ODP FY 2016/17 Budget Overview
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RCPA Children’s Division: An Overview
ODP Fiscal Work Group Update
The Department of Human Services, under Secretary Ted Dallas, has established an IDD Fiscal Work Group over the last several months. This has been led by the Office of Developmental Programs Deputy Secretary Nancy Thaler and includes several RCPA members. The focus of this work group has been on the IDD residential rate methodology.
Webinar on IMPACT Act Rescheduled for February 23
The Centers for Medicare and Medicaid Services had originally scheduled a webinar on February 11, 2016 on the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. However, the webinar had to be canceled due to technical difficulties. The webinar has now been rescheduled for Tuesday, February 23, 2016 from 1:00 – 2:30 pm.
The IMPACT Act requires the reporting of standardized patient assessment data in the following areas, to better coordinate care and improve outcomes for people with Medicare:
- Quality measures;
- Resource use; and
- Other measures in inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home health agencies.
To participate in this webinar, registration is required.
IDD Update February 16, 2016
ODP Updates
The Office of Developmental Programs has released the following information:
Changes in OLTL Waiver Enrollment Process
The Office of Long-Term Living (OLTL) has announced changes that are being made to the enrollment process for Home and Community-based Services (HCBS), including the Aging Waiver, Attendance Care Waiver, CommCare Waiver, Independence Waiver, OBRA Waiver, and Act 150 Program. Effective Tuesday, March 1, 2016, OLTL will enter into a new contract with MAXIMUS, the PA Independent Enrollment Broker (IEB). According to OLTL, the adjustments being made and expectations regarding this new contract will streamline the enrollment process, as well as ensure consistency across all home and community-based programs, in anticipation of the roll-out of Community HealthChoices (CHC), a Managed Long-Term Services and Supports program for older Pennsylvanians and adults with physical disabilities. CHC will move the Commonwealth’s home and community-based waiver system from fee-for service to a capitated Medicaid managed long-term services and supports delivery system. The changes OLTL is making to the enrollment process support the Commonwealth’s efforts to ensure that the enrollment process is conflict free, strengthening necessary firewalls between enrollment in services and the provision of ongoing service coordination and other services.
Changes made to improve the IEB process:
- The enrollment timeframe requirement has been reduced from 90 days to 60 days. This change is effective March 1, 2016.
- The IEB will assume the Aging Waiver enrollment process effective April 1, 2016.
- Enrollments that are already in process before April 1 will remain the responsibility of the Area Agency on Aging. Aging Waiver applications initiated prior to April 1 must be completed by the AAA prior to June 30. Applications still pending on June 30 will revert to Maximus for completion. OLTL will provide additional information on this process in an upcoming webinar.
- These changes, which affect all OLTL Home- and Community-Based Programs – Aging, Attendant Care, CommCare, Independence, OBRA and the Act 150 program administered through the Office of Long-Term Living – will be completed by the PA Independent Enrollment Broker (IEB), Maximus.
The tasks completed by the IEB (Maximus) include the following:
- Coordinate with the County Assistance Office to ensure timely completion of the PA 600L Medical Assistance Applications.
- Coordinate with the Area Agency on Aging to ensure timely completion of the Clinical Eligibility Determination (formerly known as the Level of Care Determination). Complete in-home visit with applicant to gather information for enrollment.
- Complete the Program Eligibility Determination.
- Provide applicant with choice of Service Coordination provider.
- Enroll applicant in waiver upon receipt of PA 162.
- Transfer record and enrollment documentation to the selected Service Coordination agency.
If you have any questions, please contact Amy High, Office of Long-Term Living, Bureau of Participant Operations, at 717-787-8091.
CMS Posts Update on Manual Medical Review for Outpatient Therapy Services
On February 9, 2016, the Centers for Medicare and Medicaid Services (CMS) posted this update to the “Therapy Cap” page on their website, regarding manual medical review (MMR) of therapy claims above the $3,700 threshold. The guidance is vague and additional information is needed for clarification. Members that provide outpatient therapy services should be cognizant that MMR will resume in the near future and should comply with medical record requests issued by Strategic Health Solutions.
IDD Update February 11, 2016
Licensing Free Trainings
The Department of Human Services Bureau of Human Services Licensing is offering free statewide trainings for community homes for individuals with intellectual disabilities, family living homes, adult training facilities, and vocational facilities for persons with intellectual disabilities. These trainings are being conducted by Northampton Community College in four regions across the state on multiple dates with multiple topics.
Children’s Committee Meeting Materials Now Available
The presentation materials, handouts, and recordings of the February 3 joint meeting of the RCPA Children’s and Mental Health Committees, as well as the Children’s Committee meeting, are now available. Materials include documents relating to the panel presentation on the needs and opportunities in early childhood services, and other documents referenced in the committee meeting discussions.
OMHSAS Releases ASD Survey Data
Last Friday, at the state’s Act 62 External Work Group meeting, the Office of Mental Health and Substance Abuse Services (OMHSAS) released and reviewed the data collected by HealthChoices contractors during the April 2015 survey of autism spectrum disorder (ASD) service capacity. This point-in-time survey reflects what was at that time the level of ASD service capacity for the delivery of behavior specialist consultant and applied behavior analysis services.
Among the highlights in this data are service access trends as of April 2015, showing:
- A 19% level of service access delays of more than 31 days, with delays ranging by managed care organizations from 14% to 30% for children that had been accepted, evaluated, and authorized for services.
- The level and reasons given for staff recruitment challenges, showing a significant level of hiring challenges among providers, with the predominant reasons being the licensure requirements of
- At least one year of experience involving functional behavior assessments of individuals under 21 years of age; and
- At least 1,000 hours of in-person clinical experience with individuals with behavioral challenges or experience in a related field with individuals with an ASD.
During review and discussion of the data, OMHSAS Deputy Secretary Marion indicated that OMHSAS will begin to meet with the managed care organizations, to more closely analyze the data, and discuss approaches and solutions to the service access and professional labor pool challenges in provider networks.
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