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CMS is hosting a training to provide states with monitoring strategies to ensure compliance with the HCBS Settings Rule. States are required to submit a Statewide Transition Plan (STP) to CMS to ensure their HCBS programs meet the criteria of the HCBS Setting Rule by March 17, 2023.

This training will:

  • Review state responsibilities for monitoring compliance with the HCB settings rule;
  • Discuss the progress states have made in systemic remediation changes to assess implementation in 1915(c) waiver submissions and/or 1915(i) SPAs;
  • Review the data report on the monitoring strategies used by states to achieve and maintain compliance with the home and community-based settings criteria;
  • Consider an additional strategy for monitoring ongoing compliance with the settings rule by incorporating performance measures into the waiver assurances/quality improvement section of a state’s 1915(c) waiver submissions and, if applicable, into the state’s 1915(i) benefit quality improvement strategy.
  • We will also review some current state examples.

This training will be held on Tuesday, October 14 from 1:30 PM to 3:00 PM ET.

Click here to register for this training.

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Office of the Governor PA WebsiteFOR IMMEDIATE RELEASE
October 2, 2020
View Online

Harrisburg, PA – Amid the pandemic, rising health care costs and magnified health inequities, Governor Tom Wolf today unveiled a plan that addresses comprehensive health reforms focusing on both physical and behavioral health and promoting affordability, accessibility and value in health care.

“I am proposing a health reform package that will make health care more affordable, hold health care corporations accountable and tackle the health inequities resulting from systemic racism,” Gov. Wolf said. “True reform means focusing on every aspect of a person that contributes to their health. Even before the pandemic, there were warning signs that Pennsylvania’s health care system wasn’t working for everyone. Many Pennsylvanians found it hard to pay their medical bills due to rising health care costs, including families who have health care coverage and often have to pay higher premiums and more out-of-pocket costs every year.”

Health care access has historically been more difficult for many, and because of the pandemic, affordability is expected to become a crisis, with more than 1.5 million Pennsylvanians expected to become uninsured.

COVID-19 has also worsened the pre-existing inequities that some disadvantaged neighborhoods face, disproportionately hurting Pennsylvanians of color.

Chief Innovation Officer at the Department of Human Services, Dr. Doug Jacobs, outlined the components of the health reform plan and how they will address these issues.

“As a board-certified and practicing internal medicine physician, I see first-hand how affordability and a whole-person approach to care is so crucial to helping Pennsylvanians access the health care they deserve,” Dr. Jacobs said. “Governor Wolf is proposing a whole-person health reform package that will make comprehensive, quality health care more affordable and accessible.”

The three main components of the plan include:

  • Interagency Health Reform Council (IHRC), established with an executive order the governor signed at the press conference today. The council will be composed of commonwealth agencies involved in health and the governor’s office. The initial goal will be to develop recommendations by December 30 to find efficiencies in the health care system by thinking about how to align programs where feasible, including the joint purchasing of medications, aligning value-based purchasing models, and using data across state agencies to promote evidence-based decisions.
  • Regional Accountable Health Councils (RAHCs). The Department of Human Services will add requirements to form five RAHCs across the state into the managed care agreements. RAHCs will be required to collectively develop regional transformation plans – built on community needs assessments – to reduce disparities, address social determinants of health, and align value-based purchasing arrangements.
  • Health Value Commission. The governor will work with the legislature to establish the Health Value Commission, charged with keeping all payors and providers accountable for health care cost growth, to provide the long-term affordability and sustainability of our health care system, and to promote whole-person care. As proposed, the newly created entity would be led by up to 15 commissioners appointed by the governor and the General Assembly who have an expertise in the health care marketplace, including five state agency heads.

Gov. Wolf and Dr. Jacobs were joined at the announcement by Pennsylvania Health Access Network director Antoinette Kraus, home health care aide Hillary Rothrock, and Little Amps owner Peter Leonard.

“Far too many Pennsylvanians put off care or skip tests and treatment because of what’s in their wallets rather than what’s best for their health,” Antoinette Kraus said. “Without reforms that directly address high and rising healthcare costs, families will continue to struggle with getting the care they need without facing financial ruin, and health disparities will also widen. We applaud Governor Wolf for addressing these issues by introducing reforms that will increase transparency, improve health equity, and lower costs.”

