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Medical Rehab

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On March 6, 2020, the Centers for Medicare and Medicaid Services (CMS) issued Frequently Asked Questions (FAQs) for health care providers, regarding Medicare payment for laboratory tests and other services associated with the 2019-Novel Coronavirus (COVID-19). Some of the information included in this FAQ document includes:

  • Guidance on how to bill and receive payment for testing patients at risk of COVID-19;
  • Details of Medicare’s payment policies for laboratory and diagnostic services, drugs, and vaccines under Medicare Part B, ambulance services, and other medical services delivered by physicians, hospitals, and facilities accepting government resources; and
  • Information on billing for telehealth or in-home provider services.

For additional up-to-date information on the COVID-19, please refer to CMS’ Current Emergencies web page.

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The Department of Human Services (DHS) is working closely with the Pennsylvania Department of Health (DOH) to ensure preparations for a response to a possible Coronavirus (COVID-19) outbreak in the state and as a result, has issued a Health Alert with pertinent information. DOH is the lead agency for the Commonwealth’s response to COVID-19. At the time of this dissemination, Pennsylvania has zero confirmed cases of COVID-19.

Again, DHS is supporting DOH in the disseminating of information related to COVID-19 and all guidance is provided by, and should be sought through, DOH.

All providers are encouraged to:

  1. Review internal infection control protocols and emergency backup plans for events in which a provider does not have adequate staffing to meet individuals’ health and safety needs.
  2. Evaluate staff adherence to provider infection control protocols.
  3. Evaluate capacity to implement emergency backup plans in the event staffing is impacted by the COVID-19 virus.

While COVID-19 is raising international concern, it presents an opportunity to evaluate preventative infection control measures. Medically fragile individuals, those in congregate settings, and the staff that support/interact with them are all at increased risk for infections of all kinds, not just COVID-19. As always, the best response is prevention and the best prevention is good infection control.

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On Thursday, March 5, 2020, the Centers for Medicare and Medicaid Services (CMS) will conduct a call to provide information about the May 2019 expansion of the Qualified Independent Contractor (QIC) Telephone Discussion and Reopening Process Demonstration. This expansion now includes Part A providers that submit second level claim appeals (reconsiderations) to C2C Innovative Solutions, Inc. (the Part A East QIC). Topics of discussion will include benefits, who can participate, and how to participate. A question and answer session will follow the presentation. Attendees may send questions in advance via email. Please include “Appeals Demonstration” in the subject line. Additional information can be obtained from the Original Medicare Appeals web page. Members interested in participating in the call must register in advance.

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The next Managed Long-Term Services and Supports (MLTSS) Subcommittee will convene on Wednesday, March 4, 2020 from 10:00 am – 1:00 pm at the Pennsylvania Department of Education Honors Suite, 1st floor, 333 Market Street Tower, Harrisburg, PA 17126. If you are unable to attend in person, the option to participate via teleconference is also an option. The conference line number is: 562-247-8422; PIN: 490-838-184. The agenda for this meeting is here.

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On February 5, 2020, ninety-nine members of the House of Representatives signed and sent a letter to Seema Verma, Administrator, Centers for Medicare and Medicaid Services (CMS), that questions the proposed eight percent cut to therapy services. The proposed cut was included in the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) final rule that was published on November 15, 2019. The letter contained two questions asked of CMS, including the methodology and data that were used in this decision making. The responses to these questions were requested by February 21, 2020. Contact RCPA Rehabilitation Services Division Director Melissa Dehoff with questions.

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After conducting many reviews and examining the coverage policies of private payers, the Centers for Medicare and Medicaid Services (CMS) finalized a decision to cover acupuncture for Medicare patients that suffer from chronic low back pain. The increased reliance on opioids and the current opioid public health crisis were large contributors to this decision. Studies have shown that patients who have suffered from chronic low back pain, and were treated by acupuncture, showed significant improvements in both function and pain. Hence, a better alternative than prescription opioids. This expansion of options for pain treatment is a large piece of the Trump Administrations’ strategy for defeating the country’s opioid crisis.

