';
Tags Posts tagged with "CMS"

CMS

0 279

In order to avoid a potential 2 percent decrease in the annual payment update for fiscal year (FY) 2025 (October 2024 – September 2025), inpatient rehabilitation facilities (IRF) are reminded that they must submit complete data in calendar year (CY) 2023 for all quality measures that are a part of the IRF Quality Reporting Program (QRP).

IRF Patient Assessment Instrument (IRF-PAI) assessment data and data submitted via the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) for July 1 – September 30 (Q3) of calendar year 2023 must be submitted no later than 11:59 pm on February 15, 2024.

The Centers for Medicare and Medicaid Services (CMS) contractor Swingtech sends informational messages to IRFs that are not meeting Annual Increase Factor (AIF) thresholds on a quarterly basis ahead of each submission deadline. These messages were sent late last week. IRFs are encouraged to check to see if any members of their QRP team received a message from the email address “QRPHelp@swingtech.com.” If members need to add or change the email addresses to which these messages are sent, please email QRP Help and be sure to include your facility name and CCN along with any requested email updates. Any IRFs who receive a Swingtech email message are encouraged to identify and review the measures stated as missing data for Q3 2023 ASAP, and resolve any data issues by the February 15 deadline.

The Pennsylvania Department of Human Services (DHS) is hosting a post-award forum regarding the federal Section 1115 Demonstration, which includes Medicaid coverage for out-of-state former foster care youth and substance use disorder (SUD) services. It will take place at 1:00 pm – 2:30 pm on Friday, March 8, 2024, via WebEx. The forum aims to gather public feedback on the progress of these initiatives, both of which were approved by the Centers for Medicare & Medicaid Services (CMS). The Former Foster Care Youth (FFCY) component allows Medicaid coverage for individuals under 26 who were in foster care in another state upon turning 18. The SUD component provides funding for essential SUD services, including residential care.

Register for the forum here. Written comments are also acceptable until the same date. For inquiries, contact Shivani Patel. Further details and the announcement can be found here. Please contact RCPA Policy Director Jim Sharp for any further questions.

Photo by Markus Winkler on Unsplash

The Office of Mental Health and Substance Abuse Services (OMHSAS) successfully collaborated with the Centers for Medicare & Medicaid Services (CMS) to revise Pennsylvania’s State Medicaid Plan for Certified Peer Specialists (CPS). The changes aim to enhance workforce opportunities, break down barriers, and establish a robust crisis system. The updated qualifications for aspiring CPS include:

  1. Elimination of the self-identification requirement for Serious Mental Illness, replaced with an attestation of a mental health diagnosis and a stage of recovery to support others;
  2. Removal of the high school diploma requirement and instead, as part of the Pennsylvania Certification Board (PCB) application, applicants will be providing narratives on how they achieved recovery and wellness; and
  3. The mandatory recent employment or volunteer experience within the last three (3) years has been removed.

Details on these changes can be found in the updated State Plan here (scroll down to 0013 Attachment 3.1A-3.1B, page 88). OMHSAS will issue a forthcoming bulletin, and inquiries can be sent electronically.

If you have further questions, please contact RCPA Policy Director Jim Sharp.

On January 26, 2024, the Centers for Medicare & Medicaid Services (CMS) forwarded the final Medicaid Access Rule (CMS-2442-F) to the Office of Management and Budget (OMB) for the last review step before Federal Register publication.

The proposed Medicaid Access Rule contained a number of policies, including the much-discussed 80/20 provision that would require 80 percent of all Medicaid payments to be spent on direct care workers and direct service professionals compensation for personal care services.

RCPA commented on these proposed regulations and will continue to monitor progress with our federal partners. The OMB is expected to issue its comments in April. If you have questions, please contact RCPA Policy Director Fady Sahhar.

The Centers for Medicare & Medicaid Services (CMS) has announced $50 million in grants to enhance school-based health services for children, particularly focusing on mental health. The grants, made possible by the Bipartisan Safer Communities Act (BSCA), will provide up to $2.5 million each to 20 states through Medicaid and the Children’s Health Insurance Program (CHIP). CMS aims to connect millions of children to critical healthcare services, emphasizing the convenience of school-based care and its impact on children’s health and educational outcomes. The grants, supporting preventive, behavioral, and physical healthcare, hope to encourage more states to cover school-based health services and enhance existing programs. The application deadline for the grants is March 25, 2024. For further details, visit the grant’s information web page. The full press release is available on the CMS website.

The Centers for Medicare & Medicaid Services (CMS) has released a set of frequently asked questions (FAQ) supplementing the 2021 State Health Official (SHO) letter about extending postpartum coverage in Medicaid and the Children’s Health Insurance Program (CHIP). The FAQ offer guidance to state Medicaid programs on the new option allowing states to provide 12 months of extended postpartum coverage to pregnant individuals in Medicaid and CHIP. They clarify what constitutes full benefits during this extended eligibility period and address whether states need to submit a state plan amendment (SPA) for coverage modifications. For more details, view the FAQ here.

This Request for Proposals (RFP) requires performance analysis activities to administer the requirements of the CMS 1915(b)(4) waiver for licensed residential habilitation, unlicensed residential habilitation, supported living, and life-sharing services, as well as for supports coordination services currently offered in all ODP 1915(c) waiver programs.

Tasks to support administering the requirements of the 1915(b)(4) waiver include but are not limited to: data collection, analysis and reporting, Provider Contract Management, managing a public facing website, and providing and maintaining an information support system.

All offerors are required to create a user profile within the DHS JAGGAER portal. Please visit here to access the portal.

Proposals are due Tuesday, March 5, 2024, by 12:00 pm. Visit PA eMarketplace for more information and to apply.

The Centers for Medicare & Medicaid Services (CMS) has introduced the Innovation in Behavioral Health (IBH) Model to enhance integration in behavioral health. This model is designed to improve care quality, access, and outcomes for individuals with mental health conditions and substance use disorders under Medicaid and Medicare. Community-based behavioral health practices will form interprofessional care teams to address behavioral and physical health, including health-related social needs. The IBH Model uses a “no wrong door” approach, providing access to all services, and emphasizes building health information technology capacity. The model is scheduled to launch in Fall 2024 and will operate for eight years in up to eight select states. For more information, visit the IBH Model web page, where you can find frequently asked questions, access a fact sheet on the IBH Model, and explore a fact sheet on the accomplishments of the HHS Roadmap for Behavioral Health Integration.

The Centers for Medicare and Medicaid Services (CMS) has released the calendar year (CY) 2024 therapy services KX Modifier threshold amounts. The CY 2024 amounts are as follows:

  • $2,330 for physical therapy (PT) and Speech-language Pathology (SLP) services combined; and
  • $2,330 for occupational therapy service.

Additional information can be found on the following web pages: