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EARLY SUMMER UPDATE Written by: DON CLAYBACK, EXECUTIVE DIRECTOR OF NCART
VIRTUAL CRT CONGRESSIONAL FLY-IN Save the date! NCART and NRRTS proudly announce this year’s CRT Virtual Congressional Fly-In will be held on Sept. 14. This annual Complex Rehab Technology (CRT)-focused advocacy event keeps the CRT community connected with Capitol Hill and creates an opportunity for CRT stakeholders to talk with Congress about ongoing issues that are impacting access. We will be holding the fly-in virtually and are excited everyone will be able to deliver important CRT access messages to their Members without leaving their homes or offices. We are also happy to report there will be NO COST to participate. Registration information and other details will be available shortly. Please save the date in your calendar and plan to join your fellow CRT advocates for a day of educating Congress and sharing the needs and benefits of CRT access with your Representatives and Senators.
OFFICE OF INSPECTOR GENERAL REPORT IDENTIFIES INAPPROPRIATE MEDICARE ADVANTAGE DENIALS On April 27, 2022, the Office of Inspector General (OIG) issued a report entitled “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care.” The OIG describes the focus of their investigation as follows: “A central concern about the capitated payment model used in Medicare Advantage is the potential incentive for Medicare Advantage Organizations (MAOs) to deny beneficiary access to services and deny payments to providers in an attempt to increase profits. Although MAOs approve the vast majority of requests for services and payment, they issue millions of denials each year, and the Centers for Medicare and Medicaid Services’ (CMS) annual audits of MAOs have highlighted widespread and persistent problems related to inappropriate denials of services and payment. As enrollment in Medicare Advantage continues to grow, MAOs play an increasingly critical role in ensuring that Medicare beneficiaries have access to medically necessary covered services and that providers are reimbursed appropriately.” The report contains the results of their claims review and identifies a key takeaway as MAOs are inappropriately denying prior authorization and payment requests that meet Medicare coverage rules. The OIG attributes this to the MAOs: (1) using clinical criteria not contained in Medicare coverage rules; (2) requesting unnecessary documentation; and (3) making manual review and systems errors.
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As a result of their findings, the OIG recommended CMS take these actions: (1) issue new guidance on the appropriate use of MAO clinical criteria in medical necessity reviews; (2) update its audit protocols to address the issues identified in this report, such as MAO use of clinical criteria and/or examining particular service types; and (3) direct MAOs to take steps to identify and address vulnerabilities that can lead to manual review errors and system errors. CMS concurred with all three recommendations. This OIG study draws attention to important issues (requesting of unnecessary information and inappropriate denials) that impact CRT funding on a national level with many payers. While the report focused on Medicare Advantage plans, we will be using it in our advocacy work to improve coverage at all payer levels. A copy of the full report can be found at www.oig.hhs.gov by searching OEI-09-18-00260.
PARTIAL EXTENSION OF CRT TELEHEALTH OPTION Recent legislation passed by Congress has extended current COVID-19 telehealth flexibilities permitted during the Public Health Emergency (PHE) for an additional 151 days after the PHE ends. In addition, Department of Health and Human Services Secretary Xavier Becerra has extended the PHE through at least July 15. This means physical and occupational therapists will be permitted to provide CRT telehealth services to their clients until at least later this year. While this extension provides people with disabilities who use CRT additional time, it is still important advocates reach out to their Members of Congress to request physical and occupational therapists be permanently designated as authorized telehealth practitioners to ensure continued access to CRT when in-person visits are not an option. Congress is currently reviewing various telehealth bills, and Members need to ensure whatever legislative language is passed, it retains these CRT telehealth options. Rather than allowing these proven flexibilities to expire, Congress must make these CRT telehealth policies permanent.
