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Tags Posts tagged with "Payment"

Payment

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The Division of Licensing Administration has created tutorials to assist with the electronic payment of application, certificate, fines, and appeals fees. A different tutorial has been designed for each program office and payment type. The tutorials give step-by-step instructions for completing the payment of fees for each office.

A new applicant tutorial has also been created. This tutorial will give applicants step-by-step instructions to complete and submit the Application for a Certificate of Compliance (HS633) to become a licensed provider of a human services setting. The HS633 has been revised, and the updated version is available here.

The following tutorials can be accessed on the Application for Human Services License website as well as viewed below:

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As described in ODPANN 24-041, providers were to request the subject payments no later than May 15. As of June 4, 2024, the Office of Developmental Programs (ODP) has processed the subject payments for all providers who have applied. These payments should be visible on the provider’s Remittance Advice on June 17, 2024, at the highest billing service location.

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RCPA recently signed two letters, one to Governor Shapiro and one to the PA Department of Human Services (DHS), alongside dozens of other organizations and the Pennsylvania Community Health Worker Collaborative (PACHW) regarding the state’s plan for an amendment to authorize payments for Community Health Worker services under Pennsylvania State Medicaid. The letters outlined several key features PACHW wished to highlight regarding these payments, including:

  • Requesting DHS set “an equitable and adequate” reimbursement rate;
  • The creation of a Community Health Worker provider type; and
  • Recognizing Social Determinants of Health (SDoH) as a primary diagnosis code.

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This is a final reminder that, per ODPANN 24-041, providers must request the one-time workforce recover supplemental payment no later than May 15. Providers may put in a request by completing a brief ODP survey. As of the morning of May 6, 2024, the Office of Developmental Programs (ODP) received requests from 505 providers.

If your MPI is on the ODP spreadsheet, this will serve as confirmation that your agency’s request has been received. ODP will release a similar file after the deadline. Late requests will not be accepted.

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The Centers for Medicare and Medicaid Services (CMS) has released the fiscal year (FY) 2025 inpatient rehabilitation facility prospective payment system (IRF PPS) proposed rule. The proposed rule will be published in the March 29, 2024, Federal Register. A high-level overview of the proposed rule is provided below:

Payment Updates:

CMS estimates an overall increase in aggregate payments to IRFs by 2.5% or $255 million (compared to the 4% payment update in FY 2024).

Market basket update for IRF services is 3.2%. This will be reduced by a productivity adjustment of 0.4%, which would result in an overall 2.8% increase. These figures are likely to change due to updated forecasts.

CMS is proposing to update the outlier threshold amount from $10,423 (FY 2024) to $12,158 (FY 2025), which would account for an estimated 0.2 percent decrease to aggregate payments across the IRF PPS in FY 2025.

Quality Reporting Program (QRP) Updates:

CMS is proposing to make additions, modifications, and removals of some QRP measures. A proposal was included to collect four new Standardized Patient Assessment Data Elements (SPADE) in the IRF QRP to bolster the collection of information on social determinants of health (SDOH):

  • Living Situation: Requests regarding the current living situation;
  • 2 Food Items: Questions about food running out;
  • Utilities: Questions about threats to shutting off utilities; and
  • A modification to an existing SPADE on Transportation.

CMS is also proposing to remove the “Admission Class” from the IRF Patient Assessment Instrument (PAI).

Feedback is requested on future revisions to the IRF QRP, as well as feedback on the development of a five-star methodology for IRFs.

Additional information will be forthcoming. Comments on the proposed rule are due to CMS by the end of May.

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The Office of Developmental Programs reminds providers and Supports Coordination Organizations that in accordance with Announcement 21-086: American Rescue Plan Act: One-Time Supplemental Payment to Address Recruitment, Retention, and COVID-19 Related Staff Expenses, the deadline to request a supplemental payment is January 31, 2022.

You can find the Provider Attestation Form for One-Time Supplemental Payment here.

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