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ACVREP’s Vision, Values and Purposes Medicare Low Vision Demonstration Project Board Agendas / Meeting Minutes |
What is 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 evaluation of the patient must be done by the supervising physician. The vision rehabilitation specialist may not do the evaluation for the purpose of developing a plan of care. The evaluation may not be billed as part of the demonstration services. This Medicare Low Vision Demonstration Project is not an evaluation of the effectiveness, need, importance, or efficacy of vision rehabilitation services for patients with a vision loss. For the purpose of this project, it is generally accepted that this need for vision rehabilitation and its effectiveness is well established. Instead, the focus of this project is an investigation of new coverage aspects by new providers under CMS (Centers for Medicare and Medicaid Services), using “general supervision” rather than “incident to” supervision. For more information and for other resources, we suggest the following: 1. Contact your local Medicare carrier or fiscal intermediary (FI) with questions. 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 Garett Holm at 520-887-6816 or gholm@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 Garett Holm 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
contact Garett Holm at 520-887-6816 or gholm@acvrep.org DEPARTMENT OF HEALTH & HUMAN SERVICES MEDICARE NEWS MEDICARE DEMONSTRATION TO STUDY REHABILITATION FOR PEOPLE WITH VISION IMPAIRMENT Under the Low Vision Rehabilitation Demonstration project, to be conducted
in 6 “This demonstration has the potential to expand access to quality vision To be eligible, beneficiaries must live in one of 6 demonstration locales and
their Medicare beneficiaries are currently able to receive low vision rehabilitation 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: 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 Changes to the Medicare Low Vision Demonstration Project
The message below was disseminated by Roxann Mayros, CEO of NCPABVI (now VisionServe Alliance); November 2007. 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 nine (9) hours of services within 90 days and
only once in the lifetime of the client. This provision will be abolished. 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 |
