On August 29 the PA Department of Human Services’ Office of Developmental Programs (ODP) hosted a statewide Residential Stakeholder Engagement forum to share details related to its previously announced residential fee schedule. The fee schedule will apply to people with intellectual disability (ID) served in residential settings who receive service funded through Medicaid waivers, which are approved by the federal government. ODP acquired data from surveys and questionnaires distributed to all residential service providers before developing and presenting its preliminary plan.
The Supports Intensity Scale (SIS), used by ODP since 2008, will be retained as the means by which PA identifies need. SIS scores will now be used to align the needs of individuals with funding on the forthcoming fee schedule. The seven existing SIS levels will be converted into four funding tiers that will comprise the foundation of the needs-based model proposed by ODP earlier this year. The number of people residing together will also be incorporated into the fee schedule matrix. Providers will now be able to obtain SIS scores for the people they support.
ODP has assembled provider representatives to serve on a workgroup to provide guidance and feedback as the methodology is further developed. Identifying appropriate pay rates, benefit levels, replacement cost factors, vacancy factors, transportation costs, required training levels, program support overhead, and other essential components will be critical to this effort. Although previously slated for July 1, 2017 the fee schedule will now become effective on January 1, 2018. Providers were advised to expect the fee schedule to be completed and disseminated in December 2016.
Following the implementation of the fee schedule, ODP announced that cost reports will no longer be required. Until now, residential rates have been based upon individual provider cost reports submitted annually. At this stage in the process, the major issue facing residential providers is how accurately and effectively the fee schedule will capture complexity, and how it will translate into a fair and equitable reimbursement model. The impact on individual providers, and the people they serve, cannot yet be determined.