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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 Office of Long-Term Living (OLTL) will be conducting the next Community HealthChoices (CHC) Third Thursday webinar on December 19, 2019 from 1:30 pm – 3:00 pm. During this webinar, Deputy Secretary Kevin Hancock will provide updates on the CHC program. To participate in the webinar, please register here. Once registered, you will receive a confirmation email that contains the information about joining the webinar. If you have any questions, please contact the OLTL Bureau of Policy Development and Communications Management at 717-857-3280.

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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.

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physiotherapist helping patient to walk

An article, “Comparison of Functional Status Improvements Among Patients with Stroke Receiving Postacute Care in Inpatient Rehabilitation vs Skilled Nursing Facilities,” was recently published in the Journal of the American Medical Association (JAMA) Network that highlights the findings from a cohort study of patients who received post-acute care in inpatient rehabilitation facilities (IRFs) or skilled nursing facilities (SNFs) following a stroke. The study examined changes in functional status. Stroke was selected because it is a major cause of disability in the United States and an important public health issue, and often requires a range of treatments and expertise.

The study included patients with stroke who were discharged from acute care hospitals to IRFs or SNFs from January 1, 2013 to November 30, 2014. Medicare claims were used to link to IRF and SNF assessments. The study does include limitations that were encountered, such as the findings don’t take into account other post-acute settings (home health, long-term care hospitals, etc.) and the inability to examine cognitive function before and after the stroke, stroke severity, or location of the stroke.

The findings of the study suggest that the care in an IRF was associated with greater improvement in mobility and self-care compared with care in an SNF. Their findings indicate the need to carefully manage discharge to post-acute care based on the patient’s needs and potential for recovery. Post-acute reform based on the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) must avoid a payment system that shifts patients with stroke who could benefit from intensive inpatient rehabilitation to lower cost settings. The IMPACT Act of 2014 is a bill that is intended to change and improve Medicare’s post-acute care services and how they are reported. Contact RCPA Rehabilitation Services Director Melissa Dehoff with questions.

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The Department of Human Services (DHS) has announced rate increases for Personal Assistance Services (PAS) in the OBRA Waiver and Act 150 program. There will also be a rate increase for Residential Habilitation in the OBRA Waiver. These rate increases become effective on January 1, 2020. The new rates for the OBRA Waiver were published in the August 24, 2019 edition of the Pennsylvania Bulletin. The new rates for the Act 150 Program were published in the November 30, 2019 edition of the Pennsylvania Bulletin. These new rates are based on a participant’s county of residence.

In addition, Home and Community Services Information System (HCSIS) service plans were updated on November 30, 2019. Service Coordinators (SCs) do not need to make any service plan updates for this rate change, as a HCSIS system-wide update is being initiated to make the necessary service data updates onto the impacted service plans.

Questions about these updates should be directed to the Office of Long-Term Living (OLTL) Provider Inquiry Line at 800-932-0939, Option 2, Monday–Friday from 9:00 am – 12:00 pm and 1:00 pm – 4:00 pm.

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The Department of Human Services (DHS), Office of Long-Term Living (OLTL) will conduct the next Managed Long-Term Services and Supports (MLTSS) Subcommittee meeting on Tuesday, December 3, 2019, in the Honor’s Suite at 333 Market Street Tower in Harrisburg from 10:00 am – 1:00 pm. Those who cannot attend in person may participate by dialing: 213-929-4212; Access Code: 524-290-985, or by webinar. If you plan to participate via webinar, registration is required.

Public comments will be accepted during presentations instead of just being heard at the end of the meeting; however, there will be an additional 15-minute period at the end of the meeting for any additional public comments.

If you have any questions about registering for the webinar or require a toll-free number to dial in, please contact the Office of Long-Term Living.

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The Office of Long-Term Living (OLTL) announced three InterRAI train-the-trainer sessions for service coordination entities (SCEs). The trainings, which are limited to two individuals per SCE, will be jointly presented by the three Community HealthChoices Managed Care Organizations (CHC MCOs): AmeriHealth Caritas, PA Health & Wellness, and UPMC CHC.

