**Please note that CMS has extended the deadline to comment to the proposed rule. The new deadline is October 14, 2015**
Federal Regulation Call to Action – Long Term Care Proposed Rule
The Centers for Medicare and Medicaid Services (CMS) recently published the proposed rule: “Reform of Requirements for Long-Term Care Facilities” (CMS-3260-P). The rule proposes revisions to the standards of care that nursing facilities must meet in order to receive federal funding.
Director of Activities Qualifications
Within the proposed rule they are seeking comments on the Director of Activities Qualifications. They are specifically requesting comments on whether the requirements for the director of the activities program remain appropriate and what should serve as minimum requirements for this position. Although CMS is not proposing specific changes at this time, it is the appropriate time to share information with them. To improve recognition of music therapists’ qualifications to serve as activities directors within Long Term Care (LTC) facilities, we are proposing CMS add music therapists to the regulatory language.
Specialized Rehabilitative Services
CMS seeks to expand the list of designated specialized rehabilitative services available to LTC residents. Expanding the list of specialized rehabilitation services ensures that residents will receive specialized services included as an option to address care and services provided in the LTC setting. The listing of specialized rehabilitative services specified within this section is not exhaustive; however, we would like to see music therapy specifically listed within the regulation.
How Can You Help?
We ask that you please join us in submitting comments to CMS via email urging the agency to include music therapists as meeting the requirements of directors of activity within long term care facilities and specifically listing music therapy as a specialized rehabilitative service available to long term care residents.
Suggested revisions are included below. Please request these specific changes, which have been worded to fit the CMS regulation format. Feel free to adapt the intro, rationale language, and closing to reflect your personal situation.
THE DEADLINE TO SUBMIT COMMENTS IS 5 PM ET, OCTOBER 14, 2015
You may submit electronic comments on this regulation to http://www.regulations.gov. In commenting, please refer to file code CMS-3260-P.
1 - CREATE A DOCUMENT BY CUTTING AND PASTING THE SCRIPT TEXT BELOW INTO MICROSOFT WORD.
2 - CUSTOMIZE DOCUMENT
3 - SAVE DOCUMENT TO DESKTOP.
4 - Cut and paste link below in browser:
5 - Click the blue “Comment Now” button.
6 - ***In the section titled "Your Information" under the "Comment" box - you will see a button titled "Upload files" UPLOAD YOUR SAVED DOCUMENT FROM YOUR DESKTOP
7 - Fill in all other required information and hit "Continue"
Script (please adapt language below as needed and remove words in CAPS before sending)
Submitted Via Regulations.gov
Centers for Medicare & Medicaid Services
Department of Health and Human Services
PO Box 8010
Baltimore, MD 21244
RE: (CMS-3260-P) – Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities; Proposed rule (Federal Register, July 16, 2015)
My name is [INSERT NAME] and I am a [INSERT POSITION--- i.e., MUSIC THERAPIST] from [CITY and STATE]. I appreciate the opportunity to submit comments on the above-referenced proposed rule. I seek to comment on the quality of care and quality of life and specialized rehabilitative services sections of the proposed rule.
[IF APPLICABLE, PLEASE INCLUDE INFORMATION ON HOW THESE SUGGESTED REVISIONS WILL POSITIVELY IMPACT ACCESS TO MUSIC THERAPY IN YOUR COMMUNITY]
II. Provisions of Proposed Regulation
I. Quality of Care and Quality of Life (§ 483.25)
I support the proposal to reorganize the current §483.25 section to include services and care that is provided in a manner intended to “support achievement of a resident’s individualized goals for attaining or maintaining his or her highest practicable physical, mental, and psychosocial well-being (42196).” To that end, I feel it is appropriate that the requirements for Directors of Activity reflect the potential needs of every long term care resident. Currently regulation (F249) §483.15(f)(2); lists the requirements for Activity Director.
