Policy Areas

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RCPA is offering this exciting opportunity, exclusively for its members!

Tuesday, September 11, 2018 – 2:00 pm to 3:00 pm

In this 60-minute educational members-only webinar, hosted by RCPA and led by Wojdak Government Relations, you will learn about the statewide Quality Care Assessment (QCA), a program that annually provides more than $1 billion in Medicaid payments to hospitals and freestanding medical rehabilitation hospitals. This webinar will provide members with a comprehensive understanding of:

  • The background of the assessment and its initial design;
  • The benefits and challenges of the assessment to the industry and to classes of providers;
  • The details of the recent five year reauthorization;
  • The current politics and state agency dynamics around the assessment;
  • The current federal climate related to provider assessments; and
  • The future opportunities for freestanding medical rehabilitation hospitals.

Following this webinar, there will be a Q&A session to further discuss the presentation and share ideas related to Medicaid payments and policy. Members may also submit questions ahead of the webinar. Please register here.

Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with any questions.

The Office of Developmental Programs (ODP) released a listing of resource accounts that provided stakeholders with more specific information on whom they could contact with their questions, suggestions, and issues in 2017. A resource account is an email box that is dedicated to a specific group or process. ODP has recently updated the Resource Account Listing on MyODP.

Additionally, ODP periodically updates a listing of communications that have been deemed obsolete. Communication Number 073-18 lists Communication Numbers, titles, and links to all communications that have been archived since the release of Announcement 082-16 on November 10, 2016. Contact Carol Ferenz, RCPA IDD Division Director, with any questions.

The Office of Developmental Programs (ODP) has announced that the current agreement with Ascend, A MAXIMUS Company for the administration of SIS assessments to individuals who receive ID/A services, will expire on September 30, 2018. In order to provide uninterrupted needs assessment services, ODP will be utilizing KEPRO to administer the SIS assessments beginning October 1, 2018. KEPRO will be utilized on an interim basis until ODP is able to finalize a procurement for needs assessment services.

KEPRO will begin contacting individuals and respondents to schedule SIS assessments starting in August 2018. Ascend will continue to schedule and administer assessments through September 30, 2018. KEPRO will be holding in-person informational sessions at multiple locations throughout Pennsylvania in the near future.

KEPRO can be reached via email. If you have any questions regarding this announcement, please email them here.

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Beginning in January 2019, Community HealthChoices (CHC) will go into effect in the Southeast part of the state. To help providers learn more about CHC and ask questions, community meetings have been scheduled starting at the end of August and will continue through mid-October. Providers are encouraged to attend one of these sessions. Registration is required (either online or by telephone) and space is limited. Please see this schedule for the dates, times, and locations of the meetings. Contact Melissa Dehoff at RCPA with any questions.

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The Centers for Medicare and Medicaid Services (CMS) published the fiscal year (FY) 2019 inpatient rehabilitation facility prospective payment system (IRF PPS) final rule in the August 6, 2018 Federal Register.

Removal of the FIM Instrument and Revisions to the IRF PPS Case-Mix Groups
RCPA was discouraged to see that CMS finalized its proposals to enact new case-mix groups (CMGs) based on function data from the Quality Indicators section of the inpatient rehabilitation facility patient assessment instrument (IRF PAI) and remove the Functional Independence Measures (FIM) instrument from the IRF PAI effective October 1, 2019 (FY 2020). On a positive note, CMS will now have two years of data (FY 2017–2018) in its analysis to develop the FY 2020 CMGs rather than using FY 2017 data alone as originally proposed. CMS has indicated that any changes to the revised CMG definitions will be addressed in future rulemaking prior to implementation in FY 2020. In addition, CMS states it plans to provide training and educational resources on the data items in the Quality Indicators section of the IRF PAI before the new policies take effect on October 1, 2019. The final rule does not include additional analytical reports or data beyond what was published in the proposed rule, but members are encouraged to review the technical report that was referred to in the proposed rule (Analyses to Inform the Potential Use of Standardized Patient Assessment Data Elements in the Inpatient Rehabilitation Facility Prospective Payment System by RTI International).

Changes to IRF PPS Coverage Requirements
CMS adopted all of its proposals relating to the IRF coverage requirements, including:

  • Proposal to allow the Post-Admission Physician Evaluation to count towards one of the required three weekly face-to-face physician visits during the first week of a patient’s stay in an IRF.
  • Remote physician attendance and allowance to lead discussion at interdisciplinary team meeting without any additional documentation requirements. CMS notes that hospitals would still be able to set their own policies about remote attendance, and that this proposal would alleviate documentation burden on physicians and allow the physicians “increased flexibility for time management.”
  • Admission order documentation requirement. CMS adopted its proposal to remove the requirement under the IRF PPS regulations that there be a physician order for inpatient care in the medical record. CMS believes this requirement is duplicative of the requirements under the Medicare Conditions of Participation (CoPs) regulations as well as the requirements under the general Medicare Part A payment regulations that are applicable to IRFs. Therefore, even though this requirement is eliminated, there will still need to be an admission order when a patient is admitted to an IRF since IRFs must adhere to all CoPs.
  • Input on additional changes to the physician supervision requirements. CMS requested input on two areas being considered for future changes. The first area is whether some of the three weekly required physician visits could be completed remotely. The second area CMS requested information on was the use of non-physician practitioners, such as physician assistants, to satisfy some of the coverage criteria that must currently be completed only by a physician. CMS did not provide a detailed response to comments submitted, but said it would consider these stakeholder comments for future rulemaking.

Proposed Changes to IRF QRP
CMS adopted its proposals to remove two measures from the IRF quality reporting program (QRP):

  • National Healthcare Safety Network (NHSN) Facility-wide Inpatient Hospital-onset Methicillin-resistant Staphylococcus aureus (MRSA) Bacteremia Outcome Measure (NQF #1716).
    • IRFs will no longer be required to submit data on this measure for the purposes of the IRF QRP beginning with October 1, 2018 admissions and discharges.
  • Percent of Residents or Patients Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine (Short Stay) (NQF #0680).
    • Providers will no longer be required to submit data on this measure for the purposes of the IRF QRP beginning with patients discharged on or after October 1, 2018. The IRF-PAI data items associated with reporting this measure (O0250A, O0250B, and O0250C) will be removed from the IRF-PAI version 3.0 effective October 1, 2019.
    • Beginning with October 1, 2018 discharges and until IRF-PAI version 3.0 is effective, IRFs should enter a dash (–) for items O0250A, O0250B, and O0250C. CMS states that it will provide ongoing guidance to providers to clarify that use of a dash for these assessment items beginning October 1, 2018 is appropriate and will not cause a non-compliance determination.

CMS finalized its proposals to begin publicly displaying data on the following four assessment-based measures in CY 2020, or as soon thereafter as technically feasible:

  • Change in Self-Care (NQF #2633);
  • Change in Mobility Score (NQF #2634);
  • Discharge Self-Care Score (NQF #2635); and
  • Discharge Mobility Score (NQF #2636).

Changes to the IRF PPS Payment Rates for FY 2019
CMS finalized most of its payment proposals for FY 2019. However, it made small adjustments to the originally proposed outlier threshold and labor-related share due to updated data that had become available since the proposed rule.

RCPA was asked to submit a letter of support from the House Ways and Means Committee; view a copy of that letter here.

These regulations become effective on October 1, 2018. For additional information, CMS has posted a fact sheet. Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with questions.

ODP is not reissuing the original communication but is providing an updated version of Announcement 071-18: Request for Approved Program Capacity and Noncontiguous Clearance.

Please use this updated attachment in place of the one originally provided.


 

ODP Communication Number 071-18 outlines the new procedure for Approved Program Capacity (APC) and the Noncontiguous Clearance to align with requirements in the Consolidated, P/FDS, and Community Living Waivers, as well as to anticipate some changes in regulatory requirements.

While ODP has established APC for residential habilitation in homes licensed under 55 Pa. Code Chapter 6400, APC will now be established for all licensed and unlicensed homes where residential habilitation, life sharing, or supported living occur. Further, the process and form include Noncontiguous Clearance of all licensed and unlicensed homes where residential habilitation and life sharing will be provided, licensed homes where Respite will be provided, as well as licensed facilities where community participation support services will be provided, to ensure that each home and facility are noncontiguous.

Prior to opening a new service location, closing an existing service location, or changing the program’s capacity, the provider will email “Request for Approved Program Capacity and Noncontiguous Location Clearance” form, attachment #1, (directions for completing this form in attachment #2) to the Regional Waiver Capacity Manager that covers the geographic area where the service location is located (see Regional Waiver Capacity Manager Contact Information, attachment #3). The form will include information about the circumstances and the location that will enable the Regional Waiver Capacity Manager to ensure that the new or existing service location meets ODP criteria contained in the waiver and applicable regulations. After the Regional Waiver Capacity Manager receives the form and reviews the information, they will document their decision on the Request for Approved Program Capacity and Noncontiguous Location Clearance form, attachment #1, and will send the determination to the provider.

This ODP Communication includes definitions for:

  • Approved Program Capacity;
  • Licensing Capacity;
  • Community Participation Support Facilities;
  • Noncontiguous Community Participation Support Facility Locations;
  • Noncontiguous Residential Service Locations;
  • Residential Services Locations; and
  • Respite Only Homes.

Providers who open a new community participation support facility must obtain approval from the Regional Waiver Capacity Managers verifying that the service location is a noncontiguous location.

The following requirements are contained in the Consolidated Waiver for Residential Habilitation and Life Sharing as well as Life Sharing in the Community Living Waiver:

All settings must be integrated and dispersed in the community in noncontiguous locations and may not be located on campus settings. To meet this requirement, the location of each setting must be separate from any other ODP-funded residential setting and must be dispersed in the community and not surrounded by other ODP-funded residential settings. Settings that share only one common party wall are not considered contiguous. Settings should be located in the community and surrounded by the general public.

