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ODP Announcement 24-074 shares that the Residential Services Provider Performance-Based Contracting (PBC) Data Submission Tool is now available for all providers choosing to submit data and documentation during the August review period (August 1 – August 31, 2024).

The Data Submission tool is web-based in QuestionPro. In addition to this communication, ODP will send a notification with instructions to residential providers via the QA&I listserv with details for completing the PBC Data Submission Tool.

There are three separate tools, one for each tier category:

The announcement contains more details about the process of choosing the proper data submission tool and information, as well as links for virtual office hours available with ODP staff.

Please direct any questions about this information to this email.

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The Office of Long-Term Living (OLTL), with support from Mercer Government Human Services Consulting (Mercer), part of Mercer Health & Benefits LLC, is conducting a rate study survey for the following Home and Community-Based Services (HCBS):

  • Adult Day;
  • Structured Day Habilitation;
  • Employment and Training;
  • Personal Assistance (Agency);
  • Personal Assistance (Participant-Directed); and
  • Residential Habilitation.

Please complete the survey for the Calendar Year (CY) 2023, which spans from January 1, 2023, through December 31, 2023, unless it is otherwise specified. Please submit the survey by Friday, August 23, 2024. This survey is one piece of the targeted rate review and is intended to collect current provider rate and wage data and general feedback on the challenges of providing these services. The information collected in this survey will be used to assist in developing a point of reference for the rate range to evaluate current payment rates. In addition to results from this survey, the review will include payment rate information from Managed Care Organizations (MCO) in OLTL claims data, recent legislative policies, department expectations, and other data obtained from publicly available sources.

HCBS providers that delivered multiple service categories during CY 2023 should fill out this survey separately for each service category you delivered.

HCBS providers that did not deliver any of the service categories listed above should disregard this survey. OLTL is partnering with Mercer to perform a rate study exclusive to the service categories listed above at this time.

The information collected for this survey will be used for both this rate study and to meet the requirements of House Bill 1300 from the 2023–2024 Pennsylvania General Assembly regular session. The information you provide will remain confidential and private and will only be shared publicly through high level summary reports that do not include provider level detail. Please comply with the Health Insurance Portability and Accountability Act (HIPPA) and do not share any protected health information (PHI) within your survey responses.

You can review the survey questions before starting the survey. This survey tool does not allow individuals to save and go back to answer questions. Please have all your agency information such as wages, employee information, and financial statements readily available. This will help you to submit accurate information when answering the questions.

HCBS providers can access the survey here. OLTL and Mercer appreciate your time and this valuable feedback. If you have any questions or need assistance, please reach out via email. A listserv has been established for ongoing updates on the CHC program. It is titled OLTL-COMMUNITY-HEALTHCHOICES; please visit the ListServ Archives page to update or register your email address.

Please share this email with other members of your organization as appropriate. Also, it is imperative that you notify the Office of Long-Term Living for changes that would affect your provider file, such as addresses and telephone numbers. Mail to/pay to addresses, email addresses, and phone numbers may be updated electronically through ePEAP, which can be accessed through the PROMISe™ provider portal. For any other provider file changes please notify the Bureau of Fee for Service Programs Enrollment and Certification Section at 1-800-932-0939 Option # 1.

If you have any questions, please contact Fady Sahhar or Melissa Dehoff.

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The Centers for Medicare and Medicaid Services (CMS) has recognized traumatic brain injury (TBI) as a chronic health condition. TBI has been added to CMS’ list of chronic conditions for chronic special needs plans (C-SNPs) through its Medicare Advantage program, effective for the January 2025 plan year.

The addition of TBI to the list of chronic conditions was included in a final rule published by CMS in the June 2024 Federal Register, which will become effective on January 1, 2025. Obtaining official recognition of TBI as a chronic condition from CMS is a significant step forward and provides validation that brain injury should be more broadly recognized as a chronic condition.

In March 2024, the Brain Injury Association of America (BIAA) published a position paper requesting CMS, along with the Centers for Disease Control and Prevention (CDC), to designate brain injury as a chronic condition. Formal recognition, the paper states, has the potential to provide several advantages for people with brain injury, including the allocation of additional public health resources to focus on the lifelong effects of brain injury as well as health insurance plans, primarily Medicare and Medicaid, providing additional benefits and other supports as they do for other chronic health conditions. The greatest benefit, however, would be an increase in public awareness of the long-term effects of brain injury that affect the estimated 5 million Americans with a brain injury-related disability.

BIAA will be hosting a live Question and Answer (Q&A) session in the near future to discuss these changes and future tools and resources to assist survivors and their loved ones advocate for further expanding coverage.

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The Office of Developmental Programs (ODP) has shared ODPANN 24-073, which announces that the Department-approved Supports Broker recertification training is available for the first seven months of Fiscal Year (FY) 2024/25. The Office of Developmental Programs (ODP) requires that Support Service Professionals/Supports Brokers under the Consolidated, Person/Family Directed Support (P/FDS), and Community Living (CL) Waivers must successfully complete a Supports Broker Certification Program provided by ODP or its designee every three years following their initial certification. Please view the announcement for details.

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Photo by Markus Winkler on Unsplash

The Office of Developmental Programs (ODP) presented updates for residential providers on Performance-Based Contracting (PBC) this morning, July 29. The Deputy Secretary also reminded residential providers that ALL providers must submit a Residential Provider agreement to ODP by August 31, 2024. Those who have not yet submitted an agreement will be receiving a warning letter.

An overview of updates included revisions to proposed waiver submissions, an implementation plan, supporting documents, instructions for tier determination, and provider data submission. Additional information was also shared on the following:

  • Adjusted Timeline: Residential providers with a signed and submitted Agreement for Provision of Residential Services may choose when to submit data and documentation to determine the PBC tier. Providers may submit information between August 1–31, 2024, or between February 15–March 15, 2025.
  • Clarification on Staff Credentialing: ODP noted that the credentialing standard is the National Alliance for Direct Support Professionals (NADSP) for Primary and Select tiers and NADSP and/or the National Association for the Dually Diagnosed (NADD) for the Clinically Enhanced tier.
  • Reduction of Measures: Measure changes were highlighted in red on the presentation.
  • Pay for Performance and Use of ARPA Funds: ODP clarified that Pay for Performance is available for Select and Clinically Enhanced providers. Use of ARPA funds has been extended for the department through June 2026 and will be available for P4P.
  • Preparedness Tools and Scoring: ODP will be using a scoring document for provider’s submitted data, which has composite scoring ability. If a provider falls short, they will have the opportunity to prove they met the measure.

View the full presentation here.

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The Office of Developmental Programs (ODP) shared ODPANN 24-072. This communication is to inform all interested parties of the submission of a proposed amendment to the Adult Autism Waiver (AAW) to the Centers for Medicare & Medicaid Services (CMS). The amendment includes all proposed changes as well as clarifications to the proposed new American Sign Language-English Interpreter service. The clarifications were added as a result of public comment.

Please view the announcement for details.

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