Changes
to the Medicare Low Vision Demonstration Project - PLEASE READ
Please click on one of the links
below for additional information on that subject:
Fact
Sheet For ACVREP Certificants And Doctors On The Medicare Low Vision
Demonstration Project
The
Future Of Vision Rehabilitation Professionals Is NOW Or It Is OVER!
Identifying
Ophthalmologists and Optometrists In The Six Demonstration Site
Areas
List
Of Eye Doctors In Six Sites Who Include Low Vision Rehabilitation In
Their Practice Is Now Available
CMS
Press Release
Special
Website For The Medicare Low Vision Demonstration Project
Link to www.lowvisionproject.org
(please click on the “Special Website For The Medicare
Low Vision Demonstration Project” link above to read about this
website before you attempt to visit it).
Fact Sheet For ACVREP
Certificants and Doctors On the Medicare Low Vision Demonstration
Project
The Medicare Low Vision Demonstration Project is intended to help
deliver vision rehabilitation services to patients with a vision
loss in new and expanded ways, including in their homes. The project
began April 1, 2006, and is scheduled to continue
for 5 years, through March 31, 2011. It involves six sites,
including 4 states and 2 cities: Kansas, New Hampshire, North
Carolina, Washington, New York City (all 5 Burroughs), and Atlanta.
To participate, patients must live in one of the six sites, and
supervising physicians must practice in one of the six sites.
It is designed to allow vision rehabilitation specialists who are
certified through ACVREP to work under the “general supervision”
of an ophthalmologist or optometrist to perform vision
rehabilitation services to patients in their homes. “General
supervision” means that the doctor does not need to be physically
present on the premises, whereas “direct supervision” requires
the doctor to be present and available on the premises while
services are provided. Only a physician can supervise the vision
rehabilitation specialist. The vision rehabilitation specialists
covered in this Medicare demonstration include low vision
therapists, orientation and mobility specialists, and vision
rehabilitation therapists (formerly called rehabilitation teachers),
all of whom need to be certified by ACVREP. Other professionals who
are not certified by ACVREP are not eligible to participate in this
Medicare Low Vision Demonstration Project, and ACVREP is the only
certifying body recognized by Medicare (CMS) for this project. Other
eligible providers who will be covered for direct services to
patients under this demonstration include ophthalmologists,
optometrists, and occupational therapists working in private
practice, in a rehabilitation facility, or employed by a physician.
Certain qualified rehabilitation
facilities may also qualify, including outpatient rehabilitation
clinics or critical access hospitals.
Vision rehabilitation specialists may provide up to 9 hours of
vision rehabilitation training
over a consecutive 90 day period to a patient with a qualifying
level of visual impairment. Qualifying visual impairment levels
include patients with a visual acuity less than 20/70 OU, or those
with a documented central scotoma, a general constriction of field
loss, or a bilateral hemianopia. Qualifying patients must show a
medical necessity for the services rendered, be capable of progress,
and must be able to derive a benefit. A plan of treatment must be
written and followed by the vision rehabilitation specialist, and
agreed upon and signed by the supervising physician. The physician
must review the plan of treatment every 30 days. Documentation of
key components of the plan of treatment must be strictly adhered to
for Medicare guidelines. The plan of treatment must include
measurable goals and a statement of where the services are to be
provided. Vision rehabilitation services must be provided one on
one, face to face, and may not be provided in a group setting.
If guidelines and procedures are correctly followed for qualifying
patients, Medicare will reimburse the supervising physician for
vision rehabilitation services provided by certified vision
rehabilitation specialists under this test “general supervision”
arrangement provided in the patient’s home. Only the supervising
physician, a qualifying rehabilitation facility, or an occupational
therapist in private practice may directly bill Medicare for vision
rehabilitation services. Payments from Medicare will not be paid
directly to the vision rehabilitation specialist (unless s/he is an
occupational therapist in private practice), since s/he does not
have a Medicare provider number, and it will be the physician who
will be billing Medicare.
