiencing any interruptions. Licensed providers only need to complete the form one time, so please coordinate within your agency to ensure there is not duplication of reporting efforts.

Please be advised that the questionnaire was written to collect information across all Department of Human Services programs, so language may not be reflective of individual program offices.

If you are experiencing issues and require assistance, please reach out to your regional program office.

Thank you for your cooperation with this activity.

Lauren A. House
Director, Bureau of Community Services
Department of Human Services | Office of Developmental Programs
625 Forster Street Room 412 | Harrisburg, PA 17120
DHS Website
Pronouns: She/Her/Hers

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