The Centers for Medicare & Medicaid Services finalized a 15% payment reduction for physical and occupational therapy assistants, and extended temporary telehealth services added to Medicare during the COVID-19 pandemic under the 2022 Physician Fee Schedule. 

CMS announced the final rule late Tuesday afternoon. As providers expected, it confirms the 15% payment cut for outpatient occupational therapy services and outpatient physical therapy services that are provided, in whole or in part, by a physical therapist assistant or occupational therapy assistant. New payment modifiers applied to claims on those services, however, could minimize the blow, providers previously theorized. 

Nonetheless, the rule’s release sent provider advocates scrambling to grasp all the final details and the full implications to the sector, including therapists, physicians and other Part B providers. A full-out lobbying effort is expected to try to defray any funding losses through other measures in the coming months. The new regulations become effective Jan. 1, 2022.

The final rule also confirmed that certain services added to the Medicare telehealth services list will remain there at least through Dec. 21, 2023, to give federal health officials additional time to evaluate whether they should be permanently retained. 

Additionally, the rule removes the geographic restrictions and added the beneficiary’s home as a permissible originating site for telehealth services when used for diagnosing, evaluation or treatment of mental disorders. The rule also requires that for these services there must be an in-person, non-telehealth service with the physician or practitioner within six months prior to the initial telehealth service. The federal government will be required to establish a frequency for subsequent in-person visits.

“We are implementing these statutory amendments, and finalizing that an in-person, non-telehealth visit must be furnished at least every 12 months for these services, that exceptions to the in-person visit requirement may be made based on beneficiary circumstances (with the reason documented in the patient’s medical record), and that more frequent visits are also allowed under our policy, as driven by clinical needs on a case-by-case basis,” CMS stated Tuesday. 

The finalized rule also limits the use of audio-only telecommunications systems to mental health services furnished by practitioners who have the capability to furnish two-way, audio/video communications, but where the beneficiary is not capable of, or does not consent to, the use of two-way, audio/video technology.

CMS issued a flurry of three final rules Tuesday afternoon, including one focused on home health’s pay increase that also touched directly on further nursing home policy.

It finalizes revisions to infection control requirements for nursing homes in the Medicare and Medicaid program, including extending mandatory COVID-19 reporting requirements  through Dec. 31, 2024. It also incorporates into regulation several existing Medicare provider enrollment policies; and finalizes certain survey and enforcement requirements for hospice programs to implement provisions of the Consolidated Appropriations Act, 2021.

A fact sheet on the final home health rule notes that it codifies expansion of the Home Health Value-Based Purchasing (HHVBP) Model and updates Medicare’s home health PPS and home infusion therapy services payment rates for calendar 2022.

It also makes permanent changes to home health conditions of participation implemented during the current COVID public health emergency. Full details can be found here in the Federal Register listing.

As part of the new doc pay rule, starting Jan. 1, 2022, CMS said it will pay $30 per dose for the administration of the influenza, pneumococcal and hepatitis B virus vaccines. The agency will also continue a $40 per dose pay rate for administering COVID-19 vaccines until the end of the year when the current public health emergency is declared over. The rates will then be recalculated to align with pay rates for other Part B preventive vaccines, officials said Tuesday.

The 2,414 pages of the 2022 physician pay rule are scheduled to be officially published in the Federal Register Nov. 19.

Check back for updates to this developing story.