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Tags Posts tagged with "Performance-Based Contracting"

Performance-Based Contracting

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ODP Announcement 24-069 provides an update to all stakeholders about the status of the Performance-Based Contracting (PBC) 1915(b)4 Waiver and 1915(c) Waiver amendment submissions to the Centers for Medicare and Medicaid Services (CMS). The Office of Developmental Programs (ODP) has changed the date for submission of proposed waiver changes to CMS to Friday, July 26, 2024.

Due to the delay in submitting the waivers, ODP has also rescheduled the July 22 webinar for residential providers to Monday, July 29, from 9:00 am – 10:00 am. In this session, ODP will review revisions to the proposed waiver submissions and implementation plan, supporting documents, and instructions for tier determination and provider data submission. Anyone previously registered does not need to re-register and can expect an email notification of the change. If you are unable to attend on July 29, ODP requests that you unregister. This session will be recorded and posted on MyODP at the Performance-Based Contracting – MyODP page.

Register for the webinar here. Please direct any questions about this information electronically.

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With the passing of the FY 2024/25 PA budget last week, intellectual and developmental disabilities and autism (ID/A) associations are attempting to obtain clarity regarding its impact on services. The Governor’s Office announced, however, that the scheduled meeting to review these impacts has been postponed in order to allow the Department of Human Services (DHS) more time to analyze the details of the budget. The Governor’s Office shared the following message:

The Commonwealth’s enacted FY24-25 budget includes a philosophical shift in how Pennsylvania approaches service delivery for individuals with intellectual disabilities and autism – a much needed and overdue course change to invest in dignity and opportunity for this community. In February, Governor Shapiro announced the intent to tackle the waiting list for services with a new approach, the Multi-Year ODP Program Growth Strategy. Accompanying this structural change is a substantial investment in services for individuals with intellectual disabilities and autism totaling $354.8M combined state and federal funds – an investment that supports providers, direct support professionals, and families who help make our vision of Everyday Lives a reality.

Included in the total funding is $280M in federal and state funds, which averages 7 percent rate increases for FY24-25. DHS is continuing the analysis of the funds appropriated for FY24-25 for ID/A services and how this will reflect in final rates that will take effect for FY24-25. Also included is an investment of $74.8M in combined federal and state funds for FY24-25 to put the commonwealth on a path to end the emergency waiting list by offering 1,500 adults enrollment in the Consolidated or Community Living Waivers and altering the management of home and community-based services capacity.

In addition to rate increases, the enacted budget includes funding for the implementation of performance-based contracting and the addition of sign language interpretation services. Performance-based contracting is scheduled to be implemented for residential services beginning in FY24-25. Sign language services will be added to ODP’s home and community-based waivers beginning January 1, 2025, pending approval from the Centers for Medicare and Medicaid Services.

We know there is great interest to further discuss the impact of the enacted budget on your programs and services. DHS will provide additional information to stakeholders related to the necessary recalculation for the fee schedule rates for FY24-25 and performance-based contracting upon completion of the analysis.

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To achieve the highest tier in the Office of Developmental Program’s (ODP) new performance-based pay initiative, providers must use an EHR and an eMAR. Providers are assessed annually, and their tier determines their reimbursement rates.

Join SETWorks on Wednesday, July 31, 2024, at 12:00 pm ET for a group discussion, where they will demonstrate how they support all criteria and reporting metrics to meet the highest performance/payment tiers from ODP.

SETWorks in Pennsylvania:

  • Integrations with all funding sources, including ODP, OLTL, OVR and Ticket to Work
  • Generation of Pennsylvania-specific forms and reports
  • Importing authorizations directly from HCSIS
  • Handling of complex rules for residential services for billing to ODP
  • Completing and reviewing required monthly forms
  • Electronic visit verification (EVV) for personal care services is integrated with Sandata
  • Simplified process for Pennsylvania residential re-authorizations

Learn More Here

Register Today!

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After reviewing hundreds of comments from stakeholders, the Office of Developmental Programs (ODP) has made some initial adjustments to the proposed Performance-Based Contracting waiver for Residential Services. Areas with high volumes of comments included:

  • Select/Clinically Enhanced Tiers being reserved for agencies serving 10 or more individuals;
  • Competitive Integrated Employment standards;
  • Populations served with average Needs Level 4.5+ and average Health Care Level 3.5+ (HCL is established using the Health Risk Screening Tool);
  • Primary providers being limited to Needs Group 1-3;
  • The number of measures; and
  • The timeline for implementation.

ODP is now offering Residential providers a choice of when they are assigned into a tier. This will be based on which data they chose for ODP to review and make a tier determination upon. The choices will be:

  • Calendar year 2023 data reviewed with notification of tier assignment occurring in November, to be effective January 1, 2025 – June 2026; or
  • Review of Calendar year 2024 data with notification of tier assignment occurring in May, to be effective July 2025 – July 2026.

ODP plans to continue their review of public comments and intends to publish additional information. On July 19, ODP hopes to submit amended the 1915(c) waivers and 1915(b)4 waiver as well as publish the following supporting documents:

  • Performance Standards;
  • Implementation Plan;
  • Attestation; and
  • Provider Data Submission Tool.

On January 1, 2025, ODP intends to begin Performance-Based Contracting (pending CMS approval).

