Medical Rehab

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The Department of Human Services (DHS) published a notice that will appear in tomorrow’s Pennsylvania Bulletin that they intend to make a supplemental payment in fiscal year (FY) 2017/2018 to certain special rehabilitation facilities (SRFs) that have high Medical Assistance (MA) and total facility occupancy levels. An SRF is one that specializes in providing services and care to adults who have a neurological/neuromuscular diagnosis and condition, as well as severe functional limitations. Because of the complex needs of these individuals, SRF’s typically incur staffing and specialized medical equipment costs that are very high. Additionally, SRF’s with high MA and total facility occupancy levels are dependent on MA payments to continue to operate. To help offset the higher costs incurred by these SRFs while they reconfigure to home and community-based services, DHS intends to make a supplemental payment to these facilities to assure that the unique services they provide continue to be available to MA beneficiaries.

To qualify for an MA dependency payment the following requirements must be met:

  • Be classified as an SRF as of the cost report end date.
  • Have MA occupancy greater than or equal to 94% as reported on Schedule A, Column A, Line 5 of the cost report.
  • Have an overall nursing facility occupancy greater than or equal to 95% as reported on Schedule A, Column A, Line 4 of the cost report.
  • Have at least 200 MA certified nursing facility beds as of the cost report end date.

DHS will accept comments on this notice for thirty days following publication. Comments should be sent to: Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Marilyn Yocum, PO Box 8025, Harrisburg, PA 17105-8025.

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The Centers for Medicare and Medicaid Services (CMS) has contracted with the Center for Outcomes Research and Evaluation (CORE) to re-evaluate the Overall Hospital Quality Star Rating on CMS’ hospital quality website, Hospital Compare. The goal of the Overall Hospital Quality Star Rating project is to improve the usability, accessibility, and interpretability of this website for patients and consumers.

CMS and the development team are seeking stakeholder input on several methodology reevaluation items designed to enhance the Overall Star Rating methodology. This public input period aims to highlight technical and policy considerations for the public. While the team has evaluated several methodological enhancements and continues to evaluate others, this public input period is designed to solicit specific feedback on the content, enhancements listed, as well as topics in active re-evaluation.

Members are encouraged to review the document thoroughly and provide feedback by close of business on Wednesday, September 27, 2017 via email.

Early bird registration has been extended for the 2017 RCPA Conference, to be held at the Hershey Lodge, Tuesday to Friday, October 10–13. This is your last chance to take advantage of the discounted early bird rates! The deadline for early bird registration and discounted rates is now Wednesday, September 20. Please be sure to register by Wednesday to receive these special rates.

This year’s annual conference features a Keynote Address from Teresa Miller, newly named

DHS Secretary, as well as two plenary presentations; one from Jean Bennett of SAMHSA and also a panel discussion with Pennsylvania’s Aging Secretary Teresa Osborne, OLTL Deputy Secretary Jen Burnett, ODP Deputy Secretary Nancy Thaler, OMHSAS Acting Deputy Secretary Ellen DiDomenico, OMAP Deputy Secretary Leesa Allen, and DDAP Acting Deputy Secretary Jen Smith. The moderator for this panel will be Charley Curie, national consultant, past SAMHSA Administrator, and past OMHSAS Deputy Secretary. The conference also features over 70 workshops offering continuing education. New this year is the Executive Level Track of workshops. In addition, there are several networking receptions, an awards dinner, exhibit hall, and entertainment. Register here for early bird savings.

If more information or assistance is needed, please contact Sarah Eyster. We look forward to seeing you in October!

On Thursday, September 28, 2017, from 2:00 pm to 3:00 pm, the Centers for Medicare and Medicaid Services (CMS) will host a special open door forum (SODF) that will provide information and solicit feedback on the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. Topics will include the goals of the IMPACT Act, RAND contract activities for item development (including pilot test results and plans for the upcoming national field test), and identifying opportunities for providers, consumers, stakeholders, researchers, and advocates to become involved over the next year. CMS welcomes questions, comments, and ideas from providers, patients, consumers, researchers, and advocates in advance or during the forum. Questions, comments, and ideas should be submitted via email. The presentation for the SODF is posted on the IMPACT Act Downloads and Videos web page.