Acupuncture is a treatment performed by practitioners who stimulate specific points on the body by inserting small thin needles through the skin. For the purpose of this decision, chronic low back pain is defined as:

  • Lasting 12 weeks or longer;
  • Nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease);
  • Not associated with surgery; and
  • Not associated with pregnancy.

Medicare will cover up to 12 sessions in 90 days, with an additional 8 sessions for those patients with chronic low back pain who demonstrate improvement. No more than 20 acupuncture treatments may be administered annually. Treatment must be discontinued if the patient is not improving or is regressing.

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Due to the increase in joint replacement surgeries and the prediction for these surgeries to become more prevalent by 2025, along with the implementation of the Bundled Payments for Care Improvement (BPCI) initiative, a request has been made by the Agency for Healthcare Research and Quality (AHRQ) for feedback on Pre-rehabilitation and Rehabilitation for joint replacement surgery. AHRQ is specifically seeking this information because decision makers are unclear about which pre-rehabilitation (e.g., resistance and proprioceptive training) and rehabilitation interventions (e.g., rehabilitation hospitalization, home physical therapy, or outpatient physical therapy) provide the most optimal patient outcomes with the most efficient use of resources. There is also discussion over the settings where these interventions provide the most value. Because of this uncertainty, a new systemic review on the effects of pre-rehabilitation and rehabilitation for major joint replacement surgery may be warranted.

RCPA encourages members to provide feedback to the key questions. The deadline to provide feedback is Friday, January 17, 2020.

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The Centers for Medicare and Medicaid Services (CMS) is seeking additional feedback and recommendations regarding the elimination of specific Medicare regulations that require more stringent supervision than existing state scope of practice laws, or that limit health professionals from practicing at the top of their license.

This request from CMS stems from President Trump’s Executive Order (EO) #13890: Protecting and Improving Medicare for our Nation’s Seniors, which directs the Department of Health and Human Services (HHS) to propose a number of reforms to the Medicare program. These reforms include those that eliminate supervision and licensure requirements of the Medicare program that are more stringent than other applicable federal or state laws and often limit health care professionals, such as Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRN) from practicing at the top of their professional license.

CMS did incorporate some of the recommendations previously submitted in several payment rules, including the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS), where one of the changes included redefining physician supervision for services furnished by Physician Assistants (PAs).

If members have additional recommendations on ways to reduce unnecessary burden, increase efficiencies, and improve the beneficiary experience, please send them to this email with “Scope of Practice” in the subject line. Recommendations must be submitted by January 17, 2020.

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The next Community HealthChoices (CHC) Third Thursday webinar has been scheduled for January 16, 2020 from 1:30 pm – 3:00 pm. During this webinar, Office of Long-Term Living’s (OLTL’s) Deputy Secretary Kevin Hancock will provide updates on the CHC program. Providers should register to participate in the webinar. Once registered, a confirmation email will be sent and will include the call information. Questions about the webinar should be directed to OLTL’s Bureau of Policy Development and Communications Management at 717-857-3280.

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The Centers for Medicare and Medicaid Services (CMS) recently announced the availability of the inpatient rehabilitation facility (IRF) provider preview reports. These reports have been updated and contain information based on quality data submitted by IRFs between Quarter 3 of 2018 and Quarter 2 of 2019. The data will reflect what will be published on IRF Compare during the March 2020 update of the website.

Providers have 30 days (December 9, 2019 – January 9, 2020) to review their performance data. While corrections to the underlying data will not be permitted during this time, providers can request CMS to review their data during the preview period if they believe the quality measure scores that are displayed are inaccurate.

Additionally, providers are reminded that the data for the quality measure Percent of Residents or Patients that have new or worsened Pressure Ulcers (short stay), will continue to reflect data collected between Quarter 3 2017 – Quarter 2 2018, and will continue to be publicly displayed until the new Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury, is publicly displayed in fall 2020, as finalized in the fiscal year (FY) 2018 IRF PPS Final Rule.

As of the March 2020 refresh, CMS will no longer publicly display the measure Percent of Residents or Patients who were assessed and appropriately given the seasonal influenza vaccine (short stay), as finalized in the FY 2019 IRF PPS Final Rule. This change is reflected in preview reports. Contact RCPA Rehabilitation Services Director Melissa Dehoff with questions.

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