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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 Centers for Medicare and Medicaid Services (CMS) has announced that a special open door forum for inpatient rehabilitation facilities (IRFs) will be held on Tuesday, October 20, 2015, from 2:00 to 3:00 pm. During the call, CMS will discuss the upcoming Dry Run for IRFs Provider Performance reports on All-Cause Unplanned Readmissions for 30-day post discharge from IRFs. This will also include timeline and content of facility dry run reports that will be disseminated to IRFs from November 3 through December 3, 2015.

To participate in this special open door forum call:
Dial: 1-866-402-6263
Conference ID #: 55982595

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The Departments of Human Services and Aging have extended an invitation for Managed Care Organizations (MCOs) and Home and Community-based Service (HCBS) providers to convene to discuss Community HealthChoices (CHC). The purpose of the meeting is to begin the conversation between the MCOs and providers, as the transition from fee-for-service to managed care begins.

The meeting has been scheduled for Wednesday, November 4, 2015, from 1:00 to 3:00 pm at the Radisson Hotel located at 1150 Camp Hill Bypass, Camp Hill, PA 17011.

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On Thursday, October 1, 2015, at 10:00 am, the House Energy and Commerce Health Subcommittee will hold a hearing, “Examining Potential Ways to Improve the Medicare Program,” that will include the review of three bills that strive to strengthen Medicare. The bills that will be examined include:

  • HR 1934, the Cancer Care Payment Reform Act, which would build on the promise of new provider delivery model development envisioned in the sustainable growth rate replacement policy, enacted into law earlier this year. This bill would establish a national oncology medical home demonstration project to improve Medicare payments for cancer care.
  • Draft legislation that would make changes to documentation and face-to-face requirements for home health providers under the Medicare program.

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One of RCPA’s members has asked for member feedback, via a survey on chronic pain patients that are being seen for Functional Capacity Evaluations (FCEs), to evaluate their eligibility to receive disability payments.

There are examples of where patients may not be physically able to return to their previous job, but would be able to perform other areas of work (more sedentary, less repetition, or other adaptations). However, many times these individuals continue to pursue disability because they do not know of, or have access to, other options.

We are curious if other members are providing FCEs for individuals applying for disability and if there are any return-to-work programs for individuals with chronic pain. Please complete this survey by Thursday, October 15, 2015, to have your responses included. Thank you for your participation.

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The Centers for Medicare and Medicaid Services (CMS) recently issued a revised inpatient rehabilitation facility patient assessment instrument (IRF PAI) training manual. The updated sections of the training manual are located on the IRF PAI web page under Downloads.

The revised training manual only covers the changes made to the IRF PAI, including:

  • Revisions to the language in the Table of Contents, Section 7: Comorbid Conditions and Section 11: Clarification of Terminology;
  • Section 2: Item-by-Item Coding Instructions;
  • Section 3: The Functional Independence Measure (FIM) – Revised Language;
  • Section 4: Quality Indicators – Revised Language; and
  • Section 6: ICD-10-CM Codes Related to Specific Impairment Groups – Updated to Reflect ICD-10 Codes.

The updated training manual becomes effective on Thursday, October 1, 2015.

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A national provider call focusing on the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 has been scheduled by the Centers for Medicare and Medicaid Services (CMS). The call has been scheduled for Wednesday, October 21, 2015, from 1:00 – 3:00 pm. Agenda topics include:

  • Legislative requirements of the IMPACT Act related to the use of standardized data, quality measures, resource use, and other measures for Skilled Nursing Facilities, Inpatient Rehabilitation Facilities, Long-Term Care Hospitals, and Home Health Agencies
  • Participation in the quality measure assessment and development process
  • Opportunities for stakeholder engagement and input

To participate in this call, providers must register. Space may be limited so early registration is recommended.

