Medical Rehab

Please join the Office of Long-term Living (OLTL) and the Office of Mental Health and Substance Abuse Services (OMHSAS) for an informational webinar on Community HealthChoices (CHC) on Friday, March 31, 2017 at 1:00 pm. The webinar will feature a presentation from OLTL’s Chief of Staff, Kevin Hancock. Kevin will provide an update on CHC, describe progress to date, and discuss next steps. There will be an opportunity for questions and answers at the end of the presentation.

Background on CHC
The commonwealth is in the process of implementing CHC. CHC is a mandatory managed care program for eligible individuals, providing physical health services and long-term services and supports, such as attendant care services. CHC is being geographically phased in across the commonwealth beginning in January of 2018 in 14 counties in southwestern Pennsylvania, followed in July 2018 by five counties in the southeastern portion of the commonwealth. The CHC implementation will be completed in January 2019, when the remaining counties are implemented. The move to CHC will assist DHS in continuing to provide quality services.  CHC managed care organizations will be required to coordinate covered services, Medicare, and behavioral health services for enrolled participants.

To register for the webinar, please follow this link. Once you have registered, you will receive a confirmation email containing connection information. Please note, the connection information you receive will be unique to you and should not be shared with others.

Reminder: All CHC-related information can be found here. Comments can be submitted electronically. If you have any questions, please contact the Office of Long-Term Living Bureau of Policy and Regulatory Management at 717-783-8412.

A listserv has been established for ongoing updates on the CHC program, titled OLTL-COMMUNITY-HEALTHCHOICES. If you would like to update or register your email address, please follow this link.

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The Centers for Medicare and Medicaid Services (CMS) recently announced a Medicare Learning Network (MLN) call that will focus on the Standardized Patient Assessment Data Collection Project. The call has been scheduled for Wednesday, March 29, 2017, from 1:30 pm to 3:00 pm EDT

During the call, information will be shared about the efforts to develop, implement, and maintain standardized Post-Acute Care (PAC) patient assessment data, including pilot testing results and plans for an upcoming national field test. Additional agenda topics include:

  • Goal of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act);
  • Timeline of activities;
  • Alpha 1 results;
  • Alpha 2 progress;
  • Plans for beta test; and
  • How to get involved.

The IMPACT Act requires the reporting of standardized patient assessment data by PAC providers, including inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), home health agencies (HHAs), and long-term care hospitals (LTCHs).

To register for the call, please visit the MLN Registration page.

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On January 12, 2017, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register a proposed rule on requirements for qualified practitioners/suppliers for prosthetics and orthotics that interprets Section 427 of the Benefits Improvement and Protection Act (BIPA) of 2000. Some of the provisions included in this proposed rule include:

  • Qualifications required for practitioners to furnish and fabricate, and qualified suppliers to fabricate prosthetics and custom-fabricated orthotics;
  • The accreditation requirement that qualified suppliers must meet in order to bill for prosthetics and custom-fabricated orthotics;
  • The timeframe in which qualified practitioners and qualified suppliers must meet applicable licensure, certification, and accreditation requirements;
  • The requirements that an organization must meet in order to accredit qualified suppliers to bill for prosthetics and custom-fabricated orthotics;
  • Removal of the current exemption from accreditation and quality standards for certain practitioners and suppliers; and
  • The sanction for submitted claims for payment of custom-fabricated orthotics or prosthetics without the required qualifications.

Essentially, the proposed rule would require physical therapists and occupational therapists to meet the Durable Medical Equipment, Prosthetics/Orthotics, and Supplies (DMEPOS) quality and accreditations when they furnish and fabricate prosthetics or custom orthotics under the Medicare program. Additionally, therapists who furnish and fabricate custom orthoses must be licensed by the state (as a qualified provider of prosthetics and custom orthotics), or certified by the American Board for Certification in Orthotics and Prosthetics or by the Board for Orthotists/Prosthetists Certification.

Comments on this proposed rule are due by Monday, March 13, 2017.

The American Society of Hand Therapists (ASHT) has developed a detailed summary of this proposed rule, as well as a sample letter that members can reference to pull relevant facts when developing comment letters in response to this proposed rule.

Department of Human Services (DHS) Secretary Ted Dallas spoke at the RCPA Board of Directors meeting on February 22 regarding Governor Wolf’s proposal to consolidate four state health and human service agencies. If approved by the legislature, the plan would be launched on July 1, 2017.

Although the Secretary referenced approximately $90 million in savings from this process, he also affirmed that this “cannot be just about saving money.” Dallas remarked that time spent dealing with the bureaucracies as currently constructed takes time away from providing services, and so the goal is to eliminate redundancies.

RCPA members brought up key topics such as population health, licensing, and services for persons with co-existing conditions. When asked how this consolidation will affect addressing the opioid crisis, Secretary Dallas responded that the focus would be shifted to treating the whole person, rather than each individual condition.

The meeting concluded with the Secretary requesting ideas for continued efficiencies and how to ultimately better serve members. On the day of the Governor’s announcement, RCPA issued a statement expressing support for the proposal and committing to working with the administration to implement the plan in a smart and cost-effective manner.

