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Medical Rehab

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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.

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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.

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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.

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RCPA hosted our 2024 Capitol Day today, March 19 inside the Main Rotunda. The rally focused on workforce issues within health and human services as well as budget items addressed in Shapiro’s 2024/25 budget. You can view our 2024 legislative and administrative priorities here.

RCPA President and CEO Richard Edley addressed the crowd, highlighting the continued need for funding, training, and assistance for those working in various areas of health and human services.

Other organizations came to support our cause as well as to advocate for themselves, their families, and their loved ones. Sherri Landis, Executive Director of The Arc of PA, spoke to the audience, while RCPA member Step by Step, Inc. showed up dressed in orange, ready to stand and offer their support!

Legislators also took to the stand to speak about the ongoing crises occurring in health and human services. Representative Stephen Kinsey and Representative Doyle Heffley, Co-Chairs for the House Human Services Committee, conveyed their support, as did Representative Dan Miller, Representative Frank Farry, and Senator Art Haywood, Co-Chair for the Senate Health & Human Services Committee.

RCPA thanks everyone, from legislators and their staff to advocates representing their friends and families, for coming out and supporting our efforts today. We appreciate and admire the work you do for our communities and will continue to serve on your behalf!

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Time is running out to register for RCPA’s Capitol Day, which will be held next Tuesday, March 19. Don’t miss out on this opportunity to advocate for yourselves and others by meeting with legislators directly! We will hold a press conference in the Main Rotunda between 10:30 am – 11:30 am, which will tentatively include speakers such as:

  • Representative Dan Miller;
  • Representative Stephen Kinsey;
  • Representative Doyle Heffley;
  • Senator Art Haywood; and
  • Senator Frank Farry.

You can register for our Capitol Day press conference by contacting Allison Brognia or Christine Tartaglione with the number of anticipated attendees. RCPA requests that members schedule appointments with their Senate and House legislators directly to discuss the state budget, legislation, and regulations after our press conference.

To help support our members and their families during these visits, RCPA asks that you use the following handouts:

Please note that copies of materials will also be available at the Capitol Rally. As an additional resource, members can visit the Pennsylvania Capitol website to locate parking and view maps of the building. If you have questions regarding our 2024 Capitol Day, please contact Jack Phillips.

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The Brain Injury Association of America (BIAA) will be conducting a virtual Brain Injury Fundamentals course on March 20, 2024 from 1:00 pm – 2:00 pm. The course will provide foundational knowledge about working with individuals who have a brain injury, and is ideal for non-licensed health care professionals, first responders, and support staff.

This course is self-paced, so those who are unable to participate in the in-person course due to scheduling conflicts or other commitments have the opportunity to complete the course with greater flexibility. Please note that while the self-paced option offers 24/7 access for independent learning and development, there is a two-hour live instructor component as well. To participate in the session, please register here.

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