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Hole torn in a dollar bill with medicaid text

The U.S. House Energy and Commerce Committee recently sent a letter to Governor Josh Shapiro and DHS Secretary Valerie Arkoosh requesting information about fraud, waste, and abuse prevention in Pennsylvania’s Medicaid program. The request is part of a broader federal oversight effort examining Medicaid program integrity following recent fraud investigations in multiple states. Similar letters were also sent to officials in ME, NE, NY, OR, WA, VT, CO, CA, and MA.

The Committee is seeking details on Pennsylvania’s fraud prevention efforts, including audits, provider screening processes, improper payment recovery, enforcement actions, and oversight of Medicaid programs, such as Home and Community-Based Services.

The letter references several recent Medicaid fraud prosecutions in Pennsylvania. However, it also highlights that Pennsylvania’s Medicaid Fraud Control Section charged more fraud cases than any other state in FY 2024 and ranked third nationally in criminal convictions. The fact that these cases were identified and prosecuted demonstrates that Pennsylvania’s fraud, waste, and abuse prevention systems are actively working to detect and address wrongdoing.

RCPA recognizes that this new federal focus on Medicaid program integrity may intersect with our ongoing advocacy to eliminate the requirement for signed encounter forms in Medicaid-funded services. RCPA has long maintained that the current requirement is administratively burdensome and does not meaningfully strengthen program integrity compared to other documentation and verification mechanisms already in place. While our advocacy continues, increased federal scrutiny around fraud prevention may influence how state and federal policymakers evaluate documentation and verification requirements moving forward.

The Pennsylvania Department of Human Services must submit responses to the Committee by March 17, 2026. RCPA will continue to monitor developments and provide updates as appropriate.

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RCPA, along with The Alliance CSP, The Arc of Pennsylvania, MAX Association, PAR, and The Provider Alliance, submitted a joint letter to ODP Deputy Secretary Kristin Ahrens outlining recommended improvements to Community Participation Support (CPS). The letter highlights policy and regulatory barriers affecting person-centered services, workforce stability, and provider sustainability, and urges ODP to pursue near-term solutions through policy clarification or regulatory waivers.

Key recommendations include:

  • Planning and Coordination Billing: Allow billing for planning and coordination while CPS services are delivered and permit billing at ratios aligned with individuals’ actual support needs (e.g., 1:1, 1:2, 1:3). Associations recommend a new billing code/modifier or a statewide ODP announcement.
  • Program Specialist Education Requirements: Align education requirements for program specialists in Chapters 2380 and 2390 with Life Sharing and unlicensed residential models by permitting a high school diploma plus six years of ID/A experience, ideally through a blanket waiver announced via ODP Bulletin.
  • Dual Licensure for Chapter 2380 Programs: Eliminate dual licensure with the Department of Aging for providers billing exclusively to ODP when serving individuals age 60 and over, and remove the age cap of 59 in Chapter 2380 through regulatory change or waiver.
  • Rounding of 15-Minute Units: Allow rounding of 15-minute service units to reduce administrative burden and align with Office of Long-Term Living practices.

The associations stress that these changes are essential to sustaining safe, meaningful, and person-centered CPS services. RCPA will continue advocacy with ODP and provide updates as they are available.

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

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RCPA, as part of a statewide provider and association coalition, has sent a letter to the PA Congressional Delegation regarding the extension of the Enhanced Premium Tax Credit (EPTC). The coalition urges Congress to move quickly to pass legislation extending EPTCs that make marketplace plans more affordable for people who purchase their own health insurance; these are set to expire at the end of 2025.

If EPTCs are not extended, an estimated 270,000 Pennsylvanians are likely to become uninsured. Pennsylvania taxpayers end up paying for their care in one way or another because uninsured people are often forced to delay or avoid care for treatable conditions. They ultimately end up sicker and require more expensive care in hospitals, which leads to higher, uncompensated care costs for both hospitals and providers. In addition, they acquire medical debt and experience health complications that can jeopardize their employment or employability.

Read the letter here. If you have any questions, please contact RCPA COO Jim Sharp.

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Young Girl Talking With Counselor At Home

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.

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