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ARPA

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The Office of Long-Term Living (OLTL) has outlined its plan to the Centers for Medicare and Medicaid Services (CMS) to strengthen the workforce and assist Adult Day Services (ADS) providers. This plan is in response to the American Rescue Plan Act of 2021 (ARPA), which provides a temporary 10 percent increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for home and community-based services (HCBS). The funding must be used to enhance, expand, or strengthen HCBS.

The OLTL ARPA plan directs $46.5 million to Personal Assistance Service (PAS), Community Integration (CI), and Residential Habilitation (Res Hab) providers to assist with recruitment and retention of direct care workers. The plan directs an additional $13 million to ADS providers to strengthen ADS. To qualify for these payments, providers must have been in operation as of November 1, 2021.

OLTL sent letters to providers with details about the payments, including information about the approved use of and reporting on these funds. For reference, samples of the letters, a list of qualifying entities and payment amounts, and a blank copy of the Provider Attestation Form are available on the DHS Long-Term Care Providers page under the heading “American Rescue Plan Act (ARPA) Funding.”

To receive a Strengthening the Workforce or Adult Day Services payment, providers must complete the OLTL Provider Attestation form and return via email or fax it to the OLTL Bureau of Finance at (717) 787-2145.  Providers who return completed forms by January 7, 2022, will receive payment in February 2022.

Strengthening the Workforce Payments

  • The total available for a one-time payment to PAS, Res Hab, and CI providers is $46,500,000. Of that, $44 million is allocated to PAS and CI, and $2.5 million is allocated to Res Hab. Amounts allocated to providers in each category were based on fee-for-service claims and managed care encounters for services provided between July 1, 2020, and March 30, 2021.
  • To calculate each PAS and CI provider’s Strengthening the Workforce payment, OLTL first divided the $44 million allocation by the total number of fee-for-service and managed care PAS and CI units billed between July 1, 2020, and March 30, 2021, to determine a per unit amount. Each provider’s payment was then calculated by multiplying the per unit amount by the provider’s number of fee-for-service and managed care PAS and CI units billed during the same period.
  • To calculate each Res Hab provider’s Strengthening the Workforce payment, OLTL first divided the $2.5 million allocation by the total number of fee-for-service and managed care Res Hab units billed between July 1, 2020, and March 30, 2021, to determine a per unit amount. Each provider’s payment was then calculated by multiplying the per unit amount by the provider’s number of fee-for-service and managed care Res Hab units billed during the same period.

Strengthening ADS Payments

  • The total funds available for a one-time payment to ADS providers is $13 million. Amounts allocated to ADS providers were based on fee-for-service claims and managed care encounters for services provided between January 1, 2019, and December 31, 2019.
  • To calculate each ADS provider’s Strengthening Adult Day Services payment, OLTL first divided the $13 million allocation by the total number of fee-for-service and managed care ADS units billed between January 1, 2019, and December 31, 2019, to determine a per unit amount. Each provider’s payment was then calculated by multiplying the per unit amount by the provider’s number of fee-for-service and managed care ADS units billed during the same period.

Acceptable Uses of ARPA Funding

ARPA funding must be used for things such as sign on bonuses, retention payments, COVID-19 related leave benefits and paid time off, vaccination incentives, or the purchase of personal protective equipment and testing supplies. Additionally, ADS providers can use the funding for retrofitting adult day centers, expenses to re-open the centers, and expenses to develop alternative models to provide ADS.

Questions about this information should be directed to the OLTL Provider Helpline at 800-932-0939.

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Deputy Secretary Ahrens presented an overview of the Office of Developmental Programs’ (ODP) plan that was conditionally approved by the Centers of Medicare and Medicaid Services (CMS) for use of the ARPA funds during a webinar on December 9, 2021. While the infusion of funds will be beneficial to the system of support in PA, RCPA staff will be carefully monitoring the details of the plans as they are released, particularly the rate refresh, and will continue to advocate for fiscal policies that will allow for stability in the service system.

