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ODP released an announcement on April 18, 2025 notifying stakeholders of the opportunity to provide public comment on proposed changes published in PA Bulletin to the Consolidated, Community Living, and Person/Family Directed Support (P/FDS) Waivers. The changes include the implementation of Performance-Based Contracting for Supports Coordination services, scheduled to take effect January 1, 2026 which will introduce new tiered requirements for Supports Coordination Organizations (SCOs), who may be placed into either a Primary or Select tier based on evaluated performance metrics. SCOs will be expected to sign an agreement affirming compliance with performance standards and may qualify for pay-for-performance supplemental payments of up to 3% of eligible revenues based on FY 2024–2025 data. Additionally, DHS proposes new amendments unrelated to selective contracting, including changes to assistive technology limits, employment services, communication supports, and provider qualifications aimed at increasing community inclusion, administrative efficiency, and service quality. Effective July 1, 2026, DHS proposes new monthly case rates and flat fee-for-service rates for SCOs in the Select tier, replacing the current 15-minute unit-based billing for those providers. These rates have been developed using a market-based approach and reflect allowable costs such as staff wages, productivity, program administration, and geographic factors. SCOs may receive stabilization payments or be subject to cost reporting depending on revenue fluctuations compared to prior fiscal years. The proposed changes are expected to have a fiscal impact of $8.096M in FY 2025–2026, supported largely by ARPA funds. These changes are contingent on approval by CMS and the Pennsylvania General Assembly. Alongside this initiative, ODP is proposing updates to the 1915(b)(4) waiver, which include amendments aimed at improving access, quality, and efficiency of services. These include adjustments to the lifetime cap on Assistive Technology, changes to employment supports and facility standards, expanded options for Housing Transition services, and streamlining provider qualifications. These changes reflect ODP’s commitment to increasing independence, promoting health and safety, and reducing administrative burden across the ID/A system. For more information visit the DHS Medicaid Waiver Amendments page or email RA-odpcomment@pa.gov. All comments must be submitted by 11:59 PM on May 26, 2025, to be considered. For more information, please see ODPANN 25-041.
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