PCQPAC provides strength in numbers: We are at a critical moment in the history of the long-term care health system in the Commonwealth and history has taught us that there is strength in numbers in meeting all of the challenges that are on the horizon. Other states, including New Jersey, have successfully formed similar coalitions and provider networks, as a response to the implementation of Managed Care.


Even with the implementation of rate floors and the continuity of care period, there remains several serious open questions with respect to supplemental payments to providers including, but not limited to:


  • Disproportionate Share Payments

  • Appendix 4, Access to Care Payments, including:

    • Nursing facility assessment tax related allowable costs for non-public nursing facilities

    • Nursing facility assessment tax quarterly supplemental payments for non-public nursing facilities

    • Supplemental ventilator care 

    • Tracheostomy care and equipment

    • Vent equipment and supplies

    • Exceptional DME payments.


To be clear, DHS has announced that the timing and form of these payments, even though they are included in the capitated payments paid to the MCOs, must be negotiated between the providers and the MCOs. This is an area where there is strength in negotiating in numbers. PCQPAC will provide members with assistance in regards to these issues.

PCQPAC assists with operational issues arising with CHC-MCOs:

  • Members facilities are encouraged to report operational problems arising with CHC-MCOs to PCQPAC. A PCQPAC representative will work with CHC-MCO representatives to remedy the issue for all PCQPAC member facilities. This may include intervention via a lobbyist or attorney.

  • PCQPAC will assist and represent members in handling CHC-MCO transportation issues that may arise.

  • Members will be regularly surveyed in order to identify areas where PCQPAC support is needed. Survey results will be distributed to membership.

  • Members will receive frequent updates on Community Health Choices implementation. A PCQPAC representative will attend various CHC-MCO meetings and distribute notes to membership after each meeting. This will ensure that PCQPAC member facilities are immediately aware of updates and changes, without sending their own representative to meetings.


PCQPAC provides members with one voice in negotiating sustainable rates:

  • PCQPAC negotiates contracts with MCOs on behalf of members entering CHC in January 2020.

  • PCQPAC educates and assists contracted members with negotiating yearly renewal contracts with CHCMCOs. 

  • PCQPAC negotiates Quality Parameters for MCO contracting.

  • PCQPAC negotiates sustainable rates after expiration of the rate floor.


Click HERE to download our Membership Packet