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Medical Rehab

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The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2024 inpatient rehabilitation facility (IRF) prospective payment system (PPS) final rule in the August 2, 2023, Federal Register. Some of the key provisions contained in the final rule include:

Payment and Coverage Provisions

  • FY 2024 Market Basket Update and Productivity Adjustment: For the FY 2024 IRF PPS payment adjustments, CMS estimates that ‎IRFs will see a 4.0 percent increase in total payments (totaling an increase of $355 million) ‎relative to FY 2023. This update is a result of a 3.6 percent market basket update, minus a ‎‎0.2 percent productivity adjustment.
  • 2021-Based IRF Market Basket: The final rule rebases and revises the IRF market ‎basket to reflect a 2021 base year (which reflects more recent data). ‎Moving forward, CMS says that it will “continue to monitor the Medicare cost report ‎data as they become available” and consider updates to the IRF market basket in future ‎rulemaking.‎
  • Case Mix Groups: Consistent with the proposed rule, CMS estimates that the vast ‎majority of cases will be in case mix groups (CMGs) and tiers that will see a ‎change of less than 5 percent in FY 2024. ‎
  • Outlier Threshold: CMS is finalizing the outlier threshold amount of $10,423, which is estimated to be ‎approximately 3 percent of the total estimated aggregate IRF payments in 2024. CMS also ‎notes that finalized changes in the Average Length of Stay (ALOS) values for FY 2024, ‎compared with FY 2023 ALOS values, are small and do not show any particular trends ‎in IRF length of stay patterns.
  • Wage Adjustments and Labor-Related Share: CMS finalized proposals to update the ‎wage index adjustments using the same methodology and factors as previous updates. ‎Based on forecasts, the total labor-related share for FY ‎‎2024 is 74.1 percent (the sum of 70.3 percent for operating costs and 3.8 percent for the labor-related share ‎of Capital-Related costs).
  • Impact Estimate: Overall, the estimated payments per discharge for IRFs in FY 2024 ‎are projected to increase by 4.0 percent, compared with the estimated payments in FY 2023. ‎IRF payments per discharge are estimated to increase by 4.0 percent in urban areas and 3.6 percent ‎in rural areas, compared with estimated FY 2023 payments. Payments per discharge to ‎rehabilitation units are estimated to increase 4.5 percent in urban areas and 3.9 percent in rural ‎areas. Payments per discharge to freestanding rehabilitation hospitals are estimated to ‎increase 3.7 percent in urban areas and 2.8 percent in rural areas.‎
  • Modifications for Excluded IRF Units: Consistent with the proposed rule, CMS is ‎finalizing new flexibilities for rehabilitation units that are seeking to be excluded from ‎the acute inpatient PPS and paid under the IRF PPS for the first time. Hospitals will now ‎be allowed to open a new IRF unit (and get paid as such) at any time within the cost ‎reporting year, instead of being limited to only the beginning of a cost reporting period. ‎The hospital must notify the CMS Regional Office and Medicare Administrative ‎Contractor (MAC) in writing at least 30 days before the change. If a unit becomes ‎excluded during a cost reporting year, that change must remain in effect at least through ‎the rest of that cost reporting period. ‎

Quality Reporting Program (QRP) Provisions: ‎CMS finalized all of the proposed changes related to quality measures for the IRF QRP put forth in the proposed ‎rule. The following changes have been finalized for the IRF QRP:

