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Tags Posts tagged with "CMS"

CMS

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The Centers for Medicare and Medicaid Services (CMS) recently announced the availability of the inpatient rehabilitation facility (IRF) provider preview reports. These reports have been updated and contain information based on quality data submitted by IRFs between Quarter 3 of 2018 and Quarter 2 of 2019. The data will reflect what will be published on IRF Compare during the March 2020 update of the website.

Providers have 30 days (December 9, 2019 – January 9, 2020) to review their performance data. While corrections to the underlying data will not be permitted during this time, providers can request CMS to review their data during the preview period if they believe the quality measure scores that are displayed are inaccurate.

Additionally, providers are reminded that the data for the quality measure Percent of Residents or Patients that have new or worsened Pressure Ulcers (short stay), will continue to reflect data collected between Quarter 3 2017 – Quarter 2 2018, and will continue to be publicly displayed until the new Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury, is publicly displayed in fall 2020, as finalized in the fiscal year (FY) 2018 IRF PPS Final Rule.

As of the March 2020 refresh, CMS will no longer publicly display the measure Percent of Residents or Patients who were assessed and appropriately given the seasonal influenza vaccine (short stay), as finalized in the FY 2019 IRF PPS Final Rule. This change is reflected in preview reports. Contact RCPA Rehabilitation Services Director Melissa Dehoff with questions.

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The Centers for Medicare and Medicaid Services (CMS) recently notified the Office of Long-Term Living (OLTL) of the approval of the OBRA Waiver amendment. The amendment is effective on January 1, 2020.

The changes in the approved amendment include:

  • Revise the Residential Habilitation service definition by modifying the number of hours that are defined as a day unit from a minimum of 12 hours to 8 hours.
  • Revise the service definitions of Job Finding, Job Coaching, Employment Skills Development, Career Assessment, and Benefits Counseling to address when employment services can be provided through the OBRA waiver, should the Office of Vocational Rehabilitation (OVR) have a waiting list (closed order of selection) or when OVR has not made an eligibility determination within 120 days.
  • Update the Abuse Registry Screening information to reflect that the Department of Human Services (DHS) utilizes IDEMIA as the data system to process fingerprint-based FBI criminal record checks, as well as other minor changes.
  • Revise cost neutrality estimates to reflect rate changes to the Personal Assistance Services (PAS) and Residential Habilitation waiver services.

If you have any questions, please contact the OLTL Bureau of Policy Development and Communications Management at 717-857-3280.

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ODP Announcement 19-102 provides information regarding the amendments submitted to the Centers for Medicare and Medicaid Services (CMS) regarding the Consolidated, Community Living, and P/FDS waivers. It is anticipated that the amendments will become effective October 1, 2019.

CMS has 90 days to review the amendments and changes may occur to the content based upon discussion with CMS during the approval process. Each full waiver application, as well as a side-by-side of substantive changes made as a result of public comment is available online here.

The amendments align with 55 Pa. Code Chapter 6100 regulations when effective, ensure compliance with the Home and Community-Based Settings regulations, and align with the Office of Developmental Programs’ Everyday Lives recommendations.

The amendments include a plan to serve medically complex children in a community home when transitioning from an extended hospital stay if they are unable to return to their family home. Also, the scope of professionals who can diagnose intellectual disability has been expanded.

ODP is adding the expectation that all providers of Community Participation Support services must offer individuals opportunities to participate in community activities that are consistent with the individual’s preferences, choices, and interests. On-call and remote support is proposed in order to support the fading of service and dependence on paid staff. The number of procedure codes and staffing levels has been decreased to more accurately reflect service delivery.

Starting January 1, 2022, CPS services may not be provided in any facility required to hold a 2380 or 2390 license that serves more than 150 individuals at any one time, including individuals funded through any source. All participants receiving prevocational services must have a competitive integrated employment outcome included in their service plan. There must be documentation in the service plan regarding how and when the provision of prevocational services is expected to lead to competitive integrated employment. CPS may not be provided in newly funded (on or after January 1, 2020) licensed 2380 or 2390 locations which serve more than 25 individuals in the facility at any one time.

