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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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physiotherapist helping patient to walk

An article, “Comparison of Functional Status Improvements Among Patients with Stroke Receiving Postacute Care in Inpatient Rehabilitation vs Skilled Nursing Facilities,” was recently published in the Journal of the American Medical Association (JAMA) Network that highlights the findings from a cohort study of patients who received post-acute care in inpatient rehabilitation facilities (IRFs) or skilled nursing facilities (SNFs) following a stroke. The study examined changes in functional status. Stroke was selected because it is a major cause of disability in the United States and an important public health issue, and often requires a range of treatments and expertise.

The study included patients with stroke who were discharged from acute care hospitals to IRFs or SNFs from January 1, 2013 to November 30, 2014. Medicare claims were used to link to IRF and SNF assessments. The study does include limitations that were encountered, such as the findings don’t take into account other post-acute settings (home health, long-term care hospitals, etc.) and the inability to examine cognitive function before and after the stroke, stroke severity, or location of the stroke.

The findings of the study suggest that the care in an IRF was associated with greater improvement in mobility and self-care compared with care in an SNF. Their findings indicate the need to carefully manage discharge to post-acute care based on the patient’s needs and potential for recovery. Post-acute reform based on the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) must avoid a payment system that shifts patients with stroke who could benefit from intensive inpatient rehabilitation to lower cost settings. The IMPACT Act of 2014 is a bill that is intended to change and improve Medicare’s post-acute care services and how they are reported. Contact RCPA Rehabilitation Services Director Melissa Dehoff with questions.

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The Department of Human Services (DHS) has announced rate increases for Personal Assistance Services (PAS) in the OBRA Waiver and Act 150 program. There will also be a rate increase for Residential Habilitation in the OBRA Waiver. These rate increases become effective on January 1, 2020. The new rates for the OBRA Waiver were published in the August 24, 2019 edition of the Pennsylvania Bulletin. The new rates for the Act 150 Program were published in the November 30, 2019 edition of the Pennsylvania Bulletin. These new rates are based on a participant’s county of residence.

In addition, Home and Community Services Information System (HCSIS) service plans were updated on November 30, 2019. Service Coordinators (SCs) do not need to make any service plan updates for this rate change, as a HCSIS system-wide update is being initiated to make the necessary service data updates onto the impacted service plans.

Questions about these updates should be directed to the Office of Long-Term Living (OLTL) Provider Inquiry Line at 800-932-0939, Option 2, Monday–Friday from 9:00 am – 12:00 pm and 1:00 pm – 4:00 pm.

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The Department of Human Services (DHS), Office of Long-Term Living (OLTL) will conduct the next Managed Long-Term Services and Supports (MLTSS) Subcommittee meeting on Tuesday, December 3, 2019, in the Honor’s Suite at 333 Market Street Tower in Harrisburg from 10:00 am – 1:00 pm. Those who cannot attend in person may participate by dialing: 213-929-4212; Access Code: 524-290-985, or by webinar. If you plan to participate via webinar, registration is required.

Public comments will be accepted during presentations instead of just being heard at the end of the meeting; however, there will be an additional 15-minute period at the end of the meeting for any additional public comments.

If you have any questions about registering for the webinar or require a toll-free number to dial in, please contact the Office of Long-Term Living.

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The Office of Long-Term Living (OLTL) announced three InterRAI train-the-trainer sessions for service coordination entities (SCEs). The trainings, which are limited to two individuals per SCE, will be jointly presented by the three Community HealthChoices Managed Care Organizations (CHC MCOs): AmeriHealth Caritas, PA Health & Wellness, and UPMC CHC.

The training sessions are two full-day sessions that begin promptly at 9:00 am. Attendees are encouraged to arrive by 8:30 am to register. The training is free and lunch will be provided. Dates and locations of the trainings are:

  • December 4–5: Wilkes Barre, PA
  • December 9–10: Camp Hill, PA
  • December 12–13: Franklin, PA

Registration is required to attend. Each session has limited spots available, so register as soon as possible. At the conclusion of this InterRAI training, participants will be able to recognize and complete each section of the InterRAI HC Assessment Tool, in accordance with the standards set forth in the CHC Agreement. Contact Melissa Dehoff with questions.