Recommended revision in BOLD:
§483.15(f)(2) The activities program must be directed by a qualified professional who--
- Is a qualified therapeutic recreation specialist or an activities professional who--
- Is licensed or registered, if applicable, by the State in which practicing; and
- Is eligible for certification as a therapeutic recreation specialist or as an activities professional by a recognized accrediting body on or after October 1, 1990; or
- Has 2 years of experience in a social or recreational program within the last 5 years, 1 of which was full-time in a patient activities program in a health care setting; or
- Is a qualified occupational therapist, or occupational therapy assistant; or
- Is a qualified music therapist who is eligible for board certification through the Certification Board for Music Therapists;
- Has completed a training course approved by the State.
- I believe that the national education, clinical training, and board certification requirements established for the music therapy profession fully qualify music therapists to serve as Activity Directors within long-term care facilities.
- Services provided or directly supervised by qualified music therapists who hold the national music therapy board certification credential referred to as Music Therapist-Board Certified (MT-BC) have a significant positive impact on quality of care and quality of life.
- Board Certified Music Therapists are trained and skilled in conducting assessments, defining treatment plan goals, implementing procedures, evaluating and making appropriate modifications and accommodations to address multiple needs of residents, and documenting residents’ response to treatment.
Q. Specialized Rehabilitative Services (§ 483.65)
I support the proposed relocation and expansion of the list of designated specialized rehabilitative services (42263). Expanding the list of specialized rehabilitation services ensures that residents will receive specialized services included as an option to address care and services provided in the LTC setting. Currently, the list of Specialized Rehabilitative Services (§ 483.45) is being revised and relocated to the new section, Specialized Rehabilitative Services (§ 483.65) and adds a specific listing of respiratory therapists as a specialized rehabilitation service available to residents. I recognize that the listing of specialized rehabilitative services within this section is not exhaustive, but believe that residents will benefit from the addition of music therapy to this list of potential services.
Recommended revision in BOLD:
§ 483.65 Specialized rehabilitative services.
(a) Provision of services. If specialized rehabilitative services such as but not limited to physical therapy, speech-language pathology, occupational therapy, respiratory therapy, music therapy, and rehabilitative services for mental illness and intellectual disability or services of a lesser intensity as set forth at § 483.120(c), are required in the resident's comprehensive plan of care, the facility must—
- The Minimum Data Set (MDS) 3.0 currently lists music therapy under Section O. Special Treatments and Procedures, O0400. Therapies, F. Recreational Therapy (includes recreational and music therapy). This listing recognizes the important service that music therapy provides within LTC treatment programs.
- Specifically adding music therapy to this list will improve facility recognition of potential specialized rehabilitative services.
I greatly appreciate your attention to my suggested revisions. Please contact me if you require additional information regarding these comments.
[INSERT NAME, ADDRESS, EMAIL AND PHONE NUMBER]
Update of ONC’s Guide to Privacy and Security of Electronic Health Information
The HHS Office of the National Coordinator for Health Information Technology (ONC) released Version 2.0 of their Guide to Privacy and Security of Electronic Health Information.
In the updated Guide, you will find practical scenarios that explain when a business associate (BA) relationship forms along with suggested questions health care providers may want to ask their health IT product developers and a seven-step approach for implementing a security management process. Read the blog post
and ONC’s updated guide
President Obama Signs the Autism CARES Act
On August 8, 2014, President Obama signed the Autism Collaboration, Accountability, Research, Education and Support Act, or Autism CARES Act of 2014 into law.
Please read more about the bill here: http://www.whitehouse.gov/blog/2014/08/11/president-obama-signs-bill-support-needs-people-autism
Americans With Disabilities Act (ADA) - Anniversary
Saturday, July 26th, marked the 24th anniversary of the Americans with Disabilities Act (ADA) -- landmark law that transformed American society for people with disabilities. It provided for full participation, independent living, and economic self-sufficiency for those of us living with disabilities, and also provided Americans with disabilities with legal remedies to safeguard all of those rights.
New HIPAA Resources from the U.S. Department of Health and Human Services Office for Civil Rights
The Office for Civil Rights (OCR) and Office of the National Coordinator for Health Information Technology (ONC) have recently developed model Notices of Privacy Practices for health care providers to use to communicate with their patients.
