OTAC has received notification from the manager of Reimbursement and Regulatory policy with AOTA, that Cigna will be imposing a 4 unit per visit limit and 15% reduction in payment for OTA/PTA treatments starting November 1st in Colorado.
Please read this announcement from Cigna and notify Cigna and your clients to express your concern over this policy change.
For the 4 unit per visit limit, please be aware that if billing more than four units, Cigna will pay the units as listed on the claim, i.e., the first four units will be the four they will pay. Cigna informed AOTA and APTA that it cannot sort units by dollar amount. Thus, the onus is on the therapist to list the procedures in descending dollar order.
Providers can write a letter to Cigna addressing how this new policy will affect their clinic setting and their ability to deliver care to Cigna beneficiaries.
Some other steps that can be taken:
- Patients can send a letter to Cigna - Encourage patients that are Cigna beneficiaries to write letters expressing their concern on how this policy will adversely impact their care. Please encourage the patient or guardian to customize the letter and to share their personal experience.
- Patients can speak to the HR department of their employer - Providers can suggest they call the HR (human resource) department to inform them of their concern about potentially losing access to OTA/OT team services.
- Talk to your legislator. While legislative action may not be possible at this time, providers can still notify legislators and make them aware of this Cigna policy change and how it will impact enrollees, the delivery of occupational therapy services, and the other adverse downstream effects. The sooner they hear about it and the greater the frequency, the more likely they will explore action to challenge the policy.
From the Colorado Department of Health Care and Policy (HCPF): Medicaid Claims must have the Referring Provider NPI number beginning July 1, 2022
Private Practice Therapists - these changes may impact you the most!
This change is to comply with federal regulation 42 CFR455.440, which requires providers to include the NPI of the person who ordered the service to be on their claim. The Referring NPI must be on the claim and must be enrolled with Colorado Medicaid. The InterChange will deny claims if the Referring Provider NPI number is not included or is invalid. 'Not included’ means the billing provider did not place it on the claim. ‘Invalid’ means the Referring NPI is on the claim but it is not enrolled with Colorado Medicaid.
Use this tool to determine if a doctor is enrolled in Colorado Medicaid. Click HERE for a link to find NPI registry numbers. Click HERE to read more information from HCPF.
OTAC's House Bill 22-1068 Medicaid Reimbursement for Therapy Using Equine Movement has passed! OTAC will be part of the signing ceremony with the governor soon!
HB22-1068 would make medical reimbursement available for therapy using equine movement when provided by an occupational therapist, physical therapist, or speech-language pathologist.
Congratulations OTAC members! Your membership dues have directly supported the creation and passage of this bill and all of OTAC's legislative advocacy efforts on behalf of OT practice in Colorado!
OTPs Needed for Home Modification Assessments in Rural Colorado
From the Division of Housing/Local Affairs in the Medicaid Home Modification program that works with HCPF (Healthcare Policy and Financing):
Several agencies throughout the state are having difficulties locating therapists to perform Home assessments in the more remote areas of the state. Specifically, urgency is needed right now in Conejos/Costilla/Alamosa counties.
Through waivers, clients have $14k to use towards an eligible home modification (ie. install ramp, convert tub/shower to walk-in or roll-in, ADA toilet, lower shelves). In addition, there are additional funds through ARPA up to $10k for a limited time. Therapists are needed to perform the assessments so clients can take advantage of these home modification benefits.
To help with Home Modification Assessments in rural Colorado please email Michelle Maddrell, Home Modification Program Assistant
Action Needed! Supporting Occupational Therapy Assistants
UPDATE FROM AOTA: Occupational therapy assistants took a 15% cut to reimbursement under Medicare Part B starting in January 2022.
We need Congress to pass the SMART Act (H.R. 5536) which would PAUSE THIS CUT for the rest of 2022 and take permanent steps towards reducing the impact of this cut to reimbursement. This legislation would enhance patient access to occupational therapy services, especially in rural and underserved areas. The list of Congressional champions supporting this bill continues to grow, but we need your help to ensure the issue receives the attention it deserves by Congress. Write to your Member of Congress to cosponsor the SMART Act https://www.congress.gov/bill/117th-congress/house-bill/5536
Extension of Pars for Pediatric Long Term Home Health until MARCH 2024
Click here for the full notice from HCPF
Humana Requiring Prior Authorization for OT, PT, and SLT Beginning January 1, 2022
AOTA has been made aware that beginning January 1, 2022, Humana will begin requiring prior authorization for OT, PT, and SLT via Cohere, a utilization management company. This will impact almost all of Humana’s commercial and Medicare Advantage lines of business, with some exceptions. Practitioners need to be aware that although Cohere markets their program as a musculoskeletal utilization management program, practitioners must submit all diagnoses for prior authorization.
Please review the following resources for more information: the announcement from Cohere, Cohere’s Provider Knowledge Center, and the Prior Authorization List [CPT©] Codes Under Management Effective January 1, 2022.
If you have any questions or concerns regarding Cohere and/or Humana, please email Julie Lenhardt, AOTA’s reimbursement and regulatory policy manager, at firstname.lastname@example.org.