May 7, 2012

Association News

PACA MH/DS Position on the Future of ID Services and Managed Care

At the PACA MH/DS Spring Conference Board meeting, the Board adopted a position paper outlining issues and principles the commonwealth must take into account when it decides to move forward with managed care for intellectual disability services. In light of nationwide trends and the level of concern with the sustainability of Medicaid spending in Pennsylvania, it is prudent to begin to prepare for these discussions. The position paper supports the county behavioral health managed care system as a viable method to deliver all home and community based services for individuals with intellectual disability. By integrating ID services with the existing behavioral HealthChoices program structure, the state can achieve cost savings and build on the successes realized in behavioral health managed care while encouraging better integration of care for dually diagnosed individuals. The HealthChoices program structure is the best managed care alternative to assure Everyday Lives values are preserved, family and consumer needs are kept in the forefront, and public accountability for future vision and direction of the community intellectual disability system is maintained.

The paper is available on the PACA MH/DS member’s only section of the website.

Benchmarking and Performance Based Contracting Training Sponsored by COMCARE

PACA MH/DS is developing training on benchmarking and performance based contracting which will be offered free of charge to up to three individuals from each COMCARE member county thanks to a sponsorship by COMCARE. The speakers that are slated to participate include a nationally known expert in benchmarking for behavioral health and a representative of CBH to talk about Philadelphia’s Performance Based Contracting system. Paul Lefkovitz of Behavioral Pathways will present on work he has participated in related to benchmarking in eight states across the country, and will focus on benchmarks related to operations, finances and clinical measures. A discussion panel that includes providers, BH MCOs, OMHSAS and the presenters will round out the day with reaction and discussion.

The training will be held on Wednesday, June 6 beginning at 10 a.m. at the Penn Stater in State College, PA. Please mark your calendars. Please make hotel reservations by May 14, 2012.

The rate for the Penn Stater single occupancy room June 5th to June 6th is $112.00. When making reservations you can contact the Penn Stater at 800-233-7505 and reference the personal reservation identification number: COUF12A.

For additional details and to register, please visit the announcement section of our site: COMCARE Benchmarking and Performance Contracting  

State News

With Less Than 60 Days Until July 1, Capitol Budget Activity Ramps Up

As both the House and Senate returned to session on Monday, April 30, consumers, advocates and families came to the halls of the Capitol to oppose the Governor’s proposed 20 percent funding cut for human services. Several revenue reports were also released that continue to paint an improving revenue picture for the commonwealth. The caucuses signaled that all are willing to consider some restoration of funding, but some also cautioned that they do not want to spend above levels that are sustainable in future years, citing increased pensions costs and transportation funding needs which have not yet been addressed.

On Monday, April 30, Huntingdon-Mifflin-Juniata County administrator Chris Wysocki participated in a briefing targeted for both republican and democratic House members on the impacts of the proposed 20 percent cut to human services. A provider and a family from each of the mental health and intellectual disability systems also participated and spoke openly about their needs for services and concerns about the impact of the cuts. About fifteen legislators attended all or a portion of the meeting. On May 1, hundreds of advocates, families and consumers packed the capitol rotunda for a rally to urge Governor Corbett: “Keep Your Promise” to provide human services for Pennsylvania’s most needy residents.

On May 1, the Independent Fiscal Office released their new projections for year-end revenues, and Pennsylvania Revenue Department Secretary Dan Meuser released collections information from the month of May. Pennsylvania’s April revenue collections exceeded expectations by approximately $100 million, and the commonwealth is now expected to end the fiscal year with a shortfall of about $300 million. The Governor based his proposed budget on an estimated shortfall of $720 million. The Independent Fiscal Office predicted the commonwealth will end the year with $400 million more in revenue than forecast by the administration in February. The fiscal office believes this $400 million will be sustained in the collections for the next fiscal year.

Meanwhile, public meetings and local outreach to legislators continue across the state. A Cumberland County fire hall was packed with more than three hundred citizens at a forum sponsored by the Cumberland and Perry County commissioners. Their entire legislative delegation attended, along with media coverage from at least three local TV stations and several local newspapers. Consumers and providers of mental health, intellectual disability and drug and alcohol services talked about the impacts of essential services and concerns about the 20 percent cut as well as the block grant.

Members should continue to contact their legislators in opposition to the 20 percent cuts. The negotiators are open to discussion on spending some or all of the revenue that is exceeding anticipations, but there are many different interests seeking restoration of their budget line items. Restoring some portion of the cut in funding for human services has momentum, but we need to continue strong grass roots efforts to assure the message is clear and consistent through the end of the negotiation process.

Re-Procurement for 23 County Contract Postponed

During the week of April 23, OMHSAS announced a decision to extend the current HealthChoices contract for the 23 county state option zone for one year and issue a re-procurement in July or August. At the PACA MH/DS conference Deputy Secretary Blaine Smith told members it was his recommendation that the process be delayed due to a design flaw in the RFP. While he did not provide details about the problems with the RFP, he reiterated his support for the carveout.

