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New recoupment terms allow providers and suppliers one additional year to start loan payments.

CMS announced amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program as required by recent action by President Trump and Congress. This Medicare loan program allows CMS to make advance payments to providers, which are typically used in emergency situations. Under the Continuing Appropriations Act, 2021 and Other Extensions Act, repayment will now begin one year from the issuance date of each provider or supplier’s accelerated or advance payment. CMS issued $106 billion in payments to providers and suppliers in order to alleviate the financial burden health care providers faced while experiencing cash flow issues in the early stages of combating the Coronavirus Disease 2019 (COVID-19) public health emergency.

“In the throes of an unprecedented pandemic, providers and suppliers on the frontlines needed a lifeline to help keep them afloat,” said CMS Administrator Seema Verma. “CMS’ advanced payments were loans given to providers and suppliers to avoid having to close their doors and potentially causing a disruption in service for seniors. While we are seeing patients return to hospitals and doctors providing care we are not yet back to normal,” she added.

CMS expanded the AAP Program on March 28, 2020, and gave these loans to health care providers and suppliers in order to combat the financial burden of the pandemic. CMS successfully paid more than 22,000 Part A providers, totaling more than $98 billion in accelerated payments. This included payments to Part A providers for Part B items and services they furnished. In addition, more than 28,000 Part B suppliers, including doctors, non-physician practitioners, and durable medical equipment suppliers received advance payments totaling more than $8.5 billion.

Providers were required to make payments starting in August of this year, but with this action, repayment will be delayed until one year after payment was issued. After that first year, Medicare will automatically recoup 25% of Medicare payments otherwise owed to the provider or supplier for 11 months. At the end of the 11-month period, recoupment will increase to 50% for another 6 months. If the provider or supplier is unable to repay the total amount of the AAP during this time-period (a total of 29 months), CMS will issue letters requiring repayment of any outstanding balance, subject to an interest rate of 4%.

The letter also provides guidance on how to request an Extended Repayment Schedule (ERS) for providers and suppliers who are experiencing financial hardships. An ERS is a debt installment payment plan that allows a provider or supplier to pay debts over the course of 3 years, or, up to 5 years in the case of extreme hardship. Providers and suppliers are encouraged to contact their MAC for information on how to request an ERS. To allow even more flexibility in paying back the loans, the $175 billion issued in Provider Relief funds can be used towards repayment of these Medicare loans. CMS will be communicating with each provider and supplier in the coming weeks as to the repayment terms and amounts owed as applicable for any accelerated or advance payment issued.

For More Information:

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FOR IMMEDIATE RELEASE
October 8, 2020

Harrisburg, PA – Department of Human Services (DHS) Secretary Teresa Miller today discussed the measures Pennsylvania is taking to protect individuals with autism, intellectual and physical disabilities and older Pennsylvanians as the COVID-19 crisis continues. She also urged Pennsylvanians to continue to diligently follow public-health guidance in order to protect vulnerable Pennsylvanians who may be more at risk of complications if they develop COVID-19.

“We know that COVID-19 is an especially serious threat and can jeopardize the health of individuals with disabilities, so protecting our most vulnerable neighbors is a collective effort,” said Secretary Miller. “DHS has been doing everything in our power to ensure that the supports that we provide continue uninterrupted. But as we begin to enter winter and flu season alongside an ever-changing public health crisis, I want to reiterate that our continued success in the fight against COVID-19 relies on each of us doing all we can, such as wearing a mask and practicing social distancing, to protect those we know and those we don’t.”

Samantha Dorm, a York County mother whose 19-year-old son Michael Graff is recovering from COVID-19, echoed Secretary Miller’s call for the public to consider the effect their actions can have on vulnerable individuals. Michael has Down syndrome and autism.

“Protecting vulnerable people like my son is a responsibility that each of us carries. If nothing else, the COVID-19 crisis has made it clear that we are all truly connected and dependent on one another. But when people are unwilling to be flexible and make inconvenient changes to their lives – like wearing a mask at the grocery store or avoiding large gatherings – it can cost lives, though it may not be their own,” Dorm said. “The only way we can mitigate the long-term impact of the virus on people with intellectual and developmental disabilities is to embrace the concept of shared responsibility and coordinated action. We are all in this together.”

DHS administers Pennsylvania’s Medicaid program, which helps more than 3 million Pennsylvanians access health care. About 17 percent – or roughly 480,000 people – are individuals with disabilities. These Pennsylvanians access health care and other assistive services primarily through DHS’ Office of Developmental Programs (ODP) and the Office of Long-Term Living (OLTL).

Office of Developmental Programs

ODP supports more than 56,000 individuals with an intellectual disability, developmental disability, or autism — a population that is particularly high risk for contracting COVID-19. ODP is responsible for regulating more than 7,500 licensed settings across the commonwealth.

ODP has adjusted policies to ensure continuity of services during the health crisis and has received flexibilities from the Center for Medicare and Medicaid Services (CMS) to allow for:

  • Expanding services that relatives can provide,
  • Expanding services that can be offered remotely, and
  • Expanded settings where services can be provided to ensure adequate quarantine and isolation space when needed.

DHS has also worked with the Pennsylvania Department of Aging to develop and provide extensive guidance and technical assistance to our providers of community participation supports or ‘day programs’ in order to re-open these facilities. This has allowed for thousands of people to return to services during the day and provides them with enriching activities aimed at promoting health and wellness.

Office of Long-Term Living

OLTL supports individuals with physical disabilities and older adults many who are dually eligible for Medicare and Medicaid with their long-term care needs. This includes more than 371,000 Pennsylvanians who receive long-term services and supports through the Community HealthChoices program and more than 65,000 Pennsylvanians who live in more than 1,200 personal care homes and assisted living residences regulated and licensed by OLTL.