The training sessions are two full-day sessions that begin promptly at 9:00 am. Attendees are encouraged to arrive by 8:30 am to register. The training is free and lunch will be provided. Dates and locations of the trainings are:

  • December 4–5: Wilkes Barre, PA
  • December 9–10: Camp Hill, PA
  • December 12–13: Franklin, PA

Registration is required to attend. Each session has limited spots available, so register as soon as possible. At the conclusion of this InterRAI training, participants will be able to recognize and complete each section of the InterRAI HC Assessment Tool, in accordance with the standards set forth in the CHC Agreement. Contact Melissa Dehoff with questions.

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The Office of Long-Term Living (OLTL) recently announced that two one-day classroom training sessions will be offered for Service Coordinators (SCs). Prior to the training sessions, and a required prerequisite, attendees must complete three OLTL SC modules. These modules will provide a strong foundation on the basics to fulfill SC requirements. Participants will be able to take what is learned from these modules and apply it to situations found every day on the job. Attendance at the training sessions is limited to SCs, not supervisors or directors. Also, two attendees will be permitted per agency. Preference will be given to SCs that were hired in 2018 and 2019. Additional registrations will be considered on a first-come, first-served basis.

Special Note: This training is required for SCs working with waiver participants enrolled in the Aging, Attendant Care, Independence, and OBRA waivers, as well as the Act 150 program.

Session information:
Thursday, December 12, 2019 in Harrisburg
Radisson Hotel Harrisburg
1150 Camp Hill Bypass
Camp Hill, PA 17011
8:00 am – 4:30 pm

Tuesday, December 17, 2019 in Philadelphia
DoubleTree
301 W Dekalb Pike
King of Prussia, PA 19406
8:00 am – 4:30 pm

Registration is required in order to attend one of these sessions. If you have any questions regarding registration, please contact Dering Consulting at 717-234-0567.

Questions about the training should be directed to OLTL’s Bureau of Participant Operations at 717-787-8091.

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The Centers for Medicare and Medicaid Services (CMS) will conduct the next hospital quality open door forum for Tuesday, November 19, 2019 at 2:00 pm. Some of the agenda topics for this call include a discussion on the calendar year (CY) 2020 outpatient prospective payment system (OPPS) final rule and the inpatient rehabilitation facility (IRF) report in the iQIES portal. While the CY 2020 OPPS final rule was released, it will be published in the November 12, 2019 Federal Register.

To participate in this open door forum, dial 888-455-1397; conference ID: 4676500.

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On November 1, 2019, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) final rule. The final rule includes updates to payment policies, payment rates, and quality program provisions for services effective on or after January 1, 2020.

Some of the provisions included in the final rule:

Medicare Telehealth Services – The following HCPCS codes are being added to the list of telehealth services: G2086, G2087, and G2088, which describe a bundled episode of care for treatment of opioid use disorders.

Evaluation & Management (E/M) Services – CMS is mirroring the E/M changes that were adopted by the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel for office/outpatient E/M visits.

Physician Supervision Requirements for Physician Assistants (PAs) – The regulation has been updated on physician supervision of PAs to provide them with greater flexibility to practice more broadly in accordance with state law and state scope of practice.

Review and Verification of Medical Record Documentation – In order to reduce burden, CMS finalized broad modifications to the documentation policy so that physicians, physician assistants, and advanced practice registered nurses (APRNs – nurse practitioners, clinical nurse specialists, certified nurse-midwives, and certified registered nurse anesthetists) can review and verify (sign and date), rather than re-documenting, notes made in the medical record by other physicians, residents, medical, physician assistants, and APRN students, nurses, or other members of the medical team.

Medicare Coverage for Opioid Use Disorder Treatment Services Furnished by Opioid Treatment Programs – CMS is implementing a new Medicare Part B benefit for opioid use disorder (OUD) treatment services, including medications for medication-assisted treatment (MAT), furnished by opioid treatment programs (OTP).

Counseling and Therapy Services – Finalized a policy to allow counseling and therapy services described in the bundled payments, to be furnished via two-way interactive audio-video communication technology as clinically appropriate.

Beneficiary Copayment – There will be a zero beneficiary copayment for 2020.

The final rule will be published in the November 12, 2019 Federal Register.

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