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 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