Medical Rehab

The Department of Human Services Office of Long-Term Living (OLTL) is establishing a Managed Long-Term Services and Supports (MLTSS) Subcommittee of the Medical Assistance Advisory Committee (MAAC). The kickoff meeting is scheduled for Tuesday, September 1, from 10:00 am to 1:00 pm at Temple University in Strawberry Square, Harrisburg, PA.

The second meeting of the MLTSS Subcommittee will be held on Monday, September 14, from 10:00 am to 1:00 pm in the PA Department of Education Honors Suite, 333 Market Street, 1st floor, Harrisburg, PA. Future meetings will be posted on the OLTL website as dates are confirmed.

The membership of the subcommittee will be announced in the coming weeks. A majority of subcommittee members will be users of long-term living services and supports, and family caregivers. The subcommittee will advise the department on the design and implementation of MLTSS in Pennsylvania. A number of RCPA members submitted nominations to be considered for the subcommittee.

The Department of Human Services (DHS) Office of Long-Term Living (OLTL) had been exploring the idea of moving the dual eligible population (Medicare and Medicaid) into the newly proposed managed long term care structure. On August 20, the decision to retain the carve-out for behavioral health services for this population was announced by DHS. This would have specifically affected many of the seriously mentally ill (SMI) population.

The decision came after a careful review of stakeholder and public comments, detailed analysis, and an understanding of the quality behavioral health HealthChoices program that is in place. DHS will continue to explore ways to further collaborate and integrate physical health with the current behavioral health HealthChoices program as the process moves forward.

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On August 12, the Centers for Medicare and Medicaid Services (CMS) announced they were extending the deadline for the submission of data associated with the inpatient rehabilitation facility (IRF) quality reporting program (QRP) for measures reported to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN).

 

This extension is being granted to provide IRFs additional time to submit data. Although the NHSN system is working, intermittent production problems have been experienced. The CDC has been working to resolve these issues and they are expected to be corrected soon.

 

The deadline for the Healthcare-associated Infection (HAI) data submission has been extended from August 15 to August 28 at 11:59 pm PT. Please Note: This extension only applies to the HAI data submission deadline. Data are submitted through the NHSN online.

The Departments of Human Services (DHS) and Aging have announced they will present their next third Thursday webinar associated with Managed Long-Term Services and Supports. The next webinar, Managed Care 101, is scheduled for Thursday, August 20, at 1:30 pm.

Included will be details on Medicare and Medicaid coordination, role of the MIPPA agreements, provider and service coordination, participant impacts, and other state’s experiences. During the webinar, participants will have the opportunity to submit questions using the chat feature provided.

To participate:

  1. Please join my Webinar.
    https://global.gotowebinar.com/register/155011011
  2. You will be connected to audio using your computer’s microphone and speakers (VoIP).  A headset is recommended.

Or, you may select “Use Telephone” after joining the Webinar.

Dial +1 (702) 489-0003
Access Code: 428-878-113
Audio PIN: Shown after joining the webinar

Webinar ID: 155-011-011

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The Centers for Medicare and Medicaid Services (CMS) published the final rule that updates the fiscal year (FY) 2016 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP) in the August 6, 2015 Federal Register. Highlights of the final rule are provided below.

Changes to the Payment Rates: CMS is updating the IRF PPS payments for FY 2016 to reflect an estimated 1.7 percent increase (reflecting a new IRF-specific market basket estimate of 2.4 percent, reduced by a 0.5 percentage point multi-factor productivity adjustment and a 0.2 percentage point reduction required by law). An additional 0.1 percent increase to aggregate payments due to updating the outlier threshold results in an overall update of 1.8 percent (or $135 million), relative to payments in FY 2015.

No Changes to the Facility-Level Adjustments: As stated in the FY 2015 IRF PPS final rule, CMS froze the facility-level adjustment factors at the FY 2014 levels for FY 2015 and all subsequent years. For FY 2016, CMS will continue to hold the facility-level adjustment factors at the FY 2014 levels as they continue to monitor the most current IRF claims data available to assess the effects of the FY 2014 changes.