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On September 10, 2015, the Medicare Payment Advisory Commission (MedPAC) conducted a public meeting to discuss Medicare issues and policy questions and approve reports and recommendations to the Congress. Included in the agenda was a session that focused on MedPAC’s task of developing a prototype prospective payment system (PPS) that spans across the post-acute care (PAC) settings, as mandated by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The IMPACT Act requires MedPAC to submit a report to Congress regarding this by Thursday, June 30, 2016. Included in the meeting was their presentation Mandated Report: Developing a Unified Payment System for Post-Acute Care. It is expected that MedPAC will conduct multiple public meetings in the months ahead regarding the development of PAC PPS before presenting their draft recommendations.

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Today, the Departments of Human Services (DHS) and Aging (PDA) released their Managed Long-Term Services and Supports (MLTSS) concept paper. This concept paper, which was developed based on public input, describes the plan’s features and includes the following highlights:

  • Coordinates physical health and LTSS through Community HealthChoices managed care organizations (CHC-MCO).
  • Provides participants with a choice of two to five CHC-MCOs in each region.
  • Includes value-based incentives to increase the use of home and community-based services and meet other program goals.
  • Creates a system that allows Pennsylvanians to receive services in the community, preserves consumer choice, and lets consumers have an active voice in the services they receive.
  • Standardizes measures of both program and participant-level outcomes to assess overall program performance and improve CHC over time.
  • CHC-MCOs will be accountable for most Medicaid-covered services, including preventive services, primary and acute care, LTSS (home and community-based services and nursing facilities), prescription drugs, and dental services.
  • Participants who have Medicaid and Medicare coverage (dual eligible participants) will have the option to have their Medicaid and Medicare services coordinated by the same MCO.
  • Behavioral health services continue to be provided through the behavioral health managed care organizations (BH-MCOs), but CHC-MCOs and BH-MCOs will be required to coordinate services for individuals who participate in both programs.

The MLTSS plan, recently re-named Community HealthChoices, is an integrated system of physical health and LTSS which focuses on improving health outcomes and allowing individuals to live safe and healthy lives with as much independence as possible. CHC supports individuals dually eligible for Medicare and Medicaid, older adults, and adults with physical disabilities, in the most integrated settings possible.

Feedback on the concept paper may be submitted through Friday, October 16, 2015. The concept paper feedback will shape the November 2015 request for proposals (RFP) for CHC-MCOs. The RFP will be tentatively awarded in March 2016, contingent upon successful readiness reviews and negotiations. CHC will go live in the Southwest region in January 2017, the Southeast region in January 2018, and the Northwest, Lehigh-Capital, and Northeast regions in January 2019.

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On September 15, 2015, an Info was issued regarding a webinar the Office of Long-Term Living (OLTL) will be holding on provider credentialing for Community HealthChoices. The registration link for this webinar sent by OLTL was incorrect. Please use the corrected link below to register for the webinar.

The Office of Long-Term Living (OLTL) will be holding a webinar on Wednesday, September 30, 2015, from 8:30 – 10:00 am for Home and Community Based Services providers and Service Coordination Entities interested in participating in Pennsylvania’s planned Managed Long Term Services and Supports (MLTSS) program, now known as Community HealthChoices. The purpose of the webinar is to provide a high level overview of OLTL’s current provider credentialing process, to obtain input on credentialing MLTSS providers, and to discuss how the provider credentialing process may look for Community HealthChoices. Information on how to access the webinar can be found below.

  1. Please join my Webinar.
    https://global.gotowebinar.com/register/152791275
  2. You will be connected to audio using your computer’s microphone and speakers (VoIP).  A headset is recommended. Or, you may select “Use Telephone” after joining the webinar.

Dial +1 (631) 992-3221
Access Code: 787-398-715
Audio PIN: Shown after joining the webinar
Webinar ID: 103-329-483

For questions regarding this email, please contact the OLTL Provider Inquiry Line at (800) 932-0939.

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The Centers for Medicare and Medicaid Services (CMS) published a correction notice in the August 25, 2015 Federal Register. This notice corrects technical and typographical errors that appeared in the Comprehensive Care for Joint Replacement Payment Model proposed rule that was published on July 14, 2015. The comment due date for the provisions contained in the proposed rule will remain at September 8, 2015.

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