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Policy Areas

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Patrick Kennedy, former United States Representative and founder of the Kennedy Forum, has issued an open letter to the heads of the leading insurance companies in response to the findings of last week’s Surgeon General’s report. The report, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, addresses a broad array of issues, ranging from illicit drug abuse to prescription drug addiction, alcohol use, binge drinking, and teen alcoholism. Mr. Kennedy’s letter urges the commercial nation’s health industry to take action in five key areas:

  1. Eliminate the onerous medical management practices responsible for inadequate, ineffective treatment of addiction;
  2. Immediately ensure that all plans cover and reimburse for well-supported medication-assisted treatment (MAT), including buprenorphine, buprenorphine-naloxone, buprenorphine-hydrochloride, methadone, naltrexone, acamprosate, and disulfiram, at rates equal to coverage for medications used to treat other forms of chronic illness;
  3. Incentivize greater coordination of care;
  4. Adequately disclose processes for ensuring parity compliance;
  5. Promote screening and work with communities to implement prevention interventions.

Each of these requests is clarified in further detail in the letter. Patrick Kennedy was the prime sponsor of the Mental Health Parity and Addiction Equity Act of 2008 and author of the book, A Common Struggle (Blue Rider Press/Penguin Random House, 2015).

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On Thursday, December 1, 2016, the Centers for Medicare and Medicaid Services will conduct a call from 1:30 pm to 3:00 pm that will focus on the soon to be released Certification and Survey Provider Enhanced Reports (CASPER) Quality Measure (QM) reports for the inpatient rehabilitation facility (IRF) quality reporting program. Agenda topics include:

  • Quality measures for public reporting in 2016;
  • Reports associated with public reporting;
  • Content of the CASPER QM reports by data source;
  • How to interpret facility and patient level results;
  • Accessing reports in CASPER; and
  • Resources for providers.

To register or for more information, visit MLN Connects Event Registration. Because space may be limited, those interested are encouraged to register early.

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From the Department of Human Services:

The Wolf Administration is committed to serving more people in the community whenever possible, and we believe that the work performed by direct care workers (DCWs), including personal attendants and other household aides, enables individuals with disabilities to live a more independent life. We have heard from many people asking for a policy clarification on the types of non-skilled, home care services and activities that DCWs can perform in home- and community-based settings.

Last week, the Wolf Administration issued a policy clarification surrounding the role of DCWs.

The non-skilled activities provided in the consumer’s place of residence or other independent living environment are specialized care, a type of home care service unique to the consumer’s care needs that are exempt from the licensure requirements under the Professional Nursing Law and Practical Nurse Law.

DCWs may perform these non-skilled services/activities, with evidence of competency or training, provided they do not represent or hold themselves out as being licensed nurses, licensed registered nurses, or registered nurses; or use in connection with their names, any designation tending to imply they are licensed to practice nursing.

Individuals with disabilities will have a greater chance of remaining in their homes and community when they are able to receive assistance with long-term supports and services from DCWs. These non-skilled, routine activities/services include:

  • assistance with bowel and bladder routines;
  • assistance with medication;
  • ostomy care;
  • clean intermittent catheterization;
  • assistance with skin care; and
  • wound care.

DHS appreciates the partnership with the departments of Health and State and the collaboration with ADAPT and Disability Rights Pennsylvania in issuing this important policy clarification. Further guidance will be issued as appropriate to ensure successful implementation.

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Yesterday, a Texas federal judge issued a temporary injunction to the Department of Labor’s (DOL) overtime rule. In granting the preliminary injunction, the federal judge said the DOL’s overtime rule exceeds the authority the agency was granted by Congress.

As you may recall, the DOL’s overtime rule was announced in May, and it has been opposed by many businesses and nonprofits. The rule was to take effect on December 1 of this year. Now with yesterday’s ruling, it is likely that President-elect Trump’s administration, which opposed the rule, will have time to review it and make changes and/or roll back various provisions contained in the current rule.

The DOL could appeal the Tuesday ruling, but with the Obama administration only having approximately two months in office, an appeal is unlikely. With many RCPA members already implementing and announcing changes to comply with the DOL’s overtime rule, it might be difficult for those members to roll back these changes, because it may impact employee morale. As further information is released, RCPA will provide additional guidance to members. Please contact Jack Phillips, RCPA Director of Government Affairs with any questions.

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The Centers for Medicare and Medicaid Services (CMS) recently posted a project on the CMS public comment page, Quality Measures to Satisfy the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) Domain of: Transfer of Health Information and Care Preferences When an Individual Transitions.

This project involves CMS contracting with RTI International and Abt Associates to further develop a cross-setting post-acute care transfer of health information and care preferences quality measure in alignment with the IMPACT Act. The purpose of the project is to develop, maintain, re-evaluate, and implement measures reflective of quality care for post-acute care (PAC) settings to support CMS quality missions, including the Inpatient Rehabilitation Facility Quality Reporting Program, Long-Term Care Hospital Quality Reporting Program, the Nursing Home/Skilled Nursing Facility Quality Reporting Program, and the Home Health Quality Reporting Program. In addition, this project will address the domains required by the IMPACT Act, which mandates specification of cross-setting quality, resource use, and other measures for post-acute care providers.

The areas of focus for commenting, along with documents for review, are provided on the public comment page and are encouraged to be reviewed prior to submitting comments. The public comment period closes on Sunday, December 11, 2016.