The vision rehabilitation specialist can be paid for his/her
services by having an employment
arrangement or contract with the supervising physician or
rehabilitation facility. The nature of the employment arrangement or
contract, as well as the reimbursement rates for services provided,
are strictly between the supervising physician (or rehabilitation
facility) and the vision rehabilitation specialist.
Vision rehabilitation services are billed in 15 minute increments.
Most Medicare regional directors do not allow more than 75 or 90
minutes of services in one session. Patients may not receive more
than 9 hours of services during the life of this demonstration
project. The supervising physician or his/her billing person submits
the bill to Medicare and the secondary insurance carrier for
reimbursement. Not all secondary insurances cover vision
rehabilitation services, so in those cases, the patient must be
billed for the portion (20%) not covered by Medicare. Patients who
do not have a qualifying level of vision loss may be responsible for
the entire portion of vision rehabilitation services provided.
Special “G” codes are to be used for billing these vision
rehabilitation services during this demonstration project, to help
identify these services in the six sites. Therapy codes that were
formerly used for vision rehabilitation services are not required
during this demonstration project. The G-codes to be used by the
respective vision rehabilitation specialists, with the approximate
current reimbursement rates, are listed below:
The Future Of Vision Rehabilitation Professionals Is NOW Or It Is
OVER!
Everyone in the field needs to be
made aware of the importance of the Medicare Low Vision
Demonstration Project that began in April, and the link it
inherently has to the future of our professions in America.
Let's say that, after the
demonstration project, CMS/Medicare reviews the numbers and outcomes
and decides that Vision Rehabilitation Professionals (VRPs) are not
needed and, therefore, decides not to reimburse for vision
rehabilitation services? Let's say that this branch of our federal
government decides we are not worth it. What do you think will
happen in the federal programs that sponsor professional training?
Think of this in light of the recent directions of RSA. We will be
dead in the water; no money for professional training programs and
no reimbursement for services. Our professional group is not
structured nor are we ready to defend this type of challenge.
However, there is one group that has political clout, connections,
and consistent planning, and I am sure they are waiting in the
wings.
If Medicare decides against us,
do you think any private insurer will pay? The answer is no.
The other side of the coin is if
the Medicare Low Vision Demonstration project is successful and
ACVREP certified professionals are to receive reimbursement. We will
then be in the position to guarantee qualified services leading to
client independence, and the future of specialized services.
Administratively, it is an ugly
world out there and we are at a crossroads; we have five years to
prove ourselves to the feds. Many administrators who do not serve
Medicare recipients are saying that this does not affect them so why
be involved? However, it truly affects everyone, including the
certified vision rehabilitation therapists who work in the school
systems, the future of the profession for all of us, the future of
professional preparation programs, and, ultimately and most
importantly, the clients. All of the agencies and schools and all of
us need to help make this demonstration project work. Educators, be
wary, this is another possible erosion of specialized services for
blind and visually impaired individuals.
So, each and every one of us, in
our positions, needs to be dedicated and passionate. AER, its
leaders, its division chairs and its membership need to be educated
and become energized leaders in support of this pivotal and
consequential opportunity in the history of our profession. We have
missed too many opportunities in the past to make us viable
professions (e.g., insurance and Medicare coverage, licensing) and
now we have the chance!!!
We must be passionate! Some of us
are disappointed in the professionals in the vision rehabilitation
field thinking we can just go on the way we are - low salaries, not
a recognized profession by the feds, not recognized by the public,
and not understanding the bigger picture.
We must not miss this window of
opportunity given to us now!
What needs to be done now?
- First,
understand the importance of this project and to act on this
understanding!
- Second,
support agencies and individuals in the current six
demonstration project sites to help them be successful; maybe we
need to funnel appropriate clients from a non-participating
agency to one that is participating. Let you local Office for
Aging know about this project and spread the word through your
medical contacts, especially in the six chosen sites.
- Third,
continue to provide the good service that we do provide.
Submitted by Martin S. Yablonski,
COMS, Chair of ACVREP’s Board of Directors
Identifying Ophthalmologists
and Optometrists In The Six Demonstration Site Areas
ACVREP is currently trying to
identify and develop a list of ophthalmologists and optometrists who
are practicing in the six Medicare Low Vision Demonstration Project
sites and include low vision rehabilitation services in their
practice. As we identify these physicians, we will help link ACVREP
certificants who wish to participate in the Medicare Low Vision
Demonstration Project with these ophthalmologists and optometrists.
