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Policy Areas

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ODP Announcement 22-003 shares that ODP and Temple University are conducting CI Friday Forums. These forums are an opportunity for current CIs and other interested parties to receive up-to-date information about the incident investigation process. The session dates and topics are:

  • February 11, 2022 — Peer Review: Year in Review
  • April 8, 2022 — Administrative Review Overview
  • June 10, 2022 — Topic to be announced (Save the Date)

There will be two sessions available on each date. One session will be hosted in the morning from 10:00 am–11:30 am, and the second session will be hosted in the afternoon from 1:00 pm–2:30 pm. The same topic will be covered in each session.

Seating is limited, and you can only sign up for one forum session per date. Participants can submit questions prior to the session until close of business (COB) the Friday before the scheduled Forum.

Registration for February 11, 2022, is now open and will close at the end of the day on February 9, 2022. See the announcement for registration details.

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Image by Dirk Wouters from Pixabay

In today’s Federal Register, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule that included updates to the Medicare Advantage program. Contained within this proposed rule is a Request for Information (RFI): Prior Authorization for Hospital Transfers to Post-Acute Care (PAC) Settings During a Public Health Emergency (PHE). The RFI highlights several concerns, including the fact that providers often wait up to three days for authorization determinations, and that a high rate of MA requests are initially denied, all of which hinder the ability of hospitals to maximize capacity during a public health emergency (PHE). The RFI requests several areas for feedback, including the overall impact of prior authorization on hospitals and patient care, the denial rates and associated burden on providers, and the consequences of delayed patient transfers.

Members are encouraged to share any direct examples of these prior authorization issues with Melissa Dehoff, Director, Rehabilitation Services Division. In addition, this issue will be discussed during the upcoming Outpatient Rehabilitation Committee and Medical Rehabilitation Committee meetings.

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The Department of Human Services (DHS) has issued updated guidance on COVID-19 for Personal Care Homes (PCHs) and Assisted Living Residences (ALRs). As the Commonwealth, along with the nation, has obtained additional data and expanded their knowledge and understanding of COVID-19, guidance continues to evolve and change. The revisions to the guidance are identified in red text.

Questions on these revisions should be sent electronically or to the regional office.

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The Centers for Medicare & Medicaid Services (CMS) has approved the Pennsylvania Department of Human Services’ (DHS) proposed minimum rates for each ASAM level of care. The rates are effective Jan. 1, 2022. According to DHS, the behavioral health managed care organizations must increase the rate being paid to any provider currently below the minimum. Providers being paid above the minimum will not be reduced to the minimum.

The rates have been posted and can be accessed through DHS’ website under “Behavioral HealthChoices Provider Resources.”

RCPA will share any additional information on the minimum rates as it becomes available. Please contact RCPA Drug and Alcohol Division Director Jason Snyder with any questions.

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CERTIFICATION CONCEPT

ODP Announcement 22-002 announces that those who achieved Quality Management (QM) certification/recertification during calendar year 2020 are due for recertification by December 31, 2022. Recertification training modules, materials, and the post-test can be accessed beginning January 10, 2022. Be sure to log in to MyODP first to gain full functionality of the website and complete the recertification process

Questions about the ODP Quality Management Strategy, QM Certification program, or other questions related to quality management can be sent via email to ODP QM.

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