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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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RCPA’s Brain Injury Committee will conduct an exclusive meeting with representatives from the Office of Long-Term Living (OLTL), including Deputy Secretary Juliet Marsala and Director of the Bureau of Coordinated and Integrated Services Randy Nolen. This meeting has been scheduled for May 22, 2024, at RCPA’s office, and will be held from 10:30 am – 12:00 pm. While this will be a hybrid meeting, members are encouraged to attend in person if possible. Register for the meeting here.

We are asking members to send topics and/or questions to Melissa Dehoff by May 8, 2024.

The Office of Long-Term Living (OLTL) hosted a virtual Transportation Summit on December 11, 2023. Answers to questions asked during that webinar can be found on the Community HealthChoices (CHC) Communications to CHC Participants web page under the heading “Community Meetings/Information Sessions.” The Q&A document is also available here.

Questions about CHC transportation provided through a CHC managed care organization (MCO) should be directed to the CHC-MCO through one of these methods:

AmeriHealth Caritas Pennsylvania Website
Phone: 1-855-235-5115 (TTY 1-800-235-5112)
Questions? Submit inquiries through this contact form.

Keystone First Website
Phone: 1-855-332-0729 (TTY 1-855-235-4976)
Questions? Submit inquiries through this contact form.

PA Health & Wellness Website
Phone: 1-844-626-6813 (TTY 711)
Questions? Submit inquiries through this contact form.

UPMC Community HealthChoices Website
Phone: 1-844-833-0523 (TTY 711)
Email

Questions about the Medical Assistance Transportation Program (MATP), including how to contact your local MATP provider, information is found on the MATP website.

For information on the Pennsylvania Department of Transportation (PennDOT) Shared-Ride Program, please visit the Seniors and Persons With Disabilities web page.

The agenda for the May 8, 2024, Long-Term Services and Supports (LTSS) Subcommittee meeting has been released. View the agenda here.

As a reminder, the meeting is being conducted in person and as a webinar with remote streaming from 10:00 am – 1:00 pm at the Honors Suite, 1st Floor, at 333 Market Street Tower, Harrisburg, PA. Additional information, including the conference line numbers, webinar links, etc. are provided below:

Comments and questions may be sent via email.
Conference line:
Bridge Number: 1-562-247-8422
PIN: 573-997-798#

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On April 25, 2024, at 12:00 pm, a virtual statewide briefing will be conducted on Medicaid unwinding and expanded enrollment options. This event will feature Health and Human Services (HHS) Regional Director Melissa Herd, Pennsylvania Department of Human Services Secretary Val Arkoosh, and Pennie Executive Director Devon Trolley.

The agenda will include a briefing on what’s happening at the federal level when it comes to Medicaid, an update on the Medicaid “unwinding” process currently wrapping up in Pennsylvania, and the expanded eligibility requirements for enrolling in Pennie coverage even when it’s not open enrollment.

To register, please visit here.

The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2025 hospital inpatient prospective payment system (IPPS) proposed rule. While the proposed rule is focused primarily on provisions specific to acute care hospitals and long-term care hospitals (LTCH), the rule includes a proposed mandatory model — the Transforming Episode Accountability Model (TEAM) — that would implement episode-based payments for five procedures: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure.

Under the proposed program, selected acute care hospitals would coordinate care for fee-for-service (FFS) beneficiaries who undergo one of the listed procedures and assume responsibility for the cost and quality of care through the first 30 days after the Medicare beneficiary leaves the hospital. Hospitals required to participate would continue to bill Medicare FFS but would receive a target price based on all non-excluded Medicare Parts A & B items and services included in an episode; inpatient rehabilitation facility (IRF) care is listed among these covered services. Hospitals may earn a payment from CMS, subject to a quality performance adjustment, if their spending is below the target price (additionally, hospitals could owe CMS a repayment amount, subject to a quality performance adjustment, if their spending was above the target price). Hospitals will face a “graduated risk” scale through different participation tracks to allow participants to ease into full-risk participation.

Per CMS, the program aims to incentivize coordination between care providers during surgery, as well as the services provided during the 30 days that follow, and require referral to primary care services to support continuity of care. CMS notes that TEAM hospitals may “want to engage in financial arrangements with providers and suppliers or participants in Medicare Accountable Care Organization (ACO) initiatives who are making contributions to the TEAM participant’s performance in the model,” and TEAM hospitals could share reconciliation payment amounts or repayment amounts with these individuals and entities. IRFs are listed among the potential “TEAM Collaborators” by CMS. Comments are encouraged on both the proposed definition of a TEAM collaborator and their role in the model.

There are several other provisions notable for IRFs, including the fact that CMS is proposing to require that TEAM hospitals “must, as part of discharge planning, account for potential financial bias by providing TEAM beneficiaries with a complete list of all available post-acute care options in the Medicare program, including home health agencies (HHA), skilled nursing facilities (SNF), IRFs, or LTCHs, in the service area consistent with medical need, including beneficiary cost-sharing and quality information (where available and when applicable).” The list must also indicate whether the TEAM participant has a sharing arrangement with the post-acute care provider.

The model would begin in 2026 and run for five years and is intended to build on other episode-based models, such as the Bundled Payments for Care Improvement Advanced and Comprehensive Care for Joint Replacement Models. Like with other Center for Medicare and Medicaid Innovation (CMMI) programs, CMS will assess whether the model would reduce Medicare spending while maintaining or improving the quality of care.

The proposed rule will be published in the May 2, 2024, Federal Register and will be open for public comments.

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The Centers for Medicare and Medicaid Services (CMS) has announced that the next hospital/quality initiative open door forum will be conducted on April 16, 2024 at 2:00 pm. The agenda topics that will be discussed during the call include:

The call will be a Zoom webinar with registration and login instructions below. To participate by webinar, please register in advance.

Meeting ID: 160 823 4591
Passcode: 200020

After registering, you will receive a confirmation email containing information about joining the webinar.

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The Centers for Medicare and Medicaid Services (CMS) has announced two days of interactive training webinars that will cover Medicare basics. The webinars will be offered on April 16 and 17, 2024, from 1:00 pm – 3:30 pm. Attendees can attend one or both days, and space is limited. CEUs will not be offered. The topics for the webinars include:

Day 1 — Medicare enrollment and eligibility; SSA and CMS roles and responsibilities; cost and coverage under Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance); why enrolling on time is important; and an overview of Medicare Supplement Insurance (Medigap) policies.

Day 2 — Medicare drug coverage (Part D); Medicare Advantage Plans; coordination of benefits; how to detect and report suspected Medicare fraud, waste, and abuse; and different resources to help you find answers to Medicare policy and coverage questions.

To register for these events, visit the CMS National Training Program website. The webinars will be recorded and posted to the NTP website. To view the recordings, visit here.

The next Long-Term Services and Supports Subcommittee (LTSS) meeting has been scheduled for May 8, 2024, as a hybrid event, with both in-person and webinar with remote streaming options available to attendees. The meeting will be held from 10:00 am – 1:00 pm at the Honors Suite, 1st Floor, at 333 Market Street Tower, Harrisburg, PA.

Register for the webinar here. After registering, you will receive a confirmation email containing information about joining the webinar.