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Report

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The Office of Developmental Programs (ODP) has announced the release of the 2023 – 2024 Employment First report. ODP believes that all people with an intellectual disability and/or autism must be encouraged to pursue their vision for an everyday life, which may include working in competitive integrated employment. Competitive integrated employment offers a person an opportunity to achieve economic independence, build self-confidence, enhance self-determination, and meet new people while building new skills. The Everyday Lives: Values in Action publication, developed by the ODP Information Sharing and Advisory Committee (ISAC), which includes self-advocates, reads, “Employment is a centerpiece of adulthood and must be available for every person. The benefits of employment for people with disabilities are significant and are the same as for people without disabilities.” This report serves as an update to all stakeholders on the progress that has been made to support individuals served by ODP on finding and maintaining competitive integrated employment.

Access the 2023-2024 Employment First report here. This document can also be found by visiting the MyODP Employment Home web page.

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The Office of Child Development and Early Learning (OCDEL) has released the outcomes from the Early Intervention (EI) Rate Methodology Study that concluded in the Fall of 2024. A key focus of the RCPA Early Intervention Steering Committee’s strategic agenda has been the review of how rates have been historically developed, including the lack of sustainable rate increases that have taken place over the past two decades. In our collaboration with OCDEL and other early intervention stakeholders, the goal was the development of a quantifiable rate methodology that uses the cost of care as a driving variable in the rate development matrix.

The EI Rate Study Final Report has been added to DHS website and can be viewed here. The study was the culmination of a year-long effort led the Public Consulting Group (PCG) and an Advisory Committee, which RCPA and other provider members were a part of.

The report reviewed the methodology and formulary variables for rate calculations across several operational dimensions of early intervention services, including staffing, operations, administration, and the calculation of how missed and cancelled visits intersect with actual costs.

The final funding review of the estimated Commonwealth fiscal impact was calculated using the number of service units provided during FY 2022/23 for Early Intervention services, current Federal Medical Assistance Percentage (FMAP), and county contributions. Services with a recommended rate decrease were kept at the current rate when calculating Commonwealth fiscal impact. The result indicated that for FY 2022/23, the rates were underfunded by more than $71M, or roughly 38% of the FY 2022/23 rate.

This year there is a proposed State budget increase of $10M that is targeted to aid Early Intervention providers in stabilizing their workforce infrastructure. This would be a 3% increase over the FY 2023/24 rate. There was no rate increase last year in anticipation of the rate methodology study report. There was hope that the study outcomes, which ended in September 2024, could have made a greater impact on this year’s projected rate increase. That notwithstanding, RCPA fully supports and will be advocating that the proposed $10M funding allocation be approved for Early Intervention services in the final budget. Additionally, there is a projected Medicaid allocation of $12.6M, for a total $22.6M that will go to the final rates for FY 2025/26.

Finally, the report indicated that between the periodic rate studies, PCG recommends that OCDEL implement a rate monitoring program to measure costs annually against payments. This monitoring should also measure inflation, and OCDEL should adjust rates annually to match the rate of inflation.

RCPA thanks OCDEL and our members for the partnership in the project and looks forward to the opportunity to work together in supporting and advocating the implementation of rates that support the cost of delivering high quality Early Intervention services to the children and families of the Commonwealth.

If you have any additional questions, please contact RCPA COO Jim Sharp or IPRC Policy Director Cindi Hobbes.

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The Office of Long-Term Living (OLTL) issued a Critical Incident Management Bulletin, with indications that they and the Managed Care Organizations (MCO) will be enforcing these regulations. Per OLTL:

Investigation of critical incidents and its documentation is an integral part of a Service Coordinator’s (SC) responsibilities, not a stand-alone function. During the course of quality reviews, Office of Long-Term Living’s (OLTL) Incident Management staff has found that critical incident investigations are not consistently following the established policy and procedure. OLTL wants to reinforce the following requirements found in various OLTL policy and procedure documents, which remain unchanged. Non-compliance with these requirements is subject to corrective action by OLTL.

1. Investigation of Critical Incidents

a. According to the Critical Incident Management Bulletin dated 2/23/2023, Community HealthChoices (CHC) managed care organizations (MCO) and SC must begin investigating a critical incident within 24 hours of discovery or of learning of the incident. This requirement was also indicated in the 2015 version of the document. The bulletin reinforces the onsite visit requirement for fact finding. The critical incident facts, sequence of events, interview of witnesses, and observation of the participant and/or environment is required. The onsite investigation is not the same as a comprehensive needs reassessment or assessment of need, and it must be completed regardless of participant choice. The participant reserves the right to refuse involvement in the critical incident investigation. However, the onsite visit must be completed. The Telephone Investigation referenced in the Bulletin does not replace the onsite investigation requirement, and is meant for instances when more information is necessary to complete the incident report. For example, when a protective services investigation is occurring and the SC needs to gather details to ensure mitigation measures are in place. Please note that while required to cooperate in the investigation, SCs are not required to investigate reported allegations of abuse, neglect, or exploitation, which are referred to a protective services agency. However, SCs remain responsible for ensuring participants health, safety, and welfare by means of risk mitigation and appropriate service implementation.

b. The 24-hour requirement to initiate an investigation is not to be interpreted as one business day. The only time business days apply is when submitting a critical incident report in Enterprise Incident Management (EIM), which is required within 48 hours excluding weekends and holidays. Please note that while the investigation must be initiated within 24 hours of incident discovery/learning of the incident, the CHC-MCO and SC will still have 30 calendar days to complete the investigation. It is also important to note that the onsite visit does not necessarily have to occur within 24 hours of incident discovery as long as it occurs at a time that enables ensuring the health and welfare of the participant, and within the allotted 30 calendar days or extended due date in the case where a timely EIM report extension was requested.

c. The Critical Incident Management bulletin also indicates the following:
No further action is required when the critical incident report meets all three of the following conditions:

  1. The facts and sequences of events are outlined with sufficient detail; and
  2. Preventative action through the service plan is either not required or is implemented and documented; and
  3. The participant is not placed at any additional risk.

