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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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The Department of Human Services (DHS) has announced that they are preparing for the end of the federal Public Health Emergency (PHE). Included in this preparation is a webinar planned for October 24, 2022, at 2:30 pm. Register for the webinar at the link below:

https://padhs19.webex.com/padhs19/j.php?RGID=re51d9b2a4909630f736cfdbb2c6a0dad

When the PHE ends, DHS will resume closing Medicaid cases for ineligible recipients. DHS has stressed that they want all recipients that remain eligible to keep their coverage and complete their renewals in a timely manner. Providers can assist by making sure that they are prepared to aid the individuals to complete their renewal when it is due, now and after the PHE ends.

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Last week, H.R.8746 — Access to Inpatient Rehabilitation Therapy Act of 2022 was introduced to ensure Medicare beneficiaries in inpatient rehabilitation facilities (IRFs) are able to access all skilled, medically necessary rehabilitation therapies that are most appropriate for their condition. This bill, also known as the “three hour rule bill,” would expand the current three hour rule in which Medicare requires IRF patients to be able to participate in, and benefit from, three hours of rehabilitation therapy per day, five days a week (or 15 hours over a seven day period). The current regulation only allows physical therapy (PT), occupational therapy (OT), speech therapy, and orthotics and prosthetics care to count towards the three hour requirement. As a result, many patients have difficulty accessing additional forms of therapy that may be more appropriate.

During the COVID-19 public health emergency (PHE), the three hour rule has been waived in its entirety. If the Access to Inpatient Rehabilitation Therapy Act is enacted, it would ensure that IRFs maintain flexibility after the expiration of the PHE. Most importantly, the legislation would allow certain therapies, including recreational therapy, cognitive therapy, and respiratory therapy, to count towards the three hour rule after the patient’s admission. These additional therapies and skilled modalities would be identified by the Secretary of Health and Human Services (HHS). At the time of admission, the existing three hour rule would still apply, ensuring that IRF admissions do not increase (and thus add to underlying costs for the Medicare program) due to the new flexibility.

This legislative solution has been developed over several years with Members of Congress and a group of stakeholders, including the American Medical Rehabilitation Providers Association (AMRPA), the American Academy of Physical Medicine & Rehabilitation (AAPM&R), the Brain Injury Association of America (BIAA), and the American Therapeutic Recreation Association (ATRA).

For additional information, please refer to Congressman Courtney’s press release.

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On August 22, 2022, the Department of Human Services (DHS) announced the availability of Pennsylvania’s Final Statewide Transition Plan (STP) for the Home and Community-Based Services (HCBS) Rule for a 30-day public comment period. The announcement contained plans for DHS to record a presentation providing a general overview of the HCBS Rule and Pennsylvania’s Final Statewide Transition Plan to prepare stakeholders for public comment. The recording of this presentation is now available on the Home and Community-Based Services Statewide Transition Plan web page.

Pennsylvania’s Final Statewide Transition Plan and information about how to provide public comment, including during webinars specific to the Office of Child Development and Early Learning, Office of Developmental Programs, and Office of Long-Term Living, are also available on the HCBS STP web page.

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The Office of Long-Term Living (OLTL) has released a communication that provides clarification to Act 150 Service Coordination entities on the Act 150 to Community HealthChoices (CHC) Waiver Transfer procedure. This procedure outlines the steps the Act 150 Service Coordinator (SC) should take once the participant has been confirmed nursing facility clinically eligible (NFCE), and a financial eligibility determination is needed to confirm if the participant is to transfer to the CHC Waiver.

As detailed in the Act 150 Guidelines, the reevaluation process is to be conducted at least once each year within 365 days of the first level of care determination and each subsequent year.

Additional questions should be sent to OLTL’s Division of Fee for Service Operations electronically.

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Northampton Community College is offering free online training programs in the fall 2022 for personal care homes (PCHs) and Assisted Living Residences (ALRs). There are a variety of training topics being offered, including Verbal De-escalation Redirection Techniques, Dementia Care in PCH, and Safe Medication Practices.

In the announcement, you can select the linked course titles to register. You may also visit the College’s website. If you have any questions about registering, please contact Northampton Community College via email or at (610) 332-6585.

Participation is limited for each course. If you register and later discover you are unavailable to participate, please cancel your registration to allow other individuals the opportunity to register.

If you need information about additional available training for administrators, please contact the Operator Support Hotline at (866) 503-3926 or electronically.

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The Department of Human Services (DHS) announced they will be accepting comments on Pennsylvania’s Final Statewide Transition Plan (STP) for Home and Community-Based Services (HCBS). This plan applies to Medicaid Waivers under the Office of Long-Term Living (OLTL), Office of Developmental Programs (ODP), and Office of Child Development & Early Learning (OCDEL). The notice is below and includes additional information about upcoming webinars.

