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CMS

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ODP Announcement 23-002 reports that the renewals for the Consolidated, Community Living, and Person/Family Directed Support (P/FDS) Waivers have been approved by the Centers for Medicare & Medicaid Services (CMS) with an effective date of January 1, 2023. CMS approves waivers for a five-year period. The current Consolidated, Community Living, and P/FDS Waivers expired June 30, 2022, but were extended twice as discussions continued between the Office of Developmental Programs (ODP) and CMS.

Major changes in the renewals include:

  • Remote Supports has been added as a separate, discrete service in all three waivers.
  • Clarification about the activities that can be performed under the Communication Specialist service has been added, the amount of Communication Specialist services that participants can receive each year has increased from 40 hours to 60 hours, and effective January 1, 2024, the communication specialist will be required to successfully complete training provided by ODP.
  • The amount of Benefits Counseling services that participants can receive each year has increased from 10 hours to 15 hours.
  • The amount of tuition that can be covered through Education Support services has increased from $35,000 to $40,000.
  • Companion services have expanded to support additional participants at their place of employment.
  • Supported Employment services can now support participants during work-related trips.
  • Participant Directed Goods and Services have been added to the Consolidated Waiver.
  • The purpose of the Supports Broker service has been clarified, and recertification requirements for Supports Brokers have been added.
  • The Specialized Supplies service will continue to cover personal protective equipment once Appendix K flexibilities end.
  • Music, Art, and Equine-Assisted Therapy are available to individuals who receive residential services.
  • Staff working for, or contracting with, Residential Habilitation, Life Sharing, or Supported Living providers must complete Department-approved training on the common health conditions that may be associated with preventable deaths.
  • Clarification about requirements for using technology in the provision of waiver services has been added with a focus on protecting individual privacy when using technology.
  • Clarification about experience and education requirements for Supports Coordinators and Supports Coordinator Supervisors has been added, and Supports Coordinators will continue to be allowed to use teleservices to perform some of the required face-to-face monitoring per year.

A list of all major changes made in the renewals is available in the record of change document and each full waiver application approved by CMS, which are available at:

ODP will be holding a webinar to discuss major changes made in these approved waiver renewals on February 9, 2023, from 1:00 pm – 2:00 pm. You can register for the webinar here.

Questions about this communication should be directed to the appropriate Office of Developmental Programs Regional Office.

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In an effort to provide additional information on a new provider type recently announced by the Centers for Medicare and Medicaid Services (CMS), a Medicare Learning Network (MLN) fact sheet was released. This new provider type, Rural Emergency Hospitals (REH), is a new Medicare Part A provider type. Starting January 1, 2023, Medicare will pay for Medicare-enrolled REHs to deliver emergency hospital, observation, and other services to Medicare patients on an outpatient basis. Additional information, including how to become an REH, billing, payment, reporting quality data, etc. is available in the fact sheet.

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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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