Waiver services provided through the Consolidated and P/FDS waivers are also known as Community MR and Waiver Services. These services exclude ICF/MR services (even though ICFs/MR are also located in the community).
Fiscally, the Community MR program in Pennsylvania has been going through many changes over the last few years. The transition is not yet over. Community MR programs previously received funding from the county MH/MR offices throughout the State, who in turn, received allocations from the State level, who in turn, received federal participation dollars from the federal government. Funding was provided to provider agencies from the county MH/MR offices based on an annual contract. While there were similarities throughout the state, there were also differences throughout the state, making no two county/provider relationships the same.
In the effort to meet federal requirements of standardizing a payment system throughout the state, DPW first started with "ratesetting forms" a few years ago. This quickly became obsolete, and DPW went forward with "cost reporting." Beginning with FY 2007-2008, provider agencies first filed cost reports in the fall of 2008 for the preceding fiscal year. These cost reports--not only serve as a formal filing of an agencies expenses--but also were to become the basis for a future year's "ratesetting," hence PPS, or Prospective Payment System. FY 2008-2009 cost reports were prepared and submitted by providers to the state in the fall of 2009, FY 2009-2010 cost reports wer due by October 17, 2010, and FY 2010-11 cost reports--known as Year 4--were due November 3, 2011, but the deadline was extended to November 7, 2011. As of this date, the actual ratesetting process is still unclear, as the Department continues to make changes and does not fully disclose the process until after something is issued, if at all. In simplest form, your reported costs and either available or utilized units are used to calculate a unit cost which is then supposed to be trended forward to a future year---but that trending forward has not brought any increases. Revenue adjustment factors (RAFs) have been applied reducing the cost report unit cost to the rate. The rates are also restricted in other ways. Caps on inleigible costs have been threatened. Fee for service rates have been issued and rescinded. FY 2011-2012 rates were issued on October 14, 2011, effective November 15, 2011. For most providers, the FY 2010-11 rates remain effective for July 1 through November 14, 2011.
Many providers have been unable to figure out how their rates were calculated, because the "rate letters" do not provide the calculation. If you need assistance with a rate analysis, contact AZTAC and we can help you with that.
DPW agreed to also implement a "revenue reconciliation process." This process was intended to "keep providers whole" and from being harmed by inadequate or incorrect rates. This process, too, has changed repeatedly, often without notice, and also to the point that providers no longer know what the revenue target is, until a reconciliation is actually occurring. It has been very difficult for providers to keep up, and apparently, it has also been a very difficult process for the State. Reveneue reconcilitation was supposed to be for two "test years"--FY 2009-2010 and FY 2010-2011. CMS didn't approve the two year's RR until the end of FY 2010-2011. As of September, 2011, DPW has not yet submitted a request to CMS for FY 2011-12 Revenue Reconciliation. We understand that discussions are ongoing with CMS.
AZTAC assists providers throughout the year as ODP issues and requests more and more. AZTAC prepares the cost reports, as well as various revenue reconciliation forms. AZTAC also assists with appeals.
Click here for information about FY 2010-2011 Cost Reporting
