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.

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. 


The pandemic has destabilized the liability insurance market causing policy premiums to spike and renewals to contain COVID-related exclusions. Best practices and policy recommendations from state and federal governing agencies have evolved rapidly, contained conflicting guidance, and left providers without necessary supports. HB1737 contains these necessary protections and was passed by the PA House and Senate. The bill now heads to Governor Wolf's desk. Urge the Governor to allow this bill to become a law - You can use the electronic form to submit an email, call directly at 717-787-2500, or send a letter: Office of the Governor; 508 Main Capitol Building; Harrisburg, PA 17120

COVID-19 has been extremely expensive for long-term care providers. The first round of CARES funding allocated in Act 24 of 2020 offered stop-gap protections to cover a plethora of increased costs. More than $1 billion dollars in federally allocated CARES Act funding remains to be allocated. Urge your member of the general assembly to support $100 million for nursing homes to provide hazard pay to front-line healthcare workers.
This document contains key fields to be included in a sample agreement for a facility’s emergency preparation plan, used to transition residents during an emergency
Yale New Haven Health System Center for Emergency Preparedness and Disaster Response Emergency Preparedness Final Rule Crosswalk 
PA Health Care Coalition Contacts 2017 Map  

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