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CMS NEWS

FOR IMMEDIATE RELEASE
January 13, 2020

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries

CMS Reduces Psychiatric Hospital Burden with New Survey Process
Streamlined process will improve quality of care for patients

Today, the Centers for Medicare & Medicaid Services (CMS) announced a streamlined survey and certification process for psychiatric hospitals, delivering on the Agency’s “Patients Over Paperwork” initiative. The full benefits of this initiative can be explored here. This new process will ensure safety and quality through more holistic and efficient hospital inspections that protect patients, while reducing burden for providers.

Currently, psychiatric hospitals surveyed by State Survey Agencies are subject to two separate onsite compliance surveys, one by the State Survey Agency (SSA) for compliance with the hospital requirements and one by an outside contractor selected by the SSA for compliance with two additional psychiatric hospital standards.

Beginning in March 2020, CMS will implement a streamlined process in which psychiatric hospitals will receive one comprehensive hospital survey performed by the SSA to review compliance with both hospital and psychiatric hospital participation requirements, allowing inspectors to take a broader view of a psychiatric hospital’s operations and better identify systemic quality issues.

“The policy of multiple inspections for psychiatric hospitals is emblematic of the absurd status quo in healthcare. For too long, fragmented and misaligned processes have increased burden and administrative costs,” said CMS Administrator Seema Verma. “Under President Trump’s leadership, CMS is upending the status quo and forging ahead with practical, commonsense changes to streamline our processes to reduce burden and improve oversight and patient safety, and reducing unnecessary administrative costs.”

To participate in Medicare, a psychiatric hospital is required to meet both general hospital Conditions of Participation (CoPs) and separate CoPs for psychiatric hospitals. CoPs are federal requirements that promote the health, safety and well-being of the patients being treated in these facilities. CMS is not making any changes to these safety and quality requirements.

Moving to a single survey process will benefit patients by ensuring psychiatric hospital services are evaluated in the context of the overall hospital survey program, making it easier for surveyors and the provider to identify and correct systemic quality issues that impact patient care. It also benefits providers by reducing the regulatory burden currently imposed on psychiatric hospitals because a single survey team conducting the survey will conduct, and only one report would be issued documenting any survey findings, instead of two.

CMS is notifying hospitals, SSAs and psychiatric hospital stakeholders of this upcoming change through a memorandum released today. This change does not affect accreditation organizations’ current methodologies for approving hospitals or psychiatric hospitals, or CMS’s criteria for approving accreditation organizations to survey such facilities. To ensure states are appropriately prepared to begin conducting these surveys in March 2020, CMS is developing an online training that will be released soon.

For more information about the change in the psychiatric hospital survey process and to see the memorandum, visit: https://www.cms.gov/httpswwwcmsgovmedicareprovider-enrollment-and-certificationsurveycertificationgeninfoadministrative/informational-notice-forthcoming-integration-psychiatric-hospital-program-hospital-program-and-state

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The Centers for Medicare and Medicaid Services (CMS) recently announced the availability of the inpatient rehabilitation facility (IRF) provider preview reports. These reports have been updated and contain information based on quality data submitted by IRFs between Quarter 3 of 2018 and Quarter 2 of 2019. The data will reflect what will be published on IRF Compare during the March 2020 update of the website.

Providers have 30 days (December 9, 2019 – January 9, 2020) to review their performance data. While corrections to the underlying data will not be permitted during this time, providers can request CMS to review their data during the preview period if they believe the quality measure scores that are displayed are inaccurate.

Additionally, providers are reminded that the data for the quality measure Percent of Residents or Patients that have new or worsened Pressure Ulcers (short stay), will continue to reflect data collected between Quarter 3 2017 – Quarter 2 2018, and will continue to be publicly displayed until the new Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury, is publicly displayed in fall 2020, as finalized in the fiscal year (FY) 2018 IRF PPS Final Rule.

As of the March 2020 refresh, CMS will no longer publicly display the measure Percent of Residents or Patients who were assessed and appropriately given the seasonal influenza vaccine (short stay), as finalized in the FY 2019 IRF PPS Final Rule. This change is reflected in preview reports. Contact RCPA Rehabilitation Services Director Melissa Dehoff with questions.

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The Centers for Medicare and Medicaid Services (CMS) recently notified the Office of Long-Term Living (OLTL) of the approval of the OBRA Waiver amendment. The amendment is effective on January 1, 2020.

