NOTICES
DEPARTMENT OF
HUMAN SERVICES
Availability of Application for a Waiver for Selective Contracting for Residential Services and Availability of Amendments to the Consolidated, Community Living, Person/Family Directed Support and Adult Autism Waivers Required for Selective Contracting of Residential Services, as Well as Additional Proposed Changes to the Waivers
[54 Pa.B. 2177]
[Saturday, April 20, 2024]The Department of Human Services (Department) is making available for public review and comment the Office of Developmental Programs' (ODP) proposed application for a section 1915(b)(4) waiver for a selective contracting program and amendments to the Consolidated and Community Living waivers required to implement selective contracting for Residential Habilitation, Life Sharing and Supported Living services. The Department is also making available for public review and comment additional proposed amendments to the Consolidated, Community Living, Person/Family Directed Support (P/FDS) and Adult Autism Waivers that are not related to implementation of selective contracting. Changes are proposed to become effective on January 1, 2025.
Background
The Department is submitting to the Centers for Medicare & Medicaid Services (CMS) for approval an application for a section 1915(b)(4) waiver to improve the quality and sustainability of Residential Habilitation, Life Sharing and Supported Living services which are available through the ODP's Consolidated and Community Living waivers. The selective contracting program will be referred to as performance-based contracting. The Department is also submitting to the CMS for approval amendments to the Consolidated and Community Living waivers that are needed to implement performance-based contracting and amendments to the Consolidated, Community Living, P/FDS and Adult Autism waivers that are not related to implementation of performance-based contracting.
When performance-based contracting is implemented, all currently enrolled residential providers will have the opportunity to enter into a performance-based contract with ODP. To help support providers with the new requirements and process, ODP will hold provider trainings so that providers have a clear understanding of the process and expectations for performance-based contracting. As part of this process, providers will submit documentation demonstrating compliance with the performance areas identified by ODP. Additionally, ODP will use data from participant experience surveys, claims, incident management, health risk screening, administrative entities and a new Performance Analysis Services vendor to evaluate each provider's performance against the established standards and determine the tier in which the provider will be placed.
Providers will be placed in one of the following tiers based on their performance:
• Conditional for providers operating under provisional or revoked licenses.
• Primary for providers that meet current standards and a few additional standards.
• Select for providers that deliver at least two of the three residential services in the performance-based contracting model and meet enhanced measures.
• Clinically Enhanced for providers that offer clinically enhanced medical or behavioral supports and meet enhanced measures.
The Department proposes the following substantive amendments to the Consolidated and Community Living waivers that will support the implementation of performance-based contracting effective January 1, 2025:
• Allow for the Department to contract with a Performance Analysis Services vendor that will provide administrative support with data collection, analysis and reporting functions.
• Require residential service providers to sign a residential provider agreement, which requires providers to comply with performance standards and reporting requirements outlined in the agreement and ODP policy.
• Implement pay-for-performance supplemental payments for residential service providers that meet or exceed performance targets for staff credentialing, employment of individuals served, transition of individuals to Life Sharing or Supported Living services and reporting on use of technology. Supplemental payments will be calculated for residential providers meeting or exceeding performance standards as a one-time or combined payment up to 3% of ODP-eligible service revenue from the applicable review period or established payment amount per qualifying event. Providers that have been determined to be a Primary, Select or Clinically Enhanced provider are eligible to receive the supplemental payments.
• Pay Licensed Residential Habilitation, Unlicensed Residential Habilitation, Life Sharing and Supported Living providers that meet the requirements to qualify as a select provider or a Clinically Enhanced residential provider a payment that is in addition to the Medical Assistance fee schedule rate. Select providers will receive a rate add-on of 5% per individual served and Clinically Enhanced providers will receive a rate add-on of 8%.
The Department also proposes the following substantive amendments to the Consolidated, Community Living, P/FDS and Adult Autism waivers that are not related to implementation of performance-based contracting effective January 1, 2025:
• Assure effective communication for individuals who use American Sign Language through implementation of a new American Sign Language—English Interpreter service. Services will be reimbursed as a vendor service based on the cost that the provider charges to the general public.
• Promote health, wellness and safety by clarifying that individuals who receive services in an acute care hospital will not be disenrolled from the waiver.
• Support the quality of Assistive Technology provided by expanding the qualification requirements for a professional who can complete an evaluation of an individual's need for Assistive Technology and clarifying that evaluations can be completed for technology costing less than $750 if the service plan team believes it will be beneficial.
• Increase community participation and employment by requiring providers of Community Participation Support and Day Habilitation services to annually complete an analysis of each individual's interests, preferences, skills and strengths that support the individual's participation in employment or other community activities.
• Revisions to align waiver requirements with regulatory requirements, correct errors and provide clarification requested by stakeholders.
