Page 9 - OPTA Access Spring 2017

Medicaid School Program Enacted
Representative Anthony DeVitis (R-Green) sponsored House Bill 89, legislation that originally proposed increases to the amount of funding school districts can recover through the federal Medicaid in Schools Program
Early in 2016 the Ohio Department of Medicaid released a bulletin that the Medicaid School Program will no longer
be reimbursing for therapy services if the service was not ordered by a physician (or a practitioner of the healing arts) This change to the Medicaid reimbursement does not impact a school districts’ obligation to provide the services to students with an IEP, only the districts’ ability to access reimbursement for the services provided to Medicaid eligible students
Understandably, many associations were concerned by this policy, including the OPTA We worked with other affected provider groups (occupational therapists, speech therapists, and audiologists) and reached out to others affected by the change
HB 89 was ultimately substituted in the Senate to be
the vehicle to change Ohio law to allow physical therapists, occupational therapists, speech therapists, and audiologists to be ORP providers for the Medicaid School Program Cheryl VanHoose represented the OPTA giving testimony to support the legislation
Governor Kasich signed HB 89 on December 19, 2016 This legislation has now been enacted
Physical Therapists Practice Act Legislation
Prior Representative Tim Brown (R – Bowling Green) and Representative Bill Reineke (R – Tif n) introduced House Bill 169 in the 131st General Assembly to update the practice act for physical therapists The legislation did two important things:
• Clari ed that “physical therapy” includes determining a diagnosis in order to treat a person’s physical impairments, functional limitations, and physical disabilities; determining a prognosis; and determining a plan of therapeutic intervention, and
• Added that physical therapy includes ordering tests such as diagnostic imaging and studies that are performed and interpreted by other licensed health care professionals
OPTA worked diligently on behalf of its members to make signi cant progress on the updated practice act legislation. Representative Bill Reineke (R-88), the second primary sponsor of HB 169, remains committed to the legislation and is eager to reintroduce during the 132nd General Assembly
OPTA members are encouraged to remain active and advocate for the practice act modi cations included in HB 169 As always, you want to be the “go to” expert for physical therapy information
For more information, contact Amanda or Mikayla at: amanda@gov-advantage com and mikayla@gov-advantage com
Payment Policy Report
Robert Swinehart – Payment Policy Specialist
Ohio Medicaid sent the following information that was effective 1/1/2017 regarding non-institutional wheelchair evaluations; the Ohio Medicaid DME program, regarding CPT 97542 Wheelchair management, is now separately reimbursable in
the non-institutional setting effective for dates of services on and after 01/01/17 the effective date of -OAC 5160-10-16 “DMEPOS: wheelchairs”
The rule language can be found at OAC 5160-10-16:
(2) Evaluators The following professionals may evaluate an individual’s particular needs:
(a) For wheelchairs incorporating CRT, a physiatrist, orthopedic surgeon, neurologist, physical therapist, or occupational therapist; or
(b) For wheelchairs not incorporating CRT, a physician, physical therapist, or occupational therapist
(5) Evaluation and management
(a) An evaluator may receive payment for determining an individual’s needs for a wheelchair Not more than one payment will be made per wheelchair per individual
Be aware that Ohio BWC is accepting the new evaluation codes effective 1/1/2017, and if you should make the change in your claims submission process effective 1/1/2017 If you still have questions regarding how to determine the best codes to use for the new evaluation coding, APTA has offered numerous webinars which are available to view on how to determine the best code Please refer to the APTA for assistance if there are still questions
PQRS reporting has sunsetted effective 12/31/2016 which means there will be no reporting of PQRS starting 1/1/2017 This has prompted several questions regarding MIPS and Advanced Alternate Payment Model Therapy services is not included in the MIPS reporting at this time but it is expected that in 2019 therapy services will be required to report Therapy services are also not included in the APM at this time so no reporting is needed Functional limitation reporting along with continued modi er reporting are still required for payers that required it prior to 2017
There have been several comments regarding speci c payers having dif culty processing authorizations, not having updated patient bene ts loaded as well as claims not being processed in a prompt manner As of the date of this article, all issues with updating payer codes have been resolved If you nd a payer who has not updated their payment codes to the new evaluation codes, please contact OPTA
CMS will issue national provider Comparative Billing Report (CBR) on Physical Therapy in February to help you understand applicable Medicare billing rules The CBR, produced by CMS contractor eGlobalTech, focuses on physical
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Legislative & Payment Policy Report