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Tags Posts tagged with "Performance-Based Contracting"

Performance-Based Contracting

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The ID/A Provider Associations of PA have joined together to request a meeting with Deputy Secretary Kristin Ahrens. We specifically want the opportunity to address concerns we have with the implementation of Performance-Based Contracting. These concerns include:

  • Ensuring Network Adequacy;
  • Ensuring workforce sustainability;
  • Ensuring Timely disputes, and/or appeals; and
  • Protecting Available funds from potential political pressures.

The Deputy Secretary has agreed to meet with us in the near future, and we will keep members apprised of any developments as a result of our discussion.

Contact Carol Ferenz for any questions regarding association concerns with Performance-Based Contracting.

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Please provide us with your input regarding PBC in a very brief survey (only 5 questions). We are asking:

  • How confident are you that you will be ready to submit all data to ODP by the deadline (February/March 2025)?
  • How many staff do you have working on the PBC standards?
  • What are the top 3 challenges you are experiencing in preparing for PBC?
  • What specifically can RCPA do to support your organization to prepare for PBC?
  • What unanswered questions do you have regarding PBC?

Please complete the survey by December 4, 2025. For any questions, contact Carol Ferenz.

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The Office of Developmental Programs (ODP) has shared a document with stakeholders that outlines draft performance standards. The Supports Coordination Organizations (SCO) Strategic Thinking Group is continuing to meet. ODP is interested in hearing feedback regarding the proposed standards.

Please share any comments you have with Carol Ferenz to share with ODP.

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The Office of Developmental Programs (ODP) met with stakeholders today, October 30, 2024, to discuss waiver amendments and to provide an overview of Performance-Based Contracting.

Waiver Amendments included:

Waiver Capacity:

  • When an individual is in an acute care hospital and receiving waiver services, ODP will not need to reserve (hold) the individual’s waiver. They will maintain enrollment in the waiver.
  • Language was updated for waiver capacity for high school graduates in the P/FDS waiver. AEs can reserve the waiver capacity for 180 days prior to when services are needed. Students can remain in service until their 22nd birthday.

Assistive Technology:

  • Updated language to explain when an independent evaluation is required and when it is optional:
    • REQUIRED: A device will cost $750 or more.
    • OPTIONAL: A device will cost less than $750.
  • An independent evaluation can be done if the team decides it would be beneficial.
  • Evaluations are included in the $10,000 lifetime limit.

Community Participation Support:

  • The Community Participation Support provider must complete and update an analysis of the following at least yearly to support individuals to experience meaningful community inclusion:
    • Strongest interests and personal preferences for community activities;
    • Skills, strengths, and other contributions likely to be valuable to employers or the community; and
    • Conditions necessary for successful community inclusion and/or competitive integrated employment.

American Sign Language (ASL) – English Interpreter Service:

  • English Interpreter service will be added to ODP’s waivers effective January 1, 2025.

Music, Art, & Equine Assisted Therapy:

  • The cumulative maximum limit of any combination of Music Therapy, Art Therapy, or Equine Assisted Therapy has increased from 26 to 52 hours per fiscal year.

STAT Overview:

  • The Specialty Telehealth and Assessment Team service was implemented in March 2024. This service may also be delivered to the participant during temporary travel, per ODP’s travel policy.

Waiver Corrections:
Life Sharing:

  • The following may not be authorized for participants who receive Life Sharing services: Residential Habilitation; Supported Living; Respite (15-minute or Day) (has been removed).

Supported Living Corrections:

  • The following services may not be authorized for participants who receive Supported Living services: Life Sharing; Residential Habilitation; Respite (15-minute or Day); Homemaker/Chore; In-Home and Community Supports; Behavioral Supports; Therapies; Shift Nursing; Consultative Nutritional Services; Communication Specialist and Specialize.

Benefits Counseling:

  • New billable indirect activities are added. The limit has increased from 15 hours per fiscal year to 24 hours per fiscal year.

The Performance-Based Contracting Review Included:

  • Effective January 1, 2025, Performance-Based Contracting will be implemented for the following services funded through the Consolidated and Community Living Waivers:
    •  Residential Habilitation;
    •  Life Sharing; and
    •  Supported Living.
  • Changes to Enrollment of New Providers.
  • What are Performance Standards?
  • What are Provider Tiers?
  • What Do These Changes Mean to Individuals and Families?

All performance-based contracting questions can be sent electronically.

Please see the distributed PowerPoint for additional information.

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ODP Announcement 24-096 is to inform all interested parties that the Centers for Medicare and Medicaid Services (CMS) approved the 1915(b)(4) Performance-Based Contracting Waiver and the Consolidated, Community Living, and P/FDS Waiver amendments effective January 1, 2025.

As communicated in ODP Announcement 24-071, the waivers were submitted to CMS on July 26, 2024. Since that time, ODP has engaged in discussions with CMS. No substantive changes were made to the waivers based on those discussions. Information regarding Performance-Based Contracting for Residential Habilitation, Life Sharing, and Supported Living services delivered through the Consolidated and Community Living Waivers can be accessed at Performance-Based Contracting – MyODP. In addition to changes needed to implement Performance-Based Contracting, the following major changes were included in the Consolidated, Community Living, and P/FDS Waivers:

  • American Sign Language – English Interpreter service will be added.
  • Billable indirect activities will be added to the Benefits Counseling service and the fiscal year limit will increase from 15 to 24 hours.
  • Clarification about evaluations will be added to the Assistive Technology service.
  • The fiscal year limit for Music, Art and Equine Assisted Therapy will increase from 26 to 52 hours.

Each full waiver application, as well as a record of all substantive changes, is available online at:

ODP will be holding one webinar to provide a general overview of Performance-Based Contracting and additional major changes made in the approved waivers. There will be time during the session for presenters to answer questions submitted by participants during the webinar.

The date, time, and registration link for these webinars are as follows:
Consolidated, Community Living, and P/FDS Waiver Amendment Overview
Wednesday, October 30, 11:00 am to 12:00 pm — Register Here.

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