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Children's Services

The next Managed Long-Term Services and Supports (MLTSS) Subcommittee meeting has been scheduled for August 5, 2021 (via webinar) from 10:00 am–1:00 pm.

As a reminder, public comments will be taken after each presentation. Questions can be entered into the chat box during the presentations, and these questions will be asked at the end of each presentation. There will be an additional period at the end of the meeting for any additional public comments.

The Department of Human Services (DHS) Office of Long-Term Living (OLTL) is using technology that allows individuals to participate in the webinar and listen through computer speakers instead of participating by dial-in. Dial-in will still be available if you do not choose to participate by webinar, but the number is no longer toll free.

To participate in the meeting via webinar, please register here. Registrants will receive a confirmation email containing information about joining the webinar. To participate via telephone, the dial-in information is: (562)-247-8321; Access Code: 541-873-565.

Dear ANCOR Members:

To keep you informed of the political and fiscal climate that will shape reconciliation and with it, the prospects for the Better Care Better Jobs Act, we flag the following article from Politico:

“Senate Democrats announced a top line budget number late Tuesday that will propel their plan to enact the full array of President Joe Biden’s social welfare and family aid promises without Republican votes.

The proposal sets an overall limit of $3.5 trillion for the spate of Democratic policy ambitions that won’t make it into a bipartisan infrastructure deal, if Congress can reach one. If the still-forthcoming budget resolution can clear both chambers with lockstep party support, it will unleash the power to circumvent a GOP filibuster using the so-called reconciliation process, the same move that Democrats used to pass the president’s $1.9 trillion pandemic aid package in March.

Combined with a bipartisan infrastructure compromise that’s still getting shaped into legislation, Senate Majority Leader Chuck Schumer said the budget’s investments in infrastructure, the middle class and more would total about $4.1 trillion, “which is very, very close to what President Biden asked us for.” Biden will also attend Democrats’ lunch on Wednesday to discuss the plans, Schumer said.

“We are very proud of this plan,” Schumer said. “We know we have a long road to go … If we pass this, this is the most profound change to help American families in generations.”

Democrats on the Senate Budget Committee reached agreement on the overall total for their party-lines spending plan during their second meeting this week with Schumer and White House officials in the Capitol. Their next step is ensuring all 50 Democratic caucus members can support the $3.5 trillion figure, said Sen. Tim Kaine (D-Va.), a member of the budget panel.

“The goal is for the Budget Committee to all be on the same page and then sell it to the caucus,” he said. “Once the Budget Committee is on the same page, numbers will start to come out. But we still have a little ways to go to get there.”

The budget resolution will require backing from every Democrat to make it through the upper chamber and officially kick off reconciliation, which will formally instruct various committees to turn the president’s priorities into legislative text. Progressives like Budget Chair Bernie Sanders (I-Vt.) had pushed for a top line as high as $6 trillion, while centrists have endorsed a smaller figure that doesn’t rely on deficit financing.

Despite getting trillions less than his original ask, Sanders said the agreement on $3.5 trillion is a “big deal” when it comes to “transforming our infrastructure.” The budget plan is set to expand Medicare to cover vision, dental and hearing for seniors – a major priority for Sanders.

Sens. Joe Manchin (D-W.Va.) and Jon Tester (D-Mont.), both moderates, said earlier Tuesday that they’ll need time to sort through the plan compiled by the Budget Committee.

“We need to pay for it,” Manchin said. “I’d like to pay for all of it. I don’t think we need more debt.”

Before an agreement was reached, Kaine and fellow Budget panel member Sen. Chris Van Hollen (D-Md.) didn’t dismiss Manchin’s financing demand outright.

“There are many ways to get there,” Van Hollen said. “Certainly, it’s important that everyone who says it needs to be paid for also identifies ways to pay for what needs to be done.”

Democrats’ massive party-line package is expected to include policies like Biden’s proposal for two years of free community college, paid leave, health care subsidies, extending the boosted child tax credit and helping families cover child care costs.

Schumer has said he hopes to adopt the budget resolution on the floor in the next few weeks. That vote will be “the first step” toward passing the “remaining elements” of Biden’s social and economic plans without Republican support, the leader told Democratic senators in a letter this month, warning of “the possibility of working long nights, weekends, and remaining in Washington into the previously-scheduled August state work period.”

Meanwhile, negotiations on a bipartisan infrastructure bill, which would require support from at least 10 Senate Republicans, are starting to get shaky amid GOP concerns over spending and ways to finance the legislation.

Embarking again on a reconciliation bill will be arduous and painful for Democratic lawmakers. The process involves enduring two more vote-a-rama sessions in the Senate, each of which will allow Republicans to fire off a barrage of politically tricky amendments.

The Senate parliamentarian, who serves as the chamber’s nonpartisan procedural enforcer, is also expected to shoot down parts of the proposal that are found to be out of bounds under the special budget process.”

