Waiver services provided through the Consolidated and P/FDS waivers are also known as Community Waiver Programs. These services exclude ICF/ID (formerly ICF/MR) services (even though ICFs/ID are also located in the community).
Fiscally, the Community Waiver program in Pennsylvania has gone through many changes over the past 10-15 years. The transition is not yet over. Community Waiver 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, 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". This quickly became obsolete, and DPW went forward with "cost reporting." Beginning with FY 2007-08, provider agencies first filed cost reports in the fall of 2008 for the preceding fiscal year. These cost reports not only were to serve as a formal filing of an agency's expenses but also were to become the basis for a future year's "ratesetting," hence PPS, or Prospective Payment System. FY 2008-09 cost reports were prepared and submitted by providers to the state in the fall of 2009, FY 2009-10 cost reports were 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. Year 5 cost reports--to report expenses for FY 2011-12-- were due November 1, 2012, but the deadline was extended due to Hurricane Sandy. Each year, the deadline was slightly different, but usually near the end of October. ODP eventually discontinued the cost reports, with the final year in FY 2015-16.
The actual ratesetting process was not fully understood and providers seemed to always be uncertain of forthcoming changes. In simplest form, however, your reported costs and available units are used to calculate a unit cost which is then the basis for the calculation of your rate two years later. Revenue adjustment factors, a negative adjustment, or "RAFS" have been applied in some years, and cost of living adjustments have been absent. The rates were also restricted in other ways. Additionally, the revenue reconciliation process was implemented, rather haphazardly for many, for two years (FY 09-10 and FY 10-11) and does not continue any longer.
Beginning with FY 2012-13, all nonresidential services and residential ineligible services have been moved to the fee-for-service Department-established rates. For residential eligible services, the outlier methodology remained in play and the parameters were tightened more each year. Additionally, a 97% vacancy factor was applied to the cost-based rates, but providers, in turn, may no longer bill for medical or therapeutic leave days. This was later changed to 96% through the "Chapter 51 agreement." Cost report based rates continued for residential eligible services through December 31, 2017. Effective January 1, 2018 all resiential eligible services became Department-set rates via the fee schedule.
The Chapter 51 regulations were published on June 9, 2012 (without going through the Independent Regulatory Review Commission). These regulations are retroactive to July 1, 2011, except where noted, and contain many provisions for the Department to publish additional changes in the Pennsylvania Bulletin. The Chapter 51 regulations are quite controversial, and it is questionale whether or not the regulations are indeed valid. Providers, through a few state-wide associations, intended to litigate a challenge to the regulations, but instead an agreement was reached with the Department, known as the "Chapter 51 agreeement." This agreement has been amended a couple times over the last couple yearrs. One of the outcomes is to be a new set of regulations, which will be known as the 6100 regulations--which are expected to be issued as final in December 2018.
AZTAC assists providers throughout the year as ODP issues and requests more and more information. AZTAC is experienced with revenue reconciliation, rate setting, fee schedules, cost reporting and appeals.