New CMS Proposal on Therapy Assistant Cut Runs Counter to CMS’ Patients Over Paperwork Initiative

New CMS Proposal on Therapy Assistant Cut Runs Counter to CMS’ Patients Over Paperwork Initiative

Cynthia Morton

Executive Vice President, NASL

The Centers for Medicare and Medicaid Services (CMS) just released the Calendar Year 2020 Physician Fee Schedule proposed rule, which provides the proposed prices for CPT codes that govern Medicare Part B payment. Implementing a law passed in the Bipartisan Budget Act of 2018 (BBA), for outpatient physician and occupational therapy services furnished on or after January 1, 2022, payment for services paid by Part B for which are furnished in whole or in part by a therapy assistant must be paid at 85 percent of the amount that is otherwise applicable.

From the rehab therapy stakeholder community perspective, this was not a popular provision in the BBA. Congress inserted the provision at the last minute to offset the new spending from repealing the Part B Therapy caps which was also contained in the BBA. This was a bitter pill that stakeholders swallowed in order to support passage of the therapy caps. In last year’s final rule, CMS began establishing two modifiers (CQ/CO) to identify therapy services that are furnished in whole or in part by a physical therapy (PT) and occupational therapy (OT) assistants, and set a de minimis 10 percent standard for when these modifiers will apply to specific services. Beginning January 1, 2020, these modifiers are required to be reported on claims. The 15% cut does not begin until January 1, 2022, but CMS is required to prepare for it by establishing the modifiers and clarifying how the cut is applied by defining “in whole or in part.”

Stakeholders, including members of the National Association for the Support of Long Term Care (NASL), are in an uproar because they feel that CMS has overreached with the proposed policy. This is because when a therapist assistant is involved in more than 10% of the total treatment time for a given service (defined by CMS as a procedure or CPT/HCPCS code), the entire service is docked 15%. Furthermore, CMS imposes new documentation requirements including the addition of a statement in the medical record for each line of every claim to explain why the assistant modifier was or was not used.  In particular, the burdensome documentation mandate runs counter to CMS’ efforts to reduce meaningless and overly burdensome paperwork and other regulatory requirements for providers that do not add to patient care. CMS has called this initiative Patients Over Paperwork and is in the second phase of receiving ideas on how to implement it. CMS Administrator Seema Verma speaks about the initiative often.

So, what are we doing about this?  NASL joined with other therapy stakeholders in writing to CMS Administrator Seema Verma requesting a meeting to understand why CMS took this overly burdensome approach.  We will enlist our Congressional champions if needed to help make the case that the way CMS has proposed the implementation of the assistant modifiers and subsequent payment reduction does not reflect Congressional intent when drafting the BBA of 2018.

I encourage all therapists to read the provision in the proposed rule and send in a comment to CMS by the September 27 deadline to express their views on the over reach of this proposal!

The opinions expressed are solely those of the author and do not necessarily reflect those of Casamba, its staff, investors or partners.

Cynthia K. Morton

Cynthia K. Morton, MPA, is a national expert on Medicaid, Medicare and other public policy affecting the long term and post-acute care sector. Currently, she serves as the Executive Vice President for the National Association for the Support of Long Term Care (NASL), where she advocates for her members’ interests.
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