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Tags Posts tagged with "centers for medicare and medicaid services"

centers for medicare and medicaid services

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Office of Developmental Programs (ODP) Announcement 20-002 requests comments regarding Proposed Heightened Scrutiny Information for Residential Services locations. Comments are being sought on attachments #1–#3 until 11:59 pm on Monday, February 17, 2020.

To be compliant with the Centers for Medicare and Medicaid Services (CMS) Home and Community-Based Settings (HCBS) rule, ODP must identify and complete onsite reviews of all service locations that are presumed to have the qualities of an institution. The purpose of these onsite reviews will be to determine whether each service location can overcome the institutional presumption by either showing proof that the requirements contained in the CMS HCBS rule are currently met, or by ensuring the requirements will be met within a timeframe specified by ODP (but no later than March of 2022).

If ODP determines that the service location does not currently meet the requirements but has a plan to meet them within the timeframe specified by ODP, the service location must be submitted to CMS for a heightened scrutiny review. CMS will then determine whether the service location has the qualities of a home and community-based setting and does not have institutional qualities.

Homes that are identified as one of the following will require an onsite heightened scrutiny review by ODP due to having the potential of isolating individuals living in the home from the broader community:

  • Farmstead – These settings are often in rural areas on large parcels of land, with little ability to access the broader community outside the farm. Individuals who live at the farm typically interact primarily with people with disabilities and staff who work with those individuals. Individuals typically live in homes only with other people with disabilities and/or staff. Their neighbors are other individuals with disabilities or staff who work with those individuals. Daily activities are typically designed to take place onsite so that an individual generally does not leave the farm to access HCBS or participate in community activities. For example, these settings will often provide a place onsite to receive clinical (medical and/or behavioral health) services, day services, places to shop and attend church services, as well as social activities where individuals on the farm engage with others on the farm, all of whom are receiving Medicaid HCBS. While sometimes people from the broader community may come onsite, people from the farm do not go out into the broader community as part of their daily life. Thus, the setting does not facilitate individuals integrating into the greater community and has characteristics that isolate individuals receiving Medicaid HCBS from individuals not receiving Medicaid HCBS.
  • Gated Community – These settings typically consist primarily of people with disabilities and the staff that work with them. Often, these locations will provide residential, behavioral health, day services, social and recreational activities, and long-term services and supports all within the gated community. Individuals receiving HCBS in this type of setting often do not leave the grounds of the gated community in order to access activities or services in the broader community. Thus, the setting typically does not afford individuals the opportunity to fully engage in community life and choose activities, services and providers that will optimize integration into the broader community.

* Campus – These settings have multiple co-located and operationally related (i.e., operated and controlled by the same provider) service locations/homes/facilities that congregate a large number of people with disabilities together and provide for significant shared programming and staff, such that people’s ability to interact with the broader community is limited. This could include group homes on the grounds of a private Intermediate Care Facility (ICF) or numerous group homes co-located on a single site or in close proximity (multiple units on the same street or a court, for example).

More information published by CMS on the HCBS rule, including heightened scrutiny requirements, can be found here. Attachment 1 lists locations requiring an onsite heightened scrutiny review from ODP. Attachment 2 and Attachment 3 are the proposed tools for evaluating and reviewing the listed sites. Questions pertaining to this announcement and accompanying attachments may be directed to this email.

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The Centers for Medicare and Medicaid Services (CMS) is seeking additional feedback and recommendations regarding the elimination of specific Medicare regulations that require more stringent supervision than existing state scope of practice laws, or that limit health professionals from practicing at the top of their license.

This request from CMS stems from President Trump’s Executive Order (EO) #13890: Protecting and Improving Medicare for our Nation’s Seniors, which directs the Department of Health and Human Services (HHS) to propose a number of reforms to the Medicare program. These reforms include those that eliminate supervision and licensure requirements of the Medicare program that are more stringent than other applicable federal or state laws and often limit health care professionals, such as Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRN) from practicing at the top of their professional license.

CMS did incorporate some of the recommendations previously submitted in several payment rules, including the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS), where one of the changes included redefining physician supervision for services furnished by Physician Assistants (PAs).

If members have additional recommendations on ways to reduce unnecessary burden, increase efficiencies, and improve the beneficiary experience, please send them to this email with “Scope of Practice” in the subject line. Recommendations must be submitted by January 17, 2020.

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The Centers for Medicare and Medicaid Services (CMS) recently announced the availability of the inpatient rehabilitation facility (IRF) provider preview reports. These reports have been updated and contain information based on quality data submitted by IRFs between Quarter 3 of 2018 and Quarter 2 of 2019. The data will reflect what will be published on IRF Compare during the March 2020 update of the website.

Providers have 30 days (December 9, 2019 – January 9, 2020) to review their performance data. While corrections to the underlying data will not be permitted during this time, providers can request CMS to review their data during the preview period if they believe the quality measure scores that are displayed are inaccurate.

Additionally, providers are reminded that the data for the quality measure Percent of Residents or Patients that have new or worsened Pressure Ulcers (short stay), will continue to reflect data collected between Quarter 3 2017 – Quarter 2 2018, and will continue to be publicly displayed until the new Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury, is publicly displayed in fall 2020, as finalized in the fiscal year (FY) 2018 IRF PPS Final Rule.

