The Office of Developmental Programs (ODP) is providing information on the pending new annual submittal requirement of audited financial statements by qualified residential providers and supports coordination organizations. Please view the announcement for details.
The Centers for Medicare and Medicaid Services (CMS) will conduct the hospital/quality initiative open door forum (ODF) tomorrow, September 6, 2023, at 2:00 pm. Some of the agenda topics for the call include:
NEW and UPDATED Open Door Forum Participation Instructions:
This call will be a Zoom webinar. To participate by webinar, register here. After registering, you will receive a confirmation email containing information about joining the webinar.
Webinar ID: 160 121 2402
Passcode: 860132
Note that, although the ODFs are now a Zoom webinar, we will only use the audio function. There is no need for cameras to be on.
The Centers for Medicare and Medicaid Services (CMS) has released a short, animated explainer video, “Social Determinants of Health Items: Determining When a Proxy Response is Allowed,” for inpatient rehabilitation facilities (IRF), home health (HH), and long-term care hospital (LTCH) providers. CMS developed this video to assist providers in accurately determining when the use of a proxy response is allowed for the following Social Determinants of Health (SDoH) items: A1005. Ethnicity, A1010. Race, A1110. Language, A1250. Transportation, B1300. Health Literacy, and D0700. Social Isolation.
If you have questions about accessing the resources or feedback regarding the trainings, please email the PAC Training Inbox. Content-related questions should be submitted to the HH QRP Help Desk, IRF QRP Help Desk, or the LTCH QRP Help Desk.
The Office of Developmental Programs (ODP) has shared a flyer regarding ODP’s Division of Quality Management’s QM Spotlight, the sixth in a series of quarterly publications that debunks the myth that entities are required to develop Quality Management Plans (QMP) for all Centers for Medicare and Medicaid Services (CMS)/Home and Community-Based Services (HCBS) Quality Framework focus areas. Administrative Entities (AE), Supports Coordination Organizations (SCO), Providers, Quality Assessment and Improvement (QA&I) reviewers, and anyone who reviews QM plans — including their own — should reference this information as they develop and evaluate QM plans.
The Office of Developmental Programs (ODP) is informing all interested parties of the submission of the Consolidated, Community Living, Person/Family Directed Support (P/FDS), and Adult Autism Waiver amendments to CMS. The waiver amendments are available on the Department of Human Services (DHS) website. It is anticipated that the amendments will be effective November 1, 2023.
Please review the announcement for additional information and details.
The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2024 inpatient rehabilitation facility (IRF) prospective payment system (PPS) final rule in the August 2, 2023, Federal Register. Some of the key provisions contained in the final rule include:
Payment and Coverage Provisions
Quality Reporting Program (QRP) Provisions: CMS finalized all of the proposed changes related to quality measures for the IRF QRP put forth in the proposed rule. The following changes have been finalized for the IRF QRP:
CMS also released a fact sheet on the final rule. The data files associated with the final rule, including the wage index tables, the rate setting data for each IRF, and the final tables for case-mix groups, relative weights, and average lengths of stay are also available. Unless otherwise noted above, the provisions in the final rule will take effect on October 1, 2023.
The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), announced the new Guiding an Improved Dementia Experience (GUIDE) Model. The purpose and goal of this model is to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities through a package of care coordination and management, caregiver education and support, and respite services.
Through the GUIDE Model, CMS will test an alternative payment for participants who deliver key supportive services to people with dementia, including comprehensive, person-centered assessments and care plans, care coordination, and 24/7 access to a support line. Under the model, people with dementia and their caregivers will have access to a care navigator, who will help them access services and supports, including clinical services and non-clinical services such as meals and transportation through community-based organizations.
The GUIDE model supports President Biden’s Executive Order that directed HHS to develop a new health care payment and service delivery model focused on dementia care that would include family caregiver supports.
There is a web page that has been created specific to this care model that provides additional information, including a link to a webinar that will provide an overview of this care model scheduled for August 10, 2023:
CMS will release the application for GUIDE, a voluntary, nationwide model, in the fall of 2023. Prior to the application release, interested organizations are encouraged to submit Letters of Intent to CMS by September 15, 2023. The model will run for eight years beginning July 1, 2024.
If you are interested in receiving additional information, updates or have questions about the GUIDE model, please send an email to the GUIDE Model team’s inbox.
Deputy Secretary Ahrens announced that in response to public comments regarding proposed waiver amendments, the Office of Developmental Programs (ODP) has adjusted the payment schedule for Recovery and Expansion incentives for CPS providers. This change has been submitted to the Centers for Medicare and Medicaid Services (CMS) for approval with the full waiver amendments. If approved, the following schedule will be implemented:
Additional updates Deputy Secretary Ahrens provided at the Medical Assistance Advisory Committee meeting can be found here.
On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Calendar Year (CY) 2024 Physician Fee Schedule (PFS) and other Medicare Part B issues, effective on or after January 1, 2024.
The calendar year (CY) 2024 PFS proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better access to care, quality, affordability, and innovation.
The proposed modifications include several pertaining to telehealth policy in the Medicare program for 2024. One of the major takeaways from the proposed 2024 PFS is the clarification that certain telehealth flexibilities that were previously extended until 151 days after the end of the public health emergency (PHE) have now been extended until December 31, 2024, in accordance with amendments made by the Consolidated Appropriations Act, 2023. These extensions have been known since the CAA’s passage in December last year and has also been addressed in a series of fact sheets and FAQ documents.
However, there were also some new changes addressed in the 2024 PFS. For example, every year CMS will consider adding new services to their list of codes that are reimbursable via telehealth. While they did not decide to add any new codes on a permanent basis to the list (though many remain on the list temporarily through the end of 2024), they did propose to add a number of codes to Category 3 (CMS’ current temporary list), including certain codes for health and well-being coaching services. Additionally, CMS announced a proposed revision to their telehealth code classification process, moving from a Category 1, 2 and 3 classification system to a binary ‘permanent’ or ‘provisional’ classification in an attempt to simplify the process beginning in CY 2025. In order to make the steps for getting a code accepted for inclusion in either the permanent or provisional telehealth lists transparent, CMS proposes a five-step process that is detailed in the proposed 2024 PFS, which includes consideration of the evidence of clinical benefits.
A few additional changes proposed in the document are listed below:
CMS will be accepting comments on their proposals until 5:00 pm EST on September 11, 2023, and RCPA will review the document and work with the National Council for Mental Wellbeing in drafting recommendations. We welcome provider feedback and comments to be included and ask that you contact and share these with your RCPA Policy Director.
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