ICD-10-CM Conversion: In the FY 2015 IRF PPS final rule, CMS finalized conversions from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) for the IRF PPS, which will be effective when ICD-10-CM becomes the required medical data code set for use on Medicare claims and IRF PAI submissions. The implementation date for ICD-10-CM is October 1.

IRF-specific Market Basket: For FY 2016, CMS is finalizing an IRF-specific market basket to replace the Rehabilitation, Psychiatric and Long-Term Care market basket. The IRF market basket is based on 2012 data (the RPL market basket is based on 2008 data). The IRF market basket is derived from using both freestanding and hospital-based IRF Medicare cost report data from FY 2012.

Changes to the Wage Index: CMS finalized its proposal for transitioning to the wage index associated with the new Office of Management and Budget delineations without any modifications. A one-year blended wage index will be provided for all IRFs, and a three-year phase-out of the rural adjustment for IRFs that were deemed rural in FY 2015 but are considered urban under the new delineations. CMS will apply the one year blended wage index in FY 2016 for all geographic areas, to assist IRFs in adapting to these changes.

  • FY 2015 rural IRFs classified as urban in FY 2016 will receive two-thirds of the FY 2015 rural adjustment in FY 2016, as well as the blended wage index.
  • For FY 2017, these IRFs will receive the full FY 2017 wage index and one-third of the FY 2015 rural adjustment.
  • For FY 2018, these IRFs will receive the full FY 2018 wage index without a rural adjustment.

Changes to the IRF Quality Reporting Program (QRP): The Improving Medicare Post-Acute Care Transformation Act of 2014 (“IMPACT” Act) added Section 1899B to the Social Security Act (the Act) to require that IRFs report data on measures that satisfy measure domains specified in the Act. These same measures are to be implemented in long-term care hospitals, IRFs, skilled nursing facilities and home health agencies. This final rule adopts measures that satisfy three of the quality domains required by the IMPACT Act in FY 2016: skin integrity and changes in skin integrity; functional status, cognitive function, and changes in function and cognitive function; and incidence of major falls. IRFs that fail to submit the required quality data to CMS will be subject to a 2 percentage point reduction to their applicable FY annual increase factor.

Finalized Changes:

The domains specified by the IMPACT Act, and the quality measures finalized, are as follows:

  • Domain 1: Skin integrity and changes in skin integrity:
    • Quality Measure: “Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened” (NQF #0678)
  • Domain 2: Functional status, cognitive function, and changes in function and cognitive function:
    • Quality Measure: Application of the “Percent of Long-Term Care Hospital Patients With an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function” (NQF #2631; Endorsed on July 23, 2015)
  • Domain 3: Incidence of major falls:
    • Quality Measure: Application of the “Percent of Residents Experiencing One or More Falls with Major Injury” (NQF #0674)

In addition to the measures listed above, CMS adopted four additional functional status quality measures, and completed the previously finalized quality measure “All-Cause Unplanned Readmission Measure for 30 Days Post Discharge from Inpatient Rehabilitation Facilities” (NQF #2502), in order to establish its newly NQF-endorsed status.

Additionally, CMS will begin publically reporting IRF quality data in the fall of 2016. This includes a 30-day period for review and correction of quality data prior to public display.

Finally, CMS is temporarily suspending their previously finalized data validation policy in order to allow time to develop a more comprehensive policy that will potentially decrease the burden on IRF providers, allow CMS the ability to establish an estimation of accuracy related to quality data submitted to them, and facilitate the alignment of the IRF validation policy with that of other CMS quality reporting programs policies.

The Centers for Disease Control and Prevention (CDC) has released a new report, Concussion at Play: Opportunities to Reshape the Culture Around Concussion. The report provides an overview of current research on concussion knowledge, awareness, attitudes, and behaviors among athletes, coaches, parents, health care providers, and school professionals.