Therefore, CHC-MCOs and SCs must ensure that, prior to submitting the Final Section of the incident report in EIM, the participant is aware of the critical incident, its resolution, and the measures taken to prevent recurrence. This includes determining whether a comprehensive needs reassessment or assessment of need must be conducted, based on the requirements outlined in OLTL’s policy and procedure documents. The SC must also ensure thorough documentation in the critical incident report of all actions taken to ensure participants health and welfare.

2. Notice to Participant

The Critical Incident Management Bulletin indicates that:

  1. The agency staff that discovered or first became aware of the critical incident is to notify the participant (and representative if requested by the participant) that a critical incident report has been filed. This notice must be provided to the participant within 24 hours and in a cognitively and linguistically accessible format. If the participant’s representative is suspected to be involved in the critical incident, the representative should not be notified.
  2. Within 48 hours of the conclusion of the critical incident investigation, the SC must inform the participant of the resolution and measures implemented to prevent recurrence.

CHC-MCOs and SCs must ensure the required notifications are made to the participant, and document completion within the Referrals and Notifications page in the EIM critical incident report.

OLTL encourages all CHC-MCOs and SCs to review the Critical Incident Management Bulletin to ensure all requirements are met.

If you have any questions, please contact Fady Sahhar.

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The Office of Developmental Programs (ODP) has announced the release of the 2022-23 Employment First report. ODP believes that all people with an intellectual disability and/or autism must be encouraged to pursue their vision for an everyday life, which may include working in competitive integrated employment. Competitive integrated employment offers a person an opportunity to achieve economic independence, build self-confidence, enhance self-determination, and meet new people while building new skills. The Everyday Lives: Values in Action publication, developed by the ODP Information Sharing and Advisory Committee (ISAC) which includes self-advocates, reads, “Employment is a centerpiece of adulthood and must be available for every person. The benefits of employment for people with disabilities are significant and are the same as for people without disabilities.” This report serves as an update to all stakeholders on the progress that has been made to support individuals served by ODP on finding and maintaining competitive integrated employment.

Access the 2022-23 Employment First report here. This document can also be found by visiting the MyODP Employment Home page.

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ADvancing States and the ARPA HCBS TA Collective Announce Release of Report Summarizing State Experiences with ARPA HCBS Initiatives

FOR IMMEDIATE RELEASE
April 23, 2024
CONTACT: Camille Dobson
202-898-2578

ARLINGTON, VA — ADvancing States and our partners in the American Rescue Plan Act (ARPA) home and community-based services (HCBS) Technical Assistance Collective (TA Collective) are proud to release a report sharing findings about states’ experience in implementing their ARPA HCBS initiatives. While the ARPA infusion of federal dollars into HCBS provided an historic opportunity to try bold, new approaches to supporting people in their homes and communities, states were challenged to make systemic improvements given the time-limited nature of the federal funds.

To gather insights into states’ experiences in implementing their ARPA HCBS spending plans, the TA Collective fielded a national survey in early 2024 that aimed to identify successful strategies used by states implementing their ARPA HCBS spending plans, as well as any barriers hindering their success. Based on responses to that survey, this report highlights the challenges and barriers states faced in thoughtfully executing their initiatives in the midst of a public health emergency. The thirty-three states that responded to the survey shared the top barriers to implementing their projects as planned. These barriers include:

  • Delays in obtaining approval from CMS for both their spending plans and the necessary federal authorities to implement those plans;
  • Lack of staff capacity to design and implement complex initiatives;
  • The time it takes to complete state procurement processes to implement projects; and
  • The need to secure legislative approval and/or budget authority before beginning work.

The report also suggests ways to make any future time-limited investments in the HCBS system more effective, including giving states more time to implement, easing the CMS approval process and providing resources to both states and CMS. Moreover, any future investments should be accompanied by a federal evaluation to glean insights into successful interventions that could be replicated across the country.

While this report highlights challenges and lessons learned, it should be noted that, against all odds, states created transformational change with their ARPA spending plan initiatives. Our hope is that this report — and the recommendations contained therein — serves as a roadmap for any future federal investment in the HCBS system.

This report is also informed by the TA Collective’s work supporting states with their ARPA initiative planning, implementation, and evaluation activities and by observations and analysis of state and federal ARPA HCBS activities. It builds upon the TA Collective’s past work including, Efforts to Evaluate the Impact of ARPA HCBS Investments, an issue brief examining state evaluation approaches, and a summary of the work of the HCBS Sustainability Summit, which provided valuable context on sustaining the HCBS commitment fostered by ARPA investments. Both reports can be found here.

We are grateful to The John A. Hartford Foundation, the Care for all with Respect and Equity (CARE) Fund, The SCAN Foundation, and the Milbank Memorial Fund for their support in making the work of the TA Collective possible.

Visit here to read the new report.

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The Pennsylvania Partnerships for Children has published its 2023 State of Child Welfare Report, providing an analysis of child safety, placement, and permanency based on 2022 data. This 14th annual report focuses on Pennsylvania’s county-administered, state-supervised child welfare system, highlighting findings such as increases in child abuse reports in 2022. The report includes policy recommendations to address system challenges and improve outcomes for children and families. The full report, state-level data tables, and county tables can be accessed on the PA Partnerships for Children website.

RCPA would like to thank PA Partnerships for their partnership and shared advocacy on behalf of children and families in Pennsylvania.

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