';
CLOSE
Featured
Featured posts

0 937

Today, the Trump Administration released a comprehensive plan that includes proactive measures to remove regulatory barriers and ensure coverage and payment for the administration of an eventual COVID-19 vaccine. To ensure broad access to a vaccine (especially for seniors), the Centers for Medicare and Medicaid Services (CMS) released an Interim Final Rule with Comment Period (IFC) that establishes that any vaccine that received Food and Drug Administration (FDA) authorization, will be covered under Medicare as a preventive vaccine at no cost to beneficiaries. The IFC also implements provisions of the CARES Act that ensures immediate coverage of a COVID-19 vaccine by most private health insurance plans without cost sharing from both in and out-of-network providers during the course of the public health emergency (PHE).

CMS also released a set of toolkits for providers, states, and insurers to help the health care system prepare to swiftly administer the vaccine when available. These resources are designed to increase the number of providers that can administer the vaccine and ensure adequate reimbursement for administering the vaccine in Medicare while making private insurers and Medicaid programs aware of their responsibility to cover the vaccine at no charge to beneficiaries.

Additionally, CMS released new Medicare payment rates for COVID-19 vaccine administration. The Medicare payment rates will be $28.39 to administer single-dose vaccines. For a COVID-19 vaccine requiring a series of two or more doses, the initial dose(s) administration payment rate will be $16.94 and $28.39 for the administration of the final dose in the series. These rates will be geographically adjusted and recognize the costs involved in administering the vaccine, including the additional resources involved with required public health reporting, conducting important outreach and patient education, and spending additional time with patients answering any questions they may have about the vaccine. Medicare beneficiaries, those in Original Medicare or enrolled in Medicare Advantage, will be able to get the vaccine at no cost. CMS is encouraging state policymakers and other private insurance agencies to utilize the information on the Medicare reimbursement strategy to develop their vaccine administration payment plan in the Medicaid program, CHIP, the Basic Health Program (BHP), and private plans. Using the Medicare strategy as a model would allow states to match federal efforts in successfully administering the full vaccine to the most vulnerable populations.

The IFC (CMS-9912-IFC) is scheduled to display at the Federal Register as soon as possible with an immediate effective date and a 30-day comment period.

Additional information on this IFC can be found in the fact sheet.

The COVID-19 vaccine resources for providers, health plans, and State Medicaid programs can be found here.

The FAQs on billing for therapeutics can be found here.

0 1472

Harrisburg, PA – Pennsylvanians are encouraged to ask their job search and unemployment compensation (UC) questions during the Pennsylvania Department of Labor & Industry’s (L&I) twenty-third virtual town hall, which will be held from 1:00 pm to 2:00 pm today, Thursday, October 29.

How to Participate in the Town Hall

A livestream will be online at the Pennsylvania Department of Labor & Industry website. Those without Internet access can listen by calling 833-380-0719; however, phone lines are limited, so we ask that they be reserved for individuals who need them.

Participants using the phone lines can ask questions directly of our UC expert. Individuals livestreaming the town hall can submit typed questions that will be read to the UC expert by a moderator. To protect participants’ personal confidential information, detailed answers about individual claim questions cannot be answered during the town hall.

Reminder to Guard Personal Information

L&I recently became aware of fraudsters who are posing as L&I employees during calls to Pennsylvanians. These fraudsters will ask for personal and confidential information such as usernames, passwords, and social security numbers, under the guise of helping with issues related to unemployment compensation. Pennsylvanians are reminded that L&I employees will never call and ask for your username, password, or full social security number.

Scammers have also been posing as L&I and US Department of Labor (DOL) officials in emails and social media messages in attempts to obtain individuals’ personal and confidential information. L&I does not offer assistance over social media due to the inability to guarantee confidentiality and security; as a result, any messages received from “L&I” over social media are likely fraudulent and should be ignored.

Emails appearing to come from L&I or the US DOL may be spoofed by fraudsters. Individuals should never click a link in an email and provide their username and password. The safest way to log into an account is to type the URL of the website into the browser window.

For more information on identifying fraud, what to do if you believe you have been a victim of fraud, or how to report fraud, visit L&I’s website.

MEDIA CONTACT: Sarah DeSantis

0 2093

To the Intellectual Disabilities and Autism Community,

October 27 marks a painful anniversary for Pennsylvania and for our nation. Two years ago today in Pittsburgh, 11 lives were taken during the brutal attack on the Tree of Life/L’Simcha Synagogue. Three of those people were members of the ID/A community. While we send strength and loving energy to the bereaved families and friends of all of those who perished that day, we are reminded of the need to keep their memories alive and to do all we can to muster the courage and hope to navigate times that test us to the core. We mark this day in quiet reflection but also with an awareness of the need to move forward even through the enormity of our sadness.