As of the March 2020 refresh, CMS will no longer publicly display the measure Percent of Residents or Patients who were assessed and appropriately given the seasonal influenza vaccine (short stay), as finalized in the FY 2019 IRF PPS Final Rule. This change is reflected in preview reports. Contact RCPA Rehabilitation Services Director Melissa Dehoff with questions.

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The Centers for Medicare and Medicaid Services (CMS) recently notified the Office of Long-Term Living (OLTL) of the approval of the OBRA Waiver amendment. The amendment is effective on January 1, 2020.

The changes in the approved amendment include:

  • Revise the Residential Habilitation service definition by modifying the number of hours that are defined as a day unit from a minimum of 12 hours to 8 hours.
  • Revise the service definitions of Job Finding, Job Coaching, Employment Skills Development, Career Assessment, and Benefits Counseling to address when employment services can be provided through the OBRA waiver, should the Office of Vocational Rehabilitation (OVR) have a waiting list (closed order of selection) or when OVR has not made an eligibility determination within 120 days.
  • Update the Abuse Registry Screening information to reflect that the Department of Human Services (DHS) utilizes IDEMIA as the data system to process fingerprint-based FBI criminal record checks, as well as other minor changes.
  • Revise cost neutrality estimates to reflect rate changes to the Personal Assistance Services (PAS) and Residential Habilitation waiver services.

If you have any questions, please contact the OLTL Bureau of Policy Development and Communications Management at 717-857-3280.

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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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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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The Centers for Medicare and Medicaid Services (CMS) recently announced the availability of a revised inpatient rehabilitation facility prospective payment system (IRF PPS) Medicare Learning Network (MLN) booklet. Topics in the booklet include: IRF PPS Elements (including rates, classification criterion, compliance percentage, and reasonable and necessary criteria); payment updates; IRF quality reporting program (QRP) measures for annual payment update; and many resources.

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ODP Announcement 19-102 provides information regarding the amendments submitted to the Centers for Medicare and Medicaid Services (CMS) regarding the Consolidated, Community Living, and P/FDS waivers. It is anticipated that the amendments will become effective October 1, 2019.

CMS has 90 days to review the amendments and changes may occur to the content based upon discussion with CMS during the approval process. Each full waiver application, as well as a side-by-side of substantive changes made as a result of public comment is available online here.

The amendments align with 55 Pa. Code Chapter 6100 regulations when effective, ensure compliance with the Home and Community-Based Settings regulations, and align with the Office of Developmental Programs’ Everyday Lives recommendations.

The amendments include a plan to serve medically complex children in a community home when transitioning from an extended hospital stay if they are unable to return to their family home. Also, the scope of professionals who can diagnose intellectual disability has been expanded.

ODP is adding the expectation that all providers of Community Participation Support services must offer individuals opportunities to participate in community activities that are consistent with the individual’s preferences, choices, and interests. On-call and remote support is proposed in order to support the fading of service and dependence on paid staff. The number of procedure codes and staffing levels has been decreased to more accurately reflect service delivery.

Starting January 1, 2022, CPS services may not be provided in any facility required to hold a 2380 or 2390 license that serves more than 150 individuals at any one time, including individuals funded through any source. All participants receiving prevocational services must have a competitive integrated employment outcome included in their service plan. There must be documentation in the service plan regarding how and when the provision of prevocational services is expected to lead to competitive integrated employment. CPS may not be provided in newly funded (on or after January 1, 2020) licensed 2380 or 2390 locations which serve more than 25 individuals in the facility at any one time.

Residential Habilitation, Life Sharing, and Supported Living Services will be required to utilize the recommendations provided in the Health Risk Screening Tool. SCs will be expected to monitor the implementation of the recommendations and incorporate them into the Individual’s Plan. Also, clarification is provided regarding the location parameters for newly funded sites.

ODP is proposing that respite can be provided by nurses for children with medical needs to assure the appropriate level of care is available.

Qualifications required for Support Service Professionals, Individuals, and Agency Providers have been clarified, including timelines for completion of certification requirements. Additionally, supported employment can be provided to individuals until OVR services are available, particularly when OVR has established a waiting list.

For a side-by-side comparison of substantive changes made as a result of public comment, see this online document. Questions about this communication should be directed to the appropriate ODP Regional Office.

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The Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) proposed rule on July 29, 2019, scheduled to be published in the August 14, 2019 Federal Register. Proposed changes to the CY 2020 Physician Fee Schedule are aimed at reducing burden, recognizing clinicians for the time they spend taking care of patients, removing unnecessary measures, and making it easier for clinicians to be on the path towards value-based care.

CMS will be conducting a listening session on Monday, August 12, 2019 from 1:00 pm – 2:30 pm to briefly cover three provisions from the proposed rule and address clarifying questions, to assist providers with formulating written comments for formal submission. Registration for the listening session is required. The three provisions include:

  • Increasing value of Evaluation and Management (E/M) payments;
  • Continuing to improve the Quality Payment Program by streamlining the program’s requirements in order to reduce clinician burden; and
  • Creating the new Opioid Treatment Program benefit in response to the opioid epidemic.

Providers are encouraged to review the following materials prior to the call:

CMS has noted that feedback received from providers during this listening session is not a substitute for formal comments on the rule. Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with questions.

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