Performance-Based Contracting Information
This FAQ contains questions not answered in the Implementation Guide or Residential Performance Standards Documents. Please review these documents if your questions are not answered below.
FAQ Last Updated: 10/18/2024
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TIER ASSIGNMENT
ODP will review the provider’s submission based on the tier for which the provider applied.
If the provider meets all of the measures for the tier, the provider will receive written notice that they have been assigned to the tier they applied for.
If a provider does not meet all of the measures for the tier, the following will occur:
If the provider applied for Primary status, the provider will be notified in writing that they have been assigned to the Primary tier, but that corrections are required prior to the next submission period. The notice will include a list of measures that were not met and must be corrected prior to the next submission period.
If the provider applied for Select status, the provider will be notified in writing that they have not met the criteria for Select status. The notice will include a list of measures that were not met.
– If the provider believes the Department made an error in the tier determination, the provider will have the opportunity to provide information supporting their position. Please note that this is not an opportunity to correct an unmet measure, but rather an opportunity for the provider to submit information that supports their position that the Department made an error when determining if a measure was met.
– Upon receipt of the provider’s materials, the Department will reexamine its findings.
~ If an error was made, the provider will be notified in writing that they have been assigned to the Select tier.
~ If no error was made, the provider will be notified in writing that they have been assigned to the Primary tier, and that corrections are required. The notice will include a list of Primary measures that were not met, instructions for what corrections must be made, and dates by which corrections are due.
If the provider applied for Clinically Enhanced status, the Department will review the provider’s submissions to determine whether the provider is eligible for the Select tier.
If the provider is eligible for the Select tier, the provider will be notified in writing that they have not met the criteria for Clinically Enhanced status, but have met the criteria Select tier. The notice will include a list of Clinically Enhanced measures that were not met.
– If the provider believes the Department made an error in the tier determination, the provider will have the opportunity to provide information supporting their position. Please note that this is not an opportunity to correct an unmet measure, but rather an opportunity for the provider to submit information that supports their position that the Department made an error when determining if a measure was met.
– Upon receipt of the provider’s materials, the Department will reexamine its findings.
~ If an error was made, the provider will be notified in writing that they have been assigned to the Clinically Enhanced tier.
~ If no error was made, the provider will be notified in writing that they have been assigned to the Select tier.
If the provider is not eligible for the Select tier, the provider will be notified in writing that they have not met the criteria for Clinically Enhanced status. The notice will include a list of measures that were not met.
– If the provider believes the Department made an error in the tier determination, the provider will have the opportunity to provide information supporting their position. Please note that this is not an opportunity to correct an unmet measure, but rather an opportunity for the provider to submit information that supports their position that the Department made an error when determining if a measure was met.
– Upon receipt of the provider’s materials, the Department will reexamine its findings.
~ If an error was made, the provider will be notified in writing that they have been assigned to the Clinically Enhanced tier.
~ If no error was made, the provider will be notified in writing that they have been assigned to the Primary tier, and that corrections are required. The notice will include a list of Primary measures that were not met, instructions for what corrections must be made, and dates by which corrections are due.
No. A provider should only apply for a tier for which they know they will meet all required measures. Providers will have the opportunity to respond to the Department’s tier determination if they believe an error has been made, but may not correct an unmet measure after the fact (see “What will happen after a provider submits their data in the Data Collection Tool?” above).
Effective January 1, 2025, when ODP determines that there is a need for additional Residential Habilitation, Life Sharing, or Supported Living providers, new residential provider applicants will be invited to qualify for enrollment through a competitive request for application process. In the meantime, we strongly encourage applicants to enroll to provide non-residential services to gain the experience necessary for successful residential service provision. This will also help providers meet the current qualification requirement to have two years’ experience providing non-residential services as described in ODPANN 24-008: Clarification Regarding New Qualification Requirements for Agencies That Want to Enroll to Provide Residential Services.
This only applies to providers that are not enrolled and qualified to provide Residential Habilitation, Life Sharing, or Supported Living services in the Consolidated and/or Community Living Waivers by December 31, 2024. All providers that are enrolled and qualified to provide residential services by December 31st will be assessed for tier determination in either August 2024 or February/March 2025.
DATA SUBMISSION TOOL
Yes, a provider may withdraw a data submission tool they completed in August 2024. Providers must send an email to ra-pwodppbc@pa.gov stating that they would like to withdraw their data submission tool. This email must include the provider legal entity name and the agency’s nine-digit Master Provider Index (MPI) Number. This email must be sent no later than 11:59 pm on September 13, 2024. Providers will receive an email within one business day confirming receipt of the request to withdraw a data submission tool.
