AMRPA Magazine | December 2020

December 2020 • Vol. 23, No. 7

December 2020 • Vol. 23, No. 7

The official publication of the American Medical Rehabilitation Providers Association (AMRPA) Anthony Cuzzola Chair, AMRPA Board of Directors, Vice President JFK Johnson Rehabilitation Institute John Ferraro, MS AMRPA Executive Director Kate Beller, JD AMRPA Executive Vice President for Government Relations and Policy Development Remy Kerr, MPH AMRPA Health Policy and Research Manager Patricia Sullivan AMRPA Senior Editor Shirley Soda Design and Layout

AMRPA Magazine, Volume 23, Number 7

AMRPA Magazine is published monthly by the American Medical Rehabilitation Providers Association (AMRPA).

AMRPA is the national voluntary trade association representing inpatient rehabilitation hospitals and units, hospital outpatient departments and settings independent of the hospital, such as comprehensive outpatient rehabilitation facilities, rehabilitation agencies and skilled nursing facilities.

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AMRPA Magazine / December 2020

Table of Contents Letter from the Chair

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Legislative Update

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Supreme Court Considers Constitutional Challenge on the Affordable Care Act

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Changes in Centers for Medicare and Medicaid Services (CMS) Documentation Requirements

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AMRPA Engages with Centers for Medicare and Medicaid Services to Improve Important Patient Care Tool

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Hospital Price Transparency Requirements Set to Take Effect in January

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Medicare Payment Advisory Commission Launches Meeting Cycle with Full Docket

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Interoperability and Information Blocking: What Rehabilitation Providers and Health IT Developers Need to Know about New Enforcement Timelines

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AMRPA 2020 Virtual Fall Conference & Expo Roundup

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Patient Success Story: Stronger, Together

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Letter from the Chair

Anthony Cuzzola Vice President JFK Johnson Rehabilitation Institute

Moving Beyond 2020 As I think back over the past year, it’s an understatement to say that 2020 was a year like no other for AMRPA, our nation and local communities. As an association (and individual hospitals), we faced unprecedented challenges from the COVID-19 public health emergency (PHE), plus a flurry of social, environmental and political challenges. And while it’s encouraging to see the recent progress in vaccine development, it is clear that the winter months will be difficult for hospital leaders, clinicians and staff as COVID-19 infection and hospitalization rates climb to even higher levels.

I’ve had a passion for the mission and work of AMRPA for many years, and I look forward to stepping into the role of chairman. At the same time, I recognize that 2021 will bring with it new challenges for the field at large. For those reasons, one of my first actions will be to restart our free, industry-wide calls focused on COVID-19 issues, protocols and procedures. In early phases of the PHE, the calls were critical to member engagement and education. As the pandemic continues to evolve, we will take the necessary steps to ensure that our members continue to have access to the latest clinical, operational and policy resources.

In addition to the uncertainty tied to the PHE, the changing political climate will make 2021 an even more of a pivotal year for AMPRA. The 117th Congress and incoming Biden administration have significant implications for pandemic preparedness response legislation, the fate of the Affordable Care Act, and post-acute care payment reform efforts. AMPRA staff and counsel will engage with members on what lies ahead in the lame duck Congressional session and the first 100 days of the new administration. I urge you to review the resources available on AMRPA Access for the latest insights and analysis of the political landscape and our field.

Finally, I’d like to thank our members for their continuous engagement and leadership over the past months. Despite the unanticipated challenges, AMRPA was able to secure key regulatory waivers, successfully advocate against the non-physician practitioner proposal in the IRF PPS proposed rule, and host our first virtual Fall Conference, just to name a few successes. These outcomes are due entirely to the dedication and passion of its members, and should position us well to weather the unknowns of 2021. I look forward to leading such an outstanding group of hospital leaders into the new year.

AMRPA Magazine / December 2020

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Find new and exciting opportunities in AMRPA’s Career Center.

Our Career Center provides services and resources to help the medical rehabilitation field meet their professional goals.

All rehabilitation professionals may browse and apply for jobs at no cost, and AMRPA members will receive discounted rates for posting positions.

