DPW Publishes New HCBS Regulations; Many Already in Place

On Saturday, the Department of Public Welfare published final regulations regarding several Medicaid programs, including Long-Term Living and Office of Developmental Programs (ODP) home and community-based services.

Act 22 of 2011 gives DPW the authority to make significant changes to Medicaid benefits and provider reimbursement rates without the usual oversight by the General Assembly or the Independent Regulatory Review Commission in order to streamline operations and contain costs.

The regulations for Long-Term Living home and community-based waiver providers focus on pre-requisites for provider participation, ongoing responsibilities of providers and service coordinator qualifications and training. Most of the provider pre-requisites are already in place, including verifying licensure, completing and submitting an MA application, reporting critical incidents and establishing policies and procedures, which are now reviewed by QMET teams.

However the major concern voiced by AAAs and other service coordination agencies is the mandate for "conflict-free service coordination," which would prohibit a service coordination entity from providing a waiver or Act 150 service, other than service coordination. Today, several FMS agencies provide service coordination and direct services.

Another issue PHA will be monitoring is the fee schedule for services under the waiver programs. The regulations state that services will be paid as either a fee schedule service or as a vendor good or service payment. The fee schedule rates and methodology will be published as a notice in a future Pennsylvania Bulletin.

"Provider rates have historically been under actual costs, so we're hopeful that the new rates will reflect the true cost of care," said Vicki Hoak, PHA CEO.

Click here to read the complete OLTL notice.

For ODP waiver providers, the regulations state that providers will have to be re-qualified on a two-year cycle and annual staff training will be required in a participant's individual support plan, including direct care workers hired by a participant. Also included in the regulation:

• Development of back-up plans to eliminate deviations in service frequency and duration;
• Implementation of quality management plan; and
• Identifying payment methodologies under one of the following methods: cost-based reimbursement, MA program fee schedule reimbursement or reimbursement as vendor goods and services.

Under Act 22, these regulations are final, not proposed. However, there is a 15-day comment period on the regulation. Comments on the OLTL regulation can be sent to RA-waiverstandard@pa.gov with the subject line "HCBS Regulation." Comments on the ODP regulation can be sent to ra-ratesetting@pa.gov with the subject line "PN Community-Based Services, Provider Qualification and Rates."

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