OLTL has ensured that no participant is to be disenrolled from Medicaid, even if they have not completed their eligibility redetermination application. OLTL continues to work with managed care organizations (MCOs) to ensure all necessary services are in place.

It has also received flexibilities from CMS to allow for:

  • Personal protective equipment to be added to a person’s service plan,
  • Services such as counseling or cognitive rehabilitation therapy to be provided virtually, and
  • MCOs to assess clients either telephonically or in person.

OLTL has also adhered to the Department of Aging’s reopening guidance for adult day care centers and the LIFE program. As adult day service providers begin to reopen in parts of the state, participants are given the choice to attend these programs or receive services in their homes.

As flu season approaches, DHS is reminding all Pennsylvanians to get flu shots, especially given the additional risk of COVID-19. DHS will continue to follow guidance coming from the Centers for Disease Control and Prevention (CDC) and the Pennsylvania Department of Health to ensure the continuity of care and protections for the communities it serves.

Secretary Miller acknowledged October as National Disability Employment Awareness Month (NDEAM), which reinforces the value and talent that people with disabilities add to workplaces and communities and affirms Pennsylvania’s commitment to being an inclusive community. Pennsylvanians with disabilities who are interested in employment should connect with the Department of Labor & Industry’s Office of Vocational Rehabilitation or visit ODP’s www.myodp.org and click “Resources” and select “Employment” for various resources. DHS’ employment services are still available to assist people who are working or seeking work, and many of these services can be provided remotely.

“As the economy recovers, it is absolutely critical to ensure that people with disabilities are able take part in that recovery. Workplaces should examine their policies to see which ones are outdated or intentionally or unintentionally excluding individuals with disabilities. They should also actively develop and promote specific employment opportunities for people with disabilities,” said Secretary Miller.

For more information visit www.dhs.pa.gov.

MEDIA CONTACT: Erin James, ra-pwdhspressoffice@pa.gov

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The Rehabilitation and Community Providers Association (RCPA) is preparing to launch its special recruitment initiative, Direct Care Works. The website is already live, with the social media component set to start October 26. This pilot project focuses on Allegheny County and some of the surrounding regions, and includes a job portal for RCPA members and partners to list job openings that potential applicants can review for opportunities. The job portal can be accessed through the Direct Care Works official site and is also available directly here.

The Direct Care Works job portal will be open to all RCPA members, and we would like to include your organization in this part of the initiative, along with a soon to be released Direct Care Works Toolkit to bolster and support your current recruitment efforts.

We encourage RCPA members who may have openings to contact us through this email to be included on the job portal. The information we will need is as follows:

  • Organization’s name and one line program description (see job portal for examples)
  • List of counties where your programs are operated
  • Contact person
  • Website link where potential candidates can view organization information and employment openings

If you have questions, please contact RCPA Children’s Division Director Jim Sharp.

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CMS wants to remind states that effective October 1, 2020, state Medicaid programs are required to provide coverage of Medication Assisted Treatment (MAT) services and drugs under a new mandatory benefit. The SUPPORT Act of 2018 (P.L. 115-271) amended the Social Security Act (the Act) to add this new mandatory benefit.  The purpose of the new mandatory MAT benefit found at section 1905(a)(29) of the Act is to increase access to evidenced-based treatment for Opioid Use Disorder (OUD) for all Medicaid beneficiaries and to allow patients to seek the best course of treatment and particular medications that may not have been previously covered.

CMS interprets sections 1905(a)(29) and 1905(ee) of the Act to require that, as of October 1, 2020, states must include as part of the new MAT mandatory benefit all forms of drugs and biologicals that the Food and Drug Administration (FDA) has approved or licensed for MAT to treat OUD.  More specifically, under the new mandatory MAT benefit, states are required to cover such FDA approved or licensed drugs and biologicals used for indications for MAT to treat OUD.  States currently cover many of these MAT drugs and biologicals (for all medically-accepted indications) under the optional benefit for prescribed drugs described at section 1905(a)(12) of the Act.

The President has signed H.R. 8337, the Continuing Appropriations Act, 2021 and Other Extensions Act. This new law made a statutory change to Section 1905(a)(29) and 1905(ee) of the Act, and now clarifies that MAT drugs when used for OUD as described under the mandatory benefit are deemed prescribed drugs, and covered outpatient drugs subject to section 1927 of the Act requirements, as appropriate.

Specifically, these amendments to the Act ensure a state’s ability to seek section 1927 drug manufacturer rebates, and apply drug utilization management mechanisms, such as preferred drug lists and prior approval, and a manufacturer’s duty to pay appropriate rebates and comply with all applicable manufacturer drug product and drug pricing reporting and payment of rebates. The change in law is effective as of the date of enactment of the original SUPPORT Act, which was October 24, 2018. Further CMS guidance will be forthcoming on other implementation issues relating to this new mandatory MAT benefit.

View in web browser: https://content.govdelivery.com/accounts/USCMSMEDICAID/bulletins/2a3b044

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Today at RCPA’s quarterly Drug and Alcohol Committee meeting, Secretary Smith informed our members that she has been asked by the Federal government to reach out to providers to determine whether providers have received Federal funds in Phase 1 or Phase 2 of the CARES Act Provider Relief Fund, and if providers have not received funds to find out whether providers applied or whether their applications were denied.

If you have not received funds in either Phase 1 or Phase 2, please send Jack Phillips an email as to when you applied for these funds and if you were denied or are still waiting for an answer on your application.

As a reminder, you may apply for Phase 3 of the Provider Relief Funds. The application deadline for Phase 3 funding is Friday, November 6. Questions, please contact Jack Phillips.

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