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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 15-20 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, DHS first started with "ratesetting forms". This quickly became obsolete, and DHS 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. Each year's cost report became the basis for that agency's rates two years later--hence "cost report based rates." ODP eventually discontinued the cost reports, with the final year in FY 2015-16, moving these services to fee schedule rates.
Beginning with FY 2012-13, all nonresidential services and residential ineligible services were moved to the fee-for-service Department-established rates. Cost report based rates continued for residential eligible services through December 31, 2017. Effective January 1, 2018 all residential 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 were quite controversial, and it is questionable whether or not the regulations are indeed valid beyond the first year they were effective. 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 Agreement." This agreement lasted for a few years, having been amended a couple times. One of the outcomes is the new set of regulations, known as the 6100 regulations, which were finally promulgated in October 2019.
One of the biggest provider concerns about the new Chapter 6100 regulations is that DHS is only required to "refresh" the rates at least once every three years. There is concern that a refresh would not be an increase. According to ODP, since the regulations were promulgated in October 2019, they are not obligated to refresh the rates until October 2022. In reality the rates in place in October 2019, had already been in effect since January 1, 2018 and some since July 1, 2017. Without increases, the providers are financially strained without any increases, and hence, many providers file appeals of the rates.
On February 26, 2022, DHS published rate revisions, effective January 1, 2022 for residential eligible rates. ODP claims this rate refresh is "early" because it is prior to October 2022. The general consensus seems to be that, while the rate increases are significant, it is not enough given that the rates have not been revised for so many years, and given the current state of inflation, staff shortages, and COVID impact.
AZTAC assists providers throughout the year as ODP issues and/or requests more and more information. AZTAC is experienced with rate setting, fee schedules, cost reporting and appeals. Contact firstname.lastname@example.org for assistance or information.