Changes and Challenges in the Pennsylvania I/DD System Presented by: Kevin M. Friel Patrick DeMico
Historical Perspective State Centers MR Act of 1966 Evolution of Self-Advocacy and Support Models County Administration Statewide Medicaid Plans with FFP 2
Rapidly Changing Landscape Home and Community Based Services (HCBS) Final Rule Statewide Transition Plan Chapter 51 Settlement Agreement Chapter 6100 Proposed Regulations Proposed Residential Fee Schedule FY 2017/2018 Employment First Executive Order Pennsylvania Waiver Renewals Department of Labor Overtime Final Rule 3
HCBS Final Rule Effective March 2019 Definition of Community Protection of Individual Rights and Choices Provider Ownership and Control of Real Estate Contiguous Setting Restrictions Mandatory Statewide Transition Plans that must be approved by CMS Legacy Programs Heightened Scrutiny 4
Employment First Executive Order March 10, 2016 PA Joins 19 States with an Employment First initiative Workforce Innovation and Opportunity Act Impact on existing ID Employment Services Forthcoming ID Regulation PA Metrics for Measuring Success 5
Chapter 51 Settlement Agreement Chapter 51 Remains Effective Chapter 51 Settlement Agreement expires June 30, 2017 ODP Extends Vacancy Exception and Retention provisions of current agreement Chapter 6100 Workgroup resulted from Settlement Agreement 6
Proposed Chapter 6100 Regulations Chapter 6100 Workgroup Anticipated Approval of Regulations Impact on Other Existing Regulations Significant Changes from Chapter 51 Regulations Influences of HCBS Final Rule, Transition Plan, and Waiver Renewals 7
Residential Fee Schedule July 1, 2017 Residential Services Represent approximately 70% of the Consolidated Waiver Appropriation Acuity and Assessment Data Collection Efforts Actuarial Studies Planned Roll-Out/Implementation Turnover of ODP Consultants and Experts 8
Pennsylvania Waiver Renewals The Consolidated Waiver, July 2017 The Person/Family Directed Services Waiver, July 2017 The Adult Autism Waiver The Adult Community Autism Program 9
Department of Labor Final Rule Effective December 1 Financial Impact Analysis Organizational Response Plan Potential for Impact to Financial, Compliance, Operations and “Satisfaction” Conditions 10
Other Driving Forces ODP Fee Schedule and Department Established Fees for ID Progress Notes and Encounter Support Managed Care Credit Risk Profile for ID Organizations 11
ODP Fee Schedule FY 2016/2017 Covers Nearly All Non-Residential Services in PA Five Consecutive Years of Virtually Flat Funding Area Assignment Methodology Static for Five Years ODP Argument that Utilization offsets the need for Rate Increases Market-Based Approach 12
Progress Notes Defined under Chapter 51 and Various ODP Announcements and Bulletins Reviewed by Licensing Inspections Teams and County Monitors Audited by CMS Subcontractors under Payment Error Measurement Rate (PERM) Reviews Audited by PA DHS Bureau of Financial Operations Providers At Risk for Recovery of Claims 13
Managed Care Recent and Current PA Managed Care initiatives: OLTL and MLTSS Fee Schedules as Pre-Cursors for Outsourcing to ID to a Managed Care Organization Trends and Activities in Other States Provider Organization Preparation 14
Strategic Plan and Risk Profile Discipline: Assess Risks and Opportunities Knowledge: Monitor Policy Changes Preparation: Plan for the Future Agility: Be Ready to Act Quickly and Withstand Uncertainty Diversification: Mitigate Risk 15
Links and Resources https://s3-us-west-2.amazonaws.com/palms-awss3- 1. repository/Shared_Content/Maestro+Calls/Consolidated+and+PFDS+Amendment +July+2016+Presentation+FINAL.pdf http://www.dhs.pa.gov/learnaboutdhs/waiverinformation/adultautismwaiver/i 2. ndex.htm https://www.hcsis.state.pa.us/hcsis-ssd/custom/ODP_Service_Descriptions.pdf 3. http://www.dhs.pa.gov/cs/groups/webcontent/documents/document/c_22066 4. 7.pdf https://www.governor.pa.gov/executive_orders/executive-order-2016-03- 5. establishing-employment-first-policy-and-increasing-competitive-integrated- employment-for-pennsylvanians-with-a-disability/ 16
Questions and Closing Remarks 17
Recommend
More recommend
