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Brain Injury

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As the implementation of Community HealthChoices (CHC) approaches the January 1, 2018 launch in the Southwest Region, the Department of Human Services (DHS) has developed informational materials for those individuals who will be covered by the new program. The documents, including notices and the pre-enrollment packet, are posted on the DHS website, where you will also find their most recent participant document, “CHC: Here’s What You Need to Know” (available for download in English and Spanish).

In addition, a document designed to clarify eligibility for CHC is available here. It includes the following information:

Individuals are NOT eligible for CHC if they are a person with an intellectual or developmental disability who is eligible for services through the Department of Human Services’ Office of Developmental Programs (ODP), OR are a resident in a state-operated nursing facility, including state veterans homes.

Please visit the CHC website or call the CHC Provider Hotline at 833-735-4417 with any questions.

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Please mark your calendars! The upcoming RCPA Brain Injury Committee meeting, originally scheduled for November 15, 2017, has been rescheduled to December 6, 2017. The meeting will take place at its regularly scheduled time (10:00 am – 2:00 pm) and location (RCPA 777 East Park Drive, Harrisburg, PA  17111). A formal meeting invitation will be forthcoming in early November. Questions regarding this change can be sent to Melissa Dehoff.

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The Department of Human Services (DHS) recently issued the following information and resources in preparation for the roll-out of Community HealthChoices (CHC) beginning January 2018 in the Southwest zone of the state.

Coming to the Southwest Zone in January 2018

The Department of Human Services (DHS) is committed to open and frequent communication to educate and inform individuals who will move to Community HealthChoices (CHC). It is critical that they are aware of the upcoming changes and are able to make an informed decision on their plan selection. We are using multiple channels to get the message out, and want to ensure that you are aware of upcoming information that potential participants will receive.

  • INFORMATIONAL FLYER

Participants in the Southwest Zone received this flyer (also available in Spanish) in August 2017 to inform them that CHC was coming to their county in January 2018.

  • CHC Community Meetings for Participants

Participants in the Southwest will receive an invitation to community meetings in late September.

There will be more than 40 events in the Southwest Zone, with at least one in each of the 14 impacted counties. The meetings will give more information about CHC, the LIFE program, and answer questions participants may have.

To register for a community meeting, participants can go to www.healthchoices.pa.gov or call 1-833-735-4416. A copy of the invitation is available here.

  • Notices

DHS will mail notices to potential participants beginning today. The notice will inform participants that they will transition to CHC in January and will need to select a health plan, also called a managed care organization (MCO).

The notice also tells potentially eligible participants that they may be eligible for the LIFE program.

Copies of the notices are be available here.

  • Pre-Enrollment Packets

Beginning on October 2, 2017, pre-enrollment packets will be mailed to participants. This packet will contain information about each of the health plans and the benefits offered by each plan, and tell participants how to enroll in a health plan. There will be a toll-free number and website for participants to use to make their selection. A day after the packets are mailed, automated calls will be made to let participants know that the packets are coming.

If participants do not select a health plan, they will get a follow-up call.

Individuals who do not select a plan by November 13, 2017, will be assigned to a plan. Individuals can change their plan at any time.

  • Social Media

DHS’ Facebook, Twitter, and YouTube accounts make CHC information readily available. If you are not following us yet, please click the provided links to make sure you are receiving all up-to-date information on CHC and all department priorities.

chc-phases-map

(Map, Community HealthChoices Phases)

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On Thursday, September 28, 2017, from 2:00 pm to 3:00 pm, the Centers for Medicare and Medicaid Services (CMS) will host a special open door forum (SODF) that will provide information and solicit feedback on the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. Topics will include the goals of the IMPACT Act, RAND contract activities for item development (including pilot test results and plans for the upcoming national field test), and identifying opportunities for providers, consumers, stakeholders, researchers, and advocates to become involved over the next year. CMS welcomes questions, comments, and ideas from providers, patients, consumers, researchers, and advocates in advance or during the forum. Questions, comments, and ideas should be submitted via email. The presentation for the SODF is posted on the IMPACT Act Downloads and Videos web page.

