ASHT Pain Management Survey
As Congress continues to consider legislation to address the opioid epidemic, ASHT wants to hear from you!
We want your voice and experience to resonate in this broader debate as ASHT continues to monitor these developments and work to shape policy to address the opioid epidemic. Knowing how you have helped clients manage chronic and acute pain through therapy and rehabilitation is a critical piece of the solution to this nationwide crisis. This survey should take approximately 5-10 minutes to complete. All answers provided will be kept in complete confidentiality.
Thank you for taking the time to complete this brief survey examining the role hand therapists play in battling the opioid epidemic. The information gathered may be used and presented to physicians, insurers and legislators by ASHT.
Congress Considers Legislation to Address the Opioid Epidemic - Hand Therapy Part of the Solution
(May 1, 2018)
Over the past few months, we’ve seen a flurry of debate on Capitol Hill around the opioid epidemic. This week marked the first significant steps taken this year toward advancing comprehensive legislation on this critical topic.
On April 24, the Senate Committee on Health, Education, Labor and Pensions (HELP) marked up S.2680: The Opioid Crisis Response Act of 2018. This bipartisan bill was a combination of 40 different policy proposals, cobbled together over seven bipartisan hearings on how to best address the opioid crisis. The Opioid Crisis Response Act of 2018 aims to accomplish many items, including:
- Require the Secretary of HHS to provide technical assistance related to the use of alternatives to opioids, including for common painful conditions and certain patient populations, such as geriatric patients, pregnant women and children.
- Spur development and research on of non-addictive painkillers, and other strategies to prevent, treat and manage pain and substance use disorders through additional flexibility for the NIH.
- Support the healthcare workforce by providing resources for pain care providers to assess, diagnose, prevent, treat and manage acute or chronic pain, as well as for the detection of early warning signs of opioid use disorders.
The Senate HELP Committee advanced S.2680 unanimously by a vote of 23-0. Chairman Lamar Alexander (R-KY) expressed his hopes that the full Senate will move the opioid legislation by this summer.
On April 30, the House Energy and Commerce Health Subcommittee concluded their opioid markup, advancing 56 opioid related bills to the full Energy and Commerce Committee. This full docket, comprised of introduced bills and draft legislation, offered a broad range of solutions to the crisis, across the areas of public health, behavioral health and Medicare and Medicaid reimbursement. According to Chairman Burgess (R-TX), the full committee markup is likely to take place in mid-May.
Among the drafts to advance was the Adding Resources on Non-Opioid Alternatives to the Medicare Handbook, which would direct CMS to compile educational resources for beneficiaries regarding opioid use, pain management and alternative pain management treatments. The legislation goes on to instruct CMS to include these resources in the “Medicare and You” handbook. Legislation like this gives ASHT the opportunity to emphasize the benefits of therapy as well as the work you do as therapists to minimize client pain and maximizing function.
As Congress continues to consider legislation like this to address the opioid epidemic, we want to hear from you! Knowing how you have helped clients manage chronic and acute pain through therapy and rehabilitation is a critical piece of the solution to this nationwide crisis.
We want your voice and experience to resonate in this broader debate as ASHT continues to monitor these developments and work to shape policy to address the opioid epidemic. Share your personal experiences, stories, and background to firstname.lastname@example.org, so we can tell Congress that Hand Therapy is part of the solution.
Hand Therapy Practice and the Opioid Epidemic (April 6, 2018)
Hand therapists have a crucial role to play in addressing the opioid epidemic. Whether it is following an upper extremity injury, surgery, or helping manage a chronic condition, hand therapists provide safe, quality, and effective pain care management for their clients.
In recent months, Washington has turned its attention to the opioid epidemic, providing nearly $4 billion in new spending in the recent funding bill and debating dozens of bills to address the multi-faceted crisis. When Congress returns from recess next week, lawmakers will seek to continue the momentum.
On April 11th, the House Energy and Commerce Committee will hold a legislative hearing to examine a new slate of bills aimed at curbing opioid use by, among other things, addressing Medicare and Medicaid coverage barriers, tracking opioid prescribing patterns, requiring drug companies to alter packaging, and allowing providers to write smaller prescriptions. In addition, the Centers for Disease Control and Prevention and now Blue Cross Blue Shield are actively advocating for a new standard that emphasizes non-opioid alternatives as the first line of treatment for pain management over opioid prescribing.