This year has brought unprecedented challenges for us all both individually and collectively. The pandemic is a stark reminder of our own vulnerability and of the fragility of life. At the same time, for so many, this is a time that has powerfully illustrated how much we all need and rely on one another. Even with the physical separation that this pandemic has necessitated, we have persevered and forged paths to connect and engage with each other.

With the myriad challenges and upheaval in our day-to-day lives and the tragic losses so many have endured, 2020 has gifted us with tremendous examples of courage, hope, and an unparalleled commitment to finding our way through unprecedented times. We see examples of this in our daily lives within our safe circles of family and friends. We also see this from our efforts with colleagues to do the most important work that focuses on helping keep others stay safe and connected to their communities and support systems.

Finally, as I sit at my desk looking out my window, I am awed by the beautiful and dramatic colors of the changing season. I don’t remember an autumn when the colors were quite so vivid and spectacular.

Perhaps the message on this day of remembrance and reflection is that, even in the midst of the hardest and most daunting challenges, there is always beauty and a reason for hope.

Kristin Ahrens

Deputy Secretary

0 1740

Rick Smith sent the following message on October 28, 2020:

To Providers of Community Participation Supports (CPS):

For those providers who have signed attestations, the Office of Developmental Programs (ODP) is currently processing the September retainer payments allowed under Appendix K at 25 percent of your pre-COVID CPS billing. These payments should be visible on your November 2 remittance advice. ODP has also reviewed CPS billing from July to September and has identified some CPS providers who have signed attestations and are at or near pre-COVID billing levels with the combination of retainers and billings. Additionally, ODP has identified a number of CPS providers who have signed attestations and currently have receivable balances beyond 30 days with the office. If you fall into either of these two categories, you will not automatically see a retainer payment and should contact Rick Smith for further details.

0 1109

National and State advocacy organizations have appealed to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma to extend flexibilities that have been vital to state systems during the COVID-19 pandemic. Our national organizations, ANCOR and ACCSES, signed this letter dated October 23, 2020. It is an Appendix K waiver that has been invaluable to maintaining the capacity of states and providers in continuing to support individuals in need of long-term supports and services throughout this pandemic.

CMS originally developed a timeline for Appendix K expiration of one year from the initial start date in recognition of the fact that it may take a year to reestablish the pre-public health emergency. However, given that the COVID-19 pandemic has continued for several months, the advocates have suggested that the one-year timeframe should actually begin when the public health emergency has ended.

The second very important issue for many states and providers of service is the continued availability of retainer payments. These payments are crucial to keeping provider networks in place during a period of time when they are unable to provide services due to the pandemic. The three 30-day periods of retainer payments were crucial to keeping providers in business; however, we are now entering a new phase of the pandemic. It is still not safe for typical services to resume. Without retainer payments, the stability of the provider network is at risk. The request to CMS is to extend to states the ability to provide retainer payments beyond the three 30-day periods.

0 3141

Governor Wolf signed Act 24 of 2020, which allocates funding from the Federal Coronavirus Aid, Relief, and Economic Security Act – also known as the CARES Act – to assist providers with COVID-19 related costs. Funding from Act 24 must be used to cover necessary COVID-19 related costs incurred between March 1, 2020 and November 30, 2020 that have not been otherwise reimbursed by Federal, State, or other sources of funding. To qualify for the one-time payment, a person or entity must have been in operation as of March 31, 2020. Under Act 24, $457 million of COVID-19 relief funds were allocated to providers of long-term living programs.

Any person or entity accepting a COVID-19 payment must provide documentation to the Department of Human Services (DHS) upon request for purposes of determining compliance with Act 24 requirements. Providers were previously advised to keep documentation to demonstrate how the funds were used for a response to the COVID-19 pandemic in case of an audit.

DHS has developed the attached reporting forms to collect information about the use of Act 24 funding. The reporting forms capture provider information; COVID-19 utilization related data; COVID-19 related staffing, expenditures, and revenue losses; and COVID-19 related revenue to determine the net impact. Providers are advised to review guidance for eligible COVID-19 costs on the US Department of Treasury website:

DHS is requesting the following two reports from the Office of Long-Term Living (OLTL) providers:

  1. An interim report, which identifies the total COVID-19 related costs each provider projects to incur by November 30, 2020. This interim report is due by November 6, 2020. To assist providers in projecting eligible costs, DHS recommends using the cost report attached and reporting costs that appear in cells H120 and H165. Providers must report the projected costs through a web-based portal.
  1. Providers are required to complete a final cost report and upload it through the web-based portal by no later than December 21, 2020. Providers must keep all documentation related to the costs reported in the final cost report for a minimum of five years.

Cost Reporting Forms:

In advance of the reports’ due date, DHS recommends that providers review the attached cost-reporting form and instructions and begin compiling the required information. Information on how to access the web-based reporting portal will be sent through a separate email.

Thank you for your ongoing assistance during these trying times. Please submit any questions about OLTL Act 24 expense reporting via email.

Prev1...567568569...581Next Page 568 of 581
© 2021 - Rehabilitation & Community Providers Association