Intellectual & Developmental Disabilities

Message from Richard Edley, RCPA President & CEO:

On January 19, 2017, RCPA sent out an announcement urging individuals to contact the governor’s office regarding the concerns over the proposed ODP Medicaid waiver amendments, specifically related to Chapter 2390 licensed vocational facilities and Chapter 2380 licensed adult training facilities. I am pleased to say that this is NOT a necessary step at this time.

I have spoken directly with Nancy Thaler, Deputy Secretary of the Office of Developmental Programs (ODP), and she has notified me that ODP will hold a meeting of all day/vocational providers in early March to review questions, concerns, and the entire process. This is similar to the recent meeting ODP had with all residential providers.

This is in addition to the upcoming three day (01/31 – 02/02) work group of stakeholders being held by ODP to review the proposed regulations and the comments received. I will be representing RCPA and we will have several provider and other member representatives also in attendance.

In light of these meetings and the proposed process, it would be more appropriate to enter in that discussion and suspend direct calls to the governor’s office. While we have concerns, ODP has assured us that there will be a forum and mechanism to voice these concerns and to have a more constructive discussion.

If you have any questions, please contact me. RCPA will certainly provide an update after the conclusion of these meetings.

From: “HS, Secretary’s Office”
Date: January 5, 2017 at 1:01:56 PM EST
Subject: [DHS-STAKEHOLDERS] DHS Awards Medicaid Agreements

Department of Human Services (DHS) Secretary Ted Dallas announced that DHS has agreed to move forward and negotiate agreements with six managed care organizations (MCOs) to deliver physical health services to Pennsylvanians through HealthChoices, Pennsylvania’s mandatory Medicaid managed care program since 1997.

“These agreements will be the most significant changes to Pennsylvania’s Medicaid program since we moved to managed care two decades ago,” said Dallas. “Over the next three years, MCOs will be investing billions of dollars in innovative approaches that reward high-quality care that improves patient health rather than just providing services for a fee.”

The $12 billion, three-year contracts include a 30 percent target for payments based on value received or outcomes, rather than on the quantity of services provided.

The MCOs were selected based on several criteria, including their current performance, the level of customer service delivered, member satisfaction, and their value-based performance plan. Performance criteria measured, among other things, management of chronic conditions such as high blood pressure, diabetes, and asthma; frequency of prenatal and post-partum care; and access to preventive services.

“The average performance ratings of the selected organizations are consistently higher than the current averages in every region. This transition will result in higher levels of quality care for the 2.2 million Pennsylvanians served by Medicaid,” said Dallas.

To drive Pennsylvania’s Medicaid system towards these better outcomes, the three-year agreements set gradual targets for all MCOs to increase the percentage of value-based or outcome-based provider contracts they have with hospitals, doctors, and other providers to 30 percent of the medical funds they receive from DHS. The result will be that billions in funds that would have otherwise been spent on traditional payment arrangements will instead be invested in outcome or value-based options such as:

  • Accountable care organizations (voluntary networks of hospitals, doctors, and other providers that work together to provide coordinated care to patients);
  • Bundled payments (increases value-based purchasing);
  • Patient-centered medical homes; and
  • Other performance-based payments.

“We’re going to reward folks for providing the right services, not just more services. You get what you pay for so we’re shifting the focus of Pennsylvania’s Medicaid system toward paying providers based on the quality, rather than the quantity of care they give patients,” said Dallas. “In addition, by focusing on improving the health of consumers, we will drive down the cost of care and ultimately save the taxpayer funds we spend on health care in Pennsylvania.”

HealthChoices delivers quality medical care and timely access to all appropriate services to 2.2 million children, individuals with disabilities, pregnant women, and low-income Pennsylvanians.

For more information, visit www.HealthChoicesPA.com or www.dhs.pa.gov.

DHS has selected the following MCOs to proceed with negotiations to deliver services in Pennsylvania beginning in June 2017. The agreements are awarded in five geographic regions:

Southeast Region Gateway Health
Health Partners Plans
PA Health and Wellness
UPMC for You
Vista–Keystone First Health Plan
Southwest Region Gateway Health
PA Health and Wellness
UPMC for You
Vista—AmeriHealth Caritas Health Plan
Lehigh/Capital Region Gateway Health
Geisinger Health Plan
Health Partners Plans
PA Health and Wellness
Northeast Region Gateway Health
Geisinger Health Plan
UPMC for You
Northwest Region Gateway Health
UPMC for You
Vista—AmeriHealth Caritas Health Plan


CESP Exam Logo

Earn the Designation of Certified Employment Support Professionals (CESP™)
by Passing the National CESP™ Examination

Hawley, PA Exam (information/registration links)
Wednesday, February 15, 2017

Wyomissing, PA Exam (information/registration links)
Wednesday, April 19, 2017


Job Coaches • Job Developers • Transition Employment Specialists • Job Placement Specialists • Employment Specialists/Consultants • Employment Managers and/or Directors

What is CESP™ Certification?