Visit our Career Center Here:

careercenter.amrpa.org

Begin by creating your free Career Cast account, which can be found on the top right hand corner of the website.

From there, you can upload and manage multiple resumes, browse through hundreds of job postings, and even research salaries of the positions in question! AMRPA members and affiliates may also purchase Posting Packages at a standard, premium, or platinum level.

AMRPA members will receive a 50% discount on all job postings.

For questions about our Career Center, please contact Elizabeth Katsion, AMRPA Member Services Associate, at ekatsion@amrpa.org or 202-207-1102.

Legislative Update

2020 Election Day (Weeks) Continues

Martha M. Kendrick, Esq., Partner, Akin Gump Strauss Hauer & Feld LLP

Highlights: »

Per John Hopkins data, more than 14 million coronavirus cases were confirmed in the United States as of December 3.

»

Pfizer and BioNTech and Moderna released preliminary analysis showing that their COVID-19 vaccines are effective at preventing symptomatic coronavirus disease.

»

The Senate Appropriations Committee released 12 Fiscal Year 2021 (FY21) appropriations bills, kicking off negotiations over a year-end spending package. The current Continuing Resolution (CR) expires December 11.

»

As the 116th Congress concludes its second session, near-term action is expected on a package to fund the government through FY21 that includes COVID-19 relief measures.

»

Post-election, Democrats and Republicans remain firm on their prior COVID proposals.

With a victory in Pennsylvania, former Vice President Joe Biden crossed the 270 electoral vote threshold on November 7, thus winning the election to serve as the 46th President of the United States. His running mate, Sen. Kamala Harris (D-CA), will be the first woman, Black person and Asian-American to serve as Vice President. Their victory is historic in an election where a deeply divided country cast a record number of ballots in the Presidential and closely contested Senate and House races. Senate Republicans currently control 50 seats, and Democrats control 48 seats. The final two Senate seats in Georgia will be decided in a runoff election on January 5. Democrats need to win both Georgia seats for Vice President-elect Harris to break the 50-50 tie and give Democrats majority control of the upper chamber.

Democrats retained control of the House of Representatives, albeit with a much narrower majority of only 14 seats. House Democrats lost seven incumbent seats, including Reps. Debbie Murcarsel-Powell (D-FL), Donna Shalala (D-FL), Xochitl Torres Small (D-NM), Collin Peterson (D-MN), Kendra Horn (D-OK), and Joe Cunningham (DSC). Democrats Kathy Manning (D-NC) and Deborah Ross (D-NC) picked up GOP-held seats in North Carolina (likely due to recent redistricting). As we go to print, the House ratio is 218(D) – 201(R) with 16 seats currently uncalled, or going to a run-off. Notably, a record number of Republican women and minorities will serve in the next House of Representatives, adding at least 13 seats to their ranks and bringing their total to 33.

This may influence future Committee assignments (currently only one GOP woman, Rep. Jackie Walorski (R-IN) serves on the Ways and Means Committee, and there are no minorities).

President Trump has not yet conceded the election, and is calling for recounts and investigations into claims of voter fraud. Reportedly, the Office of Management and Budget is moving forward with preparing a Trump administration FY22 budget proposal. President-elect Biden is proceeding with plans to transfer power on January 21, 2021. On November 9, Biden announced his COVID-19 Advisory Board led by co-chairs Dr. Vivek Murthy, former Surgeon General under President Obama; David Kessler, former head of the Food and Drug Administration under Presidents George H.W. Bush and Clinton; and Dr. Marcella Nunez-Smith with Yale School of Public Health.

The Advisory Board will focus on executing Biden’s campaign proposals, guided by three principles: 1) Listen to science; 2) Ensure public health decisions are informed by public health professionals; and 3) Restore trust, transparency, common purpose and accountability to our government. The Advisory Board will address masks, vaccine distribution, vaccine prioritization, personal protection equipment, essential drugs and supplies, standards for reopening schools, and bolstering test and trace capacity.

AMRPA Magazine / December 2020

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On November 11, President-elect Biden officially announced a transition team, referred to as “agency review teams,” to collect information about federal agency operations.

