The federal government is delivering relief to therapy providers from a burdensome and long-running rule, but also causing concern for skilled care providers.
The Centers for Medicare & Medicaid Services on Friday took some Medicare Part B payment policies to a new level, publishing them in the Federal Register. The wide-ranging Medicare Physician Fee Schedule includes provisions for everything from telehealth to physician evaluation. While some skilled nursing advocates noted some positives in the new rule, others focused on some red flags.
Dan Ciolek, associate vice president of therapy advocacy at the American Health Care Association, expressed reservations. He said his group is currently reviewing the rule and intends to fully comment before the Sept. 10 deadline. Members, especially those in smaller rural communities, would benefit from the proposed greater access to telehealth, beyond the current once-per-30-day limit.
But the AHCA is not on board with suggestions for physician evaluation and management codes.
“We are concerned that the proposed physician E&M [Evaluation & Management] code payment changes could exacerbate the challenges in identifying physicians willing to furnish care to SNF residents, especially since CMS has proposed an entirely new SNF Patient Driven Payment Model (PDPM) for SNF Part A stays starting in October 2019 that will require even more physician involvement than required under the current SNF PPS payment model,” Ciolek explained in an email.
The association is also looking closely at CMS proposals tied to the Medicare Shared Savings Program, as well as the Medicare Incentive Payment Program, and how they might affect skilled nursing. But as of Friday, “We are disappointed that SNF-based therapists are not proposed to be eligible for participation in the quality incentive programs, and intend to comment on this oversight,” Ciolek added.
Also notable for long-term care operators: On Jan. 1, the agency will remove functional status reporting requirements for outpatient therapy, which date back to 2013.
Such reporting has been a “burden” to the field for years, with no standardization in the process, said Cynthia Morton, executive vice president of the National Association for the Support of Long Term Care. Her organization has been advocating for its repeal since its inception five years ago.
“We are very happy about this,” she told McKnight’s. “You have therapists around the country using different methods to test functional limitations, so you can’t really compare the change in function from one patient to another because they’re not using the same test. It’s apples-to-oranges all over the country, and it’s really been a waste of time and resources for providers to report all of this.”
Data from such reporting was to be used to help the CMS reform Medicare payment for outpatient therapy services, which were subject to therapy caps, NASL noted in its analysis of the rule. But functional status reporting became even less purposeful, following the Bipartisan Budget Act of 2018, which repealed the therapy caps.
Also of note: The rule says that outpatient therapy services furnished on or after Jan. 1, 2022, in whole or part, by a therapy assistant will be covered at 85% of the otherwise applicable Part B payment.
The changes were first announced by CMS on July 12 and were officially published in the Federal Register on Friday.
