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CMS

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Message from the Department of Human Services (DHS):

FOR IMMEDIATE RELEASE
December 20, 2021 

Department of Human Services Discusses Spending Plan for Home and Community-Based Services Enhanced Federal Funding to Support Mental Health Services, Children 

Harrisburg, PA — Pennsylvania Department of Human Services (DHS) today highlighted Pennsylvania’s spending plan for approximately $1.2 billion in enhanced federal Medicaid funding made available to states through the American Rescue Plan Act (ARPA). This funding will support Medicaid’s home and community-based services (HCBS) system throughout the commonwealth, which helps seniors, people with disabilities, children with complex medical needs, and many other groups safely live in their community among their family and peers. This funding will strengthen Pennsylvania’s home and community-based services system by allowing more Pennsylvanians access to critical services in their communities and supporting service providers that perform this work every day.

“We owe a huge debt of gratitude to the professionals who care for our most vulnerable, including children, seniors, people with disabilities, and those needing mental health services,” said Acting Secretary Meg Snead. “This enhanced funding through the American Rescue Plan Act will allow employers to recruit and retain skilled workers and allows them to plan for the future to provide training, certification, technology access, and much more.”

DHS received conditional approval of its spending plan on December 1 from the Centers for Medicare & Medicaid Services. On today’s call, DHS outlined how funding will be used through the Office of Mental Health and Substance Abuse Services (OMHSAS), the Office of Child Development and Early Learning (OCDEL), and the Office of Medical Assistance Programs (OMAP).

  • OMHSAS will prioritize funding for workforce recruitment and retention to qualifying providers, specifically mobile crisis mental health services, intensive behavioral health services (IBHS), psychiatric rehabilitation, and family-based mental health services. While many mental health services are not considered HCBS under ARPA, within the parameters of this funding opportunity, OMHSAS also will invest in training clinicians in trauma-informed treatment modalities, technology and training for telehealth, and updating the state hospital system’s technology infrastructure and providing staff training for use of electronic health records to facilitate more efficient transitions to community-based placements and services.
  • OCDEL supported a 3 percent rate increase for Infant/Toddler Early Intervention services, which allows all providers of Early Intervention services, including Service Coordination, to receive a 3 percent rate increase for services. This rate increase went into effect on July 1, 2021.
  • OMAP will use the recommendations of its pediatric shift care nursing work group to inform ARPA spending with a focus on achieving the following goals: improve care and service coordination for children with complex medical needs; support training of private duty nurses; leverage health information technology to allow for the sharing of clinical information; use a value-based payment structure for managed care organizations to improve outcomes of children receiving pediatric shift care nursing services; and facilitate co-training opportunities for both shift nurses and families to help improve coordination, continuity, and support among caregivers.

“When we invest in the caring workforce, Pennsylvania benefits both socially and economically,” said Acting Secretary Snead. “Having care provided in your own home or within your community allows family caregivers to be part of the workforce themselves and it allows those needing home and community-based services to stay safe, healthy, and to thrive.”

More information about Pennsylvania’s home and community-based services spending plan is available on DHS’s website.

RCPA continues to meet with DHS advocating for members on the spending plan and distribution strategies to ensure the workforce issues are front and center of the plan. If you have any questions, please contact your RCPA Policy Director.

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The Centers for Medicare & Medicaid Services (CMS) has approved the Office of Long-Term Living’s (OLTL) Community HealthChoices (CHC) Waiver amendment. The amendment is effective January 1, 2022.

The changes in the approved amendment include:

  • Revised service definitions, service limitations, and/or provider qualifications for the following CHC waiver services:
    • Adult Daily Living;
    • Home Adaptations;
    • Participant-Directed Community Supports;
    • Personal Assistance Services;
    • Personal Emergency Response System (PERS);
    • Specialized Medical Equipment and Supplies; and
    • Vehicle Modifications.
  • Revised waiver performance measures.
  • Revised number of unduplicated recipients for Waiver Years 3–5 and revised corresponding cost neutrality estimates.
  • Revised Service Coordinator selection or assignment time frame from 14 days to 7 days to be consistent with the CHC Agreement.

Questions about the 2022 CHC amendment can be submitted electronically.

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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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The Centers for Medicare and Medicaid Services (CMS) released an MLN Matters publication reiterating how beginning January 1, 2022, payments will be reduced for physical therapy and occupational therapy services when they are provided in whole or in part by a physical therapy assistant (PTA) or an occupational therapy assistant (OTA). Members are encouraged to review the article to learn more, including information on the changes to payments due to the Bipartisan Budget Act (BBA) of 2018. The article also provides additional information on the payment reduction and the modifiers that will be required on the claims.

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CMS has released an official memorandum stating that it has suspended activities related to the implementation and enforcement of this vaccine mandate rule pending future developments in the litigation.

Memorandum Summary             

Survey and Enforcement of the Vaccine Requirement for Health Care Staff in Medicare- and Medicaid-certified Providers and Suppliers Suspended While Court-Ordered Injunctions Are in Effect:

The Centers for Medicare & Medicaid Services (CMS) will not enforce the new rule regarding vaccination of health care workers or requirements for policies and procedures in certified Medicare/Medicaid providers and suppliers (including nursing facilities, hospitals, dialysis facilities, and all other provider types covered by the rule) while there are court-ordered injunctions in place prohibiting enforcement of this provision.

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ODP Announcement 21-087 is to inform all interested parties of CMS’ approval of amendments to the Consolidated, Community Living, and Person/Family Directed Support (P/FDS) waivers (hereafter referred to as the Intellectual Disability and Autism [ID/A] waivers). The ID/A waiver amendments became effective on November 22, 2021, and are available on the Department of Human Services’ website.

The Office of Developmental Programs (ODP) developed a Record of Change document that contains all of the substantive changes in the approved ID/A amendments. Each full waiver application approved by CMS and the Record of Change document are available as follows:

ODP is also holding a webinar to provide an overview of all substantive changes in the approved ID/A amendments. The date, time, and link for registration to attend the webinar are as follows:

ODP is developing two additional communications regarding the provision of remote supports in residential settings and non-residential settings, including information about webinars that will be held regarding the provision of remote supports.

CONTACT: Questions about this communication should be directed to the appropriate Office of Developmental Programs Regional Office.

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