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CMS

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ODP Announcement 22-122 is to remind providers that this is the time of year to being the Provider Qualification process. The Centers for Medicare and Medicaid Services (CMS) require a statewide process to ensure providers are qualified to render services to waiver-funded individuals. The Provider Qualification Process described outlines the steps the Assigned AE and provider must follow to meet these requirements and the steps Supports Coordinators (SCs) must take to transition individuals if needed. This communication does not describe the qualification process for SC organizations

The release of this communication obsoletes ODP Announcement 22-005 Provider Qualification Process. In addition, the qualification process for Providers enrolled in the Adult Autism Waiver can be found in ODP Announcement 20-110.

Providers that are shared across Intellectual Disability/Autism (ID/A) and the Adult Autism Waiver (AAW) must complete the Provider Qualification processes with both the AE for the ID/A waivers and the Bureau of Supports for Autism and Special Populations (BSASP) for the AAW.

Providers must submit the qualification documentation (Posted on MyODP — DP 1059 and the Provider Qualification Documentation Record with all required supporting documentation) by 03/31 of the year that their requalification is due.

Failure to meet this deadline will affect the assigned AE’s ability to requalify the provider by the due date of 04/30. The updated ODP Provider Qualification Documentation Record contains all instructions and qualification requirements.

For inquiries regarding this communication, contact the ODP Provider Qualification inbox.

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The Centers for Medicare and Medicaid Services (CMS) published the calendar year (CY) 2023 Medicare Physician Fee Schedule (MPFS) in the Federal Register for November 18, 2022. Some of the key provisions contained in the final rule include (and are effective on January 1, 2023):

Medicare Telehealth Services

  • Addition of new HCPCS codes to the list of Medicare telehealth services on a Category 1 basis.
  • Implementation of the 151-day extensions of Medicare telehealth flexibilities, including allowing telehealth services to be provided in any geographic area and in any originating site setting.
  • Permission for physical therapists, occupational therapists, speech-language pathologists, and audiologists to provide telehealth services.
  • Listing of codes added to the telehealth services list are here.

Evaluation & Management (E&M) Visits

  • For CY 2023, CMS finalized changes for “Other E/M” visits that parallel the changes that were made in recent years for office/outpatient E/M visit coding and payment. Other E/M visits include hospital inpatient, hospital observation, emergency department, nursing facility, home services, residence services, and cognitive impairment assessment visits.

Behavioral Health

  • Proposal finalized to create a new HCPCS code (G0323) describing General Behavioral Health Integration performed by clinical psychologists or clinical social workers to account for monthly care integration where the mental health services provided are serving as the focal point of care integration.

Chronic Pain Management

  • Finalized a CY 2023 proposal to create two new G codes (G3002 and G3003) performed by physicians and other qualified health professionals describing monthly CPM for payment starting January 1, 2023.

Opioid Treatment Programs (OTPs)

  • CMS finalized the proposal to allow the OTP intake add-on code provided via 2-way, interactive, audio-video technology when billing for the initiation of treatment with buprenorphine using audio-video technology to start treatment with buprenorphine as authorized by the Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) at the time the service is provided.
  • CMS also finalized the proposal to permit the use of 2-way, interactive, audio-only technology to start treatment with buprenorphine in cases where audio-video technology isn’t available to the patient and all other applicable requirements are met.

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ODP Announcement 22-117 serves to announce a 30-day public comment period on the Residential and Community Participation Support (CPS) service locations that the Office of Developmental Programs (ODP) proposes to submit to the Centers for Medicare and Medicaid Services (CMS) for Heightened Scrutiny. Public comment on each service location will be accepted until 11:59 pm on December 19, 2022.

A summary of ODP’s findings for each Residential and CPS service location that ODP has determined meets one or more of these criteria is available at MyODP and DHS. A description of the process ODP used to identify service locations, complete reviews, and make determinations is also available on both websites.

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The Centers for Medicare and Medicaid Services (CMS) announced that the next hospital/quality initiative open door forum has been scheduled for November 29, 2022, at 2:00 pm. Agenda topics for the call include:

  • Announcements & Updates
    • Hospital Price Transparency Sample Format Announcement
    • OPPS/ASC Final Rule Policies
    • Rural Emergency Hospital (REH) Policies
      • REH Conditions of Participation
      • REH Payment
      • REH Enrollment
      • REH Physician Self-Referral Law Update
    • OPPS Payment Policies
      • Annual Update
      • Remote Behavioral Health Services
      • 340B Drugs
      • Clinic Visit — Rural Sole Community Hospital Exemption
      • Payment Adjustment for Domestically Made N95 Masks
    • ASC Payment Policies
      • Annual Update
      • Non-Opioid Alternatives Under Section 6082 of the SUPPORT Act
    • Partial Hospitalization Program Policies
    • Organ Acquisition Payment Policies
      • Counting Research Organs
      • Costs of Potential Organ Donors for Cardiac Deaths
  • Open Q&A

To participate: dial 888-455-1397 and reference conference passcode: 5109694.

