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Tags Posts tagged with "CMS"

CMS

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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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ODP Announcement 23-013 informs all interested parties of the submission of Pennsylvania’s Heightened Scrutiny locations to the Centers for Medicare and Medicaid Services (CMS). The information submitted is available on the Department of Human Services’ (Department) website.

On February 1, 2023, the department submitted all locations identified as requiring a Heightened Scrutiny review by CMS. The information submitted may be viewed at the bottom of this web page. CMS will make final heightened scrutiny review determinations available online. Questions about Heightened Scrutiny or this communication should be sent electronically.

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The Centers for Medicare and Medicaid Services (CMS) has updated the calendar year (CY) 2023 per beneficiary threshold amounts for therapy services. These threshold amounts, also known as therapy caps, are reflected on claims with the KX modifier to confirm that services are medically necessary as justified by appropriate documentation in the medical record. There is one amount for Physical Therapy (PT) and Speech-Language Pathology (SLP) services combined and a separate amount for Occupational Therapy (OT) services. Claims from providers for therapy services above the threshold amounts without the KX modifier are denied.

For CY 2023, the KX modifier threshold amounts are: (a) $2,230 for PT and SLP services combined, and (b) $2,230 for OT services.

For additional information, refer to CMS Transmittal 11626 and the 2023 Therapy Code List and Dispositions.

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Date: February 8, 2023
Time: 1:30 pm – 3:00 pm ET
Registration Required
Closed captioning will be available.

In this webinar, the Department of Long-Term Services and Supports (DLTSS) will be discussing state requirements and opportunities for resuming Medicaid Home and Community-Based Services (HCBS) operations when we approach the end of the Public Health Emergency (PHE). This includes:

  • CMS resources to support states in unwinding PHE flexibilities, including considerations for HCBS;
  • An overview of HCBS-related PHE flexibilities to unwind, with a focus on the 1915(c) HCBS in 1915(c) waivers and the Centers for Medicare and Medicaid (CMS) approval process;
  • An overview of HCBS-related PHE flexibilities that can be made permanent in 1915(c) waivers and the CMS approval process; and
  • Other considerations for HCBS programs when unwinding from the PHE.

Following the presentation, webinar participants will have the opportunity to ask questions.

Register Today!

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The Centers for Medicare and Medicaid Services (CMS) issued a press release announcing an increase in three accountable care initiatives that will grow and provide higher quality care to more than 13.1 million people with Medicare in 2023. The initiatives include:

The Shared Savings Program is the largest accountable care initiative in the country and is a permanent program in Medicare that was established by the Affordable Care Act (ACA). The Shared Savings Program has 456 ACOs and 10.9 million assigned beneficiaries in 2023. While the Shared Savings Program experienced a decrease in the number of ACOs and assigned beneficiaries for 2023, the policies finalized in the calendar year (CY) 2023 Medicare Physician Fee Schedule final rule are expected to grow participation in the program for 2024 and beyond, when many of the new policies are set to go into effect. These policies are expected to drive growth in participation, particularly in rural and underserved areas, promote equity, and advance alignment across the accountable care initiatives, and increase the number of beneficiaries assigned to ACOs participating in the program by up to four million over the next several years.

The ACO REACH Model aims to improve the quality of care for people with Traditional Medicare through better care coordination and by increasing access to accountable care in underserved communities. Innovative features the Model will test include benchmark adjustments to shift payments to better support care for the underserved and enhanced Medicare benefits, including care in the home. In 2023, ACO REACH will increase access to accountable care in underserved populations. The ACO REACH Model will have 824 Federally Qualified Health Centers, Rural Health Centers, and Critical Access Hospitals participating in 2023 — more than twice the number in 2022. Increasing the number and reach of ACOs in underserved communities will help close racial and ethnic disparities that have been identified among people with Traditional Medicare in accountable care relationships.

The KCC Model focuses on coordinating care for Medicare beneficiaries with chronic kidney disease stages 4 and 5 and end-stage renal disease (ESRD). In addition to care coordination, the KCC Model focuses on key areas of concern for this population, including delaying the onset of dialysis and increasing access to kidney transplantation so more patients can live fuller and longer lives.

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ODP Announcement 23-008 announces that the amendment to the Adult Autism Waiver (AAW), effective January 1, 2023, was approved by the Centers for Medicare & Medicaid Services (CMS) on January 13, 2023. The amendment to the AAW includes the following substantive changes:

  • Adding reserved waiver capacity for individuals who are discharged from a state center or are released from incarceration after a period of at least six consecutive months.
  • Aligning of provider qualifications in the AAW with the Consolidated, Community Living, and Person/Family Directed Support (P/FDS) waivers, whenever possible.
  • Allowing relatives to deliver the Life Sharing component of the Residential Habilitation service.
  • Requiring that agencies that provide Residential Habilitation/Life Sharing be qualified and enrolled to provide Residential Habilitation/Life Sharing in the Consolidated or Community Living waivers.
  • Increasing the annual fiscal limit in the Transportation service to $5,000 per participant’s Individual Support Plan (ISP) year.
  • Allowing one of the four required individual monitorings conducted by the Supports Coordinator each year to be conducted remotely. NOTE: For all individuals receiving Residential Habilitation (Community Homes or Life Sharing), remote monitorings are not permitted. See ODP Announcement 22-085 for additional information.
  • Allowing delivery of direct services using remote technology (teleservices). The requirements in the AAW will become effective when Appendix K flexibilities expire, six months after the expiration of the federal COVID-19 public health emergency.
  • Aligning the Assistive Technology service, where possible, with the Consolidated, Community Living, and P/FDS waivers. This includes adding generators for the participant’s primary residence.
  • Adding a new service, Remote Supports. A separate communication will be published in the coming weeks, providing instructions about how to add new Remote Supports procedure codes to ISPs. Remote Supports should not be added to ISPs until this communication is published.

The waiver application approved by CMS and the record of change document are available here.

ODP will be holding a webinar to discuss major changes made in the approved AAW amendment. Webinars specific to Remote Supports will be scheduled and communicated in the coming weeks. The date, time, and registration link for the general AAW amendment webinar are as follows:

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The Office of Management and Budget (OMB) has released the Unified Regulatory Agenda and Regulatory Plan, which outlines regulatory actions federal agencies are considering in the coming months. Regulations can be searched by specific agency, such as Department of Health and Human Services (HHS), which includes the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA).

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