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Brain Injury

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The Office of Long-Term Living (OLTL) has announced new services that will be available as a result of the Community HealthChoices (CHC) Waiver renewal and OBRA Waiver renewal. Effective January 1, 2025, the following services will be available:

Chore Services – CHC Only

  • Provider Type: 59
  • Specialty Code: 431
  • Procedure Code: S5131

Teleservice Cognitive Rehabilitation Therapy – CHC and OBRA

  • Provider Type: 59
  • Specialty Code: 207
  • Procedure Code: W0176

Teleservice Counseling Services – CHC and OBRA

  • Provider Type: 59
  • Specialty Code: 231
  • Procedure Code: W0175

Teleservice Nutritional Consultation – CHC and OBRA

  • Provider Type: 59
  • Specialty Code: 230
  • Procedure Code: W0170

The rates for the OLTL Home and Community-Based Services (HCBS) rates, effective January 1, 2025, are available here.

Additional information on the licensure and certification requirements can be found in the Service Definitions under Appendix C of the waivers. Please note that these documents have not received final approval from the Centers for Medicare & Medicaid Services (CMS). Once approval is received, a ListServ message will be sent with links to the final approved waiver applications.

The Fee for Service rates for Teleservice Cognitive Rehabilitation Therapy, Teleservice Counseling Services, and Teleservice Nutritional Consultation have been added to the fee schedule attached to the ListServ.

For existing OLTL providers to enroll in the services listed above a request must be submitted to the enrollment and certification resource account. The required documentation should include an updated Provider Enrollment Information Form (PEIF), a copy of the required license or certification, and a copy of the job description for the service you are requesting to add to your provider profile. If you have any questions related to the new services you can reach out to the enrollment and certification unit at 1-800-932-0939, option 1, or via email.

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Photo by Tai's Captures on Unsplash

The Pennsylvania Department of Health (DOH) has released an updated Respiratory Virus Outbreak Toolkit for Long-Term Care Facilities, including Personal Care Homes and Assisted Living Residences.

The updated toolkit was developed to provide recommendations for facilities before and during a respiratory virus outbreak. This toolkit covers many respiratory viruses, including influenza, respiratory syncytial virus (RSV), COVID-19, adenovirus, and more. While this toolkit does include information about COVID-19, a more detailed toolkit for LTCFs specific to COVID-19 can be found here. This toolkit replaces the previous Influenza Outbreak Toolkit for Long-Term Care Facilities.

DOH is in the process of updating the poster required by the Influenza Awareness Act. In the meantime, providers are encouraged to continue to use the 2023-2024 Poster.

Questions about this communication should be sent electronically.

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Join Drexel University Behavioral Healthcare Education’s visiting resident Radhika Rani, DO, for a special presentation titled “Mental Health Care for Migrants and Refugees in the U.S.: Culturally Informed Practices.”

Thursday, November 21, 2024
9:00 am – 12:15 pm ET
3 CE Hours
Live Webinar

This course aims to provide behavioral health professionals with the knowledge and skills needed to effectively address the mental health needs of migrant and refugee populations in the United States. Participants will explore the unique challenges and stressors encountered by these groups, including trauma, displacement, acculturation, and systemic barriers to care. Emphasis will be placed on culturally informed, trauma-sensitive approaches to diagnosis and treatment. In addition, the course will explore the legal, social, and policy implications impacting migrant and refugee communities as well as outline strategies for patient advocacy. Participants will also be able to gain practical skills while reflecting on personal biases and assumptions to foster more inclusive care and improve patient outcomes.

Register at the BHE website.

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The Center for Medicare and Medicaid Services (CMS) has released the Physician Fee Schedule CY 2025 Final Rule. You can view CMS’ press release, fact sheet, and final rule page in the Federal Register for more information. There were critical areas addressed in this year’s Physician Fee Schedule (PFS), including:

  • The extension of some telehealth flexibilities permitted under CMS’ authority absent Congressional action;
  • Updated payment for social determinants of health risk assessments as a part of Opioid Use Disorder intake activities furnished at Opioid Treatment Programs (OTP);
  • The establishment of a new add-on code to account for coordinated care, referral services, and peer supports at OTPs;
  • Payment for safety planning intervention and post-discharge follow-up;
  • The establishment of six G codes that mirror current interprofessional consultation Common Procedural Terminology codes used by practitioners who are eligible to bill E/M visits; and
  • Recognition of responses to CMS’ request for information on Certified Community Behavioral Health Clinics.

For the OPPS Final Rule, please see links to CMS’ press release, fact sheet, and final rule page in the Federal Register. Some highlights from this final rule include:

  • The maintenance of the Partial Hospitalization Program and Intensive Outpatient Program rate structures;
  • Narrowing the definition of “custody” in Medicare’s payment exclusion rule to mitigate barriers to Medicare access by individuals who have recently been released from incarceration or are on parole, probation, or home detention; and
  • Changes to Medicaid regulation, allowing states implementing the Medicaid clinic services benefit to cover clinic services outside the “four walls” of behavioral health clinics.

If you have any further questions regarding these final rulings or the application of the “four walls” impacts on Pennsylvania, please contact RCPA COO and Mental Health Director Jim Sharp.

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The PA Department of Labor & Industry’s Office of Vocational Rehabilitation (OVR) has further developed the draft of the Financial Needs Test (FNT) policy after incorporating feedback received during the September 2024 public comment period. As a result, there will be a second, shorter public comment period on the draft. The draft will be posted on OVR’s website for public review beginning November 11, 2024.

Virtual meetings will be held via Zoom at 9:00 am and 2:30 pm on Monday, November 18, 2024, to provide an overview of the policy and accept comments (content will be the same in both meetings). The public is invited to comment on the draft policy through November 22, 2024. Comments may be directed to OVR’s Public Comment inbox.

Zoom Meeting Information:

CART and sign language interpreters will be available for these meetings via the Zoom link.

Additional auxiliary aids and services are available upon request to individuals with disabilities. Please send your request to OVR’s Public Comment inbox.

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