Medicare Low Vision Demonstration Project Information

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:

Occupational Therapists G9041 $28.04/15 min.
Orientation & Mobility Specialists G9042 $14.97/15 min.
Low Vision Therapists G9043 $14.97/15 min.
Vision Rehabilitation Therapists G9044 $12.81/15 min.

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:


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?

  1. First, understand the importance of this project and to act on this understanding!
  2. 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.
  3. 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