ODP will conduct a webinar for residential providers on Monday, July 22, 2024, from 3:00 pm – 4:00 pm, to review publications, changes made as a result of public comment, and instructions for tier determination and data submission. Register here. This webinar will be posted on the PBC Resource Page located on the MyODP website.

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Photo by Markus Winkler on Unsplash

Today, both the ISAC Performance Review Subcommittee and the Medical Assistance Advisory Committee (MAAC) meetings were held. During these meetings, the Office of Developmental Programs (ODP) announced that as a result of public comments received regarding Performance-Based Contracting, some adjustments are being made to the plans. Tomorrow, ODP will release an announcement with more details, but for now, we know the following:

  • Residential providers will be offered a choice of when they are assigned into a tier. This will be based on which data they chose for ODP to review and make a tier determination upon. The choices will be:
    • Calendar year 2023 data reviewed with notification of tier assignment occurring in November, to be effective January 1, 2025 – June 2026; or
    • Review of Calendar year 2024 data with notification of tier assignment occurring in May, to be effective July 2025 – July 2026.

ODP plans to submit the proposed waiver to CMS on July 19, 2024.

In addition, the presentation from the MAAC meeting can be found here.

Documents from the Performance Review Subcommittee can be found below:

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July 11, 2024
1:00 pm – 2:00 pm
Register Here

Join RCPA to learn about enabling technology to support independent living and how SimplyHome aligns with performance-based contracting. SimplyHome designs and installs innovative and affordable technology solutions that transform how we care for individuals with disabilities, aging adults, and veterans. Their technology empowers individuals to live their own self-determined lifestyle while addressing the concerns of caregivers.

We will hear from Kristie Ondisco, PA/OH Representative, and Matt Wright, Enterprise Director of Sales.

Register here for this informative session. If you have any questions, contact Carol Ferenz.

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July 11, 2024
1:00 pm – 2:00 pm
Register Here

Join RCPA to learn about enabling technology to support independent living and how SimplyHome aligns with performance-based contracting. SimplyHome designs and installs innovative and affordable technology solutions that transform how we care for individuals with disabilities, aging adults, and veterans. Their technology empowers individuals to live their own self-determined lifestyle while addressing the concerns of caregivers.

We will hear from Kristie Ondisco, PA/OH Representative, and Matt Wright, Enterprise Director of Sales.

Register here for this informative session. If you have any questions, contact Carol Ferenz.

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The Information Sharing and Advisory Committee (ISAC) met today, June 11, 2024. Deputy Secretary Ahrens presented an update regarding Performance-Based Contracting. The office received comments from approximately 100 commentators, resulting in over 700 separate comments regarding the proposed Selective Contracting Waiver.

The Office of Developmental Programs (ODP) has released several tools for providers to utilize and has scheduled four summits to delve deeper into the specifics for the performance measures. Providers who do not meet all standards for the Primary category but are not in the conditional status will be placed in the Primary category with a corrective action plan required. Residential provider agreements will not need to be returned to ODP until the end of July, rather than June, as previously stated.

There are several federal rules that have been finalized recently, and Deputy Secretary Ahrens gave an overview of these.

Candi Walton reported on Recommendation #4: Support Families Throughout the Lifespan.

StationMD presented an overview of their services. Geoff Musti can be reached via email for more information.

Lauren House presented information on Recommendation #10: Expanding Housing Options and the ODP Housing Pilot Update.

Dr. Greg Cherpes provided an update on Recommendation #5: Promote Health, Wellness, and Safety & Recommendation, and Recommendation #6: Support People with Complex Need. Note that both recommendations are included in the same document.

For any questions, contact Carol Ferenz.

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Today, June 10, the Office of Developmental Programs (ODP) held the second of four Provider Preparedness Summits for Residential Providers. More discussion on specific performance standards for Performance-Based Contracting took place. The PowerPoint is now available, and a recording of the session will be posted shortly on the MyODP website.

ODP staff in attendance answered many questions submitted by providers, and the discussion was primarily focused on staff credentialing. Credentialing is unique to the DSP, is portable, and requires recertification every two years. A quick google search on NADSP will provide a thorough e-badge handbook.

There are two additional summits planned, and ODP will be recording each summit. Providers are encouraged to attend all four sessions as well as watch a pre-recorded webinar. All of these resources can be found on the MyODP website.

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Today, June 3, the Office of Developmental Programs (ODP) held the first of four Provider Preparedness Summits for Residential Services providers. The purpose of the summits are to take a deeper dive into the specifics that are being proposed for implementation of performance-based contracting (PBC).

The PowerPoint is now available, and a recording of the session will be posted shortly on the MyODP website.

ODP staff in attendance answered many questions submitted by providers. One of the key takeaways from today’s summit is that ODP will be postponing the due date for residential provider agreements to be signed and submitted to ODP. Originally, they were projected to be due by June 30, 2024; however, ODP has now stated that the due date will be July 31, 2024. The agreement has not yet been published, but it is expected to be released tomorrow, June 4, 2024.

There are three additional summits planned, and ODP will be recording each summit. Providers are encouraged to attend all four sessions as well as watch a pre-recorded webinar. All of these resources can be found on the MyODP website.

Contact Carol Ferenz for further information.

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