CMS Proposes Updates to Reduce Barriers to Coverage, Simplify Medicare Enrollment and Expand Access

Proposed rule would create Special Enrollment Periods, reduce gaps in Medicare coverage and improve administration of the Medicare Savings Programs.

[The] Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update Medicare enrollment and eligibility rules that would expand coverage for people with Medicare and advance health equity. This proposed rule would provide Medicare coverage the month immediately after enrollment, thereby reducing the uninsured period and expand access through Medicare special enrollment periods (SEPs). It would also allow eligible beneficiaries to receive Medicare Part B coverage without a late enrollment penalty. This proposed rule would make it easier for people to enroll in Medicare and eliminate delays in coverage.

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Federal Independent Dispute Resolution (IDR) Portal Launched

April 15, 2022, the Centers for Medicare & Medicaid Services opened the Federal Independent Dispute Resolution (IDR) process for providers (including air ambulance providers), facilities, and health plans and issuers to resolve payment disputes for certain out-of-network charges.

To start a dispute, an initiating party will need:

• · Information to identify the qualified IDR items or services;  
• · Dates and location of items or services;
• · Type of items or services such as emergency services and post-stabilization services; 
• · Codes for corresponding service and place-of-service;  
• · Attestation that items or services are within the scope of the Federal IDR process; and
• · The initiating party’s preferred certified IDR entity. A list of certified entities can be found here. 

At the end of the 30-business-day open negotiation period, initiating parties have 4 business days to initiate a dispute via the portal. As a result of the recent decision in Texas Medical Ass’n, et al. v HHS, the Departments will give disputing parties whose open negotiation period expired before today, April 15, 2022, 15 business days to file an initiation notice via the IDR Portal.

Even after starting the Federal IDR process, disputing parties can continue to negotiate until the IDR entity makes a determination. If the parties reach an agreement on the out-of-network payment rate, they should email the certified IDR entity and the Departments (at [email protected]).

If the disputing parties experience extenuating circumstances during the IDR process that prohibit them from complying with deadlines to submit information, they may email the Departments (at [email protected]) to receive a Request for Extension Due to Extenuating Circumstances form and instructions for next steps.

To learn more about the independent dispute resolution process, including to read guidance materials, FAQs, and model notices, visit www.cms.gov/nosurprises

President's Message

Posted: April 20, 2022

What can Orange do for you? (Apologies to UPS)

Our new primary color is a shade of orange. It’s definitely a red-orange, but it’s officially orange. The color itself is academic. The important question is: What can APTA Home Health do for you, our members? We got some great suggestions in our Virtual Town Hall last month. Oh, you missed that? Don’t worry—we’re planning another one for May or June with some content on Home Health Value Based Purchasing. We will also have time for your questions, concerns, and suggestions. Keep an eye out for the date and time!

Sincerely, 

 


 Phil Goldsmith
 President
 APTA Home Health  

Digital Health Technology and Physical Therapy

A statement from APTA President Roger Herr, PT, MPA

Increasingly we are seeing media reports and company announcements about the use of digital platforms and technologies to provide physical therapy. 

The advancement of care delivery models that embrace technology has great potential to increase consumer access to care, promote consistent evidence-based treatment, and reduce unnecessary, costly, or riskier treatment.

APTA maintains that "physical therapy," whether provided in person or virtually, is performed or directed by licensed physical therapists.

Physical therapist treatment and technology can and should coexist with the health and experience of the consumer in mind. APTA stands ready to collaborate with digital platforms and partners to ensure these care models are consistent with existing laws and regulations, uphold consumer protections, and advance quality practice provided by licensed health professionals in accordance with their professional obligations and state defined scope of practice. 

APTA will continue to advocate for consumer transparency and appropriate use of protected terminology when digital technologies are used to augment physical therapist practice.