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By Kristen O’Brien, JD Vice President, McDermott+ Consulting Last week, the Centers for Medicare and Medicaid Services (CMS) released the FY 2022 proposed rule for inpatient rehabilitation facilities (IRFs), which updates payment rates, make adjustments to the case mix group (CMG) weights, and includes proposals for the IRF Quality Reporting Program (QRP). Compared to past rules, this proposal was fairly light on significant new policy developments but does include a number of important changes for rehabilitation medicine providers. AMRPA provided a detailed summary of all the provisions in the rule via its On the Record Special Edition update, but this ...
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By Lisa Werner  It is important to keep the patient’s plan of care at the heart of the team’s decision making. While each team member creates their own discipline-specific plan of care, it is incumbent on each member to know what the plans written by other team members include. Each team member is responsible for ensuring continuity of care in order to effectively and efficiently achieve the best outcome in the shortest amount of time. To do this, all team members must work together. Be sure that your team conference includes a review of the patient’s plan of care, barriers to achieving the plan, and strategies to help the patient progress with his/her plan. ...
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By Remy Kerr, MPH, AMRPA Health Policy and Research Manager On March 15, the Medicare Payment Advisory Commission (MedPAC) released its March 2021 Report to Congress. In the report MedPAC included its standard chapters addressing each of the nine payment systems in the Medicare program, the current status of the Medicare program from which the Commission bases its payment update recommendations, and a status report on the Medicare Advantage and Medicare Part D prescription drug program. MedPAC also included an additional chapter on expansion of telehealth in the Medicare program resulting from the COVID-19 public health emergency (PHE). As expected, MedPAC ...
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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. ...
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Additional Guidance from CMS Changes Coding Methodology for COVID Patients By Lisa Werner  In last month’s blog post, I covered coding for COVID-19. Since that time, the following additional guidance from CMS was issued that changes the methodology for coding patients with active or a history of COVID-19. U07.1 – COVID-19: The first diagnosis code released was intended for patients diagnosed with the virus. Currently, it is used for patients with active virus. For inpatient rehabilitation providers, this code is used when a patient with active virus is in the hospital or unit. It may also be used as an etiologic diagnosis to explain why a patient was admitted. ...
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By Peter W. Thomas, JD, Principal, and Joe Nahra, Director of Government Relations Powers Law Firm On December 14, 2020, the Centers for Medicare and Medicaid Services (CMS) solicited public feedback on the agency’s intention to develop and implement a Medicare “Review Choice Demonstration” (RCD) for inpatient rehabilitation facilities. This demonstration would seek 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. In comments submitted on February 16, AMRPA strongly opposed this demonstration, asking CMS to fully withdraw the ...
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By Kristen O’Brien, JD Vice President, McDermott+ Consulting It was a complex beginning to 2021, with a new administration and Congress.  President Biden formally took office, the COVID-19 pandemic raged on, and Congress rappelled divided chambers and a pending impeachment trial. This environment sets the stage for a challenging legislative and policy agenda, with numerous implications for health care and rehabilitation medicine.  COVID-19 The COVID-19 pandemic remains the dominant and most immediate issue for policymakers. On day one, President Biden released numerous executive actions aimed at fighting the public health emergency with significant focus ...
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By Remy Kerr, MPH, AMRPA Health Policy and Research Manager On January 3, 2021, the 117th Congress convened, with a few seats still outstanding due to run-off elections. Following the Georgia Senate run-off on January 5, the Senate now has a 50-50 Democratic to Republican split, with two Independent Sen. s (Bernie Sanders (VT) and Angus King (ME) caucusing with Democrats and Vice President Kamala Harris serving as the tie-breaking vote and giving Democrats effective control of the Senate. In the House of Representatives, Democrats retained control of the chamber with a party split of 221 Democrats and 211 Republicans. Effective January 20, former Senate Minority ...
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By Jonathan Gold, JD Director of AMRPA Government Relations and Regulatory Counsel AMRPA is aware of the cumbersome nature of prior authorization requirements for IRF admissions, as well as the detriment that these care delays and denials have on patients. Due to this, reforms to prior authorization practices have become central to AMRPA’s advocacy efforts on the federal level. More recently, the Association has been closely monitoring the impact prior authorization has had on hospitals’ ability to meet the needs of patients in their communities during the COVID-19 Public Health Emergency (PHE). In the course of AMRPA’s ongoing engagement with Centers for ...
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By Peter W. Thomas, JD, Principal, and Joe Nahra, Director of Government Relations Powers Law Firm In the final days of the Trump administration, the Department of Health and Human Services (HHS), in particular, the Centers for Medicare and Medicaid Services (CMS), issued a number of “midnight” final rules impacting health care providers. Many of these final rules had effective dates past January 20, 2021. When President Biden was inaugurated, the new administration announced it was issuing a “freeze” on all regulations not yet in effect, a step which prior incoming administrations have also taken. Agencies including HHS have been directed to postpone the ...
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AMRPA Welcomes McDermott+ Consulting as Legislative Counsel AMRPA is pleased to announce McDermott+ Consulting has been hired by the Association as Legislative ‎Counsel. ‎McDermott+ exclusively focuses on the healthcare industry and brings significant experience ‎in the post-acute care ‎sector. McDermott+ will be providing AMRPA with lobbying, policy and data ‎analytics services to help ensure AMRPA ‎is well-positioned to advocate for the field with the new 117th ‎Congress and Biden Administration. Make sure to ‎register for the AMRPA 2021 Virtual Spring ‎Conference to hear from the McDermott+ team, and stay tuned to AMRPA Access as as McDermott+ ...