Highlights include:

  • Funding to Address High Staff Vacancy and Turnover Rates
    • One time funding for COVID-19 related staffing expenses, recruitment, and retention of Direct Support Professionals or Supports Coordinators to include funding for hazard pay, costs of recruitment efforts, sign-on bonuses, and other incentive payments that are:
      • Provided as a supplemental payment under Appendix K; and
      • Up to 5% of prior year revenue (2% for AWC) for related expenditures between April 1, 2021, and March 31, 2022.
    • Estimated total funding: $200M.
  • Updating Fee Schedule Rates
    • Proposed changes in fee schedule to be published in December for a 30-day public comment period and implemented in late January or early February 2022.
    • Rate changes for waiver services will be retroactive to July 1, 2021, for the AAW and January 1, 2022, for the ID/A waivers.
    • Proposed fee schedule includes increases in all regular fee schedule rates (exception — temporarily enhanced fee schedule rates for CPS and Transportation Trip).
    • Estimated fiscal impact of the proposed rate changes for ODP programs is approximately $400M annually (proposed rate updates are still in the final stages of review, so this number may change).
  • Funding for Staff Training, Credentialing, and Business Associates Programs for Employment
    • One time funding up to $50,000 or 1% of provider annual revenue, whichever is greater.
    • Estimated total funding $23M.
  • Respite and Family Support Funds for Individuals on the Waiting List for ID/A
    • Funding available for one-time family support grants for individuals and families on the ODP waiting list for purchase of respite and other eligible family support service.
    • Estimated funding: $12M.
  • Funding for Technology That Enhances HCBS Provision
    • One-time funding for providers to support activities, including the purchase of assistive and/or remote support technology, the purchase and implementation of new software/technology for electronic health records, quality, or risk management functions, and the purchase of technology for professional credentialing identified in ODP provider qualifications.
    • One-time funding for the purchase of technology for Supports Coordination Organizations to improve capacity to conduct remote monitoring of individuals, to improve efficiency of Supports Coordinators, including maximizing time in the field, to obtain or enhance secure inter-office communications, or to implement technology-dependent quality improvement strategies.
    • Estimated funding: $13.5M.
  • Technology Accelerator Resources : Initiative is Shared With OLTL
    • Contractor to work with ODP and stakeholders to accelerate adoption of technology through consultation, information dissemination, and training to agencies seeking to adopt remote supports and other technology solutions to support individuals receiving HCBS.
    • This includes funding for two statewide technology summits.
    • Training and materials developed will be available electronically and through ODP’s learning management system to provide access after the funding period.
  • Additional Staff to Support Intake, Eligibility of New Populations, Waiver Capacity, and Risk Management
    • Funding will be available for approximately 80 additional county staff for the following.
    • Estimated funding: $25M.
  • Incident Detection and Incident Reporting Fidelity System
    • Purchase development and implementation of dashboards/software pairing claims data and incident reports to evaluate provider incident reporting fidelity and detect unreported incidents of abuse and neglect.
  • Develop and Implement Selective Contracting
    • Purchase time limited consultation to support the Department to develop and implement selective contracting and alternative payment methods for selected HCBS services for complex populations to improve quality of service provision. Systems improvement will provide for aligning payment with performance measures and outcomes.
  • Training to Address Pandemic-Related Needs and Promote Initiatives
    • Peer-to-peer training will be available for individuals and families.
    • Training and materials developed will be available electronically and through ODP’s learning management system.
    • Estimate funding: $4M.
  • Purchase of Emergency Preparedness Kits to Non-Residential HCBS Participants
    • Estimate funding: $520k.
  • Provide Funding to Support Housing for Individuals Transitioning From Institutional or Congregate Settings
    • One-time funding will be targeted to residential providers for housing adaptations and purchase for individuals transitioning from public or private ICF, children transitioning from congregate care, medically complex adults (when cost effective and to avoid placement in a nursing facility), and adults to age in place or transition to supported living or life sharing.
    • Estimate funding: $15M.
  • Transfers from Private Intermediate Care Facility to Community
    • Additional Consolidated Waiver capacity for the transfer of 25 individuals from facility care to HCBS.
    • Estimate funding: $5M.

Visit the DHS web page to view the full spending plan.

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Overview of ODP’s American Rescue Plan Act (ARPA) Funding Plan Webinar
Thursday, December 9, 2021
12:00 pm–12:45 pm
Register

Join Deputy Secretary Ahrens for a discussion with stakeholders to review the Office of Developmental Programs’ (ODP) sections of the Department of Human Services’ ARPA Spending Plan, which received conditional approval from the Centers for Medicare and Medicaid Services on December 1, 2021.

