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CMS

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The Centers for Medicare and Medicaid Services (CMS) has approved the Office of Long-Term Living’s (OLTL) OBRA Waiver Amendment. Changes in the approved OBRA Waiver Amendment include:

  • Revised the Benefits Counseling service definition;
  • Amended the responsibilities of the Fiscal/Employer Agent;
  • Updated Appendix H Quality Improvement Strategy to the current process; and
  • Removed performance measure AA-6, as the data in AA-6 is being collected by AA-5.

The current approved OBRA Waiver document can be viewed here. If you have any questions, please contact the OLTL Bureau of Policy Development and Communications Management at (717) 857-3280.

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The Centers for Medicare and Medicaid Services (CMS) has created short videos and developed patient cue cards to assist providers with learning how to code patient assessment instruments for the following Post-Acute Care (PAC) Quality Reporting Programs (QRP):

Help LTCH, IRF, and HH patients select responses by showing them the new cue cards for:

See LTCH, IRF, HH, and SNF Quality Reporting Program Training for more information.

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The Centers for Medicare and Medicaid Services (CMS) has released the updated inpatient rehabilitation facility (IRF) provider preview reports. These ‎reports contain provider performance scores for quality measures and contain IRF-Patient Assessment Instrument (PAI) data submitted ‎by IRFs from Quarter 4 2021 through Quarter 3 2022, as well as Centers for Disease Control and Prevention (CDC) Clostridium Difficile (CDI) and Catheter-‎Associated Urinary Tract Infections (CAUTI) measures from Quarter 4 2021 through Quarter 1 2022 and Quarter 4 2021 ‎through Quarter 1 2022 of the Healthcare Personnel (HCP) Influenza measure. The HCP COVID-19 Vaccination ‎Coverage measure data for Quarter 3 2022 is also included. ‎

Providers have until April 14, 2023, to review their performance data. Providers can request CMS ‎review their data during the preview period if they believe the scores are inaccurate. The final reports ‎will be published on Care Compare and Provider Data Catalog (PDC) during the June 2023 refresh of ‎the website. For additional information, visit the CMS IRF QRP Public Reporting website.

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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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