By Peter W. Thomas, JD, Principal, and
Joe Nahra, Director of Government Relations
Powers Law Firm
On March 15-17, AMRPA members will attend the 2021 Virtual Spring Conference & Congressional Fly-In to bring the voice of medical rehabilitation professionals and patients to Capitol Hill. Following the Leadership Forum, where diverse perspectives from Members of Congress, key Congressional staff, federal agency officials, industry leaders, and AMRPA senior staff and counsel will be shared, attendees will join their state colleagues to speak with Congressional Members and staff about key issues of importance to the inpatient rehabilitation hospital field. Though we cannot gather in-person, this year’s virtual meeting provides an excellent opportunity to inform policymakers about AMRPA’s priorities and important medical rehabilitation issues.
This year’s Congressional Fly-In focuses on three primary topics: opposition to the recently proposed IRF Review Choice Demonstration (RCD), legislation for resetting the timeline of the IMPACT Act, and needed reforms to prior authorization requirements.
IRF Review Choice Demonstration
In December 2020, the Centers for Medicare and Medicaid Services (CMS) announced a preliminary proposal to develop and implement a Medicare RCD for inpatient rehabilitation facilities (IRFs). The demonstration seeks to ensure proper payment for inpatient rehabilitation hospital services by requiring IRFs impacted by the demonstration project to undergo 100% pre-claim or post-payment review. AMRPA, along with other key rehabilitation stakeholders, strongly oppose this demonstration and asks CMS to fully withdraw the proposal.
Congressional Fly-In participants will educate staff on other serious concerns with the proposal, including potential access barriers it might impose on Medicare beneficiaries in need of inpatient rehabilitation. While it is currently unclear how CMS intends to proceed with the RCD under the new Biden administration, it is important to keep Congress informed and aware of the negative impact this demonstration would have on rehabilitation patients and providers.
For more information on the IRF RCD and the rehabilitation community’s response, visit AMPRA Access.
IMPACT Act Reset Legislation
AMRPA members are familiar with the Improving Medicare Post-Acute Care Transformation Act of 2014, or the “IMPACT Act.” Among other provisions, this legislation directed CMS and the Medicare Payment Advisory Commission to study and develop proposed models for a unified post-acute care (PAC) payment system, which combines payment systems of the four current settings for PAC – IRFs, home health agencies, skilled nursing facilities, and long-term care hospitals. However, in the years since the IMPACT Act was enacted, the PAC continuum of care has seen significant changes to individual payment systems and most recently the transformative impact of the COVID-19 pandemic. As the original legislative timeline for delivering the unified payment models approaches, it is clear that any proposed payment system must be built on updated data to ensure that the effects of the current public health emergency are fully understood and built into the unified payment recommendations.
In December 2020, Rep. Terri Sewell (D-AL), and recipient of the 2021 AMRPA Chairman’s Award, introduced the Resetting the IMPACT Act of 2020. This legislation delays the timeline for full implementation of the IMPACT Act and requires that CMS incorporate patient and quality data reflecting the impact of COVID-19 and other recent changes to Medicare PAC payment, and ensures that data on social determinants of health be incorporated.
Similar legislation is expected to be re-introduced in the 117th Congress. Fly-In participants will discuss the importance of resetting and recalibrating the IMPACT Act with Congressional staff, and underscore the importance of a PAC payment system that ensures patients access to care in appropriate PAC settings.
Prior Authorization Reform
AMRPA has long recognized the undue burden that prior authorization and other utilization management techniques place on rehabilitation patients, providers and facilities. In the 116th Congress, AMRPA endorsed the Improving Seniors’ Timely Access to Care Act to streamline prior authorization and increase transparency for Medicare Advantage plans. Specifically, the bill would:
- Establish an electronic prior authorization process; minimize the use of prior authorization for routinely approved services;
- Ensure prior authorization requests are reviewed by qualified medical personnel;
- Require regular reports from Medicare Advantage plans on their use of prior authorization and rates of delay and denial; and
- Prohibit the use of prior authorization for medically necessary services performed during pre-approved surgeries or other invasive procedures.
The House version of this legislation (H.R. 3107) garnered 280 cosponsors in the 116th Congress, representing more than the 218 votes required for passage on the House floor. As congressional champions prepare to reintroduce and advance the legislation in coming weeks, AMPRA attendees will discuss the importance of reforming prior authorization in the Medicare Advantage program and opportunities for improving the legislation by specifically addressing the needs of inpatient rehabilitation hospitals and units. Enacting these reforms would combat delays and access restrictions that often accompany overuse of prior authorization for hospital-level PAC.
We look forward to discussing these important issues during the 2021 Spring Fly-In and maintaining the strong relationship between federal policymakers and the medical rehabilitation field. Learn more about the 2021 Virtual Spring Conference here.