Draft_Minutes_January_11,_2017_Medical_Services_Committee_Call

NASL Medical Services Committee Meeting
Minutes
January 12, 2017
11:00 am – 12:00 pm EST
Martha Schram, Chair
Mike Capstick, Vice Chair
I. Welcome
Martha Schram, NASL Medical Services Committee Chair, was delayed joining the call,
so Cynthia Morton, NASL Executive Vice President, called the meeting to order. Martha
welcomed Leigh Ann Frick, President of Care Navigation Consulting, LLC, to the call.
Leigh Ann is returning to NASL as the newest Associate member.
There were no minutes to approve for the December 8, 2016 Medical Services
Committee Conference Call as Cynthia Morton, presented on “Insights on the Near
Future of Medicare and Medicaid under a New Administration” in lieu of a meeting.
Slides from the webinar are available to members in the NASL MemberHQ.
Cynthia provided highlights of NASL’s 2017 Winter Legislative & Regulatory
Conference, February 6-8, 2017, at the Loews Madison Hotel in Washington, D.C.
Cynthia reiterated the Hill Day (February 8) is a very important opportunity for Medical
Services Committee members to advocate for the repeal of the Therapy Cap. The
conference will feature a panel of staff from the professional therapy associations --
American Occupational Therapy Association (AOTA), American Speech-Language-
Hearing Association (ASHA) and American Physical Therapy Association
(APTA). Martha asked that Medical Services Committee members share any regulatory
or legislative topics that they would like the panel to address.
II.
Legislative Update
Cynthia Morton and Andrea Price-Carter, NASL’s Director of Government Relations,
provided an update on the following legislative proposals:
Affordable Care Act Repeal and Replace Activities
The Senate took a first step toward repeal of the Affordable Care Act by adopting a
fiscal year 2017 budget resolution. The Senate adopted the budget resolution by a 51-
48 vote. The budget resolution includes reconciliation instructions directing
specified House and Senate committees to produce legislation (by January 27 th )
requesting that they meet numerical targets for changes in spending, taxes, or the debt
limit. The House is planning to vote on the budget resolution as early as Friday, amid
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doubts regarding voting for repeal without laying out more details about the eventual
replacement.
Medicare Post-Acute Care Value-Based Purchasing Act (H.R. 3298) / PAC VBP
2.0
In mid-December the House Ways and Means Subcommittee on Health shared with
stakeholders a revised version of draft legislation, “PAC VBP 2.0” The proposal
reflects feedback received from NASL and seven PAC provider community
organizations -- along with several new provisions. The proposal -- H.R. 3298, the
Medicare Post-Acute Care Value-Based Purchasing (PAC VBP) Act of 2015 -- was
previously introduced by the House Ways and Means Committee Chairman Kevin
Brady (R-TX) and Rep. Ron Kind. The bill establishes a new PAC VBP program
that would apply to all PAC providers and begins in 2020.
Cynthia highlighted a few major provisions of the bill, which includes:
The legislation would create a value-based purchasing program beginning in the
payment year after October 1, 2019;
Providers would be subject to a withhold of their reimbursement and eligible to
earn it back through a value-based incentive payment based on their performance
on specified resource and quality measures;
Providers would be split into two tracks for purposes of determining the withhold
amount.
Those providers falling under the high-performance risk track would see higher
levels of withholds while providers falling under the low-performance risk track
would have lower levels of withholds from 1-2%.
Providers can earn back the withhold through incentive payments based on their
performance on primarily the Medicare Spending per Beneficiary (MSPB)
measure created by the IMPACT Act.
The Secretary has considerable discretion to use contractors to construct the
current MSPB measure which is extremely complex.
NASL is concerned about several provisions in the revised legislation and will
continue to work with our PAC Coalition partners to develop comments to the
proposal. The Ways and Means Committee has indicated that it intends to move the
bill early in the 115 th Congress.
III.
New 2017 OT and PT Outpatient Therapy Evaluation Codes Update
Cynthia provided an update on the new evaluation and re-evaluation the new Current
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Procedural Terminology (CPT) codes for physical therapy (PT) and occupational therapy
(OT), that became effective January 1, 2017. She stated that during a webinar with
AOTA, they clarified that they developed an updated position that changes the discussion
of performance deficits on that component of the evaluation codes. AOTA is preparing a
one-pager description of the change available later in the month. The December 22, 2016
AOTA slides are available here:
http://nasl.mymemberfuse.com/resources2/view/profile/id/72677
CMS Issued a Technical Direction letters to MACs to correct PT and OT
Evaluation Codes Edit Errors. Cynthia noted that CMS issued a Technical Direction
letter to MACs to correct PT and OT Evaluation Codes edits errors. The National
Correct Coding Initiative (NCCI) edits tables that apply to Part B claims for January 1
through March 31, 2017, contained errors in the edits that apply to the new PT & OT
evaluation code combinations. In the table, some OT & PT code combinations could not
be billed on the same day even with an appropriate modifier.
CMS has issued a technical direction (TDL) to the MACs instructing them to utilize a
work-around from January 1 through March 31, 2017 to bypass the incorrect procedureto-procedure
(PTP) edits for the Current Procedural Terminology (CPT) PT and OT
evaluation codes, until they can be correctly updated in the April 1, 2017 version of the
NCCI edits tables. The American Health Care Association (AHCA) has done good work
on this and the two letters from CMS to AHCA to address this issue are available here.
NASL’s Payers Issues Workgroup will continue to monitor the TDL to the MACs, and
how the PTP edits for the evaluation codes are being resolved. The next Payers Issues
Workgroup conference call is scheduled for January 24, 2017.
IV.
IMPACT Act Workgroup Update
JoAnne Wisely, Genesis Healthcare Corporation, and Bob Latz, Trinity Rehab Services,
IMPACT Act Workgroup Co-chairs, provided an update on the workgroup’s recent
activities, which included the following activities:
The group recently submitted comments on CMS’ proposed specification on four
functional status quality measures (QM) for SNFs.
NASL submitted comments on the RAND PROMIS Item Set Data Elements.
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NASL members participated in the Post-Acute Care (PAC) Cross-Setting
Standardized Patient Assessment Data Technical Expert Panel (TEP), January 5-
6, 2017. Highlights of the TEP will be discussed during the upcoming IMPACT
Act Workgroup conference call.
NASL members will participate in another TEP, “Transfer of Health Information
Data at Admission TEP” at the end of January 2017.
Related to the Transfer of Health Information, RTI is looking for PAC facilities to
pilot test the transfer of health information.
The next IMPACT Act Workgroup Conference Call is scheduled for January 12, 2017.
V. Membership Report
Donna Doneski, NASL’s Director of Policy and Membership reported that NASL
has welcomed back as our newest Associate level member, Leigh Ann Frick,
President of Care Navigation Consulting, LLC. Donna also reiterated NASL’s
Winter Meeting is a prime opportunity to engage potential members – particularly
in light of the advocacy opportunities relating to the repeal of the Therapy Cap.
Medical Services Committee members should contact Donna for further details on
inviting potential members to the meeting. NASL’s Annual Meeting in Nashville
also brought us a new Bronze level member, The Therapy Zone, Inc. Martha
Shaker and several others met and spoke with Georgia Johnston at our
conference.
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