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The Centers for Medicare and Medicaid Services (CMS) published a final rule in the September 16, 2016 Federal Register that establishes national emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers to plan adequately for both natural and man-made disasters, and coordinate with federal, state, tribal, regional, and local emergency preparedness systems. It will also assist providers and suppliers to adequately prepare to meet the needs of patients, residents, clients, and participants during disasters and emergency situations. The effective date of the regulations are effective on November 15, 2016.

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Robena Web Edited

RCPA is pleased to announce the hiring of Robena Spangler as the new director for its Children’s Division. Robena has worked for NHS Human Services for many years in several key positions, including operations resource specialist, regional director – children’s services, director of out of home services and gender responsive services, and children and youth program specialist. In addition to her bachelor’s degree in sociology/human services, she holds an MS degree in leadership and professional advancement from Duquesne University.

Robena will begin in this position on September 26 – just in time for the RCPA Annual Conference. As many of you know, Connell O’Brien serves as the current children’s services director and will be retiring. Connell will remain with RCPA to assist in the transition and to continue with select initiatives. Please join us in welcoming Robena to RCPA!

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The RCPA Board of Directors is pleased to announce the appointment of Steven Alwine, CEO of HealthSouth Rehabilitation Hospital of York, as its newest member. Steve has worked at HealthSouth for almost 25 years. He was promoted in 2002 to chief financial officer at HealthSouth Nittany Valley and returned to York in 2011 as chief executive officer. He currently fills a vacancy for an unexpired term ending June 30, 2017, as an RCPA director-at-large.

In addition, the board also selected Charles Barber, CEO of Erie County Care Management, Inc., to complete the unexpired term ending June 30, 2017, as board treasurer. Charlie has already been serving on the RCPA Board of Directors, but was recently voted to fill the vacant officer position of treasurer.

Join us in congratulating these individuals in their appointments. For a complete listing of the RCPA board members, please visit our website.

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The Centers for Medicare and Medicaid Services (CMS) has announced that the inpatient rehabilitation facility (IRF) quality reporting program (QRP) provider preview reports are currently available until September 30, 2016. Members are encouraged to preview the performance date on each quality measure prior to public display on the IRF Compare website. While corrections to the underlying data will not be permitted during this timeframe, members can request a CMS review during the 30-day preview period if you feel the data is inaccurate. Additional information, including instructions on how to access preview reports, is available from the IRF Quality Public Reporting web page.

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The Department of Human Services (DHS) has published a notice that includes proposed changes to the Medical Assistance Fee Schedule for the Aging, COMMCARE, Independence, and OBRA Waivers in the Pennsylvania Bulletin.

The Office of Long-Term Living (OLTL) is proposing to add the following employment services to three of its waivers listed below:

  • COMMCARE waiver – Benefits Counseling, Career Assessment, Employment Skills Development, Job Coaching Intensive, and Follow-along and Job Finding.
  • Independence waiver – Benefits Counseling, Career Assessment, Employment Skills Development, Job Coaching Intensive, and Follow-along and Job Finding.
  • OBRA waiver – Benefits Counseling, Career Assessment, Employment Skills Development, Job Coaching Intensive, and Follow-along and Job Finding.

DHS has developed Medical Assistance (MA) fee schedule rates for the additional services added to these waivers. The proposed MA Fee schedule rates are available for review.

Comments regarding the notice and the proposed MA fee schedule rates will be accepted until Monday, October 3, 2016, and should be sent to: Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attn: HCBS Rates, PO Box 8025, Harrisburg, PA 17105-8025. Comments can also be sent via email.

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The Departments of Human Services (DHS) and Aging just announced their selection of three managed care organizations (MCOs) for Community HealthChoices (CHC). CHC will coordinate physical health and long-term services and supports (LTSS) to individuals who are dually eligible for Medicare and Medicaid, older Pennsylvanians, and individuals with disabilities.

Through a review of a request for proposals, the following MCOs have been selected to proceed with negotiations to deliver services statewide in Pennsylvania beginning in 2017:

  • AmeriHealth Caritas
  • Pennsylvania Health and Wellness (Centene)
  • UPMC for You

CHC will roll out in three phases. Persons eligible for CHC are individuals aged 21 or older who have both Medicare and Medicaid, or who receive long-term services and supports through Medicaid because they need help with everyday activities of daily living.

