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Medical Rehab

Hole torn in a dollar bill with medicaid text

On April 25, 2024, at 12:00 pm, a virtual statewide briefing will be conducted on Medicaid unwinding and expanded enrollment options. This event will feature Health and Human Services (HHS) Regional Director Melissa Herd, Pennsylvania Department of Human Services Secretary Val Arkoosh, and Pennie Executive Director Devon Trolley.

The agenda will include a briefing on what’s happening at the federal level when it comes to Medicaid, an update on the Medicaid “unwinding” process currently wrapping up in Pennsylvania, and the expanded eligibility requirements for enrolling in Pennie coverage even when it’s not open enrollment.

To register, please visit here.

The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2025 hospital inpatient prospective payment system (IPPS) proposed rule. While the proposed rule is focused primarily on provisions specific to acute care hospitals and long-term care hospitals (LTCH), the rule includes a proposed mandatory model — the Transforming Episode Accountability Model (TEAM) — that would implement episode-based payments for five procedures: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure.

Under the proposed program, selected acute care hospitals would coordinate care for fee-for-service (FFS) beneficiaries who undergo one of the listed procedures and assume responsibility for the cost and quality of care through the first 30 days after the Medicare beneficiary leaves the hospital. Hospitals required to participate would continue to bill Medicare FFS but would receive a target price based on all non-excluded Medicare Parts A & B items and services included in an episode; inpatient rehabilitation facility (IRF) care is listed among these covered services. Hospitals may earn a payment from CMS, subject to a quality performance adjustment, if their spending is below the target price (additionally, hospitals could owe CMS a repayment amount, subject to a quality performance adjustment, if their spending was above the target price). Hospitals will face a “graduated risk” scale through different participation tracks to allow participants to ease into full-risk participation.

Per CMS, the program aims to incentivize coordination between care providers during surgery, as well as the services provided during the 30 days that follow, and require referral to primary care services to support continuity of care. CMS notes that TEAM hospitals may “want to engage in financial arrangements with providers and suppliers or participants in Medicare Accountable Care Organization (ACO) initiatives who are making contributions to the TEAM participant’s performance in the model,” and TEAM hospitals could share reconciliation payment amounts or repayment amounts with these individuals and entities. IRFs are listed among the potential “TEAM Collaborators” by CMS. Comments are encouraged on both the proposed definition of a TEAM collaborator and their role in the model.

There are several other provisions notable for IRFs, including the fact that CMS is proposing to require that TEAM hospitals “must, as part of discharge planning, account for potential financial bias by providing TEAM beneficiaries with a complete list of all available post-acute care options in the Medicare program, including home health agencies (HHA), skilled nursing facilities (SNF), IRFs, or LTCHs, in the service area consistent with medical need, including beneficiary cost-sharing and quality information (where available and when applicable).” The list must also indicate whether the TEAM participant has a sharing arrangement with the post-acute care provider.

The model would begin in 2026 and run for five years and is intended to build on other episode-based models, such as the Bundled Payments for Care Improvement Advanced and Comprehensive Care for Joint Replacement Models. Like with other Center for Medicare and Medicaid Innovation (CMMI) programs, CMS will assess whether the model would reduce Medicare spending while maintaining or improving the quality of care.

The proposed rule will be published in the May 2, 2024, Federal Register and will be open for public comments.

Image by photosforyou from Pixabay

Part 1: Navigating Evidence: Finding and Synthesizing Literature for Evidence-Based Practices
Tuesday, April 23, 2024
2:00 pm – 3:00 pm EDT; 1:00 pm – 2:00 pm CDT;
12:00 pm – 1:00 MDT; 11:00 am – 12:00 pm PDT
Register Here

Part 2: Making Evidence-Based Practices Work: Strategies and Outcomes
Tuesday, April 30, 2024
2:00 pm – 3:00 pm EDT; 1:00 pm – 2:00 pm CDT;
12:00 pm – 1:00 MDT; 11:00 am – 12:00 pm PDT
Register Here

Michael Peterson, MA, CCC-SLP
Speech-Language Pathologist and Clinical Transformation Specialist

Speaker Bio:
Michael works as a Clinical Transformation Specialist, where he focuses his efforts as part of a Clinical Transformation team to promote a culture of evidence-based practice at Gillette Children’s Specialty Healthcare in St. Paul, Minnesota. Michael is also a speech-language pathologist with 12 years of clinical experience working with children and adults with childhood-onset conditions. He applies his clinical experience and advanced training in knowledge translation and implementation science to partner with and guide clinical staff to bridge the gap between evidence and clinical practice.

Objectives: At the end of these sessions, the learner will:

Part 1: Navigating Evidence: Finding and Synthesizing Literature for Evidence-Based Practices

  • Describe how to search for literature using PICOT questions
  • Identify resources to support appraisal of relevant papers
  • State the purpose of synthesis tables in supporting evidence-based practice decisions
  • Describe how to use synthesis tables to make evidence-based practice recommendations

Part 2: Making Evidence-Based Practices Work: Strategies and Outcomes

  • Describe how frameworks guide implementation of EBP
  • State how barriers and facilitators influence implementation of EBP
  • Describe implementation strategies
  • List different kinds of outcomes to monitor implementation of EBP

Audience: This webinar is intended for all interested members of the rehabilitation team.

Level: Intermediate

Certificate of Attendance: Certificates of attendance are available for all attendees. No CEs are provided for this course.

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The Centers for Medicare and Medicaid Services (CMS) has announced that the next hospital/quality initiative open door forum will be conducted on April 16, 2024 at 2:00 pm. The agenda topics that will be discussed during the call include:

The call will be a Zoom webinar with registration and login instructions below. To participate by webinar, please register in advance.

