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  • CMS Home Health Preclaim, Postpayment Review System Again Ready to Launch in Illinois

    After false starts, restarts, postponements, and more than a little pushback from APTA and other stakeholders, CMS is ready to once again roll out a home health agency (HHA) payment program in Illinois that would force HHA providers in the state to participate in preclaim or postpayment reviews—or choose a third option that would involve "minimal" postpayment review but cut payment by 25%.

    Called the "Review Choice Demonstration for Home Health Services," the program will require HHAs in Illinois to choose 1 of 3 program options: submit documentation for 100% of Medicare patients while they are receiving care (a "preclaim review"), submit 100% of all claims for a postpayment review, or opt for "minimal" postpayment review and swallow a 25% payment cut. HHAs can begin making their choice on April 17 but must submit a final decision to CMS by May 16. The system will begin on June 1.

    If parts of the system sound familiar (particularly to HHAs in Illinois), that's because they are: CMS first introduced the project in Illinois in 2016, with plans to roll out the system to 4 additional states in 2017. In the face of criticism from most HHA organizations about the excessive burden of the demonstration, CMS put the brakes on the rollout. In June 2018, CMS announced that it would move ahead with a revised demonstration in 5 states—but then held off again and announced that once the delay was over, the program would begin in Illinois.

    According to CMS, the 3-option system will serve as a kind of audition for HHAs, which, after 6 months of compliance, would be allowed additional choices including "relief from most reviews except for a review of a small sample of claims." The demonstration is intended to offer more flexibility and choice for providers, as well as reward providers who show compliance with Medicare home health policies.

    APTA staff and members of the Home Health Section submitted extensive feedback to CMS on the demonstration as it was being considered and reconsidered—and considered again. Like many other stakeholders that provided comments to CMS, APTA argued that the program was excessively burdensome and could decrease patient access to care.

    With the demonstration program ready to begin, many HHAs are wondering the same thing: will the program be expanded to other states and, if so, when?

    "At this point, it's nearly impossible to say how or if CMS will move to expand this system," said Kara Gainer, APTA director of government affairs. "Although some tweaks were made to the project, we believe it's still based on a flawed approach that could put unsustainable pressure on some HHAs. We will closely monitor the demonstration as it plays out in Illinois and take every opportunity to press CMS for significant improvements before it's applied to other states."

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    Student Loan Repayment Program to Include PTs? Health Services Corps Bill Reintroduced in US Senate

    It's back: APTA-supported legislation that would list physical therapists (PTs) among the professions included in a federal program to provide greater patient access to health care in rural and underserved areas has been reintroduced in the Senate. If passed into law, the program could open up access to a student loan repayment program for participating PTs—and help address the nation's opioid crisis in areas that have been especially hard-hit.

    The bill (S.970) would allow PTs to participate in the National Health Service Corps (NHSC) loan repayment program, an initiative that repays up to $50,000 in outstanding student loans to certain health care professionals who agree to work for at least 2 years in a designated Health Professional Shortage Area (HPSA). An estimated 11.4 million Americans are served by the NHSC. The bill was introduced by Sens John Tester (D-MT), Roger Wicker (R-MS), and Angus King (I-ME).

    APTA is a strong supporter of legislation that extends student loan forgiveness to PTs, particularly as a way to improve access to physical therapist services in areas already experiencing shortages. But according to APTA Vice President of Government Affairs Justin Elliott, there's an additional important reason that the association is advocating for the bill's passage.

    "The opioid epidemic has been especially devastating in rural and medically underserved areas," said Elliott. "And while the role of physical therapy as an important nonpharmacological alternative in the prevention, treatment, and management of pain is well-established, the current services corps law doesn't include any physical rehabilitation component. Allowing PTs to participate in the NHSC could help increase patient access to better ways to manage pain, especially for individuals who have or at risk of developing a substance use disorder."

    Advocacy for S.970 (and its yet-to-be-introduced companion in the US House of Representatives) was a major focus of Capitol Hill visits conducted by APTA members as part of the APTA Federal Advocacy Forum held from March 31 to April 2. APTA encourages members to join the push for the bill by contacting their senators to urge them to become cosponsors by way of a prewritten letter, available at the APTA Legislative Action Center, that helps to deliver a unified message (member login required).

    APTA staff will closely track the progress of this legislation—be on the lookout for more opportunities to advocate for this important change.