AOTA

Updated: 5/27/2020

Question: Can outpatient therapy services that are furnished via telehealth and separately paid under Part B be reported on an institutional claim (e.g., UB-04) during the COVID-19 PHE?

Answer: Yes, outpatient therapy services that are furnished via telehealth, and are separately paid and not included as part of a bundled institutional payment, can be reported on institutional claims with the “-95” modifier applied to the service line.

Update on CMS Authorization for OTs to Open Medicare Home Health Cases

As part of the emergency waivers, the Centers for Medicare & Medicaid Services (CMS) has temporarily authorized occupational therapists to perform initial and comprehensive assessments for all home health patients receiving therapy as part of the plan of care. AOTA has obtained clarifications about the waiver from CMS staff and created a new FAQ resource for practitioners. View Part 1 and Part 2 of AOTA's COVID-19 webinar series about what OTs need to know about starting Medicare home health cases. See all AOTA's information on occupational therapy in the era of COVID-19.

When the COVID-19 crisis ends, we anticipate our ability to practice telehealth will be eliminated with cancellation of the executive orders from Governor Mills. MeOTA is looking to garner evidence and support now so that we can advocate for further OT telehealth coverage in the future. We would like to gather key data points about therapists’ and clients’ experiences with telehealth and reimbursement.  MeOTA Telehealth Data Tracker.doc

AOTA and MeOTA wanted to give you a heads up on a state-level campaign that has been initiated by the National Association for the Support of Long Term Care.

They are asking their members to “contact your state governor’s office and urge them to temporarily suspend or waive the state supervision requirements for physical therapists, occupational therapists, and speech-language pathologists for the duration of the COVID-19 emergency.”  

We are concerned that this request is premature and could have unintended consequences. Please stay tuned for more information before taking any action. 

Governor Mill's four-stage plan for opening the economy.  Here is the link:  https://www.maine.gov/governor/mills/news/governor-mills-presents-safe-gradual-plan-restart-maines-economy-2020-04-28

The Governor’s Plan allows certain health care services to reopen in Stage One. This includes: “Health care from Maine licensed providers, with a recommendation that they prioritize care for patients with time-sensitive conditions; assure the safety of patients, staff, and communities; manage the use of essential resources such as personal protective equipment and testing supplies; and pace reopening services to the level of community COVID-19 activity, maintaining capacity in our hospitals for potential outbreaks.”  Reopening is optional and subject to the provider’s adoption of safety recommendations in the Maine DHHS COVID 19- Guidance for Health Care Providers (“DHHS Guidance”) https://www.maine.gov/dhhs/documents/coronavirus/COVID-19-Guidance-for-Health-Care-Providers-043020.pdf. 

The DHHS Guidance includes occupational therapy. Occupational therapy services that are offered pursuant to the DHHS Guidance needs to comply to all of the requirements of the DHHS Guidance and the referenced US CDC Infection Control Guidance for Health Care Professionals about COVID-19 https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control.html.  

AOTA Medicare Telehealth Success! 

4/30/2020

The Centers for Medicare & Medicaid Services (CMS) announced the long awaited news today, April 30th, that occupational therapists, physical therapists, and speech language pathologists can now perform telehealth services for Medicare beneficiaries.

New Wavier Language:

Eligible Practitioners. Pursuant to authority granted under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) that broadens the waiver authority under section 1135 of the Social Security Act, the Secretary has authorized additional telehealth waivers. CMS is waiving the requirements of section 1834(m)(4)(E) of the Act and 42 CFR § 410.78 (b)(2) which specify the types of practitioners that may bill for their services when furnished as Medicare telehealth services from the distant site. The waiver of these requirements expands the types of health care professionals that can furnish distant site telehealth services to include all those that are eligible to bill Medicare for their professional services. This allows health care professionals who were previously ineligible to furnish and bill for Medicare telehealth services, including physical therapists, occupational therapists, speech language pathologists, and others, to receive payment for Medicare telehealth services. (Emphasis added)

Based on the language in the new blanket waiver, AOTA is immediately seeking clarification regarding whether it extends to occupational therapy assistants, and will be advocating for inclusion. The waiver is retroactive to March 1, 2020 and is effective throughout the public health emergency. Telehealth services can be billed using the list of telehealth approved CPT® codes that CMS issued on March 30, 2020. AOTA will be developing a more in-depth article with billing guidance, listing the available CPT codes.

