Authors Posts by Melissa Dehoff

Melissa Dehoff

Melissa Dehoff is responsible for all medical rehabilitation and brain injury service issues. Ms. Dehoff attends multiple state-level meetings to advocate on behalf of members on brain injury and rehabilitation issues and is a member of the Department of Health Traumatic Brain Injury Advisory Board.

Members are encouraged to register to participate in the Community HealthChoices (CHC) Third Thursday coming up on June 18, 2020 from 1:30 pm – 3:00 pm. The webinar this week will focus on updates on COVID-19 by new Deputy Secretary of the Office of Long-Term Living (OLTL), Jamie Buchenauer. To participate, registration is required. Following registration, a confirmation email will be sent that contains information about joining the webinar.

Questions about the webinar should be directed to the OLTL Bureau of Policy Development and Communications Management at 717-857-3280.

Today, the Department of Human Services (DHS) announced a Request for Applications (RFA) for its new Regional Response Health Collaboration Program (RRHCP). The RRHCP is designed to directly support COVID-19 readiness and response in long-term residential care facilities, improve infection prevention, and facilitate continuity of care and other services provided by long-term care facilities in a manner that mitigates risk of spread of COVID-19 to staff or residents.

More than 45,000 Pennsylvanians live in more than 1,200 personal care homes and assisted living residences, and more than 80,000 residents live in 693 skilled nursing facilities (SNFs) throughout the Commonwealth. These residents are often some of the most vulnerable and susceptible to COVID-19 due to age, presence of existing health conditions that may lead to complications, and the congregate nature of these facilities.

The RRHCP will provide operations, management, and administrative support to protect residents in long-term care facilities from COVID-19. It will help those facilities implement best practices in infection control, implement contact tracing programs in facilities, support clinical care through on-site and telemedicine services, provide remote monitoring and consultation with physicians, and enhance testing capability for both individuals in care and staff at facilities. The RRHCP will assist in identifying alternate care arrangements for hospitalized COVID-19 patients until they are considered no longer infectious and can be safely returned to their long-term care facilities.

The RRHCP is based on the Educational Support and Clinical Coaching Program (ESCCP), a learning network that provides technical assistance and educational support to long-term care facilities in light of the current pandemic. Unlike the ESCCP, which operates on a voluntary basis, the RRHCP will operate under grant agreements. Selected grantees will be awarded $175 million collectively, with funding approved by the General Assembly.

Responses to this RFA are due by June 25, 2020. Applicants can submit questions by no later than June 15, 2020. Applications can be found online through eMarketplace. DHS hopes to have agreements in place for the RRHCP by July 1, 2020.

Guidance to DHS providers related to COVID-19 is available here.

Today, the Centers for Medicare and Medicaid Services (CMS) released a guide for health systems and patients as they consider their in-person care options while COVID-19 cases decline. During the COVID-19 public health emergency, many health care systems and patients postponed non-emergency, in-person care in order to keep patients and providers safe and to ensure capacity to care for the COVID-19 patients. As the cases of COVID-19 decline, CMS is providing these recommendations to ensure that non-emergency health care resumes safely and that patients receive in-person treatment that may have been postponed. On April 19, 2020, CMS issued Phase 1 recommendations to safely resume in-person care in areas with low incidence of COVID-19 cases. As with these Phase 1 recommendations, decisions to reopen should be consistent with federal, state, and local orders, Centers for Disease Control and Prevention (CDC) guidance, and in collaboration with state and local public health authorities.

The Centers for Disease Control and Prevention (CDC) announced an award of $140 million in additional funding to help prepare for this year’s flu season, which could also come at the same time as a second wave of COVID-19 infections. This additional funding (see the funding chart) is provided by the Coronavirus Aid, Relief, and Economic Security (CARES) Act and is to be used towards staffing, as well as increasing awareness of the flu vaccine. Additionally, the funding aims to expand access for those who do not have health insurance and those who are at a higher risk of having complications from the flu and are part of the high-risk population.

