Effective January 15, 2020, the Office of Long-Term Living (OLTL) has revised its guidance regarding the temporary changes to the Act 150 Program and the OBRA waiver in response to COVID-19. The revised guidance documents rescind and replace the guidance dated May 8, 2020. They also clarify flexibilities that remain available through March 5, 2021 or another date determined by OLTL.
A notice was released today by both the Pennsylvania Department of Health (DOH) and the Department of Human Services (DHS) regarding the continued ongoing support for long-term care (LTC) facilities and outbreaks associated with COVID-19. The ongoing support will be provided by utilizing Regional Congregate Care Assistance Teams (RCAT), staffing, testing, and more. Prior support (from July 2020 through December 2020) was provided through the Regional Response Health Collaborative (RRHC) program. This program was funded by the federal CARES Act and created by the General Assembly. That program began with select health systems providing support to long-term care facilities across the state under the direction of Pennsylvania’s Long-Term Care Task Force (LTCTF). With federal dollars ending on December 30, 2020 and a constrained state budget, the Wolf Administration prioritized the allocation of limited funds to continue providing facilities with support during COVID-19 outbreaks.
This state-funded effort will leverage the expertise of ten health systems through the RCATs and continued direction of the LTCTF. Starting on December 31, 2020 and lasting through February 28, 2021, RCATs will provide COVID-19 outbreak support to long-term care facilities that were eligible for the RRHC program. The primary focus of the RCATs will be to respond to COVID-19 outbreaks at long-term care facilities. Additional assistance provided to facilities experiencing an outbreak includes call centers for infection control assistance, personal protective equipment (PPE) distribution, staffing assistance, and testing for staff and residents through a variety of resources.
Long-Term Care Response Resources
Most of the health system partnerships established for the RRHC program will also be leveraged for the RCAT to cover six regions. The participating health systems are Thomas Jefferson University in partnership with Main Line Health and the University of Pennsylvania in partnership with Temple University Hospital, Inc. serving Southeast Pennsylvania; Geisinger Clinic and UPMC Susquehanna serving Northeast Pennsylvania; Pennsylvania State University serving Southcentral Pennsylvania; Geisinger Clinic serving Northcentral Pennsylvania; UPMC Community Provider Services in partnership with Allegheny Health Network serving Southwest Pennsylvania; and LECOM Health and UPMC Community Provider Services in partnership with Allegheny Health Network serving Northwest Pennsylvania. The Department of Health is providing staffing and testing support to congregate care facilities using contracted partners.
Curative Labs, Inc. (Curative) has been contracted to provide an end-to-end testing solution for COVID-19. The simple-to-use oral fluid or shallow nasal test is self-administered under the supervision of facility staff. Facilities will be brought on in a phased approach, and each facility will receive two to four weeks’ worth of testing kits that include (at a minimum) a specimen tube, bio-hazard bag, oral or nasal canular swab, vial with label, absorbent pad, and shelf stable medium. Facilities will also receive pre-paid shipping labels and packaging (including laboratory grade boxes) to send specimens to the lab using next-day shipping.
Two staffing agencies, Maxim and General Healthcare Resources (GHR), have been contracted to provide crisis staffing to congregate care facilities within established mission critical deadlines. The size and duration of the crisis staffing deployment is based on a review and subsequent approval by the LTCTF. That review includes an overall assessment of the facility’s COVID-19 mitigation needs, including testing, staffing, and PPE. Maxim will serve specific counties, mostly in the western part of the state. Health systems can also provide staffing assistance if they have the resources available. The Pennsylvania National Guard will also provide limited clinical support and primarily general-purpose support as determined by the LTCTF.
Prevention
In response to COVID-19 outbreaks in long-term care facilities, infection prevention practices and continuity of care and other services that mitigate the risk of spread of COVID-19 to staff and residents will be reviewed. The RCATs are available to work directly with facilities to implement current state and federal COVID-19 clinical guidance and instruct staff on ways to provide daily care in a way that minimizes the risk of COVID-19 spread. The Department of Health’s Infection Control and Outbreak Response (ICOR) team and Emergency Care Research Institute (ECRI) provide remote infection prevention consultation to facilities experiencing an outbreak as well as follow-up consultation to improve baseline practices after the outbreak is over.
