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Authors Posts by Melissa Dehoff

Melissa Dehoff

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Melissa Dehoff is responsible for all medical rehabilitation and brain injury service issues. Ms. Dehoff attends multiple state-level meetings to advocate on behalf of members on brain injury and rehabilitation issues and is a member of the Department of Health Traumatic Brain Injury Advisory Board.

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The Centers for Medicare and Medicaid Services (CMS) continues to remind hospitals about the final rule that established requirements for hospitals to establish, update, and make public a list of their standard charges for the items and services that they provide. The goal for these actions is to promote price transparency in healthcare and public access to hospital standard charges. This requirement becomes effective on January 1, 2021. The pricing information can be provided in two ways:

  • Comprehensive machine-readable file with all items and services
  • Display of shoppable services in a consumer-friendly format

CMS has developed the following resources for providers to utilize to prepare and ensure they are compliant:

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The Centers for Medicare and Medicaid Services (CMS) recently announced that the inpatient rehabilitation facility (IRF) provider preview reports have been updated on the iQIES site and are now available for Quarter 1 of 2019 through Quarter 4 of 2019 data and the annual update of the claims-based measures data from Quarter 4 of 2017 through Quarter 3 of 2019. The information contained within the preview reports contains the data that will be published on IRF Compare during the December 2020 refresh of the website. The December 2020 refresh is the rescheduled IRF Compare refresh that was initially scheduled for September 2020.

The deadline for providers to review their data is October 26, 2020. Corrections to the underlying data will not be permitted during this timeframe; however, providers can request CMS to review the data during this preview period if they believe the quality measure scores that are displayed in their reports are inaccurate. Six new measures will be displayed publicly beginning with the December 2020 refresh and will be removing one quality measure (Percent of Residents or Patients With Pressure Ulcers that are New or Worsened) from the IRF Compare and Care Compare websites. The six new measures include:

  • Changes in Skin Integrity Post-Acute Care (PAC): Pressure Ulcer/Injury,
  • Drug Regimen Review Conducted with Follow-Up for Identified Issues – PAC IRF QRP,
  • IRF Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients (NQF #2633),
  • IRF Functional Outcome Measure: Change in Mobility for Medical Rehabilitation Patients (NQF #2634),
  • IRF Functional Outcome Measure: Discharge Self-Care Score for Medical Rehabilitation Patients (NQF #2635), and
  • IRF Functional Outcome Measure: Discharge Mobility Score for Medical Rehabilitation Patients (NQF #2636)

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Earlier this week, the Department of Health (DOH) released the COVID Alert Exposure Notification App, which is now available and can be downloaded for free in the Google and Apple stores (links provided below). The COVID Alert PA is a free mobile App using Bluetooth Low Energy (BLE) technology and the Exposure Notification System developed by Apple and Google. The app offers:

  • Interactive COVID-19 symptom checker
  • Opt-in for alerts for potential exposures to the virus
  • Updates on the latest public health data about COVID-19 in PA
  • Advice for what to do if you have a potential exposure to COVID-19

COVID Alert PA protects both privacy and personal information. The app does not use GPS, location services, or any movement or geographical information. It will never collect, transmit, or store personal information. It is completely anonymous.

Existing traditional contact tracing processes rely on a positive individual to remember and name who they have been in contact with recently, and for how long. In many cases, positive COVID-19 individuals may not even know the people they were in close contact with, like if the contact happened on a bus or train, at a check-out line in a grocery store, a restaurant or some other public venue.

The app supplements traditional contact tracing processes by being able to identify strangers a positive app user came in contact with and help stop the rapid spread of COVID-19. If the app detects that you have been in close contact with another user who has tested positive for COVID-19, you will receive a push notification on your phone. This is called an exposure alert and will be followed by what you should do to monitor your own health. You can learn more about the app and how it works here.

The Department of Human Services is committed to supporting this effort and helping protect the people we serve encouraging use of COVID Alert PA. This technology only works if others have downloaded the app, which is why they are asking all Pennsylvanians to unite against COVID and download the app.

DOH also has an extensive catalog of marketing materials including posters, social media posts, press releases, and other customizable content if you are interested in helping them to get the word out.

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The Centers for Medicare and Medicaid Services (CMS) recently announced that they will be releasing a new inpatient rehabilitation facility (IRF) Pricer software package prior to October 1, 2020. This new software package will contain updated rates that are effective for IRF claims with discharges that fall within October 1, 2020 through September 30, 2021. This Pricer software is used by providers and Medicare contractors to determine payment under the IRF prospective payment system (PPS).

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The Centers for Medicare and Medicaid Services (CMS) will conduct their next hospital/quality initiative open door forum on Thursday, September 17, 2020 at 2:00 pm. This call will focus primarily on the calendar year (CY) 2021 hospital outpatient prospective payment system (OPPS) proposed rule and the fiscal year (FY) 2021 hospital inpatient prospective payment system (IPPS) final rule. Time will also be allocated for questions.

To participate, dial 888-455-1397 and reference conference passcode: 9375124

Instant replay will be available beginning one hour after the call has ended. Instant replay is an audio recording of the call and be accessed by dialing 800-753-9736 (a passcode is not required). The recording will be available through September 19, 2020.