  • CESP™ certification is a national credential for Employment Support Professionals who assist people with disabilities in finding and maintaining regular, community-based employment.
  • The CESP™ credential is earned by passing a comprehensive examination based onnational standardized competencies.
  • CESP™ certification is a complement to program certification and licensing, demonstrating a level of professionalism has been achieved.
  • The CESP™ certification is a national, portable, individual credential that remains valid for three years.

What are the Benefits of EARNING THE CESP™ Credential?

  • CESP™ certification opens the door to: improved professional advancement & job opportunities, increased income opportunities, and enhanced credibility with employers
  • Become a member of a rapidly growing, elite group of professionals:

• Reduced APSE membership fee
• National networking opportunities
• Exclusive access to CESP ™ publications & webinars
• A professional credential — not just a certificate of completion
• CESP™ Meet-ups
• CESP™ LinkedIn Group
• Your name listed on the APSE website
• Recognized as a leader in your field

The decision for Pennsylvania to postpone the implementation of Community HealthChoices (CHC) was announced today. This decision was made as a result of the delays associated with the resolution of several bid protests.

Following the announcement of the selection of the managed care organizations (MCOs) that would deliver health care coverage in Community HealthChoices, several protests were filed. As a result, the progress of major components of CHC implementation was delayed, resulting in the Department of Human Services (DHS) feeling uncertain with moving forward with their established start dates. Some of the impacted activities associated with this decision include:

  • Developing an adequate network: DHS has not been able to engage with the selected offerors. The agreement and rate negotiations and finalization typically take six weeks, and the agreements need to be finalized before the MCOs are able to engage in network development activities. The current delays mean the MCOs will not have enough time to meet the network adequacy requirements by July 1, 2017.
  • Completing a readiness review: Readiness review is a requirement for the MCOs before they are certified to be able to go live and provide services. Protests prohibit MCO engagement for readiness review and the window to complete the certification continuously shrinks. New programs require a minimum of six months to complete a readiness review.
  • Communicating: Communication about selected MCOs and their available networks is a critical component to CHC education and outreach. Individuals who will be enrolling in CHC need to have complete information about the MCO provider network in order to be able to make an informed provider choice. That communication will not be able to take place until the agreements are largely finalized and the MCOs are in a position to provide network information.

Important dates to note include:

  • Phase 1 will now begin in January 2018 in the Southwest region of the state.
  • Phase 2 will now begin in July 2018 in the Southeast region of the state.
  • The January 2019 start date for the rest of the state remains unchanged.

Thursday, January 12, 2017 • Harrisburg, Pennsylvania

In the wake of new technology and the Affordable Care Act, there has been a movement to reform the way behavioral health providers deliver and are paid for their services. Specifically, there is a consensus that health reform cannot be achieved without improved quality and simultaneously decreasing cost.

The Alliance for Health Reform hosted a briefing on Monday, December 12 to discuss the social determinants of health. For those who were unable to attend, here is the video and a transcript.

The financing of medical care is typically siloed from investments in housing, nutrition, criminal justice, and other social supports, even though all of these factors affect health outcomes and life expectancy. When allocating public dollars, policymakers need to know what investments can have the greatest impact on the health of individuals. This briefing examined the challenges of aligning or combining funding sources to achieve better health outcomes, how analysts can prove value in such ventures, and the role of health care professionals in caring for patients who have both medical and non-medical needs.

The National Council for Behavioral Health wants to help you prepare for this journey and invites you to join the new Practice Transformation Academy to get there. The National Council’s newest learning community, the Practice Transformation Academy, is a year-long change management program designed for senior leaders charged with overseeing the organizational transitions necessary for success in value-based payment arrangements. Through comprehensive technical assistance, participating organizations will have the opportunity to: design clinical pathways; create robust, data-driven quality improvement practices; and implement sustainable business operations.

Don’t miss the opportunity for peer-to-peer and individualized coaching to develop your organization’s roadmap and accomplish a practice transformation stretch goal unique to your organization. The program begins in March 2017 and runs through March 2018.