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American Rescue Plan Act: One-Time Supplemental Payment to Address Recruitment, Retention, and COVID-19 Related Staff Expenses

ODP Announcement 21-086 is to provide guidance about the process to request one-time payments to cover COVID-19 related expenses for high staff vacancy. The American Rescue Plan Act of 2021 (ARPA) provides a temporary 10% increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for home and community-based services (HCBS). The funding is to be used to enhance, expand, or strengthen HCBS beyond what is available under the Medicaid program as of April 1, 2021, and through March 31, 2024.

As part of the Office of Developmental Programs’ (ODP) ARPA spending plan to strengthen HCBS, providers can receive a one-time supplemental payment to address recruitment, retention, and COVID-19 related staffing expenses for direct support professionals or supports coordinators to include funding for hazard pay, costs of recruitment efforts, sign-on bonuses, retention bonuses, and other incentive payments. Providers will be required to complete and submit the attached Provider Attestation Form for One-Time Supplemental Payment and submit it to ODP for consideration.

Providers will be subject to recoupment of funds if it is identified in a state or federal audit or any other authorized third-party review that the provider has inappropriately billed for services or received duplicative payments for services provided or if expenses were reimbursed by duplicative funding streams. No portion of the supplemental payment can be utilized to increase executive compensation.

Providers will be required to continue providing services from December 1, 2021, through June 30, 2022, obtaining written consent from ODP for any discontinuation of a service line or closure of a service setting. Additionally, providers will comply with all reporting requirements related to the use of the supplemental payment.

Requests submitted by December 17, 2021, will be processed for payment prior to the end of December. Requests for supplemental payments may be submitted through January 31, 2022.

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The following announcement/reminder was issued and directed to Personal Care Homes (PCH), Assisted Living Residences (ALRs), and nursing facilities (NFs) by the Department of Human Services (DHS)/Office of Long-Term Living (OLTL):

This message is to serve as a reminder that the deadline to apply for American Rescue Plan Act (ARPA) payments is Friday, October 15, 2021. If you have not yet submitted your Facility Acceptance Form, please do so on or before October 15 using the highlighted directions below. The facility acceptance form may be found on the DHS Long-Term Care Providers page. PCH and ALR providers that already submitted a Facility Acceptance Form do not need to resend a form.

This message is to update and replace the Listserv email sent on August 31, 2021 with the subject “American Rescue Plan Act (ARPA) One-Time Payments – Notification, Instructions, and Timelines.”

The Office of Long-Term Living has published revised lists of qualifying entities and payment amounts for personal care home (PCH) and assisted living residence (ALR) ARPA payments. The revised lists are available as of September 9, 2021, on the DHS Long-Term Care Providers page under the heading ‘American Rescue Plan Act (ARPA) Funding.’ Revisions include the addition of providers omitted from the original published list and corrected payment amounts for providers that experienced a change of ownership or a name change between April 1, 2020 and June 1, 2021. These revisions resulted in adjustments to payment amounts for all qualifying PCH and ALR providers.

PCH and ALR providers that already submitted a Facility Acceptance Form do not need to resend a form. 

American Rescue Plan Act (ARPA) One-Time Payments – Notification, Instructions, and Timelines

Governor Wolf signed Act 24 of 2021, which allocates $282 million of federal funding from the American Rescue Plan Act (ARPA) for payments to nursing facilities (NF), personal care homes (PCH), and assisted living residences (ALR). To qualify for the one-time payment, a facility must be in operation as of June 1, 2021.

These one-time ARPA funds must be used for COVID-19 related costs not otherwise reimbursed by federal, state, or other sources of funding. The Office of Long-Term Living (OLTL) sent a letter dated August 30, 2021, with details about the payments, including information about the approved use of and reporting on these funds. For reference, a sample of the letter, a list of qualifying entities and payment amounts, and a copy of the Facility Acceptance Form are available on the DHS Long-Term Care Providers page under the heading ‘American Rescue Plan Act (ARPA) Funding.’

