Authors Posts by Carol Ferenz

Carol Ferenz


ADvancing States and the ARPA HCBS TA Collective Announce Release of Report Summarizing State Experiences with ARPA HCBS Initiatives

April 23, 2024
CONTACT: Camille Dobson

ARLINGTON, VA — ADvancing States and our partners in the American Rescue Plan Act (ARPA) home and community-based services (HCBS) Technical Assistance Collective (TA Collective) are proud to release a report sharing findings about states’ experience in implementing their ARPA HCBS initiatives. While the ARPA infusion of federal dollars into HCBS provided an historic opportunity to try bold, new approaches to supporting people in their homes and communities, states were challenged to make systemic improvements given the time-limited nature of the federal funds.

To gather insights into states’ experiences in implementing their ARPA HCBS spending plans, the TA Collective fielded a national survey in early 2024 that aimed to identify successful strategies used by states implementing their ARPA HCBS spending plans, as well as any barriers hindering their success. Based on responses to that survey, this report highlights the challenges and barriers states faced in thoughtfully executing their initiatives in the midst of a public health emergency. The thirty-three states that responded to the survey shared the top barriers to implementing their projects as planned. These barriers include:

  • Delays in obtaining approval from CMS for both their spending plans and the necessary federal authorities to implement those plans;
  • Lack of staff capacity to design and implement complex initiatives;
  • The time it takes to complete state procurement processes to implement projects; and
  • The need to secure legislative approval and/or budget authority before beginning work.

The report also suggests ways to make any future time-limited investments in the HCBS system more effective, including giving states more time to implement, easing the CMS approval process and providing resources to both states and CMS. Moreover, any future investments should be accompanied by a federal evaluation to glean insights into successful interventions that could be replicated across the country.

While this report highlights challenges and lessons learned, it should be noted that, against all odds, states created transformational change with their ARPA spending plan initiatives. Our hope is that this report — and the recommendations contained therein — serves as a roadmap for any future federal investment in the HCBS system.

This report is also informed by the TA Collective’s work supporting states with their ARPA initiative planning, implementation, and evaluation activities and by observations and analysis of state and federal ARPA HCBS activities. It builds upon the TA Collective’s past work including, Efforts to Evaluate the Impact of ARPA HCBS Investments, an issue brief examining state evaluation approaches, and a summary of the work of the HCBS Sustainability Summit, which provided valuable context on sustaining the HCBS commitment fostered by ARPA investments. Both reports can be found here.

We are grateful to The John A. Hartford Foundation, the Care for all with Respect and Equity (CARE) Fund, The SCAN Foundation, and the Milbank Memorial Fund for their support in making the work of the TA Collective possible.

Visit here to read the new report.

The Information Sharing and Advisory (ISAC) Committee for the Office of Developmental Programs (ODP) met on Tuesday, April 23, 2024. Deputy Secretary Ahrens gave an update and reminded members that on Friday, April 19, 2024, ODP published two very important announcements:

  • ODP Announcement 24-038: Open for Public Comment: Proposed Waiver Amendments and Rates for Services Funded Through the Adult Autism Waiver (AAW); and
  • ODP Announcement 24-039: Open for Public Comment: Proposed Implementation of Performance-Based Contracting for Residential Services, Waiver Amendments to the Consolidated, Community Living, and Person/Family Directed Waivers, and Rates.

Public comments are due June 4, 2024, for both of these announcements.

The proposed rates will be dependent on the governor’s budget passing with the proposed increases for ODP services remaining intact. Deputy Secretary Ahrens urged all stakeholders to advocate with legislators to keep this funding in the budget. Governor Shapiro has been visiting programs and sharing publicity about the importance of these services.

The Deputy Secretary also reviewed the current plans for Performance-Based Contracting for Residential Services with ISAC members. ODP has shared provider preparedness tools with the Residential Strategic Thinking Group for their feedback before publishing the provider preparedness tools and holding provider forums to support providers as they get ready for PBC implementation.

Provider preparedness tools include a Residential Provider Performance-Based Contracting Preparedness Assessment, which comes with a template to support providers developing plans to improve performance on the standards ahead of implementation in January 2025.

Once comments are reviewed and analyzed and any revisions made, the waiver application and amendments will be submitted to the Centers for Medicare & Medicaid Services (CMS) for review, and negotiations implementation target date is January 1, 2025.

RCPA is holding a meeting with our members to develop comments for submission to ODP on Thursday, May 9, 2024, from 9:30 am – 12:00 pm. We ask that you register for this meeting here in order to share your thoughts and help us as we develop our response.

For any questions, please contact Carol Ferenz.

The Department of Human Services (Department) is making available for public review and comment the Office of Developmental Programs’ (ODP) proposed application for a section 1915(b)(4) waiver for a selective contracting program as well as amendments to the Consolidated and Community Living waivers required to implement selective contracting for Residential Habilitation, Life Sharing, and Supported Living services. The selective contracting program will be referred to as Performance-Based Contracting.

The Department is also making available for public review and comment additional proposed amendments to the Consolidated, Community Living, Person/Family Directed Support (P/FDS), and Adult Autism Waivers that are not related to implementation of selective contracting. Changes are proposed to become effective on January 1, 2025.

When performance-based contracting is implemented, all currently enrolled residential providers will have the opportunity to enter into a performance-based contract with ODP. To help support providers with the new requirements and process, ODP will hold provider trainings so that providers have a clear understanding of the process and expectations. As part of this process, providers will submit documentation demonstrating compliance with the performance areas identified by ODP. Additionally, ODP will use data from participant experience surveys, claims, incident management, health risk screening, administrative entities, and a new Performance Analysis Services vendor to evaluate each provider’s performance against the established standards and determine the tier in which the provider will be placed.