The HIPAA Privacy Rule gives individuals a fundamental right to be informed of the privacy practices of health care providers, as well as to be informed of their privacy rights with respect to their personal health information. Covered health care providers are required to develop and distribute a notice that provides a clear, user friendly explanation of these rights and practices. Since many healthcare providers have asked for additional guidance on how to create a clear, accessible notice that their clients can understand, OCR and ONC have provided the following models:
• A notice in the form of a booklet;
• A layered notice that presents a summary of the information on the first page, followed by the full content on the following pages;
• A notice with the design elements found in the booklet, but formatted for full page presentation;
• A text only version of the notice.
The models reflect the regulatory changes of the Omnibus Rule and can serve as the baseline for covered entities working to come into compliance with the new requirements. In particular, the models highlight the new patient right to access their electronic information held in an electronic health record, if their provider has an Electronic Health Records (EHR) in their practice. Covered entities may use these models by entering their specific information into the model and then printing for distribution and posting on their websites.
• Layered Notice
• Full Page
• Text Only
• Questions and Instructions
To view these samples, please visit: http://www.hhs.gov/ocr/privacy/hipaa/modelnotices.html
For more information about the HIPAA Privacy Rule and the Notice requirements, see: http://
NYSED Letter of Clarification for Music Therapy as a Related Service
Important News for New York Music Therapists!
Thanks to advocacy by AMTA member Elizabeth Schwartz, New York music therapists now have an official "clarification letter" from the New York State Education Department regarding the recognition of music therapy as a related service under the Individuals with Disabilities Education Act (IDEA), the federal special education law.
This letter will be instrumental in supporting the provision of quality music therapy services in school districts throughout the state for any child found to be in need of music therapy.
The original purpose of IDEA was to establish a statutory right of all children to a free, appropriate public education specifying special education and related services as the vehicles to provide support for the inclusion of students with disabilities in regular education classrooms. Related services are defined in the bill under Part B as those services deemed necessary to help the child benefit from special education. Appropriate related services are to be specified in the Individualized Education Program (IEP). Published regulations provide that the law’s list of related services is not exhaustive and may include other developmental, corrective, or supportive services if they are required to assist a child with a disability to benefit from his/her special education. A school district is required to supply those services that will enable a child to receive a free and appropriate special education (FAPE).
Even though qualified music therapists have been providing music therapy as a related service to literally thousands of children with disabilities in every state of the nation over the course of the thirty-seven plus years since the passage of Public Law 94-142, the New York State Education Department had never provided specific clarification regarding the use of music therapy in special education.
Earlier this year, a Long Island pre-school program discontinued music therapy services, indicating the cuts were in part due to the fact that music therapy was not a state-approved related service. In an effort to address this problem, Elizabeth Schwartz prepared support materials about the profession, including a reference to information AMTA had obtained from the U.S. Department of Education (http://www2.ed.gov/policy/speced/guid/idea/iep-qa-2010.pdf) and presented these documents to state officials. Although Elizabeth had previously received an email indicating that New York recognized music therapy as a related service, she requested written clarification of this recognition from the Department to assist in educating local district administrators and program staff.
On August 8, 2013, the Office of P-12 Education: Office of Special Education, Coordinator of Special Education Policy and Professional Development provided the attached letter in response to Elizabeth’s request. This document provides guidance representing the interpretation of the New York State Education Department and clarifies the recognition of music therapy as a related service under IDEA. It is recommended that all New York music therapists maintain a copy of this important document within their professional files to utilize in educating administrators and consumers about the state’s recognition of music therapy within special education. Further, music therapists outside of New York are encouraged to use this letter as a template for advocacy efforts in their own states.
Elizabeth will be facilitating a round-table discussion regarding this process at the April 2014 MAR conference in Buffalo, NY.