If you know of any ODs or MDs who
meet the above criteria, please provide their names, addresses,
phone numbers, and email addresses, if possible. Please contact
Bryan Gerritsen at 801-547-5903 or bryangerritsen@comcast.net or
Sharon Mikrut at 520-887-6816 or smikrut@acvrep.org.
List Of Eye Doctors In Six
Sites Who Include Low Vision Rehabilitation In Their Practice Is Now
Available
An initial list of eye doctors
who include low vision rehabilitation in their practice in the six
Medicare Low Vision Demonstration Project sites is now available.
For those interested in participating in this project, and linking
up with an eye doctor in one of these six sites, please contact
Sharon L. Mikrut for a list of the eye doctors in your site. For
proprietary reasons and privacy, we do not want to list these eye
doctors on the web site at this time, but we can provide you on a
one-on-one basis the names of those doctors in your site. Please
e-mail or call me for this information.
Sharon L. Mikrut
President
ACVREP
smikrut@acvrewp.org
520-887-6816
CMS Press Release
DEPARTMENT OF HEALTH & HUMAN
SERVICES
Centers for Medicare & Medicaid Services
Room 303-D
200 Independence Avenue, SW
Washington, DC 20201
Public Affairs Office
MEDICARE NEWS
For immediate release
Contact: CMS Office of Media Affairs
February 22, 2006
(202) 690-6145
MEDICARE DEMONSTRATION TO STUDY
REHABILITATION FOR PEOPLE WITH VISION IMPAIRMENT
The Centers for Medicare and Medicaid Services (CMS) today announced
a
demonstration project to study the impact of standardized Medicare
coverage for
rehabilitation services that can be provided in the homes of
beneficiaries with a diagnosis of moderate to severe visual
impairment that cannot be corrected through conventional means or
surgery.
Under the Low Vision
Rehabilitation Demonstration project, to be conducted in 6
selected areas of the country, Medicare beneficiaries with moderate
to severe vision impairment will be eligible to receive up to 9
hours of rehabilitation benefits when prescribed by their
ophthalmologist or optometrist.
“This demonstration has the
potential to expand access to quality vision
rehabilitation services to more individuals in this vulnerable
population and help them to achieve a greater degree of independence
and minimize barriers to care,” said CMS Administrator Mark B.
McClellan, MD, Ph.D.. “It will put additional resources for
rehabilitation in the hands of eye care physicians and consequently
improve the quality of life of beneficiaries who are visually
impaired.”
To be eligible, beneficiaries
must live in one of 6 demonstration locales and their
eye care physician must practice in one of the locales. The
demonstration will be
conducted in New Hampshire, New York City (all 5 boroughs), North
Carolina, Atlanta, GA., Kansas, and Washington State. The
demonstration is slated to begin on April 1, 2006 and run for 5
years until March 31, 2011.
Medicare beneficiaries are
currently able to receive low vision rehabilitation
services under local coverage decisions when they are provided by
Medicare qualified therapy providers (generally occupational or
physical therapists) under the supervision of a qualified physician.
The Low Vision Rehabilitation Demonstration, however, will permit
vision rehabilitation to be provided by certified low vision
therapists, orientation and mobility specialists and rehabilitation
teachers, as well as occupational therapists, in appropriate
settings including the beneficiary’s home, without need for the
supervising physician to be on the premises.
Special Website For The
Medicare Low Vision Demonstration Project
ACVREP has a special initiative
to support the new Medicare Low Vision Demonstration Project. An
integral part of this initiative is to provide helpful information
to ACVREP certificants, to doctors, and to others interested in
participating in the project. To help do this, we have joined with
co-sponsor, Johns Hopkins Medical Center, in designing a page on the
Johns Hopkins website to explain and support the Medicare Low Vision
Demonstration Project. This page will help to inform you about the
Medicare demonstration project. It is intended to be a resource to
those who would like to become involved with the demonstration
project.
