Announcement. ODP Communication Number: Announcement

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1 Announcement NOW AVAILABLE: CMS Approved Second Waiver Amendments for ODP Consolidated and Person/Family Directed Support Waivers Effective July 1, 2013 ODP Communication Number: Announcement The mission of the Office of Developmental Programs is to support Pennsylvanians with developmental disabilities to achieve greater independence, choice and opportunity in their lives. AUDIENCE: PURPOSE: Individuals and Families, Administrative Entities (AEs), Supports Coordinators (SCs), SC Supervisors, Supports Coordination Organizations (SCOs), Providers, and other interested parties. To inform all interested parties of the approval of the second set of amendments for the Office of Developmental Programs (ODP) Consolidated and Person/Family Directed Support (P/FDS) Waivers effective July 1, These amendments are available on the Department of Public Welfare (DPW) website. BACKGROUND ODP previously released Announcement #030-14, NOW AVAILABLE: Second Waiver Amendments Submitted to CMS for ODP Consolidated and Person/Family Directed Support Waivers. This Announcement informed stakeholders that ODP submitted amendments for the Consolidated and P/FDS Waivers to the Centers for Medicare and Medicaid Services (CMS) on March 10, ODP requested that they be effective retroactively to July 1, The reason for the retroactive effective date is because the changes requested were to implement the waiting list initiative granted in Pennsylvania s Fiscal Year (FY) state budget. CMS approved the second set of amendments and the retroactive effective date on June 6, ISSUE DATE: 7/28/14 ODP Communication Number: Ann: Page 1

2 DISCUSSION: Since the release of Announcement #030-14, CMS requested additional changes to the Waivers. The following describes all substantive changes that have been made to the Waivers: Consolidated and P/FDS Waivers Appendix B-3-c the following statement was added to each category for which we reserve capacity: All participants enrolled in the Waiver have comparable access to all services offered in the waiver regardless of whether he or she is enrolled due to meeting reserved capacity criteria or the criteria for emergency status in PUNS. This is evidenced by the Individual Support Plan process that is required for all participants and requires that service options be promoted and fully explored with every individual. Appendix B-3-e added the following statement: Medicaid Waiver services available through ODP are accessible statewide. If an individual is enrolled in waiver services and chooses to relocate to a different county, the county where the individual resides has two options: 1) the county may choose to continue to provide administrative services to the individual in accordance with the AE Operating Agreement; or 2) the county may choose to transfer this responsibility and corresponding waiver capacity to the county where the individual is moving. If the second option is chosen the receiving county must accept the individual s transfer. The person s Individual Service Plan (ISP) and waiver effective date will not be affected by the transfer. Appendix I-Quality Improvement-b-i added the following statement: In the rare event that an overpayment is made, ODP will immediately notify the provider and credit any overpayment on the next PROMISe billing cycle. Thus the FMAP amount charged via the MMIS system to CMS is rapidly corrected, generally within one month or less after an overpayment is discovered. Appendix I-2-a the following statements were added: o Fee Schedule Rates This process includes a review of the service definitions and a determination of allowable cost components which reflect costs that are reasonable, necessary and related to the delivery of service as defined in DPW standards and Federal Cost Principles for Non- Profit Organizations (OMB Circular No. A-122, revised 5/10/2004). o Cost-Based Rates ODP assigns rates in the following manner: A provider shall be assigned the average of the provider s costbased rates for an existing service at a new service location if the provider has an approved cost-based rate at another service location. A provider shall be assigned the area adjusted average of provider cost-based rates for new HCBS if: (1) The cost report of the provider did not contain the new HCBS because the HCBS was not delivered during the reporting period. ODP Communication Number: Ann page 2 of 5

3 (2) A provider is a new provider who was not delivering HCBS during the reporting period of the cost report. A provider shall be assigned the lowest rate calculated Statewide based on all provider cost reports for HCBS if a provider was required to submit a cost report and failed to submit a cost report. A provider who is required to submit an audit who then fails to submit an audit shall receive the lowest rate calculated Statewide. A provider who submits an audit which indicates the information in the cost report requires adjustment and the provider does not submit a revised cost report, the provider shall be assigned the lowest rate calculated Statewide. A provider that chooses to not submit a cost report or the cost report the provider submitted is not approved will be assigned the lowest rate calculated Statewide for each cost-based services the provider provides. o Participant-directed services rates: If the participant chooses to selfdirect some or all of these needed services, he or she will utilize the current Vendor Fiscal/Employer Agent or Agency With Choice wage range communication issued by ODP. If the participant chooses not to selfdirect any of these services, the Medical Assistance Fee Schedule rate will be utilized. Appendix J-2-d was updated to reflect the additional participants served through the Waivers as a result of the waiting list initiative approved in Pennsylvania s FY , state budget. Consolidated Waiver Only Appendix B-3-c was updated to increase reserved capacity for Unanticipated Emergencies in Year 2 from 20 to 50. ODP has seen an increase in the number of individuals entering the Consolidated Waiver who meet these criteria due to the implementation of the Adult Protective Services Act. Appendix I-2-a added the following under the Cost-Based Rates section, After the unit costs for each Residential Habilitation eligible service is adjusted through the outlier review process, a single, standardized vacancy factor is applied to reflect payment to providers for an average number of vacant days. The vacancy factor is applied to finalize a provider s residential rate. As such, a separate payment is not made to providers for the vacancy factor. Appendix I-3-d added ODP makes payments based on rates established by the process outlined in Appendix I.2.a. Rate Determination Methods, at which time reasonable costs are taken into consideration. Further, ODP s fiscal regulations describe allowable costs and specifically state that the costs for services must be reasonable for the performance of the HCBS and consistent with policies and procedures that apply uniformly to both Federally-funded and other activities of the organization (55 Pa. Code, Chapter (d)). ODP Communication Number: Ann page 3 of 5

