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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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Temple University Harrisburg is offering free online training sessions that are approved to meet the Personal Care Home (PCH) and Assisted Living Residence (ALR) Administrator annual training requirements.

The training sessions are entitled:

You need only to register for one session for each topic. Please read the training announcements in full before registering to ensure you can meet the participation requirements. Please only register for these sessions if you are sure you will be able to complete them.

Participation is limited for each course. If you register and later discover you are unable to participate, please cancel your registration to create space for other participants.

You can email Temple University any questions you have about these trainings or if you require assistance with registration. If you would like information about additional trainings available for PCH and ALR administrators, please contact the Bureau of Human Services Licensing Operator Support Hotline.

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Image by DarkmoonArt_de from Pixabay

RCPA’s brain injury providers will begin to have quarterly meetings with the Community HealthChoices Managed Care Organizations (CHC-MCO) and are encouraged to save the following dates for these meetings:

  • April 6, 2023;
  • July 13, 2023; and
  • October 19, 2023.

The meetings will be held from 1:00 pm – 3:15 pm via webcast. During the meetings, each CHC-MCO will be allocated a 45-minute window of time. The focus of these quarterly meetings will be to have open dialogue on issues or concerns, ask questions, etc. Members will be encouraged to submit questions prior to the meeting dates.

The webcast information, which will include registration information, will be sent 30 days prior to the date of each call. Links to each call will be sent to registrants 24 hours prior to the call.

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House Republican Appropriations Chairman Seth Grove will lead a roundtable discussion with Medicaid (MA) Managed Care Organizations (MCOs) on February 7, 2023, at 10:00 am.

Committee Chairman Grove will be joined by House members and the following testifiers:

  • Emily Katz, Executive Director of PAMCO;
  • Joanne McFall, Market President of Keystone First;
  • Matthew Hurford, President/CEO of Community Care Behavioral Health;
  • James Schuster, Chief Medical Officer of UPMC Insurance Services Division;
  • Jack Carroll, Executive Director of Cumberland-Perry Drug & Alcohol Commission;
  • John Koehn, Market President of Community HealthChoices, AmeriHealth Caritas;
  • Justin Davis, Plan President/CEO of PA Health & Wellness; and
  • Brendan Harris, Vice President of Community HealthChoices, UPMC Health Plan.

The hearing will be held in Room 60 East Wing, Main Capitol, State Capitol Complex in Harrisburg. The hearing will also be streamed live.

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The monthly Managed Long-Term Services and Supports (MLTSS) Subcommittee convened on February 1, 2023. The meeting handouts included the agenda as well as the following PowerPoint presentations:

UPDATE on 02/06/23 — In addition to the above handouts, the following are now available:

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The Centers for Medicare and Medicaid Services (CMS) has updated the calendar year (CY) 2023 per beneficiary threshold amounts for therapy services. These threshold amounts, also known as therapy caps, are reflected on claims with the KX modifier to confirm that services are medically necessary as justified by appropriate documentation in the medical record. There is one amount for Physical Therapy (PT) and Speech-Language Pathology (SLP) services combined and a separate amount for Occupational Therapy (OT) services. Claims from providers for therapy services above the threshold amounts without the KX modifier are denied.

For CY 2023, the KX modifier threshold amounts are: (a) $2,230 for PT and SLP services combined, and (b) $2,230 for OT services.

For additional information, refer to CMS Transmittal 11626 and the 2023 Therapy Code List and Dispositions.

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The agenda for the February 1, 2023, Managed Long-Term Services and Supports (MLTSS) Subcommittee has been released. The meeting will be held in person at the PA Department of Education Honors Suite, 1st Floor, 333 Market Street Harrisburg, PA 17126 from 10:00 am – 1:00 pm. There is also the option to participate via webcast. The link to register to participate via webcast, as well as the remote streaming link, is available on the agenda.

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On an annual basis, the Bureau of Human Services Licensing (BHSL) provides approximately 500 hours of training for Personal Care Home (PCH) and Assisted Living Residence (ALR) administrators and staff. In order to help maximize the impact of BHSL’s training programs, members are requested to complete a ten question survey. Survey results will be kept anonymous and will be used to shape their training programs in 2023 and beyond.

This survey is intended only for administrators and staff of a licensed PCH/ALR. The survey is optional; however, your participation is strongly encouraged. The survey will be available until February 28, 2023.

Questions should be directed via email.

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The Office of Long-Term Living (OLTL) issued information and clarification on the recent increase to the Personal Care Home (PCH) Supplement for PCH residents currently receiving Supplemental Security Income (SSI) or currently meeting SSI disability and income criteria while applying for SSI.

In August of 2022, the Pennsylvania legislature approved an increase to the PCH Supplement, retroactive to July 1, 2022. The supplement was increased from $439.30 to $639.30 for individuals and from $957.40 to $1357.40 for married couples. The Social Security Administration (SSA) administers both the federal SSI benefit and the PCH supplement. In January 2023, SSA applied the increase and began issuing retroactive payments in lump sums.

As indicated in the Personal Care Home regulations, 55. PA Code Chapter 2600, “If a home agrees to admit a resident eligible for SSI benefits, the home’s charge for actual rent and other services may not exceed the SSI resident’s actual current monthly income reduced by the current personal needs allowance.”

For the purpose of applying the regulations to the PCH Supplement increase, a resident’s actual monthly income should be calculated by including the increased PCH supplement beginning July 1, 2022, and applied as follows:

  • Residents and/or Representative Payees are expected to provide these retroactive payments to the PCH.
  • If a resident was admitted to a PCH between July 1, 2022, and the issuance of the retroactive benefit, the PCH is only entitled to the monthly increase for the months that the resident resided in the PCH.
  • If the resident lived in another PCH prior to admission to their current PCH, the resident and/or representative payee should ensure that the appropriate monthly portions of the retroactive benefit are paid to both the discharging and admitting facilities.
  • Resident-Home Contracts are not required to be updated for the retroactive benefit; however, contracts are required to reflect the actual charges for room, board, and services no later than March 31, 2023.

Questions about the status of individual retroactive and/or monthly SSI and PCH Supplement payments can be addressed by calling SSA at 800-772-1216. Additional questions about the application of the retroactive PCH Supplement increase can be directed via email. For information about applying for SSI and or the PCH Supplement, please contact your local agency.

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