National Council Releases H.R. 1 Implementation Journey Map
Guidance
CMS Releases IRF-PAI Guidance & Update on Falls Measure
The Centers for Medicare and Medicaid Services (CMS) recently published an errata document to the inpatient rehabilitation facility patient assessment instrument (IRF-PAI) Manual, Version 4.2, related to the coding of items J1750, J1800, and J1900. This errata document was issued to update guidance related to the Falls with Major Injury (FMI) measure in the IRF Quality Reporting Program (QRP), which is effective on January 1, 2026. Specifically, the guidance related to item J1900 Number of Falls Since Admission item has revisions to the definition of Injury (except Major) and Major Injury.
CMS also released the official Technical Specification Report for the Falls with Major Injury (FMI) measure. This report incorporates feedback received during the cross-setting Technical Expert Panel (TEP) held in May 2025. The report provides an overview of the measure, a high-level summary of the key features of the re-specified measure, a description of the methodology used to construct the FMI measure, and an overview of measure testing results. Additional guidance and related updates to the IRF-PAI Manual, Quality Measure Calculations and Reporting User’s Manual, and public reporting timelines will be provided at a future date. The report is available in the Downloads section on the IRF QRP Measures Information web page.
ODP Issues Clarification on Qualification Requirements for Providers
The Office of Developmental Programs (ODP) has shared ODPANN 25-111. This communication clarifies new qualification requirements for providers of CPS, In-Home and Community Support and/or Companion services in the Consolidated, Community Living, and P/FDS Waivers that were recently approved by the Centers for Medicare and Medicaid Services (CMS). These requirements do not apply to services rendered by Support Service Professionals through a Participant-Directed Services option.
These amendments include the following provider qualification requirements:
- Providers newly enrolling to render Community Participation Support, In-Home and Community Support, and/or Companion must provide Office of Developmental Programs (ODP) home and community-based services to a minimum of 3 separate and distinct participants in the first fiscal year after enrollment.
- Starting July 1, 2026, currently enrolled providers must render ODP home and community-based services to a minimum of 3 separate and distinct participants each fiscal year. ODP will use the provider’s Master Provider Index number to determine if the provider is rendering any ODP waiver services to a minimum of 3 separate and distinct participants.
- Additionally, the provider must render ODP home and community-based services each quarter.
Please review the announcement for more details.
Update Issued for Incident Management Rebalancing Initiative Phase 1 Guidance
The Office of Developmental Programs (ODP) has shared an update to communication ODPANN 25-093. The purpose of this announcement is to provide updated guidance related to the ODP Incident Management (IM) Rebalancing Initiative. Updates have been made to the “Clarifying the Definition of Serious Injury” section of this announcement. Updates appear in red text. The guidelines are organized into seven separate topics covering the following:
- Finalizing Incident Reports
- Reducing Duplicative and Multiple Incident Reports
- Clarifying the Definition of Serious Injury
- Clarifying the Definition for Discovery Date
- Managing Events Occurring Prior to Enrollment
- Discontinuing the Use of Optionally Reportable Events (OREs)
- Discontinuing the Use of Illness/Other and Illness/COVID Incident Categories.
Please view the announcement for additional information and details.
National Council to Host Webinar on Staying Compliant With DOJ’s New DEI Guidance on October 13
Billing Guidance for CPS Facility Procedure Codes for Provider Specialty 525 and Planning Coordination
The Office of Developmental Programs (ODP) has shared ODPANN 25-087. This communication is to inform 100% community location-based Community Participation Support (CPS) providers (Specialty 525) of CPS Facility procedure codes available in HCSIS to permit billing for groups of more than 3 individuals as well as to provide guidance on the planning and coordination component of the CPS service.
Please view the announcement for additional information and details.
DHS and PDE Issue Update on Federal Guidance for Students in Foster Care
The Pennsylvania Department of Education and the Pennsylvania Department of Human Services are pleased to share a Dear Colleague letter regarding important updates to federal non-regulatory guidance for students in foster care placement.
This updated guidance, issued jointly by the U.S. Department of Education (ED) and the U.S. Department of Health and Human Services (HHS), represents the first significant update to federal guidance since the enactment of the Every Student Succeeds Act (ESSA) in 2015.
Please see the letter for details about this announcement, and thank you for your continued dedication to supporting students in foster care.
Please contact Emma Sharp with any questions.
ODP Shares Reminder, Guidance for Medication Administration Trainers
The Office of Developmental Programs (ODP) has shared ODPANN 25-08. This announcement provides guidance for Certified Medication Administration Trainers that train for multiple eligible providers. You can also view “Maintaining your Trainer Certificate” for instructions on ensuring your certificate may be used to teach in eligible provider settings.
If you have any questions regarding this announcement, please submit a ticket through the MA Help Desk.
DOJ Issues Guidance on Trump Administration’s DEI Policy for Recipients of Federal Funds
Clarifying Guidance on CIE and Self-Employment in the SC Individual Monitoring Tool
The Office of Developmental Programs (ODP) has shared ODPANN 25-072 and its accompanying attachments. The purpose of this announcement is to provide updated guidance for completing the SC Individual Monitoring Tool (IMT), specifically regarding when self-employment is considered Competitive Integrated Employment (CIE).
With the implementation of Performance-Based Contracting (PBC) for ID/A Residential Providers and SCOs, ODP has reviewed how CIE data is collected and interpreted. Because CIE performance measures rely on information collected through the SC IMT, ODP is issuing updated guidance to clarify how SCs should apply CIE criteria — particularly in cases involving self-employment. While PBC is not being implemented for Residential Providers or SCOs enrolled in the AAW, the AAW is also updating its IMT guidance in alignment with the ID/A IMT guidance.
These updates do not change the monitoring tool questions themselves in either the ID/A or AAW IMT. The new guidance provides additional instructions to ensure consistent understanding and documentation.
ATTACHMENTS:
- Attachment #1: ID/A Individual Support Plan Monitoring Tool – SC Guidance Document – Reissued 7/23/2025
- Attachment #2: AAW SC Individual Monitoring Guidance – Reissued 7-2025
Please review the announcement and attachments for additional information and details.
