Medical Rehab

0 1387

On February 9, 2016, the Centers for Medicare and Medicaid Services (CMS) posted this update to the “Therapy Cap” page on their website, regarding manual medical review (MMR) of therapy claims above the $3,700 threshold. The guidance is vague and additional information is needed for clarification. Members that provide outpatient therapy services should be cognizant that MMR will resume in the near future and should comply with medical record requests issued by Strategic Health Solutions.

0 1463

The Centers for Medicare and Medicaid Services (CMS) released a proposed rule that was published in the February 3, 2016 Federal Register, which updates the methodology used to measure the performance of Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program.

Under the proposed rule, CMS would modify the process for resetting the benchmarks, which are used to determine ACO performance for those renewing their participation agreements. The proposed rule addresses changes to the Shared Savings Program that would modify the program’s benchmark rebasing methodology, to encourage ACOs’ continued investment in care coordination and quality improvement, and identifies publicly available data to support modeling and analysis of these proposed changes. In addition, it would streamline the methodology used to adjust an ACOs historical benchmark for changes in its ACO participant composition. Comments on the proposed rule are due by March 28, 2016.

In an effort to promote “Government that Works,” the Office of Child Development and Early Learning (OCDEL) has made it a priority to integrate early childhood education services, so that providers can offer multiple OCDEL services to families without duplicating paperwork, and families can more easily access the services they need. To lead and promote this approach to improving and streamlining bureaucratic and operational challenges faced by providers and families, OCDEL has produced a short video overview with Deputy Secretary Michelle Figlar.

Providers are also being asked to share their experiences with OCDEL programs to help shape this work. It is critical for the RCPA Children’s Steering Committee and work groups to hear how OCDEL programs work for providers and families. Input from providers of early childhood care will significantly inform and influence this work. For RCPA members, it will be vital that providers of early childhood mental health, behavioral consultation, autism, and pediatric rehabilitation services, that need to be delivered in a coordinated and collaborative manner, help to inform this process. RCPA members who serve young children are encouraged to complete a short survey by Monday, February 8. The survey includes five pages of questions and should take an average of five minutes to complete. For more information, visit the PA Keys website.

OCDEL has made stakeholder engagement one of its priorities to assure high quality services for children and families. For a listing of all open stakeholder engagement opportunities, please visit the PA Keys website.

This training session is designed to educate new providers wishing to enroll, and existing enrolled providers wishing to revalidate, in the PA Medical Assistance program on the electronic provider application system. The electronic provider enrollment user interface will allow providers to complete their PA Medical Assistance enrollment application online, effective January 29, 2016.

Please join any of the following sessions:

  • Monday, January 25 – 9:00 to 11:00 am
  • Monday, January 25 – 1:00 to 3:00 pm
  • Tuesday, January 26 – 9:00 to 11:00 am
  • Tuesday, January 26 – 1:00 to 3:00 pm
  • Wednesday, January 27 – 9:00 to 11:00 am
  • Wednesday, January 27 – 1:00 to 3:00 pm

Providers can register here. DHS encourages providers who need to revalidate by March 24, 2016, to submit revalidation applications as soon as possible. Please do not wait for the electronic provider enrollment application to submit your revalidation application.

DHS and PDA Invite Brain Injury Providers to Meet With MCOs Interested in Community HealthChoices

The Departments of Human Services (DHS) and Aging are continuing to develop Community HealthChoices (CHC), Pennsylvania’s plan for managed long-term services and supports. The success of CHC will be determined by a number of factors, including the relationships between future managed care organizations (MCOs) and existing providers. It is extremely important to continue the conversation with MCOs and Pennsylvania’s experienced providers, to successfully transform the fee-for-service system to managed care.

An invitation has been extended to RCPA’s Brain Injury Committee members to participate in an upcoming MCO meet and greet session, exclusively for brain injury providers. As a part of this invitation, we were asked to establish a panel and presentation, as well as participate in a facilitated discussion with the MCOs. Because of the importance of this meeting, please plan on sending at least one representative from your organization to this event. We have also been asked to submit questions we may have for the MCOs prior to the meeting date.

The meeting is scheduled for Thursday, January 14 from 11:30 am to 2:30 pm at the Hilton Harrisburg, 1 North 2nd Street. This will be a working lunch meeting (boxed lunches will be provided to registered attendees). Registration/RSVP is required.

Please respond to Melissa Dehoff if you will be attending. Responses are due no later than Monday, January 11, so the list of attendees can be provided prior to the meeting and the appropriate number of lunches ordered.

The Bureau of Autism Services (BAS) is conducting a preliminary survey to help inform the design of services for individuals with autism spectrum disorder (ASD) who are transitioning out of high school, including those who may have had justice intersections or psychiatric hospitalizations. This survey is designed to be completed by professionals with or without experience supporting individuals with ASD ages 18-25. BAS is asking for feedback on both surveys by Friday, January 1.

BAS has developed two versions of this survey; one for individuals and families, and another to be completed by professionals. The professionals survey can be completed here. Any questions about these surveys can be directed to the Bureau of Autism Services via email.

Time is running out; the deadline for revalidating is Thursday, March 24, 2016. Numerous RCPA members have already gone through this process, but it appears that large numbers of providers have not yet done so. A special provider revalidation webinar will be held by RCPA on Wednesday, January 6 at 10:00 am. Jamie Buchenauer, from the Department of Human Services, will be presenting the webcast.

0 1418

On December 11, 2015, the Centers for Medicare and Medicaid Services (CMS) posted an update to the inpatient rehabilitation facility (IRF) quality reporting spotlight & announcements page of their website, regarding an extension of the IRF quality reporting program data submission. CMS made the decision to extend the National Healthcare Safety Network (NHSN) data submission deadline for IRF providers until Monday, February 15, 2016. The extension also applies to the submission deadline to the calendar year 2015 quarters 1 and 2, fiscal year 2017 payment determination. In addition, the extension applies to the submission deadlines for assessment data for the quality reporting program.

Members are encouraged to run the applicable CMS output reports within their facility prior to each quarterly reporting deadline. Detailed guidance on how to run and interpret these reports, and additional information, are posted on the Centers for Disease Control and Prevention (CDC) website. Additionally, once these reporting deadlines have passed, members should run the advanced analysis reports within NHSN to view when each data element was first entered and last modified, to determine whether all data were complete at the time of the reporting deadline.

Additional information on how to run and interpret these reports is provided by the CDC/NHSN. Questions on the reports within NHSN should be directed to the NHSN help desk. Additional questions can be directed to the CMS help desk.