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Doris Parfaite-Claude
Federal Advocacy and Research Manager
American Network of Community Options and Resources
Alexandria, VA
(703) 535-7850 (108)

The Centers for Medicare and Medicaid Services (CMS) has released the calendar year (CY) 2022 Medicare Physician Fee Schedule (MPFS) proposed payment rule. Some of the proposed provisions include:

CY 2022 Physician Fee Schedule (PFS) Payment Rate Update

With the proposed budget neutrality adjustment to account for changes in RVUs (required by law), and expiration of the 3.75 percent payment increase provided for CY 2021 by the Consolidated Appropriations Act, 2021 (CAA), the proposed CY 2022 PFS conversion factor is $33.58, a decrease of $1.31 from the CY 2021 PFS conversion factor of $34.89. The PFS conversion factor reflects the statutory update of 0.00 percent and the adjustment necessary to account for changes in relative value units and expenditures that would result from our proposed policies.

Evaluation and Management (E/M) Visits

CMS is engaged in an ongoing review of payment for E/M visit code sets. For CY 2022, there are several proposals that take into account the recent changes to E/M visit codes, as explained in the AMA CPT Codebook, which took effect January 1, 2021. CMS is also proposing to clarify and refine policies that were reflected in certain manual provisions that were recently withdrawn.

CMS is proposing to refine their longstanding policies for split (or shared) E/M visits to better reflect the current practice of medicine, the evolving role of non-physician practitioners (NPPs) as members of the medical team, and to clarify conditions of payment that must be met to bill Medicare for these services. In the CY 2022 PFS proposed rule, the following is proposed:

  • Definition of split (or shared) E/M visits as evaluation and management (E/M) visits provided in the facility setting by a physician and an NPP in the same group.
  • The practitioner who provides the substantive portion of the visit (more than half of the total time spent) would bill for the visit.
  • Split (or shared) visits could be reported for new as well as established patients, and initial and subsequent visits, as well as prolonged services.
  • Requiring reporting of a modifier on the claim to help ensure program integrity.
  • Documentation in the medical record that would identify the two individuals who performed the visit. The individual providing the substantive portion must sign and date the medical record.

Telehealth Services under the PFS

CMS continues to evaluate the temporary expansion of telehealth services that were added to the telehealth list during the COVID-19 public health emergency (PHE) and is proposing to allow certain services added to the Medicare telehealth list to remain on the list to the end of December 31, 2023, so that there is a path to evaluate whether the services should be permanently added to the telehealth list following the COVID-19 PHE. Section 123 of the CAA removed the geographic restrictions and added the home of the beneficiary as a permissible originating site for telehealth services when used for the purposes of diagnosis, evaluation, or treatment of a mental health disorder, and requires that there be an in-person, non-telehealth service with the physician or practitioner within six months prior to the initial telehealth service, and thereafter, at intervals as specified by the Secretary.

CMS is proposing to require an in-person, non-telehealth service be provided by the physician or practitioner furnishing mental health telehealth services within six months prior to the initial telehealth  service, and at least once every six months thereafter. CMS is requesting feedback on whether a different interval may be necessary or appropriate for mental health services furnished through audio-only communication technology. CMS is also seeking comment on how to address scenarios where a physician or practitioner of the same specialty/subspecialty in the same group may need to furnish a mental health service due to unavailability of the beneficiary’s regular practitioner.

CMS is also soliciting comment on: (1) whether additional documentation should be required in the patient’s medical record to support the clinical appropriateness of audio-only telehealth; (2) whether or not we should preclude audio-only telehealth for some high-level services, such as level 4 or 5 E/M visit codes or psychotherapy with crisis; and (3) any additional guardrails we should consider putting in place in order to minimize program integrity and patient safety concerns.

Therapy Services

CMS is implementing the final part of section 53107 of the Bipartisan Budget Act of 2018, which requires CMS, through the use of new modifiers (CQ and CO), to identify and make payment at 85 percent of the otherwise applicable Part B payment amount for physical therapy and occupational therapy services furnished in whole or in part by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs), for dates of service on and after January 1, 2022.

For CY 2022, in response to numerous stakeholder questions and to promote proper therapy care, CMS is proposing to revise the de minimis standard established to determine whether services are provided “in whole or in part” by PTAs or OTAs. Specifically, CMS is proposing to revise the de minimis policy to allow a timed service to be billed without the CQ/CO modifier in cases when a PTA/OTA participates in providing care to a patient with a physical therapist or occupational therapist (PT/OT), but the PT/OT meets the Medicare billing requirements for the timed service without the minutes furnished by the PTA/OTA by providing more than the 15-minute midpoint (also known as the 8-minute rule).