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An RCPA Info was issued on August 18, 2016 regarding a project that was announced by the Centers for Medicare and Medicaid Services (CMS) specific to the development and maintenance of a post-acute care (PAC) cross-setting standardized assessment data. Originally, the comment deadline on this project was set for August 26, 2016. Due to concerns voiced to CMS regarding a two-week comment period, the deadline has now changed. The comment period on this project has now been extended to Monday, September 12, 2016.

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On August 15, 2016, the Centers for Medicare and Medicaid Services (CMS) posted to their public comment page, Development and Maintenance of Post-Acute Care (PAC) Cross-Setting Standardized Assessment Data, with a request for comment deadline of August 26, 2016.

This project involves CMS contracting with RAND to develop standardized assessment-based data items to meet the requirements as set forth under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, Section 2(a). Development of standardized data items includes conducting environmental scans of the evidence, data item conceptualization, drafting data item specifications, convening technical expert panels, and feasibility piloting.

The Centers for Medicare & Medicaid Services (CMS) seeks comments from stakeholders on data items that meet the IMPACT Act domains of: cognitive function and mental status; special services, treatments, and interventions; medical conditions and co-morbidities; and impairments. In addition to general comments, CMS is specifically interested in public feedback regarding the topics below:

  • Potential for improving quality: includes consideration of the data element’s ability to improve care transitions through meaningful exchange of data between providers; improve person-centered care and care planning; be used for quality comparisons; and support clinical decision-making and care coordination;
  • Validity: includes consideration of the data element’s proven or likely inter-rater reliability (i.e., consensus in ratings by two or more assessors) and validity (i.e., whether it captures the patient attribute being assessed);
  • Feasibility for use in PAC: includes consideration of the data element’s potential to be standardized and made interoperable across settings; clinical appropriateness; and relevance to the work flow across settings; and
  • Utility for describing case mix: includes whether the data element could be used with different payment models, and whether it measures differences in patient severity levels related to resource needs.

Comments may be submitted on the entire set of data elements or specific to individual data elements and should be sent via email or to:

RAND Corporation
1200 South Hayes Street
Arlington, VA 22202-5050
Attn: Barbara Hennessey, W7E

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The Department of Human Services (DHS) has just issued a Medical Assistance (MA) Bulletin for providers relating to Act 62 titled, Payment of Claims for Services Provided to Children and Adolescents for the Diagnostic Assessment and Treatment of Autism Spectrum Disorder (ASD). The purpose of this bulletin is to remind providers enrolled in the MA Program, both fee-for-service (FFS) and HealthChoices, of the requirement to bill a child’s or adolescent’s private health insurance company before submitting a claim for the diagnostic assessment or treatment of ASD. It is also to inform providers of the diagnosis codes and procedure codes which will be included in the MA FFS cost avoidance process, effective Friday, September 30. HealthChoices managed care organizations will provide guidance and information to contracted practitioners and providers in the Medicaid managed care system with regard to implementation by September 30.

The DHS clinical staff has identified behavioral health, physical health, and rehabilitation procedure codes that reflect services for the diagnostic assessment and treatment of ASD covered under Act 62. The procedure codes that are on the MA Program fee schedule will be subject to the cost avoidance process for MA FFS claims beginning September 30.

Registration is open now for two webinar sessions on Thursday, August 25 that are being held by DHS in collaboration with RCPA:

  • Session 1, 12:00–1:00 pm: The target audience for this webinar session is BH-MCOs, counties, and county oversight organizations.
  • Session 2, 1:00–2:00 pm: The target audience for this webinar session is behavioral health and pediatric rehabilitation provider organizations.

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The Centers for Medicare and Medicaid Services (CMS) will be hosting a webinar on Tuesday, August 23, 2016, 1:30 – 3:00 pm EDT focusing on the preview reports for inpatient rehabilitation facilities (IRFs) and also long-term care hospitals (LTCHs) that will be made available to providers soon. During the webinar, CMS will review how to access the reports, how to interpret the content of the reports, and what to do if providers feel their reports contain an error. To participate in the webinar, registration is required.

Additional information is available on the IRF Quality Reporting Training web page. Questions regarding the webinar should be directed to the IRF Quality Reporting web desk.

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