In the News

New Member Benefit Provides Medicaid Payment Information

APTA's State Medicaid Payment Rate Guide is an expansive resource that can help members understand and participate in the program.

News

Date: Friday, June 16, 2023

Medicaid is a huge program, serving an estimated 77.3 million Americans. And as just about any PT familiar with the program can tell you, the system can be a challenging one to navigate for providers.

That challenge just got a little easier for APTA members.

Now available: the APTA State Medicaid Payment Rate Guide, available for free as a member benefit, that helps PTs navigate the Medicaid landscape.

Offered in the form of an Excel spreadsheet, this rich resource serves up in-depth information on Medicaid fee-for-service payment rates for PT services provided by state Medicaid programs. The resource is not only a useful tool for individual members, but because it offers comparisons among states, it also can be an aid to state APTA chapters advocating for payment increases.

The guide offers payment rates for selected CPT codes as well as links to the Medicaid manuals for all 51 U.S. jurisdictions, and includes a terminology look-up, data dictionary, and frequently asked questions, among other features. The resource is also scalable, allowing users to zero in on specific states, codes, or other information. There's even a brief instructional video to help you familiarize yourself with the guide's features.

APTA President Roger Herr, PT, MPA, sees the guide as an important step in making Medicaid more approachable for PTs, and in turn increasing patient access to needed care.

"By helping our members better understand Medicaid, we're empowering them to participate fully in this crucial program that provides care to families, children, pregnant individuals, the elderly, and people with disabilities," Herr said. "PT services are needed in Medicaid, and APTA wants to do whatever we can to support access."

 

U.S. Supreme Court Clarifies Employer’s Religious Accommodation Obligations

  • The U.S. Supreme Court has announced its decision in Groff v. DeJoy, a long-awaited decision explaining employers’ obligations under Title VII to reasonably accommodate employees’ religious beliefs, observances, and practices.
  • In the case, a former United States Postal Service (USPS) mail carrier, Gerald Groff claimed that he was unlawfully denied his requested religious accommodation to not work Sundays. The USPS tried to find other carriers to cover Groff’s Sunday shifts, but because of a shortage of rural carriers, it often failed. Groff requested that the USPS exempt him from Sunday work, but the USPS declined, stating that his requested accommodation would lead to undue hardship for the USPS.
  • Under Title VII of the Civil Rights Act, employers are required to reasonably accommodate employees whose sincerely held religious beliefs or observances conflict with work requirements, unless doing so would create an undue hardship for the employer. With no statutory definition of “undue hardship”, courts have relied on the Supreme Court’s decision in TWA v. Hardison, 432 U.S. 63 (1977), to determine the parameters of the term. In Hardison, the Court stated that requiring an employer “to bear more than a de minimis cost in order to give [an employee] Saturdays off is an undue hardship.” In Groff, the Court changed the test. According to the Court, it now “understands Hardison to mean that ‘undue hardship’ is shown when a burden is substantial in the overall context of an employer’s business.” The Court declined to incorporate the undue hardship test under the Americans with Disabilities Act which requires significant difficulty and expense.

If employers have any questions or concerns, we recommend they contact us to ensure compliance. For assistance, contact us at 423-764-4127 or by email at [email protected]

 

Report: Hospital Capacity Challenges To Drive Expansion Of At-Home Care 

Home Health Care News | By Patrick Filbin
 
A new report found that hospital capacity challenges will persist for the next decade. That, in turn, is a promising sign for more at-home care opportunities in the future.
 
The report — Sg2’s 2023 Impact of Change Forecast — found that hospital capacity challenges will be severely tested, driven by higher patient-acuity levels and staffing shortages.
 
The complexity in patients is one of the driving factors in an increase in case mix index and longer hospital stays. Since 2019, case mix index — a measure reflecting the diversity, complexity and severity of patient illnesses – is up by 5%
 
During the same time frame, the average length of stay for patients admitted to a hospital has risen 10%.
 
