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Medicare

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Last week, H.R.8746 — Access to Inpatient Rehabilitation Therapy Act of 2022 was introduced to ensure Medicare beneficiaries in inpatient rehabilitation facilities (IRFs) are able to access all skilled, medically necessary rehabilitation therapies that are most appropriate for their condition. This bill, also known as the “three hour rule bill,” would expand the current three hour rule in which Medicare requires IRF patients to be able to participate in, and benefit from, three hours of rehabilitation therapy per day, five days a week (or 15 hours over a seven day period). The current regulation only allows physical therapy (PT), occupational therapy (OT), speech therapy, and orthotics and prosthetics care to count towards the three hour requirement. As a result, many patients have difficulty accessing additional forms of therapy that may be more appropriate.

During the COVID-19 public health emergency (PHE), the three hour rule has been waived in its entirety. If the Access to Inpatient Rehabilitation Therapy Act is enacted, it would ensure that IRFs maintain flexibility after the expiration of the PHE. Most importantly, the legislation would allow certain therapies, including recreational therapy, cognitive therapy, and respiratory therapy, to count towards the three hour rule after the patient’s admission. These additional therapies and skilled modalities would be identified by the Secretary of Health and Human Services (HHS). At the time of admission, the existing three hour rule would still apply, ensuring that IRF admissions do not increase (and thus add to underlying costs for the Medicare program) due to the new flexibility.

This legislative solution has been developed over several years with Members of Congress and a group of stakeholders, including the American Medical Rehabilitation Providers Association (AMRPA), the American Academy of Physical Medicine & Rehabilitation (AAPM&R), the Brain Injury Association of America (BIAA), and the American Therapeutic Recreation Association (ATRA).

For additional information, please refer to Congressman Courtney’s press release.

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The Centers for Medicare and Medicaid Services (CMS) recently released a Request for Information (RFI) requesting public comments on the Medicare Advantage program. CMS is asking for input on ways to achieve the agency’s vision so that all parts of Medicare are working towards a future where people with Medicare receive more equitable, high quality, and person-centered care that is affordable and sustainable, essentially asking for ways to strengthen this program.

CMS’s intent is to better align the Medical Assistance (MA) program with the agency’s vision for Medicare and the CMS Strategic Pillars. CMS is strongly emphasizing the importance of stakeholder comments for this process. This openness to feedback presents MA plans, providers, and other stakeholders an opportunity to inform the agency’s early thinking as it considers potential regulatory actions impacting supplemental benefits, value-based contracting arrangements, risk adjustment, prior authorization, and marketing among other issues.

CMS will accept comments on the RFI until August 31, 2022.

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RCPA has signed onto a letter to Congressional leaders of the Ways and Means Committee and the Senate Committee on Finance, along with 244 other signatories, outlining the need for parity in addiction and mental health care under Medicare.

As the President’s 2023 Budget and Senate Finance Committee’s bipartisan report has highlighted, Medicare is not subject to the Mental Health Parity and Addiction Equity Act (Parity Act). As a result, Medicare beneficiaries do not have coverage of or access to the full range of mental health and substance use disorder benefits they need, and often lose access to treatment they were receiving prior to becoming eligible for Medicare. Although Congress has eliminated disparate financial requirements for Medicare beneficiaries, Medicare still imposes both quantitative (e.g. 190-day lifetime limitation on psychiatric hospital care) and non-quantitative treatment limitations that would violate the Parity Act. Applying the Parity Act to Medicare Parts A, B, C, and D is the critical next step to make mental health and substance use disorder services available and accessible to the millions of Medicare beneficiaries in need of treatment.

Read the full letter here.

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Medicare binary sign concept illustration design over black

The Centers for Medicare and Medicaid Services (CMS) is conducting interactive training webinars that cover Medicare basics today, June 14, 2022, and tomorrow, June 15, 2022, from 1:00 pm – 3:00 pm. The topics and registration links for both days are provided below:

Day 1 (June 14) — Topics will include Medicare enrollment and eligibility; SSA and CMS roles and responsibilities; cost and coverage under Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance); why enrolling on time is important; and an overview of Medicare Supplement Insurance (Medigap) policies.

Register for the Day 1 webinar here.

Day 2 (June 15) — Topics will include Medicare drug coverage (Part D); Medicare Advantage Plans; coordination of benefits; how to detect and report suspected Medicare fraud, waste, and abuse; and different resources to help you find answers to Medicare policy and coverage questions.

Register for the Day 2 webinar here.

These webinars will be recorded and posted to the National Training Program (NTP) website. You can view the recordings here.

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Source: The Center Square, June 1, 2022
By Anthony Hennen

After a months-long controversy over unionization language in Medicaid contracts that sparked a lawsuit, the Pennsylvania Department of Human Services has removed the provision in question, citing concerns about “misinformation” and “confusion.” …The language prompted the Hospital & Healthsystem Association of Pennsylvania to file a lawsuit against DHS in early May, alleging that DHS overstepped its authority and didn’t follow proper procedure for adding the unionization language.

On May 26, DHS confirmed that the work stoppage provision would be dropped from the Medicaid contracts.

View the full article here. If you have any questions, please contact your RCPA Policy Director.

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