focus on affairs

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Vol. 18 •Issue 5 • Page 10
focus on affairs

AOTA Protests Axing Of Rehab Peer Review

The American Occupational Therapy Association is working on two fronts on Capitol Hill this month, pushing for repeal of the $1,500 annual per-patient cap on outpatient services set to go back into effect Jan. 1, 2003, and protesting a change in the Medicare program Integrity Manual that strips therapists of their privilege of peer review of Medicare claims.

When the cap was initiated in the Balanced Budget Act of 1997, it spurred a two-year recession in the rehab industry. Congress placed a moratorium on the cap in 1999 that will expire Dec. 31. Meanwhile, AOTA has written to the Center for Medicare and Medicaid Services (CMS) asking that occupational therapists continue to review occupational therapy claims. Leslie Stein Lloyd of AOTA’s government affairs division says AOTA will meet with Timothy Hill, director of program integrity for CMS.

A revision found in Transmittal 17, Change Request 1891 (December 2001) instructs carriers and intermediaries that “a clinician reviewer is a nurse (LPN or RN) or physician reviewer.”

According to Rehab Wire, up to this point, fiscal intermediaries (FIs) have been allowed to determine which medical personnel should sit on review boards. Stein Lloyd was particularly surprised at the initiative, she said, because CMS has recently confirmed that it wants therapists to help craft its program integrity efforts. AOTA considers the elimination of peer review for OT claims unfair.

“Not only were we surprised that we were not apprised of the potential for this policy change, but we were shocked to read it as a de facto policy on the CMS Web site,” Stein Lloyd told Rehab Wire.

The setback comes as rehab disciplines anticipates passage of the Medicare Access to Rehabilitation Services Act of 2002, co-sponsored by Reps. Phil English (R-PA), Ben Cardin (D-MD), Roy Blunt (R-MO) and Frank Pallone (D-NJ). The Senate began working on the issue last Sept. 4, when John Ensign (R-NV) introduced S. 1394 that would do essentially the same thing.

Its broad Congressional support suggests the bill has a good chance of becoming law. In June of 1998, according to an AOTA press release, the Medicare Payment Advisory Committee found that at the current usage rate, up to one-third of non-hospital-based rehab patients would have exceeded the cap. The potential for adverse effects to chronically ill patients in nursing homes was high, other studies showed.

AOTA President Barbara Kornlau stated in the AOTA release, “This is a critical bill for seniors and people with disabilities…(it) will correct an ill-conceived policy that could harm the quality of life for those who need therapy services.”

Health Care Facilities File Suit Against HHS

Led by the American Hospital Association (AHA) and the National Association of Public Hospitals and Health Systems (NAPHS), hospitals and their affiliated health systems in five states are suing the U.S. Department of Health and Human Services over a new reimbursement rule that would knock 33 percent off public hospitals’ reimbursement percentage for Medicaid patients. According to AHA’s News Now online service, the plaintiffs claim the move would cut $27 billion from the Medicaid program over the next decade.

Joining AHA and NAPHs in a request for an injunction to block the policy from taking effect March 19 are the National Association of Children’s Hospitals, the Association of American Medical Colleges and hospitals/health care associations from Arkansas, New York, Florida, Georgia and California.

Filed with the U.S. District Court in Little Rock March 7, the suit alleges that HHS violated the Administrative Procedures Act in determining Medicaid’s new upper payment limit for local public hospitals. The new rule would set state Medicaid reimbursements at 100 percent of what they are for Medicare procedures of the same kind. The current ceiling is 150 percent.

Congress directed HHS last fall to gain adequate input from interested parties before changing the directive, something the plaintiffs in the lawsuit feel didn’t happen.

According to News Now, NAPHS President Larry Gage said, “We have repeatedly made the case that this program is essential to the financial stability of the nation’s public health infrastructure…But HHS has…pushed these funding cuts through…”

GI Bill Benefits to Vets Who Sit For OT Exam

Veterans who qualify for G.I. Bill benefits can now be reimbursed for the fees they .pay to take the NBCOT Occupational Therapist Registered OTR (or Certified Occupational Therapy Assistant COTA (Certification Examinations offered by the National Board for Certification in Occupational Therapy Inc. (NBCOT). NBCOT received notification last month from the U.S. Dept. of Veterans (VA) that both examinations have been approved.

According to NBCOT, the reimbursement plan is a new service recently approved by the VA, retroactive to March 1, 2001. Reimbursement is made directly to eligible veterans.

The VA reimbursement is limited to fees for the examinations, however, and does not cover costs related to education or preparation typically required to successfully pass the exams. But candidates do not have to pass the exam to receive the benefit. And payment is permitted for re-taking the test, and for exams taken to renew national certification, if applicable. VA benefits also apply to NBCOT-approved exams taken outside the U.S.

Veterans interested in requesting reimbursement must send copies of their test results, along with a cover note requesting reimbursement, to the VA offices in their home states. Further information is available on the Internet at www.gibill.va.gov (go to the link for certification and licensure examinations.) Veterans may also call 1-888-442-4551.

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