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ODP Announcement 24-071 informs stakeholders of the submission of the Performance-Based Contracting (PBC) 1915(b)4 Waiver and 1915(c) Waiver amendments to the Centers for Medicare and Medicaid Services (CMS). The Office of Developmental Programs (ODP) has included with this announcement multiple documents and resources that are essential for understanding and implementing PBC. The documents are:

Submitted amendments for Consolidated and Community Living 1915(c) and 1915(b)(4) Selective Contracting Waiver for Residential Services are available online. All significant changes resulting from public comments can be found in the PBC Implementation Guide under Appendix A, titled, “Significant Changes to Performance-Based Contracting Proposal as a Result of Public Comment April 20-June 4, 2024.”

As a reminder, all residential providers must sign and return the Residential Provider Agreement to ODP by July 31, 2024. Please direct any questions about this information to ODP electronically.

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ODP Bulletin 00-24-01 Performance-Based Standards for Residential Services has been published, providing detailed information regarding the standards that will be utilized to evaluate performance of residential providers in PA. An expected timeline for implementation of residential performance standards and tier assignment and the evaluation standards that will be used to assign tiers to providers have also been published.

ODP submitted waiver amendments for the 1915(c) waiver and the new 1915 (b)(4) waiver to the Centers for Medicare & Medicaid Services (CMS) on July 26, 2024. RCPA anticipates the fee schedule rates will be published in the PA Bulletin on August 31, 2024. Implementation of the new rates will happen October 1, 2024, with an effective date of July 1, 2024.

All non-residential services, including participant directed services, will receive an 8% increase. All residential services will receive a 6% increase. Implementation of PBC will include rate add-ons of:

  • Select Providers: 3%
  • Clinically Enhanced Providers: 5%

Pay for Performance will also be available.

ODP will hold a webinar on Monday, July 29, to provide an overview of these changes. You can register for the meeting here. Please direct any questions about this information to ODP electronically.

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Photo by Markus Winkler on Unsplash

Deputy Secretary Ahrens of the Office of Developmental Programs (ODP) shared a PowerPoint today, July 25, 2024, at the MAAC meeting. Highlights included ODP’s plan to publish several documents. ODP will be submitting waiver amendments for the 1915(c) waiver and the new 1915 (b)(4) waiver to the Centers for Medicare & Medicaid Services (CMS) on July 26, 2024. In addition, ODP Bulletin 00-24-01: Performance-Based Standards for Residential Services and an ODP announcement regarding the waiver submission, including an implementation guide and provider self-assessment, will be released tomorrow, July 26.

RCPA will share these documents with members as soon as they are available.

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ODP Announcement 24-069 provides an update to all stakeholders about the status of the Performance-Based Contracting (PBC) 1915(b)4 Waiver and 1915(c) Waiver amendment submissions to the Centers for Medicare and Medicaid Services (CMS). The Office of Developmental Programs (ODP) has changed the date for submission of proposed waiver changes to CMS to Friday, July 26, 2024.

Due to the delay in submitting the waivers, ODP has also rescheduled the July 22 webinar for residential providers to Monday, July 29, from 9:00 am – 10:00 am. In this session, ODP will review revisions to the proposed waiver submissions and implementation plan, supporting documents, and instructions for tier determination and provider data submission. Anyone previously registered does not need to re-register and can expect an email notification of the change. If you are unable to attend on July 29, ODP requests that you unregister. This session will be recorded and posted on MyODP at the Performance-Based Contracting – MyODP page.

Register for the webinar here. Please direct any questions about this information electronically.

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Photo by Markus Winkler on Unsplash

The Office of Mental Health and Substance Abuse Services (OMHSAS) Deputy Secretary Jen Smith recently provided an update on the federal four walls rule. The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule, or Notice of Public Rulemaking, that could create exceptions to the existing four walls requirement for IHS/Tribal clinics, behavioral health clinics, and clinics located in rural areas.

The official language posted to the federal register can be found on page 15 of the Federal Register, which is scheduled to be published on July 22, and is copied below.

“This proposed rule includes a proposal to create exceptions to the Medicaid clinic services benefit four walls requirement, to authorize Medicaid payment for services provided outside the four walls of the clinic for IHS/Tribal clinics, behavioral health clinics, and clinics located in rural areas. Our current regulation at 42 CFR § 440.90(b) includes an exception to the four walls requirement under the Medicaid clinic services benefit only for certain clinic services furnished to individuals who are unhoused. We believe these proposed exceptions would help maintain and improve access for the populations served by IHS/Tribal clinics, behavioral health clinics, and clinics located in rural areas.”