PROTECT REHABILITATION SERVICES CRITICAL TO MEDICARE BENEFICIARIES WITH INJURIES, ILLNESSES, DISABILITIES AND CHRONIC CONDITION
WRITTEN TESTIMONY ON PROPOSALS TO REFORM MEDICARE POST-ACUTE CARE BEFORE THE HOUSE WAYS AND MEANS HEALTH SUBCOMMITTEE
JUNE 28, 2013
Thousands of individuals with disabilities and chronic conditions utilize Medicare to access the rehabilitation services they need to remain healthy, functional, and live as independently as possible in their homes and communities. According to the Centers for Medicare and Medicaid Services (CMS), more than two thirds of Medicare beneficiaries, or about 21.4 million individuals, had at least two chronic conditions in 2010. To these individuals and others with injuries and illnesses, Medicare is a lifeline to a better quality of life through improved health and functional status.
In connection with the June 14 hearing to examine the President’s and other bipartisan Medicare proposals related to post-acute care, the House Ways and Means Health Subcommittee is considering numerous changes to the Medicare program that impact people requiring varying levels of rehabilitative care in inpatient and, potentially, in outpatient settings. We hope the Subcommittee is sensitive to the importance of preserving access to high quality rehabilitation care under the Medicare program. Senator Kirk, Senator Johnson, and former Congresswoman Gabby Giffords offer compelling examples of how comprehensive rehabilitation leads to a return to health, function, and independent living.
As representatives of people with disabilities and chronic conditions and providers who serve them, the undersigned organizations of the Coalition to Preserve Rehabilitation recognize the importance of Medicare reforms that prolong and strengthen the long term viability of the program. However, we have serious concerns with efforts to unduly focus Medicare spending reductions in settings in which post-acute care is provided, particularly in inpatient rehabilitation hospitals and units (IRH/Us) as well as outpatient therapy services.
Overall, Medicare spending growth has been extremely low over the past three years and the Congressional Budget Office has projected this historically low rate of growth as contributing hundreds of billions of dollars in deficit reduction. In addition, Medicare data establish that spending in the IRH/Us setting has remained relatively flat over the past decade due in part to policy changes made by previous Congresses.
As members of the Coalition to Preserve Rehabilitation (CPR), we strongly believe that any changes to the Medicare program should not have the effect of impeding access to rehabilitation and other post-acute care services. Congress should avoid proposals that decrease short-term healthcare expenditures by simply shifting costs to beneficiaries, decreasing benefits, or erecting policy barriers that affect beneficiaries by channeling them into settings of post-acute care that do not meet their individual rehabilitation needs in terms of amount, duration, intensity and scope of rehabilitation services.
A number of pilots and demonstrations authorized under existing Medicare law are already reforming the Medicare post-acute care system and these reforms ought to be given time to achieve their promise. New delivery models that focus on persons with multiple chronic conditions are in their infancy and should be give time to demonstrate their value. Bundling proposals are being pursued that have not yet had the opportunity to produce meaningful results and CMS has not even implemented some existing programmatic requirements to date (i.e., the Continuing Care Hospital pilot program). These and other programs should better align financial incentives with coordination of high quality care and prioritize care provided in the home and community while preventing unnecessary institutionalization, readmissions, and promoting person-centered care and decision making.
Inpatient Rehabilitation Hospital Proposals
With respect to some of the post-acute care proposals currently being considered by the Committee, the Coalition to Preserve Rehabilitation opposes policies that would severely restrict access to IRH/U services for Medicare beneficiaries with injuries, illnesses, disabilities and chronic conditions.
As this Subcommittee considers Medicare proposals that reduce spending to offset the cost of a fix to the physician fee schedule or otherwise reduce the overall deficit, we ask you to NOT include in your legislation the following proposals.