As the debate unfolds over the coming months, ASHT will continue to educate lawmakers about the important role hand therapists play in safe, effective pain management. ASHT will also be emphasizing the importance of non-opioid alternatives to pain management and working to improve and support policies that embrace the benefits of therapy and rehabilitation.
Stay tuned to ASHT's Legislative Action Center for updates on this issue.
Victory! Repeal Becomes Law (February 9, 2018)
This morning, February 9th, President Trump signed the latest stopgap funding bill into law, which included the Permanent Repeal of the Medicare Therapy Cap!
Today marks a huge victory for the profession that was twenty years in the making. As a member of the American Society of Hand Therapists, we wanted to thank you, sincerely, for your steadfast commitment to addressing this critical issue. You have lent your voice to this cause many times, and today, your emails and phone call were finally heard. Today, we can finally say, “The Medicare Therapy Cap is repealed!”
As we look to the future, we recognize that this victory is one part of a larger journey to ensure people have access to therapy services and ultimately a chance at functioning fully. We must now look to continue seeking improvements through the rulemaking and implementation phases of this permanent repeal. Your voice will be vital to this process as we find the best path forward for the profession.
Thank you for all of your support and congratulations on a job well done!
For more information on the new law, visit our Legislative Action Center
Medicare Therapy Cap (February 7, 2018)
Swift action in the House of Representatives this week has brought full and permanent repeal of Medicare's outpatient therapy cap one giant step closer to reality. Since 1997, ASHT and its allies in the therapy community have fought long and hard to repeal this harmful and arbitrary cap on Medicare beneficiary care. Our chance for victory is now!
On Monday evening, House negotiators unveiled a spending package aimed at avoiding another government shutdown and quickly readied it for consideration. The measure would extend government funding at current levels through March 23rd and address a slate of expired Medicare 'extender' policies, including a permanent solution to Medicare's outpatient therapy cap. Following debate yesterday afternoon, the House passed the bill last night by a margin of 245-182.
In addition to immediately repealing the therapy cap, the language codifies the targeted review mechanism as well as the use of the KX modifier after a threshold of $3,000. In exchange for these changes and the corresponding costs associated with repealing the cap, negotiators included an offset that would reduce payment for therapy assistant (OTA and PTA) services beginning in 2022 to 85% of what is currently reimbursed. In the remainng time before the Senate considers its version, ASHT will work with its allies in the therapy community to advocate for an alternative offset.
With the Senate poised to make changes, it's critical your Senators hear from you today. We need your help to ensure this giant step forward in the Houe is indeed a path to victory. Please contact your senators today and urge them to permanently repeal the therapy cap.
Medicare Access to Rehabilitation Services Act (January 24, 2018)
After a weekend of wrangling, the House and Senate reconvened this past Monday and agreed to end its shutdown stalemate. Ultimately, Congress approved an amended continuing resolution (CR) that reopened the government and extended funding through Feb. 8th. The agreement also reauthorized and funded the popular Children's Health Insurance Program (CHIP) for six-years and delayed a number of ACA-related tax provisions imposed on medical devices, high-cost health plans, and health insurers.
Despite progress, Congress faces a lengthy to-do list in the coming weeks, including finding a long-term solution on FY2018 spending levels, reaching compromises on immigration, passing health insurance market stabilization measures, and, importantly, addressing expired Medicare extenders policies, like the outpatient therapy cap.
With some of our nation’s frailest seniors projected to hit the cap later this month and the Centers for Medicare and Medicaid Services (CMS) currently holding claims for physical, speech, and occupational therapy, we are quickly reaching an untenable situation. It’s critical that our voice resonate above the noise and negotiations of Washington, especially in the coming days. A bipartisan solution to permanently address the therapy cap exists, and ASHT strongly urges you to reach out to your Members of Congress and call on them to support a permanent solution today!
CMS Proposed Orthotics and Prosthetics Rule Update
CMS has officially withdrawn the proposed orthotics and prosthetics rule (CMS 6012-P) published last January, which would require therapists to be certified in orthotics in order to receive payment for custom-fabricated orthotics for Medicare beneficiaries. Congratulations to all of our members who contributed comments in support of our profession! This victory was only possible because of the effort of every single person who chose to be involved.
