Regulatory Update

American Physical Therapy Association: APTA-Backed Bill Advantage Prior Authorization Presses for Medicare Reforms

Polaris Group
August 12, 2021

The legislation would require MA plans to share data, provide transparency, create more efficient systems, and do a better job of listening.

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American Physical Therapy Association: APTA-Backed Bill Advantage Prior Authorization Presses for Medicare Reforms

The legislation would require MA plans to share data, provide transparency, create more efficient systems, and do a better job of listening.

APTA-supported bipartisan legislation taking aim at misuse of prior authorization in Medicare Advantage plans has arrived at the U.S. House of Representatives. If signed into law, the bill could mark a major shift in Medicare Advantage by holding plans more accountable for their use of prior authorization, establishing a pathway for "real time" coverage decisions, and requiring MA companies to get more input from providers and other stakeholders on what is and isn't deemed clinically appropriate. Known as the "Improving Seniors' Timely Access to Care Act" (H.R.3173) the bill now in the house wouldn't completely eliminate the use of prior authorization but would move Medicare Advantage toward a more transparent and less burdensome process — a longtime policy goal for APTA. Reps. Suzan DelBene, D-Wash.,, Mike Kelly, R-Penn., Ami Bera, D-Calif., and Larry Bucshon, R-Ind., introduced the bill.  The legislation is intended to put up guardrails around MA's prior-authorization practices. According to a press release, the changes are necessary to improve a system that when misused "can result in administrative burdens for providers, taking previous time away from patient care and delaying needed medical intervention.”  Specifically, the bill would establish an electronic prior authorization process, require the implementation of a "real-time" decision system for items and services that are routinely approved, mandate that MA plans provide more detailed reports on use of prior authorization to the U.S. Centers for Medicare & Medicaid Services(including their rates of approvals, denials, and average time for approvals),and press MA providers to do a better job of incorporating input from healthcare providers in their authorization programs and decisions.  David Scala, APTA senior specialist of congressional affairs, says the legislation is a good first step that's in line with APTA's 2021-2022 public policypriorities. "Prior authorization is receiving increased scrutiny from legislators and policymakers for good reason — because while it may be necessary in some form, when it's misapplied or shaped by misinformed decisions about care, patients can be put at risk," Scala said. "This legislation is an acknowledgement that administrative burden associated with prior authorization ultimately affects patients. APTA applauds House members DelBene, Kelly, Bera, and Bucshon for their work to introduce this bill."  APTA government affairs staff will monitor the progress of this legislation and provide updates and opportunities to make your voice heard as they arise.

AAPACN: Considerations for Long-Term Care Facilities on Acquiring COVID-19 Vaccination Resources

The purpose of this document is to provide long-term care facilities (LTCFs) with information about acquiringCOVID-19 vaccination resources for staff and residents. All LTCF staff members are categorized as health care personnel, the highest priority group for receiving the vaccination, and are eligible for vaccination now. As a reminder, the COVID-19 vaccine is free of charge to all people living in the United States. No one can be denied a vaccine if they are unable to pay the vaccine administration fee. 

AAPACN: Cultural Competence Resources

AAPACN put together a collection of resources to identify cultural competence.  This includes a collection of assessment tools, educational and learning materials.  One is titled Disparities & Culturally Competent Care: Fostering Cultural Competence and the other is titled The Cultural Awareness Video Series: From Action to Change.  Here is the link to those resources:

OIG: Meeting the Challenges Presented by COVID-19: Nursing Homes

The OIG initiated a nationwide, three-part study to examine how the pandemic affected nursing homes. According to the OIG website this study is to “prevent and mitigate future outbreaks”.  The first part of the three-part study will “analyze the extent to which Medicare beneficiaries residing in nursing homes were diagnosed with COVID-19 and describe the characteristics of those who were at greater risk”.  The second part will “describe the characteristics of the nursing homes that were hardest hit by the pandemic (i.e., homes with high numbers of beneficiaries who had COVID-19)”. The third part will “describe the strategies nursing homes used to mitigate the unprecedented challenges of COVID-19. These challenges include procuring critical supplies, testing residents and staff, isolating high numbers of contagious residents, caring for those afflicted, and protecting residents and staff on a scale never before experienced in this country”.  This has been added to the OIG 2021 Active Workplan items list.  They expect to issue the findings in 2022. 

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