May 1, 2013 Departments

News in Brief: May 2013

Open-Access Supplement Investigates Access to Cochlear Implants

Access to Cochlear Implantation, a March 2013 supplement to the peer-reviewed journal Cochlear Implants International, explores why so many children and adults who could benefit from cochlear implants are not receiving the intervention. Use by children varies greatly in the countries reviewed—Belgium, China, Japan, the United Kingdom and the United States—with only 50 percent of eligible U.S. children receiving cochlear implants compared with 90 percent or more in many European countries. Adult use of cochlear implants was 5 percent or less across all five countries.

Articles in the supplement cover the reasons for the low rates: consumers' low awareness of the benefits; lack of specific referral pathways; political issues relative to the deaf community, particularly in the United States; financial considerations; and stringent candidacy requirements.

The supplement was organized by the newly formed American Cochlear Implant Alliance, a not-for-profit organization of cochlear implant professionals and consumer advocates that works to remove barriers to access in the United States. The open-access supplement is available online.

Sequestration Cuts Medicare Rates by 2 Percent

Medicare Advantage, Part A and Part B providers should expect a 2 percent reduction in payment for services provided to Medicare beneficiaries on or after April 1. The cut, required under sequestration, affects only the final payment to the provider. All fee schedules remain the same; the reduction applies after payment is calculated (based on current fee schedules and after any co-pays, deductibles and adjustments have been applied).

As of mid-April, Congress had not taken action to reverse the series of automatic, across-the-board cuts (sequestration) to federal programs mandated under the Budget Control Act of 2011 and the American Taxpayer Relief Act. These laws require $85 billion in cuts in 2013, and $1.2 trillion in cuts over the next 10 years. Several key mandatory programs—including Social Security, Medicaid and the Children's Health Insurance Program—are exempt from sequestration, deepening the cuts for affected programs.

Participating providers should continue to bill at published 2013 Medicare fee schedule rates and to collect the 20 percent Medicare co-payment based on those rates. Nonparticipating providers should calculate the limiting charge based on the published fee schedule rate (not including the 2 percent cut). Providers may not increase charges to Medicare beneficiaries to offset the reduced payment amount.

  • The following example illustrates how the cuts work:
  • The Medicare fee schedule rate for a Part B procedure is $100.
  • The provider charges the patient the 20 percent copay ($20).
  • The provider bills Medicare for the $80 balance.

Medicare reimburses the provider $78.40 (the balance minus 2 percent).

For questions related to Medicare reimbursement, contact reimbursement@asha.org. For information on sequestration and federal legislation, contact Ingrida Lusis, ASHA director of federal and political advocacy, at ilusis@asha.org.

Orofacial Myology Convention

The International Association of Orofacial Myology will hold its 2013 convention Oct. 11–13 in Washington, D.C.

IAOM comprises a multidisciplinary group of health professionals, mostly speech-language pathologists and dentists, who share knowledge and expertise on the assessment and treatment of orofacial myofunctional disorders. The 2013 convention will provide a variety of courses, both clinical and didactic, to improve orofacial myologists' assessment, diagnosis, treatment planning, treatment implementation and evaluation of patients with orofacial myofunctional disorders.

For more information, visit the International Association of Orofacial Myology website.

House of Representatives to Consider Hearing Aid Tax Credits

Reps. Tom Latham (R-Iowa) and Carolyn McCarthy (D-N.Y.), along with eight other co-sponsors, reintroduced the Hearing Aid Tax Credit Bill in the U.S. House of Representatives in March.

The bipartisan bill (H.R. 1317) is similar to legislation introduced and considered in the past that provides tax benefits for people who purchase hearing aids. The current bill, however, applies to hearing aid purchasers of all ages. Earlier bills restricted the benefit to children and to people 55 and older. The sponsors plan to work to ensure that the legislation is considered in this congressional term, given that major federal tax reform is on the horizon. A Senate bill is expected to be introduced later this spring.

According to the Better Hearing Institute, 61 percent of hearing aid purchases involve no third-party payment, which places the entire burden on the buyer. Although H.R. 1317 would not cover the entire cost of hearing aids, the tax credit provides some financial relief.

Medicare Recommends 'Regular' Diets for Nursing Home Patients

Nursing home residents should receive a "regular" diet whenever possible, and interdisciplinary teams should weigh the risks and benefits of alternative diets, according to newly released Medicare dining practice standards for nursing homes.

According to a March memorandum from the Centers for Medicare and Medicaid Services, the default diet in nursing homes should be a regular diet. Advocating expanded diet options, the memorandum states that research shows "little benefit" from therapeutic (for example, low-sodium, diabetic, cardiac) diets, tube feedings and altered consistency diets.