The changes in the approved amendment include:

  • Revise the Residential Habilitation service definition by modifying the number of hours that are defined as a day unit from a minimum of 12 hours to 8 hours.
  • Revise the service definitions of Job Finding, Job Coaching, Employment Skills Development, Career Assessment, and Benefits Counseling to address when employment services can be provided through the OBRA waiver, should the Office of Vocational Rehabilitation (OVR) have a waiting list (closed order of selection) or when OVR has not made an eligibility determination within 120 days.
  • Update the Abuse Registry Screening information to reflect that the Department of Human Services (DHS) utilizes IDEMIA as the data system to process fingerprint-based FBI criminal record checks, as well as other minor changes.
  • Revise cost neutrality estimates to reflect rate changes to the Personal Assistance Services (PAS) and Residential Habilitation waiver services.

If you have any questions, please contact the OLTL Bureau of Policy Development and Communications Management at 717-857-3280.

ODP Announcement 19-102 provides information regarding the amendments submitted to the Centers for Medicare and Medicaid Services (CMS) regarding the Consolidated, Community Living, and P/FDS waivers. It is anticipated that the amendments will become effective October 1, 2019.

CMS has 90 days to review the amendments and changes may occur to the content based upon discussion with CMS during the approval process. Each full waiver application, as well as a side-by-side of substantive changes made as a result of public comment is available online here.

The amendments align with 55 Pa. Code Chapter 6100 regulations when effective, ensure compliance with the Home and Community-Based Settings regulations, and align with the Office of Developmental Programs’ Everyday Lives recommendations.

The amendments include a plan to serve medically complex children in a community home when transitioning from an extended hospital stay if they are unable to return to their family home. Also, the scope of professionals who can diagnose intellectual disability has been expanded.

ODP is adding the expectation that all providers of Community Participation Support services must offer individuals opportunities to participate in community activities that are consistent with the individual’s preferences, choices, and interests. On-call and remote support is proposed in order to support the fading of service and dependence on paid staff. The number of procedure codes and staffing levels has been decreased to more accurately reflect service delivery.

Starting January 1, 2022, CPS services may not be provided in any facility required to hold a 2380 or 2390 license that serves more than 150 individuals at any one time, including individuals funded through any source. All participants receiving prevocational services must have a competitive integrated employment outcome included in their service plan. There must be documentation in the service plan regarding how and when the provision of prevocational services is expected to lead to competitive integrated employment. CPS may not be provided in newly funded (on or after January 1, 2020) licensed 2380 or 2390 locations which serve more than 25 individuals in the facility at any one time.

Residential Habilitation, Life Sharing, and Supported Living Services will be required to utilize the recommendations provided in the Health Risk Screening Tool. SCs will be expected to monitor the implementation of the recommendations and incorporate them into the Individual’s Plan. Also, clarification is provided regarding the location parameters for newly funded sites.

ODP is proposing that respite can be provided by nurses for children with medical needs to assure the appropriate level of care is available.

Qualifications required for Support Service Professionals, Individuals, and Agency Providers have been clarified, including timelines for completion of certification requirements. Additionally, supported employment can be provided to individuals until OVR services are available, particularly when OVR has established a waiting list.

For a side-by-side comparison of substantive changes made as a result of public comment, see this online document. Questions about this communication should be directed to the appropriate ODP Regional Office.

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The Centers for Medicare and Medicaid Services (CMS) recently announced an upcoming in person inpatient rehabilitation facility quality reporting program (IRF QRP) training. This two-day “train-the-trainer” event for providers is scheduled for August 15–16, 2019 at the Four Seasons Hotel, 200 International Drive, Baltimore, MD 21202.

The primary focus of this training, which is open to all IRF providers, associations, and organizations,  will be to provide those responsible for training staff at IRFs with information about IRF QRP changes and updates to the IRF Patient Assessment Instrument (PAI) v.3.0, which will become effective on October 1, 2019. Topics will include, but are not limited to:

  • An overview of the changes between the IRF-PAI v.2.0 and v.3.0;
  • Updated training materials for Section GG, which will include videos of patient scenarios; and
  • An interactive session on the use of reports to identify opportunities for process improvement and utilize information contained in reports available via the Certification and Survey Provider Enhanced Reports (CASPER) system, which will be used to develop quality improvement plans.

A full agenda is available for both days of the training. Registration is limited to 100 people on a first-come, first-served basis. Questions or additional information requests should be sent to the PAC Training mailbox.

Final Rule will strengthen popular Medicare private health insurance plans, expand telehealth access for patients, and improve coordination for dual-eligible individuals

Today, the Centers for Medicare & Medicaid Services (CMS) finalized policies that will increase plan choices and benefits, including allowing Medicare Advantage plans to include additional telehealth benefits. These policies continue the agency’s efforts to modernize the Medicare Advantage and Part D programs, unleash innovation and drive competition to improve quality among private Medicare health and drug plans.

“Today’s policies represent a historic step in bringing innovative technology to Medicare beneficiaries,” said CMS Administrator Seema Verma. “With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth. By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality.”

