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Policy Areas

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Photo by Markus Winkler on Unsplash

The Office of Developmental Programs has shared an updated copy of the PBC Implementation Guide that was released yesterday.

In Attachment 1 — Performance Based Contracting (PBC) Residential Services Implementation Guide, Appendix F: Performance-Based Contracting Residential Scoring Tool, a typo has been corrected within Measure RD.01.1 and now displays the correct date (January 1, 2026).

The updated Implementation Guide is available here or at the Performance-Based Contracting Information web page on MyODP.

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The Office of Mental Health and Substance Abuse Services (OMHSAS) has released the Intensive Behavioral Health Services (IBHS) Regulatory Compliance Guide (RCG). This guide has been developed to provide clear explanations of the regulatory requirements of Title 55 Pa. Code, Chapter 5240, “Intensive Behavioral Health Services” regulations. It is meant to help agencies providing IBHS services, with the goal of ensuring safe and effective services to children, youth, and young adults through regulatory compliance as well as to help OMHSAS Licensing Representatives protect those served by these programs by conducting consistent and comprehensive inspections.

This guide is a companion piece to Title 55 Pa. Code Chapter 5240 regulations. It is intended to be a helpful reference for these regulations. The explanatory material contained in this guide in no way supplants the plain meaning and intent of the regulations set forth in 55 Pa. Code Chapter 5240.

The RCPA IBHS Steering Committee will be reviewing UBHS RCG and will provide further clarification to members in the near future.

Feedback or questions on the RCG can be sent to OMHSAS electronically.

If you have any questions or are interested in joining the RCPA IBHS Committee, please contact RCPA COO & Mental Health Policy Director Jim Sharp or RCPA Policy Associate Emma Sharp.

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The Office of Developmental Programs (ODP) is informing stakeholders of updates to the Performance-Based Contracting (PBC) Residential Services Implementation Guide. Revisions to the Implementation Guide appear in red.

Some significant changes to the Performance-Based Contracting Proposal (Appendix A) are as a result of public comment and feedback from the first round of tier determinations. These changes include:

Performance Standard:

  • Revision: (RM-IM.01.3) Data pull will be for 2024 calendar year (CY) quarters 1-2 (Q1-2), and an adjustment variable of 1% will be applied.
  • Revision: (RM-IM.01.3) Temporarily changing the threshold from 90% to 86%. For fiscal year (FY) 2027-28, the threshold will return to 90% using CY 2026 data.
  • Revision: (RM-IM.01.4) Moved to future measure in FY 2027/28 using CY 2026 data.

Scoring Tool:

  • Revision: Measures RM-IM.01.1, RM-IM.01.2, and RM-IM.01.3, RM-IM.01.1 – RM-IM.01.3 Scoring as composite requiring 2 out of 3.

Attachments:

  • Attachment 1: Performance-Based Contracting Residential Implementation Guide
  • PBC Residential Services Provider Self-Assessment Toolkit
    • Attachment 2A: Provider Performance-Based Contracting Preparedness Self-Assessment
    • Attachment 2B: Provider Preparedness Workbook 2025 Updates (20250107)
  • Attachment 3: Residential Performance-Based Contracting Attestation

Please view ODPANN 25-003 for additional changes, information, and details.

The updated version of the PBC Residential Services Implementation Guide is located on the Performance-Based Contracting Information web page on MyODP.

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In an effort to gain a better understanding of providers’ ongoing needs and challenges in addressing third party liability (TPL) claims, RCPA is requesting that our members complete the following TPL Survey. This survey was designed to capture critical barriers so as to develop strategic pathways to ensuring access and equity.

In January 2024, Governor Shapiro announced that commercial insurers would be required to meet their obligations under Pennsylvania law to provide coverage for autism benefits by categorizing autism services as a mental health benefit. With this action, all autism services will be treated as mental health services, leading to greater mental health parity for those with autism spectrum disorders. The goal of the Shapiro Administration’s legislation is to improve much-needed access to services for individuals diagnosed with autism, a challenge that the Commonwealth has faced for decades.

As providers of mental health, autism services, and substance abuse disorders, our members treat a vast array of individuals who are insured by either commercial insurance, Medicaid insurance, or both. For those who have just Medicaid, billing is simple: providers bill the Medicaid payor, and they pay the claim. The same is true for those who have just commercial insurance if the provider is in network with the commercial insurance carrier.

