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Authors Posts by Melissa Dehoff

Melissa Dehoff

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Melissa Dehoff is responsible for all medical rehabilitation and brain injury service issues. Ms. Dehoff attends multiple state-level meetings to advocate on behalf of members on brain injury and rehabilitation issues and is a member of the Department of Health Traumatic Brain Injury Advisory Board.

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physiotherapist helping patient to walk

The Centers for Medicare and Medicaid Services (CMS) recently released the fiscal year (FY) 2027 hospital inpatient prospective payment system (IPPS) proposed rule. Included in this rule is a proposal for the expansion of CMS’s Comprehensive Care for Joint Replacement (CCJR) model nationwide to improve care coordination and reduce costs for Medicare patients undergoing hip, knee, and ankle replacements. The model would hold hospitals accountable for the full episode of care, including surgery and 90 days of recovery, encouraging better outcomes and a more efficient use of resources.

For background purposes, from April 2016 through December 2024, the CMS Innovation Center tested the CJR Model to improve care for Medicare patients undergoing joint replacement procedures. During that time, the model generated significant Medicare savings while maintaining quality of care for beneficiaries. Under the CJR Model, hospitals were held responsible for Medicare spending for the joint replacement surgery, the hospital stay, and the first 90 days of recovery, including follow-up care such as physical therapy.

Based on the evaluation of the CJR Model, the CJR Expanded (CJR-X) Model would create strong incentives for hospitals to coordinate care more effectively, avoid unnecessary services like avoidable re-hospitalization and emergency care, and focus on delivering the best outcomes for patients. It would specifically encourage better communication with post-acute care providers to support recovery. Beginning October 1, 2027, CJR-X would be required for most hospitals, making it the first mandatory, nationwide test of an episode-based payment model.

Comments on the proposed rule are due by June 9, 2026.

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The Brain Injury Advisory Board (Board), established under section 1252 of the Federal Traumatic Brain Injury Act of 1996 (42 U.S.C. § 300d-52), will hold a public meeting on May 1, 2026, from 10:00 am – 3:00 pm. The meeting will be held in person at the Health and Human Services Building, 7th Floor, Conference Room A, 625 Forster Street, Harrisburg, PA 17120. A virtual meeting option is available via Microsoft Teams. To join the Microsoft Teams meeting, call (267) 332-8737. The phone conference ID is 428991948#.

Meeting materials will be sent out before the meeting and will also be available on the Department of Health’s (DOH) website. Questions should be sent to Nicole Johnson electronically.

DOH’s Head Injury Program (HIP) strives to ensure that eligible individuals who have a traumatic brain injury (TBI) receive high quality rehabilitative services aimed at reducing functional limitations and improving quality of life. The Board assists DOH in understanding and meeting the needs of persons living with acquired brain injuries, both traumatic and nontraumatic, and their families. This quarterly meeting will provide updates on a variety of topics, including the number of people served by HIP. In addition, meeting participants will discuss budgetary and programmatic issues, community programs relating to traumatic and nontraumatic brain injuries and available advocacy opportunities.

For additional information or for persons with a disability who wish to attend the meeting and require an auxiliary aid, service, or other accommodation to do so, contact Nicole Johnson, Division of Community Systems Development and Outreach, (717) 772-2763. For individuals who need assistance with speech or for deaf or hard of hearing persons, contact the Pennsylvania Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

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Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, and Congressman Morgan Griffith (VA-09), Chairman of the Subcommittee on Health, recently announced a hearing titled Healthier America: Legislative Proposals to Improve Public Health.

The hearing, scheduled for April 15, 2026, at 10:15 am, will focus on the bills below that address various areas of public health, including disease research and prevention efforts, bolstering resources for rural medical services and health care providers, promoting healthy activities, and increasing access to care.

The hearing will be open to the public and will be livestreamed online.

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The Centers for Medicare and Medicaid Services (CMS) has released the fiscal year (FY) 2027 inpatient rehabilitation facility prospective payment system (IRF PPS) proposed rule.

The proposed rule includes some technical proposals that would modify the IRF coverage and documentation requirements as well as IRF QRP submission deadlines. The proposed rule does not include any proposals to modify the existing IRF transfer policy. The proposed rule does, however, include several Requests for Information (RFI) that could indicate potential future impactful changes.

On the FY 2027 payment side, the rule would provide an overall 2.8% increase to estimated payments per discharge, compared to the 2.6% payment update that CMS finalized for FY 2026.

FY 2027 Payment Updates

  • Aggregate Estimated Payment Increase: 2.8% / $355 million (field-wide)
  • Market Basket Update (with Productivity Adjustment): 2.4%
  • Labor-Related Share: 74.5%
  • Standard Payment Conversion Factor: $19,881
  • Outlier Threshold: $8,689 (from $10,141 in FY 2026)

FY 2027 Coverage, Payment, and Documentation Policy Changes

Initiation of Therapy Requirement
CMS proposes to clarify the requirement that therapy be initiated within 36 hours of midnight of the day of admission to the IRF.

