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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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Photo by Markus Winkler on Unsplash

RCPA has received notification from PA Health & Wellness (PHW) regarding an update to the prior authorization process for Residential and Structured Day Habilitation services. The updates included in the notice are effective starting August 1, 2023.

Questions regarding this update should be directed to PHW’s Provider Services at 844-626-6813 or to Provider Relations via email.

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The Centers for Medicare and Medicaid Services (CMS) released a revised Medicare Learning Network (MLN) fact sheet on telehealth services. A number of changes have been made due to the end of the public health emergency (PHE), including the following items:

  • Information on the end of the COVID-19 public health emergency as well as CY 2023 and telehealth policies.
  • Status of Ongoing Flexibilities:
    • Through December 31, 2024, all patients can get telehealth wherever they are located. They do not need to be at an originating site, and there are no geographic restrictions.
    • Through December 31, 2024, all providers who are eligible to bill Medicare for professional services can provide distant site telehealth.
    • For behavioral or mental health telehealth, you may use 2-way, interactive, audio-only technology. This is also part of the PA Telehealth Statute under Act 98.
  • Additional Resources Provided:
    • Chapter 12, Section 190 of the Medicare Claims Processing Manual
    • Telehealth Policy Changes After the COVID-19 PHE
    • Tips for Telehealth Success
  • Added information on:
    • New G-codes. Starting January 1, 2023, you may voluntarily report the use of telehealth technology in providing home health (HH) services on HH payment claims. See MLN Matters Article MM12805 for more information.
    • Consent for care management and virtual communication services.

Providers are encouraged to review this document closely and bookmark it for future reference.

As RCPA continues its efforts to expand access via telehealth in Pennsylvania, we will be submitting comments on the new Calendar Year (CY) 2024 Physician Fee Schedule (PFS). RCPA will be sending out a communication on this in the coming days.

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The Centers for Medicare and Medicaid Services (CMS) has released a number of additional and updated documents related to the inpatient rehabilitation facility (IRF) review choice demonstration (RCD). Included in these documents are:

  • An updated and revised Operational Guide — Clarifies key programmatic details regarding the different review choices and other facets of the demonstration.
  • Frequently Asked Questions Document — The FAQ focuses on major areas of confusion on the choice selection and submission processes, the Pre-Claim Review Track, and medical necessity determinations.
  • Transcript and Recording — From the June 27, 2023, special open-door forum on the IRF RCD.

Additional information about the IRF RCD can be found on the CMS IRF RCD web page.

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Temple University Harrisburg will be offering some no-cost training options that are approved to meet Personal Care Home (PCH) and Assisted Living Residence (ALR) Administrator annual training requirements. The training sessions that will be offered in the fall include:

Interested individuals 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, as 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.

If you have any questions about these trainings or if you require assistance with registration, you can email Temple University. 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 via email.

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The Centers for Medicare and Medicaid Services (CMS) conducted a special open door forum on June 27, 2023, that focused on the Review Choice Demonstration (RCD) for inpatient rehabilitation facilities (IRF). Beginning August 21, 2023, the RCD will begin for IRF services in Alabama. CMS has shared that IRFs in Pennsylvania will be included in the next phase of the demonstration. For additional information, there is an RCD web page dedicated to this. The presentation from the June 27 special open door is also available.

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The agenda for the July 6, 2023, Managed Long-Term Services and Supports (MLTSS) Subcommittee meeting has been released. The meeting will held in person at the PA Department of Education Building’s Honors Suite, 1st floor, 333 Market Street in Harrisburg, or via webinar. The meeting is scheduled to take place from 10:00 am – 1:00 pm.

To participate in the meeting via webinar, please register here. Registrants will receive a confirmation email containing information about joining the webinar. Note that if you have trouble accessing the webinar registration through the Internet Explorer or Safari web browsers, please try accessing it through a different web browser, such as Chrome or Edge.

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