Policy Areas

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One of the topics on the agenda at the March 2019 Medicare Payment Advisory Commission (MedPAC) public meeting focused on the evaluation of an episode-based payment system for post-acute care (PAC). MedPAC advises Congress about the federal programs (Medicare and Medicaid). Over the years, there have been many discussions regarding whether the federal government should implement one payment system across post-acute providers, which vary greatly in how they are paid. Post-acute providers include inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), home health agencies, and long-term care hospitals (LTCHs). During the March presentation, MedPAC shared that they favor a stay-based system, rather than one tied to a whole episode of care for fear that the episode of care would encourage providers to discharge patients early. The Department of Health and Human Services (HHS) will work with an outside vendor to build a unified PAC payment model with a goal to submit it to Congress by 2022. Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with questions.

The State Employment Leadership Network (SELN) announces its Spring 2019 Training Series, SELN Shorts entitled: The 30-Minute Series Case Managers: Guides on the Pathway to Employment.  There are six sessions offered beginning Tuesday, March 26, 2019.

As a member of the SELN, the Office of Developmental Programs (ODP) strongly encourages participation in this opportunity for employment service providers. To learn more about the series, visit this website or submit questions via email.

ODP Communication 19-030 is intended to provide guidance to AEs, SCOs, SCs, and Direct Service Providers for creating Fiscal Year 2019­–2020 renewal plans.

The following topics are included in the communication:

  • Service Changes for Fiscal Year 2019–2020
    • Community Participation Supports
    • Transportation Trip
    • Homemaker
    • Update to Specialties
    • Supported Employment
    • Advanced Supported Employment
    • Benefits Counseling
  • P/FDS Remaining Individual Cap Exceptions
  • Variance Approvals
  • Consolidated Waiver Fee Schedule Residential Rate Exceptions
  • Transportation Mile
  • Leap Year
  • Systems Issues impacting the FY Renewal
  • FY 2019–2020 Waiver Rate Load Activities
  • Reserve to Encumbrance (R2E)

Attachment #1 outlines the new Community Participation Supports (CPS) Services effective July 1, 2019. Contact Carol Ferenz, RCPA IDD Division Director, with questions.

The Office of Developmental Programs (ODP) issued announcement 19-025 with accompanying documents to clarify information regarding the Intellectual Disability/Autism (ID/A) Waiver Employment Service definition. There are two documents to access. The first is the Employment Service Definition Quick Guide for ID/A Waivers and Base-Funded Participants (this was updated on 3/8/19).

Also included in the announcement is the Intellectual Disability/Autism (ID/A) Waiver Employment Service Definition Question and Answer Document Version 2. Included in this document are new questions regarding provider payment guidelines for retention of a job, provider use of a Discovery Portfolio completed as part of the certification process for Outcome Based Payments, acceptable settings for Advanced Supported Employment, guidance for increases and decreases of units of service, etc.

Contact Carol Ferenz, RCPA IDD Division Director, with any questions.

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RCPA congratulates Chuck Ingoglia on being appointed President and CEO of the National Council. We have enjoyed working with Linda Rosenberg, and look forward to continuing our work together with Chuck in advancing human services policy and practice.

 

WASHINGTON, DC (March 11, 2019) – The National Council for Behavioral Health, today announced that its board of directors unanimously selected Chuck Ingoglia as the next president and CEO for the organization. He will succeed Linda Rosenberg, the current president and CEO on June 1, 2019… (read full release from the National Council here).

ODP Announcement 19-024 proposes changes to the procedure codes and fee schedule for Community Participation Support and changes to the Transportation Trip Service rates to become effective July 1, 2019.

The changes to Community Participation Support include simplifying the procedure codes and changing the staff to individual ratios to make planning, authorizing, and billing for the Community Participation Support service more efficient and to reflect service delivery more accurately. ODP has also proposed adding procedure codes and Fee Schedule Rates to the Community Participation Support service for on-call and remote support. The on-call and remote support component of Community Participation Support is pending approval from the Centers for Medicare and Medicaid Services (CMS). On-call and remote support will be available to participants for whom the provider has coordinated community activities in which the participant is supported through unpaid supports and/or as a component of the fading strategy where on-call and remote is needed as a backup. The provider may bill for on-call and remote support when all the following conditions are met:

  • The activity was coordinated by the provider of Community Participation Support services;
  • The participant does not receive Residential Habilitation services;
  • The participant requires on-call or remote support for health and safety reasons; and
  • Remote support is available immediately to the participant and on-call staff can be available for direct service within a maximum of 30 minutes (less if agreed upon by the individual plan team).