1. Cuts to Future Investments in Inpatient Rehabilitation Hospitals and Units
The magnitude of aggregate reductions in annual inflation updates to IRH/U care included in the President’s most recent budget proposal, is completely disproportional to Medicare expenditures in this setting of care. According to the data, Medicare expenditures for IRH/Us has been relatively flat for the past several years, in stark contrast to many other areas of both acute and post-acute care spending under the program. In fact, Medicare spending on inpatient rehabilitation services makes up only 1.2% of total Medicare spending and only 11.4% of Medicare spending on post-acute care services. During the hearing, Jon Blum was specifically asked about appropriate margins and he stated that anytime margins were in the double digits the Agency felt this was problematic. Given that this double digit threshold has not been exceeded it would be inappropriate to impose market basket reductions. Large spending reductions in post-acute care will deal a serious blow to the capacity of IRH/Us—and all post-acute settings—to accommodate the needs of an aging population with disabling conditions. Inpatient hospital rehabilitation is cost-effective by maximizing the functional capacity of individuals who receive such services. The ability to leave the hospital and live as independently as possible in the home and community-based setting, as opposed to spending long periods of time in institution-based care or being readmitted to the acute care hospital, will avert the need for enormous unnecessary spending for these beneficiaries in future years.
2. Increasing the 60% Rule for Inpatient Rehabilitation Hospitals and Units
We oppose raising the 60% rule, which was established by Congress in 2007, up to a 75% compliance threshold, a percentage that would clearly restrict access to IRH/U services. This is an issue that has been debated for several years and that Congress has resolved. Congress settled this debate in the Medicare, Medicaid and SCHIP Extension Act of 2007 ("MMSEA") with the implementation of a reasonable rule that has been demonstrated to permit appropriate access to inpatient hospital rehabilitation in the years that have followed. The data clearly establishes that the 60% Rule is working in its current form. Inpatient rehabilitation has not experienced nearly the same increases in Medicare expenditures that other settings of post-acute care have over the past several years. Raising the rule from 60% to 75% would simply take clinical decision-making out of the hands of physicians and the rehabilitation team and place those decisions into the hands of bureaucrats. We strongly urge you to preserve the 60% rule so as to not erect arbitrary barriers to intensive, hospital-based rehabilitative care.
3. Site-Neutral Payment Proposals
This proposal would reduce significantly access to inpatient rehabilitation for patients with particular conditions. These conditions, depending on the severity of the patient, are treated in bothIRH/Us as well as Skilled Nursing Facilities (SNFs). The fallacy behind this proposal is that similar patients achieve equal outcomes when treated in either setting. But even the study that the Medicare Payment Advisory Commission (MedPAC) cites for this proposition states that its "results are preliminary, and additional work is needed to define clinically meaningful differences in self-care and mobility functional status." (See, Research Triangle Institute Study, Vol. 4, Sec. 8, page 58.) Implementation of site-neutral payment for patients with hip fractures, joint replacements and other conditions would simply eliminate access to intensive rehabilitation programs by erecting a financial disincentive for admission of these individuals in IRH/Us. This appears to be just another proposal to drive patients to less intensive, less appropriate rehabilitation settings, rather than the setting that best meets their rehabilitation needs.
Outpatient Therapy Services
The Coalition to Preserve Rehabilitation cannot pass up the opportunity in the context of this hearing to express our dismay with CMS’s implementation of the exceptions process medical manual review to the Medicare outpatient therapy caps. Although consumer and disability organizations have long opposed these arbitrary caps in therapy benefits, CMS’s current use of Recovery Audit Contractors (RACs) to review claims in excess of $3700 per person is highly objectionable. The use of RACs to assess whether therapy services for these beneficiaries are reasonable and necessary creates a presumption of fraud, abuse and overutilization, and creates a chilling effect on access to services above this $3700 cap.
This cap serves to deny care to the very individuals who need it most, approximately 5% of those requiring outpatient therapy services. This policy has a disproportionate impact on people with disabilities and chronic conditions who utilize therapy services to improve, maintain and prevent deterioration of their function and health status. We ask the Subcommittee to (1) prevent CMS from utilizing RACs to administer the outpatient therapy benefit, (2) extend the exceptions process for the therapy caps beyond December 2013, (3) streamline the exceptions process for those with documented disabilities and chronic conditions, and (4) consider redesigning the physical therapy, occupational therapy and speech-language pathology benefits to focus on functional outcomes rather than arbitrary caps on the benefit.
