Honoring President Bush’s Influence on the Americans with Disabilities Act (ADA)

by Connie Welcome, OT

As America mourns the passing of our 41 st President, Mr. George H. W. Bush, what has become almost palpable is how his influence is intertwined within the fabric of our society. There are so many contributions he made that continue to penetrate our current democracy; foremost in my mind is the passage of the landmark civil rights law, the Americans with Disabilities Act (ADA) of 1990. On the day President Bush signed the bill into law, he remarked, “Every man, woman, and child with a disability can now pass through once-closed doors into a bright new era of equality, independence, and freedom.” He went on to say, “Today’s legislation brings us closer to that day when no American will ever again be deprived of their basic guarantee of ‘life, liberty, and the pursuit of happiness’. Together, we must remove the physical barriers we have created and the social barriers that we have accepted. For ours will never be a truly prosperous nation until all within it prosper.”

The ADA was passed my freshman year in college, so I well remember how it impacted society, from the grumblings of business owners who had to comply with the demands of the law, to the excitement of those with disabilities who could access previously unknown worlds. For the first time in my life, I became more keenly aware that there was a large population of society who did not have access to many things that I took for granted. I began to look at the world differently, seeing it from their eyes. When I would enter a small restroom stall, I wondered what someone in a wheelchair did when they needed to go to the bathroom. Did they just stay home because it was too much trouble? I surmised that staying home was probably what I would have done. This was a time of change, change for the better, and it intrigued me to the point that I eventually went to graduate school and became an occupational therapist, with the goal of making my world a more accessible place.

Today, nearly 29 years later, society often takes for granted the sweeping changes this law made. As therapists, it means that the patients we serve can access public transportation without having to leave their wheelchairs behind, shop at grocery stores without fear of being turned away and bravely enter a restaurant without fear of being refused service. There is access to public restrooms, ramps to access federal buildings and shopping centers, handicap parking spaces and doors that open with the push of a button, crosswalk signs and sounds, braille signs for those with visual impairments, and telephones and television access for the hearing impaired. From the perspective of an occupational therapist, possibly one of the most important changes was employers had to accommodate those with disabilities without discrimination. It meant our patients could and continue to be able to be gainfully employed, becoming active members of society, enjoying the benefits that work and interaction within the environment afford. For our elderly, it meant they no longer had to be “shut-ins”, but could freely access society and be accepted, not shunned.

The ADA not only opened doors for patients, but for therapists alike. It provided a way for me personally to channel my desire to help others and created opportunities for therapists to implement their skills and advocate for their patients like never before. It opened a world of possibilities for successes for many in our society who had experienced few, allowing them to demonstrate their abilities. Without its passage, I would truly not be the therapist I am today, and our world would be a vastly different place!

So today, as we honor the legacy of Mr. George H. W. Bush, let us continue to carry the torch and be “points of light” for the patients we serve. In his words, “Our success with this act proves that we are keeping faith with the spirit of our courageous forefathers who wrote in the Declaration of Independence, ‘We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights.'”
Connie is an Occupational Therapist and Clinical Services Specialist with Reliant Rehabilitation.

Year in Review: Client Connection

Reliant offers education opportunities monthly. Each topic is selected based on your feedback, regulatory changes, and industry trends. 2019’s schedule will be packed with information you don’t want to miss! Below are topics from 2018; let your Regional Director of Operations know if you missed one of these training sessions, and you’d like to know more!

  • Survey Preparedness
  • Therapy Cap Update
  • Discharge Planning: What’s Next?
  • Clinical Appeals Portal Demo
  • CMS Updates: SNF Proposed Rule
  • Fall Prevention: Tips to Make Your “Fall” Numbers Fall
  • 2018 MDS Updates: Section GG
  • Reducing Rehospitalizations Using S.O.S.
  • Partnering for Outcomes Using Reliant’s Model 10 2.0
  • Compliance Department Overview
  • Ringing in the New Year with Resolutions for Regulatory Success

HIPAA Privacy Rule Refresher

Refresh your memory with some of the Privacy Rule points below.

• HIPAA’s Privacy Rule goal is to protect the confidentiality of patient/resident healthcare information.

• Protected Health Information (PHI) is individually identifiable health information collected from an individual and created or received by a health care provider, health plan, or health care clearing house relating to past, present, or future physical or mental health conditions of an individual.

• Information is “individually identifiable” when any one or more of 18 types of identifiers can be used to identify an individual (e.g. name, address, dates such as birth date, account number etc.)

• The HIPAA Privacy Rule applies to healthcare organizations, healthcare plans, healthcare clearinghouses, and Business Associates with access to Protected Health Information (PHI).

• PHI can be in paper form, electronic as well as in verbal communications.

• Photos and videos of patients/residents are PHI and require documented authorization to take and use. • Access to PHI must be restricted to the minimum access needed to accomplish the intended objective.

