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CY 2026 Final Outpatient Payment Rule Released
The Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2026 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final payment system rule. The final rule not only includes policies and payment rates for CY 2026 but also updates CMS’ existing Hospital Price Transparency requirements. Hospitals and ASCs that meet their quality reporting requirements will see a 2.6% increase in their OPPS rates. CMS also finalized proposals to eliminate the Inpatient Only list over a three-year period, beginning with the removal of nearly 300 musculoskeletal procedures from the list in CY 2026.
For additional information, members are encouraged to review CMS’ press release on the rule as well as the fact sheet.
DHS Releases New Work Requirements Resource for SNAP Recipients & Applicants
Under new federal rules, to keep or become eligible for SNAP benefits, some recipients will have to meet work requirements that include working, volunteering, or participating in an education or training program for at least 20 hours a week (or 80 hours each month) AND report that they are meeting these work requirements.
To help SNAP recipients and applicants find out if they need to meet this requirement, the Pennsylvania Department of Human Services (PA DHS) has launched a new online screening tool.
By answering a simple set of yes or no questions, SNAP applicants and recipients can find out if they need to meet the work requirements, if they are already meeting the work requirements, or if they are eligible for an exemption.
The screening tool is not a final determination of whether someone is meeting the work requirements or is eligible for an exemption, but it can help recipients and applicants have a more informed conversation with their caseworker.
The new work requirements will apply to Pennsylvanians who:
- Are between 18-64 years old;
- Do not have a dependent child under 14 years old; and
- Are considered physically and mentally able to work.
In addition, being a veteran or a current or former foster youth age 18–24 will no longer be an exemption.
Some people may still be exempt from work and reporting requirements if they meet a different exemption. You can learn more about these work reporting requirements, who they affect, and more about exemptions at DHS’s website.
State Budget Investments Help Fight Food Insecurity
Pennsylvania’s charitable food network and our agricultural community are vital to keeping our neighbors and communities fed. Governor Shapiro’s 2025/26 budget delivers major investments to combat hunger, strengthen the charitable food network, and support Pennsylvania farmers. The budget includes a historic $11 million increase for food security, including:
- $3 million for the State Food Purchase Program and $1 million for the Pennsylvania Agricultural Surplus System (PASS);
- $2 million for a new state Food Bucks program to supplement SNAP; and
- $5 million in new funding to Pennsylvania food banks.
Help Us Spread the Word
PA DHS has developed a communications toolkit to help Pennsylvanians understand the changes happening to SNAP.
We ask RCPA members, advocates, and stakeholders to view and share the toolkit, which includes sample text, social media posts, and more.
Reminder: From Chaos to Clarity — RCPA and PUPS Software Webinar on December 9
From Chaos to Clarity: How Human Service Leaders Bring Order to Oversight
Tuesday, December 9, 2025
12:00 pm ET
Register Here
Keeping up with inspections and licensing requirements can feel like an endless chase — especially when each site or program has its own system. Many organizations are finding new ways to bring structure, visibility, and calm to these responsibilities, even with limited resources.
Join us on Tuesday, December 9, 2025, at 12:00 pm ET for From Chaos to Clarity: How Human Service Leaders Bring Order to Oversight, a live webinar co-hosted by RCPA and PUPS Software. This session brings together leaders for an open, practical conversation about streamlining inspections, licensing, and operational readiness.
Featured Panelists:
- Jim Sharp, Chief Operating Officer & Director of Mental Health Services, RCPA
- Savannah David, Service Director – ID/A NE Region, Step By Step, Inc.
- Morgan Gerety, Director of Maintenance, Caring, Inc.
We’ll talk about:
- Practical steps to bring consistency and visibility to inspections and licensing;
- How to move from paper and spreadsheets to digital processes without overwhelming your team;
- Real examples of accountability and readiness in action; and
- Lessons learned from organizations that replaced annual scrambles with steady progress.
Whether your team is just getting started or already modernizing oversight, you will walk away with useful ideas, peer insights, and tools to support your next steps.