Biden Administration First 100 Days President-elect Biden’s agenda and approach for his first 100 days in office depends on whether Democrats flip control of the Senate or Republicans maintain their majority. Many of his major campaign promises—comprehensive climate solutions, sweeping immigration reform, infrastructure spending and tax reforms— are only possible with a Democratic majority in both the House and Senate. If Republicans win either of the run-off elections in Georgia and maintain control of the Senate, President-elect Biden’s first 100 days in office will likely focus on executive actions rather than major legislation.

Aside from appointing a cabinet, one of the first orders of business for any new president is taking action to rescind, modify or terminate any pending regulatory actions, executive actions or policies from the previous administration that differ in policy approach. President-elect Biden will likely take executive action to change Trump-era policies and fulfill his campaign promise to strengthen and preserve the Patient Protection and Affordable Care Act (ACA). He has suggested he will implement a special health care enrollment period for the federal marketplace to address gaps in insurance coverage for those who may have lost employment and benefits due to the economic downturn associated with the COVID-19 pandemic. He is also likely to reverse Trump administration policies expanding association health plans and short-term limited-duration insurance plans, which Democrats argue fracture the individual marketplace and drive up costs in the ACA exchanges. It is expected that the Biden administration will roll back Trump administration Section 1332 guidance, which gave states additional flexibility to waive ACA insurance requirements. During a November 10 press conference, following the Supreme Court’s hearing over the constitutionality of the Affordable Care Act (California v. Texas), President-elect Biden promised to bolster the law regardless of the outcome of the case. Within his first 100 days, Biden may instruct his administration to drop federal lawsuits that threaten to strike down the law.

Clearly, the pandemic will be a primary focus of the incoming administration. Look for President-elect Biden to reverse the Trump administration’s withdrawal from the World Health Organization and work with state and local officials to promote a consistent, science-based approach to tackling the pandemic.

Biden will also take actions to restore public trust and insulate the Food & Drug Administration, Centers for Disease Control and the National Institutes of Health (NIH) from politics and future political interference. The expansion of telehealth, including the extension of flexibilities implemented during the pandemic, will be a prime focus. The new administration will work with Congress to enact permanent telehealth expansions and advocate for a significant increase in funding for rural broadband to allow greater adoption of this mode of care nationwide.

The Biden administration will also work with Congress to enact limits on drug price increases and provide authority for Medicare to negotiate prices directly with manufacturers. Absent a willing 6

AMRPA Magazine / December 2020

Congress, look for the Biden administration to use demonstration authority to advance drug pricing reform. President-elect Biden aims to stop balance billing when patients cannot choose their provider, but his administration will need to work with Congress to enact a solution. Congress has yet to reach consensus on how to prevent balance bills. The Biden administration will followthrough on its pledge to make a $125 billion federal investment for opioid prevention, treatment and recovery services.

Enforcement efforts will likely focus on patient brokers and substance use disorder treatment facilities that are not evidencebased.

President-elect Biden will deny any pending requests from states seeking permission to test work requirements in Medicaid and shift his administration’s positions in the litigation challenging Medicaid work requirements approved in other states. Under his direction, the new administration will use existing antitrust authority to tackle market concentration in the health care system.

A Lame Duck Session As the lame duck 116th Congress concludes its second session, we expect near-term action on several must-pass measures prior to January. The top priority is extending government funding beyond December 11, when the current continuing resolution (CR) expires. The House passed 10 of its 12 FY21 Appropriations bills. On November 10, the Senate Appropriations Committee released all 12 FY21 appropriations bills, kicking off negotiations over a year-end spending package. The Senate process stalled in June, after Democrats indicated they would add policy amendments to the bills as additional pandemic relief and social justice funding. House and Senate appropriators may also pursue a dual package – “CROmnibus” – that includes an assortment of agreed-upon FY21 appropriations bills combined with a CR to fund remaining appropriations bills at current levels through the end of the fiscal year – September 30, 2021.