Complications occur when an individual has both commercial insurance and Medicaid. Coordination of Benefits (COB) requires that the commercial insurance is billed first, and then Medicaid pays what is not covered. Services like the delivery of Applied Behavior Analysis (ABA) or Intensive Behavioral Health Services (IBHS) are two good examples of services that can fall into this category.

With this survey, we hope to gather information that will assist RCPA and members in addressing the barriers in insurance coverage for children, families, and individuals in Pennsylvania. We thank you for taking the time to complete the survey so that we can continue to seek solutions to access services in our communities.

If you have any questions, please contact RCPA Policy Associate Emma Sharp.

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Senator Carolyn Comitta and Senator Lindsey Williams shared the following message with all Senate members. You may want to contact your local legislator requesting their support.

Posted: January 6, 2025, 12:56 pm
From: Senator Carolyn T. Comitta and Sen. Lindsey M. Williams
To: All Senate members
Subject: ID/A Market Index for DSP Services

Making our government more efficient and effective often means innovating ways to more closely align bureaucratic processes with best practice solutions. Pennsylvania’s method of compensating our invaluable Direct Support Professionals (DSPs) is one such opportunity. Over 55,000 Pennsylvanians with intellectual disabilities and autism need some assistance during the day to reach their highest level of independence and opportunity. These people and their families rely upon our committed DSPs to support some of the most personal tasks and make sure they live safely while engaging in the community. Often, our DSPs become like family to their clients.

Sadly, if you looked at the pay DSPs receive in Pennsylvania you would not know how critical they are to those who need their services. Despite best efforts, too many great staff leave the profession due to necessity in order to support themselves and their families. This often leads to a very high staff turnover rate even amongst our best providers, which has a negative effect on their clients.

Regulation requires a three-year refresh of market-based data in order to adopt a fee schedule, but there is no requirement for Pennsylvania to change rates at all – no matter what happens to inflation. Under this process, rates are already a year behind by the time they become effective. Last year’s rate increase was 3-4% below actual inflation, without any guarantee of correction for at least 3 years. For many providers, annual increases to health insurance, worker’s compensation, liability and other factors far exceed the available funds.

To help stabilize this workforce and provide better care for individuals with intellectual disabilities and autism, Senator Lindsey Williams and I will soon introduce legislation to amend the Human Services Code requiring that rates annually be set based on a national market consumer index. The adoption of a nationally recognized market index will help provide stability to this system and also support the hard-working DSPs that are essential to the delivery of services for Pennsylvanians with intellectual disabilities and autism. This legislation was SB684 and a companion to Rep. Miller’s HB661 in the 2023-24 session.

We hope you will join us in cosponsoring this important legislation.

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Image by ekavesh from Pixabay

February is just around the corner, so it’s time to start planning your organization’s Black History Month celebrations! Black History Month at work is a great opportunity to foster inclusivity, celebrate diversity, and recognize the contributions of Black individuals to history, culture, and society.

To create a thoughtful and engaging program that educates, inspires, and honors the achievements of the Black community, involve employees in the planning process to ensure that the event feels meaningful and authentic.

Here are some ideas you may wish to include as you celebrate Black History Month at work:

  • Sponsor Learning: Offer funded scholarships for team members interested in learning more about Black History. Have applicants submit an event, budget, and rationale for requested events (examples: attend a play, concert, poetry reading, or documentary).
  • Volunteer: Volunteer with Black-led charities or non-profit organizations as a team. Provide paid time off or complete during scheduled work hours if possible.
  • Support Black-owned businesses: Buy lunch from a Black-owned restaurant or purchase items for the office from a Black-owned business. Promote economic empowerment.
  • Donate to anti-racism charities: Choose an anti-racism charity to donate to as a team. Clearly communicate the choice and why.
  • Host a speaker series: Invite a speaker to discuss Black history and culture, or a social justice activist to discuss racial justice. Feature a speaker who can share stories/experiences that center around Black identity and/or how to promote diversity.
  • Host a Black author book club: Create a book club focused on Black authors and their works.
  • Host a film screening: Screen documentaries or movies to learn about Black History.
  • Black History Trivia: Host a Black History trivia event. Help your team learn more about Black history in a fun, exciting way.
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