The document includes a link to the full dining practice standards and a video that describes the process of developing the recommendations. The full standards state that:

  • "Unless a medical condition warrants a restricted diet, consider beginning with a regular diet and monitoring how the person does eating it" (p. 12).
  • "Interdisciplinary team members, including health care practitioners, should be involved in balancing the risks of aspiration against the potential benefits of more liberal diets and food consistency, and deciding whether there are viable alternatives" (p. 25).

The standards were developed by an interdisciplinary task force sponsored by the Pioneer Network and Rothschild Foundation that included a delegate from ASHA and organizations representing dietitians, occupational therapists, nurses and medical directors of long-term care facilities.

The memorandum reflects the increased attention on long-term care that centers on patients' rights, including the right to make decisions that may not align with health care providers' recommendations based on best or safest practices (see "It's My Body ... and I'll Refuse Treatment if I Want to").

The CMS guidance to state surveyors states that these practice standards are not requirements. ASHA has contacted CMS for clarification and plans to meet with CMS officials regarding the interpretation and implementation of these standards.

Janet Brown, ASHA director of health care services in speech-language pathology, jbrown@asha.org

Nursing Home Company to Pay $2.7 Million Settlement

Grace Healthcare LLC, a Tennessee-based operator of skilled nursing facilities, will pay the federal government more than $2.7 million to settle charges that Grace submitted false claims to Medicare and Medicaid for medically unreasonable and unnecessary rehabilitation therapy.  

The allegations were made by a former Grace employee, who claimed that 10 of the company's skilled nursing facilities billed for unnecessary and unreasonable physical and occupational therapy and speech-language treatment to meet the corporation's reimbursement goals from 2007 to 2011. The whistleblower suit—United States of America and State of Tennessee ex rel. Ottinger v. Grace Healthcare, LLC, Grace Ancillary Services, LLC, and John Does 1-5, No. 3:10-cv-83 (E.D. Tenn.)—claims that Grace violated the False Claims Act.

Grace did not admit to wrongdoing, saying it settled to avoid an expensive suit that would distract from its operations. Grace acknowledges that some of its facilities' therapy billings exceeded state averages, but claims that the figures do not make the claims for services incorrect or false.

The government, however, maintains that Grace pressured clinicians to increase the amount of therapy provided to patients to meet Medicare revenue targets that were set without regard to patients' individual therapy needs and that could be achieved only by billing for a large amount of therapy per patient.

Grace will enter into a Corporate Integrity Agreement that requires procedures and reviews to be put in place to avoid and promptly detect conduct similar to that claimed in the suit. The former Grace employee received $405,000 under the settlement agreement.

This resolution is part of the government's emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team initiative—a partnership between the Department of Justice and the Department of Health and Human Services—which aims to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.

New Regulation Reduces Paperwork Burden in Schools

A new federal regulation helps ease a bit of the Medicaid paperwork burden for school-based clinicians. The rule took effect March 18, 2013.

Under the new rule, schools no longer must obtain parental consent each time they bill a state Medicaid program—or other public benefits program—for a child's special education services, including speech-language intervention. Issued by the Office of Special Education and Rehabilitative Services of the U.S. Department of Education, the rule amends regulations for Part B of the Individuals With Disabilities Education Act.

ASHA and many other commenters supported this revision, stating that it would reduce paperwork and simplify the process of accessing public benefits or insurance. Specifically, the rule:

  • Requires a school to obtain parental consent before accessing a child's or parent's Medicaid or other public benefits or insurance (such as the Children's Health Insurance Program) for the first time.
  • Requires a school to provide written notification to the child's parents before accessing a child's or parent's Medicaid (or other public benefits or insurance) for the first time and annually thereafter.
  • Clarifies that written parental consent must specify the personally identifiable information that may be disclosed (for example, information about the services provided to a child), the purpose of the disclosure (for example, billing for services) and the agency to which the disclosure may be made (usually the state's Medicaid program). It must also specify that the parent understands and agrees that the school may bill Medicaid or other public programs for the services.
  • Clarifies the specific information that must be included in the written notification: a statement of the parental consent provisions; a statement of the "no-cost" provisions; a statement that the parents have the right to withdraw their consent to disclosure of information to the public program at any time; and a statement that the school must still provide free services to a child even if parents withdraw or refuse consent to disclose personally identifiable information.

ASHA staff will analyze the final regulations and provide implementation information to members. For more information, contact Catherine D. Clarke, ASHA director of education and regulatory advocacy, at cclarke@asha.org or 800-498-2071, ext. 5611.


  

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