  • Implementation of the New COVID-19 Vaccine for Patients: Data collection for the ‎‎“Percent of Patients/Residents Who Are Up-to-Date” will be placed on an updated IRF-‎Patient Assessment Instrument (PAI) and begin with discharges on or after October 1, 2024, for use in the FY 2026 IRF ‎QRP.‎
  • Update of the COVID-19 Vaccination Measure for Healthcare Personnel: CMS ‎finalized its proposed modification of the COVID-19 Vaccination Coverage among‎ ‎Healthcare Personnel (HCP COVID-19 Vaccine) measure‎ to include the CDC “up-to-‎date” consideration for reporting purposes. Data collection for this modification is to ‎begin October 1, 2023, for use in the FY 2025 IRF QRP.‎
  • Implementation of the New Discharge Function Score Measure: No new data ‎collection is required, but the calculations and reporting of this measure will begin with ‎discharges on or after October 1, 2023, for use in the FY 2025 IRF QRP.‎
  • Measure Removal: Three measures have been removed from the IRF QRP and will no ‎longer require the collection of certain data elements for discharges on or after October ‎‎1, 2023:‎
    • Application of Percent of Long-Term Care Hospital Patients with an Admission ‎and Discharge Functional Assessment and a Care Plan That Addresses Function;
    • IRF Functional Outcome Measure: Change in Self-Care Score for Medical ‎Rehabilitation Patients (CBE #2633)‎; and
    • IRF Functional Outcome Measure: Change in Mobility Score for Medical ‎Rehabilitation Patients (CBE #2634)‎.
  • New Public Reporting: CMS announced the start of public reporting for the following ‎measures:‎
    • Transfer of Health (TOH) Information to the Provider — Post-Acute Care (PAC) ‎Measure (TOH-Provider) beginning with September 2025 Care Compare refresh ‎‎(even though proposed rule and other language in final rule stated September ‎‎2024 Care Compare refresh)‎. CMS staff has been alerted to this discrepancy.
    • TOH Information to the Patient — PAC Measure (TOH-Patient) beginning with ‎September 2025 Care Compare refresh (even though proposed rule and other ‎language in final rule stated September 2024 Care Compare refresh)‎.
    • Discharge Function Score Measure — Beginning with the September 2024 Care ‎Compare refresh or as soon as technically feasible.‎
    • COVID-19 Vaccine: Percent of Patients/Residents Who Are Up-to-Date Measure — Beginning with the September 2025 Care Compare refresh or as soon as ‎technically feasible.‎

CMS also released a fact sheet on the final rule. The data files associated with the final rule, including the wage index tables, the rate setting data for each IRF, and the ‎final tables for case-mix groups, relative weights, and average lengths of stay are also available. Unless otherwise ‎noted above, the provisions in the final rule will take effect on October 1, 2023. ‎

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For those in health and human services, keeping up-to-date with the latest in payment, treatment, and worker recruitment methods is essential. At the 2023 RCPA Annual Conference A Decade of Unity, you’ll have access to workshops that both highlight and educate on the latest developments in the field, including the use of AI, selective contracting, and telehealth. Our full brochure is available, and you can expect to see workshops such as the following:

  • Guiding the Use of Evidence-Based Practice to Drive Improved Quality Outcomes Across Levels of Care
    • Examine the use of evidence-based practices and the outcomes of value-based payment programs with the PA Opioid Use Disorder Centers of Excellence.
  • Recruitment and Retention of Front Line Workers
    • Focus on the HR challenges of recruiting and retaining workers by reviewing why workers are leaving and analyzing what HR can do to meet goals.
  • Preparing Your Organization’s Infrastructure for Selective Contracting for IDD Providers
    • Define what a preferred IDD provider is when it comes to selective contracting and discuss how to prepare for transitioning your organization’s infrastructure.
  • Not If But When You Use AI and Machine Learning – But is the AI Trustworthy? Some Things to Look For
    • Discuss AI use in the health and human services field in order to make informed decisions for your organization.
  • Connecting Through Movement: Bringing Accessible and Enjoyable Movement Experiences Into the Home and Community
    • Explore ways of staying physically active in community settings with home-based, telehealth methods.
  • A Brief Multi-Disciplinary Intervention for Supporting Adults With IDD and Co-Occurring Mental Health Conditions
    • Analyze the use of the ANSA-DD for holistic intervention and treatment for those with IDD and co-occurring mental health conditions.
  • Community Partnerships That Work: Community Mental Health Centers – School Districts
    • Identify the strengths in collaboration when school districts, community mental health agencies, and their communities work together to assist families struggling with violence and trauma.
  • Leadership and Navigating Change
    • Tackle resistance in a team that is going through significant adjustments and learn how to be a leader by focusing on the ‘people side’ of change.
Register today!

In addition to an impressive roster of speakers, our 2023 Conference will have an exciting array of sponsors and exhibitors. We thank those who have signed on thus far! If you are interested in sponsoring or exhibiting, visit here for more details or contact Carol Ferenz, Conference Coordinator, with any questions you may have. Keep up-to-date and register today for #rcpaconf!

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If you haven’t registered yet for the 2023 RCPA Annual Conference A Decade of Unity, then don’t wait any longer! Our plenary sessions throughout the week are sure to inspire you with new ideas to tackle priorities in health and human services. Looking ahead, we have:

  • Returning speaker Michael Cohen, Esq., addressing practical ways for attracting high-caliber employees in a rapidly-changing job market;
  • A panel addressing the realities of the workforce crisis, featuring Tine Hansen-Turton of Woods Services, Toni Pergolin of Bancroft, Rita Gardner of Melmark, and Marco Giordano of Resources for Human Services; and
  • National updates from National Council for Mental Wellbeing’s Chuck Ingoglia as well as ANCOR’s Donna Martin.

