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Medical Rehab

The Centers for Medicare and Medicaid Services (CMS) recently announced their intent to adopt a new interpretation of the statute that impacts how adjustments to the fee schedule based on information from competitive bidding programs apply to wheelchair accessories used with Group 3 complex rehabilitative power wheelchairs. As of July 1, 2017, the fee schedule amounts for wheelchair accessories and back and seat cushions used with Group 3 complex rehabilitative power wheelchairs will not be adjusted using information from the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. Instead, the fee schedule amounts will be based on the unadjusted fee schedule amounts updated by the annual fee schedule covered item update. Suppliers are being instructed to continue to use the KU modifier when billing for wheelchair accessories and seat and back cushions furnished connection with Group 3 complex rehabilitative power wheelchairs with dates of service beginning July 1, 2017. This new action will help to protect access to complex rehabilitative power wheelchair accessories for those individuals that depend on them.

The Traumatic Brain Injury (TBI) Advisory Board, which is established under section 1252 of the Federal Traumatic Brain Injury Act of 1996, will convene for their public meeting on Friday, August 4, 2017, from 10:00 am to 3:00 pm in the large conference room of the Community Center, 2nd Floor, Giant Food Store located at 2300 Linglestown Road, Harrisburg, PA 17110.

The Board assists the Department of Health in understanding and meeting the needs of persons living with traumatic brain injury and their families. This quarterly meeting will provide updates on a variety of topics including the number of people served by the Department of Health’s Head Injury Program (HIP). In addition, meeting participants will discuss budgetary and programmatic issues, community programs relating to traumatic brain injury, and available advocacy opportunities.

For additional information, or for persons with a disability who wish to attend the meeting and require an auxiliary aid, service, or other accommodations to do so, please contact Michael Yakum, Division of Community Systems Development and Outreach, 717-772-2763. For speech and/or hearing impaired persons, contact V/TT 717-783-6514 or the Pennsylvania AT&T Relay Service at 800-654-5984.

The Office of Long-Term Living (OLTL) has released two documents for direct service providers that serve COMMCARE Waiver participants. The documents outline the activities that will occur in the coming months as the COMMCARE Waiver participants transition to either the Community HealthChoices (CHC) program or the Independence Waiver. These documents include a detailed overview and timeline of the transition and a fact sheet about CHC. The COMMCARE Waiver will end statewide on December 31, 2017.

OLTL Service Coordination Entities (SCEs) and participants will be notified of these changes in a separate communication in mid-July.

The Medicare Payment Advisory Commission (MedPAC) has released its June 2017 Report to Congress: Medicare and the Health Care Delivery System. This report includes, among other topics, a chapter focusing on implementing a unified payment system for post-acute care. Specifics in this chapter includes implementing a post-acute care prospective payment system (PAC PPS) beginning in 2021 with a three-year transition, lower aggregate payments by five percent, absent prior reductions to the levels of payments, start to align setting-specific regulatory requirements, and periodically revise and rebase payments to keep payments aligned with the cost of care.

Some of the topics included in the other chapters include Medicare Part B drug payment policy issues; redesigning the merit-based incentive payment system (MIPS) and strengthening advanced alternative payment models, etc. MedPAC also released a fact sheet on the report.

Thu, Jul 20, 2017 11:00 am – 12:00 pm EDT

A PA ABLE Savings Program account gives individuals with qualified disabilities (Eligible Individuals), and their families and friends, a tax-free way to save for a wide range of disability-related expenses, while maintaining government benefits. The state and federal tax-free investment options are offered to encourage Eligible Individuals and  their families to save private funds to support health, independence, and quality of life. Some of the topics that we will discuss include: eligibility requirements for opening a PA ABLE account, the federal and state tax benefits of PA ABLE, and how PA ABLE account interacts with current benefits. Register here for this free webinar.

The Pennsylvania Departments of Aging and Human Services recently announced an agreement with Aging Well (a subsidiary of the Pennsylvania Association of Area Agencies on Aging or P4A that represents all Area Agencies on Aging) to partner on the implementation of Community HealthChoices (CHC).