Of interest to AMRPA, the Senate Labor-Health and Human Services report encourages the Centers for Medicare and Medicaid Services (CMS) to take into account how existing budget neutrality requirements will affect access to various sections of the provider community. A provision encourages CMS to expand program integrity programs, such as the Recovery Audit Validation Contractor program, other parts of Medicare and Medicaid, and to ensure accurate physician payments through the National Correcting Coding Initiative. Additionally, the report notes that health care waste, fraud and abuse accounts for $70 billion annually, and the Committee supports artificial intelligence software to examine waste, fraud and abuse in the health care settings. The Committee also recommends $114,470 million for the National Institute on Disability, Independent Living, and Rehabilitation Research, including an increase of $2.5 million for the ADA National Network Centers.

COVID Relief An agreement on a targeted legislative package to address the COVID-19 pandemic remains a possibility in the lame duck Congress. However, a far-reaching COVID-19 relief deal appears unlikely. Republicans argue that loss of Democrat House seats and recently improved jobs numbers indicate support

for a smaller package (somewhere between $500 billion to $1 trillion). However, Speaker Nancy Pelosi has not backed down from support for a robust relief package, noting Democrats maintain the majority and COVID-19 infection rates continue to increase nationwide. The Georgia Senate elections may actually incentivize a deal before year-end. In negotiations over the summer, both parties agreed on additional funding for health care priorities, the Paycheck Protection Program, child care, US Postal Service and stimulus checks. However, they diverge on unemployment insurance payments, state and local funding, liability protections and back-to-school funding. Prior to the election, President Trump called for spending more than the $2.4 trillion House Democrats included in their aid package (HEROES 2, HR 925). Whether Trump will negotiate after losing his bid for reelection is a critical unknown factor.

Supreme Court Begins Hearing On November 10, the Supreme Court heard oral arguments in Texas v. California, a case that will ultimately decide the future of the ACA. The case focuses on the constitutionality of the individual mandate. Although the Justices’ questions did not provide a clear picture on how the Court may rule on the threshold Article III standing issues and the constitutionality of the ACA’s minimum-coverage provision (i.e., the so-called “individual mandate”), there seem to be at least five votes to sever that provision (if found unconstitutional) and leave the rest of the ACA intact. Chief Justice Roberts and Justice Kavanaugh

signaled that the ACA should not fall with the mandate. Chief Justice Roberts made clear that 2010 Congressional findings on the importance of the individual mandate in creating markets does not translate to an inseverability clause, and Congress’s 2017 targeted amendment constitutes “compelling evidence” of its contrary intent. He stated that it is “not our job” to repeal the remainder of the ACA. Justice Kavanaugh pressed both Texas and the federal government on “straightforward” and “fairly clear” severability analysis under this Court’s precedents. A decision on the case may come as early as February 2021 or early next summer. *** As we go to press, we cannot resist noting the unique opportunity that occurs only once every two years—identifying and cultivating relationships with the new incoming Congress.

Turnover has been extremely high in each of the last four sessions of Congress, and it remains critical that AMRPA identify and build new champions. As we head into 2021, join us! AMRPA urgently needs new, strong Congressional champions, and we stand ready to work with you to meet and achieve this challenge. In closing, heartfelt thanks for your amazing work in serving and meeting the complex medical needs of the most vulnerable Medicare beneficiaries.

AMRPA Magazine / December 2020

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AMRPA Magazine / December 2020

Supreme Court Considers Constitutional Challenge on the Affordable Care Act

Peter W. Thomas, JD, Principal, Powers Pyles Sutter & Verville, PC

Leela Baggett, JD, Associate, Powers Pyles Sutter & Verville, PC

On November 11, 2020, the U.S. Supreme Court heard its third major case challenging the constitutionality of the Patient Protection and Affordable Care Act (ACA). California v. Texas (Docket No. 19-840), questions whether the entire ACA should be struck down because Congress, in 2017 tax cut legislation, eliminated the tax penalties for failure to comply with the individual insurance mandate, referenced in the ACA text as integral to the law. Without the tax penalty, the argument states, the constitutionality of the law cannot be based on Congress’ power to tax its citizens and, therefore, the entire law must be struck down.

