CMS’ CY 2021 Fee Schedule Proposed Reduction

August 3rd, CMS released the Proposed 2021 (eff 1/1/21) Medicare Physician Fee Schedule, to be published in the August 17th Federal Register. Within this proposal, CMS details the following items impacting our Long-Term Care Rehab programming and reimbursement:

  • Part B rehab reimbursement reduction of 9% to offset additional payments to primary care providers for Evaluation and Management Codes (including potential rehab evaluation code increases).

  • Maintenance Therapy provision expansion to include at the therapist’s discretion use of PT and OT assistants. This was granted at the time of the PHE announcement and is to continue through the duration of the PHE. Maintenance therapy is the skilled establishment, education and training of ongoing intervention intended to assist beneficiary’s in maintaining functional progress made or to slow further deterioration in situations for example where patients have chronic progressive disorders. Ongoing delivery of maintenance therapy may require the skills of a therapist based on the complexity and risk associated with the program. This inclusion of assistants is in line with current delivery of care options for skilled rehab by Physical and Occupational Therapists.

  • Telehealth potential inclusion post this PHE which may allow ongoing telehealth coverage as we have been granted under this PHE

We at QRM support NASL as they are actively collaborating with many industry activists launching an aggressive advocacy campaign to defeat these cuts and to ensure the changes presented in the final rule will not result in a negative impact to our vulnerable patient population – especially in the midst of COVID’s dire consequences.

Comments are due by Oct 5th, 2020. CMS must publish the final rule by Dec 1, 2020 for an effective date of 1/1/21.

Let's Get to the Point:

QRM will continue to provide updates and strategies to ensure our patients receive the care needed to regain and maintain their highest possible level of care. Advocacy is critical at this time when CMS is considering reduction in reimbursement for therapy.