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Authors Posts by Tim Sohosky

Tim Sohosky

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The Office of Developmental Programs (ODP) has released Announcement 26-039 and its accompanying attachment, detailing the Pay-for-Performance (P4P) initiatives under Performance-Based Contracting (PBC) for the 2026/27 fiscal year. These initiatives provide supplemental payments to eligible residential providers who meet or exceed specific performance benchmarks.

Providers of Residential Habilitation, Life Sharing, and Supported Living services provided through the Consolidated and Community Living Waivers that are assigned to the Primary, Select, or Clinically Enhanced tiers are eligible to participate.

P4P Initiative Areas:

  • Staff Credentialing: Focuses on stabilizing the workforce by incentivizing DSP and FLS credentialing.
    • Criteria: Providers must have 25–30% of DSPs and 45–50% of FLSs credentialed by December 31, 2026.
    • Payment: 0.3% of the prior calendar year’s residential revenue, paid in May 2027.
  • Rural Capacity Expansion: Supports increasing service capacity in designated rural counties.
    • Criteria: Development and approval of a Rural Capacity Expansion Plan with Administrative Entities (AE).
    • Payment: Tiered milestone payments (Planning: $10,000; Implementation: $15,000; Stability: $25,000).
  • Transition to Independent Living: Incentivizes moving individuals from licensed Residential Habilitation (4 or fewer people) to Life Sharing or Supported Living.
    • Payment: Two payments of $15,000 (totaling $30,000 per individual) based on successful transition and six-month retention.
  • Remote Supports: Allows providers to retain savings when utilizing remote supports while billing the daily fee schedule rate.

Important Deadlines:

  • Credentialing Data Submission: February 15, 2027 – March 15, 2027.
  • Rural Capacity Milestones: Submission deadlines vary by milestone (October 2026, January 2027, and April 2027).

Providers should review the detailed criteria in the ODP announcement attachment to ensure internal tracking systems are aligned with the required reporting metrics for 2026/27.

Questions can be directed via email.

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The Office of Developmental Programs (ODP) has issued Announcement 26-034 reminding providers and Supports Coordination Organizations (SCO) of the annual training requirements under Chapter 6100. Key highlights include:

  • 24 hours annually required for Direct Support Professionals (DSP), Support Coordinators, life sharers, and their supervisors.
  • 12 hours annually required for administrative, management, and ancillary staff, as well as certain contractors, volunteers, and interns working independently with individuals.
  • Training must cover core topics, including person-centered practices, abuse prevention and reporting, individual rights, incident recognition, behavior supports (if applicable), and implementation of individual plans.
  • ODP offers free trainings via MyODP, many of which are NADSP-accredited and count toward credentialing.
  • Providers and SCOs must maintain detailed training records, and staff are responsible for retaining their own training transcripts.

Members are encouraged to review their current training practices to ensure full compliance with Chapter 6100 requirements.

Please direct any questions or feedback to Tim Sohosky.

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Hole torn in a dollar bill with medicaid text

The U.S. House Energy and Commerce Committee recently sent a letter to Governor Josh Shapiro and DHS Secretary Valerie Arkoosh requesting information about fraud, waste, and abuse prevention in Pennsylvania’s Medicaid program. The request is part of a broader federal oversight effort examining Medicaid program integrity following recent fraud investigations in multiple states. Similar letters were also sent to officials in ME, NE, NY, OR, WA, VT, CO, CA, and MA.

The Committee is seeking details on Pennsylvania’s fraud prevention efforts, including audits, provider screening processes, improper payment recovery, enforcement actions, and oversight of Medicaid programs, such as Home and Community-Based Services.

The letter references several recent Medicaid fraud prosecutions in Pennsylvania. However, it also highlights that Pennsylvania’s Medicaid Fraud Control Section charged more fraud cases than any other state in FY 2024 and ranked third nationally in criminal convictions. The fact that these cases were identified and prosecuted demonstrates that Pennsylvania’s fraud, waste, and abuse prevention systems are actively working to detect and address wrongdoing.

RCPA recognizes that this new federal focus on Medicaid program integrity may intersect with our ongoing advocacy to eliminate the requirement for signed encounter forms in Medicaid-funded services. RCPA has long maintained that the current requirement is administratively burdensome and does not meaningfully strengthen program integrity compared to other documentation and verification mechanisms already in place. While our advocacy continues, increased federal scrutiny around fraud prevention may influence how state and federal policymakers evaluate documentation and verification requirements moving forward.

The Pennsylvania Department of Human Services must submit responses to the Committee by March 17, 2026. RCPA will continue to monitor developments and provide updates as appropriate.

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