· Updated Website Resources on DHS Website: Crucial for understanding the responsibilities of Managed Care Organizations (MCOs), and any changes, such as the adjustment of service coordination caseload sizes from 1:65 to 1:60.
· Access to Agreements and Templates: You can find agreements and hearing templates on the DHS website. These are essential for understanding the legal and operational frameworks in which we work.
· Electronic Visit Verification (EVV) Goal: By January 1, 2025, the expectation is that no more than 15% of claims should require manual edits on a quarterly basis. This goal was announced in the Medical Assistance Bulletin published by PA DHS in August 2022.
· Community Health Choices (CHC) Waiver Renewal: The CHC waiver is due for renewal by December 31 of this year.
· OBRA Amendments and Material Changes: As part of the waiver renewal process, material changes to the waivers will be presented at the July LTSS subcommittee meeting. Stakeholder input is strongly encouraged through the 30-day public comment period opening at the end of June and through attendance at the subcommittee meeting.
· NEW RULE: Nursing Home Staffing Standards: The rule sets nationwide staffing standards for nursing facilities. We will need to compare these new federal standards against existing staffing ratios mandated by the Pennsylvania DHS to identify any gaps or necessary adjustments.
· NEW RULE: Ensuring Access to Medicaid Services: While primarily focused on fee-for-service models, this rule also affects authorities under 1915(c), which includes home and community-based services (HCBS) like those provided under the OBRA waiver and Community Health Choices waiver in Pennsylvania.
· NEW RULE: HCBS Payment Adequacy: At least 80% of all Medicaid payments for specific HCBS — homemaker services, home health aide services, and personal care services — must be spent on compensation for direct care workers.
· Person-Centered Planning: The push to increase compliance with person-centered planning to 90% and is critical for enhancing the quality of care.
· Grievance System for Fee-for-Service: There is a new requirement for a grievance system specific to person-centered service plans to address participant concerns.
· NEW RULE: Section 504 Final Rule: Prohibits discrimination on the basis of disability. It encompasses several key areas, including discrimination in medical treatment, standards for accessible medical diagnostic equipment, and accessibility requirements for web content and mobile apps.
· NEW RULE: Adult Protective Services (APS) Final Rule: The new federal regulations aim to enhance the quality and consistency of APS across states. This is the first time federal regulations have been established for APS.
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