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Policy Areas

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The Office of Developmental Programs (ODP) has shared ODPANN 25-105. The purpose of this communication is to provide notice that the Federal Supplemental Security Income (SSI) payment will increase beginning in January 2026.

The SSI federal program provides benefits to adults and children who meet the SSA’s requirements for disability, income, and resources. This income benefit is designed to help qualified individuals meet basic needs for food, clothing, and shelter. Periodically, COLA affects the maximum monthly allotment. Effective January 2026, the SSA increased the SSI allotment by 2.8 percent to reflect an increase in the cost of living.

To account for the new COLA, room and board agreements should be reviewed to determine appropriate adjustment. The Room and Board Residency Agreement § 6100.687 (DP 1077) is found on the MyODP website.

Please see the bulletin for additional information. If you have any questions, please reach out to your Office of Developmental Programs (ODP) Regional Office.

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Message from the Center for Connected Health Policy (CCHP):

On November 10, 2025, the U.S. Drug Enforcement Administration (DEA) posted a fourth temporary extension of the COVID-19 telemedicine flexibilities for prescribing controlled substances. These flexibilities were set to expire at the end of the year. Although the DEA has not yet released the full text of the extension — including how long it will last. At this point, the final rule is still pending regulatory review. Historically, extensions have added a year of continued flexibility, though this extension could be shorter. For context, the previous extension, issued in November 2024, extended the telemedicine allowances through December 31, 2025. Until the fourth extension rule is approved and the complete text published, the duration and any potential policy adjustments remain unknown.

As background, permanent federal law under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 largely prohibits the prescribing of controlled substances without an initial in-person examination. While the statute outlines several exceptions under the defined “practice of telemedicine,” these apply primarily when a patient is located in a hospital or clinic or in the presence of another practitioner. As a result, these exceptions do not cover the routine model of telehealth widely used today, in which the patient (and sometimes the provider) participate from home settings. Importantly, the in-person requirement under the Ryan Haight Act applies only to the initial visit, and the DEA has never required subsequent in-person encounters. While the full details are not yet available, it is likely that the forthcoming temporary extension will mirror previous ones by continuing to suspend the initial in-person visit requirement for the period of the extension.

It is important to note that these DEA extensions affect only federally-controlled substance prescribing rules. States maintain their own requirements, which may include stricter requirements for in-person visits prior to the prescribing of controlled substances. Please check the Online Prescribing category of CCHP’s Policy Finder to reference state specific requirements.

Additionally, the DEA’s in-person prescribing requirement is separate from Medicare’s policy requiring an in-person visit within six months prior to an initial telehealth mental health service and annually thereafter. That Medicare mental health requirement — often confused with the DEA’s prescribing standard — is tied to Medicare reimbursement rules and applies only to Medicare beneficiaries and providers seeking reimbursement for mental health services through Medicare if their situations do not meet certain exceptions, not to all patients. Additionally, this Medicare in-person visit requirement is currently waived until January 30, 2026 (as passed in the most recent government funding bill), whereas the DEA’s in-person requirement, which is the topic of this particular newsletter and the new fourth extension rule, governs all practitioners prescribing controlled substances nationwide, regardless of payer.

If RCPA members have any questions, please contact RCPA COO and Mental Health Policy Director Jim Sharp.

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RCPA has formalized its opposition to SB 716 in a brief position paper. Senator Laughlin’s SB 716 would amend Pennsylvania’s Mental Health Procedures Act (MHPA) by defining substance use disorder (SUD) as a mental illness, thereby subjecting those with an SUD to the same procedures outlined in MHPA, including an involuntary commitment to a 120-hour hold in a psychiatric hospital, which is commonly referred to as a 302 (Section 302 of MHPA).

RCPA determined its position after months of discussion and analysis, including:

  • Written input from the entire RCPA SUD treatment provider membership;
  • Extensive conversations and meetings with RCPA members, including SUD and mental health treatment providers, the SUD Steering Committee, and governmental entities;
  • Multiple meetings with staff from key legislators’ offices, including Sen. Laughlin;
  • Multiple meetings with the Shapiro administration; and
  • A review of published research detailing experiences other states have had with involuntary commitment for SUD.

RCPA has offered to work with the legislature and Sen. Laughlin to implement alternative strategies that are proven effective in reducing overdoses and connecting those with SUD to treatment.

