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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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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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The Department of Human Services Office of Long-Term Living (OLTL) is establishing a Managed Long-Term Services and Supports (MLTSS) Subcommittee of the Medical Assistance Advisory Committee (MAAC). The kickoff meeting is scheduled for Tuesday, September 1, from 10:00 am to 1:00 pm at Temple University in Strawberry Square, Harrisburg, PA.

The second meeting of the MLTSS Subcommittee will be held on Monday, September 14, from 10:00 am to 1:00 pm in the PA Department of Education Honors Suite, 333 Market Street, 1st floor, Harrisburg, PA. Future meetings will be posted on the OLTL website as dates are confirmed.

The membership of the subcommittee will be announced in the coming weeks. A majority of subcommittee members will be users of long-term living services and supports, and family caregivers. The subcommittee will advise the department on the design and implementation of MLTSS in Pennsylvania. A number of RCPA members submitted nominations to be considered for the subcommittee.

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On August 12, the Centers for Medicare and Medicaid Services (CMS) announced they were extending the deadline for the submission of data associated with the inpatient rehabilitation facility (IRF) quality reporting program (QRP) for measures reported to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN).

 

This extension is being granted to provide IRFs additional time to submit data. Although the NHSN system is working, intermittent production problems have been experienced. The CDC has been working to resolve these issues and they are expected to be corrected soon.

 

The deadline for the Healthcare-associated Infection (HAI) data submission has been extended from August 15 to August 28 at 11:59 pm PT. Please Note: This extension only applies to the HAI data submission deadline. Data are submitted through the NHSN online.

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The Departments of Human Services (DHS) and Aging have announced they will present their next third Thursday webinar associated with Managed Long-Term Services and Supports. The next webinar, Managed Care 101, is scheduled for Thursday, August 20, at 1:30 pm.

Included will be details on Medicare and Medicaid coordination, role of the MIPPA agreements, provider and service coordination, participant impacts, and other state’s experiences. During the webinar, participants will have the opportunity to submit questions using the chat feature provided.

To participate:

  1. Please join my Webinar.
    https://global.gotowebinar.com/register/155011011
  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 (702) 489-0003
Access Code: 428-878-113
Audio PIN: Shown after joining the webinar

Webinar ID: 155-011-011

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