The Office of Long-Term Living (OLTL) has issued a notice regarding the implementation of a temporary change in the processing of 180-day claims exception requests. This change was made due to the Commonwealth employees who work in Dauphin County and the Capitol Complex that were instructed to telework as of March 16, 2020 to mitigate the spread of COVID-19. While these employees were teleworking, OLTL reduced access to the physical site where paper mail is delivered. Therefore, OLTL is requesting that providers email their requests and supporting documentation until further notice.

Providers should follow the instructions below when submitting 180-day claims exception requests via email:

When submitting claims for 180-Day review electronically, please be sure to only send one email per recipient.

Subject line must include:

  • 9-digit PROMISe™ Provider ID and four-digit service location code
  • Recipient First and Last name
  • From and To Dates of Service

*Example: 123456789-0001 John Smith 1/1/2019–6/30/2019

 Nursing Facility claim requests must attach supporting documentation in the following order:

Direct Care Provider claim requests must attach supporting documentation in the following order:

  1. 1500 Claim form completed correctly according to the billing guide.
    1. CMS-1500 Billing Guide for PROMISe ™ Home Health Agencies
  2. Include documentation to support untimely billing.
    – Include letter on company letterhead detailing the reason for untimely filing.
    *This can be communication between the Provider and Service Coordination Agency.
    – Any updated service authorizations.

Questions regarding these instructions should be directed to the OLTL Provider Helpline at 800-932-0939, Option 2.

The meeting documents from the May 12, 2020 Managed Long-Term Services and Supports (MLTSS) meeting were recently released. The documents include the transcript, Office of Long-Term Living’s (OLTL) slide presentation that was included in their update, and a PowerPoint presentation on the 2019 Home and Community-Based Services (HCBS) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results.

On May 1, 2020, Governor Wolf announced that 24 counties from the northwest and north-central regions of Pennsylvania would be moving from red phase to yellow phase beginning Friday, May 8, 2020 as part of the Wolf administration’s process to reopen PA. This marks a reduction in some restrictions on work and social interactions. However, restrictions related to congregate care settings remain in place.

The following counties moved from red phase to yellow phase on May 8, 2020: Bradford, Cameron, Centre, Clarion, Clearfield, Clinton, Crawford, Elk, Erie, Forest, Jefferson, Lawrence, Lycoming, McKean, Mercer, Montour, Northumberland, Potter, Snyder, Sullivan, Tioga, Union, Venango, and Warren.

These counties were deemed ready to move to the yellow phase because of low per-capita case counts, the ability to conduct contact tracing and testing, and appropriate population density to contain community spread.

OLTL Services in Counties the Governor Declares in the Yellow Phase

Moving from the red phase to the yellow phase does not change any guidance that has been issued by OLTL or the Community HealthChoices (CHC) managed care organizations (MCO). All conditions outlined in the guidance noted below continue to apply to each provider category.

Home and Community-Based Services CHC Waiver Operational Guidance and the OBRA Waiver Operational Guidance including remote initial level of care assessments, Service Coordinator contacts, person-centered service plan development and provision of service.
Nursing Facilities


Clarification Guidance for Pennsylvania Pre-Admission Screening Resident Review (PASRR), the Interim Guidance on Visitation in Nursing Facilities During COVID-19, and  Guidance for Infection Control and Prevention
Living Independence for the Elderly (LIFE) LIFE Provider Guidance Related to COVID-19
Assisted Living Residences and Personal Care Homes Interim Guidance on Visitation in Nursing Facilities During COVID-19,the Guidance for Infection Control and Prevention, the Guidance Suspending and Restricting License Requirements for Personal Care Homes and Assisted Living Residences, and Visitation Restrictions in Personal Care Homes and Assisted Living Residences

Providers are encouraged to continue to monitor the Department of Health (DOH) COVID-19 website for the most up-to-date DOH guidance on COVID-19, the Department of Human Services (DHS) COVID-19 website for the most up-to-date DHS guidance on COVID-19, and Governor Wolf’s website for responding to COVID-19 in Pennsylvania.

OLTL will continue to evaluate the steps necessary to address the Governor’s plan to reopen PA and communicate updated guidance as the situation evolves.

If you have questions about the information in this ListServ email, please contact the OLTL Provider Helpline at 800-932-0939.