In its Pennsylvania Bulletin announcement on June 18 the PA Department of Public Welfare (DPW) described changes to the disproportionate share hospital (DSH) Payments to small and sole community hospitals and changes to the MA Rehabilitation Adjustment Payment. Under the approved State Plan Amendment (SPA), freestanding rehabilitation hospitals that qualify for a MA Rehabilitation Adjustment Payment receive a payment amount equal to 92% of the total inpatient MA fee-for-service (FFS) payment amount made to the hospital as reported in the hospital’s FY 2007-2008 MA cost report available to DPW as of July 2010. Since CMS approval of this payment, an additional $4.2 million has been allocated to this payment. DPW is proposing to increase the aggregate amount of the MA Rehabilitation Adjustment Payments to $18.619 million and the percentage used to determine the payment amount for each qualifying freestanding rehabilitation hospital to 116% of a hospital’s FY 2007-2008 inpatient MA FFS payments. Interested persons are invited to submit written comments to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received by July 18 will be reviewed and considered for any subsequent revision of the notice. Bill Miller, Senior Associate, S.R. Wojdak & Associates, is schedule to review the DPW announcement at the June 22 meeting of the PARF Medical Division. FMI: See http://www.pabulletin.com/secure/data/vol41/41-25/1025.html.
On June 14 the Pennsylvania Health Care Cost Containment Council (PHC4) released its 2010 Annual Report. The title of the Annual Report is “Good Data Drives Good Decisions.” The PHC4 annual report highlights how various stakeholder groups use PHC4 data for informed decision making and critical evaluation. The report is available at http://www.phc4.org/council/annualreports/annual2010report.pdf. FMI: Stephanie Suran, Communications Manager, PA Health Care Cost Containment Council, Phone 717.232.6787. See http://www.phc4.org/.
On June 15 PA DPW Office of Developmental Programs (ODP) Bureau Director Joe Church presented a review of current fiscal policies to the PARF MH MR Finance Committee. Church indicated that direct care providers FY2012 rates were currently being loaded into HCSIS and that providers would be able to access their rates on HCSIS on Thursday, June 16.Church said that ODP would also be sending providers their FY2012 Rate Letters electronically. (See related article below.) Church also reported that ODP is planning to carry out the FY2011 Revenue Reconciliation process as originally proposed – with a Period 2 (November 2010 – February 2011) and Period 3 (March 2011 – June 2011) reconciliation. Church said that ODP is currently working on updating Waiver providers’ Revenue Targets for Period 2. ODP expects to issue a preliminary Period 2 Revenue Target letter (similar to the December. 17, 2010 Period 1 preliminary letter) on or about July 7, 2011. Church said that providers will then have until approximately July 26 to work with their ODP Regional office to address any issues with the preliminary letter. ODP then expects to issue final Period 2 Revenue Reconciliation letters to providers on or about September 2, 2011. In reference to ODP Announcement 007-11 issued on January 14, 2011 and ODP plans to incorporate the use of an Occupancy Factor in the reimbursement methodology for Residential services for FY2012, Church said that ODP has decided t would not implement the Residential Occupancy Factor reimbursement system. He said that providers will continue to invoice PROMISe for Residential services similar to the current (FY2011) methodology. FMI: Contact PARF at parfmail@parf.org
On June 16 PA Department of Public Welfare (DPW) Office of Developmental Programs (ODP) released notices on payment and policies affecting home and community services provided to people with intellectual disabilities served under Medicaid waiver programs. ODP released Informational Memo # 074-11 as an update to the Consolidated Waiver, P/FDS Waiver and, when applicable, base funded services, effective July 1, 2011. ODP notes that the information related to the proposed cost report payment rates, Medical Assistance (MA) fee schedule rates and Department established fees outlined in Informational Memo # 074-11 are contingent on the final budget enacted by the General Assembly. ODP says that the FY 2011-2012 proposed rates and fees in HCSIS should be used to process claims submitted to the Provider Reimbursement and Operations Management Information System in electronic format (PROMISe™) for services provided during FY 2011-2012 until a notice announcing final rates is published. According to the memo the following non-Residential services have been placed on the ODP Fee Schedule effective July 1: Unlicensed Home & Community Habilitation; Licensed Day Habilitation (ATF); Prevocational Services; Supported Employment; Transitional Work Service; and, All Waiver-funded Respite Services excluding Respite Camp. ODP says that as part of DPW efforts to continue to align rates and rate-setting methodology across all offices and programs, DPW-ODP has finalized the FY 2011-2012 rate setting methodologies. The processes and changes apply to Consolidated Waiver, P/FDS Waiver services/rates and when applicable base-funded services/rate, effective July 1, 2011.A copy of the 11 12 Proposed Rate Letter was also sent to all providers. FMI: See www.odpconsulting.net. For more information contact PARF at parfmail@parf.org
On June 16 PA DPW Office of Developmental Programs (ODP) released Informational Packet # 075-11 to direct service providers including Consolidated and Person/Family Directed Support (P/FDS) Providers and Supports Coordination Organizations (SCOs). The packet provides notification that the Prudent Payment of Claims policy will be enforced effective July 1, 2011. ODP says that original claim submissions, resubmitted claims and claim adjustments submitted to PROMISeTM for Consolidated and P/FDS Waiver services with a claim submission date of July 1, 2011 and forward will be subject to the Prudent Payment of Claims policy. FMI: See www.odpconsulting.net or email PARF at parfmail@parf.org.
On June 15 the Medicare Payment Advisory Commission (MedPAC) released its June 2011 Report to the Congress on Medicare and the Health Care Delivery System. The report did not include a chapter specific to rehabilitation hospital payment policies. The MedPAC report includes recommendations to help motivate and support quality improvement among health care providers who treat Medicare patients. The recommendations would fundamentally restructure Medicare’s Quality Improvement Organization (QIO) program. MedPAC also offers recommendations concerning ancillary services, such as diagnostic imaging and other tests. In its report MedPAC examines the sustainable growth rate system (SGR) as well as addressing the coordination of care dual-eligible beneficiaries and the use of federally qualified health centers. FMI: See www.medpac.gov.