4 Appendix J-2-c-ii added Factor D on the waiver renewal was based on the average per participant non-waiver state plan service costs for SFY , as reported in the CMS-372 reports. Subsequent to the approval of the waiver renewal, ODP received legislative funding for bringing PA residents off the waiting list. ODP received two years of new initiatives. Funding for an additional 430 new participants was provided in Year 1 (FY ) and funding for 380 new participants for Year 2 (FY ) for the consolidated waiver. In addition to the waiting list funding, ODP continues to see more complex acuity (primarily with new participants) which is driving up the need for services. This is particularly true for participants with complex behavioral needs. This is reflected in the cost estimates in residential habilitation. Finally, more participants entering the waiver are requiring residential eligible care than the legacy participants they replace. This, combined with increased acuity described above, drives cost estimates in the consolidated waiver primarily residential habilitation. ODP did not adjust Year 1 costs and/or participants for the most current waiver amendment, as ODP is now in Year 2 of the waiver renewal. These considerations are reflected in the Schedule J estimates that were revised for Year 2 on the current amendment. Appendix J-2-c-iv added Factor G on the waiver renewal was based on the SFY average cost per recipient for non-institutional state plan services provided to individuals in the ICF/ID program and state centers, as reported in the CMS-372 reports, as reported in the CMS-372 reports. Subsequent to the approval of the waiver renewal, ODP received legislative funding for bringing PA residents off the waiting list. ODP received two years of new initiatives. Funding for an additional 430 new participants was provided in Year 1 (FY ) and funding for 380 new participants for Year 2 (FY ) for the consolidated waiver. In addition to the waiting list funding, ODP continues to see more complex acuity (primarily with new participants) which is driving up the need for services. This is particularly true for participants with complex behavioral needs. This is reflected in the cost estimates in residential habilitation. Finally, more participants entering the waiver are requiring residential eligible care than the legacy participants they replace. This, combined with increased acuity described above, drives cost estimates in the consolidated waiver primarily residential habilitation. ODP did not adjust Year 1 costs and/or participants, for the most current waiver amendment as ODP is now in Year 2 of the waiver renewal. These considerations are reflected in the Schedule J estimates that were revised for Year 2 on the current amendment. P/FDS Waiver Only The unduplicated number of individuals was increased in Years 2 through 5 to 12,600 in Appendix B-3-a to reflect the number of individuals served in the Waiver through the waiting list initiative. Appendix B-3-c was also updated to reserve capacity for those individuals served in the Waiver through the waiting list initiative. ODP Communication Number: Ann page 4 of 5

5 Appendix J-2-c-ii added Factor D on the P/FDS waiver renewal was based on the average per participant non-waiver state plan service costs for SFY , as reported in the CMS-372 reports. Subsequent to the approval of the waiver renewal, ODP received legislative funding for bringing PA residents off the waiting list. ODP received two years of new initiatives. In the P/FDS waiver, two years (FY and FY ) of funding for 700 students graduating from secondary education has been provided. The increases in P/FDS spending, in particular licensed day habilitation, are driven by the 1,400 new participants who will ultimately enter the waiver. ODP did not adjust Year 1 costs and/or participants for the most current waiver amendment as ODP is now in Year 2 of the waiver renewal. Appendix J-2-c-iv added Factor G on the waiver renewal was based on the SFY average cost per recipient for non-institutional state plan services provided to individuals in the ICF/ID program and state centers, as reported in the CMS-372 reports, as reported in the CMS-372 reports. Subsequent to the approval of the waiver renewal, ODP received legislative funding for bringing PA residents off the waiting list. ODP received two years of new initiatives. In the P/FDS waiver, two years (FY and FY ) of funding for 700 students graduating from secondary education has been provided. The increases in P/FDS spending estimates, in particular licensed day habilitation, are driven by the 1,400 new participants who will ultimately enter the waiver. ODP did not adjust Year 1, cost estimates and/or participants for the most current waiver amendment, as ODP is now in Year 2, of the waiver renewal. Appendices J-2-a and J-2-d-i were also updated to reflect those individuals served in the Waiver through the waiting list initiative. Information on the Consolidated and P/FDS Waiver Amendments can be found on the DPW Website ( Learn about DPW > Waiver Information > Consolidated Waiver for Individuals with Intellectual Disabilities or Person/Family Directed Support Waiver. Direct links to the Consolidated and P/FDS Waiver Amendments are provided below: Consolidated Waiver Amendment: Person/Family Directed Support (P/FDS) Waiver Amendment: If you have any questions regarding the waiver amendment process or the information posted, please RA-odpcomment@pa.gov. ODP Communication Number: Ann page 5 of 5