This report also describes opportunities to help build a culture in sports where athletes take steps to lower their chances of getting a concussion, and recognize and report concussion symptoms. This involves moving beyond our general concussion knowledge and changing the way we talk about and respond to concussion. The goal is to empower athletes not to play with a concussion or hide their symptoms. The document builds from the work of the Institute of Medicine (IOM) report, Sports-Related Concussions in Youth: Improving the Science, Changing the Culture.

On May 29, the Department of Human Services released a request for information (RFI) to help guide the department’s planning process for the release of a new procurement for the provision of managed care services for physical health. RCPA submitted comments and recommendations to the department in response to the RFI. Secretary Dallas has worked to be transparent during this process and has published a summary of some of the most frequently provided comments in the responses to the RFI. He has also identified some of the changes that the department is considering for the new HealthChoices physical health managed care procurement. This list is not intended to be final and merely reflects some of the ideas that are being considered at this time. Because many of the comments and related action plans communicated by Secretary Dallas address integrated physical and behavioral health care, data and information sharing, service system simplification, and other initiatives that have implications for RCPA members, this interim report is being shared at this time. Please submit any additional comments on the concepts included in this summary, or an area that is not listed in the document, via email by August 10.

The Pennsylvania Athletic Trainers’ Society, through a grant from the Pennsylvania Department of Health, brings you “A Consumer’s Guide to the Management and Care of Concussion in Sport.” This program gives a detailed look at the importance of proper identification and treatment of sport concussion, and the role of the licensed athletic trainer as part of the health care team to manage these injuries appropriately. The Safety in Youth Sports Act directs schools and athletic programs to create a health care team, and a concussion policy action plan, to aid in the management of concussions. This program will air on the Pennsylvania Cable Network (PCN) during the “Sunday Fusion” programming on the following dates and times:

  • Sunday July 26, 3:30 pm
  • Sunday August 2, 2:30 pm
  • Sunday August 9, 5:30 pm
  • Sunday August 16, 2:30 pm
  • Sunday August 23, 4:00 pm

Beginning Monday, July 20 the program will be available on the PCN website.

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On July 14, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule in the Federal Register, announcing the implementation of a new Medicare Part A and B payment model called the Comprehensive Care for Joint Replacement (CCJR) model. Under this model, acute care hospitals in 75 selected geographic areas would receive retrospective bundled payments for episodes of care for lower extremity joint replacement or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedures will be included in the episode of care.

CMS anticipates the proposed CCJR model would benefit Medicare beneficiaries by improving the coordination and transition of care, improving the coordination of items and services paid through Medicare fee-for-service, encouraging more provider investment in infrastructure and redesigned care process for higher quality and more efficient service delivery, and incentivizing higher value care across the inpatient and post-acute care spectrum spanning the episode of care. According to CMS, hip and knee replacements are the most common inpatient surgery for Medicare beneficiaries and can require lengthy recovery and rehabilitation periods.

CMS proposes to test CCJR for a five year performance period, beginning January 1, 2016, and ending December 31, 2020. Comments will be accepted on the proposals contained in the proposed rule, as well as other alternatives or suggestions, through September 8. Contact Melissa Dehoff at RCPA with questions.

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The Centers for Medicare and Medicaid Services (CMS) has released an updated inpatient rehabilitation facility patient assessment instrument (IRF PAI) training manual that includes updated information on new items that become effective for IRF discharges occurring on or after October 1. These new items, including the arthritis attestation item and therapy information, were finalized in the IRF prospective payment system fiscal year 2015 final rule. The Updated IRF PAI Training Manual, Helpful Resources Document and Section 2 (Item by Item Coding Instructions) are located in the “Downloads” section of the IRF PAI web page. CMS has also made available a YouTube video slideshow from the January 2015 national provider call that focused on training providers how to code and complete these new items on the IRF PAI.