On May 20 Centers for Medicare & Medicaid Services Center for Medicaid, CHIP, and Survey & Certification issued a letter to state Medicaid directors on the federal Community Living Initiative. The letter (SMDL# 10-008) provides information on new tools for community integration and existing tools for states to support community living. CMS says that it will provide separate guidance to describe the newly enacted provisions of the Affordable Care Act that provide additional opportunities for Medicaid beneficiaries to receive services in the most integrated settings. In its May 20 letter CMS points to several resources: National Quality Enterprise (NQE) to assist states to design and improve their quality improvement systems (see www.nationalqualityenterprise.net) and the new National PASRR Technical Assistance Center which provides technical assistance to states at no cost to facilitate in implementing Preadmission Screening and Resident Review (see www.PASSRassist.org). CMS also discussed resources provide through Money Follows the Person (MFP), Medicaid Infrastructure Grant (MIG), HCBS Participant Experience Measures, Aging and Disability Resource Center (ADRC), and Person-Centered Hospital Discharge Planning Model Grants. In highlighting resources provided through the Medicaid Infrastructure Grant, CMS said that CMS and the Office of the Assistant Secretary for Planning and Evaluation are collaborating with the Rehabilitation Services Administration, Social Security Administration, Department of Labor, and Substance Abuse and Mental Health Services Administration to produce a guide for the federal financing of customized employment and the Individual Placement and Support Model of Supported Employment for people with mental health needs. FMI: To obtain a copy of the letter see http://www.cms.gov/smdl/downloads/SMD10008.pdf
AMRPA Regional Meeting will be held at Good Shepherd Rehabilitation Hospital at Good Shepherd Plaza, 850 South 5th Street, Allentown, PA on July 16, 2010. AMRPA has posted a Preliminary Agenda that starts the day from at 9:00 a.m. to 10:15 a.m. with a Regulatory Update on the 2011 IRF PPS Proposed Rules, Health Care Reform Provider Cuts, Medical Rehabilitation Provisions and Continuing Care Hospital with Carolyn Zollar, J.D. AMRPA. From 10:30 a.m. to 11:45 a.m. the meeting will feature a Legislative Update on the Impact of Health Insurance Reform and Other Medicare Changes on Medical Rehabilitation and Politics of the Upcoming Election with Martha Kendrick, J.D. Patton Boggs, LLC. From 12:00 noon to 1:15 p.m. there will be a lunch and tour of Good Shepherd Rehabilitation Hospital. From 1:30 p.m. to 2:30 p.m. there will be a presentation from a Highmark Representative. From 2:45 p.m. to 4:00 p.m. a presentation on Rehabilitation Strategies under Healthcare Reform will consider how rehab providers will need to change their delivery models and community relationships to succeed in the future. The presentation will be offered by Harry Ting, PhD, FACHE from Good Shepherd Rehabilitation Network, Allentown, PA. FMI: See www.amrpa.org, Contact PARF at parfmail@parf.org.
The PA Developmental Disabilities Council will be hosting a roundtable discussion on transportation and work on June 30 from 10 a.m. to 2:00 p.m. The roundtable on Transportation and the Culture of Employment will be facilitated by Bob Schmitt, of RTR Associates (a project funded by the Pennsylvania Developmental Disabilities Council). More information on participation in the roundtable will be forthcoming. The roundtable will explore several questions, including: Can we estimate the demand for transportation to work at the local level?; What sources of funding are available – or could be developed – for supporting unconventional modes of work transportation?; How can we encourage transit providers and persons with disabilities to explore solutions to work transportation?; and, What are the most viable options, other than shared-ride transportation, for transportation to work?. PDDC is looking for a limited number of mental health representatives that can offer creative ideas and solutions. If interested, contact Kevin Burrell at 717-214-8103 or fax- 717-772-0738.
On May 27 the PA Department of Public Welfare (DPW) Office of Developmental Programs (ODP) issued a bulletin offering the new service definitions reflecting changes effective July 1, 2010. The new service definitions include clarifications that have been distributed to ODP’s stakeholders in other correspondence since the service definitions went into effect July 1, 2009. The revisions and clarifications to the service definitions include: Addition of 1 service – Additional Individualized Staffing; deletion of 2 services – Home Finding and Base-funded Respite, 15 Minutes; addition of Prior Authorization requirements for Supplemental Habilitation and Additional Individualized Staffing; and revision of the Travel Policy. In addition to the above changes, many definitions were revised to promote greater clarity in the scope of the service as well as to promote consistency in application of the definition. The ODP Bulletin includes an attachment with Service Definitions Narrative for Consolidated Waiver, Person/Family Directed Support Waiver, Administrative Services, and Base-Funded Services. FMI: See www.odpconsulting.net.
On June 1 the PA DPW Office of Developmental Programs regional staff was scheduled to begin a review of individual service plans (ISP).ODP says that the purpose of the review process will entail ODP regional staff’s review of ISPs containing a prescribed list of services/procedure codes. The Regional ISP Review process is designed to ensure that administrative entities are authorizing services in the ISP in response to assessed needs for individuals in accordance with waiver service definitions. It is also to identify policy areas that need to be clarified or developed in relation to ISP system practices. ODP says that it is also intended to identify areas where service definitions need clarification or revision and where additional training and technical assistance are needed. FMI: See the Informational Packet #074-10 Regional ISP Review Process and Form, effective June 1, 2010 on www.odpconsulting.net. See also www.dpw.state.pa.us.
The PA DPW Office of Developmental Programs (ODP) has issued FY2010-2011 rates that are significantly lower than current rates. The proposed payment rates were developed from data in each provider’s June 30, 2009 ODP cost reports. A Rate Adjustment Factor (RAF) of 4.73% was applied to each per-unit cost (except fee schedule, outcome-based, and vendor services) so that the estimated waiver expenditures would not exceed the available waiver appropriation. ODP described how rates were assigned to services and/or service locations when cost report data were not available. ODP determined values for each service and identified and adjusted providers’ “outlier” per-unit costs. ODP did not provide the actual calculations used to develop their rates. The ODP letter to service providers also outlines the process for requesting a Gross Adjustment for FY2010-2011. FMI: See www.odpconsulting.net.
