1. NATA LAWSUIT ADDRESSES “INCIDENT TO”
2. THERAPY PLANS (INCLUDING INITIAL PLAN) MUST BE RECERTIFIED EVERY 30 DAYS

1. NATA LAWSUIT ADDRESSES “INCIDENT TO”

PLEASE BE ADVISED THAT KEY PORTIONS OF THIS REGULATION, SLATED TO GO INTO EFFECT THROUGHOUT MEDICARE ON JUNE 6, HAVE BEEN STAYED PER THE ONGOING NATIONAL ATHLETIC TRAINERS’ ASSOCIATION (NATA) LAWSUIT.

ACA has a meeting scheduled with Centers for Medicare & Medicaid Services (CMS) representatives this week to discuss how this will affect our demonstration project. Stay tuned for updates!!!

A consistent concern we have been raising in our meetings with CMS is the “incident to” therapy requirement which was applied to the demo. This regulation does not allow chiropractic assistants to perform physical medicine services, and we feel this could negatively affect participation in the demonstration project. ACA has also objected to the “incident to” therapy requirement in general on several occasions. Click here to read one set of comments filed as early as October 2003:http://www.acatoday.com/government/medicare/regulatory/comments_on_changes.shtml

The recent NATA lawsuit addresses this same requirement and halted its scheduled implementation on June 6 (from http://www.nata.org):

“In response to a lawsuit filed by NATA on May 27, the U.S. Department of Health and Human Services has agreed in a court order to delay implementing key portions of a new rule from the Centers for Medicare & Medicaid Services. Parts of CMS’ rule governing "incident to" therapy services will be suspended until the court issues a decision on NATA’s motion for preliminary injunction or until July 22, 2005, whichever comes first. A hearing is scheduled July 1.

“The rule at issue, published in CMS’ Medicare Carrier’s Manual May 6, was set to take effect June 6. In it, CMS decided to no longer pay for therapy services incident to a physician’s services unless the ovider is a physical therapist, occupational therapist or speech/language pathologist.

“NATA contends such a decision improperly restricts athletic trainers’ ability to practice. If the rule were allowed to take effect, doctors would not be able to bill Medicare for treatment provided by athletic trainers. NATA’s lawsuit seeks to prevent this practice limitation.”

To read the court order, click here: http://www.nata.org/documents/CMS_courtorder.pdf.

2. THERAPY PLANS (INCLUDING INITIAL PLAN) MUST BE RECERTIFIED EVERY 30 DAYS

According to CMS representatives, we have received confirmation that therapy plans must be done every 30 days. The initial plan is only good for 30 days, not 60!