Be sure to view our registration brochure to book your seat (and your hotel room) today!

We extend our thanks to those organizations that have already contributed and shown their support! Sponsor and exhibitor spots are filling up quickly, so complete the sponsor/exhibitor brochure today! As a reminder, sponsors, exhibitors, and advertisers who wish to be listed on the website, the mobile app, and in the conference program must submit all materials by September 8. In order to be considered for booth self-selection, a completed contract with payment must be submitted, and no reservation is considered complete without payment. If questions remain, please contact Carol Ferenz, Conference Coordinator.

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Caregiver supporting sick elderly man in the wheelchair during stay in the hospice

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), announced the new Guiding an Improved Dementia Experience (GUIDE) Model. The purpose and goal of this model is to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities through a package of care coordination and management, caregiver education and support, and respite services.

Through the GUIDE Model, CMS will test an alternative payment for participants who deliver key supportive services to people with dementia, including comprehensive, person-centered assessments and care plans, care coordination, and 24/7 access to a support line. Under the model, people with dementia and their caregivers will have access to a care navigator, who will help them access services and supports, including clinical services and non-clinical services such as meals and transportation through community-based organizations.

The GUIDE model supports President Biden’s Executive Order that directed HHS to develop a new health care payment and service delivery model focused on dementia care that would include family caregiver supports.

There is a web page that has been created specific to this care model that provides additional information, including a link to a webinar that will provide an overview of this care model scheduled for August 10, 2023:

CMS will release the application for GUIDE, a voluntary, nationwide model, in the fall of 2023. Prior to the application release, interested organizations are encouraged to submit Letters of Intent to CMS by September 15, 2023. The model will run for eight years beginning July 1, 2024.

If you are interested in receiving additional information, updates or have questions about the GUIDE model, please send an email to the GUIDE Model team’s inbox.

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The Secretaries of the Department of Human Services, Department of Drug and Alcohol Programs, Department of Health, and Department of Aging have written a letter to human services organizations about the budget impasse and an estimated $5.9 billion in planned state and federal funding that cannot be disbursed without a signed budget. The letter details specific funds that cannot be distributed through each department.

For Gov. Shapiro to sign HB 611, the General Appropriations bill for Fiscal Year 2023/24, which was passed by both the House and Senate, Senate President Pro Tempore Kim Ward must first deliver a signed physical copy of the bill to him. Sen. Ward is the only person with the power to call the Senate into session to complete this procedural step. Ward has adjourned the Senate until Sept. 18, 2023.

Read the full letter here.

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The Americans with Disabilities (ADA) Act passed in 1990. As the country celebrates the upcoming 33rd anniversary of the ADA, the Federal Emergency Management Agency (FEMA), with the guidance of the ADA, has committed to improving services and programs to be uniformly available to individuals with disabilities and others with access and functional needs.

To support the disability community, FEMA made equity in emergency management one of the top goals in its 2022–2026 Strategic Plan. In support of this plan, the agency has:

  • Improved the survivor registration intake process nationwide, expanding disability-related questions and making it easier for people with disabilities impacted by disasters to get the assistance they need.
  • Continued updating the FEMA App, available in English and Spanish, so that it is now more accessible to people with disabilities. The app is screen reader compatible on iOS (11.0 and later) and Android (5.0) devices. The user interface has also been redesigned to fit a wider variety of screen sizes, making it easier for users to interact with it on their preferred device.
  • Worked extensively with state, local, tribal and territorial officials, and nongovernmental and private sector partners and stakeholders to facilitate ADA compliance. This includes removing physical, communication, and programmatic barriers that people with disabilities could face.
  • Designed programs, services, policies, and procedures to include the needs of people with disabilities before disasters happen, rather than solely reacting to barriers that are identified during response and recovery.

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Explore unique leadership and up-to-date support strategies in health and human services at the 2023 RCPA Annual Conference A Decade of Unity, as our speakers will be covering topics that touch on hoarding disabilities, handling subpoenas, and even tackling social anxiety with tabletop games! Held at the Hershey Lodge October 10 – 13, participants can earn CEs through these exciting and interactive workshops. Our full brochure is available, and below is a sampling of the many sessions being offered:

  • Hoarding Recovery and Maintenance Program
    • Learn about the Hoarding Recovery and Maintenance Program, which was designed to support individuals dealing with anxiety and stress as they let go of their hoarded possessions.
  • Make Difficult People Disappear: How to Reduce Stress and Eliminate Conflict in the Workplace
    • Obtain tricks and resources to not only managing stressful individuals but making them disappear without worsening the situation.
  • Investigating the Use of Tabletop Role-Playing Games as a Potential Therapeutic Intervention for Individuals With Social Anxiety
    • Discover how tabletop role-playing games like Dungeons & Dragons can assist adults in dealing with anxiety, particularly social anxiety.
  • A Treatment Outcome Measurement System That Helps to Get & Keep Treatment Funding
    • Develop a simple yet effective treatment outcome measurement system in order to keep funding, including Medicaid funding.
  • Addressing Cultural Barriers to Treatment: How to Be Respectfully Curious When Working With Families
    • Address leadership tactics for being curious yet respectful when interacting with fellow employees in order to avoid causing more harm or enforcing one’s personal beliefs.
  • Subpoenas, Court Orders, and Requests for PHI: Obligations Under HIPAA, the MHPA, and Other Statutes
    • Delve into HIPAA and PA statues in order to learn about the complexities regarding subpoenas and court-related orders when working in health and human services.
  • Enabling Technology: The Why, What, and How Needed to Make it Happen
    • Understand how companies can improve organization capacity in order to provide up-to-date technology to disabled communities.
  • Leadership and Navigating Change
    • Tackle resistance in a team that is going through significant adjustments and learn how to be a leader by focusing on the ‘people side’ of change.
Register today!

In addition to an impressive roster of speakers, our 2023 Conference will have an exciting array of sponsors and exhibitors. We thank those who have signed on thus far! If you are interested in sponsoring or exhibiting, visit here for more details or contact Carol Ferenz, Conference Coordinator, with any questions you may have. Keep up-to-date and register today for #rcpaconf!

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Governor Shapiro’s office published a list of regulations being considered by the state agencies in the Pennsylvania Bulletin on July 22, 2023. The document lists regulations being drafted by state agencies that cover a wide variety of activities under oversight of the state government. Under Executive Order 1996-1, all agencies under the jurisdiction of the Governor must submit for publication semi-annually an agenda of regulations under development or consideration. This list is current as of July 15, 2023.

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On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Calendar Year (CY) 2024 Physician Fee Schedule (PFS) and other Medicare Part B issues, effective on or after January 1, 2024.

The calendar year (CY) 2024 PFS proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better access to care, quality, affordability, and innovation.

The proposed modifications include several pertaining to telehealth policy in the Medicare program for 2024. One of the major takeaways from the proposed 2024 PFS is the clarification that certain telehealth flexibilities that were previously extended until 151 days after the end of the public health emergency (PHE) have now been extended until December 31, 2024, in accordance with amendments made by the Consolidated Appropriations Act, 2023. These extensions have been known since the CAA’s passage in December last year and has also been addressed in a series of fact sheets and FAQ documents.

However, there were also some new changes addressed in the 2024 PFS. For example, every year CMS will consider adding new services to their list of codes that are reimbursable via telehealth. While they did not decide to add any new codes on a permanent basis to the list (though many remain on the list temporarily through the end of 2024), they did propose to add a number of codes to Category 3 (CMS’ current temporary list), including certain codes for health and well-being coaching services. Additionally, CMS announced a proposed revision to their telehealth code classification process, moving from a Category 1, 2 and 3 classification system to a binary ‘permanent’ or ‘provisional’ classification in an attempt to simplify the process beginning in CY 2025. In order to make the steps for getting a code accepted for inclusion in either the permanent or provisional telehealth lists transparent, CMS proposes a five-step process that is detailed in the proposed 2024 PFS, which includes consideration of the evidence of clinical benefits.

A few additional changes proposed in the document are listed below:

  • The list of telehealth practitioners is amended to recognize marriage and family therapists and mental health counselors as telehealth practitioners, effective Jan. 1, 2024.
  • CMS will pay for place of service (POS) 10 at the non-facility PFS rate, while 02 will be paid at the facility rate beginning Jan. 1, 2024.
  • Frequency limitation would be removed for subsequent inpatient visits through the duration of CY 2024.
  • Multiple clarifications are provided for billing both remote physiologic monitoring (RPM) and remote therapy monitoring (RTM) codes.
  • Direct supervision is allowed to include real-time audio video interactive telecommunication through Dec. 31, 2024 (including for FQHCs and RHCs). Direct supervision requirements are also addressed for occupational therapists in private practice (OTPP) and physical therapists in private practice (PTPP) for unenrolled physical and occupational therapists when providing remote RTM.

CMS will be accepting comments on their proposals until 5:00 pm EST on September 11, 2023, and RCPA will review the document and work with the National Council for Mental Wellbeing in drafting recommendations. We welcome provider feedback and comments to be included and ask that you contact and share these with your RCPA Policy Director.

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