The changes for Transportation Services include adding procedure codes and Fee Schedule Rates for Transportation Trip services in both participant-directed services models. For Transportation Trip providers who do not submit a cost report, the proposed Fee Schedule Rates will be assigned. Additionally, ODP intends to change the zones covered in the Transportation Trip service for cost-based services captured in cost reports effective July 1, 2019.

The proposed Fee Schedule Rates in this communication will also serve as the Department-established fees under 55 Pa. Code § 4300.115(a) for base-funded services managed through county programs for individuals with an intellectual disability under the Mental Health and Intellectual Disability Act of 1966 (50 P.S. §§ 4104—4704), 55 Pa. Code Chapter 4300 (relating to county mental health and intellectual disability fiscal manual), and 55 Pa. Code Chapter 51 (relating to Office of Developmental Programs home and community-based services).

Assumption logs used to develop these rates are available online.

There are no changes proposed to rates for any service other than those outlined in this communication since they were published as final in the Pennsylvania Bulletin Volume 48, Number 4 on Saturday, January 27, 2018. The current rates for all other services are available on the Department of Human Services website.

Interested persons are invited to submit written comments within 30 days regarding the proposed rate changes to:

Department of Human Services
Office of Developmental Programs, Division of Provider Assistance and Rate Setting,
4th Floor, Health and Welfare Building
625 Forster Street, Harrisburg, PA 17120

Comments can also be sent to this email. Use subject header ”FY19-20 Rate Changes.” Comments received by 11:59 pm on April 5, 2019 will be reviewed and considered for revisions.

RCPA will be submitting comments based upon member input, including discussion at the IDD meeting March 20, 2019 from 10:00 am – noon. (to register for the meeting use this link). If you are unable to attend the meeting, please share your comments and concerns with Carol Ferenz.

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Webinar Wednesdays: Preview Spring Webinars
The Institute for Research, Education and Training in Addictions (IRETA) spring calendar is filling up quickly. IRETA is bringing three addiction experts to Webinar Wednesday where they will present on Cognitive Behavioral Therapy (CBT), opioid harm reduction, and more. Find more information and registration links here.

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The Centers for Medicare and Medicaid Services (CMS) recently updated the inpatient rehabilitation facility (IRF) provider preview reports. The data contained in these reports is based on quality data that was submitted by providers between Quarter 3 for 2017 and Quarter 2 for 2018 and reflects what will be published on IRF Compare when the site is refreshed in June 2019. Instructions are available for providers on how to review the reports. The reports will be available for providers to review until April 3, 2019. Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with questions.

Training Concept. Button on Modern Computer Keyboard.

The Office of Developmental Programs (ODP) announced updates to their schedule of virtual trainings and virtual office hours during the months of January, February, and March 2019. This alignment of the training schedule for all ODP programs provides courses for Supports Coordination Organizations and Agencies, Other Service Providers, and Other Professionals Supporting Individuals with Autism, Intellectual Disabilities, and Other Developmental Disabilities.

Please see the links for updates to the GoToWebinars in ODP Announcement 19-023. The announcement provides detailed information about individual training topics, dates and times, and intended audiences. To register, click on the linked title of each training you plan to attend. Once you preregister, you will receive an email with instructions to participate, including a new link to join the meeting. It is recommended that you register in advance to ensure you receive the meeting reminder. For questions about this announcement, please submit via email.

ODP Announcement 19-022 serves to inform providers of Transportation Trip of the requirement to complete and submit a cost report by March 24, 2019 to help determine future fee schedule changes, as well as to provide information as to the availability of the Year 11 Transportation (Trip) cost report template and supporting materials on MyODP.org. These services will continue as cost-based for at least another fiscal year, while ODP develops rates based on provider’s historical expense data.

To help arrive at the determined rates, ODP is requiring providers who deliver discrete Transportation (Trip) services as Provider Type 26 to individuals enrolled in the Consolidated, Person/Family Directed Support (P/FDS) or Community Living (CL) Waiver programs to complete the Year 11 cost report. Additionally, providers who expended $750,000 or more in combined federal and Commonwealth funds on Transportation Trip services during the FY 2017/2018 must also submit their independent audit with the Year 11 cost report, which can be accessed via this link: Year 11 Trip Cost Report Template.

Provider submissions are due no later than 11:59 pm on Sunday, March 24, 2019. If the provider does not complete the cost report and submit to ODP by this date, ODP will assign the rate for Transportation Trip services, effective 7/1/2019. The Year 11 Transportation (Trip) cost report and/or audit must be submitted to the rate setting mailbox.

All questions about this communication should also be submitted to the rate setting mailbox.