HCBS Settings Rule – Background

CMS published the HCBS Rule, which amends the Medicaid regulations for HCBS waivers under section 1915(c) of the Social Security Act. The HCBS Rule supports enhanced quality of programs and services and adds protections for individuals receiving services. The HCBS Rule reflects CMS’ intent to ensure all individuals receiving services and supports through Medicaid waivers have full access to the benefits of community living, including receiving services in the most integrated setting. The HCBS Rule includes a provision requiring states to develop a transition plan to ensure that services will meet federal requirements by March 2023.

Statewide Transition Plan

The Department received initial approval of its STP on August 30, 2016, which can be accessed at the Department’s HCBS Stakeholder Waiver and Planning Team web page.

To receive final approval of Pennsylvania’s STP, the Department is required to complete the following remaining steps and submit an updated STP with this information included:

  • Complete a thorough, comprehensive site-specific assessment of all HCBS settings, implement necessary strategies for validating the assessment results, and include the outcomes of this assessment within the STP;
  • Draft remediation strategies and a corresponding timeline that will resolve issues that the site-specific settings assessment process and subsequent validation strategies uncovered by the end of the HCBS rule transition period (March 17, 2023);
  • Outline a detailed plan for identifying settings that are presumed to have institutional characteristics, including qualities that isolate HCBS beneficiaries, as well as the proposed process for evaluating these settings and preparing for submission to CMS for review under heightened scrutiny;
  • Develop a process for communicating with beneficiaries that are currently receiving services in settings that the state has determined cannot or will not come into compliance with the HCBS settings rule by March 17, 2023; and
  • Establish ongoing monitoring and quality assurance processes that will ensure all settings providing HCBS continue to remain fully compliant with the rule in the future.

This information is included in Pennsylvania’s Final STP for public comment. A presentation providing a general overview of the HCBS Rule and Pennsylvania’s Final STP will be recorded by the Department and posted by the end of August to prepare stakeholders for public comment. Information about where to access the presentation will be published when it is available.

As outlined in the public comment section below, the Office of Child Development and Early Learning (OCDEL), Office of Developmental Programs (ODP), and Office of Long-Term Living (OLTL) will each hold webinars to go over information in Pennsylvania’s STP that is specific to their waivers and programs. Public comment will be accepted during each of these webinars.

Public Comment

Pennsylvania’s Final STP is available for a 30-day public comment period at the Department’s HCBS STP web page. Comments will be accepted no later than 11:59 pm on September 22, 2022. Stakeholders may provide public comment through one of the following methods:

  1. Electronic comments submitted via email
    1. Stakeholders are asked to use the subject header “PA Final STP” and submit comments to this mailbox.
  2. Written comments submitted via mail
    1. Mailing address: Department of Human Services, Office of the Secretary, P. O. Box 2675, Harrisburg, PA 17105-2675.
  3. Verbal and written comments during public comment webinars
    1. The following dates and times below are for stakeholders to participate in the public comment webinars:
      1. Webinar Specific to STP Information for OCDEL
        September 12, 2022
        9:00 am – 10:00 am
        Please register for the webinar via email.
      2. Webinars Specific to STP Information for ODP
        September 8, 2022
        10:00 am – 12:00 pm
        Please register for the webinar.
        September 12, 2022
        1:00 pm – 3:00 pm
        Please register for the webinar.
      3. Webinar Specific to STP Information for OLTL
        September 15, 2022
        2:00 pm – 3:00 pm
        Please register for the webinar.

When submitting electronic or written comments, it is recommended that you include the following information:

  • The page number or Appendix where the information you are commenting on is located; and
  • Which office (OCDEL, ODP, or OLTL) the comment applies to, if applicable.

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The Office of Long-Term Living (OLTL) issued the following notice regarding the American Rescue Plan Act (ARPA) one-time payments for personal care homes (PCH) and Assisted Living Residences (ALR):

Background Info:

Governor Wolf signed Act 54 of 2022, which allocates $26.767 million of federal funding from the American Rescue Plan Act (ARPA) for payments to nursing facilities (NF), personal care homes (PCH), and assisted living residences (ALR). To qualify for the one-time payment, a facility must be in operation as of July 1, 2022.

These one-time ARPA funds must be used for COVID-19 related costs not otherwise reimbursed by federal, state, or other sources of funding. OLTL will send a letter with details about the payments, including information about the approved use of and reporting on these funds. An Act 54 Facility Acceptance Form must be completed by September 2, 2022.

Additional information on Act 54, payment amounts and approved use of this funding will be available at the DHS Long-Term Care Providers page.

