APTA: Working for You
APTA Submits Comments on SNF and IRF Proposed Rules
This week, APTA
submitted three sets of comments on proposed Medicare rules for skilled
nursing facilities (SNF) and inpatient rehabilitation facilities (IRF)
released by the Centers for Medicare and Medicaid Services (CMS) in
early May. The rules include extensive changes to the calculation of
concurrent therapy minutes on the SNF Minimum Data Set, potential
restrictions on the use of group therapy within the IRF 3-hour rule, and
new definitions for determining medical necessity in the Medicare
Benefits Policy manual for admission to an IRF.
In its
comments, APTA discusses each of these changes and their effect on the
provision of physical therapy services and outlines recommendations to
the agency. Following a description of a concurrent therapy session, the
association says, "… physical therapists working in SNFs should be
able to use a combination of individual, concurrent, and group therapy
as medically necessary in accordance with Medicare coverage guidelines
for skilled therapy. We believe that the use of all three modes
(individual, concurrent, and group) can reflect optimal care for
patients within the SNF setting."
Follow this
link to
the SNF comments and a detailed summary of the proposed rule. Comments
on the IRF proposed rule and changes to the Medicare Benefits Policy can
be found at this link.
CMS will
release final rules on the provisions by August 1.
APTA Provides Clarification to Aetna for PT Services
Bulletin
In recent
comments related to Aetna's clinical policy bulletin on physical therapy
services, APTA provides
clarification and suggestions for revisions in the areas of medical
necessity, specifically direct access; massage therapy and myofascial
release; microwave; therapeutic exercise vs neuromuscular re-education;
coding pairs; and ICD-9 codes.
In addition,
APTA suggested to Aetna that it consider creating a non-physician
advisory committee, or adjunct committee, to its existing Physician
Advisory Committee. APTA has offered to be a participant of this
committee if it is created.
IOM and Federal Council Release Comparative Effectiveness Research
Priorities
The Institute of
Medicine and the Federal
Coordinating Council for Comparative Effectiveness Research on
Tuesday released their national priorities for comparative effectiveness
research that should be supported by the $1.1 billion in the American
Recovery and Reinvestment Act.
An initial
review of the reports shows that APTA's
recommendations for comparative effectiveness research, made to the council in
April, are well-represented. In the comments, APTA pointed out that
physical therapy for conditions such as low-back pain and knee
osteoarthritis could potentially improve public health while providing
efficiencies for a reformed health care delivery system. However, the
association emphasized that funding for research of rehabilitation
interventions has not been equitable when compared to funding for
research of pharmaceutical and surgical interventions.
APTA will
provide a comprehensive summary of the priorities that are relevant to
physical therapy in next week's PT Bulletin Online.
Read more about
the reports and post your thoughts on comparative effectiveness research
on APTA's Moving Forward blog. A statement by APTA President R. Scott Ward, PT,
PhD, is available in APTA's
Health Care Reform Resource Center.
CMS Issues Payment Updates for 2010
The Centers for Medicare & Medicaid Services (CMS)
yesterday
announced proposed changes to policies and payment rates for services
that would be furnished in 2010 by physicians, physical therapists, and
other health care providers who are paid under the Medicare Physician
Fee Schedule. In the rule
CMS projects a
rate reduction of -21.5% for calendar year 2010 due to the update
formula. In addition, the rule would refine practice expenses,
remove physician-administered drugs from the definition of "physician
services" for the purposes of computing the update formula, revise the
Physician Quality Reporting Initiative (PQRI) program, and implement
provisions in recent legislation adding new Medicare benefit categories
for cardiac and pulmonary rehabilitation services.
APTA will submit comments to CMS in response to the rule by the
agency's August 31 deadline. The agency will respond to all the comments
in a final rule that will be issued by November 1. A summary of the
rule will be available on APTA's Web site in the near
future.
To read a CMS
fact sheet on the proposed rule, click here.
CMS Finalizes Rescission of Medicaid Outpatient Rule at APTA's
Urging
On Tuesday, the
Centers for Medicare and Medicaid Services (CMS) rescinded its final
rule on the Clarification of Outpatient Hospital Facility Services
Definition. This rule would have restricted Medicaid reimbursement to
outpatient hospitals; only services that Medicare reimburses as
outpatient hospital services would be included. The restriction could
have been detrimental to Medicaid patients' access to physical therapy
services in the outpatient hospital setting, APTA said in comments it
submitted to CMS in May.
APTA commented that the
Clarification of Outpatient Hospital Facility Services Definition could
have adverse effects on the provision of physical therapy due to the
current nature of state Medicaid funding. CMS said this week in the
final rule that it understood APTA's concerns and it was never the
agency's intention to "limit access to or the quality of PT." The agency
said that it was rescinding the Clarification of Outpatient Hospital
Facility Services Definition rule "to eliminate such
confusion."
Updated Health Care Reform Podcast Now Available
In this week's
health care reform podcast, Justin Moore, PT,
DPT, vice president of APTA
government and payment advocacy, discusses the markup of the Senate
Health, Education, Labor and Pensions Committee's American Health
Choices Act, the debate on how the Senate Finance Committee plans to
finance its proposal, and the unified approach the House has taken in
crafting its "tricommittee" proposal.
A transcript
of the podcast is
available in APTA's Health Care Reform
Resource Center. The Web page, which includes the association's latest actions
related to reform, is updated regularly as new information is available.
Department of Practice Seeks Examples of Innovative Models of Care
Delivery
APTA's
Department of Practice is collecting data on innovative models of
physical therapy care delivery. Members are encouraged to provide
examples of new and emerging practice models that demonstrate improved
access to care, cost effectiveness, and the physical therapist's role in
the management of patients.
Examples of alternative models of care delivery are:
- chronic
disease management initiatives
- emergency
department triage, evaluation, and treatment
- managed care
and public health clinic entry point models
- disease
prevention initiatives
- primary care
initiatives
Members are asked to send a brief description (300 words or fewer) of
innovative practice models along with contact information (name, phone
number, and e-mail address) by August 15, 2009, to brandybradley@apta.org.
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