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Published October 31, 2022

PYA Principal Quoted in HCCA Article on OPPS Rule’s Effect on Some Home Services Post-PHE

PYA Principal Martie Ross is quoted in the recently published Report on Medicare Compliance in an article about the Outpatient Prospective Payment System (OPPS) rule related to home services and the COVID-19 public health emergency (PHE). In “OPPS Rule May Cover Some Services at Home That End After PHE,” Martie explains how some OPPS home service coverage ends with the end of the PHE, and that these services don’t qualify for extended telehealth coverage. Martie discusses how related Medicare payments will dry up, but then partially reappear, because of a new regulation.

Article Excerpt

But preservation of the coverage is probably coming from another source, [Martie] Ross said. If a provision in the proposed 2023 OPPS rule is finalized, behavioral health services furnished remotely by clinical staff of hospital outpatient departments to patients in their homes will be covered outpatient services paid under the OPPS. That includes staff of critical access hospitals.

“What happens at the end of the PHE is the authority to deem the patient’s home an outpatient hospital department goes away,” Ross clarified. “With this proposed rule change, such designation no longer would be necessary, as CMS is re-defining the scope of outpatient services to permit these services to be delivered virtually.”

Read the full article on the Health Care Compliance Association’s (HCCA) COSMOS, an online platform for easy access to the latest compliance information.

The HCCA article also mentions Martie’s webinar on preparing for the end of the PHE, which she presented with PYA Senior Manager Kathy Reep. The webinar can be found here.

If you have questions about coverage for certain home services after the end of the PHE and OPPS’s effect on those services in the future, one of our executive contacts would be happy to assist. You may email them below, or call (800) 270-9629.

Executive Contacts

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