Documenting Function in Preadmission Screen
CMS proposes to expand the elements required in the preadmission screening (PAS) to include “current functional status” as well as prior level of function.

Timing of Interdisciplinary Team Meeting
CMS proposes to tighten the requirement for the timing of the weekly interdisciplinary team meeting by requiring an initial interdisciplinary team meeting to occur “on or before the fourth day from midnight on the date the patient is admitted” and subsequent team meetings to occur “at least once per week after the date of the prior team meeting.”

Request for Information on Future IRF Payment Reform
The rule includes an extensive Request for Information (RFI) on future IRF payment reform, specifically two major areas of reform:

  1. Refining the current IRF patient classification system by creating a draft list of IRF-specific clinical categories; and
  2. Creating a new system of comorbidity scoring to better account for the severity and number of comorbidities for IRF patients.

The RFI does not propose any of these changes be implemented in FY 2027 but requests stakeholder feedback on both areas. CMS also references two new technical reports addressing their PPS changes under consideration; these are available for download as part of the rule’s associated data files here.

FY 2027 Quality Reporting Program Updates

Proposal to Revise Data Submission Deadlines for the IRF QRP
For the FY 2029 IRF QRP, which will be based upon Calendar Year 2027 data, CMS is proposing to reduce this timeline to the “15th day of the second month following the end of calendar quarter.”

The proposed rule will be published in the Federal Register on April 6, 2026. Comments on the proposed rule are due by June 1, 2026.

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The Office of Long-Term Living (OLTL) released Bulletin 59-26-03, which updates the standardized Participant Review Tool (PRT) for Service Coordinators (SC). The bulletin provides additional clarification on the location of face-to-face visits with participants when completing the PRT. The bulletin also provides guidance to SCs on when increased face-to-face visits with program participants should be scheduled to protect their health, safety, and welfare.

This bulletin rescinds OLTL Bulletin 59-26-02 and any other OLTL policy documents or parts of policy documents that are inconsistent with this bulletin’s contents.

This bulletin applies to enrolled Service Coordination Entities (SCE) performing services in OLTL Medical Assistance Home and Community-Based Services (HCBS) for the OBRA waiver and the Act 150 Program.

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The American Association of Retired Persons (AARP) Public Policy Institute has released a series of new research insights that highlights American adults’ views on a variety of issue areas. One of the recent releases focuses on brain health and includes the following resource topics:

  • Healthy Eating
  • Dementia
  • Hearing and Brain Health
  • Traumatic Brain Injury
  • Music and Brain Health
  • Mental Health, Emotional Well-Being, and Resiliency
  • Delirium

Visit here to read more about each of these resource topics.

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The Office of Developmental Programs (ODP) has shared the Medication Administration face-to-face schedule for April–June 2026 in ODPANN 26-035. New Trainer classes are for first-time trainers who are designated as “New Trainer” and start at 8:30 am.

Recertifying Trainer Classes are available in the morning and in the afternoon according to the schedule. Morning classes are designated as AM Recertification classes and will start at 8:30 am. Afternoon classes are designated as PM Recertification classes and will start at 1:00 pm.

You may register for one of these sessions after completing the course materials in the Train-the-Trainer course on MyODP’s Medication Administration website.

Please review the announcement for class schedule and additional details.

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The Centers for Medicare and Medicaid Services (CMS) has released the final rule that implements requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the Patient Protection and Affordable Care Act (ACA), as amended by the Health Care and Education Reconciliation Act of 2010, enacted on March 30, 2010.

Specifically, this final rule adopts standards for health care claims attachments transactions, which will support health care claims transactions and a standard for electronic signatures to be used in conjunction with health care claims attachments transactions.

The final rule will slash wasteful spending and antiquated paperwork by swapping out faxing and mailing for streamlined electronic transactions. This action lets providers spend less time on administrative hassle and more time caring for patients and is projected to save the healthcare industry approximately $781 million on an annual basis.

The final rule will be published in tomorrow’s (March 24, 2026) Federal Register and will become effective on May 19, 2026. Covered entities must comply by May 19, 2028.

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Novitas Solutions, the Medicare Administrative Contractor (MAC) for Pennsylvania, has announced the introduction of a new and improved Medicare Navigator program for providers.

The program includes webinars focused on supporting providers so they can successfully navigate Medicare program requirements and submit complete, accurate transactions. March’s Medicare Navigator Program also spotlights the Foundations of Compliance:

  • March 24, Foundations of Compliance: Locating and Utilizing Local Coverage Determinations (LCDs)
  • March 26, Foundations of Compliance: Purposeful Documentation

Members are encouraged to review Novitas’s event calendar for the full listing of events and opportunities to register.

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