RCPA Member Qualifacts to Host Webinar on CHE Behavioral Health Services Dashboard December 3
Insight to Impact: How CHE Behavioral Health Services Uses Dashboards for Real-World Outcomes
Featuring: CHE Behavioral Health Services & Qualifacts
Wednesday, December 3, 2025
1:00 pm ET; 12:00 pm CST
Register Here
In just over a year, CHE Behavioral Health Services leveraged Qualifacts’s modern Business Intelligence (BI) solution — an integrated data and analytics visualization platform delivering critical insights — to revolutionize its operations. The result? Improved financial performance, reduced denials, enhanced provider productivity, and board-ready reporting.
Join this webinar to see how CHE scaled dashboards across 11 states, built role-specific dashboards and reports, and turned data into meaningful, motivating narratives.
This webinar will:
- Unpack the organizational challenges that led CHE to stand up a modern BI solution.
- Learn the strategies CHE deployed to turn dashboards into decisions, with a focus on how CHE tracks clinical outcomes and quality assurance.
- Show how role-based dashboards track productivity, incomplete visits, and more — giving regional managers and providers shared visibility.
- Reveal what’s next for CHE and review best practices for behavioral health organizations looking to build a data-driven culture.
Featured Speakers:
Delnaz Moran
Chief Operating Officer, CHE Behavioral Health Services
Delnaz develops CHE’s overarching business strategy and implements workflows and resource allocation models that drive growth, operational excellence, and clinical impact. Her experience spans leadership roles across healthcare operations, behavioral health, and applied behavior analysis — each focused on improving access and outcomes for vulnerable populations.
Rich Rose
Senior Business Intelligence Consultant, Qualifacts
With nearly 30 years of experience in Quality and Compliance, Rich began his career with the Indian Health Service before leading quality improvement and compliance at an Oregon behavioral health program. Today, he helps organizations leverage Qualifacts’s BI tools to track outcomes and transform data into decision-making power.
PA Releases Rural Health Transformation Plan
From Pennsylvania Capital-Star “Pa.’s Rural Health Application Reveals Priorities in Federal Funding Request,” November 20, 2025:
Pennsylvania is hoping to secure its own slice of a $50 billion rural health fund in the face of federal Medicaid cuts, with a focus on bolstering a beleaguered workforce and expanding health access for more than two million people.
The Rural Health Transformation Fund was a last-minute addition to President Donald Trump’s summer budget bill that imposed Medicaid work requirements and cut upwards of $51 billion in funding to the commonwealth over the next decade. That new fund is worth roughly 37% of the estimated lost Medicaid funding in rural areas…
The 67-page application requests up to $200 million in annual funding over the next five years, totaling $1 billion. Its six focuses include: technology and infrastructure, workforce, maternal health services, behavioral health services, aging and access, and emergency medical services and transportation.
The U.S. Department of Human Services is expected to award funding by the end of the year.
Key objective targets are:
- Access to care: More than 85% of Pennsylvanians can get a routine primary care appointment within four weeks and urgent care appointments within one week.
- Digital connectivity and telehealth: More than 85% of rural hospitals and clinics will have broadband and telehealth functionality. More than 50% of rural hospitals and clinics connected via Fast Healthcare Interoperability Resources.
- Workforce adequacy: Reduce rural hospital vacancy rates by 10% for key direct care roles. Add three new rural training programs.
- System sustainability: More than 60% of systems partnered with rural Community Health Centers for specialty care.
- Health outcomes: Reduce the number of pregnant women living in rural areas with inadequate prenatal care by 20%.
From the PA Rural Health Transformation (RHT) Program Application:
Pennsylvania’s rural health transformation strategy is grounded in a balance of statewide coordination and regional leadership and collaboration. Pennsylvania’s “Health Hub” state agencies (Human Services, Health, Aging, Insurance, Drug and Alcohol Programs), and other partner agencies will establish clear strategic priorities focusing on access, workforce, maternal health, aging, behavioral health, EMS and infrastructure. Pennsylvania will leverage statewide technical expertise, evaluation, and financial oversight and support. Strong regional rural care collaborative will be composed of a roster of regional stakeholders that prioritize local needs, develop effective local sustainable solutions, and leverage existing resources and assets.
