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Tags Posts tagged with "CMS"

CMS

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Late yesterday, the Centers for Medicare and Medicaid Services (CMS) issued the fiscal year (FY) 2024 inpatient rehabilitation facility prospective payment system (IRF PPS) proposed rule.

The proposed rule includes a 3.7 percent payment increase, compared to the 3.9 percent payment update that CMS finalized for FY 2023. This payment update reflects the effects of the proposed IRF market basket update for FY 2024 of 3.0 percent, which is based on the proposed IRF market basket increase factor (3.2 percent), productivity adjustment (0.2 percent), and outlier payment increase (0.7 percent).
** Please note that these figures are subject to change in the final rule if updated forecasts become available, which typically occurs.

CMS is making a number of changes to the Quality Reporting Program (QRP), including the future addition of a discharge function score measure and patient-level COVID vaccination measure as well as a modification of the current healthcare personnel COVID-19 vaccination measure to reflect the latest vaccination recommendations.

In addition, CMS is proposing to allow hospitals to open a new IRF unit and begin being paid under the IRF PPS at any time during the cost reporting period (rather than the current restrictive enrollment rules). The proposed rule does not address any of the COVID-19 PHE waivers, including the three-hour rule and virtual team conferences, nor does it include any further discussion of the expanded transfer policy (to include certain discharges under the care of home health) that was the subject of a Request for Information (RFI) in last year’s rule.

A more detailed and extensive summary of the proposed rule will be forthcoming.

The proposed rule will be published in the Federal Register for April 7, 2023. Comments on the proposed rule will be considered until 5:00 pm on June 2, 2023. For additional information, CMS also released a fact sheet.

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The Office of Long-Term Living (OLTL) has released the transition plans that outline how the Appendix K flexibilities will be phased out on May 11, 2023, with the end of the Public Health Emergency. The transition plans apply to the Community HealthChoices (CHC) Waiver, OBRA Waiver, and Act 150 program.

Since March 6, 2020, the Office of Long-Term Living (OLTL) has been operating under an Appendix K Emergency Preparedness and Response amendment that was approved by the Centers for Medicare & Medicaid Services (CMS). Appendix K allowed temporary changes to the CHC Waiver, OBRA waiver, and Act 150 waiver in response to the COVID-19 Public Health Emergency.

Effective May 11, 2023, OLTL is discontinuing the emergency flexibilities noted in the attached guidance and is returning to pre-emergency operations. Providers should make any changes that are necessary to resume normal operations and be in compliance by May 11, 2023. Service Coordinators have been instructed to work with participants and providers to ensure a seamless transition to normal operations.

The transition plans have been updated to reflect the new expiration date for the flexibilities. In addition, as a general note, resuming pre-emergency waiver operations means the following:

  • All assessments, including the comprehensive needs assessments and reassessments, must be conducted face-to-face;
  • Service Coordinators must monitor participants and Individual Services Plans (ISPs) through face-to-face contacts; and
  • ISP meetings and development must be conducted face-to-face.

Questions about this information should be directed to the OLTL Provider Helpline at 800-932-0939.

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The Centers for Medicare and Medicaid Services (CMS) has approved the Office of Long-Term Living’s (OLTL) OBRA Waiver Amendment. Changes in the approved OBRA Waiver Amendment include:

  • Revised the Benefits Counseling service definition;
  • Amended the responsibilities of the Fiscal/Employer Agent;
  • Updated Appendix H Quality Improvement Strategy to the current process; and
  • Removed performance measure AA-6, as the data in AA-6 is being collected by AA-5.

The current approved OBRA Waiver document can be viewed here. If you have any questions, please contact the OLTL Bureau of Policy Development and Communications Management at (717) 857-3280.

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The Centers for Medicare and Medicaid Services (CMS) has created short videos and developed patient cue cards to assist providers with learning how to code patient assessment instruments for the following Post-Acute Care (PAC) Quality Reporting Programs (QRP):

Help LTCH, IRF, and HH patients select responses by showing them the new cue cards for:

See LTCH, IRF, HH, and SNF Quality Reporting Program Training for more information.

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The Centers for Medicare and Medicaid Services (CMS) has released the updated inpatient rehabilitation facility (IRF) provider preview reports. These ‎reports contain provider performance scores for quality measures and contain IRF-Patient Assessment Instrument (PAI) data submitted ‎by IRFs from Quarter 4 2021 through Quarter 3 2022, as well as Centers for Disease Control and Prevention (CDC) Clostridium Difficile (CDI) and Catheter-‎Associated Urinary Tract Infections (CAUTI) measures from Quarter 4 2021 through Quarter 1 2022 and Quarter 4 2021 ‎through Quarter 1 2022 of the Healthcare Personnel (HCP) Influenza measure. The HCP COVID-19 Vaccination ‎Coverage measure data for Quarter 3 2022 is also included. ‎

Providers have until April 14, 2023, to review their performance data. Providers can request CMS ‎review their data during the preview period if they believe the scores are inaccurate. The final reports ‎will be published on Care Compare and Provider Data Catalog (PDC) during the June 2023 refresh of ‎the website. For additional information, visit the CMS IRF QRP Public Reporting website.

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The Centers for Medicare and Medicaid Services (CMS) has approved the renewal of the Community HealthChoices (CHC) 1915(b) waiver effective January 1, 2023, for a 5-year period. Under the 1915(b) waiver, Pennsylvania operates the CHC managed care program.

As part of the CHC 1915(b) waiver renewal, the Office of Long-Term Living (OLTL) was required to obtain an independent evaluation or assessment of its CHC waiver program and submit the findings when renewing the CHC 1915(b) waiver.

The CHC 1915(b) waiver renewal and the Independent Assessment of the 1915(b) waiver are posted to the CHC-Supporting Documents website. Questions about the CHC 1915(b) waiver amendment or Independent Assessment can be submitted electronically.

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On February 15, 2023, the Centers for Medicare and Medicaid Services (CMS) released a proposed National Coverage Determination (NCD) that power seat elevation equipment on Group 3 power wheelchairs falls within the benefit category for durable medical equipment (DME).

CMS is proposing that the evidence is sufficient to determine that power seat elevation equipment is reasonable and necessary for individuals using power wheelchairs when all of the following conditions are met:

  • The individual performs weight bearing transfers to/from the power wheelchair while in the home, using either their upper extremities during a non-level (uneven) sitting transfer and/or their lower extremities during a sit to stand transfer. Transfers may be accomplished with or without caregiver assistance and/or the use of assistive equipment (e.g. sliding board, cane, crutch, walker); and,
  • The individual has undergone a specialty evaluation by a practitioner who has specific training and experience in rehabilitation wheelchair evaluations, such as a physical therapist (PT) or occupational therapist (OT), that assesses the individual’s ability to safely use the seat elevation equipment in the home.

The proposed NCD is open for public comment for 30 days. The 30-day comment period will close on March 17, 2023.

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The Centers for Medicare and Medicaid Services (CMS) has published resources to assist healthcare workers prepare for the end of the public health emergency (PHE) on May 11, 2023. Included in these resources are a number of provider-specific fact sheets for information about COVID-19 PHE waivers and flexibilities; two specific documents included are the Long-Term Care Facilities and Inpatient Rehabilitation Facilities fact sheets.

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