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Medical Rehab

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As we approach the conclusion of the Governor’s Council on Reform public comment period on December 16, 2019, RCPA would like to ensure that each member has the materials for providing their public comments, feedback, and support. RCPA will be submitting commentary within each policy director’s purview, and we strongly urge your agency to submit your thoughts to the Council, including areas and issues that may not be represented in the current recommendations.

If you would like to send your submissions to your respective policy director for inclusion in the RCPA public comment, please have them submitted by close of business on Wednesday December 11, 2019.

Below you will find the links to important documents relating to the Council on Reform, including the Public Comment Submission Form. If you have further questions, please contact your respective RCPA Policy Director.

  1. Governor’s Executive Order
  2. November 1 Press Release
  3. Recommendation Document
  4. Public Comment Form

Thank you for your efforts and partnership to bring these recommendations to the forefront of your work.

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physiotherapist helping patient to walk

An article, “Comparison of Functional Status Improvements Among Patients with Stroke Receiving Postacute Care in Inpatient Rehabilitation vs Skilled Nursing Facilities,” was recently published in the Journal of the American Medical Association (JAMA) Network that highlights the findings from a cohort study of patients who received post-acute care in inpatient rehabilitation facilities (IRFs) or skilled nursing facilities (SNFs) following a stroke. The study examined changes in functional status. Stroke was selected because it is a major cause of disability in the United States and an important public health issue, and often requires a range of treatments and expertise.

The study included patients with stroke who were discharged from acute care hospitals to IRFs or SNFs from January 1, 2013 to November 30, 2014. Medicare claims were used to link to IRF and SNF assessments. The study does include limitations that were encountered, such as the findings don’t take into account other post-acute settings (home health, long-term care hospitals, etc.) and the inability to examine cognitive function before and after the stroke, stroke severity, or location of the stroke.

The findings of the study suggest that the care in an IRF was associated with greater improvement in mobility and self-care compared with care in an SNF. Their findings indicate the need to carefully manage discharge to post-acute care based on the patient’s needs and potential for recovery. Post-acute reform based on the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) must avoid a payment system that shifts patients with stroke who could benefit from intensive inpatient rehabilitation to lower cost settings. The IMPACT Act of 2014 is a bill that is intended to change and improve Medicare’s post-acute care services and how they are reported. Contact RCPA Rehabilitation Services Director Melissa Dehoff with questions.

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The Centers for Medicare and Medicaid Services (CMS) will conduct the next hospital quality open door forum for Tuesday, November 19, 2019 at 2:00 pm. Some of the agenda topics for this call include a discussion on the calendar year (CY) 2020 outpatient prospective payment system (OPPS) final rule and the inpatient rehabilitation facility (IRF) report in the iQIES portal. While the CY 2020 OPPS final rule was released, it will be published in the November 12, 2019 Federal Register.

To participate in this open door forum, dial 888-455-1397; conference ID: 4676500.

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On November 1, 2019, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) final rule. The final rule includes updates to payment policies, payment rates, and quality program provisions for services effective on or after January 1, 2020.

Some of the provisions included in the final rule:

Medicare Telehealth Services – The following HCPCS codes are being added to the list of telehealth services: G2086, G2087, and G2088, which describe a bundled episode of care for treatment of opioid use disorders.

Evaluation & Management (E/M) Services – CMS is mirroring the E/M changes that were adopted by the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel for office/outpatient E/M visits.

Physician Supervision Requirements for Physician Assistants (PAs) – The regulation has been updated on physician supervision of PAs to provide them with greater flexibility to practice more broadly in accordance with state law and state scope of practice.

Review and Verification of Medical Record Documentation – In order to reduce burden, CMS finalized broad modifications to the documentation policy so that physicians, physician assistants, and advanced practice registered nurses (APRNs – nurse practitioners, clinical nurse specialists, certified nurse-midwives, and certified registered nurse anesthetists) can review and verify (sign and date), rather than re-documenting, notes made in the medical record by other physicians, residents, medical, physician assistants, and APRN students, nurses, or other members of the medical team.

Medicare Coverage for Opioid Use Disorder Treatment Services Furnished by Opioid Treatment Programs – CMS is implementing a new Medicare Part B benefit for opioid use disorder (OUD) treatment services, including medications for medication-assisted treatment (MAT), furnished by opioid treatment programs (OTP).

Counseling and Therapy Services – Finalized a policy to allow counseling and therapy services described in the bundled payments, to be furnished via two-way interactive audio-video communication technology as clinically appropriate.

Beneficiary Copayment – There will be a zero beneficiary copayment for 2020.