AOTA has been proactively and tirelessly advocating for this change with the U.S. Department of Health and Human Services (HHS) and CMS through many means, including meetings, the submission of comment letters, and development of a fillable template comment letter for the profession to engage in advocacy directly. On April 6, AOTA, along with APTA and ASHA, met with CMS to discuss the CARES Act waiver authority to expand the list of telehealth eligible professionals and implore CMS to allow OTs, PTs, and SLPs to perform telehealth immediately amid the COVID-19 PHE.

AOTA is analyzing additional Medicare flexibilities in the 1135 waiver. Additional changes include increased payments to telephone services retroactive to March 1. CMS is also allowing physical and occupational therapists to delegate maintenance therapy services to physical and occupational therapy assistants in outpatient settings. AOTA continues to analyze the new waiver and will provide an update on any additional flexibilities. Read the full press release.

Maine OT Licensing info

These waivers from the Centers for Medicare and Medicaid Services were updated on April 9th.

https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf

CMS Allows OTs to Open Medicare Home Health Cases

Late on April 9, the Centers for Medicare & Medicaid Services (CMS) temporarily suspended certain regulatory requirements through 1135 waivers so that health care facilities can maximize their frontline medical staff during the COVID-19 national health emergency, including a key rule for occupational therapy. After years of AOTA advocacy to allow occupational therapists to open Medicare home health cases, CMS has temporarily suspended the rule that would prevent OTs from opening Medicare home health cases, with a retroactive effective date of March 1, 2020, through the end of the emergency declaration. Occupational therapists may now perform initial and comprehensive assessments for all home health patients receiving therapy as part of the plan of care. According to the CMS Fact Sheet, the waiver:

Allow[s] occupational therapists (OTs) to perform initial and comprehensive assessment for all patients. 42 C.F.R. 484.55(a)(2) and 484.55(b)(3). CMS is waiving the requirement that OTs may only perform the initial and comprehensive assessment if occupational therapy is the service that establishes eligibility for the patient to be receiving home health care. This temporary blanket modification allows OTs to perform the initial and comprehensive assessment for all patients receiving therapy services as part of the plan of care, to the extent permitted under state law, regardless of whether occupational therapy is the service that establishes eligibility.
https://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/News/2020/CMS-Medicare-Home-Health-Open.aspx 

Notice of Agency Emergency Rule-making Adoption 

AGENCY: Department of Health and Human Services, Office of MaineCare Services

CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Ch. 1, Section 5,  COVID-19 Public Health Emergency Services 

ADOPTED RULE NUMBER:

CONCISE SUMMARY:

This emergency rulemaking institutes measures, effective immediately, to expedite and improve access to medical care for MaineCare members due to the 2019 Novel Coronavirus (COVID-19). Pursuant to 5 M.R.S. Sections 8054 and 8073, the Department has determined that immediate adoption of this rule is necessary to avoid a potentially severe and immediate threat to public health, safety or general welfare. The Department’s findings of emergency are included in detail in the Emergency Basis Statement. Maine is facing a substantial public health threat posed by the global spread of COVID-19. On March 11, 2020 the World Health Organization declared COVID-19 a worldwide pandemic. On March 15, 2020, Governor Janet T. Mills declared a state of civil emergency in Maine.

 

This is a single new section of the MaineCare Benefits Manual that implements emergency changes for multiple types of MaineCare services. The following sections of MaineCare policy are affected by this rulemaking: Ch. 1, Section 1 (General Administrative Policies and Procedures); Ch. I, Section 4 (Telehealth Services); Chs. II and III, Section 31 (Federally Qualified Health Center Services); Chs. II and III Section 40 (Home Health Services); Chs. II and III, Section 45 (Hospital Services); Ch. II, Section 55 (Laboratory Services); Ch. II, Section 60 (Medical Supplies and Durable Medical Equipment); Chs. II and III, Section 65 (Behavioral Health Services); Ch. II, Section 80 (Pharmacy Services); Ch. II, Section 90 (Physician Services); Chs. II and III, Section 96 (Private Duty Nursing and Personal Care Services; Ch. II, Section 101 (Medical Imaging); and Chs. II and III, Section 103 (Rural Health Clinic Services).

 

The Department is waiving certain co-payment requirements for all MaineCare members, including pharmacy, clinical visits, medical imaging, laboratory services, behavioral health services, medical supplies and durable medical equipment, private duty nursing, and home health services. Should COVID-19 specific treatments or vaccines become available during the duration of this rule, co-payments will be waived for those services as well.