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The Centers for Medicare and Medicaid Services (CMS) recently approved five new employment-related services in the Office of Long-Term Living’s (OLTLs) CommCare and Independence waivers. The services offer providers an opportunity to expand their profiles, particularly those who have been providing prevocational services and supported employment. Listed below are the new services, their credentialing and certification requirements, and rates that will be paid for the services.

  • Benefits Counselors must hold a Certified Work Incentives Counselor (CWIC) certification that is accepted by the Social Security Administration for its Work Incentives Planning and Assistance program. To learn more about CWIC, visit this web page.
  • Employment Skills Development (replaces Prevocational Services), Job Coaching (replaces Supported Employment), Job Finding, and Career Assessment workers must hold one of the following:
  1. A Certified Employment Support Professional (CESP) credential from the Association of People Supporting Employment First (APSE); and
  2. A Basic Employment Services Certificate of Achievement or Professional Certificate of Achievement in Employment Services from an Association of Community Rehabilitation Educators (ACRE) organizational member that has ACRE-approved training. Individuals without one of these certifications must be supervised by an individual holding the above certification until certification is achieved. Certification must be achieved within 18 months of employment.

Information on APSE credentialing can be found here.
Information on how to receive a certificate of achievement from ACRE can be found here.

(NOTE: Employment Skills Development services that are provided in vocational rehabilitation facilities that fall under 55 PA Code Chapter 2390 are not required to have the above credential or certification. Employment Skills Development services provided in the community do require the above credential or certification.)

A complete description of these services and provider qualifications can be found in the CommCare and Independence waivers here.

NOTE: OLTL has scheduled a webinar on Friday, November 18, 2016 at 1:00 pm to review and discuss these new services. Registration is required to participate.

Listed below are the rates for the new employment services:

 
Service PT/Spec CC IW Procedure Code Modifier Region 1 Region 2 Region 3 Region 4 Unit
Benefits Counseling 59/502 X X W1740 $9.78 $10.21 $10.54 10.87 15 mins
Career Assessment 59/503 X X W1732 $11.12 $12.12 $12.39 12.67 15 mins
Employment Skills Development (1:1) 59/505 X X W1728 $9.44 $11.22 $10.07 10.12 15 mins
Employment Skills Development (1:2 to 1:3) 59/505 X X W1729 $3.77 $4.49 $4.03 4.05 15 mins
Employment Skills Development (1:15) 59/505 X X W1741 $6.29 $6.50 $6.96 6.54 15 mins
Job Coaching 1:1 (Follow-Along) 59/504 X X W1733 U5 $9.78 $10.21 $10.54 10.87 15 mins
Job Coaching 1:2 to 1:4 (Follow-Along) 59/504 X X W1734 U5 $3.26 $3.40 $3.51 3.62 15 mins
Job Coaching 1:1 (Intensive) 59/504 X X W1733 U4 $9.78 $10.21 $10.54 10.87 15 mins
Job Coaching 1:2 to 1:4 (Intensive) 59/504 X X W1734 U4 $3.26 $3.40 $3.51 3.62 15 mins
Job Finding 59/530 X X W1735 $11.15 $12.11 $11.98 12.34 15 mins

 

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On November 4, 2016, the Centers for Medicare and Medicaid Services (CMS) published the final rule with comment period for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as the payment program that will replace the Sustainable Growth Rate methodology. The rule finalizes MACRA’s Quality Payment Program, whose primary goal is to reduce administrative burden on physicians to allow them to focus on improving care, promote the adoption of value-based care, and smooth the transition to these new models of care. The final rule establishes guidelines for Medicare health care providers to participate in either the Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS), which consolidates components of three existing programs: the Physician Quality Reporting System, the Physician Value-based Payment Modifier, and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals. According to CMS, the Advanced APMs pathway provides clinicians with the opportunity to be paid more for better care and investments that support patients by reducing existing requirements, while still emphasizing and rewarding quality care. Participants in the advanced APMs must meet the following requirements:

  • Be part of CMS Innovation Center models, Shared Savings Program tracks, or certain federal demonstration programs;
  • Use certified EHR technology;
  • Base payments for services on quality measures comparable to those in MIPS; and
  • Be a medical home model expanded under innovation center authority or require participants to bear more than nominal financial risk for losses.

The final rule has a 60-day comment period, with comments due by Monday, December 19, 2016. RCPA will be offering a webinar in the near future on the details of the final rule, hosted by the American Medical Rehabilitation Providers Association (AMRPA). The date and time will be released soon.

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On October 31, 2016, the Centers for Medicare and Medicaid Services (CMS) announced the awards for the Medicare Fee-for-Service (FFS) Recovery Audit Contractor (RAC) contracts. The five regions include:

  • Region 1 – Performant Recovery, Inc.;
  • Region 2 – Cotiviti, LLC;
  • Region 3 – Cotiviti, LLC;
  • Region 4 – HMS Federal Solutions; and
  • Region 5 – Performant Recovery, Inc.

Pennsylvania is under Region 4. Maps depicting the new regions and related RACs are available in the “Downloads” section of the Future Changes page on CMS’ website.

The RACs in Regions 1–4 will perform post-payment reviews to identify and correct Medicare claims that contain improper payments (overpayments or underpayments), made under Part A and Part B, for all provider types other than Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Home Health/Hospice. The Region 5 RAC will be dedicated to the post-payment review of DMEPOS and Home Health/Hospice claims nationally. These awards continue the implementation of many of the Recovery Audit Program enhancements designed to reduce provider burden, enhance program oversight, and increase transparency in the program. CMS will continue to update this website with more information on the implementation of the new RACs.

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