Brain Injury

The Administration for Community Living (ACL) has extended an invitation to participate in a listening session tomorrow (Friday, August 11, 2017) from 1:30 pm to 3:30 pm. This listening session is an opportunity to hear about the Partnerships for Innovation, Inclusion, and Independence, which is a proposed grant program that would combine the activities carried out by the State Councils on Developmental Disabilities, Statewide Independent Living Councils, and Traumatic Brain Injury Advisory Councils into a single state grant program. Please refer to the invite for additional information.

Listening Session Dial-In Information:
Number: 800-857-9877
Participant Code: 8400563

The Office of Long-Term Living (OLTL) has announced the availability of a link to an online application for interested individuals to request employment services from the Pennsylvania Office of Vocational Rehabilitation (OVR).

OVR is a state agency within the Department of Labor and Industry whose mission is “to assist Pennsylvanians with a disability secure and maintain employment and independence.” A person with a disability can either refer themselves, or their service coordinator (SC), advocate, family member, or friend may make a referral.

As a reminder, participants must first seek employment services through OVR before utilizing employment services through the Office of Long-Term Living waivers. To contact the OVR district office in your area, use this link. OVR now has an online application to request services. SCs are strongly encouraged to assist OLTL participants in completing the online application using the attached instructions.

Any questions or concerns regarding the above, including to request an alternate format, should be addressed to Edward Butler via email or phone at 717-214-3718.

On July 28, 2017, an Info was issued regarding the Office of Long-Term Living’s (OLTL’s) proposed waiver amendments to the Aging, Attendant Care, Independence, and OBRA waivers. On August 1, OLTL issued a follow-up email regarding these amendments, as well as some additional information including how to view a side-by-side comparison of the current and revised language, the comment forms, and information on webinars that have been scheduled in August. The webinars will be used to receive comments on the proposed waiver amendments. The information in that email is provided below for additional details. As a reminder, the public comment period on the proposed waiver amendments ends on August 31, 2017.

 

From OLTL
In September 2017, the Department of Human Services (DHS) Office of Long-Term Living (OLTL) will be submitting amendments to the Aging, Attendant Care, Independence, and OBRA waivers. To view a side-by-side comparison of the current and revised language, and to access the amendments in their entirety, please use this link.

 

On this site, select the individual waiver amendment you would like to view under “Related Topics.” All documents are available in alternate format and in paper copy upon request by calling the Office of Long-Term Living Bureau of Policy and Regulatory Management at 717-783-8412.

 

Public Input

The July 29, 2017, Volume 47, Number 30 issue of the Pennsylvania Bulletin contains the public notice announcing amendments to the Aging, Attendant Care, Independence, and OBRA waivers. OLTL is seeking public comment on these waiver amendments. Interested persons are invited to submit written comments to the Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Aging Waiver, Attendant Care, Independence, or OBRA Waiver, PO Box 8025, Harrisburg, PA 17105-8025. Comments can also be sent via email using the comment forms that OLTL has provided. The comment forms can be found at this link.

 

On this site, select the individual waiver amendment you would like to view under “Related Topics” and the comment form will be listed in the documents. The public comment period ends on August 31, 2017. Comments received within the 30-day comment period will be reviewed and considered for revisions to the amendments.

 

The Office of Long-Term Living will offer two webinars in August for public input and discussion. The webinars will be held on Monday, August 7, 2017, from 10:00 am – 11:00 am and Wednesday, August 16, from 1:30 pm – 2:30 pm. Please see the information below for further details on the scheduled webinars.

 

  • Please register here for the Aging, Attendant Care, Independence, and OBRA Waiver Changes Webinar on August 7, 2017 10:00 am EDT.
  • Please register here for the Aging, Attendant Care, Independence, and OBRA Waiver Changes Webinar on August 16, 2017 1:30 pm EDT.

    After registering, you will receive a confirmation email containing information about joining the webinar. The connection link you receive will be unique to you and should not be shared with others.

On July 31, 2017, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2018 inpatient rehabilitation facility prospective payment system (IRF PPS) final rule. Some of the key provisions contained in the final rule include:

 

Updates to IRF Payment Rates

Update to the Standard Payment Rates

CMS finalized an update to the IRF PPS payments to reflect a 1.0 percent increase factor, in accordance with section 1886(j)(3)(C)(iii) of the Social Security Act, as added by section 411(b) of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). An additional approximate 0.1 percent decrease to aggregate payments due to updating the outlier threshold results in an overall estimated update for FY 2018 of approximately 0.9 percent (or $75 million), relative to payments in FY 2017.

 

Update to CMG Weights, Lengths of Stay and Comorbidities

CMS updated the Case Mix Group (CMG) weights based on FY 2015 IRF cost report data and the FY 2016 IRF claims data, as well as the average lengths of stay (ALOS) per CMG. The final rule estimates 99.3 percent of all IRF cases are in CMGs and tiers that would experience less than a five percent change in the CMG relative weight under their proposal.