This will apply to licensed settings that are funded through any source (OCYF, OMHSAS, private pay, etc.), not just through ODP funding sources.

For residential habilitation, life sharing, and supported living, the following requirements will be contained in the 55 Pa. Code Chapter 6100 regulations when published:

A provider shall submit a written request to the Department on a form specified by the Department and receive written approval from the Department prior to increasing or decreasing the Department-approved program capacity of a service location.

A request for APC must be made when the service provider plans to open a new residential service location, close a residential service location, or change the program capacity for an existing residential service location. APC will be approved as follows:

  • A residential habilitation service location newly enrolled to provide waiver services on July 1, 2017 or later shall not exceed a program capacity of 4. With ODP’s written approval, an ICF/ID licensed in accordance with 55 Pa. Code Chapter 6600 with a licensed capacity of 5 to 8 individuals may convert to a Residential Habilitation Service location exceeding the program capacity of 4.
  • A residential habilitation service location enrolled to provide waiver services prior to July 1, 2017, shall not exceed a program capacity of 8. With ODP’s written approval, a residential habilitation service location with a program capacity of 8 may move to a new location and retain the program capacity of 8.
  • Residential habilitation service locations enrolled prior to the publication of the Chapter 6100 regulations, that are in a duplex, two bi-level units, or two side-by-side apartments are permitted as long as the total in both units does not exceed a program capacity of 8.
  • A life sharing service location shall not exceed a program capacity of 2.
  • A supported living service location shall not exceed a program capacity of 3.
  • Effective the date the Chapter 6100 regulations are published, any newly funded residential habilitation service locations in a duplex, two bi-level units, or two side-by- side apartments are permitted as long as the total in both units does not exceed a program capacity of four.

For questions regarding licensing, submit to this email.

On July 30, 2018, President Trump signed HR 6042 which delays the requirement for personal care service providers to utilize an electronic visit verification (EVV) system. This action changes the deadline by one year, to become effective January 1, 2020. HR 6042 was signed into law in order to delay reduction in the Federal Medicaid Assistance Percentage (FMAP) for personal care services furnished without an EVV system, and also requires more stakeholder input into the implementation process. For questions, contact Carol Ferenz, RCPA IDD Division Director.

Medical assistance and cardiology concept: red heart, case with first aid kit and stethoscope isolated on white background

The Office of Developmental Programs (ODP) has issued a Health Alert in order to make all providers, staff, and other caregivers aware of the serious issue of choking. All should become familiar with resources to aid in the identification of individuals at risk for choking, the training of staff, and the appropriate documentation of special dietary needs and choking precautions. Swift action is essential to prevent Irreversible harm or death!

There are two key issues to promote safety for individuals:

  1. The information contained in the participants’ care plans, including medical evaluations/recommendations, assessments, Individual Support Plans (ISPs), and any treatment plans used by the agency (hereafter “care plans”) must be accurate, consistent, and followed precisely for feeding plans, supervision of the individual while eating to maintain safety, proper positioning, and the use of specialized equipment.
  2. All staff providing service to an individual must be trained on the individual’s dietary needs, including awareness of proper foods and food textures, supervision needs during meals, proper positioning during a meal, and the use of specialized equipment related to the risk of aspiration and choking.

Action to Take for an Individual Choking:

  • Call 911 immediately! Seconds matter. Do not delay by seeking supervisory approval prior to calling 911.
  • Initiate First Aid with abdominal thrusts.
  • If the individual becomes unresponsive, move him/her to the floor and begin CPR.
  • Contact the health care practitioner after any episode of choking.

A single choking event may be a warning sign for future choking events. This warning sign needs to be taken seriously and follow-up with the health care practitioner can avoid tragic consequences.

Contact RCPA IDD Division Director Carol Ferenz with any questions.

The Department of Human Services (DHS) proposes to add Chapters 1155 and 5240 relating to IBHS to Title 55 of the Pennsylvania Code. The proposed rulemaking is published in the Pennsylvania Bulletin on August 4, 2018 and can be accessed here.

Written comments, suggestions, or objections regarding this proposed rulemaking may be submitted to the Office of Mental Health and Substance Abuse Services (OMHSAS) at the following address:

Attention: Tara Pride, Bureau of Policy, Planning and Program Development, Commonwealth Towers, 11th Floor, PO Box 2675, 303 Walnut Street, Harrisburg, PA 17105 or by email during the 30-day public comment period, which closes September 4, 2018.

The next RCPA BHRS/IBHS work group will be held on Wednesday, August 15. The work group will compile comments from discussions held over the past year and those offered by the members of the group. We are asking providers who choose to send comments into OMHSAS directly to also send a copy of your comments to Robena Spangler. This is our long-awaited opportunity to provide input into the regulations; we hope that all BHRS providers and ABA professionals are engaged. If you have any questions, please feel free to contact me at the email address above.