The Centers for Medicare and Medicaid Services (CMS) published a final rule; delay of effective date notice in the February 17, 2017 Federal Register that delays the effective date of the rule, “Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement (CJR) model.” This notice clarifies that, in accordance with the White House’s regulatory freeze, provisions of CMS’ bundled payment final rule that were to become effective on February 18, 2017, are now delayed until March 21, 2017.

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The Centers for Medicare and Medicaid Services (CMS) recently announced that due to system issues, the February submission deadline for the inpatient rehabilitation facility (IRF) quality reporting program (QRP) data submitted via the Centers for Disease Control and Prevention (CDC) National Health and Safety Network (NHSN) has been extended to May 15, 2017.

The deadline has been extended for the following IRF quality reporting programs, measures, and reporting programs:

May 15, 2017 IRF QRP for Quarter 3 2016

  • CDC NHSN Healthcare-Associated Infection (HAI) Measures for quarter 3 2016
    • Catheter-associated Urinary Tract Infection (CAUTI)
    • Methicillin-resistant Staphylococcus aureus (MRSA)
    • Clostridium difficile Infection (CDI)

CMS is granting this extension to provide facilities additional time to submit quality reporting data and run applicable reports to ensure accurate submission. For further assistance regarding the IRF & long-term care hospitals (LTCH) quality reporting programs and policy information, visit the IRF Quality Reporting Data Submission Deadlines web page.

On February 8, the Department of Human Services (DHS) Secretary Ted Dallas announced the availability of onboarding grant funds to help connect hospitals and ambulatory practices to the Authority’s Pennsylvania Patient & Provider Network, or P3N.

The P3N enables electronic health information exchange (eHIE) across the state through the connection of health care providers to health information organizations (HIO), and the participation of the HIOs in the P3N.

“These grants will assist providers in the efficient delivery of quality services to the individuals we serve across the commonwealth,” said DHS Secretary Ted Dallas. “As more providers participate, individuals will experience better coordination of care and a better quality of health care.”

The grant program, available to Pennsylvania HIOs to enable the connection of inpatient hospital/facilities and outpatient practice or other outpatient provider organizations participating in the Medicaid Electronic Health Records (EHR) Incentive Program, includes:

  • Up to $75,000 to connect each eligible inpatient hospital or other inpatient facility to an HIO;
  • Up to $35,000 to connect each eligible outpatient practice or other outpatient provider organization to an HIO; and
  • Up to $5,000 to enable other eligible providers that do not fit into the two categories above, but want to enable HIE participation and connect to an HIO via a portal.

Each eligible provider will connect via an HIO to the P3N.

Only a single award is permitted to any one hospital/facility or outpatient practice. The anticipated performance period for this grant runs through September 30, 2017.

The grant will:

  • Help providers deliver higher quality and more efficient care, particularly through better care coordination for patients covered by Medicaid;
  • Support provider participation in private-sector HIOs by offsetting connection costs;
  • Incentivize HIOs to join the P3N, a precondition for receiving funding;
  • Support rapid movement toward the participation in eHIE, and support various care reform efforts currently underway across the Commonwealth; and
  • Defray up-front costs for individual providers to join an HIO, thus helping to achieve meaningful use and satisfy obligations under the Medicaid EHR Incentive Program.

This program will be made possible through an $8.125 million grant from the federal Centers of Medicare & Medicaid Services (CMS). Under the terms of the federal grant, CMS will provide 90 percent of the onboarding grant, with the remaining 10 percent funded by the Commonwealth. The grant applications and supporting materials are available online here.

(Information courtesy of DHS)

The Department of Human Services (DHS) has announced the recent changes to the OBRA Waiver that have been approved by the Centers for Medicare and Medicaid Services (CMS). Some of the waiver amendments include:

  • Adds five new employment-related service definitions that are replacing two existing employment service definitions. Five employment services have been added (benefits counseling, career assessment, employment skills development, job coaching, and job finding) (C-1/C-3).
  • Corrects the regulatory citation for an Outpatient or Community-Based Rehabilitation Agency provider type in the Occupational Therapy (OT), Physical Therapy (PT), Speech and Language Therapy (SLP) service definitions (C-1/C-3).
  • Clarifies that Personal Assistance Services (PAS) are only available to individuals in the waiver 21 years of age and over. All medically necessary Personal Assistance Services for children under age 21 are covered in the state plan pursuant to the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit (C-1/C-3).

The complete service definitions and requirements are now included in an updated OBRA Waiver document. The effective date of these changes is February 1, 2017.

The OBRA Waiver PROPOSED rates for the new Employment Services have also been released. Questions regarding these rates should be directed to (717) 783-8412.

On February 23, 2017, from 1:30 pm to 3:00 pm, the Centers for Medicare and Medicaid Services (CMS) will host a call, “Looking Ahead: The IMPACT Act in 2017,” focusing on the Improving Medicare Post-Acute Care Transformation (IMPACT Act) of 2014. The IMPACT Act requires the reporting of standardized patient assessment data by post-acute care (PAC) providers, including inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), home health agencies (HHAs), and long-term care hospitals (LTCHs). Agenda topics during this call will include the requirements, goals, progress to date, and key milestones for 2017. CMS will also convene a question and answer session following the presentation. To participate in the call, registration is required.