Pennsylvania: Performance-Based Contracting (PBC) for SCs
The Hardship: Moving from 15 Minutes to "Outcomes"
Effective January 1, 2026, Pennsylvania has implemented a concurrent 1915(b)(4) waiver to launch Performance-Based Contracting for Supports Coordination Organizations (SCOs). The era of simple 15-minute unit billing is being replaced by a monthly case rate and, more importantly, a 3% supplemental "Pay-for-Performance" pool.
RCM Insight: The PAS Data Integrity Audit
To access that 3% revenue supplement, your RCM and clinical teams must satisfy a new vendor: the Performance Analysis Service (PAS). The PAS vendor audits data integrity across areas like "Least Restrictive Service Options" and "Employment Outcomes." If your SCO’s documentation doesn't show active movement toward these goals, you lose the supplement. For the first time, Pennsylvania RCM is no longer just about how much you did, but how well you moved the needle on a member's independence.