Nursing Facility Payments

  • ARPA NF Payment #1 – Medical Assistance (MA) Days
    • The total funds available for a one-time payment to Non-Public and County NFs pursuant to Act 24 (ARPA NF Payment #1) is $198,000,000. Each facility’s ARPA NF Payment #1 is calculated by dividing the facility’s MA days, as reported for the NF Assessment for the third quarter of calendar year 2019, by 4,976,570, the revised total 2019 MA days for all facilities, as reported for the NF Assessment for the third quarter of calendar year 2019, to obtain an NF specific quotient. Each NF’s quotient is multiplied by $198,000,000 to determine its payment amount.
  • ARPA NF Payment #2 – Licensed NF Beds
    • The total funds available for a one-time payment to Non-Public and County NFs pursuant to Act 24 (ARPA NF Payment #2) is $49,000,000. Each facility’s ARPA NF Payment #2 is calculated by dividing the facility’s licensed NF beds as of March 31, 2020 by all licensed Non-Public and County NF beds as of March 31, 2020 to obtain an NF specific quotient. Each NF’s quotient is multiplied by $49,000,000 to determine its payment amount.

NFs enrolled in MA do not need to submit requests for funding. All NFs enrolled in MA will receive the funding, provided they meet the criteria described above. OLTL will distribute the funding as a one-time gross adjustment. NFs enrolled in MA can expect to see the payment appear as a gross adjustment transaction/lump sum payment on the PROMISe remittance advice dated September 6, 2021, with payment occurring September 15, 2021.

NFs not enrolled in MA must complete the Facility Acceptance Form and return it by October 15, 2021, to DHS. Providers may also fax the completed form to the OLTL Bureau of Finance at 717-787-2145. Checks will be issued and mailed in the order in which DHS receives Facility Acceptance Forms.

PCH/ALR Payments

  • ARPA PCH/ALR Payment #1 – Licensed Occupancy
    • The total funds available for a one-time ARPA payment to PCHs and ALRs pursuant to Act 24 (ARPA PCH/ALR Payment #1) is $27,000,000. Each PCH/ALR Payment #1 is calculated by dividing the licensed occupancy of the PCH or ALR, as determined by the most recent DHS inspection on or before April 1, 2020, by the total licensed occupancy of all PCHs and ALRs, including those with a special care designation, as determined by the most recent DHS inspection on or before April 1, 2020, to obtain a facility-specific quotient for each PCH and ALR. Each facility’s quotient is multiplied by $27,000,000 to determine its payment amount.
  • ARPA PCH/ALR Payment #2 – Supplemental Security Income (SSI) Residents Served
    • The total funds available for a one-time ARPA payment to PCHs and ALRs pursuant to Act 24 (ARPA PCH/ALR Payment #2) is $3,000,000. Each ARPA PCH/ALR Payment #2 is calculated by dividing the number of individuals for whom the PCH/ALR received a state SSI payment from DHS in March 2020 by the total of all PCH’s/ALR’s individuals for whom a state SSI payment was made in March 2020 to obtain a facility-specific quotient. Each PCH’s/ALR’s quotient is multiplied by $3,000,000 to determine its payment amount.

PCHs and ALRs must complete the Facility Acceptance Form and return it by October 15, 2021, to DHS. Providers may also fax the completed form to the OLTL Bureau of Finance at 717-787-2145. Checks will be issued and mailed in the order in which DHS receives the Facility Acceptance Forms. 

Act 24 of 2021 requires the ARPA funding to be obligated by December 31, 2024, and spent by December 31, 2026, or returned to the commonwealth. Additionally, these funds must be used for COVID-19 related expenses. Providers must keep documentation to prove that these funds were used for their response to the COVID-19 pandemic in case of an audit. Any person or entity accepting an ARPA payment agrees to provide documentation to DHS, upon request, for purposes of determining compliance with Act 24 requirements. Instructions on expenditure reporting will be provided at a later date.

DHS recommends that providers consult their accountants or attorneys for further clarification on acceptable uses of ARPA funding. DHS encourages providers to review guidance for eligible expenditures on the U.S. Department of the Treasury website in their Compliance and Reporting Guidance.

NFs that have questions about the information in this Listserv should contact the OLTL Provider Helpline at 800-932-0939.

PCHs and ALRs that have questions about the information in this Listserv should contact the Operator Support Hotline at 866-503-3926 or via email.

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