Another Barrier for Jimmo implementation that may not yet have percolated to the top is the Medicare fee schedule rates for rehabilitation services negatively impacting providers willingness to not only risk providing services for fear of denials and recoupments, but also because payment rates may not sufficiently cover expenses with current and pending Medicare fee schedule reductions, including the therapy cap. Providers may not be willing or able to provide these services.
An example of this type of limitation is seen in this article about the Texas Medicaid program (Sam P.K. Collins, ThinkProgress.org, Aug 12, 2015).
“Many payers, such as private insurance, rely on federal and state rates to set their own rates, which typically are at a rate lower than Medicaid. These drastic cuts would have a devastating effect on the quality of care and availability of therapy for children with disabilities.”
To the average consumer, payment rates may not outwardly appear to be related to access but when cuts result in payments below costs, for example as we see in the DMEPOS arena, it absolutely impacts access.
Laura J. Cohen PhD, PT, ATP/SMS
Principal, Rehabilitation & Technology Consultants, LLC