The Johns Hopkins website is
located at www.lowvisionproject.org. After entering the site, you
will need to create a login name. A password will be e-mailed to
you. After entering your login name and password, locate the link at
the bottom of the page on the first screen after login occurs,
entitled “Medicare Low Vision Demonstration Project —ACVREP.”
Once on that page, key features include a welcome and description of
the page, a Fact Sheet about the project, and headings at the bottom
that include:
• Agenda
• Announcements
• Polls
• Links
• Forums
By clicking on one of these
headings, you can discover any announcements regarding the Medicare
Low Vision Demonstration Project, participate in a poll or discover
relevant links that have further information on the Medicare Low
Vision Demonstration Project. This site is updated at least weekly
with new and current information.
ACVREP is the only certifying
body recognized by Medicare for certification of vision
rehabilitation specialists who wish to participate in the Medicare
Low Vision Demonstration Project. Vision rehabilitation specialists
who are not certified by ACVREP cannot participate. For more
information on certification requirements and procedures offered
through ACVREP, please see the links to that on ACVREP’s website (www.acvrep.org).
We hope you will find this web
page informative and helpful. Your comments and suggestions are
encouraged.
Bryan Gerritsen
ACVREP Medicare Low Vision Demonstration Project Coordinator
(801) 547-5903
bryangerritsen@comcast.net
Changes to the Medicare Low
Vision Demonstration Project - PLEASE READ
The message below was
disseminated by Roxann Mayros, CEO of NCPABVI.
I am excited to update you on the
following issues regarding the Medicare Low Vision Demonstration
Project:
As most of you know, our industry is in the midst of a 5 year
demonstration project to establish the cost of Medicare
reimbursement for the services of ACVREP certified vision
rehabilitation professionals. Six of our member agencies are
participating - Lighthouse International, Center for the Visually
Impaired, Metrolina Association for the Blind, New Hampshire
Association for the Blind, Envision, and Community Services for the
Blind and Partially Sighted.
In 2006, the National Vision Rehabilitation Network (the
organization that deserves all of the credit for promoting and the
ultimate implementation of the Low Vision Demonstration Project)
ceased to exist because they were successful in achieving their
mission. At that time, NCPABVI's Board of Directors voted to assume
responsibility for oversight of the Project for three reasons - 1)
to assist those member agencies participating in the project, 2) to
foster a dialogue between the various organizations interested in
supporting the Project, and 3) because the success or failure of the
Project could impact Federal funding in the future.
Not unexpectedly, many issues arose during implementation of the
Project, all of which had significant impact on those NCPABVI
agencies. In addition, it didn't take long to discover inherent
design flaws in the project that not only discouraged participation,
but outright, prevented reimbursement for quality services.
I am proud to announce that due to a joint effort between the
agencies providing services under the Project (listed above), the
American Academy of Ophthalmology, Representative Capuano
(Massachusetts), Senator Sununu (New Hampshire), and NCPABVI, we
have just received notification that Medicare will revise the
Project to include changes that we believe will improve
opportunities for participation. These include:
1. Removing the limitation of 9 hours of services within 90 days and
only once in the lifetime of the client. This provision will be
abolished.
2. Each client will be allowed to receive twelve hours of vision
rehabilitation services annually.
3. Seven counties in New York will be added (currently limited to
the 5 New York Burroughs) – Westchester, Nassau, Putnam, Dutchess,
Orange, Sullivan, Ulster, and Suffolk.
4. 477 additional zip codes (31 counties) will be added in Georgia
(currently limited to a very small pocket of Metro Atlanta).
These four items do not represent the entire spectrum of changes
that NCPABVI requested, but we believe we received important
concessions from Medicare that will allow for increased
participation by vision rehabilitation professionals, and most
importantly, to create an environment that will allow for consistent
quality services to be provided under the Project.
Roxann Mayros, CEO
National Council of Private Agencies
for the Blind and Visually Impaired (NCPABVI)
8760 Manchester Rd.
St. Louis, MO 63144
314-961-8235
314-968-9003 (fax)
rmayros@agenciesfortheblind.org
Visit us at: www.agenciesfortheblind.org