The disability and chronic illness community understand the magnitude of the problem that our nation faces in attempting to contain federal spending and finally fix the physician fee schedule. However, achieving significant federal savings on the backs of people with disabilities and some of our most vulnerable citizens is not the path to success.
We look forward to working with you to preserve the Medicare program while preserving access to rehabilitation services for all Medicare beneficiaries. Thank you for the opportunity to submit this testimony for the written record. For more information, please contact Peter Thomas at email@example.com or (202) 872-6730.
American Academy of Physical Medicine and Rehabilitation
American Congress of Rehabilitation Medicine
American Medical Rehabilitation Providers Association
American Music Therapy Association
American Occupational Therapy Association
American Physical Therapy Association
American Speech-Language-Hearing Association
American Therapeutic Recreation Association
Association of Academic Physiatrists
Association of Rehabilitation Nurses
Brain Injury Association of America
Center for Medicare Advocacy
Christopher & Dana Reeve Foundation
National Association of State Head Injury Administrators
National Association for the Advancement of Orthotics and Prosthetics
National Disability Rights Network
Paralyzed Veterans of America
The Arc of the United States
United Spinal Association
US Department of Health and Human Services (HHS) Issues Message to Our Nation’s Health Care Providers
HHS has issued a letter to health care providers to ensure that they are aware of their ability under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule to take action, consistent with their ethical standards or other legal obligations, to disclose necessary information about a patient to law enforcement, family members of the patient, or other persons, when they believe the patient presents a serious danger to himself or other people.
Department of Labor - Employment and Training Administration (ETA), Allied Health Competency Model
"The mission of the Employment and Training Administration is to contribute to the more efficient functioning of the U.S. labor market by providing high quality job training, employment, labor market information, and income maintenance services primarily through state and local workforce development systems." (http://www.doleta.gov/etainfo/mission.cfm)
The Employment and Training Administration (ETA) has worked with technical and subject matter experts from education, business, and industry to develop a comprehensive competency model for the Allied Health industry sector. The model identifies the knowledge, skills, and abilities needed for workers to perform successfully in the field of Allied Health.
AMTA Government Relations Director, Judy Simpson, participated as a Subject Matter Expert (SME) for ETA's Industry Competency Initiative for Allied Health. AMTA also served as a Validator and Industry Champion in the Model development process. Ongoing collaboration with the Health Professions Network (HPN) was instrumental in AMTA's participation in this project.
National Endowment for the Arts (NEA) Releases White Paper on Arts and Human Development
The National Endowment for the Arts is leading a new task force of 13 federal agencies and departments to encourage more and better research on how the arts help people reach their full potential at all stages of life. The new task force will look for ways to facilitate discussion, showcase, and share recent research on the arts and human development. A white paper titled "The Arts and Human Development: Framing a National Research Agenda for the Arts, Lifelong Learning, and Individual Well-Being," has been developed to examine the relationship between the arts and positive health and educational outcomes at various segments of the lifespan -- from early childhood, to youth and adolescence, to older adult populations. AMTA was invited to participate in the introductory webinar and will be contributing to the collection process as it moves forward.
Institute of Medicine (IOM) - Allied Health Workforce Workshop Summary Released
Earlier this year, the Institute of Medicine (IOM) held a two-day meeting titled, "Workshop on the Allied Health Workforce and Professions." The workshop was intended to examine the current allied health care workforce and consider how that workforce contributes to solutions for improving access to health care services, particularly for underserved, rural, and other populations.
Content included a discussion on the definition of the allied health workforce and improving workforce strategies geared towards increasing access to allied health services. Attention was focused on raising awareness for policy makers, state and local governments, and allied health care providers to improve regulations related to allied health care delivery.
HPSO - Risk Advisor Newsletter
The HPSO Risk Advisor is published as an added benefit for the insurance customers of Healthcare Providers Service Organization. The Risk Advisor shares articles of interest, answers to frequently asked questions and actual case studies. Please click here for more information