As a reminder, this is a proposed rule intended to announce and explain CMS’s plan to address the problem. As such, all proposed rules must be published in the Federal Register to notify the public and give them an opportunity to submit comments. The proposed rule and the public comments received on it form the basis of a final rule. More information on the final rulemaking process is available here. Interested parties should provide public comments on this proposed rule to the addresses listed in the federal register by September 9, 2024.

While CMS works through this process, OMHSAS, RCPA, and the PA General Assembly continue efforts to address this through the recently released HCO 3450 legislation that will address the psychiatric outpatient in-office requirements and the Medicaid “4 walls” standards. RCPA will work with our members and the National Council for Mental Wellbeing on developing public comments for submission regarding this proposed rule. If you have any questions, please contact RCPA COO and Mental Health Policy Director Jim Sharp.

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The Centers for Medicare & Medicaid Services (CMS) announced the availability of $500 million in grants over the next five years to increase the number of organizations who help people enroll in health coverage through the Federally-Facilitated Marketplace (FFM) on HealthCare’s website. This is the largest funding allocation CMS has made available for Navigator grants to date. With the additional funding, CMS encourages eligible entities and individuals to apply, especially those that focus on education, outreach, and enrollment efforts to underserved and diverse communities.

Please read the the full announcement details and guidance below. If you have questions, please contact RCPA COO and Policy Director Jim Sharp.

What’s new for this year’s Navigator Notice of Funding Opportunity (NOFO)?

  • Focuses on increased participation of smaller, community-based organizations as part of CMS efforts to reach people where they are.
  • Provides longer multi-year grant funding.
  • Shorter and easier to understand application.

Who can apply?
Eligible organizations may include but are not limited to community and consumer-focused nonprofit groups; trade, industry, and professional associations; commercial fishing industry organizations; ranching and farming organizations; chambers of commerce; unions; resource partners of the Small Business Administration; and non-healthcare licensed insurance agents and brokers. Such other entities may include but are not limited to Indian tribes, tribal organizations, urban Indian organizations, and state or local human service agencies.

How much funding is available through this funding opportunity?
CMS expects to award $500 million total over the five-year period of performance, provided in five budget periods of 12 months each; $100 million is available for the first 12-month budget period.

Will there be technical assistance available for applicants?
CMS will hold two technical assistance sessions for potential applicants. These sessions will provide applicants with an overview of this project, relay budget guidance, and review the instructions for applying outlined in the 2024 Navigator funding opportunity. Applicants are encouraged to submit questions in advance of each session to CMS via email.

Technical Assistance Session #1

Technical Assistance Session #2

What is the deadline to submit an application for the NOFO?

Applications must be submitted by July 8, 2024 at 11:59pm ET. You must submit your application through the Grants website. Grants.gov creates a date and time record when it receives the application. If you submit the same application more than once, we will accept the last on-time submission.

For instructions on how to submit in Grants.gov, see the Quick Start Guide for Applicants.

Can my organization help promote the NOFO?

CMS encourages partners to share this listserv with your networks and to use the below social media and attached graphics on your social accounts.

  • CMS has announced $500 million in grants over the next 5 years for Navigator programs, as part of the continued efforts to connect people to the ACA Marketplace and other health coverage options. Learn more.
  • CMS has announced $500 million in grants over the next 5 years for Navigator programs, as part of the continued efforts to connect people to the ACA Marketplace and other health coverage options. These awards mark the first time the grants have been awarded for a period of more than three years of funding, allowing grantees to better retain and add more staff who are trained to help consumers find affordable, comprehensive health coverage.

For more information about the Navigator NOFO, visit the links below:

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Photo by Christina @ wocintechchat.com on Unsplash

The Centers for Medicare and Medicaid Services (CMS) has announced that the next hospital/quality initiative open door forum has been scheduled for June 4, 2024, from 2:00 pm – 3:00 pm. The agenda topics will include:

Register for the webinar.
Meeting ID: 160 823 4591
Passcode: 200020

After registering, you will receive a confirmation email containing information about joining the webinar.

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