Pennsylvania I/DD System Presented by: Kevin M. Friel Patrick - - PowerPoint PPT Presentation

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

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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

1.

https://s3-us-west-2.amazonaws.com/palms-awss3- repository/Shared_Content/Maestro+Calls/Consolidated+and+PFDS+Amendment +July+2016+Presentation+FINAL.pdf

2.

http://www.dhs.pa.gov/learnaboutdhs/waiverinformation/adultautismwaiver/i ndex.htm

3.

https://www.hcsis.state.pa.us/hcsis-ssd/custom/ODP_Service_Descriptions.pdf

4.

http://www.dhs.pa.gov/cs/groups/webcontent/documents/document/c_22066 7.pdf

5.

https://www.governor.pa.gov/executive_orders/executive-order-2016-03- establishing-employment-first-policy-and-increasing-competitive-integrated- employment-for-pennsylvanians-with-a-disability/

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Questions and Closing Remarks

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