The final rule will be published in the November 12, 2019 Federal Register.

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Press Release from Governor Tom Wolf

Council on Reform Submits Recommendations for the Protection of Vulnerable Populations to Gov. Wolf
> Public Comment Period through December 16, 2019 <

November 1, 2019

Harrisburg, PA – Today, Governor Tom Wolf’s Council on Reform, established through his Protection of Vulnerable Populations Executive Order 2019-05, submitted its recommendations for improving the state’s systems to protect its most vulnerable individuals and families.

In late July, Gov. Wolf charged this diverse group of community leaders, providers, stakeholders, and cabinet members with taking a comprehensive look at needs to best serve the state’s vulnerable populations with a mandate to report those recommendations back to him by Nov. 1.

“I took action in July to address long-standing issues with the state’s systems designed to protect our most vulnerable,” Gov. Wolf said. “The first task for the newly formed Council on Reform was to buckle down and develop a comprehensive list of recommendations for how we can best protect vulnerable Pennsylvanians.

“My thanks to all of the council members who shared their expertise and considerable time, and to those who participated by meeting with council members or submitting information and recommendations. Your tireless commitment to this process demonstrates your passion for protecting all Pennsylvanians, especially our most vulnerable. I look forward to reading and analyzing these recommendations and to our next steps to make much-needed changes.”

The 25-member council held its first meeting immediately following the governor’s announcement. In determining its charter and scope, the council defined populations and subpopulations, established committees, and adopted values.

The council determined it would look at protecting vulnerable populations from three perspectives with a separate committee for each: prevention and diversion, protection and intervention, and justice and support.

Populations were broken out by age with subpopulations to ensure vulnerabilities unique to each were considered:

Ages 0-17
Subpopulations – African Americans, Asian American & Pacific Islanders, Latinos, LGBTQ+ children, young women, children experiencing mental illness, children with intellectual disabilities/autism, children with physical/sensory disabilities, delinquent children, and dependent children

Ages 18-59
Subpopulations – African Americans, Asian American & Pacific Islanders, Latinos, LGBTQ+ adults, veterans, women, adults experiencing mental illness, adults with intellectual disabilities/autism, adults with physical/sensory disabilities, adults with Alzheimer’s or a related dementia, and domestic violence victims

Ages 60+
Subpopulations – African Americans, Asian American & Pacific Islanders, Latinos, LGBTQ+ seniors, women, veterans, seniors experiencing mental illness, seniors with intellectual disabilities/autism, seniors with physical/sensory disabilities, seniors with Alzheimer’s or a related dementia, and domestic violence victims

The council recommended two overarching goals for Pennsylvania to better protect vulnerable populations:
• Empower and strengthen the workforce serving vulnerable populations by providing comprehensive training, livable salaries and benefits, and support for staff experiencing vicarious trauma.

  • Empower communities and vulnerable populations by ensuring access to services for all Pennsylvanians and conducting culturally appropriate and diverse outreach efforts.

The council adopted values they believe to be relevant to protecting and serving vulnerable populations – these values are reflected throughout the recommendations:

Cultural Competence – Recognizing and honoring diversity

Person-Centered Approach – Focusing on the individual’s best interest

Community Engagement – Hearing from vulnerable populations, families, experts, and stakeholders

Context & Awareness – Understanding current environment and avoiding past failings

Trauma-Informed – Utilizing trauma-informed approaches across all systems

Workforce Empowerment – Ensuring the workforce is equipped and supported

Members heard from a wide array of existing oversight and advisory bodies, stakeholders, legislators, and constituents. Information was provided through in-person meetings, letters, emails, and a webform that council members distributed to their networks. These contributors provide recommendations for the council to consider and essential insight and context to ensure the council was fully informed. Many council members also served on advisory bodies connected to this work.

The council compiled the recommendations submitted by others along with recommendations from existing reports and assigned them to the appropriate committee for review and consideration. Committee members reviewed all that was submitted, identified common trends, eliminated duplication, and developed new recommendations.

After committees finalized their lists of recommendations, themes were identified that spanned all populations and committees. The result is the comprehensive list of recommendations presented to Gov. Wolf today.

The council advised Gov. Wolf that it “fully recognizes the funding implications of the recommendations that have been developed and the substantial amount of time and work it takes to carry out these recommendations. It is our hope that Pennsylvania will rise to the occasion and put its best effort into driving this much needed change – our most vulnerable are counting on it.”

The council asked that the governor direct the appropriate agencies, organizations, branches of government, and advisory bodies to carry out the recommendations he would like to move forward.