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The PA Office of Developmental Programs (ODP) hosted a Supports Coordination Organization (SCO) Forum to provide status updates and data related to the recently completed desk review for Performance-Based Contracting. All PBC submissions have been scored, and results will be emailed to SCOs shortly, with final results published on the DHS website in January 2026. The new contract cycle is effective from January 1, 2026, to June 30, 2027.

Pay-for-Performance (P4P) and Portal Feedback

  • P4P Updates: Capacity building investments continue, with $3.835 million available for Credentialing and another $3.835 million available for Technology. A total of 45 SCOs submitted for at least one of these two investments.
  • MyPBC Portal: ODP requested feedback on SCOs’ experience using the new MyPBC Portal for submissions.

Notification Letters and the Critical Resolution Process

Notification letters regarding determination are now being sent, which will include a list of any performance measures the SCO did not meet.

  • Mandatory QM Plans: SCOs with unmet measures are required to create and implement a Quality Management Plan (QMP) to meet the standards before the next PBC submission period.
  • Resolution Deadline is Strict: The most crucial detail shared is the deadline for challenging an unmet measure determination. SCOs will have only seven calendar days from the receipt of their determination letter to initiate the Resolution Process.
  • Process Guidance: The Resolution Process is strictly for submitting existing documentation that was inadvertently omitted or contained typographical errors to refute ODP’s determination. This is not an opportunity to create new materials solely to meet the standard, and newly created policies, plans, or comments on the process will not be reviewed.

Top Unmet Measures

The presentation included a breakdown of the top unmet measures across all SCOs, highlighting specific compliance challenges:

Measure Measure Description Number of SCOs Unmet Percent of SCOs Unmet
PCP.01.2 90% compliance with monitoring frequency by waiver type 38 73%
QDI.01.6 Restrictive procedure data is 86% accurate as compared to the most current BSP. 30 58%
RN.01 Register in PA Navigate Resource Platform as a CBO 15 23%

QDI (Quality Data Integrity) Measures: The purpose of QDI measures is to stress that SCOs are the primary source of data collection, and data integrity is essential for data-driven policies. ODP plans to drop these measures over time as performance improves.

  • For QDI.01.1 (Demographic Data), ODP focused on Completeness (86% threshold) this cycle, as checking for both ‘Complete AND Accurate’ resulted in nearly every SCO failing the measure. The threshold is set to increase to 93% for the FY 2027/28 contract cycle.
  • The target for PCP.01.2 (Monitoring Frequency Compliance) is 90% (P/FDS: once every three months; Consolidated/Community Living: once every two months). This threshold is also scheduled to increase to 93% in the FY 2027-2028 contract cycle.

Restrictive Procedures and Dissatisfaction Measures

  • Restrictive Procedures (RP): ODP presented details on the calculation for QDI.01.6, which compares the restrictive procedure checkbox in HCSIS against the most current Behavior Support Plan (BSP) summary text. Data showed a continued overall decrease in the rate of Restrictive Procedures incidents from 2022 to 2024.
  • Dissatisfaction Measure: For the Dissatisfaction Measure, ODP will utilize the data submitted by SCOs (the number of individuals who chose another SCO due to dissatisfaction and the reasons why) to establish a baseline for the measure and determine how to proceed with it in the future.

The presentation slide deck can be found here. SCO Providers are encouraged to continue to submit feedback and questions to ODP via the PBC Inbox.

For questions or comments, please contact Tim Sohosky.

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Early this year, the FASD Respect Act was introduced in the Senate to authorize and modify programs administered by the Department of Health and Human Services to address fetal alcohol spectrum disorders (FASD), and became a provision of the SUPPORT for Patients and Communities Reauthorization Act. The bill sought to establish FASD Centers for Excellence to support FASD prevention through screenings, public awareness, and trainings at a local and state level. In September, Congress passed the SUPPORT Act, and last week the President signed it into law, which officially authorizes the FASD Respect Act.

The legislation will allow the US Department of Health and Human Services to promote and fund FASD education and awareness, as well as the promotion of FASD resources. Beyond funding and program expansion, the FASD Respect Act will task the federal government with addressing FASD through a realigned perspective that supports individuals and families and respects their lived experience.

Please contact Emma Sharp with any questions.

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The Pennsylvania Department of Human Services’ (DHS) Office of Mental Health and Substance Abuse Services (OMHSAS) and the Office of Medical Assistance Programs (OMAP) have jointly issued the Medical Assistance Bulletin Targeted Case Management Services for Eligible Juveniles Enrolled in Medical Assistance Prior to Release From a Carceral Setting, implementing Section 5121 of the Consolidated Appropriations Act, 2023. Eligible juveniles are individuals under 21 years of age who are determined eligible for MA or an individual 18–25 years of age who was determined eligible for the mandatory eligibility group for former foster care children.

