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RCPA submitted comments to the Office of Developmental Programs (ODP) regarding the proposed amendments to the Consolidated, Person/Family-Directed Support (P/FDS), Community Living, and Adult Autism Waivers to allow providers to request a one-time supplemental payment to cover recruitment, retention, and any unusual staffing expenses resulting from the COVID-19 pandemic for direct support professionals, frontline supervisors, or supports coordinators.

ODP will review and consider all comments received by 11:59 pm today.

While we are grateful for the opportunity for members to access additional funds this fiscal year, we wanted to express our strong belief that the calculation of the dispersal of funds includes the NEA rates. There has been discussion with ODP staff that indicates they may not be including those amounts in the calculation.

Please see our comments and feel free to share your thoughts with ODP as well by 11:59 pm tonight.

The Centers for Medicare and Medicaid Services (CMS) recently released a Request for Information (RFI) requesting public comments on the Medicare Advantage program. CMS is asking for input on ways to achieve the agency’s vision so that all parts of Medicare are working towards a future where people with Medicare receive more equitable, high quality, and person-centered care that is affordable and sustainable, essentially asking for ways to strengthen this program.

CMS’s intent is to better align the Medical Assistance (MA) program with the agency’s vision for Medicare and the CMS Strategic Pillars. CMS is strongly emphasizing the importance of stakeholder comments for this process. This openness to feedback presents MA plans, providers, and other stakeholders an opportunity to inform the agency’s early thinking as it considers potential regulatory actions impacting supplemental benefits, value-based contracting arrangements, risk adjustment, prior authorization, and marketing among other issues.

CMS will accept comments on the RFI until August 31, 2022.

Photo by Chris Montgomery on Unsplash

Upcoming Meeting of the President’s Committee for People with Intellectual Disabilities
Thursday, July 28 | 12:00 pm – 4:00 pm ET
Register for the meeting.

About the President’s Committee for People with Intellectual Disabilities:

Initially established in 1966 by President Lyndon B. Johnson, the PCPID advises the President and the Secretary of Health and Human Services on a broad range of topics that impact people with intellectual disabilities, as well as the professional fields that support people with intellectual disabilities and their families. Its goal is to improve the quality of life experienced by people with intellectual disabilities by upholding their full citizenship rights, independence, self-determination, and lifelong participation in their communities.

The President’s Committee for People with Intellectual Disabilities (PCPID) will host a virtual meeting for its members to identify emerging topics to examine in the Committee’s Report to the President. All the PCPID meetings, in any format, are open to the public. This virtual meeting will be conducted in a presentation and discussion format. View more details published in the Federal Register notice.

Stakeholder input is very important to the PCPID. Comments and suggestions, especially from people with intellectual and developmental disabilities, are welcome at any time. If there are comments or feedback you would like to share with the PCPID as it begins to prioritize its work, please share them through this form. Comments received by June 30 will be shared with the PCPID at the July meeting. Comments received after June 30 will be compiled and shared with the PCPID quarterly.

Image by Werner Moser from Pixabay

The Office of Developmental Programs (ODP) is accepting feedback and comments on the proposed Fee Schedule Rates for services funded through the Consolidated, Community Living, P/FDS, and Adult Autism Waivers as well as Base-Funded programs, residential ineligible services, and the accompanying rate assumption logs.

After receiving feedback from our members, we submitted our comments today. We look forward to continued discussion with ODP regarding the development of rates that will sufficiently support services to individuals with ID/A in the community.

While we continue to develop our submission for the Office of Developmental Programs (ODP), we wanted to share a summary of the comments that we will be submitting on January 31. We know that some of you would like to be able to utilize these comments in developing your own. The following are some of our major points of concern.

It is understood that the basis for the rate setting methodology are several assumptions of average costs of doing business. We have several concerns about the assumptions. By far the biggest expense lines for providers consist of staffing costs: salary and benefits. Several of these assumptions have a significant impact on the rates, and we believe that they are not based on accurate data.

  • The proposed rates will not support increasing wages (and does not even cover the 7% annual inflation experienced each of the past two years). Providers have calculated that this increase may allow them to raise wages to $13–$14 an hour, far less than what is stated in the proposed rates. The fact that these rates may be in place for up to three years increases our concern with this range for pay rates.
  • The estimated health insurance at $571.29 per employee is not at all accurate of the true cost of health insurance. This is actually a 7% decrease from the current assumption. The assumed cost decrease is also inconsistent with a Mercer report published in December 202. Mercer published a National Survey of Employer-Sponsored Health Plans, finding employer-sponsored health insurance costs rose sharply in 2021, the highest annual increase since 2010. Mercer’s analysis of actual health benefit costs reported a cumulative 16.3% average increase over the last four years and, including their 2022 cost projection, expects the five-year cost increase to approximate 20.7%.
  • It also appears that employee benefits do not include dental or vision coverage and that the cost of any portion of dependent healthcare coverage is also excluded. Additionally, the assumptions do not include any benefits for part-time staff.
  • The assumption for staff turnover is 24%. RCPA conducted a recent survey of providers in PA that showed despite the overwhelming need for direct support professionals, these individuals separated from their positions within three months of hire at an annual turnover rate of more than 130% during the pandemic. While these are unusual times, our members have reported that pre-pandemic, the turnover rate was closer to 45%.
  • The overtime assumption of 5% is also significantly lower than what providers are actually experiencing. In the same survey, providers’ vacancy rate for direct support professional positions was 24.0%. Also, using a salary threshold for positions to determine the number of employees eligible for overtime is not an accurate measure. Salary alone does not allow for exemption, and some of these positions do not also meet the duties test that allows for exemption from overtime in labor laws.
  • Administrative costs are assumed to be 10%. None of our members report that their administrative costs are only 10%. It would be helpful to understand what ODP considers as part of their Administrative costs. A more reasonable estimate is 13–14%. In an already highly-regulated system, providers have been faced with increasing administrative responsibilities in the past 3–4 years with Incident Management requirements, increased need for Certified Investigators, Incident Management Representatives, Human Rights Teams, completion of HRSTs and the follow-up included, and Quality Improvement activities, to name a few. ODP has recognized the need to increase oversight staff in the department in order to keep up with these additional duties. Providers need additional staffing to manage these responsibilities. These responsibilities also have a direct impact on Supports Coordination Organizations due to their increased responsibilities and provider oversight. Lastly, providers are experiencing increased costs for cyber insurance with the increased use of technology and D&O insurance.
  • The assumptions for training days for employees is inadequate (especially residential services staff, which was estimated lower than other services). In order for staff to complete new orientation training that covers all of ODP regulatory requirements and annual training for all services, the amounts included do not cover what is needed.

Specific Service Rates

  • In reviewing specific service rates, a major concern expressed by our members is the inequity of increases across services.
  • The most concerning are the CPS Facility rates (with the exception of the 1:1 rate). These rates are not sustainable and will likely result in the closure of facility-based services. Facility-based services are necessary to many individuals for various reasons, including personal care needs, behavioral issues, personal choice, etc. Ultimately this will result in individuals losing this choice and potentially being without services.
  • The proposed increase to Supported Employment Services is also a disappointment to our members who provide these services. Given the fact that PA is an “Employment First” state, an increase of just less than 1% does not show support to these providers, particularly in light of the likelihood that these rates will be in place for up to three years.
  • Supports Coordinator Organizations have concerns with the proposed rates for many of the reasons already discussed: additional responsibilities that have been added to their roles, benefits and salary levels, amount of training that is required for their positions, and the impact on their ability to complete billable work due to all of the above. Also, the population eligible for services has expanded, which increases the demand for SC services. The competition for SCO staff has increased greatly in PA with the implementation of CHC, and the MCOs have been able to offer a much higher salary, making it nearly impossible for the SCOs to compete, leading to a high level of turnover in the SC positions. SC positions require a BS degree, but the SCOs cannot compete for qualified staff. A 6.6% increase is not adequate to address staffing needs.
  • Agency with Choice rates do not meet the new wage rates. Most significantly, there is a mismatch between W1726 and W1726 U4, as the wages went up by 69% and 80% respectively, while the reimbursement rate went up by only 34% and 35%.
  • Home and Community-Based Services face the same concerns regarding the staffing pay rate assumptions, as well as the ongoing issue of lost billable time when the service is short of the 15 minutes captured by the EVV system. We implore ODP to adopt the rounding policy as implemented in the Office of Long-Term Living for comparable services. As it currently stands, the only rounding of units for HCBS is rounding down, to the great disadvantage of the providers.

Overall, our concerns of the impact these rates will have on services not only relate to the provider system in our state, but also to the individuals and families who need and rely on these services to live an everyday life. As we have experienced throughout the pandemic and the undeniable staffing crisis, when families and individuals do not have the needed support from staff in their homes, it has an impact on their quality of life, their mental health and the family members’ abilities to keep their employment outside of their home. Individuals who have complex needs will be even more at risk since the services that are necessary to support those who have more intense support needs due to medical or behavioral challenges are not equitably considered in these proposed rates.

The rates act as disincentives to providers to serve those who are in need of higher levels of staff care. Providers cannot recruit and maintain a stable work force with competitive wages if there is not some type of annual CPI or COLA Rate increase.

RCPA submitted comments regarding the upcoming waiver renewals after receiving feedback from members. The comments on Consolidated, Community Living, and P/FDS Waivers include comments on the Consolidated-Community-Living-PFDS Waiver Record of Change document published by the Office of Developmental Programs (ODP). The comments on the Adult Autism Waiver also include comments made directly on the AAW Record of Change document published by ODP.