Residential Habilitation, Life Sharing, and Supported Living Services will be required to utilize the recommendations provided in the Health Risk Screening Tool. SCs will be expected to monitor the implementation of the recommendations and incorporate them into the Individual’s Plan. Also, clarification is provided regarding the location parameters for newly funded sites.

ODP is proposing that respite can be provided by nurses for children with medical needs to assure the appropriate level of care is available.

Qualifications required for Support Service Professionals, Individuals, and Agency Providers have been clarified, including timelines for completion of certification requirements. Additionally, supported employment can be provided to individuals until OVR services are available, particularly when OVR has established a waiting list.

For a side-by-side comparison of substantive changes made as a result of public comment, see this online document. Questions about this communication should be directed to the appropriate ODP Regional Office.

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The Centers for Medicare and Medicaid Services (CMS) recently announced an upcoming in person inpatient rehabilitation facility quality reporting program (IRF QRP) training. This two-day “train-the-trainer” event for providers is scheduled for August 15–16, 2019 at the Four Seasons Hotel, 200 International Drive, Baltimore, MD 21202.

The primary focus of this training, which is open to all IRF providers, associations, and organizations,  will be to provide those responsible for training staff at IRFs with information about IRF QRP changes and updates to the IRF Patient Assessment Instrument (PAI) v.3.0, which will become effective on October 1, 2019. Topics will include, but are not limited to:

  • An overview of the changes between the IRF-PAI v.2.0 and v.3.0;
  • Updated training materials for Section GG, which will include videos of patient scenarios; and
  • An interactive session on the use of reports to identify opportunities for process improvement and utilize information contained in reports available via the Certification and Survey Provider Enhanced Reports (CASPER) system, which will be used to develop quality improvement plans.

A full agenda is available for both days of the training. Registration is limited to 100 people on a first-come, first-served basis. Questions or additional information requests should be sent to the PAC Training mailbox.

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On Tuesday, November 27, 2018, the RAND Corporation (a contractor for the Centers for Medicare and Medicaid Services), will hold a stakeholder meeting to discuss their results from the Improving Medicare Post-Acute Care Transformation (IMPACT) Act national beta test of candidate standardized patient assessment data elements (SPADEs). They will also discuss areas of support and key concerns raised by stakeholders during prior engagement activities and answer questions from attendees.

The meeting will be held at the RAND offices, 1200 South Hayes St., Arlington, VA 22202-5050, from 12:00 pm to 4:00 pm.

Attendees can register to attend in person or by phone using the links below. The limited number of in-person spaces will be available on a first-come, first-served basis.

Contact Melissa Dehoff, RCPA Rehabilitation Services Director, with questions.

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The Centers for Medicare and Medicaid Services (CMS) has released the updated Inpatient Rehabilitation Facility Quality Reporting Program (IRF QRP) Measure Calculations and Reporting User’s Manual (Version 3.0). This version of the manual is effective on October 1, 2018. The manual provides detailed information for IRF Patient Assessment Instrument (PAI) based quality measures, including inclusion and exclusion criteria, quality measure definitions, and measure calculation specifications. All of the materials are available on the Downloads section located at the bottom of the IRF Quality Reporting Measures Information web page.

Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with any questions.

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It has been reported that the Centers for Medicare and Medicaid Services (CMS) has issued letters of non-compliance to Inpatient Rehabilitation Facilities (IRFs) specific to the IRF quality reporting program (QRP) requirements for the data collection period affecting federal fiscal year (FFY) 2019 reimbursement. IRFs that did not meet the IRF QRP reporting requirements will receive a two percent payment reduction on their IRF prospective payment system (PPS) annual increase factor in FY 2019.

