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CMS

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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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ODP Announcement 22-108 has been issued to announce that the Office of Developmental Programs (ODP) is adding a new provider qualification to the Consolidated, Community Living, and Adult Autism Waivers for residential services. All provider staff who will spend any time alone with a participant during the provision of residential services must complete a “Department approved training on the common health conditions that may be associated with preventable deaths in people with an intellectual or developmental disability.”

The Office of Developmental Programs (ODP) anticipates that the new qualification requirement will become effective between mid-October and late December of 2022 based on feedback from the Centers for Medicare and Medicaid Services (CMS). This guidance is being released prior to CMS approval of the Consolidated and Community Living waiver renewals and the Adult Autism Waiver (AAW) amendment to give providers sufficient time to implement this new requirement.

This applies to provider staff that are direct employees of an agency, contracted employees of an agency, or volunteers. A list of Department approved trainings to meet this requirement is available here.

This page lists each organization with currently approved training(s). The approved training(s) that must be completed for the organization are listed next to the “details” bullet underneath the organization. To meet the qualification requirement, staff are required to complete approved training(s) through one of the organizations listed. Provider staff hired before the effective date of the waiver changes must complete the required training no later than three months after the effective date of the waiver changes. Provider staff hired on or after the effective date of the waiver changes must complete the required training before working alone with an individual. For purposes of this requirement, a provider staff is “working alone” when they are not in the line of sight of other persons who have received Department-approved training.

For current providers, AEs or ODP (for the AAW) will verify that residential services staff received the required training the next time the provider goes through the requalification process.

Questions relating to this announcement may be directed to the ODP Provider Qualification Unit for Consolidated and Community Living Waiver providers. Adult Autism Waiver providers should send questions to BSASP Provider Enrollment.

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The Centers for Medicare and Medicaid Services (CMS) released a Request for Information (RFI) that seeks public input on the concept of establishing a National Directory of Healthcare Providers and Services (NDH) that could serve as a centralized data hub for health care provider, facility, and entity directory information nationwide. The goal of this directory is to improve access to care, reduce clinician burden, and support interoperability throughout the health care sector.

CMS is seeking comment on how a CMS-led directory could reduce directory maintenance burden on providers and payers by creating a single, centralized system, promoting real-time accuracy for patients.

Feedback obtained in response to the RFI will aid CMS’ understanding of the current landscape of health care directories, as well as information useful to CMS when considering an NDH. CMS is specifically requesting public feedback on the NDH concept and potential benefits, provider types, entities and data elements that could be included to create value for the health care  industry, the technical framework for an NDH, priorities for a possible phased implementation, and prerequisites and actions CMS should consider taking to address potential challenges and risks.

The RFI will be published in the Federal Register on October 7, 2022. Comments on the RFI will be accepted through December 6, 2022.

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RCPA has been in communication with the American Medical Rehabilitation Providers Association (AMRPA), who has been working with the Centers for Medicare and Medicaid Services (CMS) to ensure inpatient rehabilitation facilities (IRFs) do not face inappropriate non-compliance penalties related to the IRF Patient Assessment Instrument (PAI) version 4.0 that is set to go into effect tomorrow (October 1, 2022). One particular concern is new items in version 4.0 do not include a “skip logic” to account for unplanned discharges that classify as incomplete stays. This oversight could lead to many IRFs not meeting the 95 percent data completion threshold for the Inpatient Rehabilitation Facility Quality Reporting Program (IRF QRP).

Yesterday, CMS released a statement on the issue along with a Question & Answer (Q&A) document. CMS also noted that the agency will determine if a permanent fix is necessary and will release any related guidance or data specifications in the coming weeks.

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The Department of Human Services (DHS) Office of Long-Term Living (OLTL) has announced the launch of the American Rescue Plan Act of 2021 (ARPA) Funding Reporting portal. The online portal will be available on September 30, 2022, for OLTL providers to submit costs associated with ARPA funding distributed in 2021 in order to comply with DHS reporting requirements.

Background: ARPA Funding Information 

In 2021, federal funding from ARPA was allocated by the General Assembly under Act 24 and enacted by Governor Wolf to provide funding to nursing facilities (NF), personal care homes (PCH), and assisted living residences (ALR). These ARPA funds should be used for COVID-19 relief for costs not otherwise reimbursed by federal, state, or other sources of funding.

In addition, ARPA provided a temporary 10 percent increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for home and community-based services (HCBS). The funding must be used to enhance, expand, or strengthen HCBS. OLTL outlined in its plan to the Centers for Medicare & Medicaid Services (CMS) initiatives to strengthen the workforce and assist Adult Day Services (ADS) providers. The OLTL ARPA plan directed funding to Personal Assistance Service (PAS), Community Integration (CI), and Residential Habilitation (Res Hab) providers to assist with recruitment and retention of direct care workers. The plan also directed additional funding to providers to strengthen ADS.

ARPA funding must be used for things such as sign-on bonuses, retention payments, COVID-19 related leave benefits and paid time off, vaccination incentives, and/or the purchase of personal protective equipment and testing supplies. Additionally, ADS providers can use the funding for retrofitting adult daily living centers, expenses to re-open the centers, and expenses to develop alternative models to provide ADS.

Additional detailed information about the distribution of the 2021 ARPA funding can be found on the DHS Long-Term Care Providers web page.

ARPA Funding Reporting Portal
Effective September 30, 2022, providers can access the portal and begin to report ARPA 2021 costs. Providers can access the portal through the Funding Portal Login web page. The first report due date will be November 30, 2022, and should reflect two reporting periods. Providers are required to submit reports in the portal on a bi-annual basis thereafter according to their exhaustion of the funds. Please reference the chart below.

Report Period 

Due Dates 

07/01/2021 – 12/31/2021

01/01/2022 – 06/30/2022

 11/30/2022
07/01/2022 – 12/31/2022 2/28/2023
 01/01/2023 – 6/30/2023 8/30/2023
 07/01/2023 – 12/31/2023 2/28/2024

Providers must keep all documentation related to the costs reported in the final cost report for a minimum of five years.

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