“Little Amps has long been striving to find a way to provide high quality health care coverage to our team – my peers in the small business community know just how difficult this can be despite how essential it is to our collective wellbeing,” Peter Leonard said. “It simply is not affordable, and that is unacceptable. We support Governor Wolf’s Whole-Person Health Reform proposal because of its ability to decrease costs and make healthcare more affordable for small businesses like ours.”

“I’m grateful to Governor Wolf for introducing the Whole-Person Health Reform initiative,” Hillary Rothrock said. “So many of us in health care want desperately to provide everything we can for our consumers, but we aren’t given the resources we need. Finding cost savings that can be redirected toward direct care is critically needed.”

“The COVID-19 pandemic has exacerbated many of the challenges that our commonwealth faced prior to this year,” Gov. Wolf said. “We are more aware now of how precarious many systems we all took for granted are, and how the inequities that exist in those systems harm some of our most vulnerable Pennsylvanians. We need to take these actions now to make sure that health care is affordable and accessible for every Pennsylvanian, and to guarantee that the care Pennsylvanians receive is valuable and of high quality.”

MEDIA CONTACT:    Lyndsay Kensinger, [email protected]

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RCPA’s IDD Committee will be meeting on October 15, 2020 from 12:00 pm until 3:00 pm.  We are fortunate to have a panel of guest speakers confirmed from the Office of Developmental Programs (ODP).  Julie Mochon, Director Division of Policy, Ashley Senoski, Grants and Fiscal Manager Bureau of Financial Management and Support, Alisa Hendrickson and Nora Campanella from the Regulatory Administration will be joining the meeting to address topics that we have specifically asked to discuss.

We have given them a list of issues we have recently heard from our members.  If you have questions that you would like for us to submit, please send those to Carol Ferenz by the close of business on Wednesday, October 6, 2020.  This will allow time for our guest speakers to prepare for our meeting.

If you have not yet registered for the IDD Committee meeting, you can do so here. We are looking forward to a productive discussion with ODP and appreciate the time they have committed to us on the 15th.

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On September 30, the Oversight and Investigations Subcommittee (of the Energy & Commerce (E&C) Committee) held a virtual hearing (Pathway to a Vaccine: Ensuring a Safe and Effective Vaccine People Will Trust) with public health experts on the continued oversight of the development and safety of potential COVID-19 vaccines. Key witnesses from the hearing included:

  • Helene Gayle, M.D., M.P.H., Co-Chair, Committee on Equitable Allocation of Vaccine for the Novel Coronavirus, National Academies of Sciences, Engineering, and Medicine
  • Ashish K. Jha, Dean, M.D., M.P.H., Dean, School of Public Health, Brown University
  • Ali S. Kahn, M.D., M.P.H., M.B.A., Dean, College of Public Health, University of Nebraska Medical Center
  • Mark McClellan, M.D., Ph.D., Founding Director, Duke-Margolis Center for Health Policy, Duke University
  • Paul A. Offit, M.D., Director, Vaccine Education Center, Children’s Hospital of Philadelphia

 

The E&C website contains the videos from the hearing. The key takeaways from the hearing include:

  • There are many safeguards in place for a COVID-19 vaccine approval process;
  • All the guardrails in place should make it difficult to politicize the COVID-19 vaccine approval process;
  • The emergency use authorization process is similar to full approval;
  • Unlike Russia and China, the United States is only going to approve or authorize COVID-19 vaccines with large phase 3 clinical trials that meet high safety and efficacy standards;
  • No corners are being cut; and
  • States are not able to replicate FDA’s gold standard of vaccine review.

 

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From ANCOR:

Big news from HHS….and welcome news, considering the uncertain future of the 4th package negotiations between the House, the Senate and the Administration.  See the highlighted sections below, but at first read, our members are eligible.  (Note:  the Medicaid only tranche was considered part of the Phase 2 General Distribution).

We will continue to dig into the details and also analyzing the reporting requirements that came out recently!

Statement from HHS: 
Today, under the leadership of President Trump, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing $20 billion in new funding for providers on the frontlines of the coronavirus pandemic. Under this Phase 3 General Distribution allocation, providers that have already received Provider Relief Fund payments will be invited to apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. Previously ineligible providers, such as those who began practicing in 2020 will also be invited to apply, and an expanded group of behavioral health providers confronting the emergence of increased mental health and substance use issues exacerbated by the pandemic will also be eligible for relief payments.

