Regulations & Reimbursement

Long-term care providers are among the most regulated entities by both the state and federal governments — and, unfortunately, this burden continues to expand. Our new Federal and State Regulations Guide provides LeadingAge PA members with up-to-date information and resources regarding the numerous and varied regulations affecting retirement living communities and other long-term care providers.

The guide provides specific information on senior living regulations, including skilled nursing facilities, assisted living residences, personal care homes, home and community-based services, housing entities and general regulations.

Patient-Driven Payment Model 

LeadingAge PA strives to meet your needs with the upcoming transition of Medicare prospective payment from the use of RUG-IV to the Patient-Driven Payment Model (PDPM). Please visit the new PDPM section of our website to review our useful list of PDPM preparation resources! LeadingAge PA members, please watch for ongoing communication in our weekly Government Affairs Update, and check back often for new resources. If you have questions or suggested resources, please contact Beth Greenberg. 

Community HealthChoices

Community HealthChoices (CHC) is the Commonwealth’s program delivering Medicaid-funded physical and behavioral health services in addition to long-term services and supports through a capitated, managed care model to older Pennsylvanians and adults with physical disabilities. CHC uses managed care organizations to coordinate the physical health, behavioral health, and long-term service and support needs of participants in order to improve access, efficiency, and quality to qualifying populations. The PA Community HealthChoices program is designed to ensure that individuals get the care they need, no matter where they live.

Below, you’ll find a list of resources to inform you about Community HealthChoices. They can help you understand what the program covers, what it doesn’t cover, how to enroll as a provider, and how to explain it to your residents so they may select a managed care organization.

• CHC Questions and Answers document
• CHC Contact Information
• How to Apply
• DHS CHC Provider Summit Presentations
• MA Bulletin for Exceptional DME
• MA Bulletin: Quarterly Budget Adjustment Factor in CHC
• CHC Listserv Sign Up
• Nursing Facility Payments Under CHC

Still have questions about Community HealthChoices in PA?  Find more information here.

Emergency Preparedness

One important area of retirement living regulation is emergency preparedness. If a fire, flood or other natural disaster strikes, will your community be ready? A new set of requirements, entitled “The New Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers,” is now in effect. Compliance with these retirement living regulations — including documentation of exercises and requisite planning — will be reviewed during annual surveys, and at LeadingAge PA, we want to help you make sure your community is ready. Below, you’ll find a set of resources to help you understand the new senior living regulations and implement them in your organization.