Under this new agreement, Aging Well will have the following responsibilities:

  • Complete the Functional Eligibility Determinations (FEDs) (via subcontracts with AAAs). Aging Well will conduct the FEDs for participants seeking eligibility for long-term services and supports. Aging Well will also perform the annual in-person re-determinations for people over the age of 60. While FEDs currently need to be completed for individuals applying for the Office of Long-Term Living (OLTL) waivers, ACT 150 program, Living Independence for the Elderly (LIFE), and nursing facility coverage, as the commonwealth begins its implementation of Community HealthChoices, Aging Well will continue to fulfill this role. In addition, as the commonwealth transitions from the existing assessment tool (the Level of Care Determination) to the FED, Aging Well will continue to actively support and facilitate this conversion.
  • Conduct Pennsylvania Preadmission Screening Resident Review Evaluation (PASRR-EV Level II Tool) (via subcontracts with AAAs). Aging Well will conduct the screening for individuals with a mental illness, intellectual disability or related condition, who are seeking admission to Medicaid certified nursing facilities regardless of payer source. These individuals must have the PASRR process completed prior to admission to the nursing facility.
  • Annual re-determinations (via subcontracts with AAAs). Prior to the implementation of CHC, Aging Well will conduct an annual in-person re-assessment within 10 business days of request by a service coordinating entity for all Aging Waiver participants. After the implementation of CHC, Aging Well will review FED assessment data collected by the managed care organizations for all CHC waiver participants in order to confirm annual redeterminations of level of care have been properly conducted. This will be completed as a desk review.
  • Conduct CHC outreach and education activities statewide (via partnerships with AAAs, nursing facilities, and community-based organizations). Aging Well will begin outreach and education activities in July 2017 for the rollout of Phase 1. These activities include 20 public information sessions and training of service coordinators and nursing facility staff.

On Thursday, June 29, 2017, the Centers for Medicare and Medicaid Services (CMS) and the Office of Medicare Hearings and Appeals (OMHA) will host a call from 1:00 pm to 3:00 pm that will focus on the recent regulatory changes to the Medicare claims appeals process. There will also be discussion surrounding the Medicare Appeals Final Rule that was published in the January 17, 2017 Federal Register, as well as the changes that are intended to streamline the administrative appeals processes, reduce the backlog of pending appeals, and increase the consistency in decision making across appeal levels.

To participate in the call, registration is required by 12:00 pm on June 29, or until the event is full. Following the presentation, time will be allocated to a session for questions and answers.

In this year of challenging state-level budget negotiations, RCPA is working with a coalition of community foundations, United Way organizations, Labor Unions, religious and advocacy groups, and other key stakeholders in the #FamilyFirstPA Coalition. The growing list of coalition members can be viewed on the #FamilyFirstPA#FamilyFirstPA website. The main goal of the #FamilyFirstPA Campaign is to ensure that there are no cuts to human services in upcoming 2017/2018 state budget. Cuts to human services not only cause irreparable damage to Pennsylvania families, but they also have adverse impacts on organizations that our families rely on. Sharing family stories via social media was the first phase of this campaign. Now, we need your support to push our efforts to the next level. As a coalition partner, RCPA is encouraging our members to amplify the work of the coalition by making use of the social media resources created by this initiative for the coalition. Engage with #FamilyFirstPA on social media; “Like” us on Facebook and “follow us” on Twitter. The initiative is now sharing family stories from across Pennsylvania and engaging legislators through our posts and tweets. Encourage your staff, families, other organizations, county and state level stakeholders, to like and follow the campaign as well.

Any questions about the work of the #FamilyFirstPA Coalition can be directed to Connell O’Brien, who is serving as liaison between RCPA and the #FamilyFirstPA initiative.

The Office of Long-Term Living (OLTL) recently announced an upcoming stakeholder meeting regarding the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Home and Community-based Services (HCBS) survey. This meeting, scheduled for Wednesday, June 7, 2017, at 1:30 pm, will include representatives from the State of Connecticut (CT) who will share their experiences during the testing of the tool. Members are invited to participate in person (Honor’s Suite 333 Market Street Tower, Harrisburg, PA) or via webinar by registering prior to the meeting. After registering, you will receive a confirmation email containing information about the webinar. Members are encouraged to submit any questions for the representatives from CT in advance of the call to Melissa Dehoff by 12:00 pm on Tuesday, June 6.

During the past few years, the state Medicaid program, HealthChoices, has begun to implement and expand the use of Value-Based Purchasing models in procurement contracts with all Physical Health Managed Care Organizations (PH-MCOs). With a goal of increasing clinical outcomes, patient satisfaction, and cost management, the PH-MCOs have called for increased use of such Value-Based Purchasing models as Pay for Performance, Patient Centered Medical Homes, and Bundled Payments. On May 25, the leadership of the Offices of Medical Assistance Programs (OMAP) and Mental Health and Substance Abuse Services (OMHSAS) conducted a webcast to review the implementation process used in HealthChoices by the PH-MCOs and their provider networks, and to introduce the process of expanding Value-Based Purchasing to the Behavioral Health Managed Care Organizations and their provider networks. The OMHSAS target for introducing this expansion is January, 2018 with a focus on integrated and collaborative behavioral and physical health and care coordination.