Both of those factors have further exacerbated the workforce challenges in the health care space, the authors of the report found.
 
“As the population continues to age and chronic disease incidence rises, we expect increased demand across all sites of care,” Tori Richie, intelligence senior director with Sg2, said in a statement. “The reality is access is a challenge for these patient populations and care redesign will be critical to prevent the acute exacerbation of their medical conditions.”
 
The picture for traditional facility-based settings of care is far from rosy. As the report notes, that should open the door to more care-at-home opportunities.

Read Full Article 

 

Home Health Providers Have 'More Power Than They Did Yesterday' In MA Plan Negotiations 

Home Health Care News | By Joyce Famakinwa

It has become increasingly difficult for home health providers to ignore Medicare Advantage (MA) plans’ growing reach. Providers looking to thrive will need to learn to navigate this evolving reimbursement landscape. 

In 2023, MA plan enrollment surpassed traditional Medicare enrollment. There has been a growth of more than 10 million MA plan enrollees over the last decade.  

“There’s been a lot of celebrity endorsements of Medicare Advantage, a lot of marketing and it’s paid off,” National Association for Home Care & Hospice (NAHC) President William A. Dombi said during a recent MedBridge webinar. 

Home health providers will experience a financial impact from this, as MA plans generally pay less for home health services than traditional Medicare does.  

“This translates to likely losing money on the [MA] program,” Dombi said. “This would require subsidization from other payers. The other payers primarily subsidizing [MA] is the Medicare program, which has had a margin of sorts for many years, but that traditional Medicare margin is shrinking, as there are payment rate cuts, combined with a growing proportion of agency patients coming from [MA].”  

In order to operate successfully, providers will need to have a strong understanding of the business relationship with plans, have a thorough understanding of their contracts and prepare evidence that  

“Imagine saving the MA plan the cost of a hospitalization through your high-quality service that presents a lot of value to the plan, and the opportunity to negotiate a better payment rate,” he said.  

Dombi also noted that providers should have a willingness to consider innovative payment models. 

This could mean episodic contracts rather than per-visit ones. It could also mean capitated payments, where providers take on risk.  

“No matter what model you use, expect to show the financial value to the plan,” Dombi said.  

He also touched the tricky referral dynamics that can occur between MA plans and providers. 

“Many home health agencies accept [MA] patients because their referral sources are saying, ‘You won’t get our traditional patients unless you take the [MA] patients off our hands,’” he said.  

In these instances, it’s important for providers to determine if the organization has enough resources for both types of patients.  

Ultimately, providers should be able to answer the question: Is this MA plan the right fit for your organization? 

“For the first time in years, we are hearing from our members who are actually saying no to plans, because they cannot sustain their existence if they continue to get those rates of payment,” Dombi said. “[This is] creating some negotiating leverage. Clearly, it’s a David and Goliath situation. You don’t have great leverage, but you have more today than you had yesterday.” 

 

Guidebook of Policies and Procedures for Pre-Rulemaking Measure Review (PRMR) and Measure Set Review (MSR)

The Guidebook of Policies and Procedures for Pre-Rulemaking Measure Review (PRMR) and Measure Set Review (MSR) is now available for public comment.  The Guidebook was developed as part of a CMS-funded contract, the National Consensus Development for Strategic Planning and Healthcare Quality Measurement. It provides an overview of the PRMR (previously conducted via the Measure Applications Partnership) and MSR policies and procedures, associated timelines, measure selection and removal criteria, a summary of the committee compositions, and how committees will be engaged. We will host an informational session on July 10th 2-4 pm EST to discuss the Guidebook prior to closing the public comment period. You can register here.

Please submit comments by visiting the Partnership for Quality Measurement website.

Public comment will remain open for 30 days, closing at 11:59 PM ET on July 21. If you have any questions about the comment submission process, please contact [email protected].

 
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