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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 rate of emergency departments (ED) visits for bicycle-related traumatic brain injuries (TBI) and concussions decreased by almost half (49%) among children, but only by 6% among adults between 2009 and 2018 according to a new report in CDC’s Morbidity and Mortality Weekly Report.

Key findings from the report, “Emergency Department Visits Due to Bicycle-Related Traumatic Brain Injuries Among Children and Adults — United States, 2009-2018,” also show that:

  • There were more than half a million estimated ED visits for bicycle-related TBI in the U.S. during the study period.
  • The rate of ED visits for bicycle-related TBI decreased by almost half (49%) among children age 17 and under, and by only 6% among adults during the study period.
  • Among all age groups examined, ED visits for bicycle-related TBIs were highest for children ages 10-14 years.
  • The rate of bicycle-related TBI ED visits among males of all ages was three times greater than among females.

Bicycling is a great physical activity and is growing in popularity among Americans. Findings in this report highlight the need to expand effective bicycle safety interventions such as improving compliance to traffic laws, helmet use and bicycling infrastructure. These can help children and adults enjoy the benefits of bicycling and stay safe from injury, including TBIs.

Additional Information:

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The Centers for Medicare and Medicaid Services (CMS) published an interim final rule with comment period (IFC) in the May 13, 2021 Federal Register that revises the infection control requirements that long-term care (LTC) facilities and intermediate care facilities for individuals with intellectual disabilities must meet to participate in the Medicare and Medicaid programs. The goal of this IFC is to reduce the spread of COVID-19 by requiring education about COVID-19 vaccines for LTC facility residents, ICF-IID clients, and staff serving both populations, and by requiring that such vaccines, when available, be offered to all residents, clients, and staff. It also requires LTC facilities to report COVID-19 vaccination status of residents and staff to the Centers for Disease Control and Prevention (CDC). These requirements are necessary to help protect the health and safety of ICF-IID clients and LTC facility residents. In addition, the rule solicits public comments on the potential application of these or other requirements to other congregate living settings over which CMS has regulatory or other oversight authority. The regulations are effective on May 21, 2021; however, comments will be accepted but must be submitted by 5:00 pm on July 12, 2021 to be assured for consideration.

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The Senate Aging and Youth Committee has announced an upcoming public hearing on Thursday, May 20, 2021 at 11:00 am. This public hearing will focus on the current status and needs of long-term care facilities one year after COVID-19. This hearing will be live streamed and will also be archived for future viewing.

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The Centers for Medicare & Medicaid Services’ (CMS) accelerated payment program provides necessary funds when there are disruptions in claims submission and/or processing. The Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116–136) expanded the program to include not only acute care hospitals, but also children’s hospitals, certain cancer hospitals, and critical access hospitals. CMS further expanded eligibility for accelerated/advance payments during the COVID-19 public health emergency (PHE) to all Medicare providers and suppliers.

On April 1, 2021, CMS issued a notice “Repayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021” for all Medicare providers and suppliers who requested and received COVID-19 Accelerated and Advance Payments (CAAPs) from CMS due to the COVID-19 PHE. It notifies providers that CMS began recovering the CAAP payments as early as March 30, 2021 (depending upon the one-year anniversary of when a provider received their first payment). The notice also provides information on how to identify recovered payments. Some highlights from the article include:

  • Accelerated payments function as a loan and must be repaid to CMS in full. The Continuing Appropriations Act, 2021 and Other Extensions Act, enacted on October 1, 2020, established new repayment terms for accelerated/advance payments. Among other provisions, the new terms include:
    • One year (from date payment was issued) before repayment begins — hospitals begin repayment as early as April 2021;
    • 25 percent withhold of Medicare claims during the first 11 months of repayment, followed by a 50 percent withhold during the subsequent six months; and
    • 4 percent interest applied to any remaining balance at the end of the repayment period.

The accelerated payments provided a critical lifeline to health systems during this PHE. The requirement to repay these funds could place health systems in financial distress while trying to recover from the pandemic. RCPA is requesting feedback from members on the impact of the accelerated payment relief plan. Please take a few minutes and respond to the following questions:

  1. Are you/your organization aware of the Accelerated Payment Relief program from CMS?
  2. Have you taken advantage of this?
  3. Are there any issues with the repayment?
  4. Have you been involved in any lobbying efforts to:
    1. Get this to better payment terms (e.g., interest rate, timing)?
    2. Move this to loan forgiveness?
  5. Have you contacted any state or federal legislators? If so, whom?
  6. Has your organization also received Provider Relief Funding and/or any other extraordinary CARES Act Funding?
  7. If so, has this impacted your interest in pursuing action relative to the Accelerated Payment Relief?
  8. Any additional comments?

Please send your responses to Melissa Dehoff by Wednesday, May 26, 2021.

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Photo by Christina @ wocintechchat.com on Unsplash

The Center for Connected Health Policy (CCHP) will be conducting their third webinar as part of their spring webinar series on May 14, 2021 from 2:00 pm–3:30 pm. This webinar, Medicaid Telehealth Policies for Seniors, will bring together Medicaid officials for a panel discussion about how state programs and Medicaid agencies incorporate telehealth into their services for seniors and other benefits for dually-enrolled for Medicare and Medicaid beneficiaries. State Medicaid presenters will also discuss relevant policy changes during COVID-19 and how that has impacted plans for the future of telehealth and seniors in their states. Members interested in participating in this webinar are encouraged to register as soon as possible.

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The Centers for Medicare and Medicaid Services (CMS) issued a reminder that the submission deadline for the inpatient rehabilitation facility (IRF) quality reporting program (QRP) is coming up on Monday, May 17, 2021.

IRF Patient Assessment Instrument (PAI) assessment data and data submitted to CMS via the Center for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) October 1–December 31 (Q4) of calendar year (CY) 2020 are due with this submission deadline. In addition, the annual NHSN Influenza Vaccination among Healthcare Personnel measure is also due with this deadline. The list of measures required for this deadline is found on the CMS QRP website.

As a reminder, it is recommended that providers run applicable CASPER/iQIES/NHSN analysis reports prior to each quarterly reporting deadline in order to ensure that all required data has been submitted.

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The Office of Long-Term Living (OLTL) has scheduled a Financial Management Services (FMS) stakeholder meeting for Thursday, May 13, 2021 from 9:30 am–11:00 am. The purpose of this public meeting is to discuss upcoming changes for the administration of FMS under Community HealthChoices (CHC), the Omnibus Budget Reconciliation Act (OBRA) Waiver, and Act 150 programs. There will be representatives from both OLTL and the CHC Managed Care Organizations (MCOs) in attendance to discuss the upcoming changes.

Questions should be directed to OLTL.

Meeting Details:
Join From the Meeting Link:
https://pa-hhs.webex.com/pa-hhs/j.php?MTID=mfa820e764fe1eb75e7a97c010f700515 

Join by Meeting Number:
Meeting Number (access code): 132 262 1290
Meeting Password: uHg3WpK2KC8

Tap to Join From a Mobile Device (attendees only):
+1-408-418-9388,,1322621290## (United States toll)
+1-202-860-2110,, 1322621290## (United States toll, Washington D.C.)

Join by Phone:
+1-408-418-9388 United States Toll
+1-202-860-2110 United States Toll (Washington D.C.)
Global Call-In Numbers

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Image by StockSnap from Pixabay

During the May 4, 2021 Managed Long-Term Services and Supports (MLTSS) Subcommittee meeting, the following documents were shared with attendees. The primary focus of this meeting was on stakeholder experiences with COVID-19 with the Community HealthChoices (CHC) Managed Care Organizations (MCOs).

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On April 29, 2021, the Centers for Medicare and Medicaid Services (CMS) released the final rule that extends and makes changes to the Comprehensive Care for Joint Replacement (CJR) model. This final rule revises the episode definition, payment methodology, and makes other modifications to the model to adapt the CJR model to changes in practice and fee-for-service (FFS) payment occurring over the past several years. The final rule provides the time needed to test modifications to the model by extending the CJR model for an additional three performance years through December 31, 2024 for certain participant hospitals.

For background purposes, the CJR model is a Medicare Part A and B payment model test, led by the CMS Innovation Center and implemented under section 1115A of the Social Security Act. In this model, all providers and suppliers are paid under the usual payment system rules and procedures of the Medicare program throughout the year for episodes of care for lower extremity joint replacement or reattachment of a lower extremity (referred to as LEJR). At the end of a model performance year, actual spending for the episode (total expenditures for related services under Medicare Parts A and B) is compared to the Medicare target episode price for the responsible hospital. Depending on the participant hospital’s quality and episode spending performance, the hospital may receive an additional payment from Medicare or be required to repay Medicare for a portion of the episode spending.

Some of the key provisions contained in the final rule include:

  • Revision to definition of a CJR episode to now include lower extremity joint replacement procedures performed in the hospital outpatient department;
  • Changes to target price calculation from three years of claims data to one year of claims data;
  • Changes to the reconciliation process;
  • Addition of an episode-level risk adjustment; and
  • Finalized the proposal to exclude rural and low-volume hospitals in the 34 mandatory Metropolitan Statistical Areas (MSAs) and any voluntary hospitals in the 33 voluntary MSAs that had opted into the model for performance years 3 through 5.

There is additional information located on the CJR model page on the CMS’ website. The final rule will be published in the May 5, 2021 Federal Register.

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On Tuesday, April 27, 2021, the Centers for Medicare and Medicaid Services (CMS) issued a revised guidance for COVID-19 long-term care (LTC) facility testing requirements for both staff and residents. These revisions apply to the original guidance that was issued on August 25, 2020 and focus primarily on testing and vaccinations. CMS also revised the nursing home visitation guidance during the COVID-19 public health emergency (PHE), which includes the impact of the COVID-19 vaccination.

Based on these recent revisions, the Department of Human Services (DHS) encourages all personal care homes (PCHs) and Assisted Living Residences to implement the policies contained in these revised guidances immediately. DHS will issue updated guidance in the near future. Questions about these revisions should be directed to ARL Headquarters.

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