To participate in the SODF, dial:
Conference ID: 66557294

A transcript and audio recording of this SODF will be posted to the Special Open Door Forum website, and for downloading under the downloads section, as well as the IMPACT Act Downloads and Videos web page.

The Council on Brain Injury (CoBI) will be offering an upcoming presentation and discussion as part of their Clinical Forum Series on Thursday, September 21, 2017, from 3:00 pm to 4:30 pm. The presentation, Traumatic Brain Injury as a Result of Domestic Violence: Education, Screening & Model Practices, will be facilitated by Fern Wilkerson, MA, from the Pennsylvania Coalition Against Domestic Violence (PCADV).

Registration is free and Certified Brain Injury Specialist (CBIS) credits will be available. Contact Dana Rhoads for additional information or to register for the program.

The Centers for Medicare and Medicaid Services (CMS) and measure developers will host an upcoming call on Wednesday, September 6, 2017, from 1:30 pm to 3:00 pm that will focus on the IMPACT Act’s adopted Medicare Spending per Beneficiary Post-Acute Care (PAC) resource use measures. The call will focus on the components of each measure, as well as public reporting.

The IMPACT Act of 2014 requires the development of resource use measures for PAC providers, including inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), home health agencies (HHAs), and long-term care hospitals (LTCHs).

A question and answer session will follow the presentation. To participate in the call, please register here.

The Centers for Medicare and Medicaid Services (CMS) has launched the Jimmo Settlement Agreement web page. This web page provides access, in one location, to various public documents and resources related to the Jimmo Settlement Agreement, including a Frequently Asked Questions (FAQs) link.


Background on Settlement Agreement:

On January 24, 2013, the US District Court for the District of Vermont approved a settlement agreement in the case of Jimmo v. Sebelius, in which the plaintiffs alleged that Medicare contractors were inappropriately applying an “Improvement Standard” in making claims determinations for Medicare coverage involving skilled care (e.g., the skilled nursing facility (SNF), home health (HH), and outpatient therapy (OPT) benefits). The settlement agreement sets forth a series of specific steps for CMS to undertake, including issuing clarifications to existing program guidance and new educational material on this subject. The goal of this settlement agreement is to ensure that claims are correctly adjudicated in accordance with existing Medicare policy, so that Medicare beneficiaries receive the full coverage to which they are entitled.


The Jimmo Settlement Agreement may reflect a change in practice for those providers and contractors who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve. The Settlement Agreement is consistent with the Medicare program’s regulations governing maintenance nursing and therapy in skilled nursing facilities, home health services, and outpatient therapy (physical, occupational, and speech) and nursing and therapy in inpatient rehabilitation hospitals for beneficiaries who need the level of care that such hospitals provide.

The Centers for Medicare and Medicaid Services (CMS) has submitted a proposed rule (“Cancellation of Advancing Care Coordination through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model”) to the Office of Management and Budget (OMB). The proposed rule is currently pending regulatory review.

Included in the proposed rule is the reduction of the number of mandatory geographic areas participating in the Center for Medicare and Medicaid Innovation’s (CMMI’s) Comprehensive Care for Joint Replacement (CJR) model from 67 to 34. In addition, CMS proposes to allow CJR participants in the 33 remaining areas to participate on a voluntary basis. In this rule, CMS also proposes to make participation in the CJR model voluntary for all low volume and rural hospitals in all of the CJR geographic areas.

CMS also is proposing through this rule to cancel the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) incentive payment model, which were scheduled to begin on January 1, 2018.

The proposed rule (CMS-5524-P) will be published in the Federal Register. Public comments will be due by October 16, 2017.

The Administration for Community Living (ACL) has extended an invitation to participate in a listening session tomorrow (Friday, August 11, 2017) from 1:30 pm to 3:30 pm. This listening session is an opportunity to hear about the Partnerships for Innovation, Inclusion, and Independence, which is a proposed grant program that would combine the activities carried out by the State Councils on Developmental Disabilities, Statewide Independent Living Councils, and Traumatic Brain Injury Advisory Councils into a single state grant program. Please refer to the invite for additional information.

Listening Session Dial-In Information:
Number: 800-857-9877
Participant Code: 8400563