Earlier this summer, the Office of Developmental Programs (ODP) released its proposed policies for rate setting in an “advance notice of final rulemaking” for comment. These rate setting provisions are part of the proposed Chapter 6100 regulations governing programs and supports administered and funded by ODP.
PAR and a number of our partner associations as well as numerous other commenters submitted comments with recommendations to the department
. Over 70%* of the comments provided to the state have sounded the alarm with regard to the Commonwealth's plan to address rates
that support the delivery of service.
Under the proposed ODP regulations, rates will be reviewed for "rate refresh" every three years. While welcoming the state's effort to recognize the need to improve rates over current inadequacies, the overwhelming majority of people and associations that submitted comments to ODP are concerned that
the absence of an annual market based adjustment of rates, leads to a rate and wage freeze
for the second and third year before the next refresh would occur. In addition, the standards to be used in the rate refresh have not been identified in regulation which is a serious deficit in the proposed regulation. The annual market based adjustment, using a known and objective index, uses data related to inflation, from one year to the next, to help the federal government adjust Medicare and other similar rates. PAR has recommended to ODP the use of an annual market based index prepared by CMS or other such indexes prepared by a nationally recognized authority.
ODP estimates that 80% or more of the rates relate to wage payments, thus a two year gap presents a significant hardship for providers in obtaining and retaining staff and to Direct Support Professionals in being able to accept employment in this industry or stay in the job.
PAR and other provider and advocacy associations and organizations are working for the adoption of an index as a critical part of the campaign to address the
inadequacy of Direct Support Professional wages.
PAR is deeply concerned that low wages and high turnover from inadequate rates has a direct impact on quality and system stability. PAR has produced a video that illustrates the dimension of the crisis. Go to
#FixTheDSPCrisis video.
At last month's PAR Solutions Conference, Governor Tom Wolf raised expectations of PAR members, self-advocates and family members when he stated:
“We must continue to support and invest in those programs and ensure that Direct Support Professionals are paid a living wage.”
PAR Members remain optimistic based upon the Governor's affirmative and engaged support in the FY17-18 budget for ID/A.
PAR has been meeting with ODP, DHS and members of the Governor's staff to explore how the Administration may best accomplish the Governor's desire to
"ensure that Direct Support Professionals are paid a living wage".
Many advocates have advised the Governor's office that an nationally-recognized market based index is part of the remedy, in addition to allocating additional appropriations for wage increases.
PAR
, as well as partner associations including
RCPA,
MAX,
The Provider Alliance
as well as numerous other organizations have called for the establishment in the 6100 Regulations of a nationally recognized Index to ensure fairness and accuracy with respect to the Commonwealth setting rates for ID/A programs. Being the sole funder of these services, with no insurance, co-pay, or other funding available, government bears the burden and the responsibility for this service sector.
Additionally a letter was sent to ODP, on November 7, 2017, from the Intellectual Disability and Autism (ID/A) Coalition, which includes PAR, The Arc of PA, RCPA, UCP of PA and Disability Rights Pennsylvania which urges ODP to
"include in regulation that rate development will include a factor tied to a nationally-recognized index that will be applied to rates to help prevent rate regression which impacts direct support wages and service quality."
PAR and others specifically have recommended the following language:
The Department will refresh (using Market Based Data such as the Medicare Market Based Index or any other nationally known Index) and examine and use the data sources...to recalculate and establish fee schedule rates at least every 3 years. Every fiscal year, the Department will determine and include in its annual recommended budget request to the Governor the funding amount necessary to support the application of the Medicare Market Basket Index to recalculate the HCBS fee schedule rates and bring the rates forward through the following fiscal year.
It is anticipated that ODP will soon transmit its 6100 Regulations to the Independent Regulatory Review Commission for their final review.
PAR and our colleagues are continuing to urge the Wolf Administration to adopt the Index as a provision in the regulations. PAR will continue to advocate with ODP Deputy Secretary Nancy Thaler, DHS Secretary Teresa Miller and Governor Tom Wolf's office.
*the percentage of respondent support for an annual market basket index may be higher than 70%, noting that the department lumped together responses from some agencies and associations, listing them as a single source of comments; however, of the 63 responses listed below, 45 or 71.4% specifically listed the market basket index in their submissions. There were no comments opposing the index.
