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The Centers for Medicare and Medicaid Services (CMS) issued a press release announcing an increase in three accountable care initiatives that will grow and provide higher quality care to more than 13.1 million people with Medicare in 2023. The initiatives include:

The Shared Savings Program is the largest accountable care initiative in the country and is a permanent program in Medicare that was established by the Affordable Care Act (ACA). The Shared Savings Program has 456 ACOs and 10.9 million assigned beneficiaries in 2023. While the Shared Savings Program experienced a decrease in the number of ACOs and assigned beneficiaries for 2023, the policies finalized in the calendar year (CY) 2023 Medicare Physician Fee Schedule final rule are expected to grow participation in the program for 2024 and beyond, when many of the new policies are set to go into effect. These policies are expected to drive growth in participation, particularly in rural and underserved areas, promote equity, and advance alignment across the accountable care initiatives, and increase the number of beneficiaries assigned to ACOs participating in the program by up to four million over the next several years.

The ACO REACH Model aims to improve the quality of care for people with Traditional Medicare through better care coordination and by increasing access to accountable care in underserved communities. Innovative features the Model will test include benchmark adjustments to shift payments to better support care for the underserved and enhanced Medicare benefits, including care in the home. In 2023, ACO REACH will increase access to accountable care in underserved populations. The ACO REACH Model will have 824 Federally Qualified Health Centers, Rural Health Centers, and Critical Access Hospitals participating in 2023 — more than twice the number in 2022. Increasing the number and reach of ACOs in underserved communities will help close racial and ethnic disparities that have been identified among people with Traditional Medicare in accountable care relationships.

The KCC Model focuses on coordinating care for Medicare beneficiaries with chronic kidney disease stages 4 and 5 and end-stage renal disease (ESRD). In addition to care coordination, the KCC Model focuses on key areas of concern for this population, including delaying the onset of dialysis and increasing access to kidney transplantation so more patients can live fuller and longer lives.

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ODP Announcement 23-008 announces that the amendment to the Adult Autism Waiver (AAW), effective January 1, 2023, was approved by the Centers for Medicare & Medicaid Services (CMS) on January 13, 2023. The amendment to the AAW includes the following substantive changes:

  • Adding reserved waiver capacity for individuals who are discharged from a state center or are released from incarceration after a period of at least six consecutive months.
  • Aligning of provider qualifications in the AAW with the Consolidated, Community Living, and Person/Family Directed Support (P/FDS) waivers, whenever possible.
  • Allowing relatives to deliver the Life Sharing component of the Residential Habilitation service.
  • Requiring that agencies that provide Residential Habilitation/Life Sharing be qualified and enrolled to provide Residential Habilitation/Life Sharing in the Consolidated or Community Living waivers.
  • Increasing the annual fiscal limit in the Transportation service to $5,000 per participant’s Individual Support Plan (ISP) year.
  • Allowing one of the four required individual monitorings conducted by the Supports Coordinator each year to be conducted remotely. NOTE: For all individuals receiving Residential Habilitation (Community Homes or Life Sharing), remote monitorings are not permitted. See ODP Announcement 22-085 for additional information.
  • Allowing delivery of direct services using remote technology (teleservices). The requirements in the AAW will become effective when Appendix K flexibilities expire, six months after the expiration of the federal COVID-19 public health emergency.
  • Aligning the Assistive Technology service, where possible, with the Consolidated, Community Living, and P/FDS waivers. This includes adding generators for the participant’s primary residence.
  • Adding a new service, Remote Supports. A separate communication will be published in the coming weeks, providing instructions about how to add new Remote Supports procedure codes to ISPs. Remote Supports should not be added to ISPs until this communication is published.

The waiver application approved by CMS and the record of change document are available here.

ODP will be holding a webinar to discuss major changes made in the approved AAW amendment. Webinars specific to Remote Supports will be scheduled and communicated in the coming weeks. The date, time, and registration link for the general AAW amendment webinar are as follows:

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By The Times-Tribune

Editor: Providers who care for individuals with intellectual disabilities and autism are pummeled by a workforce shortage driven by low wages and high vacancy and turnover rates.

The Arc of Pennsylvania recently partnered with other social service associations to get a better picture of the state’s workforce in the field.

The survey evaluated critical data on pay practices, hourly wages, scheduled positions, filled positions and separations for more than 9,000 employees representing 40 different positions in 52 organizations, including many in Northeast Pennsylvania.

The findings are stark.

Wages for direct support professionals who help children and adults with their basic daily living needs average $16.61 per hour — less than wages at some fast-food restaurants. The turnover rate for direct support workers is 38% with providers reporting a vacancy rate of 28%. The numbers are similar for other residential and program supervisors.

The study also found that 14% of all direct support professionals’ hours are paid at an overtime rate, and 41% of providers now engage in a more costly practice of contracting for staffing services to manage the workforce shortage.

Because human services for those with intellectual disabilities and autism are funded primarily by Medicaid, providers cannot raise prices like private businesses to pay higher wages. So, chronic underfunding by the state only exacerbates these operational challenges.

Service providers simply do not have the staff they need to serve thousands of Pennsylvanians receiving or waiting for critical services. This is a system that is strained past its breaking point, and it needs our support now.

SHERRI LANDIS
THE ARC OF PENNSYLVANIA
HARRISBURG

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Photo by Markus Winkler from Pexels

Former Department of Drug and Alcohol Programs (DDAP) Secretary Jennifer Smith has been named Deputy Secretary for the Office of Mental Health and Substance Abuse Services (OMHSAS). As DDAP Secretary, Smith led DDAP’s efforts to fulfill its mission of engaging and coordinating the commonwealth’s efforts to prevent and reduce substance use disorder and problem gambling and to promote recovery. Smith was integral in the formation and implementation of Pennsylvania’s first licensure program for recovery houses as well as leading Pennsylvania’s treatment system transition away from the Pennsylvania Client Placement Criteria to ASAM Criteria.

Dr. Dale Adair, who has served as Acting Deputy Secretary for OMHSAS, will continue to serve as the Chief Psychiatric Officer for OMHSAS.

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The Office of Management and Budget (OMB) has released the Unified Regulatory Agenda and Regulatory Plan, which outlines regulatory actions federal agencies are considering in the coming months. Regulations can be searched by specific agency, such as Department of Health and Human Services (HHS), which includes the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA).

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The Pennsylvania Department of Drug and Alcohol Programs (DDAP) is making available $4 million in grant funding for organizations to establish or expand substance use disorder (SUD) services, community outreach and education to Black, Indigenous, and People of Color (BIPOC) communities.

In 2020, overdose death rates increased 39 percent for black Pennsylvanians, compared to 2019. In 2021, black Pennsylvanians died from an overdose at a rate that was nearly two times higher than white Pennsylvanians.

Grants up to $400,000 each will be awarded for a 12-month period beginning July 1, 2023, through June 30, 2024. Funds can be applied toward a range of activities, including construction and building infrastructure, staffing, and evidence-based programming.

Eligible applicants include organizations that provide services, outreach, and/or education to BIPOC communities in any of the following areas:

  • Harm reduction;
  • Access to low-barrier medications for opioid use disorder and SUD treatment;
  • Recovery and peer supports; and
  • Reentry supports.

Funding for these grants is provided from the opioid settlement funding that the General Assembly appropriated to DDAP.

Download the Grant Initiative Funding Application.

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