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The Office of Long-Term Living (OLTL) released the rate study that was commissioned last August after RCPA and other industry associations collaborated to access the information needed to establish rates for services.

For background purposes, HCBS are offered through Medicaid as an alternative to facility or institutional care. Reimbursement rates for these programs are set by DHS and are informed by an actuarial rate setting process and a public comment process. Long-term services and supports (LTSS) help older Pennsylvanians and adults with physical disabilities.

The rate study revealed the need for substantial and immediate rate increases for the services which were evaluated. The study concluded, “Given the comparisons to benchmark rates, it appears that revisions to the rates studied for this report would be appropriate. The tables below show detailed results from the benchmark rate comparison.” The specific rate gaps were:

  • Adult Day                                                                     19%
  • Employment and Training Services                             35%
  • Personal Assistance — Agency                                   23%
  • Personal Assistance — PDS                                       12%
  • Residential Habilitation                                                44%
  • Structured Day Habilitation                                          22%

Findings of the study are used to inform the Commonwealth’s budget and future rate setting processes. View the results here.

If you have any questions, please contact Fady Sahhar or Melissa Dehoff.

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Dear ANCOR Members,

Next week, some Members of Congress will be back in their districts, making it the perfect time to meet with them and urge them to protect Medicaid funding for home and community-based services (HCBS).

The newly released House budget framework calls for 1.5 trillion in cuts over ten years and directs the House committee with jurisdiction over Medicaid to cut at least $880 billion in spending. While the details have not yet been finalized, these reductions would likely result in deep cuts to Medicaid funding. Even if proposals do not specifically target funding for I/DD services, the resulting pressure on state budgets from Medicaid cuts creates an elevated risk of further limits and cuts to services for individuals with I/DD. In-district meetings and site visits are some of the most effective ways to educate lawmakers and their staff on how these cuts would harm people with intellectual and developmental disabilities (I/DD), providers, and families.

To help you prepare, we’ve put together key advocacy resources, including:

Why Your Action Matters:
Studies show that constituent messages are the most effective way to influence lawmakers. When they see firsthand the impact of Medicaid-funded services in their communities, they are far more likely to protect funding.

Take this opportunity to reach out to your Members of Congress while they’re home next week or check their website for an email list signup to make sure you don’t miss any opportunities to engage while they are home — let’s make sure they understand why Medicaid funding must be protected.

Thank you for your advocacy.

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Young caregiver helping older lady to stand up

The Office of Long-Term Living (OLTL) recently shared additional guidance for providers related to the Centers for Medicare & Medicaid Services (CMS) Home and Community-Based Services (HCBS) Settings Final Rule.

This clarification applies to Residential Habilitation and Personal Care Home Providers.

Regulations at 42 CFR 441.301(c)(4)(vi)(B) require that participants in residential settings have the ability to close and lock doors within their living units. As a part of the Office of Long-Term Living (OLTL) residential provider reviews, it was found that several sites did not meet this requirement. As remediation, some providers opted to have participants sign a form stating that they do not wish to have a lock on their doors, which OLTL’s settings review panel accepted as compliant.

The Centers for Medicare & Medicaid Services (CMS) has reviewed OLTL’s oversight activities and has deemed that participant sign-off waiving installation of locks does not sufficiently satisfy the requirement. CMS has determined that all doors with access to participant units or private spaces (such as a bedroom) must have locks installed. The participant’s choice is whether to utilize the lock or not. Based on this feedback, as OLTL moves forward with ongoing oversight of HCBS settings requirements, all doors to participant units/private spaces in residential settings will be required to have working locks in order to be deemed compliant for future settings reviews.

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The Centers for Medicare & Medicaid Services (CMS) has made updates to the training schedule for Home and Community-Based Services (HCBS) provisions of the Medicaid Access Rule. The new training session dates and tentative topics for each session can be found below. These dates and topics are subject to change.

  • May 14, 2025, 3:00 pm ET: Timely Access, Waiting Lists, Person-Centered Planning Reporting Requirements & Minimum Performance Levels, and Website Requirements
  • June 11, 2025, 3:00 pm ET: Institutional Rule Provisions*

*Nursing Facility and Intermediate Care Facilities for Individuals with Intellectual Disabilities Rate Transparency provisions finalized in CMS-3442-F: Medicare and Medicaid

You can learn more about the training series and register for upcoming sessions on the HCBS Provisions of the Medicaid Access Rule Training Series registration web page.

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The Centers for Medicare and Medicaid Services (CMS) has approved the Office of Long-Term Living’s (OLTL) Community HealthChoices (CHC) Waiver renewal. The renewal will be effective on January 1, 2025.

The current approved CHC Waiver document is available here. Additional information about the CHC Waiver is located here.

Changes in the approved renewal include:

  1. Amend the following service definitions:
    1. Benefits Counseling
    2. Employment Skills Development Home Adaptations
    3. Telecare
  2. Add teleservices to the following services (details regarding teleservices can be found within each service definition as well as in the Main Module):
    1. Cognitive Rehabilitation
    2. Counseling Services
    3. Nutritional Consultation
  3. Add Chore Services as a new waiver service.
  4. Add language to reinforce that if a participant’s rights in a setting need to be modified due to an assessed need, it must be documented in the Person-Centered Service Plan (PCSP), and if a provider creates a treatment or service plan, that plan must be incorporated into the PCSP.
  5. Remove references to the Organized Health Care Delivery System (OHCDS) and the Participant Review Tool.
  6. Reduce timeframes for developing and implementing Person-Centered Service Plans from 30 days to 15 business days.
  7. Reduce the years of experience needed for Structured Day Habilitation Support Staff from five years to two years.
  8. Update Appendix C-5 to include information about the Home and Community-Based Settings Rule.
  9. Update Appendix E: Participant Direction of Services that Service Coordinators are responsible to inform the participant of the availability of the direct care worker referral and matching system.
  10. Update Appendix G: Participant Safeguards to the current process.
  11. Update the Quality Strategy to current process.
  12. Modify language throughout for better readability.

Questions about the 2025 CHC renewal can be submitted electronically.

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