Pennsylvania will leverage established regional entities that coordinate regional economic development. These Partnerships for Regional Economic Performance (PREP) organizations are long-standing, quasi-governmental organizations that convene regional stakeholders, administer federal and state grants, collect local data, report outcomes, and catalyze public and private partnerships for regional economic development. They bring established governance structures, convening power, and a track record of successful cross-sector collaboration. PREPs (Figure 2) will convene regional stakeholders to create Rural Care Collaborative (RCCs) to align initiatives with regional economic planning and development – making the RHTP investments sustainable and promoting long-term partnerships.
If you have any questions, please contact RCPA COO and Mental Health Policy Director Jim Sharp.
MyODP LMS Outage Reminder and Registration for Walkthrough Now Available
An upgrade to the MyODP LMS is scheduled to begin at 10:00 pm today, Monday, November 24, 2025. This outage will impact all training courses currently available on MyODP. All users should complete any lesson modules, quizzes, or exams and be logged out of any training or courses by 10:00 pm or their progress may be lost. Overall course progress and all course completions will be saved. Please plan accordingly for all your training needs for the week of November 24, 2025 – December 2, 2025. It is planned that MyODP will be available by 12:00 pm on December 2.
Please see ODP Announcement 25-100 for additional details regarding the upgrade.
Registration is now available to attend a walkthrough of the MyODP Upgrade and Enhancements. ODP will show visual changes to the LMS, enhancements, and the new MyLearning Transcript report that is now available. The Transcript report will be the primary record of course completion for MyODP coursework.
The walkthrough will be held on Tuesday, December 9 from 2:00 pm – 3:00 pm. Please visit here to register. There are a limited number of seats available; however, the session will be recorded and will be available on MyODP shortly after the live session concludes. View ODP Announcement 25-104 for further details.
For questions regarding registration for the webinar, please contact ODP Outreach via email.
CMS Publishes Draft IRF-PAI Version 4.4
The Centers for Medicare and Medicaid Services (CMS) has published the draft inpatient rehabilitation facility patient assessment instrument (IRF-PAI) version 4.4. This version of the IRF-PAI becomes effective on October 1, 2026.
This draft version has the following modifications from the current IRF-PAI Version 4.2:
- IRF-PAI Item 8. Gender – has been moved to IRF-PAI Item A0810. Sex.
- IRF-PAI Item 14. Admission Class – has been removed.
- Transportation Item A1250 – has been modified into Transportation Item A1255 with new item verbiage and response options and is only to be collected at admission. Transportation item A1250 has been removed from the discharge assessment.
- Item O0350. Patient’s COVID-19 vaccination is up to date – has been removed from the discharge assessment.
As finalized in the fiscal year (FY) 2026 Final Rule, draft version 4.4 also removes the Section R Social Needs items. The four items removed were social determinants of health (SDoH) data elements related to living situation, food, and utilities, which were previously scheduled to be implemented October 1, 2026.
Mental Health America Releases 2025 Annual Report
Mental Health America has released their State of Mental Health in America 2025 Report. The report highlights the latest national data and provides state-level rankings on mental health and wellbeing in the U.S. It serves as a collection of data across all 50 states and the District of Columbia, with the goal of providing a snapshot of mental health status among youth and adults, tracking changes in prevalence of mental health issues and access to mental health care, and understanding how changes in national data reflect the impact of legislation and policies.
The report highlights:
- Prevalence of mental health and substance use issues;
- Access to adequate insurance and mental health care; and
- Which states have higher barriers in accessing mental health care.
Pennsylvania ranked 7th in the overall rankings, indicating a lower prevalence of mental illness and higher rates of access to care. Individually, PA was ranked 4th in access to care, 30th in prevalence of any mental illness, and 31st in mental health workforce availability.
Read the full report here. Please contact Emma Sharp with any questions.
Updated Waiver Amendment Submissions and Supporting Documents for SC PBC
The Office of Developmental Programs (ODP) has shared an update to ODPANN 25-075. This announcement informs stakeholders of updates to the Implementation Guide. All changes are highlighted in red within the communication. The attachment to this communication replaces Appendix C: Supports Coordination Minimum Activity for Billing. Each document referenced in this announcement can be found at MyODP’s website under Performance-Based Contracting. Please review the announcement for additional details.
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