Providers can begin applying for funds on Monday, October 5, 2020.

“HHS has worked to ensure that all American healthcare providers receive support from the Provider Relief Fund in a fast and fair way, and this new round helps ensure that we are reaching America’s essential behavioral health providers and takes into account losses and expenses relating to coronavirus,” said HHS Secretary Alex Azar. “We’ve worked with all of the resources we have across HHS to ensure that America’s heroic healthcare providers know they can apply for support.”

HHS has already issued over $100 billion in relief funding to providers through prior distributions. Still, HHS recognizes that many providers continue to struggle financially from COVID-19’s impact. For eligible providers, the new Phase 3 General Distribution is designed to balance an equitable payment of 2 percent of annual revenue from patient care for all applicants plus an add-on payment to account for revenue losses and expenses attributable to COVID-19.

Further, HHS recognizes constraints such as the stay-at-home orders and social isolation have been particularly difficult for many Americans. A recent Centers for Disease Control and Prevention (CDC) report found the prevalence of symptoms of anxiety disorder in the second quarter of 2020 was approximately three times those that reported in the second quarter of 2019 (25.5% versus 8.1%); and the prevalence of depressive disorder was approximately four times that reported in the second quarter of 2019 (24.3% versus 6.5%). Our behavioral health providers have shouldered the burden of responding and confronting this expanded challenge triggered by the pandemic. When traditional face-to-face counseling was restricted and new telehealth flexibilities were put in place in response to the pandemic, many behavioral health providers invested in and adopted – PDF telehealth technologies to continue providing patient care. While some Medicare or Medicaid behavioral health providers have already received prior General Distribution payments, others have not. Working with the Substance Abuse and Mental Health Services Administration (SAMHSA), HRSA developed a list of the nation’s behavioral health providers now eligible for funding, which includes, for example, addiction counseling centers, mental health counselors, and psychiatrists.

Eligibility

HHS is making a large number of providers eligible for Phase 3 General Distribution funding, including:

  • Providers who previously received, rejected or accepted a General Distribution Provider Relief Fund payment. Providers that have already received payments of approximately 2% of annual revenue from patient care may submit more information to become eligible for an additional payment.
  • Behavioral Health providers, including those that previously received funding and new providers.
  • Healthcare providers that began practicing January 1, 2020 through March 31, 2020. This includes Medicare, Medicaid, CHIP, dentists, assisted living facilities and behavioral health providers.

Payment Methodology – Apply Early

All eligible providers will be considered for payment against the below criteria.

  1. All provider submissions will be reviewed to confirm they have received a Provider Relief Fund payment equal to approximately 2 percent of patient care revenue from prior general distributions. Applicants that have not yet received Relief Fund payments of 2 percent of patient revenue will receive a payment that, when combined with prior payments (if any), equals 2 percent of patient care revenue.
  2. With the remaining balance of the $20 billion budget, HRSA will then calculate an equitable add-on payment that considers the following:
    • A provider’s change in operating revenues from patient care
    • A provider’s change in operating expenses from patient care, including expenses incurred related to coronavirus
    • Payments already received through prior Provider Relief Fund distributions.

We know providers want to receive payments shortly after submitting their information. However, this distribution requires cooperation on the part of all applicants. Again, HHS is urging all eligible providers to apply early; do not wait until the last day or week of the application period. Applying early will help to expedite HHS’s review process and payment calculations, and ultimately accelerate the distribution of all payments.

All payment recipients will be required to attest to receiving the Phase 3 General Distribution payment and accept the associated Terms and Conditions.

Application Deadline

Providers will have from October 5, 2020 through November 6, 2020 to apply for Phase 3 General Distribution funding. HHS’s top priority is ensuring as many providers possible have an opportunity to apply. HHS will continue to host webinars to assist providers through the application process and the call center is also available to address questions.

HHS recognizes the multifaceted challenges of this pandemic cannot be won without frontline healthcare providers focused on containing the virus and delivering holistic care. Funding for this Phase 3 General Distribution was made possible through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act, which allocated $175 billion in relief funds to hospitals and other healthcare providers.

