Update from your MOKSACVPR Standards and Issues Chair…

NPP bill: There is a US House bill for the NPP bill-HR 3911. Work continues on a Senate companion bill introduction. This bill will allow NPPs to independently order CR/PR services. It will also allow NPPs to serve in the capacity of “immediately available”. The hope is that this bill is attached to whatever “Medicare fix package” passes in this fall’s Congressional session. There is no date of effectiveness at this point, CBO has not yet scored the bill, and it remains TBD how the proposed CMS 2020 OPPS regulation to shift these services to general supervision would or would not affect this bill and CR/PR requirements. AACVPR will work with AHA, ACC, PCNA, AAPA, and other professional organizations this fall on passage of this bill.

Site of Service bill: We continue to believe this is the most important legislative initiative AACVPR is currently undertaking, given increasing Congressional recommendations to remove grandfathered status for various aspects of hospital outpatient services. Legislative Counsel is writing the bill language, so we are encouraged that we will have a bill # to push this issue in the fall session.

CMS CAG: AACVPR and NAMDRC had a meeting this week with CMS Coverage & Analysis Group (CAG wrote the CR/PR regulations) to discuss common confusion among providers, MACs, and auditors over some requirements. While no decisions were offered, our points are under consideration and we were optimistic that a need for more clarity is appropriate. This will be discussed in more detail at the MAC TF meeting in September.

2020 Proposed Regulations: The proposed hospital outpatient and physician fee schedule regulations are being reviewed and a summary of anything of relevance to CR and PR programs will be included in a soon-to-follow Health Policy & Reimbursement Update. Proposed payment rates for CR & PR in the hospital setting remain close to 2019 rates.

 3.   DOTH 2018: 80 people from 32 states attended.  Main message was thanking members for supporting HR 1155 and S.1361, and requesting support for fixing Section 603 of the BBA of 2015 that has had a negative impact on the ability of CR and PR programs to expand due to the change to Physician Fee Schedule reimbursement which is a fraction of the reimbursement of Hospital Outpatient Prospective Payment System.  Most meetings seemed to be positive – they understood the issue, and they were aware of it b/c they have heard from hospitals about the problem. Hope to have a champion soon who will sponsor a bill, or move to try for an administrative fix to the language to exclude CR and PR from the effects of the BBA of 2015.

4.   KX Modifier – MLN Matters came out recently that was referring to “therapy” meaning PT/OT.  Many people felt it was related to CR and PR. It is not. There  is no change in how CR and PR use the KX Modifier.

5.   Palmetto MAC recently published a new CR LCD stating there must be 31 minutes of exercise rather than session duration of 31 minutes.  They must have copied and pasted from an old LCD.  If you have people asking about this, it does not affect our MAC!  Liaisons from that MAC and Karen will be having a call with the Palmetto Medical Director to help him understand the error in the LCD, and change it.