The Centers for Medicare & Medicaid Services pleasantly surprised long-term care therapy providers with several parts of the new 2022 Medicare Physician Fee Schedule Proposed Rule that it released Tuesday.

Overall payments would drop but only by about one-fourth the expected levels.

That’s according to a preliminary analysis of the proposed rule, which extends some telehealth service coverages that were expanded during the pandemic through at least calendar year 2023.

But the biggest eye-openers for long-term care operators among the 1,747-page document centered on pay rates on the therapy side, namely their unexpected mildness.

Cynthia Morton

“It’s not looking too bad. It’s looking like CMS is not cutting all the specialties like they did in this current year,” said Cynthia Morton, executive vice president of the National Association for the Support of Long Term Care, on Tuesday. 

“On balance, it looks like the combined impact of all the policies in the proposed rule, including changes to the Conversion Factor, result in about 2% cuts. That’s nothing like last year’s 9% cuts. It’s a huge improvement.”

In addition, portable X-ray suppliers would see a 10% rise in total allowed charges under Tuesday’s proposed rule.

“This is an incredible improvement from what we were expecting, which was somewhere around a minus-6% reduction that was finalized in last year’s final rule,” Morton said.

She also said that family practices — such as where gerontologists may see patients in nursing homes — are in line for a 2% increase. “They were thinking they’d get a decrease,” she said

CMS is moving forward with the 15% differential pay cuts for physical and occupational therapy assistants, but it has newly detailed modifications to billing minutes that appear to minimize the blow. If so, it would be the third approach in three years aimed at honing in on more equitable rates. 

New rates would kick in Jan. 1, 2022, according to the proposed rule.

Last year, some physical and occupational therapy providers were dealt 9% cuts in the 2021 PFS rule that stakeholders described as “devastating.” Lobbying efforts, however, ultimately helped trim the actual cut to 3%.

Telehealth expansion

CMS said requests to permanently enact telehealth payment expansion that sprang up during the pandemic, including for rehab therapy services, are not possible to fulfill at this time.

“However, CMS is proposing to retain all of the services, including rehab therapy services, which were added to the Medicare telehealth services list for the duration of the [public health emergency] on a Category 3 basis, until the end of CY 2023,” the NASL analysis pointed out.

The agency is taking the compromise action in order to buy time and create a “glide path” to judge whether the services should be permanently added to the telehealth coverage list.

On Tuesday, CMS also called for the removal of 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. 

“CMS is proposing to expand access to mental health services for rural and vulnerable populations by allowing, for the first time, Medicare to pay for mental health visits when they are provided by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) to include visits furnished through interactive telecommunications technology,” the agency said in a statement. “This proposal would expand access to Medicare beneficiaries, especially those living in rural and other underserved areas.”

CMS also said that audio-only telehealth services would be covered for home care calls under certain conditions for eligible practitioners. That would encompass counseling and therapy services for opioid treatments.

“These changes would be particularly helpful for those in areas with poor broadband infrastructure and among people with Medicare who are not capable of, or do not consent to the use of, devices that permit a two-way, audio/video interaction for their health care visits,” CMS said in a statement Tuesday.

The agency also proposed a requirement that there must be in-person, non-telehealth service with the physician or practitioner within six months prior to the original telehealth service and at least once every six months thereafter. CMS will gather comments on whether another interval may be necessary or appropriate.”

Federal health officials had previously expressed interest in Medicare permanently retaining telehealth expansions.

“The COVID-19 pandemic has put enormous strain on families and individuals, making access to behavioral health services more crucial than ever,” CMS Administrator Chiquita Brooks-LaSure said in a statement accompanying the proposed pay rule. “The changes we are proposing will enhance the availability of telehealth and similar options for behavioral health care to those in need, especially in traditionally underserved communities.”

Tuesday’s proposed rule also outlines efforts CMS will undertake to “better measure and analyze disparities across its program and policies.” The agency will examine data categories such as race and ethnicity, LGBTQ+, dual-eligible beneficiaries, disability and rural populations.

CMS is asking stakeholders for comments on the proposed rule by Sept. 13, 2021.