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The next Managed Long-Term Services and Supports (MLTSS) Subcommittee meeting will be held on October 7, 2020 as a webinar with remote streaming from 10:00 am – 1:00 pm. To register for the webinar, please use this webinar registration link. After registering, you will receive a confirmation email containing information about joining the webinar. Remote captioning and streaming services will be provided. If you require these services, please use this remote captioning and streaming services link.

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The Centers for Medicare and Medicaid Services (CMS) has launched a new health care comparison tool, Care Compare, that provides a single user-friendly interface that patients and caregivers can use to make informed decisions about health care based on cost, quality of care, volume of services, and other data. The site provides information about doctors, hospitals, nursing homes, and other health care services in one location rather than searching through multiple tools. In addition, patients can obtain information about quality measures, helpful hints and guides, and costs for procedures. Additional information about this new tool is available from the Press Release issued by CMS.

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Deadline, as Letters on a Clock

This communication is to update and replace the ListServ email sent on August 4, 2020 regarding the subject: Updated- CARES Act Provider Relief Fund Payments Available for Medicaid/CHIP Providers – Application Deadline Extended to August 28, 2020. The U.S. Department of Health and Human Services (HHS) has extended the deadline to submit the application to HRSA for this funding to September 13, 2020. This information has been updated below. Please disregard the previous communication.

Updated – CARES Act Provider Relief Fund Payments Available for Medicaid/CHIP Providers
The US Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced additional distributions from the Provider Relief Fund to eligible Medicaid and Children’s Health Insurance Program (CHIP) providers that participate in state Medicaid and CHIP programs. HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Allocation. The original deadline to submit the application to HRSA for this funding was July 20, 2020, then it was updated to August 3, 2020 and August 28, 2020. The deadline to submit the application to HRSA has once again been extended and is now September 13, 2020. Please read the full announcement for further details.

Eligibility Requirements:
To be eligible to receive HHS’ Medicaid Provider Phase 2 General Distribution payments, initial key eligibility requirements for Medicaid and CHIP programs and/or Medicaid and CHIP managed care organization providers include:

  • The provider must have directly billed or own (on the application date) an included subsidiary that has billed a state Medicaid/CHIP program and/or a Medicaid/CHIP managed care plan for health care-related services between January 1, 2018 and December 31, 2019;
  • The provider must have either (i) filed a federal income tax return for fiscal years 2017, 2018 or 2019 or (ii) be an entity exempt from the requirement to file a federal income tax return and have no beneficial owner that is required to file a federal income tax return (e.g. a state-owned hospital or healthcare clinic);
  • The provider must have provided patient care after January 31, 2020;
  • The provider must not have permanently ceased providing patient care directly, or indirectly through included subsidiaries; and
  • If the applicant is an individual, they must have gross receipts or sales from providing patient care reported on Form 1040, Schedule C, Line 1, excluding income reported on a W-2 as a (statutory) employee.

Providers who have received a payment under Phase 1 of the General Distribution are no longer prohibited from submitting an application under Phase 2 of the General Distribution. Providers who received a previous Phase 1 – General Distribution payment are eligible to apply and, if they have not yet received a payment that is approximately 2 percent of annual revenue from patient care, may receive additional funds.

Examples of types of Medicaid/CHIP providers that are eligible for these payments include pediatricians, obstetrician-gynecologists, dentists, opioid treatment and behavioral health providers, assisted living facilities, and other providers of home and community-based services. In order to receive Provider Relief Fund payments, eligible Medicaid/CHIP providers must take action through HRSA’s application portal and comply with the Medicaid Relief Fund Payment Terms and Conditions.

Provider Relief Fund payments will be at least two percent (2 percent) of reported gross revenue from patient care. Eligible Medicaid/CHIP providers can report their gross annual patient revenue through the Enhanced Provider Relief Fund Payment Portal and the final amount that a provider receives will be determined after such data is submitted, including information on the number of Medicaid patients served. HHS has issued a comprehensive set of instructions for submitting an application through the application portal.

Before applying through the Enhanced Provider Relief Fund Payment Portal, applicants should:

In addition, DHS encourages Medicaid/CHIP providers to carefully review the Medicaid Relief Fund Payment Terms and Conditions with their attorneys and accountants on the appropriate use of and questions about CARES Act Provider Relief Funds.

HHS has created a listing of CARES Act Provider Relief Funds Frequently Asked Questions (FAQ).

The complete press release is on the HHS website.

A PDF fact sheet explaining the application process has also been released to address questions. Please note that the fact sheet lists the outdated application submission deadline. The application submission deadline is now September 13, 2020.

More information about eligibility and the application process is also available on the HHS website.

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In June 2020, the Office of Long-Term Living (OLTL) issued transition plans to phase out temporary changes to the OBRA Waiver and Act 150 Program via the OLTL Listserv. The transition plans direct the OBRA and Act 150 Program Service Coordinators (SCs) to resume performing face-to-face assessments and allow telephonic assessments when risk factors are present in the participant’s home. The transition plans also allow the SCs to make adjustments (additions or reductions) to service plans as determined by the participant’s assessment. On August 26, 2020, OLTL issued additional guidance for OBRA and Act 150 SCs as they resume face-to-face assessments. Questions about this information should be directed to the OLTL Provider Helpline at 800-932-0939.

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