PCH/ALR Payments:

  • ARPA PCH/ALR Payment #1 — Licensed Occupancy
    • The total funds available for a one-time ARPA payment to PCHs and ALRs pursuant to Act 54 (ARPA PCH/ALR Payment #1) is $24,090,000. Each PCH/ALR Payment #1 is calculated by the dividing the census of the PCH or ALR, as determined by the most recent DHS inspection on or before July 1, 2022, by the total census of all PCHs and ALRs, including those with a special care designation, as determined by the most recent DHS inspection on or before July 1, 2022, to obtain a facility-specific quotient for each PCH and ALR. Each facility’s quotient is multiplied by $24,090,000 to determine its payment amount.
  • ARPA PCH/ALR Payment #2 — Supplemental Security Income (SSI) Residents Served
    • The total funds available for a one-time ARPA payment to PCHs and ALRs pursuant to Act 54 (ARPA PCH/ALR Payment #2) is $2,677,000. Each ARPA PCH/ALR Payment #2 is calculated by dividing the number of individuals for whom the PCH/ALR received a state SSI payment as in March 2022, divided by the total of all PCH’s/ALR’s individuals for whom a state SSI payment was made in March 2022, to obtain a facility-specific quotient. Each PCH’s/ALR’s quotient is multiplied by $2,677,000 to determine its payment amount.

PCHs and ALRs must complete the Facility Acceptance Form by August 26, 2022. Checks will be issued and mailed in the order in which DHS receives the Facility Acceptance Forms.

Act 54 of 2022 requires the ARPA funding to be obligated by December 31, 2024, and spent by December 31, 2026, or returned to the commonwealth. Additionally, these funds must be used for COVID-19 related expenses. Providers must keep documentation to prove that these funds were used for their response to the COVID-19 pandemic in case of an audit. Any person or entity accepting an ARPA payment agrees to provide documentation to DHS, upon request, for purposes of determining compliance with Act 24 requirements. Instructions on expenditure reporting will be provided at a later date.

The Department of Human Services (DHS) recommends that providers consult their accountants or attorneys for further clarification on acceptable uses of ARPA funding. DHS encourages providers to review guidance for eligible expenditures on the U.S. Department of the Treasury website in their Compliance and Reporting Guidance.

Any questions about this information or the Facility Acceptance Form should be sent to PW, OLTL COVID Payments.

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Photo by Markus Winkler on Unsplash

Message from the Bureau of Human Services Licensing (BHSL) regarding the renewals of assisted living residences (ALR) and personal care homes (PCHs) license renewals:

Due to staffing issues, BHSL Licensing Administration is currently experiencing a delay in processing renewals 130 days in advance of expiration. In most cases, Licensing Administration is issuing the license in the month that it expires.

If your license has expired and you have not yet received your renewal, please contact Licensing Administration at 717-705-0383 or via email directly so that your renewal can be expedited. Any Certificates of Compliance that have or will be expired on or before August 31, 2022, have been emailed to the email addresses we have on file. We are currently working on the September expiration dates. To expedite the process, you will be receiving your Certificate of Compliance electronically. It is being sent to the email address(es) as noted on your renewal application. If changes to your email address(es) are needed at any time throughout the year, please send a notification email here and to your regional office.

The Certificate of Compliance may also be printed from the Provider Directory, which is updated when the Certificate of Compliance is issued via email. It can be found by searching the name of your home here. Select the Certificate hyperlink in the License Status & License # column of your directory listing.

Please be reminded that if you have not received your approval letter from BEO, you will need to submit a Civil Rights Attestation electronically. You can find the form here. The Attestation may be submitted via email ONLY if you had previously submitted the CRCQ without receiving a letter of approval from the BEO. It should be emailed here. Any email correspondence sent to Licensing Administration should have this format in the subject line: LICENSE #, NAME OF HOME, DESCRIPTION OF CONTENTS, i.e.: 123450 – ABC Personal Care Home – Attestation.

When submitting the Civil Rights Compliance Attestation with the renewal application and renewal application fee, they must submitted in one mailing via physical mail to:

Via USPS:

DHS/BHSL
Room 623
PO Box 2675
Harrisburg, PA 17105-2675                               

Or via courier:

DHS/BHSL
Health & Welfare Building Rm 623
625 Forster Street
Harrisburg, PA 17120  

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The next Financial Management Services (FMS) stakeholder meeting is scheduled for Friday, September 2, 2022, from 1:00 pm – 2:30 pm. The purpose of this meeting is to discuss the upcoming changes for the administration of FMS under the Community HealthChoices (CHC), OBRA Waiver, and Act 150 programs. Representatives from the Office of Long-Term Living (OLTL) and CHC Managed Care Organizations (MCOs) will be in attendance to discuss upcoming changes.

Please register using this registration link. After registering, you will receive a confirmation containing information about joining the webinar.

If you choose to use your phone to call in, please use the numbers below:
Dial in: 562-247-8422
Access Code: 834499387#
Audio PIN: shown after joining the webinar

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