DPW Secretary’s Flexibility Work Group

Earlier this year, DPW Secretary Gary Alexander convened a work group of commissioners to gather input from counties regarding the delivery of human services and ways to achieve greater efficiency and cost savings in the system. The workgroup was formed as a result of CCAP’s efforts to have the department address administrative and structural issues that could potentially lead to savings for counties. This work group created several subcommittees who have been meeting over the last couple of months to generate recommendations for the work group. One of the subcommittees was to focus on MH and ID issues. Several county administrators were appointed by their commissioners to serve on this subcommittee. At a meeting on April 30, the subcommittees presented their top five priority recommendations to the full work group. There is agreement between the secretary, deputy secretaries and commissioners on the work group that the Department will evaluate each of the issues identified and report back in June if or how the Department can act on each item to improve flexibility of county-administered services.

OMHSAS Deputy Secretary Blaine Smith and his staff provided support to the MH/ID subcommittee. As a result, the recommendations put forward focus on mental health services, but there are also issues to be resolved with the Office of Developmental Programs. The recommendations from the MH/ID subcommittee include: 1) examining licensing regulations as well as credentialing and accreditation process to look for ways to streamline, consolidate or eliminate unnecessary processes; 2) examine outpatient regulations to address issues such as psychiatric sign off on treatment plans and use of extenders; 3) Redesign BHRS to focus on evidence based approaches, skill transference and outcomes; 4) Examine alternative methods of administering the proposed co-pay for PH-95 loophole children through BH MCOs; and 5) revisit county plan and reporting requirements in the context of block grant discussions.

ODP Issues Updates on Administrative Entity Operating Agreement         

On April 26, 2012 the Office of Developmental Programs (ODP) sent all county intellectual disability programs information regarding changes to the Administrative Entity Operating Agreement. The changes are contingent upon the Centers for Medicare and Medicaid Services approval of the waiver renewal applications. The changes include refinements to the delegated functions including: defined performance measures and processes to maintain compliance for delegated functions; and identification of whether incident management is a delegated function. ODP is requesting identification of all functions listed in section 3.1 of the AE Operating Agreement that are currently delegated or that the AE anticipates delegating. Each function that can be delegated must have a corresponding performance measure, data collection and system for analysis, remediation, tracking and reporting to CMS. A spreadsheet was provided with the mailing for compilation of responses. Each county must complete the spreadsheet and submit it to the regional office even in the event the county does not delegate any functions under the waiver. ODP requested a response by May 4, 2012.

If you did not receive this information, contact Deb Neifert at dneifert@pacounties.org. All responses and questions should be directed to ODP regional planning managers.

Early Intervention Contract Update

ITF Waiver County and Provider Contracts have been revised to allow for a three year contract. The use of this multi-year contract is optional; county program may continue to enter into a contract with providers for a one year period of time. Counties choosing to enter into a contract with providers for only one year at a time should use the single year contract (second link).

·         OCDEL Provider and County Contract April 2012

·         OCDEL Provider and county contract March 2011

If you have any questions please contact Cathi Berkey at cberkey@pa.gov or at 717-346-1119.

PACA MH/DS Board members made a request of OCDEL program staff at a CAAC meeting in February to consider evergreen contracts. The Association thanks the office for quick action to streamline a paperwork mandate.

National News

SAMHSA Promotes Children's Mental Health Awareness

To promote the importance of children's mental health, the Substance Abuse and Mental Health Services Administration (SAMHSA) sponsors National Children's Mental Health Awareness Day on May 9. This year’s public awareness effort continues the "Caring for Every Child's Mental Health” effort to spread the message that positive mental health is essential for healthy development.

SAMSHA is sponsoring Heroes of Hope Flickr challenge. Between April 2 and May 31youth are encouraged to upload to Flickr a photo of their hero, a photo with their hero, or a photo that represents their hero in building resiliency and experiencing trauma. For more information on the Flickr challenge, visit the SAMSHA website. The site also has listings of events throughout the nation and issue briefs and reports to support local awareness activities.

CMS Issues Final Community First Choice Option Rules

The Center for Medicare and Medicaid Services (CMS) released the Community First Choice (CFC) Option final rule also known as a “1915(k)”. CFC fulfills a provision of the Affordable Care Act to provide an incentive to states to expand community-based attendant services and supports to people with disabilities who are eligible for an institutional level of care. States that choose the CFC option will receive a 6 percent increase in their federal Medicaid match for those services.

The rule requires states to provide CFC services only in a “home and community” setting, but does not state the definition of a home and community setting. The proposed definition generated so many comments that CMS decided to revise the definition and seek public input again. The revised definition will appear in the proposed rules implementing the Home and Community Based State Plan option (detailed in another article). Once a definition is finalized it will apply across all of the home and community programs including 1915(c) waiver programs, the 1915(i) State Plan option, and the 1915(k) CFC Option. The CFC final rule is expected to be published in the Federal Register on May 7, 2012.

The final rule is available in the April 26, 2012 edition of the Federal Register.

CMS Proposes Rules Regarding Home and Community Based State Plan Option

Centers for Medicare and Medicaid Services (CMS) announced the proposed State Plan Home and Community-Based Services (HCBS) rule, otherwise known as the “1915(i)”. The proposed rule gives states guidance about how to amend their state Medicaid plans to make home and community-based services available without having to design waivers or demonstrations. The HCBS rules would make services more accessible to individuals with significant needs who will not have to meet institutional level of care. Services do not have to meet the “cost neutrality” standard and can include a variety of populations. If a state chooses the option, services must be available to anyone who meets eligibility standards as waiting lists are not permitted.

The proposed rule also states CMS’s definition of home and community settings that would apply to Community First Choice options. The rule prohibits nursing facilities, institutions for mental diseases, or intermediate care facilities for the intellectually disabled and further specifies the following qualities:

 “The setting is integrated in, and facilitates the individual’s full access to, the greater community including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, like individuals without disabilities. . . “

CMS will rely on the proposed setting definition as it reviews new 1915(k) CFC options and will expect states to comply with the setting requirements. If there are changes to the definition when the rule is finalized, CMS will give states a transition period, at a minimum of one year, to make any needed changes.

The proposed rule is available in the April 26, 2012 edition of the Federal Register. Comments will be accepted for 30 days.

CMS Proposes 10 Year Look-back for 60 Day Repayment Obligation Rules

In March 2010, The Affordable Care Act created new requirements for all health care providers, suppliers, and managed care organizations receiving Medicare or Medicaid funds regarding overpayments. The requirements include the return of federal fund overpayments within 60 days from the date the overpayment is identified. Non-compliance subjects the provider to penalties under the False Claims Act, Civil Monetary Penalties Law and potential exclusion from participation in federal health care programs.

In February the Centers for Medicare and Medicaid Services (CMS) proposed regulations to clarify overpayment and start of the 60 day clock. CMS has specifically requested comments on the 10 year period for looking back as it is from the False Claims Act statute of limitation and may be unworkable in the repayment context.

The proposed regulations are available at the February 1, 2012 edition of the Federal Register. In addition, the Pennsylvania Department of Public Welfare has an established formal mechanism for making a voluntary disclosure on their website.

Resources

Medicaid Infrastructure Grant, Promoting Employment for Persons with Disabilities Requests for Proposals - April 2012

The Medicaid Infrastructure Grant (MIG) has enabled Pennsylvania to support the collaboration of community agencies, educational institutions, and businesses to promote competitive employment for people with disabilities. As one of the final initiatives of the MIG, the Works for Me Program is seeking intermediate units, schools, Careerlinks, community agencies, consumer groups, centers for independent living, organizations who serve people with disabilities, and other stakeholders to actively promote employment for people with disabilities. More information: Proposal  and Template

Webinar on Juvenile Diversion Programs

“Implementing Juvenile Diversion Programs: Guidelines and Innovative Approaches” is a webinar that will be available from 2:00 - 3:00 p.m. on Thursday, May 10, 2012. The focus is on diverting youth with mental health disorders, including those with co-occurring substance dependence, from the juvenile justice system to improve outcomes for both the youth and his or her family. This webinar will explore successful practices for directing youth to treatment with effective innovative programming. Diversion practices along the continuum of his or her contact with the juvenile justice system will be discussed. Register at the Council of State Government’s Justice Center’s website.

County Offender Reentry Planning Grants     

The Office of Criminal Justice System Improvements of the Pennsylvania Commission on Crime and Delinquency (PCCD) announced the availability of up to $120,000 in Byrne Justice Assistance Grant (JAG) Funding. The funds are being made available to help counties create an offender re-entry plan that should be included in their county criminal justice strategic plan. The Community Revitalization and Re-entry Initiative is available to provide assistance to county Criminal Justice Advisory Boards as they establish offender re-entry strategies.

If you are not registered, go to the website www.pccdegrants.state.pa.us and select Register. Once your registration is accepted, select the Login button. Enter the User ID and Password established when you registered, and Login to the system through the Egrants Production link. Then you will see the User Management Profile Details page. You must save this information in order to access the system.

The application deadline in June 15, 2012, but the recommended agency and user registration dates are prior to this.

ODP Communications

04/30 - FY 2010-2011 IM4Q Report Available Announcement #031-12

04/26 - MIG Mini Grant Application

04/25 - Mileage Rate Change Announcement #033-12

04/25 - Removal of Illness as Secondary IM Category under Hospitalizations Announcement #032-12

04/20 - Status of 2012 SC Required Training Announcement #030-12

04/20 - Introduction to Work Incentives and Ticket to Work for Professionals Serving Youth in Transition

Upcoming Events