Yes, all providers of residential services through the Consolidated and Community Living Waivers are required to submit data and documentation for tier consideration, regardless of the tier for which they meet the criteria.
COMPOSITE SCORING
On the scoring tool you will see a column labeled “Composite Category”.
– If NA appears in the column, the measure stands alone and is not part of a composite category. The provider must meet the measure in order to obtain the desired tier.
– If CN appears in the column, the measure is part of the Complex Needs composite category.
– If D appears in the column, the measure is part of the Data Management composite category.
– If WA appears in the column, the measure is part of the Workforce Administration composite category.
In most cases, providers need to achieve at least 70% of the measures from the Complex Needs, Data Management, and Workforce Administration composite categories to obtain the desired tier. In some cases, providers might need to achieve slightly less than 70%, because not meeting one measure will result in a score of slightly less than 70%.
Yes. As an example, to meet the Clinically Enhanced tier there are 6 measures in the Data Management (D) composite category. Each measure equals 16.67%. Providers will need to meet at least 5 of the 6 measures in the Data Management composite category to meet the Clinically Enhanced tier requirements (score of 83%).
If your organization is applying for the Clinically Enhanced tier, then the measure applies whenever any of the following appear in the “Applicability” column:
– ALL (Applies to all tiers)
– C (Applies to Clinically Enhanced only)
– SC (Applies to Select and Clinically Enhanced)
If you cross-reference the Composite Categories for the measures that apply to ALL, C, and SE, you will note that:
– CN has 7 measures.
– D has 6 measures.
– WA has 6 measures.
Therefore, to meet or exceed the 70% threshold for each Composite Category, a provider that is applying for the Clinically Enhanced tier must meet at least:
– 5 CN measures, and
– 5 D measures, and
– 5 WA measures.
Additionally, all Clinically Enhanced providers must fall into one of the following categories:
– Clinically Enhanced for Medical Support,
– Clinically Enhanced for Behavioral Support (“Dual Diagnosis” in some documents), OR
– Clinically Enhanced for Medical Support and Behavioral Support
You will note that each measure that applies to the Clinically Enhanced tier has one of the following codes in the “Clinically Complex Category” field:
– NA
– BS
– MA
To be Clinically Enhanced for Medical Support, the provider must meet:
– All “NA” measures / composite measures
– CN-M.01.1
– CN-M.01.2
But does not have to meet:
– CN-DD/Bx.01.2
– CN-DD/Bx.02.2
– CN-DD/Bx.03.3
To be Clinically Enhanced for Behavioral Support, the provider must meet:
– All “NA” measures / composite measures
– CN-DD/Bx.01.2
– CN-DD/Bx.02.2
– CN-DD/Bx.03.3
But does not have to meet:
– CN-M.01.1
– CN-M.01.2
To be Clinically Enhanced for Medical Support and Behavioral Support, the provider must meet:
– All “NA” measures / composite measures
– CN-M.01.1
– CN-M.01.2
– CN-DD/Bx.01.2
– CN-DD/Bx.02.2
– CN-DD/Bx.03.3
You will note that CN-DD/Bx.01.2 is also a CN measure, so if a Clinically Enhanced provider wants to be Clinically Enhanced for Behavioral Support, they must meet CN-DD/Bx.01.2 even though it is part of a composite measure.
PERFORMANCE MEASURES: CONTINUUM OF SERVICES
See Residential Performance Standards
PERFORMANCE MEASURES: WORKFORCE
Providers should click on the original link in the invitation email they used to access the survey. If they completed the survey, they will be brought to this page:
Then, they can click on “Review”. At the bottom of the Review page, there is an option to “PRINT” the responses. This will allow providers to download their responses as a PDF.
ODP recommends reviewing the resources under “Supporting Organizations with tools to improve diversity, equity and inclusion (DEI) performance” on https://home.myodp.org/resources/diversity-equity-inclusion/.
PERFORMANCE MEASURES: SUPPORTING INDIVIDUALS WITH COMPLEX NEEDS
The residential provider’s Behavioral Support Specialist does not meet this requirement. To meet this requirement, the residential provider must describe external established professional relationships with agencies or professionals such as a relationship with a local behavioral health provider, peer specialist, and/or primary care health/medical provider that has training/experience in autism or developmental disabilities. If the residential provider does not have any external established professional relationships in the community/communities they serve, this should be reported in the data submission tool. ODP expects that residential providers will establish these relationships to ensure individuals have access to all needed medical and mental health assessment and treatment.