IRFs found to be non-compliant should have received notification from their Medicare Administrative Contractor (MAC) and are also expected to receive a letter in their provider Certification and Survey Provider Enhanced Reporting (CASPER) folder with specific details regarding the missing quality reporting data. Additional information on the data collections requirements and submission timeframes for FY 2019 compliance determination can be found in the CMS Data Collection & Final Submissions table posted on the CMS website, as well as the CMS IRF QRP website.

IRFs that feel they have received a non-compliance notification letter in error may request CMS reconsideration of the decision. Providers have 30 days to file a reconsideration request. Detailed filing instructions can be found on the IRF Quality Reporting Reconsideration and Exception & Extension web page.

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The Centers for Medicare and Medicaid Services (CMS) has posted a number of various inpatient rehabilitation facility patient assessment instrument (IRF PAI) resources to their website, including the RTI International Report on patient assessment data elements.

Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) Proposed Rule for FY 2019: Reminder: Comments are due by June 26, 2018. See May 4, 2018 RCPA Info for additional information on the proposed provisions.

PROPOSED IRF-PAI Version 3.0: The proposed assessment tool indicates an effective date of October 1, 2019. However, the fiscal year (FY) 2019 IRF prospective payment system (PPS) proposed rule indicates it will be effective in FY 2020.

Change Table: Proposed IRF-PAI Version 3.0 – Effective October 1, 2019 (FY 2020) – Changes from Version 2.0 to 3.0: This table highlights the differences between the IRF PAI Version 3.0 and IRF PAI Version 2.0.

RTI International Report: Analyses to Inform the Potential Use of Standardized Patient Assessment Data Elements in the Inpatient Rehabilitation Facility Prospective Payment System: This report includes a summary by RTI on the use of  assessment data in the current IRF PPS and describes the process used to substitute data from the quality indicators sections of the IRF PA into the IRF PPS. The report also presents the case-mix groups (CMGs) and payment weights based on those elements that CMS proposes for FY 2020.

Contact Melissa Dehoff with questions.

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Registration is now open for providers interested in attending a free two-day, in person training session on the inpatient rehabilitation facility quality reporting program (IRF QRP). The session, scheduled for Wednesday, May 9 –  Thursday, May 10, 2018 in Baltimore, MD will be hosted by the Centers for Medicare and Medicaid Services (CMS).

The primary focus of this “Train-the-Trainer” event will be to provide those responsible for training staff at IRFs with information about IRF QRP changes and updates to the Inpatient Rehabilitation Facility–Patient Assessment Instrument (IRF-PAI) v. 2.00, effective October 1, 2018. Topics will include information on new items, including those associated with the drug regimen review quality measure. Presenters will also discuss resources available on the CMS website, support available through the IRF help desks, public reporting, and use of reports to aid providers in better understanding the IRF QRP.

Additional information, including the registration page and agenda, is posted on the CMS website. Interested providers are encouraged to register as soon as possible as the in-person training is limited to the first 200 people on a first-come, first-served basis.

The training will not be available via webcast, but will be available via a link from the IRF QRP training web page after the training has completed.

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The Centers for Medicare and Medicaid Services (CMS) published a final rule and interim final rule with comment period that cancels the Episode Payment Models (EPM) and Cardiac Rehabilitation (CR) Incentive Payment Model and rescinds the regulations governing these models in the December 1, 2017 Federal Register. It also implements certain revisions to the Comprehensive Care for Joint Replacement (CJR) model. Some of these revisions include:

  • Allowing certain hospitals selected for participation in the CJR model a one-time option to choose whether to continue their participation in the model;
  • Technical refinements and clarifications for certain payment, reconciliation, and quality provisions; and
  • Change to increase the pool of eligible clinicians that qualify as affiliated practitioners under the Advanced Alternative Payment Model (APM) track.

An interim final rule with comment period is also being issued in conjunction with the final rule in order to address the need for a policy to provide some flexibility in the determination of episode costs for providers located in areas impacted by extreme and uncontrollable circumstances.

Comments will be accepted on the interim final rule with comment period until January 30, 2018. The final and interim final regulations become effective on January 1, 2018.

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