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business conference. people sitting rear and woman speaking at the screen

The Office of Long-Term Living (OLTL) recently announced that two one-day classroom training sessions will be offered for Service Coordinators (SCs). Prior to the training sessions, and a required prerequisite, attendees must complete three OLTL SC modules. These modules will provide a strong foundation on the basics to fulfill SC requirements. Participants will be able to take what is learned from these modules and apply it to situations found every day on the job. Attendance at the training sessions is limited to SCs, not supervisors or directors. Also, two attendees will be permitted per agency. Preference will be given to SCs that were hired in 2018 and 2019. Additional registrations will be considered on a first-come, first-served basis.

Special Note: This training is required for SCs working with waiver participants enrolled in the Aging, Attendant Care, Independence, and OBRA waivers, as well as the Act 150 program.

Session information:
Thursday, December 12, 2019 in Harrisburg
Radisson Hotel Harrisburg
1150 Camp Hill Bypass
Camp Hill, PA 17011
8:00 am – 4:30 pm

Tuesday, December 17, 2019 in Philadelphia
DoubleTree
301 W Dekalb Pike
King of Prussia, PA 19406
8:00 am – 4:30 pm

Registration is required in order to attend one of these sessions. If you have any questions regarding registration, please contact Dering Consulting at 717-234-0567.

Questions about the training should be directed to OLTL’s Bureau of Participant Operations at 717-787-8091.

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The Centers for Medicare and Medicaid Services (CMS) will conduct the next hospital quality open door forum for Tuesday, November 19, 2019 at 2:00 pm. Some of the agenda topics for this call include a discussion on the calendar year (CY) 2020 outpatient prospective payment system (OPPS) final rule and the inpatient rehabilitation facility (IRF) report in the iQIES portal. While the CY 2020 OPPS final rule was released, it will be published in the November 12, 2019 Federal Register.

To participate in this open door forum, dial 888-455-1397; conference ID: 4676500.

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On November 1, 2019, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) final rule. The final rule includes updates to payment policies, payment rates, and quality program provisions for services effective on or after January 1, 2020.

Some of the provisions included in the final rule:

Medicare Telehealth Services – The following HCPCS codes are being added to the list of telehealth services: G2086, G2087, and G2088, which describe a bundled episode of care for treatment of opioid use disorders.

Evaluation & Management (E/M) Services – CMS is mirroring the E/M changes that were adopted by the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel for office/outpatient E/M visits.

Physician Supervision Requirements for Physician Assistants (PAs) – The regulation has been updated on physician supervision of PAs to provide them with greater flexibility to practice more broadly in accordance with state law and state scope of practice.

Review and Verification of Medical Record Documentation – In order to reduce burden, CMS finalized broad modifications to the documentation policy so that physicians, physician assistants, and advanced practice registered nurses (APRNs – nurse practitioners, clinical nurse specialists, certified nurse-midwives, and certified registered nurse anesthetists) can review and verify (sign and date), rather than re-documenting, notes made in the medical record by other physicians, residents, medical, physician assistants, and APRN students, nurses, or other members of the medical team.

Medicare Coverage for Opioid Use Disorder Treatment Services Furnished by Opioid Treatment Programs – CMS is implementing a new Medicare Part B benefit for opioid use disorder (OUD) treatment services, including medications for medication-assisted treatment (MAT), furnished by opioid treatment programs (OTP).

Counseling and Therapy Services – Finalized a policy to allow counseling and therapy services described in the bundled payments, to be furnished via two-way interactive audio-video communication technology as clinically appropriate.

Beneficiary Copayment – There will be a zero beneficiary copayment for 2020.

The final rule will be published in the November 12, 2019 Federal Register.

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On October 28, 2019, the Administration for Community Living (ACL) announced the launch of the Traumatic Brain Injury (TBI) Technical Assistance and Resource Center. The goal of this center is to help states promote access to integrated, coordinated services and supports for individuals who have sustained a TBI, their families, and caregivers. This center will provide program support to ACL and technical assistance to ACL’s TBI State Partnership program grantees, and will develop and compile resources that will be available to the public. This effort reflects ACL’s commitment to independent living and person-centered planning.

The new center will be administered by the Human Services Research Institute and the National Association of State Head Injury Administrators (NASHIA), as well as subject matter experts that include individuals who have experienced a TBI.