While the Specialty Telehealth and Assessment Team (STAT) service meets the requirements of the measure, ODP expects residential providers to have additional external established professional relationships in the community/communities they service to ensure all individuals have access to all needed medical and mental health assessment and treatment. ODP is asking for relationships that have been established by July 1, 2024, for providers that are submitting for tier assignment in August and February 15, 2025, for providers submitting in February/March 2025.
An equivalent basic course on effectively supporting individuals with Autism Spectrum Disorder must cover the following topics:
– The core deficits in individuals with autism. Co-occurring mental and physical conditions, as they present in individuals with autism. How deficits can change dependent on the environment, daily routines/activities, trauma, medical/psychiatric presentations, and/or supports present/absent in a person’s life.
– Basic information about Applied Behavioral Analysis, including common terms, basic principles used to change behavior and teach new skills. An overview of the process and use of Functional Behavioral Assessments to drive the development and implementation of a Behavioral Support Plan.
– Information on identifying and teaching adaptive skills used in everyday life, the importance of adaptive and independent living skills, and challenges that may arise when teaching adaptive skills to individuals with autism.
– Community engagement, including how community engagement plays a role in supporting individuals with autism and their families. Information about how to best support participants in making informed choices and decisions, while also being aware of the dignity of risk.
– How to support participants in finding and maintaining meaningful employment and educational opportunities. This includes the benefits of employment and postsecondary education in a participant’s life, available vocational and educational supports, and the impact of employment on benefits.
– Information on the basic social and communication deficits associated with autism, and challenges individuals with autism may have in navigating social relationships. Methods that can be used to help individuals improve their social skills. Recognition of the differences in language and communication.
For the first contract year, this measure solely requires submission of an attestation. As outlined on the attestation form, the provider is expected to produce documentation demonstrating the Residential Provider meets the requirements for all items checked upon request by ODP.
While there are varying definitions of polypharmacy, the term typically refers to the simultaneous use of multiple drugs (such as 5 or more) by a single individual for one or more conditions, or multiple drugs used by an individual for a single ailment or condition. Since this measure is evaluated by providers’ submission of the use of data to impact individual outcomes over time based on measurable factors, the provider may determine how they define polypharmacy as part of their submission to ODP.
The following crisis prevention and de-escalation training programs meet measure CN-DD/Bx.03.3:
– Ukeru
– Crisis Prevention Institute (CPI)
– Collaborative and Protective Solutions (CPS)
– Mandt System®
– Non-Violent Crisis Intervention® Training
– Safe Crisis Management (SCM)
– Quality Behavioral Solutions (QBS) – Safety Care
– Therapeutic Options
NOTE: “Positive Behavioral Interventions and Supports (PBIS)” was removed from the original list because PBIS is an approach to behavioral intervention and not a curriculum. One cannot get liability coverage through PBIS nor can one be certified in PBIS in the same way these can be accomplished in other curricula listed.
PERFORMANCE MEASURES: REFERRAL AND DISCHARGE PRACTICES
See Residential Performance Standards
PERFORMANCE MEASURES: DATA MANAGEMENT
The provider can choose to submit an operational or quality report that covers either Calendar Year 2023 or Fiscal Year 2023-24.
PERFORMANCE MEASURES: RISK MANAGEMENT
Providers can access their data for RM.IM.01.2, RM.IM.01.3, and RM.IM.01.4 through the Enterprise Incident Management dashboard. ODP recommends reviewing Incident Reporting Overview Dashboard Training Guide for more information. ODP will publish Calendar Year 2023 percentages by MPI for RM-IM.01.1 on Performance-Based Contracting – MyODP.
PERFORMANCE MEASURES: EMPLOYMENT
See Residential Performance Standards
PERFORMANCE MEASURES: USE OF REMOTE SUPPORT TECHNOLOGY
See Residential Performance Standards
PERFORMANCE MEASURES: REGULATORY COMPLIANCE
See Residential Performance Standards
PERFORMANCE MEASURES: QUALITY
See Residential Performance Standards
PERFORMANCE MEASURES: ADMINISTRATION
Providers of Residential Habilitation, Life Sharing, and/or Supported Living services are required to “annually submit to ODP the most recent financial statement” in order to remain qualified to render the service(s). For this reason, the Data Collection Tool for each tier asks “Did your agency submit financial statements to ODP within the past 12 months?” If you answer “Yes” to this question, you will be prompted to enter the date financial statements were submitted. If you answer “No” to this question, you will be prompted to upload current financial statements.