 

The Department is altering some of the MBM, Section 80, Pharmacy Services, requirements in order to expedite and improve access to prescriptions. Restrictions are lifted for asthma and immune-related prescriptions. Prior Authorizations for COVID-19 treatments and vaccines, should they come available, are waived. Early refills of prescriptions are allowed, and the physical assessment requirements for Buprenorphine and Buprenorphine Combination products for SUD are waived.

Prior Authorization requirements for certain durable medical equipment are being extended and early refills/orders allowed for individuals with COVID-19, in self quarantine who may have COVID-19, or in a high-risk category for developing complications from COVID-19.

Home Health Services document submission requirements are being extended for Plans of Care submissions.

The Department is waiving the advance written notice/consent for telehealth services, waiving the comparability requirement for specific services subject to approval by the Department, and allowing telephone-only evaluation and management services.

In the event of conflict between the COVID-19 Public Health Emergency Services rule and any other MaineCare rule, the terms of this rule supersede other rules and shall apply.

The Department shall seek and anticipates receiving approval of those changes from the Centers for Medicare and Medicaid Services (CMS) retroactive to March 18, 2020.

 

These emergency rule changes shall be effective for ninety (90) days, per 5 M.R.S. § 8054. MBM.

 

http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

 

EFFECTIVE DATE:                             March 20, 2020

           

AGENCY CONTACT PERSON:       Anne E. Labonte, Comprehensive Health Planner II

AGENCY NAME:                              Division of Policy

ADDRESS:                                         109 Capitol Street, 11 State House Station

Augusta, Maine 04333-0011

EMAIL:                                                  Anne.Labonte@Maine.gov

TELEPHONE:                                       (207)-624-4082 FAX: (207) 287-1606

                                                                TTY users call Maine relay 711

Emergency Adopted MaineCare Benefits Manual, Ch. I, Section 5, COVID-19.pdf

https://www.aota.org/coronavirus

3/16/2020

The continued spread of Coronavirus Disease (COVID-19) across the globe has sparked concern in the occupational therapy profession regarding practice, options for delivering quality therapy services while doing our part to slow the spread and “flatten the curve,” and academic requirements for educators and students. AOTA is continuing to closely monitor this fluid situation, and has compiled resources to answer practitioners’ frequently asked questions.

AOTA’s top priority as we navigate this pandemic together is the health and safety of occupational therapy practitioners, students, and the clients they serve. We will update this page as information becomes available and will continue to empower students, educators, and clinicians to navigate these unprecedented circumstances.

Resources for Occupational Therapy Practitioners

·          OT and Telehealth in the Age of COVID-19: Additional flexibilities for telehealth have been incorporated into both federal programs and private insurance. However, these flexibilities don’t always expand the definition of who can provide telehealth services.

·          Looking for information on whether you can use telehealth in your state and considerations for practice while many areas are under precautions for COVID-19? AOTA’s Telehealth Resources page contains resources to help OT practitioners to navigate this emerging area.

·          AOTA has created a comprehensive list of State-by-State Resources pertaining to COVID-19 (PDF)

·          CMS Guidance to Providers About COVID-19: The Centers for Medicare & Medicaid Services (CMS) has taken action to protect the health and safety of our nation’s patients and providers in the wake of the COVID-19 outbreak. This includes clear, actionable information on the screening, treatment, and transfer procedures to follow when interacting with patients. AOTA recommends you review CMS actions if you treat Medicare or Medicaid beneficiaries, many of whom are at high risk for COVID-19.

·          Provision of Special Education, Early Intervention, and 504 Services During the COVID-19 Outbreak: On March 12, the U.S. Department of Education released guidance on how to continue providing services to children with disabilities during the COVID-19 outbreak. Based on that guidance, AOTA has provided some answers to the most frequently asked questions.

·          To connect with your colleagues and learn more information as this situation develops, visit AOTA’s online community, CommunOT.

AOTA is continuing to develop more resources pertaining to COVID-19. Please check back for more information, which will be posted here as it becomes available.

Stateside Associates is publishing a state by state chart of state legislative actions, executive agency actions, and gubernatorial actions related to the outbreak of the coronavirus.

https://www.stateside.com/sites/default/files/2020-03/Covid-19%20Overview_31620_311p%20-%20PUBLIC.pdf ).

As we respond to COVID-19, we encourage MaineCare providers to consider utilizing telehealth services for the delivery of MaineCare-covered services when appropriate and necessary. MaineCare has long had a robust telehealth policy and has recently created additional flexibility for its usage. Please read this message in its entirety to understand your options and additional resources.