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Passion and Progress Dedicated to staying physically active and honing his talents, 55-year-old Clint Coleman enjoys working on his golf game, exercising and playing the guitar. But a little over four years ago, an unexpected and frequently fatal medical condition forced him to take a break from and readjust his way of pursuing those passions. In October 2016, Clint’s aorta dissected, necessitating a 14-hour surgery at UCLA Health Hospital. Shortly after, he suffered a stroke, which caused paralysis on his right side and some memory loss. Persisting complications from the dissection and the stroke led to circulation issues that caused death of the skin ...
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MedPAC Formally Votes to Recommend a 5% Payment Reduction for IRFs in FY 2022; Discusses Issues for Inclusion in March and June Reports to Congress By Remy Kerr, MPH, AMRPA Health Policy and Research Manager On January 14 and 15, the Medicare Payment Advisory Commission (MedPAC) met virtually for its January public meeting to discuss issues to include in the March and June 2021 Reports to Congress. In the post-acute care (PAC) payment update sessions, MedPAC commissioners formally and unanimously voted to finalize each of the draft recommendations discussed during the December 2020 meeting. For IRFs, MedPAC formally recommended a 5% payment reduction ...
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What You Should Know About the 60% Rule Waiver‎ By Lisa Werner  At the beginning of the COVID-19 public health emergency, the Centers for Medicare and Medicaid Services (CMS) enacted waivers that would enable smooth patient care transitions and alleviate capacity in acute care. One of these waivers was the 60% rule waiver for inpatient rehabilitation facilities (IRF). IRFs are allowed to admit patients and exclude them from their 60% rule calculation. The excerpt below is from the CMS website in the IRF Flexibilities Document updated on July 9, 2020. Flexibility for Inpatient Rehabilitation Facilities Regarding the “60 Percent Rule”: ...
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By Peter W. Thomas, JD, Principal, and Joe Nahra, Director of Government Relations Powers Law Firm On December 10, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule titled, Reducing Provider and Patient Burden by Improving Prior Authorization Processes and Promoting Patients’ Electronic Access to Health Information . The rule would streamline prior authorization processes for Medicaid, Children’s Health Insurance Program (CHIP) and federal Affordable Care Act (ACA) plans, while also expanding on policies from CMS’ earlier Patient Access and Interoperability rule. As proposed, the prior authorization provisions in this rule ...
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By Remy Kerr, MPH, AMRPA Health Policy and Research Manager On December 3-4, the Medicare Payment Advisory Commission (MedPAC) convened for a virtual public meeting. The meeting included MedPAC’s annual sessions for evaluating payment adequacy and providing payment update recommendations for Medicare-certified inpatient rehabilitation hospitals and units (IRFs), skilled nursing facilities (SNFs), home health agencies (HHAs), and long-term care hospitals (LTCHs). Of note, MedPAC stated that the draft recommendations are based on 2019 data, and that the Commission believes the impacts of the COVID-19 public health emergency (PHE) should be addressed through separate, ...
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By Martha M. Kendrick, Esquire Partner,   Akin Gump Strauss Hauer & Feld LLP Congressional Developments Appropriations House and Senate appropriators on November 24 reached a bipartisan agreement on spending allocations for the 12 annual appropriations bills, laying the groundwork for a $1.4-trillion Omnibus package. The current Continuing Resolution (CR) was set to expire this past Friday, December 11, but Congress passed another one-week stopgap to give themselves until December 18 to work on Fiscal Year (FY) 2021 appropriations and COVID-19 relief. Reportedly, they worked hard to resolve funding disputes around immigration and veterans’ ...
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Uncertainty. That’s what Laurel DuPont felt when she found out she failed a routine temperature screen and started exhibiting symptoms of COVID-19. Laurel is CEO of Northshore Rehabilitation Hospital , which at the time of her COVID diagnosis, had only been open for five months. As with many other health care facilities at the beginning of the pandemic, her inpatient rehabilitation hospital was grappling with a number of questions, first and foremost how to maintain the safety of its patients and employees. How could I have gotten COVID-19? “We had built a very strong culture in those short five months, but now that would be put to the test,” ...
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2021 Fee Schedule Final Rule Reduced Payment for Outpatient Therapy and Inpatient Physician Services By Jonathan Gold, JD Director of AMRPA Government Relations and Regulatory Counsel On Tuesday, Dec. 1, the Centers for Medicare and Medicaid Services (CMS) released the  Physician Fee Schedule Final Rule  for CY 2021. CMS finalized its much discussed proposal to update payment rates for outpatient physician visits, effective January 1, 2021. As a result of mandated budget neutrality rules, a significant reduction of approximately 10% will be applied to the base payment rate (“conversion factor”) used in the fee schedule. The result is that most services, ...
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AMRPA Helps with Price Transparency Requirement Rule Invites Additional Participation in Upcoming Member Call On September 23, AMRPA hosted a Members-Only Open Forum Call on the pending Hospital Transparency Rule that goes into effect on January 1, 2021. AMRPA provided members with background and specifics, addressed issues that inpatient rehabilitation facilities may have with compliance, Centers for Medicare and Medicaid Services (CMS) non-compliance enforcement authority, and AMRPA’s position and advocacy efforts. Also on the call, AMRPA member hospital Select Medical shared their preparation efforts for implementation and the issues they have encountered ...
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