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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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    Congratulations to Melissa McGuire, who is retiring on July 26 after 29 years as RCPA member Evergreen Elm’s Residential Executive Director!

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    The Pennsylvania Department of Drug and Alcohol Programs (DDAP) has issued Licensing Alert 06-2024 to notify licensed treatment facilities and recovery houses of the new process for submitting licensing regulations exceptions and facility requests to DDAP. This licensing alert replaces Licensing Alert 23-03 and is a result of DDAP streamlining its internal processes. The licensing alert explains how to submit exception requests and facility requests electronically.

    Questions about the alert or the new process should be directed to DDAP.

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    The Department of Human Services (DHS) Office of Mental Health and Substance Abuse Services (OMHSAS) and Office of Developmental Programs (ODP) have announced that they are holding their Statewide Quarterly Positive Approaches & Practices virtual meeting on Thursday, August 8. The meeting will be held from 10:30 am – 3:00 pm, and the topic will be “Building Dementia Friendly Pennsylvania.”

    View the flyer for detailed session and registration information.

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    The agenda for the August 7, 2024, Long-Term Services and Supports (LTSS) Subcommittee meeting has been released. The meeting is hybrid and will be held for in-person attendees in the Honors Suite, 1st floor, 333 Market Street, Harrisburg, PA 17126. The meeting is scheduled for 10:00 am – 1:00 pm. Comments and questions may be sent electronically. Details for attending via webinar can be found below:

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