A Question and Response Addendum has been added to the PA e-Marketplace website, for the request for proposals (RFP) for managed care organizations that will be submitting their proposals and responses for the Community HealthChoices program. The addendum is located under “Flyers/Addendums” on the web page. The 81-page addendum includes the RFP section, questions, and answers to each question posed.
In late February, the Office of Medicare Hearings and Appeals (OMHA) announced an expansion (Phase III) of its Settlement Conference Facilitation pilot to include Medicare Part A claims, which includes claims under dispute from Inpatient Rehabilitation Facilities. This announcement was part of an Appellant Forum hosted by OMHA. The agenda and slide presentation from the forum provide additional information.
OMHA is the entity that is responsible for administering the Administrative Law Judge (ALJ) level of the Medicare appeals process. This expansion, which became effective on February 25, 2016, is an effort to help resolve the extensive backlog of ALJ hearing requests, which is approximately at 240,000 for FY 2015. The previous phases of expansion were limited to Part B claims and have been in effect since June of 2014. To date, only a small amount of claims have been removed from the queue.
On March 14, 2016, the House Energy and Commerce Oversight and Investigations Subcommittee convened a forum on the state of the knowledge relating to the causes, effects, and treatments of concussions. The forum featured input from experts representing the medical, military, athletic, and research communities with a goal of building a collaborative body of knowledge to help improve the diagnosis and treatment of concussions. Included in the opening statement by Honorable Tim Murphy, Chairman of the Subcommittee: “Today, we begin a new chapter in the national dialogue on concussions. We are not here to re-litigate past actions, point fingers or cast blame. We are here to take a step back, to gain some perspective and to begin a conversation focused on solutions, not on problems.” And most importantly, “We are also here today to make one thing clear – this is not just a sports issue or a military issue. This is a public health issue…That is why we are here today – to ensure we are on the path, though it may be long, to providing the public the answers they deserve.”
The list of participants and webcast of the forum are available on the Energy and Commerce Committee’s website.
The next Community HealthChoices (CHC) Third Thursday webinar is coming up on Thursday, March 17, 2016 at 1:30 pm. Office of Long-Term Living’s (OLTL) Deputy Secretary Jennifer Burnett will offer an update on CHC, followed by information about the Commonwealth’s waiver documents. In addition, Virginia Brown will discuss the waiver authority Pennsylvania is pursuing to implement CHC. To participate in the webinar, please register online.
The Department of Human Services (DHS) has released the long-awaited Request for Proposals (RFP) for Community HealthChoices (CHC). CHC is a new initiative that will provide managed long-term services and supports (MLTSS) to older individuals, persons with physical disabilities, and physical health coverage to those who are dually eligible for Medicare and Medicaid.
The goals of CHC are to:
The official release of the RFP is the first step in the procurement process for the selection of managed care organizations (MCOs). The Commonwealth plans to coordinate health and LTSS through MCOs. Participants will have a choice of two to five MCOs in each region. Responses to the RFP by the managed care organizations are due on Monday, May 2, 2016.
The Department of Human Services Office of Long-Term Living (OLTL) announced they will be submitting a renewal of the OBRA waiver, which expires on June 30, 2016. This announcement/public notice will be published in the February 27 Pennsylvania Bulletin, which seeks public comments.
Written comments regarding the OBRA Waiver renewal should be sent to the Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: OBRA Renewal, PO Box 8025, Harrisburg, PA 17105-8025 or via email, using the comment forms that OLTL has provided. Please use OBRA Renewal as the subject line. The comment forms, as well as a side-by-side comparison of the current and revised language, and the renewal in its entirety (including the OBRA-specific HCBS Allowable Settings Transition Plan and the Community HealthChoices Transition Plan, which are contained in the main module), can be found on the “OLTL Waiver Amendment, Renewals and Accompanying HCBS Transition Plans” web page. The public comment period ends on Monday, March 28, 2016.
OLTL will offer two webinars for public input and discussion on March 9 and March 23, 2016. Please see the information below for further details on the scheduled webinars.
Title: OBRA Renewal
Date: Wednesday, March 9, 2016
Time: 1:00 – 2:00 pm
Join WebEx meeting
Meeting number: 644 892 538
Meeting password: OBRA##1
Join by phone
1-877-668-4493 Call-in toll-free number (US/Canada)
1-650-479-3208 Call-in toll number (US/Canada)
Access code: 644 892 538
Toll-free calling restrictions
Title: OBRA Renewal
Date: Wednesday, March 23, 2016
Time: 10:00 – 11:00 am
Join WebEx meeting
Meeting number: 640 051 990
Meeting password: OBRA##2
Join by phone
1-877-668-4493 Call-in toll-free number (US/Canada)
1-650-479-3208 Call-in toll number (US/Canada)
Access code: 640 051 990
Toll-free calling restrictions
The Centers for Medicare and Medicaid Services had originally scheduled a webinar on February 11, 2016 on the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. However, the webinar had to be canceled due to technical difficulties. The webinar has now been rescheduled for Tuesday, February 23, 2016 from 1:00 – 2:30 pm.
The IMPACT Act requires the reporting of standardized patient assessment data in the following areas, to better coordinate care and improve outcomes for people with Medicare:
To participate in this webinar, registration is required.
The Office of Long-Term Living (OLTL) has announced changes that are being made to the enrollment process for Home and Community-based Services (HCBS), including the Aging Waiver, Attendance Care Waiver, CommCare Waiver, Independence Waiver, OBRA Waiver, and Act 150 Program. Effective Tuesday, March 1, 2016, OLTL will enter into a new contract with MAXIMUS, the PA Independent Enrollment Broker (IEB). According to OLTL, the adjustments being made and expectations regarding this new contract will streamline the enrollment process, as well as ensure consistency across all home and community-based programs, in anticipation of the roll-out of Community HealthChoices (CHC), a Managed Long-Term Services and Supports program for older Pennsylvanians and adults with physical disabilities. CHC will move the Commonwealth’s home and community-based waiver system from fee-for service to a capitated Medicaid managed long-term services and supports delivery system. The changes OLTL is making to the enrollment process support the Commonwealth’s efforts to ensure that the enrollment process is conflict free, strengthening necessary firewalls between enrollment in services and the provision of ongoing service coordination and other services.
Changes made to improve the IEB process:
The tasks completed by the IEB (Maximus) include the following:
If you have any questions, please contact Amy High, Office of Long-Term Living, Bureau of Participant Operations, at 717-787-8091.
On February 9, 2016, the Centers for Medicare and Medicaid Services (CMS) posted this update to the “Therapy Cap” page on their website, regarding manual medical review (MMR) of therapy claims above the $3,700 threshold. The guidance is vague and additional information is needed for clarification. Members that provide outpatient therapy services should be cognizant that MMR will resume in the near future and should comply with medical record requests issued by Strategic Health Solutions.
The Centers for Medicare and Medicaid Services (CMS) released a proposed rule that was published in the February 3, 2016 Federal Register, which updates the methodology used to measure the performance of Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program.
Under the proposed rule, CMS would modify the process for resetting the benchmarks, which are used to determine ACO performance for those renewing their participation agreements. The proposed rule addresses changes to the Shared Savings Program that would modify the program’s benchmark rebasing methodology, to encourage ACOs’ continued investment in care coordination and quality improvement, and identifies publicly available data to support modeling and analysis of these proposed changes. In addition, it would streamline the methodology used to adjust an ACOs historical benchmark for changes in its ACO participant composition. Comments on the proposed rule are due by March 28, 2016.
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