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Today in a meeting with RCPA, Deputy Secretary Ahrens confirmed that even though the Department of Human Services’ (DHS) budget Blue Book indicates that Prudent Pay would be reinstated in Fiscal Year 2022/23, a decision has been made to continue the suspension. We anticipate a formal notification will be forthcoming. While we are grateful for the suspension for an additional year, RCPA will continue working with the legislature for a permanent solution.

ODP Announcement 22-025 serves to provide the hourly wage and benefits ranges for specific Participant Directed Services (PDS) for participants utilizing the Vendor Fiscal/Employer Agent (VF/EA) FMS model, effective March 1, 2022. The Office of Developmental Programs (ODP) updated the data used in establishing rates, which impacted the hourly wage and benefits ranges. The high end of the hourly wage and benefits ranges either increased or remained the same. There were no decreases to the high end of the hourly wage and benefits ranges. These wage and benefit ranges will be used to pay SSPs and to support claims processing in the Provider Reimbursement and Operations Management Information System in electronic format (PROMISe™) by the VF/EA FMS organization. This communication will only be updated when changes occur to the information contained within.

ODP Announcement 22-026 is to announce that the proposed Fee Schedule Rates and Department-Established Fees for Consolidated, Community Living and P/FDS Waiver services, as well as the Community Intellectual Disability Base-funded program were published at 52 Pa.B. 102 (January 1, 2022).

The Department received comments from 134 stakeholders regarding the proposed changes to the Fee Schedule Rates and Department-Established Fees. After reviewing the comments on the proposed rates, the Department determined that an increase to the Fee Schedule Rates for the Agency With Choice Financial Management Services monthly administrative fee from $285.28 to $311.68 was necessary to cover staff wages and the costs of implementing participant directed services in accordance with requirements in the approved Waivers.

No other changes were made to the rates as a result of public comment.

ODP Announcement 22-024 is intended to provide the hourly wage and benefits ranges for specific Participant Directed Services (PDS) provided to participants utilizing the AWC FMS model, effective March 1, 2022.

ODP updated the data used in establishing rates, which impacted the hourly wage and benefits ranges effective March 1, 2022. The high end of the hourly wage and benefits ranges either increased or remained the same.

These wage and benefit ranges will be used to pay SSPs and to support claims processing in the Provider Reimbursement and Operations Management Information System (PROMISe™) in electronic format by the AWC FMS organization. This communication will only be updated when changes occur to the information contained within.

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The Centers for Medicare and Medicaid Services (CMS) has announced a redesigned Accountable Care Organization (ACO) model that better reflects the agency’s vision of creating a health system that achieves equitable outcomes through high quality, affordable, person-centered care. The ACO Realizing Equity, Access, and Community Health (REACH) Model, a redesign of the Global and Professional Direct Contracting (GPDC) Model, addresses stakeholder feedback, participant experience, and Administration priorities, including CMS’ commitment to advancing health equity.

In addition to transitioning the GPDC Model to the ACO REACH Model, CMS is canceling the Geographic Direct Contracting Model (also known as the “Geo Model”), effective immediately. The Geographic Direct Contracting Model, which was announced in December 2020, was paused in March 2021 in response to stakeholder concerns. A comparison table of ACO REACH and GDCM is available for additional information.

CMS, through the Innovation Center, is testing new models of health care service delivery and payment to improve the quality of care that people receive, including those in underserved communities. The Innovation Center is making improvements to existing models and launching new models to increase participation in our portfolio, and CMS will be a strong collaborator to health care providers that participate in those models.”

As CMS works to achieve the vision outlined for the next decade of the Innovation Center, CMS wants to work with partners who share its vision and values for improving patient care, guided by three key principles. First, any model that CMS tests within Traditional Medicare must ensure that beneficiaries retain all rights that are afforded to them, including freedom of choice of all Medicare-enrolled providers and suppliers. Second, CMS must have confidence that any model it tests works to promote greater equity in the delivery of high-quality services. Third, CMS expects models to extend their reach into underserved communities to improve access to services and quality outcomes. Models that do not meet these core principles will be redesigned or will not move forward.

REACH ACOs will be responsible for helping all different types of health care providers — including primary and specialty care physicians — work together, so people get the care they need when they need it. In addition, people with Traditional Medicare who receive care through a REACH ACO may have greater access to enhanced benefits, such as telehealth visits, home care after leaving the hospital, and help with co-pays. They can expect the support of the REACH ACO to help them navigate an often complex health system.

The GPDC Model will continue until December 31, 2022, and then will transition to the ACO REACH Model. The first performance year of the redesigned ACO REACH Model will start on January 1, 2023, and the model performance period will run through 2026. CMS is releasing a Request for Applications for provider-led organizations interested in joining the ACO REACH Model. Current participants in the GPDC Model must agree to meet all the ACO REACH Model requirements by January 1, 2023, in order to participate.

The following is a list of March event dates for PA Family Network Workshops, monthly updates, and group meetings. Flyers containing event descriptions, details, and Zoom links are included. All the events are virtual and being held through Zoom.

Safety in the Community Workshop:
March 1, 2022 10:00 am–12:00 pm

Waiver Basics (101) Part 1 Workshop:
March 15, 2022 10:00 am–12:00 pm

Waiver Basics (101) Part 2 Workshop:
March 15, 2022 1:00 pm–3:00 pm

Advanced Waiver Part 1 Worskhops:
March 2, 2022 6:00 pm–8:00 pm
March 17, 2022 10:00 am–12:00 pm
March 21, 2022 6:00 pm–8:00 pm
March 29, 2022 6:00 pm–8:00 pm

Advanced Waiver Part 2 Worskhops:
March 3, 2022 6:00 pm–8:00 pm
March 17, 2022 1:00 pm–3:00 pm
March 23, 2022 6:00 pm–8:00 pm
March 31, 2022 6:00 pm–8:00 pm

Transition Workshop:
March 8, 2022 10:00 am–12:00 pm

Long-Term Planning Workshop:
March 22, 2022 10:00 am–12:00 pm

Sibling Good Life Group Meeting:
March 7, 2022 6:30 pm–8:30 pm

Family Forum: Updates:
March 16, 2022 6:30 pm–7:30 pm