Pennsylvania: Performance-Based Contracting (PBC) for SCs

The Hardship: Moving from 15 Minutes to "Outcomes"

Effective January 1, 2026, the landscape for Pennsylvania Supports Coordination Organizations (SCOs) changed forever. The Department of Human Services has officially moved away from traditional 15-minute unit billing, replacing it with a Performance-Based Contracting (PBC) model.

For many agencies, this isn't just a billing update—it’s an operational earthquake.

Why "Business as Usual" is No Longer Enough

Under the old 15-minute unit system, revenue was tied to time spent. Under the new 1915(b)(4) waiver, revenue is tied to outcomes.

The new structure introduces:

• Monthly Case Rates: A fixed fee per member, requiring tighter efficiency.
• The 3% Pay-for-Performance Pool: A supplemental revenue stream that is only accessible if you can prove your impact.

The challenge? You can no longer just do the work; you have to prove the quality of the work through rigorous data integrity.

The Gatekeeper: The PAS Data Integrity Audit

To access that critical 3% revenue supplement, SCOs must now satisfy a new vendor: the Performance Analysis Service (PAS). The PAS isn't looking at how much you did; they are auditing how well you moved the needle on a member’s independence.

They are specifically looking for documented movement in:

• Least Restrictive Service Options: Are members living in the most independent settings possible?
• Employment Outcomes: Is the SCO actively facilitating competitive integrated employment?

If your documentation doesn't clearly show active movement toward these goals, that 3% supplement vanishes.

How Statewise Empowers Pennsylvania Agencies

In this new "Outcome Era," your EHR and RCM tools are either your greatest liability or your strongest asset. Statewise was built specifically to bridge the gap between clinical care and performance-based reimbursement.

1. Audit-Ready Documentation

Statewise streamlines the capturing of "Outcome Data." Instead of burying employment progress in long-form narratives, Statewise allows SCs to tag and track specific milestones that the PAS vendor looks for. When the audit happens, you aren't digging for proof—it’s already there.

2. Real-Time Revenue Protection

Our platform provides RCM teams with a dashboard view of the 3% supplemental pool. Statewise flags members who lack the necessary "independence markers" in their documentation before the billing cycle ends, giving your clinical team time to correct course and secure your funding.

3. Maximizing the Case Rate

With 15-minute billing gone, agency profitability depends on efficiency. Statewise automates the "busy work" of supports coordination, allowing your SCs to focus on high-quality member interactions that drive the outcomes Pennsylvania now demands.

The Bottom Line

The era of simple billing is over. Pennsylvania RCM is now a game of data integrity. With Statewise, your agency won’t just survive the transition to PBC—you’ll lead the way in showing what true "performance" looks like.

Is your agency ready for the PAS Audit?

• Source: PA Department of Human Services, Waiver Amendments to Implement Performance-Based Contracting (Effective Jan 1, 2026).