Summary of Public Comments Received and ODP Responses Regarding the Proposed Fee Schedule Rates for Supports Coordination and Targeted Support Management Services
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Summarizes public comments and ODP responses about proposed fee schedule rates and rate-setting methodology for Supports Coordination and Targeted Support Management services; affects Supports Coordination Organizations (SCOs) and related stakeholders in Pennsylvania.
Supports Coordination Organizations (SCOs) will transition from 15-minute unit payments to monthly case rates plus a flat fee for initial person-centered planning and initial ISP development, effective July 1, 2026.
ODP may provide stabilization payments when aggregated average revenue per individual served drops by 3% or more relative to the prior year for FYs 2026-2027 through 2028-2029.
Pay-for-performance (supplemental) payments will be available effective January 1, 2026, for SCOs that meet or exceed performance targets, up to 3% of ODP-eligible SCO revenue or per-event payments.
Tiering of SCOs will not be implemented; all SCOs are required to meet the same performance standards and will receive the monthly case rates and flat fee.
Implementation and Coverage Criteria
Implementation and payment criteria
Payment and implementation criteria for Supports Coordination and Targeted Support Management as described by ODP responses:
Rate Structure and Coding Details
| Transition from 15-minute unit billing to monthly case rates and flat fee for initial planning; no CPT/HCPCS codes specified in document. |
Provider Payment Model Changes & Actions
Transition to monthly case rates and potential stabilization payments
Effective July 1, 2026, SCOs will be paid monthly case rates plus a flat fee that covers each individual's initial person-centered planning and initial Individual Support Plan development. To support the transition from 15-minute unit payments to monthly case rates and flat fees during FY2026-2027 through FY2028-2029, ODP may make stabilization payments when the aggregated average revenue per individual served results in a loss of 3% or greater relative to the prior year's aggregated average revenue per individual.
- Monthly case rates replace 15-minute unit billing for all SCOs.
- Flat fee covers initial person-centered planning and initial ISP development.
- Stabilization payments may be made if aggregated average revenue per individual declines by >= 3% vs prior year (FY2026-2027 through FY2028-2029).
Pay‑for‑performance supplemental payments (effective 2026-01-01)
Supplemental Pay-for-Performance payments will be available beginning January 1, 2026 for SCOs that meet or exceed specified performance targets; payments will be one-time or combined payments up to 3% of ODP-eligible SCO revenue from the applicable review period or an established payment amount per qualifying event.
- Payments are tied to meeting or exceeding performance targets (person-centered planning and community integration).
- Calculated as one-time or combined payments up to 3% of ODP-eligible SCO revenue or per-event established amounts.
- Additional details and criteria are provided in Appendix B of the Supports Coordination Services Implementation Guide.
Key Definitions
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