As the council carried out its process, they believed more could be done to engage with constituents. To achieve this, the council added an online public comment form available today through Dec. 16.

View press release online

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The Centers for Medicare and Medicaid Services (CMS) published a final rule in the September 30, 2019 Federal Register that revises requirements for discharge planning for inpatient rehabilitation hospitals, hospitals (including acute, children’s, long term acute care, and critical access), and home health agencies. Each of these facilities must meet these requirements as a condition to participate in the Medicare and Medicaid programs. In addition to this final rule requiring the discharge planning process to focus on the patient’s goals of care and treatment preferences, it also empowers patients to make informed decisions about their care as they are discharged from acute care to post-acute care (PAC).

The final rule includes a new requirement that sends necessary medical information to the receiving facility or appropriate PAC provider after a patient is discharged from the hospital or transferred to another PAC provider. In addition, hospitals must ensure and support patients’ rights to access their medical records in the form and format requested by the patient.

These regulations are effective on November 29, 2019. Contact RCPA Rehabilitation Services Director Melissa Dehoff with questions.

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September is Emergency Preparedness Month. While there frequently seems to be a day, week, or month dedicated to recognizing or learning about various topics, this particular topic became a pertinent event this week. The newly renovated central office of a LEAP (Life Enrichment Advancing People), a nonprofit agency in Maine, was leveled in an explosion on Monday. LEAP provides community services to individuals with intellectual disabilities. The explosion occurred on Monday morning shortly after the LEAP Maintenance Director noticed a strong smell of gas in the basement of the building and alerted everyone to evacuate the building before it exploded. Sadly, one of the firefighters who responded to the call was killed in the explosion, and six other people were injured, including the Maintenance Director.

LEAP is a member of ANCOR, as is RCPA, and so we share a connection. There has been much conversation regarding this incident in an online ANCOR Forum. LEAP CEO Darryl Wood responded to the outpouring of support on this forum, stating:

There are heroes among us. Our maintenance director evacuated everyone and was working with the first responders when the explosion occurred. Many lives were saved by an attentive person and a team that evacuated as we practiced. Don’t take those emergency plans for granted folks.

Inspired by Darryl’s message, ANCOR is offering two webinar recordings about emergency preparedness free of charge to their members. Offering these webinars is only a small part — but hopefully a meaningful part — of how ANCOR works to support our friends at LEAP and, more broadly, ANCOR members who experience all manner of disasters.

Both of these webinars, which were broadcast previously, offer information that remains relevant for providers seeking to understand the steps they can take to be more responsive to disasters of all kinds. To access the webinars, please use the following links:

We hope all providers take the time to reflect on disaster preparedness by watching these recordings, as well as to review your Disaster Plans and training for all staff and people supported. Other actions that have been suggested include:

  • Evaluate the location of your meeting place when evacuating. In this case, it was really far from the building, yet right on the periphery of the blast area.
  • When evacuating, people should leave immediately and not stop to pick up personal items.
  • People should not attempt to use their cell phones while the emergency is in process. Among other things, phones can trigger explosions.
  • If you have propane at any one of your sites, you should have a propane detector.

In an upcoming issue of RCPA News, there will be additional information provided, as well as resources available to assist agencies with emergency preparedness. For any questions regarding this info or how to assist LEAP in their recovery from this disaster, contact Carol Ferenz, RCPA IDD Division Director.

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During the September 5–6, 2019 Medicare Payment Advisory Commission (MedPAC) public meeting, the agenda included a presentation that focused on a value incentive program (VIP) for post-acute care (PAC) providers. During the presentation, MedPAC reviewed their intention to develop this PAC-VIP over the coming months, which will tie providers’ payments under a unified PAC prospective payment system (PPS) to their performance on uniform cross-setting metrics. MedPAC feels PAC-VIP is essential to incentivize provider improvement. Some of the proposed measures to be included:

  • All-condition hospitalization within the PAC stay;
  • Successful discharge to the community; and
  • Medicare-spending per beneficiary (MSPB).

Performance will be scored using absolute, prospectively set targets, and a five percent withhold will fund the incentive payments, which is consistent with Medicare’s existing value-based programs. In addition, because there is variation in performance across settings, there will be an initial need to score within each setting.

Next steps include modeling the PAC-VIP based on the Commission’s feedback and presenting their results in the spring. MedPAC also seeks feedback on the design of the PAC-VIP, such as measure set, scoring methodology, and size of the withhold. Contact RCPA Director of Rehabilitation Services, Melissa Dehoff, with questions.

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