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Tags Posts tagged with "CY 2023"

CY 2023

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In order to gather responses from providers that were not able to submit previously, the Office of Long-Term Living (OLTL) has reopened the Calendar Year (CY) 2023 rate study survey for the following Home and Community-Based Services (HCBS):

  • Adult Day;
  • Structured Day Habilitation;
  • Employment and Training;
  • Personal Assistance (Agency);
  • Personal Assistance (Participant Directed); and
  • Residential Habilitation.

Please complete the survey for CY 2023, which spans from January 1, 2023, through December 31, 2023, unless otherwise specified. Please only complete the survey if you did not previously participate. The reopening of the survey will ensure every provider has ample time to offer input to broaden and improve the resulting analysis. The survey will remain open until Friday, November 15, 2024.

This survey is one piece of the targeted rate review and is intended to collect current provider rate and wage data as well as general feedback on the challenges of providing these services. The information collected in this survey will be used to assist in developing a point of reference for the rate range to evaluate current payment rates. In addition to results from this survey, the review will include payment rate information from Managed Care Organizations (MCO) in OLTL claims data, recent legislative policies, department expectations, and other data obtained from publicly available sources.

HCBS providers that delivered multiple service categories during CY 2023 should fill out this survey separately for each service category you delivered. HCBS providers that did not deliver any of the service categories listed above should disregard this survey. OLTL is partnering with Mercer to perform a rate study exclusive to the service categories listed above at this time.

The information collected for this survey will be used for both this rate study and to meet the requirements of HB 1300 from the 2023–2024 Pennsylvania General Assembly regular session. The information you provide will remain confidential and private and will only be shared publicly through high-level summary reports that do not include provider-level detail. Please comply with the Health Insurance Portability and Accountability Act (HIPAA) and do not share any protected health information (PHI) within your survey responses.

Please note the survey tool does not allow individuals to save and go back to answer questions. Please have all your agency information such as wages, employee information, and financial statements readily available. This will help you to submit accurate information when answering the questions.

HCBS providers can access the survey here.

OLTL and Mercer appreciate your time and this valuable feedback. If you have any questions or need assistance, please reach out via email.

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The Office of Long-Term Living (OLTL) has released information about the Act 150 Program sliding fee scale for calendar year (CY) 2023. This information includes:

  1. 2023 Act 150 Sliding Fee Scale;
  2. Monthly Act 150 Participant Fee Report (Age 60 and Over);
  3. Monthly Act 150 Participant Fee Report (Under Age 60);
  4. Monthly Act 150 Participant Fee Reports (Excel Version);

Please note: the bulletin’s effective date is January 1, 2023. Collection of Act 150 participant fees based on the 2023 Fee Scale must begin on the bulletin’s effective date.

The above documents are available in alternate format upon request by calling (717) 857-3280. For future reference, a copy of this bulletin will be posted to the DHS Bulletin Results page for OLTL.

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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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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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