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In July 2016, the Centers for Medicare and Medicaid Services (CMS) proposed new bundled payment models to shift Medicare payments from rewarding quantity to rewarding quality by creating strong incentives for hospitals and clinicians to deliver better care to patients at a lower cost. These proposed new bundled payment models focus on heart attacks, heart bypass surgery, and hip fracture surgery, and would reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery. This proposal follows the implementation of the Comprehensive Care for Joint Replacement (CCJR) Model that began earlier this year which introduced bundled payments for certain hip and knee replacements.

CMS just released the second annual evaluation report for Models 2–4 of the Bundled Payments for Care Improvement (BPCI) Initiative, which include both retrospective and prospective bundled payments that may or may not include the acute inpatient hospital stay for a given episode of care. This report describes the characteristics of the participants and includes quantitative results from the first year of the initiative. Key highlights include:

  • 11 out of the 15 clinical episode groups analyzed showed potential savings to Medicare. Future evaluation reports will have more data to analyze individual clinical episodes within these and additional groups;
  • Orthopedic surgery under Model 2 hospitals showed statistically significant savings of $864 per episode while showing improved quality as indicated by beneficiary surveys. Beneficiaries who received their care at participating hospitals indicated that they had greater improvement after 90 days post-discharge in two mobility measures than beneficiaries treated at comparison hospitals; and
  • Cardiovascular surgery episodes under Model 2 hospitals did not show any savings yet but quality of care was preserved. Over the next year, we will have significantly more data available, enabling CMS to better estimate effects on costs and quality.

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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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The Department of Human Services (DHS) Secretary Ted Dallas announced several improvements to ChildLine, the department’s child abuse hotline, as well as to the child abuse history clearance process.

“Keeping children safe is a critical part of our mission at DHS and has been a priority of the Wolf Administration from day one,” said DHS Secretary Ted Dallas, “The improvements we are announcing today represent the highest performance levels since 24 new bills that amended the child protection law went into effect in January 2015.” The department experienced significant challenges in January 2015, when the changes went into effect, and by the Wolf Administration’s first day in office, DHS was inundated with calls and clearance applications that the department was not adequately staffed or funded to handle. From 2014 – 2015, the department experienced:

  • 14 percent increase in calls to ChildLine from 164,911 to 188,357;
  • 39 percent increase in reports of suspected child abuse; and
  • 162 percent increase in clearance requests from 587,545 to 1,536,921.

As a result of these increases, performance and ChildLine suffered in early 2015. Specifically:

  • Processing time for child abuse clearances averaged 26 days – well above the 14 days required by law;
  • 48 percent of clearances were processed on time; and
  • 43 percent of calls to ChildLine were abandoned or deflected.

DHS acted immediately to address these issues by adding staff and improving training. In addition, DHS has implemented technology changes that properly record all calls, regardless of the nature of the call, and make it easier for staff to receive and process calls. As a result, DHS data today reads much differently:

  • Clearances are processed on average in 1.6 days, well below the statutorily required 14 days;
  • 100 percent of clearances are processed on time; and
  • The abandoned or deflected rate is down to 2 percent.

“None of the improvements I am announcing today could have happened without the hard work of staff at DHS and, on behalf of the administration, I thank them for all their efforts,” said Dallas. DHS has also encouraged individuals to use its website to get more information on the changes to the law, mandated reporting information and training, and clearances. This has resulted in approximately 80 percent of clearance requests and 42 percent of child abuse referrals currently coming in electronically, reducing paperwork for staff and the public.

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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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On August 25, RCPA, in collaboration with key state agencies, hosted a webinar on changes impacting providers of child and adolescent autism services as well as HealthChoices managed care organizations. The webinar also reviewed the use of 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.

The webinar also included a review of updated information and guidance for families that providers can duplicate and make available to families of children with an autism spectrum disorder. Visit the DHS Act 62 web page for resources to use when communicating with families, including:

  • Fact Sheet
  • Frequently Asked Questions
  • How to Appeal
  • Sample Appeal Letters
  • Act 62 Infographics

Representatives from the Department of Human Services (DHS) and the Insurance Department reviewed the recently issued 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 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. New codes will be implemented by September 30. The recording of the webinar is available for review. The Power Point presentations for both the managed care and the service provider presentations are also now available.

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