MEDICARE DEMONSTRATION PROJECT Introduced by Greg Goodrich, Ph.D.
NOTE: Dr. Goodrich was a major presentor at last year’s Mary T. Adams Educational Seminar. Since Kansas is one of the states designated as a participant in the demonstration grant discussed below, KABVI members are curious why Kansas Services for the Blind and Visually Impaired (KSBVI) is not actively involved in this project. Dr. Goodrich notes, “In recent months this project has been widely debated, proposed, canceled and finally reinstated. After all of this it is now beginning. AER is working with a variety of organizations to help ensure that this project is successful. As you know, the success of this project will mean that COMS, CLVT, & CVRT providers will be eligible for compensation (within certain restrictions) for services provided to Medicare eligible clients. While the amount Medicare will reimburse does not cover the cost of devices, nor all the services an individual may need, it is still a dramatic improvement. It will mean greater access to services for clients and a greater ability to provide those services. In short, its an important step forward. … We all look forward to the initial reports from those who begin providing services under Medicare. What are the benefits? What are the limitations? What are the problems that will need to be solved? And, are more clients receiving more services because of this project? The Medicare Demonstration Project is scheduled to last 5 years. We will learn much during that time, but I look forward to this process and anticipate a successful conclusion to the project.” Alert for Rehabilitation Providers: Medicare Low Vision Rehabilitation Demonstration CENTERS FOR MEDICARE and MEDICAID SERVICES; Medicare is conducting a demonstration project that will expand benefits for patients with moderate to severe visual impairments. Through this demonstration, Medicare will assess the impact of providing reimbursement for up to 9 hours of vision rehabilitation services in appropriate settings, including in the patient’s home, by qualified vision rehabilitation professionals under general supervision by the physician. Vision rehabilitation services under the demonstration are not subject to Medicare therapy caps. Who Can Provide Services? Qualified occupational therapists, and low vision therapists, orientation and mobility specialists, and vision rehabilitation therapists who are certified by the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP) may provide vision rehabilitation services under the demonstration when delivering services to an eligible Medicare beneficiary under the general supervision of a qualified physician. Who Is Eligible for Services?An eligible Medicare beneficiary must be enrolled in Medicare Part B fee-forservice and not be a member of a Medicare Advantage Plan; ** have a diagnosis of moderate to severe vision impairment, including blindness that cannot be corrected by conventional means; ** reside in one of six demonstration areas; ** and ??be able to derive benefit from the rehabilitation. What Are the Demonstration Sites? The demonstration will take place in the following areas: Atlanta, Georgia; Kansas; New Hampshire; New York City (all five boroughs); North Carolina and Washington State How Will It Work? Typically, an ophthalmologist or optometrist whose practice is in the same demonstration area as the patient’s residence would make a diagnosis of moderate-to-severe vision impairment that cannot be corrected by conventional means, such as surgery or glasses. The physician would create a vision rehabilitation plan of care that specifies the types of services the patient should receive and then assign the rehabilitation to a qualified occupational therapist or certified vision rehabilitation professional. This could be as much as 9-hours of rehabilitation over a consecutive 90-day period. Each time rehabilitation services are provided the physician will submit a claim for the services using a special demonstration billing code according to which rehabilitation professional billed the services. The codes are: G 9041 Occupational Therapist G 9042 Orientation and Mobility Specialist G 9043 Low Vision Therapist G 9044 Vision Rehabilitation Therapist (also called Rehabilitation Teacher) Occupational therapists in private practice (OTPP) with Medicare provider numbers are permitted to submit claims for the demonstration services they perform. However, they must use the demonstration billing code G9041 for an occupational therapist. OTPPs may not submit claims for, or supervise, other rehabilitation providers. Why Should You Participate? The Low Vision Rehabilitation Demonstration allows physicians to utilize the full range of qualified rehabilitation professionals available in their practice areas. It is up to the physician to decide which vision rehabilitation professional or professionals will provide the services. Some ophthalmologists and optometrists may not know how to contact qualified occupational therapists or certified vision rehabilitation professionals. Therefore, it is in your best interest to communicate with local eye care physicians to make them aware of your availability and how to access your services. Although participation in this demonstration is voluntary, Medicare is encouraging all qualified occupational therapists and certified vision rehabilitation professionals practicing in a demonstration area to seek out opportunities to participate. Currently, certified low vision rehabilitation professionals may not be reimbursed for services by Medicare, except under the demonstration. For more details about the demonstration, see CMS ’Low Vision Rehabilitation Demonstration Web page at www.cms.hhs.gov/DemoProjectsEvalRpts/ MD/list.asp( from this page, enter “vision” in to the keyword search box, and then click “refreshlist” button. Scroll down to “MedicareLowVisionRehabilitationDemonstration”.) If you have questions about this demonstration, please contact the Low Vision Rehabilitation Demonstration Project Officer at visiondemo@cms.hhs.gov What You Need to Know About Billing: For complete details about claims submission, please read “New Requirements for Low Vision Rehabilitation Demonstration Billing” <www.cms.hhs.gov/MedlearnMattersArticles/downloads/MM3816.pdf,
or, contact your local Medicare carrier.
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