 

Rural Adjustment Transition

FY 2018 is the third and final year of the phase-out of the 14.9 percent rural adjustment for the 20 IRF providers that were designated as rural in FY 2015 and changed to urban under the new Office of Management and Budget (OMB) delineations in FY 2016. As a result, the rural adjustment for these IRF’s will no longer be applied.

 

ICD-10-CM Presumptive Compliance Coding Changes 

CMS made refinements to the ICD-10-CM lists used in determining IRFs’ presumptive compliance with the 60 Percent Rule. The complete lists of the adopted code revisions are available for download on the IRF Data Files website. CMS notes that the version of these finalized lists will constitute the baseline for any future updates to the presumptive methodology lists. The changes will be effective for discharges on or after October 1, 2017. CMS adopted only those coding changes that will increase the number of cases counting toward presumptive compliance and did not adopt any changes that would remove codes from counting toward the presumptive compliance threshold. CMS also stated that since it is not making any negative changes, it would consider the comments it received on the need for a delayed effective dates should any of these negative changes occur in future rulemakings.

For FY 2018, the following refinements to the ICD-10-CM lists used in determining IRFs’ presumptive compliance to ensure that these lists reflect as accurately as possible the types of patients that should count presumptively toward the 60 percent rule were finalized by:

  • Counting certain ICD-10-CM diagnosis codes for patients with traumatic brain injury and hip fracture conditions; and
  • Revising the presumptive methodology list for major multiple trauma by counting IRF cases that contain two or more of the ICD-10-CM codes from three major multiple trauma lists in the specified combinations.

CMS did not finalize the proposal to remove certain ICD-10-CM codes from the presumptive methodology at this time indicating they would continue to monitor and consider their appropriateness for inclusion on the presumptive methodology lists for future policy development and rulemaking.

 

Other Policy Changes

CMS proposed several changes for the purposes of eliminating redundancies and simplifying administrative burden for providers and for the agency and finalized the following:

  • Remove the 25 percent payment penalty for late submissions of the IRF PAI beginning October 1, 2017;
  • Remove the voluntary swallowing assessment item (Item 27) in the IRF PAI beginning October 1, 2017; and
  • Use the height/weight items on the IRF PAI (items 25A and 26A) to determine patients’ BMI greater than 50% for cases of lower extremity single joint replacement.

 

IRF Quality Reporting Program (QRP)

Under the IRF QRP, the applicable annual payment update for any IRF that does not submit the required data to CMS is reduced by 2 percentage points. In this final rule, CMS is finalizing the replacement of the current pressure ulcer measure with an updated version of that measure, as well as the removal of the All-Cause Unplanned Readmission Measure for 30 Days Post-Discharge from IRFs (NQF #2502). CMS is also finalizing the public display of six additional quality measures on the IRF Compare website in calendar year 2018.

 

In addition to the proposals related to quality measures and public reporting, CMS is finalizing that the data IRFs submit on the measure Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay) (NQF #0678) meet the definition of standardized patient assessment data for the FY 2019 IRF QRP. For the FY 2020 IRF QRP, CMS is finalizing that the data IRFs submit on the measures Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631) and Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury meet the definition of standardized patient assessment data. However, in response to the comments received for the FY 2020 program year, CMS is not finalizing the proposed additional standardized data elements.

 

Request for Information

CMS also included a Request for Information (RFI) in the proposed rule for continuing feedback on the Medicare Program. Input was requested on potential regulatory, sub-regulatory, policy, practice and procedural changes to make the delivery system less bureaucratic and complex, reduce burden for clinicians and providers, and increases quality of care while decreasing cost. CMS said it would not respond to RFI comment submissions in the final rule, but rather will actively consider all input in developing future regulatory proposals or future sub-regulatory guidance. There was no response provided in the final rule.

 

The final rule will be published in the August 3, 2017 Federal Register, which will be sent to members upon publication.

The Department of Human Services (DHS) has made available for public review and comment the Office of Long-Term Living’s (OLTL) proposed waiver amendments to the following waivers:

The notices were released and will be published in the July 29, 2017 Pennsylvania Bulletin. Comments on the proposed waiver amendments submitted within 30 days will be reviewed and considered. They can be submitted to the Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Aging Amendments; Attendant Care Amendments; Independence Amendments; or OBRA Amendments (based on which waiver comments are being submitted), PO Box 8025, Harrisburg, PA 17105-8025. Comments may also be submitted to the Department via email. Use “Aging Waiver Amendments,” “Attendant Care Waiver Amendments,” Independence Waiver Amendments,” or ”OBRA Waiver Amendments” as the subject line depending on which waiver comments are being submitted.

DHS will be holding two webinars on the proposed waiver amendments. The dates and times of the webinars, including the call information, will be posted to the DHS OLTL Waiver Information website or by calling 717-783-8412.

In follow-up to the Info published on July 14, 2017, Subcommittee on Health for Ways & Means Committee Hearing – Medicare Outpatient Therapy Cap, the Subcommittee on Health for the Ways and Means Committee just posted the witnesses for the hearing, as well as the text of legislation to be reviewed during the hearing. Included in the witnesses will be a Speech-Language Pathologist (SLP), the CEO of the American Physical Therapy Association (APTA), Chair of the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, among many others. Included in the legislative text is HR 1148, Furthering Access to Stroke Telemedicine (FAST) Act of 2017 and Discussion Draft of HR ____, To amend title XVIII of the Social Security Act to extend the therapy cap exceptions process and manual medical review under the Medicare program.

