The Office of Developmental Programs (ODP) intends to implement a new way of selecting and managing providers in the state of Pennsylvania who offer residential services for people with intellectual disabilities and autism, called Performance Based Contracting.
Under the current agreement with Centers for Medicare & Medicaid Services (CMS), payments to providers are based on Fee for Service (FFS), which is a method where providers are paid for each service performed if the basic requirements are met. Under Performance Based Contracting providers will be placed in tiers based on a set of performance metrics, and ODP would follow an Alternative Payment Model (APM), with pay-per-performance measures that may include payments for reporting, and payments and/or bonuses for achieving quality outcomes.
Performance Based Contracting seeks to enhance quality outcomes and improve the satisfaction of people supported and their families with preferred providers of residential services.
ODP has seen a rise in compliance issues in residential community homes in recent years. From July 2018 to January 2020 the percentage of licenses operating under provisional or revocation pending appeal status more than tripled. From January 2020 to January 2023 those numbers increased again, representing 200 licensed homes. This led to more unannounced inspections that revealed increases in the number of violations per inspection, including abuse, improper medication administration, and failure to arrange or provide health services.
For residential services, ODP will establish three tiers – Primary Providers; Select Residential Providers; and Clinically Enhanced Residential Providers – with specific criteria to evaluate eligibility. This is to ensure that there is a preferred provider pool and continuity of care for individuals receiving residential services. Each provider will be contracted by their qualified tier definition and will be recertified annually, with provider agreement renewal every three years.
As a provider that prides itself on delivering the highest quality supports to the people it serves, our goal is to achieve the top tier status – Clinically Enhanced Residential Provider. Our senior leadership team has developed and will be implementing a plan that outlines all the initiatives needed for us to obtain this status. As that plan rolls out, additional communications will be provided to ensure that all team members are aware of their department’s responsibilities.
“We have faced many challenges together over the past year, and this is just another step in achieving success,” said Kim Love, CEO. “I have every confidence in our team members to ensure that 2024 is a defining year for InVision. We have the opportunity to set the standard for what it means to be a provider of choice for people experiencing intellectual disabilities, autism, and mental health issues in the state of Pennsylvania.”