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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 Disease Control and Prevention (CDC) has released a new report, Concussion at Play: Opportunities to Reshape the Culture Around Concussion. The report provides an overview of current research on concussion knowledge, awareness, attitudes, and behaviors among athletes, coaches, parents, health care providers, and school professionals.

This report also describes opportunities to help build a culture in sports where athletes take steps to lower their chances of getting a concussion, and recognize and report concussion symptoms. This involves moving beyond our general concussion knowledge and changing the way we talk about and respond to concussion. The goal is to empower athletes not to play with a concussion or hide their symptoms. The document builds from the work of the Institute of Medicine (IOM) report, Sports-Related Concussions in Youth: Improving the Science, Changing the Culture.

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On July 22, the Departments of Human Services and Aging announced the next steps in Governor Wolf’s plan to improve care coordination and move to Medicaid Managed Long-Term Services and Supports (MLTSS). These updates are a result of overwhelming response to the public comment period and stakeholder input.

Along with feedback on how MLTSS should be implemented in the Commonwealth, the departments heard feedback on changes that can be made today to improve the current system. They will take the following steps:

 

Doubling the number of staff who work on Nursing Home Transition (NHT)
PDA and DHS recognize that current processes to move individuals who are able to be better served in the community from institutional settings are lengthy and complicated. To address this, the departments will:

  • Increase the number of staff assigned to NHT from 5 to 10;
  • Identify and implement strategies intended to
    • improve the process
    • enhance program outcomes
    • advance the opportunities for individuals to either avoid premature placement and/or transition back into the community;
  • Evaluate and redesign the entire NHT process; and
  • Increase training for all current NHT staff and providers.

 

Creating an advisory committee with at least 50 percent representation by participants and caregivers and conducting monthly webinars
Throughout the MLTSS public input sessions, participants, advocates, and providers made it clear that more education, involvement, and communication are necessary as the Commonwealth moves to MLTSS. In order to accomplish this, the departments will:

  • Host monthly webinars on the third Thursday of every month.
  • Create an MLTSS Advisory Committee that will meet under the federally mandated purview of the Medical Assistance Advisory Committee (MAAC).
    • MLTSS program participants will comprise half of the membership, with the remaining half representing provider communities
    • Opportunities for participation via telephone for increased accessibility and convenience
    • This committee will meet bi-weekly
  • Encourage open communications; questions can be submitted via email.

 

Restructuring existing contracts to provide more choice for participants
Issue a procurement for a home modification quality improvement program in August 2015: In some cases, the transition from a nursing home to living in the community can be accomplished through a simple home modification such as the installation of a ramp for wheelchair access. The new procurement will streamline the current process to make this easier to complete these modifications, while at the same time ensuring that only high-quality contractors complete the work. The contracts will include two providers in each part of the state to provide choices in completing the work.

Issue a financial management services procurement in November 2015: There is currently one statewide vendor that acts on behalf of the consumer to make payroll, withhold and report taxes, and pay bills for individuals in home- and community-based waiver programs. Moving forward, multiple vendors will be awarded the contracts to ensure choice, and they will be required to maintain a regional presence throughout the state.

Award New Contracts for Independent Enrollment Broker (IEB) Services in November 2015: One of the most significant barriers to serving individuals in the community is the length of time it takes to enroll someone in home- and community-based services. The new contracts will be awarded in four regional lots and include new, strong performance standards, to ensure that the vendors are held accountable and participants are not stuck waiting for services.

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On July 14, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule in the Federal Register, announcing the implementation of a new Medicare Part A and B payment model called the Comprehensive Care for Joint Replacement (CCJR) model. Under this model, acute care hospitals in 75 selected geographic areas would receive retrospective bundled payments for episodes of care for lower extremity joint replacement or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedures will be included in the episode of care.

CMS anticipates the proposed CCJR model would benefit Medicare beneficiaries by improving the coordination and transition of care, improving the coordination of items and services paid through Medicare fee-for-service, encouraging more provider investment in infrastructure and redesigned care process for higher quality and more efficient service delivery, and incentivizing higher value care across the inpatient and post-acute care spectrum spanning the episode of care. According to CMS, hip and knee replacements are the most common inpatient surgery for Medicare beneficiaries and can require lengthy recovery and rehabilitation periods.

CMS proposes to test CCJR for a five year performance period, beginning January 1, 2016, and ending December 31, 2020. Comments will be accepted on the proposals contained in the proposed rule, as well as other alternatives or suggestions, through September 8. Contact Melissa Dehoff at RCPA with questions.

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On July 14, Estelle Richman, former secretary of the Department of Human Services (DHS), will conduct a presentation; Person-Driven Services in Managed Care Long-Term Services and Supports (MLTSS), from 1:00 to 3:00 pm at Temple University, Ritter Annex Room 555, 1301 Cecil B. Moore Avenue, Philadelphia, PA 19122. Members can participate in person or online.

Topics will include:

  • Overview of DHS discussion document on managed care;
  • Overview of federal options for self-directed services and supports in managed care; and
  • Discussion of what stakeholders can do to ensure that good self-directed options are available in any managed care model that DHS administers.
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