On November 30, 2017, AAPM&R joined the American Medical Rehabilitation Providers Association (AMRPA) in a meeting with Demetrios Kouzoukas, Principal Deputy Administrator of Centers for Medicare and Medicaid Services (CMS), and additional CMS officials, to discuss rehabilitation access under the Medicare Advantage (MA) program.
During the meeting, AAPM&R and AMRPA stressed key points submitted in an October 23 letter, specifically, that MedPAC data (March 2016 Report and March 2017 Report) confirms that MA enrollees receive far less access to IRF care than fee-for-service beneficiaries. Our organizations emphasized that the issue mainly stems from the use of proprietary guidelines for IRF admissions. Medicare law requires that MA enrollees have access to the same benefit package as FFS enrollees. AAPM&R and AMRPA reiterated that CMS should instruct MA plans to ensure they use Medicare FFS medical necessity guidelines when deciding whether to grant authorization of an MA enrollee’s IRF stay.
AAPM&R and AMRPA urged CMS to publish in the annual “Call Letter” to MA plans, an affirmation that MA plans must use FFS medical necessity guidelines when deciding whether to cover an IRF referral, and to not rely on proprietary guidelines for this important determination.
Click here to view the October 23 letter to CMS concerning Medical Rehabilitation Medicare Advantage (MA).