The final policies announced today leverage new authorities provided to CMS in the Bipartisan Budget Act of 2018, which President Trump signed into law last year. CMS is finalizing changes that would allow Medicare Advantage beneficiaries to access additional telehealth benefits, starting in plan year 2020. These additional telehealth benefits offer patients the option to receive health care services from places like their homes, rather than requiring them to go to a healthcare facility.

Before this year, seniors in Original Medicare could only receive certain telehealth services if they live in rural areas. Starting this year, Original Medicare began paying for virtual check-ins across the country, meaning patients can connect with their doctors by phone or video chat. Historically, Medicare Advantage plans have been able to offer more telehealth services, compared to Original Medicare, as part of their supplemental benefits. But with the final rule, it will be more likely that plans will offer the additional telehealth benefits outside of supplemental benefits, expanding patients’ access to telehealth services from more providers and in more parts of the country than before, whether they live in rural or urban areas.

CMS is also finalizing changes that will make improvements to Medicare Advantage and Part D Star Ratings so that consumers can identify high-value plans. The final rule updates the methodology for calculating Star Ratings, which provide information to consumers on plan quality. The new Star Ratings methodology will improve the stability and predictability for plans and will adjust how the ratings are set in the event of extreme and uncontrollable events such as hurricanes.

The final rule will improve the quality of care for beneficiaries dually eligible for Medicare and Medicaid who participate in Dual Eligible Special Needs Plans (D-SNPs). These beneficiaries usually have complex health needs; if they have a complaint about their healthcare or about access to items and services, they have to work with multiple organizations, one responsible for Medicare benefits and another responsible for Medicaid benefits, in order to file an appeal. The final rule will create one appeals process across Medicare and Medicaid, which will make it easier for enrollees in certain D-SNPs to navigate the healthcare system and have access to high quality services. The final rule will also require plans to more seamlessly integrate Medicare and Medicaid benefits across the two programs, such as notifying the state Medicaid agency (or its designee) of hospital and skilled nursing facility admissions for certain high-risk beneficiaries, to promote coordination of care for these patients.

Today’s announcement builds on the 2020 Rate Announcement and Final Call Letter released earlier this week that gives Medicare Advantage plans flexibility to offer chronically ill patients a broader range of supplemental benefits that are not necessarily health related and can address social determinants of health. With these new telehealth and supplemental benefits, Medicare Advantage plans will have the flexibility to provide a historic set of offerings to beneficiaries. Medicare Advantage plans will be able to compete for patients based on their new offerings and overall cost. CMS is working to update the Medicare Plan Finder with these new choices, so that beneficiaries will be able to see their new choices and benefits and can pick the plans that work best for them.

The fact sheet on the CY 2020 Medicare Advantage and Part D Flexibility Final Rule (CMS-4185-F) can be found here. The final rule can be downloaded from the Federal Register.

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On Tuesday, November 27, 2018, the RAND Corporation (a contractor for the Centers for Medicare and Medicaid Services), will hold a stakeholder meeting to discuss their results from the Improving Medicare Post-Acute Care Transformation (IMPACT) Act national beta test of candidate standardized patient assessment data elements (SPADEs). They will also discuss areas of support and key concerns raised by stakeholders during prior engagement activities and answer questions from attendees.

The meeting will be held at the RAND offices, 1200 South Hayes St., Arlington, VA 22202-5050, from 12:00 pm to 4:00 pm.

Attendees can register to attend in person or by phone using the links below. The limited number of in-person spaces will be available on a first-come, first-served basis.

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

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The Centers for Medicare and Medicaid Services (CMS) has released the updated Inpatient Rehabilitation Facility Quality Reporting Program (IRF QRP) Measure Calculations and Reporting User’s Manual (Version 3.0). This version of the manual is effective on October 1, 2018. The manual provides detailed information for IRF Patient Assessment Instrument (PAI) based quality measures, including inclusion and exclusion criteria, quality measure definitions, and measure calculation specifications. All of the materials are available on the Downloads section located at the bottom of the IRF Quality Reporting Measures Information web page.

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

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Breaking: CMS Proposes Historic Changes to Restore the Doctor-Patient Relationship & Streamline Clinical Billing

From HIT Consultant
by Jasmine Pennic 07/12/2018

On Thursday, the Centers for Medicare & Medicaid Services (CMS) proposed historic changes that would increase the amount of time that doctors and other clinicians can spend with their patients by reducing the burden of paperwork that clinicians face when billing Medicare. The proposed rules would fundamentally improve the nation’s healthcare system and help restore the doctor-patient relationship by empowering clinicians to use their electronic health records (EHRs) to document clinically meaningful information, instead of information that is only for billing purposes… Read full article.