Instant replay (audio recording) of the call will be available: 888-562-0227 through December 1, 2022. No passcode is needed.

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The Centers for Medicare and Medicaid Services (CMS) has released a new Frequently Asked Question (FAQ) document that addresses how their review contractors (Medicare Administrative Contractors, Recovery Audit Contractors, and the Supplemental Medical Review Contractor) will conduct medical reviews after the COVID-19 public health emergency (PHE). Read the FAQ here.

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Date: November 16, 2022
Time: 1:30 pm – 3:00 pm EST

The Medicaid Home and Community-Based Services (HCBS) Settings Final Rule was made effective on March 17, 2014. The settings rule set specific requirements for settings presumed to have institutional characteristics, including settings in institutions, settings on the grounds of or adjacent to a public institution, and settings that have qualities that isolate Medicaid beneficiaries. Referred to as “presumptively institutional settings,” states are required to assess these settings and, where the state has determined that the setting overcomes the institutional presumption and the setting complies or will comply with the settings rule by March 17, 2023, submit to CMS documentation that demonstrates the setting’s compliance. CMS has launched a series of heightened scrutiny site visits to presumptively institutional settings in states. This training will cover:

  • An overview of CMS’ heightened scrutiny site visit process;
  • Overarching themes identified during CMS’ heightened scrutiny site visits; and
  • Considerations for states moving forward.

Following the presentation, webinar participants will have the opportunity to share any questions, comments, experiences, or suggestions with CMS and the presenter.

Please register for this webinar here.
Conference Line: 844-875-7777; Access Code: 715810#

Please note that closed captioning will be provided.

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ODP Announcement 22-112 informs all interested parties that on October 31, 2022, the Department submitted Pennsylvania’s Statewide Transition Plan to the Centers for Medicare & Medicaid Services (CMS). CMS is responsible for reviewing the Statewide Transition Plan to ensure all federal regulatory requirements are met. During the review process, CMS may request that technical changes be made to the plan. When this occurs, CMS usually includes a summary of changes made with the final approval letter. The Department will notify all interested stakeholders when CMS has given its approval and will make the approved version available at that time.

The Statewide Transition Plan may be viewed here. Questions about the Statewide Transition Plan or this communication should be sent electronically.

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This week, the Centers for Medicare & Medicaid Services (CMS) announced the Calendar Year 2023 Physician Fee Schedule (PFS) final rule. The final rule includes several National Council and RCPA recommended priorities. These are wins for mental health and substance use care organizations that will help expand access to care by strengthening the workforce.

RCPA recommends members review this 2023 Physicians Fee Schedule Final Rule Summary for impacts on your agencies practice and/or policies.

Key Highlights:

  • Telehealth Flexibility Extensions: CMS is extending telehealth flexibilities implemented under the Public Health Emergency (PHE) for a 151-day period after the expiration of the PHE.
  • CMS is allowing behavioral health clinicians to offer services incident to a Medicare practitioner under general (rather than direct) supervision.
  • Licensed professional counselors and marriage and family therapists are now able to bill incident to Medicare practitioner for their services.
  • Medicare will allow opioid treatment programs to use telehealth to initiate treatment with buprenorphine for patients with opioid use disorder, continuing the flexibilities under the Ryan Haight Act of 2008.
  • CMS is also clarifying that opioid treatment programs can bill for opioid use disorder treatment services provided through mobile units, such as vans, in accordance with Substance Abuse and Mental Health Services Administration (SAMHSA) and Drug Enforcement Administration (DEA) guidance.

The Final Rule, in alignment with the Consolidated Appropriations Act (CAA) of 2022, implements an extension of a number of flexibilities for a 151-day period after the expiration of the Public Health Emergency (PHE), which is set to expire on January 11, 2023.

In the event of further extensions of the federal PHE, we will communicate this info to members. Under the current timeframe for PHE continuation, states must be notified by November 11, 2022.

We thank our members and Steering Committees for their guidance, recommendations, and support through the review process. If you have any questions, please contact your respective RCPA Policy Director.

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