Pennsylvania’s Office of Developmental Programs (ODP) received CMS approval for significant amendments to its 2026 1915(b)(4) Performance-Based Contracting waiver and three key HCBS waivers. The changes take effect January 1, 2026, impacting the Consolidated Waiver, Community Living Waiver, and Person/Family Directed Support (P/FDS) Waiver.
Performance-based contracting changes
The updated 1915(b)(4) waiver shifts provider payments from flat service fees to a model tied to performance outcomes and compliance standards. This transition promotes accountability by linking reimbursement to provider quality and service effectiveness. ODP plans to host a December 15 webinar to review these modifications, including a Q&A for stakeholders to engage with the new framework.
Key adjustments across waivers
The Consolidated, Community Living, and P/FDS waivers include multiple revisions beyond contracting reforms:
Assistive Technology funding caps have been revised. The Consolidated Waiver introduces a $3,000 annual limit with variance options for exceptional cases. The Community Living and P/FDS waivers eliminate lifetime limits on assistive technology spending, except for generators, which remain restricted separately.
Provider billing flexibility has expanded. Services such as Benefits Counseling can now be billed when delivered to a waiver participant’s Representative Payee.
Service delivery standards have been updated. Providers of Community Participation Support, In-Home/Community Support, and Companion services must serve at least three individuals annually and provide quarterly service delivery.
Looking ahead, starting January 1, 2027, prevocational facilities must meet Pennsylvania licensing requirements to participate in certain supported employment services.
Preparing for implementation
Agencies and providers should review the revised waiver documents available through DHS and ODP to understand changes in funding limits, billing protocols, and service expectations. The December 15 informational webinar offers a detailed overview critical for operational and compliance planning. Adjustments in service delivery models and claims processing will be necessary to align with the updated standards and contracting mechanisms. These amendments emphasize performance metrics and regulatory alignment, marking a notable shift in Pennsylvania’s IDD service delivery and payment structure for 2026 and beyond.
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