Response
When long-term care facilities’ resources engage with a facility or are called in to help with a concern identified by collaboration between DHS, DOH, and the Pennsylvania Emergency Management Agency (PEMA) daily calls, these are classified as missions. A mission could be anything from assistance with testing, staffing support, and rapid response deployment to facilities and other questions or concerns requiring consultation. The RCATs also offer 24/7 call centers that are available to provide direct support and assistance as issues arise. If a facility is at risk of an outbreak or experiencing an outbreak, RCAT rapid response teams can be deployed to help facilities manage difficult situations. Rapid response teams are comprised of registered nurses, clinicians, epidemiologists, and infection control experts who assist with cohorting of residents, transferring residents if needed, and providing other support necessary to stabilize the outbreak and prevent further spread.
Education
The Jewish Healthcare Network operates a statewide learning and peer support network that is available to all long-term care facilities. This network is available for ad-hoc webinars on topics related to responding to and mitigating the spread of COVID-19. In addition, regional Health Care Coalitions host bi-weekly calls for facilities in which ICOR presents to provide clinical guidance and updates.
Expectations
The RCATs will leverage the knowledge and experience the health systems, LTCTF, and PA National Guard obtained through their engagement in the RRHCP to respond to COVID-19 across our long-term care system. While the RCAT funds are limited, the teams involved are committed to collectively working together and sharing the knowledge and resources needed to support long-term care facilities who are experiencing an outbreak. While we are in unprecedented times, there is assurance that commonwealth agencies, contracted testing and staffing partners, contracted health systems, and educational resources have resolved to provide continued support for the residents, staff, caregivers and communities of congregate care facilities in the commonwealth.
On December 27, 2020, the Consolidated Appropriations Act of 2021 (stimulus relief for COVID-19) modified the calendar year (CY) 2021 Medicare Physician Fee Schedule (MPFS) final rule to include the following:
The Centers for Medicare and Medicaid Services (CMS) has recalculated the MPFS payment rates and conversion factor to reflect these changes. The revised MPFS conversion factor for CY 2021 is 34.8931; it is included in the final rule.
On January 4, 2021, the Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 12126 or Medicare Learning Network Matters MM12126, “2021 Annual Update to the Therapy Code List.” The article provides updates to the list of codes that describe therapy services and includes the policies that were implemented in the calendar year (CY) 2021 Medicare Physician Fee Schedule (MPFS) final rule.
CR 12126 updates the therapy code list and associated policies for CY 2021. CMS designated all these HCPCS/CPT codes as “sometimes therapy,” to permit physicians and certain Non-Physician Practitioners (NPPs), including nurse practitioners, physician assistants, and clinical nurse specialists, to render these services outside a therapy plan of care when appropriate. These HCPCS/CPT codes are considered communication technology-based (CTB) services so other NPPs, such as psychologists and social workers, in addition to therapists (physical therapists, occupational therapists, and speech-language pathologists), can render these services whether in private practice or facility-based.
Also, these codes for CTB services replace codes for similar services that CMS included in CR 11791. For the five codes below (2 HCPCS and 3 CPT codes), CY 2021 rulemaking made these codes permanent, meaning they are no longer restricted by the effectiveness timeline of the Public Health Emergency (PHE) for COVID-19. The HCPCS codes and long descriptors are provided in the CR. CMS removed the following HCPCS codes from the therapy code list, effective for dates of service on and after January 1, 2021:
On January 5, 2021, the Managed Long-Term Services and Supports (MLTSS) Subcommittee met via webinar. The call included updates from Office of Long-Term Living’s (OLTL) Deputy Secretary Jamie Buchenauer; a presentation on the Community HealthChoices (CHC) Performance Improvement Projects; an update on the 2021 CHC Waiver Amendment; and a presentation on Conducting and Managing Telephonic Assessments from the CHC Managed Care Organizations.
Included were the following handouts/presentations:
The next MLTSS Subcommittee meeting is scheduled for February 3, 2021.
