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Medical Rehab

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The Centers for Medicare and Medicaid Services (CMS) has updated the calendar year (CY) 2023 per beneficiary threshold amounts for therapy services. These threshold amounts, also known as therapy caps, are reflected on claims with the KX modifier to confirm that services are medically necessary as justified by appropriate documentation in the medical record. There is one amount for Physical Therapy (PT) and Speech-Language Pathology (SLP) services combined and a separate amount for Occupational Therapy (OT) services. Claims from providers for therapy services above the threshold amounts without the KX modifier are denied.

For CY 2023, the KX modifier threshold amounts are: (a) $2,230 for PT and SLP services combined, and (b) $2,230 for OT services.

For additional information, refer to CMS Transmittal 11626 and the 2023 Therapy Code List and Dispositions.

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Photo by Kane Reinholdtsen on Unsplash

The 2023 RCPA Conference, which will be celebrating our 10-year anniversary as a leader in shaping policy and enhancing lives, will be held October 10 – 13 at the Hershey Lodge for a statewide audience. The Conference Committee is seeking workshop proposals in every area for possible inclusion, particularly those that assist providers in developing and maintaining high-quality, stable, and effective treatments, services, and agencies in an industry where change is constant. The committee looks for presentations that:

  • Highlight new policy, research, and treatment initiatives, such as telehealth innovations, suicide prevention, and employing people with disabilities;
  • Provide specific skills and information related to individual and organizational leadership development and enhancement;
  • Discuss advanced ethics practices;
  • Address system changes that affect business practices, including integrated care strategies, value-based purchasing, acquisitions/mergers, and alternative payment models;
  • Provide guidance on building a culture of a committed workforce, including recruitment and employee development as well as effective remote workforce strategies;
  • Offer concrete skills and tools to operate more efficient, effective agencies; and
  • Inspire ideas for organizations to be leaders in their field.

The committee welcomes any proposal that addresses these and other topics essential to rehabilitation, mental health, substance use disorder, children’s health, aging, physical disabilities, and intellectual/developmental disabilities & autism. Members are encouraged to consider submitting and to forward this opportunity to those who are exceptionally good speakers and have state-of-the-art information to share.

The Call for Proposals (featuring a complete listing of focus tracks) and accompanying Guidelines for Developing Educational Objectives detail requirements for submissions. The deadline for submissions is Monday, March 13, 2023, at 5:00 pm. Proposals must be submitted electronically on the form provided; confirmation of receipt will be sent. Proposals submitted after the deadline will not be considered.

If the proposal is accepted, individuals must be prepared to present on any day of the conference. Workshops are 90 or 180 minutes in length. At the time of acceptance, presenters will be required to confirm the ability to submit workshop handouts electronically four weeks prior to the conference. Individuals unable to meet this expectation should not submit proposals for consideration.

Individuals are welcome to submit multiple proposals. Notification of inclusion will be made via email by Friday, May 12, 2023. Questions may be directed to Carol Ferenz, Conference Coordinator.

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The Finance & Reimbursement Committee would like to remind members that recipients of Federal Provider Relief Fund Phase 4 payments must report on the use of those funds by March 31, 2023.

Per the HRSA website, PRF Phase 4 is under the following timeframes:

  • Payments Received Period: 7/1/2021 – 12/31/2021
  • Period of Availability: 1/1/2020 – 12/31/2022
  • Reporting Time Period: 1/1/2023 – 3/31/2023

For further information, please visit the HRSA website.

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The agenda for the February 1, 2023, Managed Long-Term Services and Supports (MLTSS) Subcommittee has been released. The meeting will be held in person at the PA Department of Education Honors Suite, 1st Floor, 333 Market Street Harrisburg, PA 17126 from 10:00 am – 1:00 pm. There is also the option to participate via webcast. The link to register to participate via webcast, as well as the remote streaming link, is available on the agenda.

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The Traumatic Brain Injury (TBI) Advisory Board, established under section 1252 of the Federal Traumatic Brain Injury Act of 1996 (42 U.S.C. § 300d-52), will hold a public meeting on February 3, 2023, from 10:00 am – 3:00 pm. The meeting will be held at the Pennsylvania Training and Technical Assistance Network, 6340 Flank Drive, Harrisburg, PA 17112, in the Cambria Conference Room.

Meeting materials will be sent out before the meeting and will also be available on the TBI Board’s website and at the meeting location. Questions regarding the meeting should be directed to Nicole Johnson.

The Department of Health’s (DOH) Head Injury Program (HIP) strives to ensure that eligible individuals who have a TBI receive high quality rehabilitative services aimed at reducing functional limitations and improving quality of life. The TBI Board assists DOH in understanding and meeting the needs of persons living with TBI and their families. This quarterly meeting provides updates on a variety of topics, including the number of people served by HIP. In addition, meeting participants will discuss budgetary and programmatic issues, community programs relating to traumatic brain injury, and available advocacy opportunities.

For additional information or for persons with a disability who wish to attend the meeting and require an auxiliary aid, service, or other accommodation to do so, contact Nicole Johnson, Division of Community Systems Development and Outreach, (717) 772-2763. For speech and/or hearing-impaired persons, contact V/TT (717) 783-6514 or the Pennsylvania Hamilton Relay Service at (800) 654-5984.

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