Providers will be placed in one of the following tiers based on their performance:

  • Conditional for providers operating under provisional or revoked licenses;
  • Primary for providers that meet current standards and a few additional standards;
  • Select for providers that deliver at least two of the three residential services in the performance-based contracting model and meet enhanced measures; or
  • Clinically Enhanced for providers that offer clinically enhanced medical or behavioral supports and meet enhanced measures.

The Department proposes the following substantive amendments to the Consolidated and Community Living waivers that will support the implementation of performance-based contracting, effective January 1, 2025:

  • Allow for the Department to contract with a Performance Analysis Services vendor that will provide administrative support with data collection, analysis, and reporting functions;
  • Require residential service providers to sign a residential provider agreement, which requires providers to comply with performance standards and reporting requirements outlined in the agreement and ODP policy; and
  • Implement pay-for-performance supplemental payments for residential service providers that meet or exceed performance targets for staff credentialing, employment of individuals served, transition of individuals to Life Sharing or Supported Living services, and reporting on use of technology.

Supplemental payments will be calculated for residential providers meeting or exceeding performance standards as a one-time or combined payment up to 3% of ODP-eligible service revenue from the applicable review period or established payment amount per qualifying event. Providers that have been determined to be a Primary, Select, or Clinically Enhanced provider are eligible to receive the supplemental payments.

  • Pay Licensed Residential Habilitation, Unlicensed Residential Habilitation, Life Sharing, and Supported Living providers that meet the requirements to qualify as a select provider or a Clinically Enhanced residential provider a payment that is in addition to the Medical Assistance fee schedule rate. Select providers will receive a rate add-on of 5% per individual served, and Clinically Enhanced providers will receive a rate add-on of 8%.

Other proposed amendments unrelated to Performance-Based Contracting include:

  • Assuring effective communication for individuals who use American Sign Language through implementation of a new American Sign Language — English Interpreter service. Services will be reimbursed as a vendor service based on the cost that the provider charges to the general public.
  • Promoting health, wellness, and safety by clarifying that individuals who receive services in an acute care hospital will not be disenrolled from the waiver.
  • Supporting the quality of Assistive Technology provided by expanding the qualification requirements for a professional who can complete an evaluation of an individual’s need for Assistive Technology and clarifying that evaluations can be completed for technology costing less than $750 if the service plan team believes it will be beneficial.
  • Increasing community participation and employment by requiring providers of Community Participation Support and Day Habilitation services to annually complete an analysis of each individual’s interests, preferences, skills, and strengths that support the individual’s participation in employment or other community activities.
  • Including revisions to align waiver requirements with regulatory requirements, correct errors, and provide clarification requested by stakeholders.
  • Increasing employment of individuals by allowing indirect activities to be billed through the Benefits Counseling service and improving access to Benefits Counseling for individuals who are not eligible for the Federal Work Incentives Planning and Assistance program.

The Department proposes the following substantive amendments to the Adult Autism Waiver that are not related to implementation of performance-based contracting effective January 1, 2025:

  • Support the quality of Residential Habilitation, Community Home, and Life Sharing services, through alignment of provider qualifications with the qualifications included in the Consolidated and Community Living waivers.
  • Promote health, wellness, and safety by clarifying that Residential Habilitation providers must have a licensed nurse available if the provider serves individuals with needs that require care by a licensed nurse.
  • Promote self-direction, choice, and control by clarifying that Community Transition Services can be used to support individuals transitioning from settings such as Residential Habilitation to private residences in alignment with guidance in the CMS instructions, technical guide, and review criteria for 1915(c) waivers.

View Performance-Based Contracting Information:

View Proposed Changes to the Waivers, Including Changes Not Related to Performance-Based Contracting:

Comments received within 45 days of publication of this notice will be reviewed and considered for revisions to the proposed application for a section 1915(b)(4) waiver as well as proposed amendments to the waivers. Comments should be addressed to Julie Mochon, Department of Human Services, Office of Developmental Programs, 625 Forster Street, Room 510, Harrisburg, PA 17120. Comments may also be submitted to the Department via email using the subject header ”Waiver Comments.”

RCPA will be scheduling a meeting for members to develop comments in response to these proposed amendments. Please contact Carol Ferenz with any questions.

The Office of Developmental Programs (ODP) and Governor Josh Shapiro’s office invite you to Move Your Way! To acknowledge the National Day of Exercise and ODP’s new campaign to encourage physical activity, Governor Josh Shapiro has signed a proclamation, which recognized April 18, 2024, as Move Your Way Day.

What is Move Your Way?

Move Your Way is the physical activity campaign based on the second edition of the Physical Activity Guidelines for Americans. It offers tools and resources for individuals and professionals to learn about the Physical Activity Guidelines, share its key messages, and encourage individuals to become more active. Recognizing the health disparities and co-existing medical conditions experienced by many individuals with intellectual disabilities, developmental disabilities, and autism, ODP is promoting Move Your Way in cooperation with the Office of Disease Prevention and Health Promotion of the U.S. Department of Health and Human Services. Becoming more physically active can help lead to happier, healthier lives.

How Can You Move Your Way?

Anything that gets your heart beating faster counts. And it all adds up.

Find what works for you! Walking, dancing, gardening, swimming, and stretching are just a few suggestions for weekly movement.

Adults need a mix of physical activity to stay healthy: moderate-intensity aerobic activity at least 150 minutes a week, and muscle-strengthening activity at least 2 days a week. Do activities that make your muscles work harder than usual.

What’s Your Move?

Do you have a weekly movement routine? Share your story with us!

Email ODP, and they may feature your story on MyODP News Online!