This bulletin advises providers of billing procedures for the physical health (PH) and behavioral health (BH) Targeted Case Management (TCM) services provided to eligible juveniles enrolled in the Medical Assistance (MA) Program within 30 days of release from a carceral setting and for at least 30 days following release. This bulletin also advises providers of a new provider specialty (Spec) for TCM services.

Questions and comments can be sent electronically. You can also contact RCPA Policy Associate Emma Sharp with any questions.

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Healing Hands — A Collaborative Approach to Treating Pediatric Hand Burns
Monday, December 8, 2025 
2:00 pm – 3:00 pm EST; 1:00 pm – 2:00 pm CST;
12:00 pm – 1:00 pm MST; 11:00 am – 12:00 pm PST
Register HerePresenter Bios:

Hannah Gift, OTR/L, CHT, COMT UE, CEAS
Hannah Gift is an occupational therapist and certified hand therapist at St. Louis Children’s Hospital in St. Louis, Missouri. Her primary role is providing upper extremity rehabilitation for pediatric patients with acquired, traumatic, and congenital conditions; she also serves on a team specializing in complex pain and neurological disorders. Hannah previously served on the American Society of Hand Therapists (ASHT) board of directors in roles including Education Division Director and Board Member at Large, and she has taught live and virtual education courses for Select Medical, ASHT, and other local and national organizations.

Jennifer Seigel, RN, CPNP, CWCN
Jennifer Seigel is a Pediatric Nurse Practitioner at WashU at St. Louis Children’s Hospital. She works in the Pediatric Surgery Department and has specialized in burn recovery and wound care for 25 years. St. Louis Children’s Hospital is a level 1 trauma hospital and sees several hundred burn patients per year through both their inpatient and outpatient departments. Jennifer has authored textbook chapters on burn care and often lectures on the topic. She enjoys caring for children and their families in the St. Louis Children’s Hospital burn wound unit called PAWS: Pediatric Acute Wound Service.

Objectives: Following this course, the learner will:

  • Describe 2 common mechanisms of pediatric hand burns and their implications for wound depth and tissue involvement;
  • Differentiate between the grades of burn injury to guide appropriate medical and rehabilitation interventions;
  • Identify the correct position of an orthosis based on the location of the hand burn; and
  • Discuss the purpose of pressure garments and other scar management techniques in improving functional outcomes for pediatric patients.

Audience: This webinar is intended for all interested members of the rehabilitation team.

Level: Beginner-Intermediate

Certificate of Attendance: Certificates of attendance are available for all attendees. No CEs are provided for this course.

Complimentary webinars are a benefit of membership in IPRC/RCPA. The registration fee for non-members is $179. Not a member yet? Consider joining today.

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Message from the Office of Developmental Programs:

The Office of Developmental Programs is excited to announce the launch of a new Provider Innovation Series — an exclusive opportunity for the Provider community to showcase and be recognized for their innovations, new and ongoing, in support of the everyday lives of those we serve. We believe in the power of peer learning and support, and we look forward to showcasing your innovative practices that drive quality.

This exciting new series will premiere during the Everyday Lives conference (May 12–14, 2026), as selected Providers will have the opportunity to join ODP’s Director of Training & Communications, Rochelle Troutman, to present their innovative program, policy, or practice to their peers.

Presenters will also be celebrated for their innovation and leadership in the field with a showcase on MyODP News, a certificate of appreciation, and a digital badge, which can be added to email signatures and displayed on their website and social media.

Join Rochelle Troutman, along with ODP’s Deputy Secretary, Kristin Ahrens for an informational webinar to learn more about this opportunity on December 2 from 9:00 am – 9:30 am EST. The webinar will be recorded and made available on MyODP. Selected presenter(s) will be announced in early February and will receive support as they prepare.

Register for the Informational Webinar

Don’t miss this opportunity to demonstrate your impact! We encourage all Provider organizations, large and small, to consider what innovations they may like to share, and look forward to both learning more about — and sharing with others — your innovative work!

Proposals will be accepted from December 1 — January 5. ODP will select providers to present based on the provider’s innovative practices, and encourages providers to use ISAC Recommendations and Strategies to identify areas of innovation.

To submit an application, please complete the survey.

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