As a reminder, the hearing is scheduled for Thursday, July 20 at 10:00 am and will be available via webcast.

On July 13, 2017, the Centers for Medicare and Medicaid Services (CMS) released two proposed payment rules, both of which include Requests for Information (RFI):

Hospital Outpatient Prospective Payment System (OPPS)
This proposed rule updates payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The proposed rule is one of several for 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in health care; and promote transparency, flexibility, and innovation in the delivery of care. The OPPS and ASC payment system are updated annually to include changes to payment policies, payment rates, and quality provisions for those Medicare patients who receive care at hospital outpatient departments or receive care at surgical centers. Among the provisions in this rule, CMS is proposing to change the payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B program. The proposed rule also includes a provision that would alleviate some of the burdens rural hospitals experience in recruiting physicians by placing a two-year moratorium on the direct supervision requirement currently in place at rural hospitals and critical access hospitals (CAHs). In addition, CMS is releasing within the proposed rule a Request for Information (RFI) to welcome continued feedback on positive solutions to better achieve transparency, flexibility, program simplification and innovation in the Medicare program. CMS is also soliciting ideas for regulatory, sub-regulatory, policy, practice, and procedural changes to better accomplish these goals. Ideas could include recommendations regarding payment system re-design; elimination or streamlining of reporting; monitoring and documentation requirements; operational flexibility; and feedback mechanisms and data sharing that would enhance patient care, support the doctor-patient relationship in care delivery, and facilitate patient-centered care within outpatient stays at hospitals and services performed at ambulatory surgical centers. Additional information available to members includes a fact sheet. The proposed rule will be published in the Federal Register on July 20, 2017. Comments on this proposed rule will be accepted until September 11, 2017.
Medicare Physician Fee Schedule (MPFS)
This proposed rule updates the Medicare payment, policies and quality provisions for physicians and other clinicians who treat Medicare patients in calendar year (CY) 2018. The proposed rule seeks public input via a request for information (RFI) on solutions to better achieve transparency, flexibility, program simplification, and innovation. CMS cites in the proposed rule its desire to start a national conversation about improving the health care delivery system; how Medicare can contribute to making the delivery system less bureaucratic and complex; and how we can reduce burden for clinicians, providers, and patients in a way that increases quality of care and decreases costs, thereby making the health care system more effective, simple, and accessible while maintaining program integrity and preventing fraud. CMS is soliciting ideas for regulatory, sub-regulatory, policy, practice, and procedural changes to better accomplish these goals. Ideas could include recommendations regarding payment system re-design; elimination or streamlining of reporting; monitoring and documentation requirements; operational flexibility; and feedback mechanisms and data sharing that would enhance patient care, support the doctor-patient relationship in care delivery, and facilitate patient-centered care. Ideas could also include recommendations regarding when and how CMS issues regulations and policies and how CMS can simplify rules and policies for beneficiaries, clinicians, providers, and suppliers. In responding to the RFI, CMS should be provided with clear and concise proposals that include data and specific examples. The proposed rule also includes provisions to better align incentives and provide clinicians with a smoother transition to a new Merit-based Incentive Payment System under the Quality Payment Program. It also encourages more fair competition between hospitals and physician practices by promoting greater payment alignment, and it would improve the payment for office-based behavioral health services that are often the therapy and counseling services used to treat opioid addiction and other substance use disorders. CMS is also proposing several modifications to the rules for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program. In addition, the proposed rule makes additional proposals to implement the Center for Medicare and Medicaid Innovation’s (CMMI) Medicare Diabetes Prevention Program expanded model starting in 2018. CMS released a fact sheet to provide more detailed information. The proposed rule will be published in the Federal Register on July 21, 2017. Comments on this proposed rule will be accepted until September 11, 2017.

The Subcommittee on Health for the Ways and Means Committee recently announced that they will be conducting a hearing on Thursday, July 20, 2017 at 10:00 am. The hearing, “Examining Bipartisan Legislation to Improve the Medicare Program,” is likely to include discussion on the potential repeal of the Medicare Outpatient Therapy Cap. The legislative text will be posted on the US House of Representatives Committee Repository website prior to the hearing. The hearing will also be available via webcast.

The Centers for Medicare and Medicaid Services (CMS) announced they will host an inpatient rehabilitation facility (IRF) quality reporting program (QRP) refresher training webinar. The webinar is scheduled for August 15, 2017 from 2:00 pm to 4:00 pm ET. The primary focus of the webinar is to provide additional training and guidance on correct data collection and submission procedures for the IRF PAI 1.4 and information on preliminary trends from the data analysis of new items that went into effect on October 1, 2016. A demonstration on how to access resources available on the CMS website to assist providers in better understanding the IRF QRP will also be provided. Those interested should register to participate.