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Tags Posts tagged with "CY 2025"

CY 2025

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The Office of Developmental Programs (ODP) convened for the Provider Performance Review Subcommittee on December 18, 2025, to provide updates on service utilization, National Core Indicators (NCI), and family engagement initiatives.

Service Utilization Updates

The statewide summary for services in CY 2025 highlights a continued focus on community-based and non-residential options.

  • Residential and Non-Residential Distribution: As of late 2025, Non-Residential Services account for the majority of utilization at 71.12%.
  • Residential Service Breakdown: Within residential settings, Residential Habilitation remains the most common at 25.68%, followed by Life Sharing at 2.76% and Supported Living at 0.44%.
  • Housing Support: ODP tracked the percentage of enrolled individuals receiving Housing Transition and Tenancy Services by SCO for CY 2025, with participation rates reaching up to 6% among certain providers.

National Core Indicators (NCI) and Satisfaction

ODP shared findings from the NCI-IDD In-Person Survey (2023/24) to measure person-centered outcomes and satisfaction.

  • Community Inclusion (NCI-IDD PCP-5): Pennsylvania’s average satisfaction with community inclusion was 84% for FY 2023/24, consistently exceeding the NCI-IDD national average of 82%.
    • Activity Satisfaction: High percentages of participants reported they “go out to eat enough” (77%), “go shopping enough” (81%), and “go out into the community enough” (80%).
    • Future Performance-Based Contracting: Beginning January 1, 2026, SCOs will be required to attest to supporting ODP data collection for this measure to inform future performance benchmarks.
  • Service Plan Relevance (NCI-IDD PCP-2): 92% of respondents reported “Yes,” their service plan includes things that are important to them.
    • Benchmarking: By 2027, SCO performance on this measure is expected to meet or exceed 90%.

Residential Services: Family Engagement

ODP is actively measuring how well providers engage with and support families through communication and relationship building.

  • Performance Measure (QI.03.3): Effective January 1, 2025, providers must attest to assisting ODP in collecting data on family satisfaction with provider engagement.
  • Family Satisfaction Survey Status: As of December 2025, 1,790 family members of individuals in residential habilitation have responded to the survey.
    • Provider Participation: Currently, 350 providers have positive response rates, while 18 providers have not yet been heard from.
    • Deadline: The survey is scheduled to close on December 31, 2025.

For Questions or Additional Information
Please contact Tim Sohosky for any follow-up or inquiries related to this update.

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The Center for Medicare and Medicaid Services (CMS) has released the Physician Fee Schedule CY 2025 Final Rule. You can view CMS’ press release, fact sheet, and final rule page in the Federal Register for more information. There were critical areas addressed in this year’s Physician Fee Schedule (PFS), including:

  • The extension of some telehealth flexibilities permitted under CMS’ authority absent Congressional action;
  • Updated payment for social determinants of health risk assessments as a part of Opioid Use Disorder intake activities furnished at Opioid Treatment Programs (OTP);
  • The establishment of a new add-on code to account for coordinated care, referral services, and peer supports at OTPs;
  • Payment for safety planning intervention and post-discharge follow-up;
  • The establishment of six G codes that mirror current interprofessional consultation Common Procedural Terminology codes used by practitioners who are eligible to bill E/M visits; and
  • Recognition of responses to CMS’ request for information on Certified Community Behavioral Health Clinics.

For the OPPS Final Rule, please see links to CMS’ press release, fact sheet, and final rule page in the Federal Register. Some highlights from this final rule include:

  • The maintenance of the Partial Hospitalization Program and Intensive Outpatient Program rate structures;
  • Narrowing the definition of “custody” in Medicare’s payment exclusion rule to mitigate barriers to Medicare access by individuals who have recently been released from incarceration or are on parole, probation, or home detention; and
  • Changes to Medicaid regulation, allowing states implementing the Medicaid clinic services benefit to cover clinic services outside the “four walls” of behavioral health clinics.

If you have any further questions regarding these final rulings or the application of the “four walls” impacts on Pennsylvania, please contact RCPA COO and Mental Health Director Jim Sharp.

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