For the CMS announcement follow this link: https://www.federalregister.gov/documents/2017/10/04/2017-21425/medicare-program-establishment-of-special-payment-provisions-and-requirements-for-qualified
Medicare Card Number Changes (July 17, 2017)
In an effort to protect Medicare and their beneficiaries from fraud and identity theft, and to protect program and personal information, CMS will be removing Social Security numbers from Medicare cards. Social Security-based Health Insurance Claim Numbers (HICN) will be replaced by a unique, randomly assigned Medicare Beneficiary Identifier (MBI) number.
CMS will begin mailing out replacement cards in April 2018, and the replacement process should be completed by April 2019.
CMS is developing a secure tool for providers to look up MBI numbers at point of service to facilitate this changeover.
Your systems need to be ready to accept the new MBI numbers by April 2018; however, there will be a 21-month transition period during which you can bill patient services using either a HICN or MBI number.
Another Update on Misvalued OT Evaluation Codes (April 14, 2017)
CMS has issued Change Request 9977, which states MACs are not responsible for searching through files to identify misvalued claims, but will adjust those claims brought to their attention retroactive to January 1, 2017. Occupational therapists should contact their individual MACs to determine how to resubmit the underpaid evaluation claims. Learn more
CMS Miscalculated OT Evaluation Code Rates (April 7, 2017)
AOTA discovered that CMS lowered the reimbursement rate on the new tiered occupational therapy evaluation codes due to an error in the amount used for the practice expense portion of the code in some MAC regions. AOTA met with CMS, who has corrected the error in its April Quarterly Update Transmittal and has communicated the correction to the Part B Medicare administrative contractors. The corrected rates should be posted soon and are retroactive to January 1, 2017.
No action is required on the part of providers; however, it is a good idea to keep checking the fee schedule to make sure the correction is put in place. Affected MAC regions should see an increase and receive the retroactive payments in the next months.
Background of Proposed Rule CMS-6012-P (February 6, 2017)
- Establishment of Special Payment Provisions and Requirements for Qualified Practitioners and Qualified Suppliers of Prosthetics and Custom-Fabricated Orthotics
Three pieces of previously passed legislation modifying the Social Security Act of 1935 are the basis for the proposed rule affecting payment for custom-fabricated orthoses (c/f O) and prostheses (P) for Medicare beneficiaries.
The first was precipitated by a report by the Office of Inspector General issued in October 1997 exploring the extent of questionable billing of Medicare for orthotics, which concluded that 19% were medically unnecessary, 68% of unnecessary orthotics were provided by a DME company and 35% by orthotists. (You are correct: This adds up to more than 100%). They also concluded 68% of billed orthoses from SNFs were “questionable” and were typically provided by DME companies. They concluded there was a need to develop guidelines better defining orthoses; distinguish between custom-made and OTS; develop policies for the codes for which they prioritized upper-limb devices identified as being the most problematic; work with American Orthotist and Prosthetist Association to develop a table of devices that should not be used together; and consider stricter standards for identifying who was allowed to bill for orthotics (sic), such as requiring professional credentials for orthotic suppliers. 1
Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) which became part of Public Law 106-554, adopted in December 21, 2000.
- Amended §1834(h)(1)(F): “No payment will be made for c/f O or P unless furnished or fabricated by a qualified practitioner or supplier at a facility that meets criteria the Secretary of Health and Human Services determines appropriate.
- Qualified practitioner is a physician or other individual who is a qualified PT or OT; is licensed in orthotics or prosthetics; in the cases where the state provides such licensing, or in states where the state does not provides such licensing, is specifically trained and educated to provide or manage the provision of prosthetics and custom-designed or fabricated orthotics AND is certified by the ABC or the BOC; OR is credentialed and approved by a program that the Health and Human Services Secretary determines has the training and education standards that are necessary to provide such prosthetics and orthotics.
- Scheduled to go into effect one year after adoption. (December 21, 2000, in effect December 21, 2001)
A committee was established to determine how to enact the law, but the committee was unable to reach consensus by 2003.
Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA)
- Added §1834(a)(20): requiring HHS Secretary to implement quality standards for suppliers of items and services including orthotics and prosthetics as a condition of obtaining a DMEPOS supplier number and being reimbursed by Medicare.
- Directed HHS Secretary to designate independent accreditation organizations to enforce the quality standards.
- Established procedures for designation of national accreditation organizations.
The Quality Standards were published in 2006 and 11 accreditation organizations were approved. Presently, nine of those organizations are still active; six are approved for credentialing c/f O and P.
Medicare Improvement for Patients and Providers Act of 2008 (MIPPA)
- Suppliers had to show evidence of accreditation by one of the accreditation organizations.
- HHS Secretary was given the right to exempt “eligible professionals” including qualified OTs, PTs and physicians as well as “Other Persons,” such as orthotists and prosthetists, from the quality standards and accreditation requirements unless the HHS Secretary determined the standards were specifically designed to be applied to the eligible providers and other persons.
- Eligible professionals were identified as ”MDs, PAs, nurse practitioners, certified nurse specialists, anesthetists, certified nurse midwives, clinical social workers, clinical psychologists, PTs, OTs or SLPs.
The exception has been in place for eight years. No new reports have been issued by OIG on Medicare orthoses billing and therefore, no data is available to measure the efficacy of the payment changes on fraudulent billing.
On January 11, 2017, HHS Secretary Sylvia Burwell and CMS’ Acting Director Andy Slavitt released the proposed rule, which was published in the Federal Register on January 12, 2017 with a 60-day comment period.
On January 24, 2017, the current administration issued an executive order directing all federal agencies to stop sending any new regulations to the Federal Register until otherwise directed. Any regulation sent to the Federal Register but not published was ordered to be withdrawn. This had no effect on the proposed rule, which had already been published.2
- Effective one year from implementation, all practitioners and suppliers billing Medicare for c/f O or P will be required to be accredited by the American Board for Orthotists and Prosthetists Certification (ABC).
- All facilities where any c/f O or P are fabricated must be accredited by ABC.
- All facilities where any c/f O or P are fabricated must have specific equipment.
(click here to view list)
CMS does not believe beneficiary access to care will be significantly affected and the benefit in improved quality of care outweighs any possible discontinuity of care. CMS states the goal is to ensure that the specialized needs of Medicare beneficiaries who require prosthetics and c/f orthotics are met.
- Department of Health and Human Services Office of Inspector General. Medicare Orthotics. October 1997: https://oig.hhs.gov/oei/reports/oei-02-95-00380.pdf (accessed online 1/29/17).
- Federal Register January 24, 2017, 82;14 :8346: https://www.gpo.gov/fdsys/pkg/FR-2017-01-24/pdf/2017-01766.pdf (accessed 1/25/17).
- List of affected orthotics and prosthetics: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/CMS-6012-P_HCPCS_Code_List.pdf (accessed 1/20/17).
- Federal Register January 12, 2017. 82;8:3678-3694: https://www.federalregister.gov/documents/2017/01/12/2017-00425/medicare-program-establishment-of-special-payment-provisions-and-requirements-for-qualified (accessed online 1/16/17).
Assistants and L code Billing (May 31, 2016)
ASHT has recently confirmed that Medicare does not have restrictions on COTAs or PTAs billing L codes under the supervision of their respective PT or OT. Although Medicare does not have this restriction, individual state laws may be more restrictive. Providers should confirm that orthotic fabrication is within the scope of practice in their respective state practice acts.
Reimbursement News (August 28, 2015)
If your clinic had Medicare Advantage reimbursement cut due to sequestration, you may want to check out a new article in Modern Healthcare. Florida providers are suing Humana over reimbursement cuts to providers for services under their Medicare Advantage Plan.
Humana reduced reimbursement 2%, citing the cuts were part of the sequestration and were in response to CMS cutting reimbursement to Medicare Advantage carriers. They stated they were acting as “federal officers” on behalf of a federal agency (CMS). The providers contend the cuts violated their Humana contracts. The case was reviewed in U.S. District court in Miami where the judge ruled “Humana’s payments to providers are governed by its contracts with those providers and not federal laws or programs, and that CMS did not tell Medicare Advantage Plans how to handle the sequestration cuts.” Similar cases are being heard in other states and against other insurers, e.g. Pennsylvania vs. Highmark.