Meeting ID: 160 823 4591
Passcode: 200020

After registering, you will receive a confirmation email containing information about joining the webinar.

Medicare binary sign concept illustration design over black

The Centers for Medicare and Medicaid Services (CMS) has announced two days of interactive training webinars that will cover Medicare basics. The webinars will be offered on April 16 and 17, 2024, from 1:00 pm – 3:30 pm. Attendees can attend one or both days, and space is limited. CEUs will not be offered. The topics for the webinars include:

Day 1 — Medicare enrollment and eligibility; SSA and CMS roles and responsibilities; cost and coverage under Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance); why enrolling on time is important; and an overview of Medicare Supplement Insurance (Medigap) policies.

Day 2 — Medicare drug coverage (Part D); Medicare Advantage Plans; coordination of benefits; how to detect and report suspected Medicare fraud, waste, and abuse; and different resources to help you find answers to Medicare policy and coverage questions.

To register for these events, visit the CMS National Training Program website. The webinars will be recorded and posted to the NTP website. To view the recordings, visit here.

Photo by Markus Winkler from Pexels

With close to 400 members, the priorities of RCPA leadership are to maintain the quality standards of membership communication, along with advocacy at the state and federal levels. To continue to serve our members effectively and efficiently, it has become imperative that RCPA leadership include a Chief Operating Officer (COO) position. We are pleased to announce that RCPA policy staff member Jim Sharp will start as the COO — and remain Director of Mental Health — effective Monday, April 8, 2024.

Jim has been with RCPA for five years. He has more than 35 years of cross-systems advocacy with organizational and strategic planning experience. He previously worked for RCPA member Merakey, and has served in several key positions, including Chief Juvenile Probation Officer at the Philadelphia Family Court, Admissions Director at George Junior Republic, and he began his career at Montgomery County Juvenile Probation. He holds a Master of Administration, and graduated Magna Cum Laude from Shippensburg University.

This COO role will provide management, leadership, and vision to ensure that RCPA continues to meet its short-term and long-term goals and objectives, by creating policies and a company culture that strengthens operational efficiency and quality of services. Jim Sharp demonstrates a depth of knowledge regarding RCPA’s mission, vision, and values. Please join me in congratulating Jim in his new role.

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The Centers for Medicare and Medicaid Services (CMS) has released the fiscal year (FY) 2025 inpatient rehabilitation facility prospective payment system (IRF PPS) proposed rule. The proposed rule will be published in the March 29, 2024, Federal Register. A high-level overview of the proposed rule is provided below:

Payment Updates:

CMS estimates an overall increase in aggregate payments to IRFs by 2.5% or $255 million (compared to the 4% payment update in FY 2024).

Market basket update for IRF services is 3.2%. This will be reduced by a productivity adjustment of 0.4%, which would result in an overall 2.8% increase. These figures are likely to change due to updated forecasts.

CMS is proposing to update the outlier threshold amount from $10,423 (FY 2024) to $12,158 (FY 2025), which would account for an estimated 0.2 percent decrease to aggregate payments across the IRF PPS in FY 2025.

Quality Reporting Program (QRP) Updates:

CMS is proposing to make additions, modifications, and removals of some QRP measures. A proposal was included to collect four new Standardized Patient Assessment Data Elements (SPADE) in the IRF QRP to bolster the collection of information on social determinants of health (SDOH):

  • Living Situation: Requests regarding the current living situation;
  • 2 Food Items: Questions about food running out;
  • Utilities: Questions about threats to shutting off utilities; and
  • A modification to an existing SPADE on Transportation.

CMS is also proposing to remove the “Admission Class” from the IRF Patient Assessment Instrument (PAI).

Feedback is requested on future revisions to the IRF QRP, as well as feedback on the development of a five-star methodology for IRFs.

Additional information will be forthcoming. Comments on the proposed rule are due to CMS by the end of May.

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The next phase of the Centers for Medicare and Medicaid Services (CMS) inpatient rehabilitation facility (IRF) review choice demonstration (RCD) is scheduled to be implemented in Pennsylvania on June 17, 2024, and will last for five years. This demonstration applies to only IRF providers physically located in Pennsylvania.

Between May 3, 2024, and June 2, 2024, IRFs must select either 100% pre-claim review or 100% post-payment claim review.

CMS has stated that creating a review choice process will ensure Medicare coverage and documentation requirements are likely met. This program reduces the number of Medicare appeals, improves provider compliance with Medicare program rules, does not alter the Medicare IRF benefit, and should not delay medically necessary care to Medicare beneficiaries.

Novitas Solutions is the Medicare Administrative Contractor (MAC) for Pennsylvania and will process the IRF claims. In preparation for the implementation of IRF RCD, Novitas Solutions will be conducting their first webinar on April 24, 2024, from 1:00 pm – 2:30 pm. Registration to participate in this webinar is now open. Members are strongly encouraged to participate in this webinar to prepare for this demonstration. If the registration link does not work, please copy and paste the below link into your browser to register:
https://fcso.webex.com/webappng/sites/fcso/meeting/register/0fd87e2111f7446fa477d0a25f78674c?ticket=4832534b000000073a942d9e6f94601b6b106adc8f502bcee359653432e8c326edb0f50ebc253329&timestamp=1711559626291&RGID=re6663754d2fe70defe3195e29c69465a

In addition to information on the CMS website, Novitas Solutions has a dedicated website that provides a great deal of information and resources on IRF RCD.