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Brain Injury

(From OLTL)

TO: Office of Long-Term Living (OLTL) Cognitive Rehabilitation Therapy Providers
RE: Procedure Code for Cognitive Rehabilitation Therapy Services – Processing Issue

This notice is to advise Cognitive Rehabilitation Therapy Providers that after removing service procedure 97532 SE and replacing it with the new procedure code 97127 for Cognitive Rehabilitation, a processing issue occurred causing many claims to deny.

OLTL is aware of this issue and is working on a system fix.  OLTL will send a follow up communication in the very near future advising providers of the fix and when it is appropriate to rebill.  In the meantime, OLTL asks that providers refrain from billing for Cognitive Rehabilitation in the Independence and OBRA waivers.

If you have any questions regarding the procedure code change, please contact the OLTL Provider Inquiry Unit at RA-ProviderOperation@pa.gov or 1-800-932-0939.

A listserv has been established for ongoing updates on the CHC program. It is titled OLTL-COMMUNITY-HEALTHCHOICES, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.

Please share this email with other members of your organization as appropriate. Also, it is imperative that you notify the Office of Long-Term Living for changes that would affect your provider file, such as addresses and telephone numbers. Mail to/pay to addresses, email addresses, and phone numbers may be updated electronically through ePEAP, which can be accessed through the PROMISe™ provider portal. For any other provider file changes please notify the Bureau of Quality and Provider Management Enrollment and Certification Section at 1-800-932-0939 Option #1.

To ensure you receive email communications distributed from the Office of Long-Term Living, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.

NOTICE: This confidential message/attachment contains information intended for a specific individual(s) and purpose. Any inappropriate use, distribution or copying is strictly prohibited. If received in error, notify the sender and immediately delete the message.

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The Office of Long-Term Living (OLTL) recently issued a notice to share that Community HealthChoices (CHC) pre-transition notices were being sent this week to individuals eligible for CHC in Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. If members receive questions from eligible enrollees, they should encourage them to visit the HealthChoices website for more details or to enroll in information sessions. Please note that information sessions are intended for potential enrollees, and providers may attend only if they are not taking a spot from a potential enrollee. A copy of the notices and all CHC participant communications are available online.

OLTL also issued a CHC Complaints and Grievances Fact Sheet. CHC offers protections for participants who disagree with a CHC managed care organization (CHC-MCO) decision to deny or decrease a service or approve a service or item that differs from what was requested. Participants also have protections if they are dissatisfied with their CHC-MCO.

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

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Beginning in January 2019, Community HealthChoices (CHC) will go into effect in the Southeast part of the state. To help providers learn more about CHC and ask questions, community meetings have been scheduled starting at the end of August and will continue through mid-October. Providers are encouraged to attend one of these sessions. Registration is required (either online or by telephone) and space is limited. Please see this schedule for the dates, times, and locations of the meetings. Contact Melissa Dehoff at RCPA with any questions.

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The June 2018 Medicaid and CHIP Payment and Access Commission (MACPAC) Report to Congress included a chapter on Managed Long-Term Services and Supports (MLTSS). The chapter provides an overview of MLTSS, the growing role of managed care in long-term services and supports, reviews the results of MACPAC’s initial work in this area, and identifies gaps in our knowledge about what drives     success in MLTSS programs. It also includes highlights of reports describing state MLTSS programs and program outcomes. In addition, the report focuses on operational issues and the future of MLTSS.

In preparation for the launch of Community HealthChoices (CHC) in the Southeast region, this CHC Fact Sheet explains the delivery of service coordination through the program. Under CHC, service coordination is a function of the managed care organizations (MCOs). A service coordinator is the MCO’s designated, accountable point-of-contact for each participant receiving long-term care services, their person-centered service plan, and service coordination. Therefore, the Office of Long-Term Living (OLTL) sees the service coordinators as part of the MCO under CHC.

In addition to the fact sheets, there are now short, easily digestible overview trainings on CHC that can be found here in order to increase stakeholder knowledge in anticipation of the Southeast rollout of the program.

To assist stakeholders in finding answers to questions more quickly, all FAQs have been consolidated into a single CHC Questions and Answers Document. The new document is in searchable PDF format and contains a table of contents that allows the user to easily move to different sections within the document.

The CHC Questions and Answers Document can be found on both the Participant and Provider sections of the CHC website by clicking on “View CHC Publications” or by following this link.

CONTACT: If you have any questions, please visit the CHC website or submit comments via email.

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The Pennsylvania Department of Health (DOH), Bureau of Family Health (BFH) has been awarded the Administration for Community Living (ACL) Traumatic Brain Injury (TBI) State Partnership Program Mentor Grant. This funding opportunity will allow for the BFH to develop a NeuroResource Facilitation Program. The program will connect families and individuals with TBI to services and resources through case management. The BFH will also fund brain injury education and training to increase knowledge of TBI with a focus on TBI screening in the juvenile justice and the older adult population. The overall project aim is to help maximize the health, independence, and well-being of persons with TBI and their families in Pennsylvania. Through the Mentor Grant Program, the BFH will also mentor other states to assist with enhancing their programming, and will collaborate with ACL and other Mentor States to build on the overall TBI infrastructure. Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with questions.

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As a result of the many Community HealthChoices (CHC) stakeholder events, the Department of Human Services (DHS) has added frequently asked questions (FAQ) documents to the CHC website for providers and participants.

To assist stakeholders in finding answers to questions more quickly, DHS recently consolidated all FAQs into a single CHC Questions and Answers document. This new document is in a searchable pdf format and contains a table of contents that allows the user to easily move to different sections within the document.

For more information, visit the DHS CHC web page.

This week, both the US Senate and US House introduced bipartisan legislation (HR 5912 in the House and S 2897 in the Senate) designed to delay implementation of the Electronic Visit Verification (EVV) provision of the 21st Century Cures Act and require public input from stakeholders. The bill was led by Senators Lisa Murkowski (R-AK) and Sherrod Brown (D-OH) and co-sponsored by a range of Democrats and Republicans in the Senate and House. The EVV delay bill gives states an additional year to implement EVV, having it take effect on January 1, 2020 instead of January 1, 2019.

In late 2016, Congress had ordered states to install EVV systems as a way of preventing fraud in Medicaid as part of the 21st Century Cures Act, but many challenges arose after the bill passed. This is partially due to CMS not releasing guidance on the EVV statute until May 2018, leaving states in the dark for a full 18 months following passage of the EVV law. Even despite CMS’ recent guidance, many concerns remain about which disability supports and services are required to comply with the rule. Additionally, because there has been little stakeholder input, questions abound about privacy, costs, and other aspects of compliance.

Please contact your legislators and ask them to support the EVV delay bill. The American Network of Community Options and Resources (ANCOR) has been instrumental in advocating for this legislation; RCPA is proud to be a member of ANCOR and appreciates their initiative on this issue.

The following documents provide information from the Association of People Supporting Employment First (APSE) regarding the Certified Employment Specialist Professional (CESP) recertification process and the requirements for Continuing Education (CE) credits.

The CESP Certification is valid for a 3-year period, during which time the CESP must demonstrate a commitment to professional development by obtaining 36 CE Credits in order to maintain their certification. One CE credit is equivalent to one hour of clock time (except as noted on the “Requirements for Continuing Education Form”). Documentation which verifies the reported number of CE credits must be submitted with the recertification application. Repeat CE activities/content within the same 3-year recertification cycle will NOT count for credit.

In addition to providing appropriate documentation of 36 CE Credits, the recertification application must be submitted with the recertification fee of $125 paid per 3-year term.

Please refer to the following documents for more detailed information: