Eli's Rehab Report
Headaches On 'Close To' Therapy Change Remain
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Not all is bleak for therapy visit coverage in the final rule. According to CMS' final rule of the prospective payment system published in the Nov. 8
Old way:
Currently, when beneficiaries receive more than one type of therapy in a home health episode, the therapist's reassessment visit "need only be 'close to' the 13th and 19th visits," the Centers for Medicare & Medicaid Services reiterated in the home health proposed rule published in the July 13 Federal Register.Proposed change:
In July, CMS proposed "to revise the regulations ... to clarify that in cases where the patient is receiving more than one type of therapy, qualified therapists could complete their reassessment visits during the 11th, 12th, or 13th visit for the required 13th visit reassessment and the 17th, 18th, or 19th visit for the required 19th visit reassessment," the agency said in the rule. These visit ranges match the ones CMS allows when the patient is in a rural area or has other documented circumstances outside the therapist's control that prevent the reassessment visit from occurring exactly on the 13th or 19th visit.CMS proposed the change because it received repeated questions about what "close to" means under the current requirements. "We recognize the industry's need for additional guidance [and will] provide more precise guidance," the agency said in the proposed rule.
The proposal brought a storm of industry comments protesting the move. The change would make reassessment scheduling cumbersome if not downright impossible, multiple commenters insisted. And it would add unnecessary therapy visits.
New way:
CMS has listened to agencies' comments, although it hasn't abandoned its proposal altogether. "We find compelling the commenters' concerns regarding the feasibility for patients receiving more than one type of therapy [from] qualified therapists from each of the therapy discipline[s] reassessing the patient within the proposed timeframes when modalities differ significantly in frequency," the agency says in the final rule released Nov. 2. "In those cases we do not expect an HHA to schedule an extra unnecessary visit or delay a visit in order to reassess the patient within the proposed timeframes."In other words:
"In instances where patients are receiving more than one type of therapy, and the frequency of a particular discipline, as ordered by a physician, does not make it feasible for the reassessment to occur during the specified timeframes without providing an extra unnecessary visit or delaying a visit, it would still be acceptable and satisfy the reassessment requirement, for the qualified therapist for that discipline to provide the therapy service and functionally reassess the patient during the visit associated with that discipline that is scheduled to occur close to the 14th Medicare-covered therapy visit, but no later than the 13th Medicare-covered therapy visit," CMS concludes.The same goes for the 20
th visit deadline. This finalized exception to the ranges has "basically moved 'close to' to 'closest to,'" explains physical therapist Cindy Krafft with Fazzi Associates. The revision is still an unwelcome change from the original timing, "but not as rigid as we feared," Krafft tells Eli.Potential problem:
Figuring out when the "close to" standard applies versus when the 11-to-13 visit or 17-to-19 visit ranges apply is still likely to cause providers headaches, industry veterans worry.Coverage Tweaks Should Help Agencies
In more positive changes, CMS finalizes its proposals regarding therapy coverage surrounding missed assessments. First, in multi-therapy-discipline cases, only the discipline that missed the reassessment deadline would go without Medicare coverage, CMS says.
Second, when a therapist misses a reassessment, "therapy coverage would resume with the visit during which the qualified therapist completed the late reassessment, not the visit after the therapist completed the late reassessment," CMS confirms in the final rule.
The changes are "modest" improvements, judges the
National Association for Home Care & Hospice.
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