The Department proposes the following substantive amendment to the Consolidated, Community Living and P/FDS waivers that are not related to implementation of performance-based contracting effective January 1, 2025:
• Increase employment of individuals by allowing indirect activities to be billed through the Benefits Counseling service and improve access to Benefits Counseling for individuals who are not eligible for the Federal Work Incentives Planning and Assistance program.
The Department proposes the following substantive amendments to the Adult Autism Waiver that are not related to implementation of performance-based contracting effective January 1, 2025:
• Support the quality of Residential Habilitation, Community Home and Life Sharing services, through alignment of provider qualifications with the qualifications included in the Consolidated and Community Living waivers.
• Promote health, wellness and safety by clarifying that Residential Habilitation providers must have a licensed nurse available if the provider serves individuals with needs that require care by a licensed nurse.
• Promote self-direction, choice and control by clarifying that Community Transition Services can be used to support individuals transitioning from settings such as Residential Habilitation to private residences in alignment with guidance in the CMS instructions, technical guide and review criteria for 1915(c) waivers.
Copies of this notice, the application for a section 1915(b)(4) waiver and the proposed amendments to the Consolidated, Community Living, P/FDS and Adult Autism waivers may be obtained by contacting Julie Mochon, Department of Human Services, Office of De- velopmental Programs, 625 Forster Street, Room 510, Harrisburg, PA 17120, RA-odpcomment@pa.gov. The documents are also available at https://www.dhs.pa. gov/Services/Disabilities-Aging/Pages/Proposed-Waiver-Amendments.aspx.
Fiscal Impact
In Fiscal Year 2024-2025 the anticipated cost for the Intellectual Disabilities (ID)—Community Waiver Programs' implementation of performance-based contracting for Residential Habilitation, Life Sharing and Supported Living is $50.000 million ($22.455 million in State funds).
In Fiscal Year 2024-2025 the anticipated cost for the implementation of the new American Sign Language—English Interpreter service is $2.080 million ($0.934 million in State funds).
The amount of funding available is dependent upon the funds appropriated by the General Assembly for the forthcoming year. Therefore, performance-based contracting and the American Sign Language—English Interpreter service are dependent on approval by the General Assembly.
Public Comment
Interested persons are invited to submit written comments regarding the application for a section 1915(b)(4) waiver for a selective contracting program and amendments to the Consolidated and Community Living waivers required to implement performance-based contracting and additional proposed amendments to the waivers. Comments should be addressed to Julie Mochon, Department of Human Services, Office of Developmental Programs, 625 Forster Street, Room 510, Harrisburg, PA 17120. Comments may also be submitted to the Department at RA-odpcomment@pa.gov using the subject header ''Waiver Comments.''
Comments received within 45 days of publication of this notice will be reviewed and considered for revisions to the proposed application for a section 1915(b)(4) waiver and proposed amendments to the waivers.
The Department has scheduled multiple public comment webinar sessions. The full listing of sessions with information about registration can be found at https://www.dhs.pa.gov/Services/Disabilities-Aging/Pages/Proposed-Waiver-Amendments.aspx.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service by dialing 711 or by using one of the toll-free numbers: (800) 654-5984 (TDD users), (800) 654-5988 (voice users), (844) 308-9292 (Speech-to-Speech) or (844) 308-9291 (Spanish).
VALERIE A. ARKOOSH,
SecretaryFiscal Note: 14-NOT-1617. Under section 612 of The Administrative Code of 1929 (71 P.S. § 232), (1) General Fund;
(7) ID—Community Waiver Program; (2) Implementing Year 2023-24 is $0; (3) 1st Succeeding Year 2024-25 is $23,375,000; 2nd Succeeding Year 2025-26 is $46,750,000; 3rd Succeeding Year 2026-27 is $48,590,000; 4th Succeeding Year 2027-28 through 5th Succeeding Year 2028-29 are $52,271,000; (4) 2022-23 Program—$1,877,000,000; 2021-22 Program—$1,798,000,000; 2020-21 Program—$1,621,000,000;
(7) Autism Intervention and Services; (2) Implementing Year 2023-24 is $0; (3) 1st Succeeding Year 2024-25 is $14,000; 2nd Succeeding Year 2025-26 is $28,000; 3rd Succeeding Year 2026-27 is $56,000; 4th Succeeding Year 2027-28 through 5th Succeeding Year 2028-29 are $112,000; (4) 2022-23 Program—$27,610,000; 2021-22 Program—$27,493,000; 2020-21 Program—$27,262,000;
(8) recommends adoption. Funds have been included in the proposed budget to cover this increase but are dependent on the enactment of the budget.
[Pa.B. Doc. No. 24-560. Filed for public inspection April 19, 2024, 9:00 a.m.]
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