The Centers for Medicare and Medicaid Service (CMS) has approved the Office of Long-Term Living’s (OLTL) Community HealthChoices (CHC) Waiver amendment, which became effective on January 1, 2021.
Some of the changes in the approved amendment include:
Questions about the 2021 CHC amendment can be submitted here.
The Department of Human Services (DHS)/Office of Long-Term Living (OLTL) released a transition plan, which is to be used with the January 4, 2021 Temporary Changes to the Community HealthChoices (CHC) 1915(c) Waiver revised guidance.
The Centers for Medicare and Medicaid Services (CMS) approved the temporary changes to the CHC Waiver in March 2020 in response to the COVID-19 public health emergency (PHE). Approval of these changes is covered under Appendix K, “Emergency Preparedness and Response”, which states may use during emergency situations to request amendments to their approved waivers. These changes addressed potential staffing shortages and the need for service provision not included in approved service descriptions to ensure that participant health and safety needs could be accommodated for the duration of the COVID-19 statewide emergency.
As described in the Temporary Changes to the CHC Waiver revised guidance, the changes were not intended to apply to all participants nor to be considered across-the-board changes that must be implemented for each participant. These flexibilities were to be evaluated on a case-by-case basis in coordination with the CHC Managed Care Organizations (MCOs).
CMS recently approved an amendment to Appendix K, which allows some flexibilities to continue until March 5, 2021 and adds new flexibilities for adult daily living services. The guidance replaces and rescinds the Appendix K transition plan guidance issued on June 25, 2020 that references the red, yellow, and green phases related to Pennsylvania’s reopening plan.
If you have questions about the information in the transition plan, please contact the CHC-MCOs for guidance on implementation.
The Office of Long-Term Living (OLTL) has issued a guidance that provides operational guidance to Adult Daily Living providers for the new Appendix K flexibilities approved for the Community HealthChoices (CHC) and OBRA Waivers during the COVID-19 public health emergency (PHE). OLTL submitted an amendment to Appendix K to the Centers for Medicare and Medicaid Services (CMS) in late November; this amendment was approved by CMS on December 7, 2020. Members are encouraged to review the guidance for all of the allowable services as well as information on reimbursement for telephonic and remote services and documentation requirements.
Questions about the information contained in the guidance should be directed to the following:
On May 29, 2020, Pennsylvania’s State Legislature appropriated $175 million dollars from the federal CARES Act to protect residents and staff in long-term care facilities (LTCFs). With this funding, and in partnership with select health systems, Pennsylvania’s Long-Term Care Task Force (LTC-TF) developed the Regional Response Health Collaborative (RRHC) program. Federal funding for the RRHC program ended on December 30, 2020.
Due to federal dollars no longer being available and a constrained state budget, the Wolf Administration has prioritized the allocation of limited funds to continue providing facilities with support during COVID-19 facility outbreaks. This state-funded effort will leverage the expertise of the health systems through the Regional Congregate Care Assistance Teams (RCAT), a new, more limited version of the RRHC. Starting on December 31, 2020 and lasting through February 28, 2021, the RCAT will provide COVID-19 outbreak support to facilities. Those facilities who were eligible for the RRHC program will also be eligible for the RCAT.
With the introduction of the RCAT, coverage remains the same as the RRHC program except for the Northeast Region. Engagement with LECOM, UPMC (including Allegheny Health Network, Excela, Penn Highlands, and St. Clair), Penn State, University of Pennsylvania (including Temple), and Thomas Jefferson (including Main Line Health) will remain the same. Geisinger will continue to provide coverage for the Northcentral region and has expanded to support Carbon, Monroe, and Pike Counties as well. The LTC-TF will backstop RCAT support across the commonwealth and ensure support for facilities located in Lehigh and Northampton Counties.
Some services provided by the health systems have changed. Members are encouraged to refer to the updated contact list.
Today, a joint guidance was issued by the Pennsylvania Department of Health (DOH) and the Department of Human Services (DHS) about the Regional Response Health Collaborative Program (RRHCP). The guidance includes a number of frequently asked questions (FAQs).