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The Brain Injury Association of America (BIAA) recently released information about a Traumatic Brain Injury (TBI) Behavior study. The researchers of the study are looking for individuals that have experienced a TBI and are showing symptoms of aggression, agitation, and irritability. The results of the study will provide more information (safety and effectiveness) about an investigational drug and whether it could one day be used to help treat behavioral problems due to TBI.

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Recently, the Pennsylvania Department of Military and Veterans Affairs (DMVA), Bureau of Programs, Initiatives, Reintegration, and Outreach reached out to RCPA to share information with members about PA VETCONNECT, which is an exciting new regional outreach initiative. Members can assist with this program by sharing resources and/or services that can assist a veteran in need.

Pennsylvania is home to nearly 800,000 veterans – the fourth largest veteran population in the nation. The DMVA recognizes that they are only one player of a vast network of organizations that are necessary to successfully serve these veterans. While DMVA – through its Office of Veterans Affairs (OVA) – provides a number of programs and benefits for veterans, there are still areas for which they do not have formal programs such as unemployment, homelessness, mental health issues, post-traumatic stress disorder (PTSD), and traumatic brain injury (TBI). DMVA hopes to address these gaps through creative inter-agency coordination and community partnerships.

The first phase of PA VETCONNECT encompasses a three-and-a-half-year rollout that began in December of 2018. During the first six months of this phase the concept was developed, requirements were documented, vision & mission statements were defined, initial stakeholders were identified, a focus group was engaged, and regions were established across the Commonwealth. DMVA-OVA looked at current processes to determine the most economical approach to accomplish this goal. To that end, three employee positions were repurposed and/or roles were redefined to administer and implement PA VETCONNECT.

By dividing the Commonwealth into five regions, DMVA will be better able to identify and create partnerships with local community resources and providers that can serve veterans and their families. This includes resources that are not traditionally thought of as veterans’ services or programs. Once identified, the information on the service provider can be entered into a resource database that will be made available to County Directors of Veterans’ Affairs, Veteran Service Officers & Specialists, and any other veterans’ advocates for quick and easy reference.

DMVA-OVA further scrutinized its business plan and found cost saving measures to make several operational functions run more efficiently. The monies realized from the noted cost savings measures, as well as small cuts in other areas, created enough funding to support the hiring of the first five regional personnel for fiscal year 2019/2020. Moreover, DMVA will look at existing department owned facilities or partnerships with sister agencies to house regional personnel so as not to incur additional facility expenses.

Regional Program Outreach Coordinators (RPOCs) will be the “boots on the ground” individuals who will support the outreach team throughout the region, and establish and maintain working relationships with community leaders and local/regional organizations, Veteran Service Organizations, local/county/state government agencies, and other community partners, to gather information and identify resources to facilitate the delivery of services to veterans and their beneficiaries.

One of the elements of this project is a unique Information and Referral (I&R) database that provides those who serve veterans with the names, contact information, and basic overview of organizations that have resources to address veteran-specific needs. This database will eventually contain thousands of organizations throughout the Commonwealth that have the resources to assist veterans’ needs. With a county system already staffed by County Directors of Veterans Affairs, and a vast network of nonprofit organizations at their disposal, this I&R database will have the flexibility to connect veterans, service members, and their dependents to the programs and services they need regardless of the municipality, county, or region where they reside. Through this tool, advocates can more easily assist veterans in locating organizations or resources throughout the state that offer programs and services geared to their specific needs (Note: It is not the intent that advocates would simply hand the veteran or family member a printout of available resources. They believe the best practice would include working with the veteran or family member to find the appropriate resource or service by contacting the service provider, setting up appointments, arranging transportation, etc.).

The DMVA realizes that there is no way a program of this magnitude can be successful without the cooperation of our community partners, especially those who are on the ground level and work every day to improve the lives of veterans. The information and referral tool will roll out in phases, with the first quarter of 2020 targeted for a full statewide rollout.

Members can further assist in this project by completing the Resource Application to self-report. Members should note that the service provided need not consist of veteran-specific assistance or services; you would just need to provide services a veteran might need. Contact Melissa Dehoff, RCPA Rehabilitation Services Director, with questions.

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