For updates and to learn more about the Provider Relief Program.
——————————
Shannon McCracken
Vice President of Government Relations
ANCOR
606.271.3555
[email protected]
——————————

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The Centers for Medicare and Medicaid Services (CMS) continues to remind hospitals about the final rule that established requirements for hospitals to establish, update, and make public a list of their standard charges for the items and services that they provide. The goal for these actions is to promote price transparency in healthcare and public access to hospital standard charges. This requirement becomes effective on January 1, 2021. The pricing information can be provided in two ways:

  • Comprehensive machine-readable file with all items and services
  • Display of shoppable services in a consumer-friendly format

CMS has developed the following resources for providers to utilize to prepare and ensure they are compliant:

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ODP has updated Announcement 20-069 to provide guidance to Individual Support Planning Teams on the criteria for requesting a cap exception for the Person/Family Directed Support (P/FDS) and Community Living Waivers. (Updates appear in the document in red).

ODP will continue allowing additional P/FDS and Community Living Waiver cap exceptions consistent with the following guidance:

  1. CPS facility units may be re-allocated among CPS Facility, CPS Community, In-Home and Community Supports, Companion and/or Respite services.
  2. The cap exception is needed because of any other change in service as a result of the COVID-19 pandemic.
  3. All cap exception changes must include documentation of why the impact of COVID-19 resulted in the need for the cap exception.
  4. The federal approval to grant COVID-19 related cap exceptions currently expires on March 10, 2021, so absent a further extension, FY 2021-22 individual plans must be within established caps for the P/FDS and Community Living waivers. In preparation for the expiration of the COVID-19 related cap exceptions, teams should meet prior to March of 2021 to discuss plan changes that will be necessary to ensure that FY 2021-22 plans are within established caps for P/FDS and Community Living Waiver.

In order to request a FY 20-21 cap exception as a result of the COVID-19 pandemic, please complete the attached template and submit to your Regional Waiver Capacity Manager.

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Governor Wolf signed Act 24 of 2020, which allocates funding from the federal Coronavirus Aid, Relief, and Economic Security Act – also known as the CARES Act – to assist providers with COVID-19 related costs. Funding from Act 24 must be used to cover necessary COVID-19 related costs incurred between March 1, 2020 and November 30, 2020 that have not been otherwise reimbursed by Federal, State or other source of funding. To qualify for the one-time payment, a person or entity must have been in operation as of March 31, 2020. Under Act 24, $259.28 million of COVID-19 relief funds were allocated to providers of Intellectual Disabilities – Community Waiver program.

Any person or entity accepting a COVID-19 payment must provide documentation to the Department of Human Services (DHS), upon request, for purposes of determining compliance with Act 24 requirements. Providers were previously advised to keep documentation to demonstrate how the funds were used for a response to the COVID-19 pandemic in case of an audit.

DHS has developed the attached reporting forms to collect information about the use of Act 24 funding. The reporting form captures provider information; COVID-19 related staffing, expenditures and revenue losses; and COVID-19 related revenue to determine the net impact. Providers are advised to review guidance for eligible COVID-19 costs on the U.S. Department of Treasury website: Coronavirus-Relief-Fund-Guidance and  Coronavirus-Relief-Fund-Frequently-Asked-Questions and DHS guidance DHS Frequently Asked Questions.

DHS is requesting the following two reports from providers:

An interim report which identifies the total COVID-19 related costs each provider projects to incur by November 30, 2020. This interim report is due by October 20, 2020. To assist providers in projecting eligible costs, DHS recommends using the cost report attached and reporting costs that appear in cells H92 and H125. Provider must report the projected costs through a web-based portal.

Providers are required to complete a final cost report and upload it through the web-based portal by no later than December 21, 2020. Providers should keep all documentations related to the costs reported in the final cost report for a minimum of 5 years.

In advance of the report’s due date, DHS recommends providers review the attached cost reporting form and instructions and begin compiling the required information. Information on how to access the web-based reporting portal will be sent through a separate email to each provider.  This information will be provided in advance of the submission due dates noted above.

Thank you for your ongoing assistance during these trying times.  Please submit any questions about ODP Act 24 expense reporting to Rick Smith.

Rick Smith  l  Director

PA Department of Human Services  l  Office of Developmental Programs

Bureau of Financial Management and Program Support

625 Forster Street Room 412  l  Harrisburg, PA  17120

717.783.4873

www.dhs.pa.gov  www.myodp.org

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