• PHI cannot be used or disclosed without documented patient authorization unless it is for any of the following purposes or situations:

o Use or disclosure to the patient

o Use or disclosure for treatment, payment, or general healthcare operations

o Use or disclosure if the individual has the opportunity to agree or object to a disclosure such as a patient bringing a family with them when discussing care with a physician

• Covered Entities (CE) are required to provide residents/patients with a Notice of Privacy Practices (NPP) to tell how the CE may use and share their health information.

• Disposal of documents containing PHI must be rendered unreadable. Shredding is the most common method of disposal. Before disposal, be sure to follow your organization’s data retention policies.

For more information regarding HIPAA Privacy, visit www.hhs.gov.

CMS’ Calendar Year 2019 Medicare Physician Fee Schedule Final Rule

On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.

Reliant’s Real Time Memo, which summarizes the final rule, can be downloaded here. The following is included in the summary:

  • Conversion factor update
  • Discontinuation of functional status reporting (G-code) requirements for outpatient
  • Update on outpatient physical therapy and occupational therapy services furnished by assistants
  • KX modifier attestation amount
  • Medicare telehealth services update

Payment provisions

Nursing Facility Case-Mix Payment Changes October 1, 2019

CMS issued an informational bulletin earlier this month notifying providers of changes that will impact states’ payments for Medicaid beneficiaries in the nursing home setting.

The bulletin indicates with the implementation of PDPM in October 2019 a new optional assessment, specific for states that rely on RUG-III and RUG-IV assessment schedule, will be available. The assessment will be active from 10/1/2019 through 9/30/2020, at which time states will have to determine an alternate calculation system for Medicaid payment. Additional detail was provided in the December 11th MLN call. Read full bulletin here.

SNF PPS: New Patient Driven Payment Model Call

On December 11, 2018, CMS hosted a national Medicare Learning Network call which provided a detailed look at the Patient Driven Payment Model (PDPM).

Some specific details are provided in the article above, and additional resources are available at the PDPM webpage.

Reliant is actively following CMS updates and clarification to ensure our resources and training are up to date and accurate. Watch for education opportunities in early 2019! Full audio recording and transcript are now available on the MLN homepage for download.

PDPM Part 4: Information Overload, Time to Review

When PDPM was finalized in July’s final rule, there was no stopping the development of training and resources by those in our industry who make us successful. It’s what educators do, dissect, synthesize and disseminate information. However, PDPM’s outline in the final rule lacked detail in certain areas and created questions in others. Chances are, some of the training and resources you have saved (even CMS’) are now inaccurate or incomplete.

During the Medicare Learning Network call earlier this month many elements of PDPM were clarified and a few were introduced including:

1. Mapping to the PDPM clinical category will come from new items set, I0020B (What’s the main reason this person is being admitted to the SNF?) coupled with possible responses to new item set J2100-J5000 (Surgical procedures that occurred during the inpatient hospital stay that immediately preceded the SNF admission).

2. PDPM classification groups designated under administrative presumption including

a. Nursing groups within Extensive Services, Special Care High, Special Care Low, and Clinically Complex,

b. PT and OT groups TA, TB, TC, TD, TE, TF, TG, TJ, TK, TN, and TO,

c. SLP groups SC, SE, SF, SH, SI, SJ, SK, and SL; and d. NTA highest category of 12+.

3. Revised Health Insurance Prospective Payment System (HIPPS) coding algorithm.

4. Further instruction on the Interim Payment Assessment including use of Interim Section GG column for reporting and look back.

5. Addition of Optional State Assessment for Medicaid determination (Not a Part A PPS assessment).

6. Examples to clarify Interrupted stay policy and group and concurrent calculation.

7. Extensive instruction on RUG-IV and PDPM transition and mandated transitional IPA if patient is receiving skilled part A services prior to 10/1/2019 and continuing.

8. RAI Manual draft expected “early” 2019.

So with all of the PDPM chatter, how do we filter for quality and accuracy? How do we trust the resource we have is accurate and up to date? Here are a few tips for just that:

1. Gather information from multiple sources. Subscribe to industry leaders and state associations for updates. Read the Reliant Reveal and Real Time Memos as they arrive.

2. Take it a step at a time. No one becomes an expert overnight. Start with the clinical component and case mix groups, then move on to ICD-10 coding, or assessment time frames and rules, but be confident in one element before you begin learning the next.

3. Look for cited sources (RAI Manual, CMS material) and revision dates to resource materials. CMS has indicated they will begin time stamping the FAQ documents to indicate revisions made. Resources from other entities should do the same.

4. When possible, go to CMS webpage for clinical and NTA crosswalk information. These references are available in savable zip file format but have been updated at least two times since their initial release in August.

5. If something clicks and suddenly makes sense, write it down. Don’t assume you’ll remember.

6. Ask questions! If a comment or statement does not make sense, ask for clarification and citation.

Your partners in patient care should want to support you in your journey for knowledge and a successful transition to PDPM. Reliant is ready to keep you up to date, answer your questions, and problem solve for strategic success!