Overall, the de minimis standard would continue to be applicable in the following scenarios:

  • When the PTA/OTA independently furnishes a service, or a 15-minute unit of a service “in whole” without the PT/OT furnishing any part of the same service.
  • In instances where the service is not defined in 15-minute increments including:  supervised modalities, evaluations/reevaluations, and group therapy.
  • When the PTA/OTA furnishes eight minutes or more of the final unit of a billing scenario in which the PT/OT furnishes less than eight minutes of the same service.
  • When both the PTA/OTA and the PT/OT each furnish less than eight minutes for the final 15-minute unit of a billing scenario.

Physician Assistant (PA) Services

CMS is proposing to implement section 403 of Division CC of the CAA that authorizes Medicare to make direct payment to PAs for professional services they furnish under Part B beginning January 1, 2022. Medicare currently can only make payment to the employer or independent contractor of a PA. Consequently, PAs could not bill and be paid by the Medicare program directly for their professional services; they also did not have the option to reassign payment for their services or to incorporate with other PAs to bill the program for PA services. Beginning January 1, 2022, PAs would be able to bill Medicare directly for their services and reassign payment for their services.

Vaccine Administration Services Comment Solicitation

Over the last several years, Medicare payment rates for physicians and mass immunizers for administering certain preventive vaccines (flu, pneumonia and hepatitis B vaccines) have decreased by approximately 30 percent. Given the ongoing stakeholder interest in this issue, the proposed rule includes a comment solicitation to obtain information on the costs involved in furnishing preventive vaccines, with the goal to inform the development of more accurate rates for these services. More specifically CMS is seeking information on:

  • The different types of health care providers who furnish vaccines and how have those providers changed since the start of the pandemic.
  • How the costs of furnishing flu, pneumococcal, and hepatitis B vaccines compare to the costs of furnishing COVID-19 vaccines, and how costs may vary for different types of health care providers.
  • How the COVID-19 PHE may have impacted costs, and whether health care providers envision these costs to continue.

CMS is also seeking stakeholder input on a proposed policy to pay $35 add-on for certain vulnerable beneficiaries when they receive a COVID-19 vaccine at home. CMS is interested in stakeholder input on what qualifies as the “home” and how they can balance ensuring program integrity with beneficiary access. CMS is also seeking comments on whether they should treat these products the same way we treat other physician-administered drugs and biologicals under Medicare Part B.

Opioid Treatment Program (OTP) Payment Policy

CMS is proposing to allow OTPs to furnish counseling and therapy services via audio-only interaction (such as telephone calls) after the conclusion of the COVID-19 PHE in cases where audio/video communication is not available to the beneficiary, including circumstances in which the beneficiary is not capable of or does not consent to the use of devices that permit a two-way audio/video interaction, provided all other applicable requirements are met. CMS is proposing to require that OTPs use a service-level modifier for audio-only services billed using the counseling and therapy add-on code and document in the medical record the rationale for a service being furnished using audio-only services, in order to facilitate program integrity activities.

The proposed rule will be published in the July 23, 2021 Federal Register. Comments will be accepted until September 13, 2021.

Across Pennsylvania, there are qualified therapists prepared to support individuals who have experienced trauma. Likewise, there are therapists dedicated to supporting ID/A populations. However, there are few providers equipped to offer support through both the trauma and neurodiversity lenses.

To meet this need, TRAIN is being launched in early fall 2021. This pilot program, developed by psychologists with diverse backgrounds in both trauma and ID/A populations, will be comprised of live webinars and self-paced learning activities, which will take place over a span of 12 weeks. To provide a fully robust learning experience, there will be access to discussion boards and live supervision for additional communication with and between learners. Continuing Education (CE) credits will be provided through the National Board for Certified Counselors (NBCC).

Please share with any therapists you know who are currently supporting or are interested in supporting individuals with Intellectual Disabilities or Autism. If you are a therapist currently supporting ID/A clients and would like to learn more about TRAIN, or if you would like to be considered as part of our pilot training session, please email AIDinPA.

 

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Photo by Joshua Hoehne on Unsplash

Many early care and education programs stayed open during the COVID-19 pandemic to provide needed care. But for many families, the pandemic meant keeping their children at home. Transitioning back to early childhood programs or school, or starting them for the first time, can be hard for children and families. Transition in a time of physical distancing, masks, and extra stress is extra hard.

Learn what parents and teachers can do to help children make a successful transition to in-person learning and care here.

The documents from the July 7, 2021 Managed Long-Term Services and Supports (MLTSS) Subcommittee meeting are now available. Included in these documents are:

  • Agenda
  • OLTL Updates
  • Medicaid Research Center’s (University of Pittsburgh) Presentation: Community HealthChoices (CHC) Participant Experience: Before and After Implementation
  • Community HealthChoices Managed Care Organizations (CHC MCO) Contact Center Presentations
  • MLTSS Subcommittee Transcript

The next MLTSS Subcommittee meeting is scheduled for August 5, 2021.