Utilizing Telehealth to Satisfy Face-to-Face Requirements in MaineCare Policies

Telehealth allows providers to deliver services to individuals remotely so that providers can monitor and address health conditions. This can be done through Interactive Telehealth Services, which are real time, interactive visual and audio telecommunications; or telephonically when Interactive Telehealth Services are unavailable.

With few exceptions such as personal care services and ambulance, telehealth can be used to satisfy the MaineCare face-to-face requirements when telehealth delivery of the service is of comparable quality to in-person service delivery. Providers are also required to ensure they are complying with all federal, state, and local regulations that apply, including HIPAA requirements, when network services are used.

Member & Service Criteria for Telehealth Eligibility

The significant majority of medically necessary MaineCare-covered service may be delivered via Interactive Telehealth Services if the following requirements are met:

1. The member is otherwise eligible for the covered service, as described in the appropriate section of the MaineCare Benefits Manual; and,
2. The covered service delivered by Interactive Telehealth Services is of comparable quality to what it would be if it were delivered in person.

If a member is eligible to receive the underlying covered service, and if delivery of the covered service via telehealth is medically appropriate as determined by the health care provider, the member is eligible to receive telehealth services. For services that traditionally have not been considered medically appropriate or of comparable quality via telehealth (e.g. Intensive Outpatient Treatment (IOP) or Home & Community Based Treatment (HCT)), providers are encouraged to consider alternative treatment options that could be more appropriately delivered via telehealth (e.g. 1:1 counseling visits). 

Delivery of Telehealth via Telephone

In addition to Interactive Telehealth Services, telephones are an acceptable mode to deliver telehealth if Interactive Telehealth Services are unavailable, and if Telephonic Service is medically appropriate for the underlying covered service.

Prior Authorization (PA) Requirements

Prior Authorization (PA) is only required for Interactive Telehealth Services if a PA is required for the underlying covered service. In these cases, the PA relates to the underlying covered service, not to the telehealth mode of delivery.

Telehealth and Pharmacy – NEW!

Through emergency rules, going forward the Department will allow for prescribing through telehealth. 

Telehealth Sites

Two distinct sites are necessary for delivering interactive telehealth. The first site – called the Originating Site – is where the MaineCare member is located when receiving the service. The second site – the Receiving Site – is where the provider who is administering the covered service or consultation is located.

The Originating Site can be a member’s home, nursing facility, long-term care facility, or other health care facility, with telehealth capabilities.

Telehealth Provider Eligibility

To receive reimbursement for telehealth services, a health care provider must be:

·          Acting within the scope of his or her license,

·          Enrolled as a MaineCare provider, and;

·          Otherwise eligible to deliver the underlying covered service according to the requirements of the applicable section of the MaineCare Benefits Manual.  

Billing for Telehealth

In general, services must be billed in accordance with applicable sections of the MaineCare Benefits Manual. Providers must submit claims in accordance with Department billing instructions. The same procedure codes and rates apply to the underlying covered service as if those services were delivered face-to-face. When billing for Interactive Telehealth Services, health care providers at the Receiving (provider) Site should bill for the underlying covered service using the same process they would if it were delivered face-to-face; with the addition of a GT modifier to the claim.

Reimbursement for Originating Sites

In general, when a member is receiving telehealth services, any health care provider who is present with the member at the Originating Site (where the member is, e.g. a nursing facility or the member’s home), may not bill for assisting the health care provider delivering the covered telehealth service from the remote Receiving Site. However, if a health care provider at an Originating site is not providing clinical services but is making a room and telecommunications equipment available, that health care provider may bill MaineCare for an originating facility fee using code Q3014 for the service of coordinating the telehealth service.

Telehealth Resources for Providers

Providers who need assistance with implementing and/or have general billing questions regarding telehealth services are encouraged to contact the Northeast Telehealth Resource Center (NETRC) by email: netrc@mcdph.org or 1-800-379-2021. Specific questions can also be submitted to NETRC at https://www.netrc.org/contact.php. Many other helpful telehealth resources are available on NETRC’s website including NETRC’s Telehealth Toolkit for COVID-19.

MaineCare providers with telehealth questions related to MaineCare-specific billing and/or policies should contact their provider relations specialist or call Provider Services at 1-866-690-5585.

MaineCare encourages providers who would like to learn more about telehealth to participate in the National Consortium of Telehealth Resource Center’s webinar on March 17^th related to telehealth and COVID-19.

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