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Public Comment

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The Department of Human Services (DHS) has made the Medical Assistance (MA) and Children’s Health Insurance Program (CHIP) Managed Care Quality Strategy (MCQS) for the Commonwealth available for public review and comment. The MCQS is an updated version of the previous strategy submitted to the Centers for Medicare and Medicaid Services (CMS) in December 2020 and accounts for the ongoing post-pandemic delivery system pressures that have affected how managed care organizations (MCOs) deliver care. The MCQS may be viewed online. Comments may be submitted via email, and those received within 30 days will be reviewed and considered. Additional information is available on the Pennsylvania Bulletin.

If you have any questions, please contact Fady Sahhar.

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Image by Werner Moser from Pixabay

The Administration for Community Living (ACL) is seeking input on a proposed rule to establish the first-ever federal regulations for adult protective services (APS) programs. Instructions for submitting comments and registering for an informational webinar can be found on ACL’s website and below.

APS programs across the country support older adults and adults with disabilities who experience, or who are at risk of, abuse, neglect, self-neglect, or financial exploitation. APS programs investigate reports of maltreatment; conduct case planning, monitoring, and evaluation, and provide, or connect people who have experienced maltreatment to, a variety of medical, social service, economic, legal, housing, law enforcement, and other protective, emergency, or support services to help them recover. Over the past decade, ACL has led federal efforts to support the critical work of APS programs through a variety of initiatives.

First-Ever Federal Regulations for APS

The proposed rule aims to improve consistency and quality of APS services across states and support the national network that delivers APS services, with the ultimate goal of better meeting the needs of adults who experience or are at risk of maltreatment. To those ends, the proposed rule:

  • Establishes a set of national standards for the operation of APS programs that all state APS systems must meet. These standards formalize — and build upon — the existing National Voluntary Consensus Guidelines for State APS Systems.
  • Establishes common definitions for the national APS system to improve information sharing, data collection, and standardization between and within states.
  • Requires state APS systems to develop policies and procedures, consistent with state law, for coordination and sharing of information to facilitate investigations with other entities, such as state law enforcement agencies and state Medicaid agencies.
  • Requires state policies and procedures to be person-directed and based on concepts of least restrictive alternatives.
  • Establishes requirements for data collection, retention, and reporting.
  • Establishes requirements for mandatory staff training and ongoing education on core competencies for APS staff and supervisors.

ACL has created a fact sheet with highlights of key provisions of the rule, and the full text of the proposed rule can be found on the Federal Register website.

Input Needed

The proposed rule is the culmination of many years of engagement with stakeholders from APS and long-term care ombudsman programs, as well as disability advocates, from across the country. It also reflects input received through several listening sessions, extensive research, and analysis of data from a 2021 survey of 51 APS systems, ACL’s National Adult Maltreatment Reporting System, and policy profiles from APS programs in all states and territories.

ACL now seeks feedback on the proposed rule from all who are interested in improving implementation of APS programs and services. Input from the aging and disability networks and the people served by APS programs is particularly crucial.

Comments will be accepted for 60 days, beginning when the proposed rule is officially published in the Federal Register (which currently is scheduled for Tuesday, September 12). Instructions for commenting, along with the comment deadline, can be found in the Federal Register notice and on ACL’s website.

An informational webinar will be held on Monday, September 18, at 11:30 am ET. Advance registration is required.

For additional questions, contact Fady Sahhar.

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Last week, the US Department of Health and Human Services (HHS) Secretary Xavier Becerra hosted a press conference to announce a rule proposed by the HHS Office for Civil Rights that would update Section 504 of the Rehabilitation Act of 1973. This is the first time these critical regulations will have been updated since they were originally signed in 1977, after four years of tireless advocacy and a 28-day protest led by disability civil rights leaders.

Updates to the rule include:

  • Clarifications on the obligations to provide services in the most integrated setting appropriate to a person’s needs, consistent with the Supreme Court’s decision in Olmstead v. L.C;
  • Medical treatment decisions are not based on biases or stereotypes about people with disabilities, judgments that an individual will be a burden on others, or beliefs that the life of an individual with a disability has less value than the life of a person without a disability;
  • Adoption of standards for accessible diagnostic medical treatment;
  • Adoption of the Web Content Accessibility Guidelines (WCAG) 2.1, Level AA, which are accessibility standards for websites and mobile applications;
  • Clarification of requirements in HHS-funded child welfare programs and activities to help eliminate discriminatory barriers faced by children, parents, caregivers, foster parents, and prospective parents with disabilities; and
  • Prohibition of the use of value-of-life assessments in treatment decisions.

Read the official announcement, full rule, fact sheet, and instructions on how to provide comments on the HHS website. If you have any questions, please contact Fady Sahhar.

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Image by Dirk Wouters from Pixabay

On May 25, 2023, Governor Shapiro signed Executive Order 2023-09 — Pennsylvania’s Master Plan for Older Adults. This Executive Order directs the Pennsylvania Department of Aging to lead the Master Plan for Older Adults, a state-led, stakeholder-driven, 10-year strategic planning resource that can help states transform their infrastructure and coordination of services for older adult and disability populations.

The Department of Aging has been leading stakeholder listening sessions and presenting at various venues across the state in order to gather input and comments that will support the development of the master plan. Visit here to see the dates and times of virtual listening sessions planned in September; included in these sessions is a PowerPoint presentation.

Members are encouraged to contribute what you think should be the plan’s priority goals, objectives, and initiatives to support the highest quality of life for older adults. Comments can be shared here, via email, or by mail to Pennsylvania Department of Aging c/o Master Plan, 555 Walnut Street, 5th Floor, Harrisburg, PA 17101.  

Members are also encouraged to complete the Needs Assessment Survey, which is designed to capture the experience of older adults and adults with disabilities. The survey will remain open until September 30, 2023.

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Image by Dirk Wouters from Pixabay

The Pennsylvania Department of Drug and Alcohol Programs (DDAP) is inviting public comments on the Pennsylvania Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block Grant submission. The submission process consists of three parts: the draft of the Substance Use Prevention Treatment and Recovery Services Assessment and Plan, or Mini-Application, which is currently open for review; the Substance Abuse Prevention and Treatment Block Grant Report, which is to be posted in November; and the Annual Synar Report, which is to be available in December. These documents can be accessed here using “citizenpa” as the login and “citizen” as the password. Public comments are requested to be submitted electronically by September 30.

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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:

  • The list of telehealth practitioners is amended to recognize marriage and family therapists and mental health counselors as telehealth practitioners, effective Jan. 1, 2024.
  • CMS will pay for place of service (POS) 10 at the non-facility PFS rate, while 02 will be paid at the facility rate beginning Jan. 1, 2024.
  • Frequency limitation would be removed for subsequent inpatient visits through the duration of CY 2024.
  • Multiple clarifications are provided for billing both remote physiologic monitoring (RPM) and remote therapy monitoring (RTM) codes.
  • Direct supervision is allowed to include real-time audio video interactive telecommunication through Dec. 31, 2024 (including for FQHCs and RHCs). Direct supervision requirements are also addressed for occupational therapists in private practice (OTPP) and physical therapists in private practice (PTPP) for unenrolled physical and occupational therapists when providing remote RTM.

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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