To participate in the SODF, dial:
1-800-837-1935
Conference ID: 66557294

A transcript and audio recording of this SODF will be posted to the Special Open Door Forum website, and for downloading under the downloads section, as well as the IMPACT Act Downloads and Videos web page.

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The Council on Brain Injury (CoBI) will be offering an upcoming presentation and discussion as part of their Clinical Forum Series on Thursday, September 21, 2017, from 3:00 pm to 4:30 pm. The presentation, Traumatic Brain Injury as a Result of Domestic Violence: Education, Screening & Model Practices, will be facilitated by Fern Wilkerson, MA, from the Pennsylvania Coalition Against Domestic Violence (PCADV).

Registration is free and Certified Brain Injury Specialist (CBIS) credits will be available. Contact Dana Rhoads for additional information or to register for the program.

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The Centers for Medicare and Medicaid Services (CMS) and measure developers will host an upcoming call on Wednesday, September 6, 2017, from 1:30 pm to 3:00 pm that will focus on the IMPACT Act’s adopted Medicare Spending per Beneficiary Post-Acute Care (PAC) resource use measures. The call will focus on the components of each measure, as well as public reporting.

The IMPACT Act of 2014 requires the development of resource use measures for PAC providers, including inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), home health agencies (HHAs), and long-term care hospitals (LTCHs).

A question and answer session will follow the presentation. To participate in the call, please register here.

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The Centers for Medicare and Medicaid Services (CMS) has launched the Jimmo Settlement Agreement web page. This web page provides access, in one location, to various public documents and resources related to the Jimmo Settlement Agreement, including a Frequently Asked Questions (FAQs) link.

 

Background on Settlement Agreement:

On January 24, 2013, the US District Court for the District of Vermont approved a settlement agreement in the case of Jimmo v. Sebelius, in which the plaintiffs alleged that Medicare contractors were inappropriately applying an “Improvement Standard” in making claims determinations for Medicare coverage involving skilled care (e.g., the skilled nursing facility (SNF), home health (HH), and outpatient therapy (OPT) benefits). The settlement agreement sets forth a series of specific steps for CMS to undertake, including issuing clarifications to existing program guidance and new educational material on this subject. The goal of this settlement agreement is to ensure that claims are correctly adjudicated in accordance with existing Medicare policy, so that Medicare beneficiaries receive the full coverage to which they are entitled.

 

The Jimmo Settlement Agreement may reflect a change in practice for those providers and contractors who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve. The Settlement Agreement is consistent with the Medicare program’s regulations governing maintenance nursing and therapy in skilled nursing facilities, home health services, and outpatient therapy (physical, occupational, and speech) and nursing and therapy in inpatient rehabilitation hospitals for beneficiaries who need the level of care that such hospitals provide.

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The Centers for Medicare and Medicaid Services (CMS) has submitted a proposed rule (“Cancellation of Advancing Care Coordination through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model”) to the Office of Management and Budget (OMB). The proposed rule is currently pending regulatory review.

Included in the proposed rule is the reduction of the number of mandatory geographic areas participating in the Center for Medicare and Medicaid Innovation’s (CMMI’s) Comprehensive Care for Joint Replacement (CJR) model from 67 to 34. In addition, CMS proposes to allow CJR participants in the 33 remaining areas to participate on a voluntary basis. In this rule, CMS also proposes to make participation in the CJR model voluntary for all low volume and rural hospitals in all of the CJR geographic areas.

CMS also is proposing through this rule to cancel the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) incentive payment model, which were scheduled to begin on January 1, 2018.

The proposed rule (CMS-5524-P) will be published in the Federal Register. Public comments will be due by October 16, 2017.

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The Administration for Community Living (ACL) has extended an invitation to participate in a listening session tomorrow (Friday, August 11, 2017) from 1:30 pm to 3:30 pm. This listening session is an opportunity to hear about the Partnerships for Innovation, Inclusion, and Independence, which is a proposed grant program that would combine the activities carried out by the State Councils on Developmental Disabilities, Statewide Independent Living Councils, and Traumatic Brain Injury Advisory Councils into a single state grant program. Please refer to the invite for additional information.

Listening Session Dial-In Information:
Number: 800-857-9877
Participant Code: 8400563

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