The case was brought by a group of Attorneys General from 18 Republican-led states1 and argued by the Texas Solicitor General. In an unusual twist, the U.S. Department of Justice (DOJ) joined the case with Texas, though the federal government typically defends the laws of the United States before the court. However, in this case the DOJ argued that the ACA should be invalidated. As a result, a group of Attorneys General from Democrat-led states2 obtained permission from the court to intervene and defend the law, joined in oral arguments by counsel for the U.S. House of Representatives, another unusual development.

History of ACA Challenges Previous challenges to the ACA in 2012 and 2015 resulted in landmark decisions that preserved the sanctity of the law. In National Federation of Independent Business v.

Sebelius, the Supreme Court held that the mandate to purchase health insurance under the ACA was constitutional, not under the interstate commerce clause, but under the taxing power afforded to Congress. The case also established that the ACA Medicaid expansion policy was coercive, as written, and that states had to have a meaningful choice in expanding Medicaid without risking the loss of federal matching funds for their existing Medicaid program. The majority opinion was written by Chief Justice John Roberts, considered part of the conservative block of Justices, but who joined with the liberal wing of the Court to produce a 5-4 decision in the case.

In 2015, King v. Burwell reached the Supreme Court and, again, the Court decided by a vote of 6-3 to preserve the financial subsidies provided to low income enrollees in the state and federal exchanges (marketplaces), though the text of the ACA appeared to limit subsidies to state exchanges only. Finally, in 2017, the Senate came within one vote of repealing the ACA, but the late Sen. John McCain (R-AZ) cast the deciding vote to maintain the law, dealing a major blow to then President Trump.

1 T he respondents include the states of TX, AL, AR, AZ, FL, GA, IN, KS, LA, MS, MO, NE, ND, SC, SD, TN, UT, and WV, along with two individual plaintiffs living in TX. 2 The petitioners include the states of CA, CO, CT, DE, DC, HI, IL, IA, KY, MA, MI, MN, NV, NC, NJ, NY, OR, RI, VA, VT, and WA.

AMRPA Magazine / December 2020

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The Scope and Importance of the ACA The complexity of invalidating the entire ACA cannot be overstated. Fully implemented for 10 years, the ACA forms the basis for how private insurance markets function. Nearly 23 million Americans receive health insurance coverage through either the ACA exchanges or expanded Medicaid programs (split nearly evenly between the two mechanisms). All but about a dozen states have expanded their Medicaid programs to date, and this year voters in two states, Missouri and Oklahoma, approved initiatives to expand their state Medicaid programs under the ACA, bringing the total number of Medicaid expansion states to 39 (including Washington, DC).

harm by the offending law, which a favorable court decision can redress. The Texas Solicitor General set forth seven ways that the ACA harmed Texas by forcing the state to pay a share of Medicaid expenses if it chose to expand its Medicaid population, the other states, and two individual Texas citizens. Additional harm included the mandate imposed on individuals to purchase insurance that covers essential benefits when they wanted only to purchase lesser coverage at lower cost. The arguments did not appear to persuade several Justices on the standing issue, but it was unclear whether a majority would dismiss the case based on standing. Failure to meet the standing requirement would be the easiest way for the Court to rid itself of the case.

The law seeks to cover as many Americans as possible (i.e., universal coverage) coupled with a prohibition against discrimination in the private insurance market. This includes guaranteed issue and renewal, protections against pre-existing condition exclusions, community rating of premiums, essential benefits packages, premium subsidies for those with lower incomes, prohibitions on annual and lifetime insurance limits and many other insurance protections. The law is designed to have private plans compete against each other in structured marketplaces to keep costs as low as possible.

Constitutionality of the Individual Mandate On the merits of the case, Justices asked several questions of counsel directed at the taxing power, questioning whether the law would be constitutional in the absence of a tax penalty for failing to comply with the individual mandate. Justice Roberts expressed some degree of impatience that the question of ACA constitutionality was again before the Court. In telling remarks, he noted that those who wished the Court to invalidate the law were essentially asking the Court to do the work of Congress.

As important as the insurance provisions and Medicaid expansions are to the law, the ACA implemented numerous health reforms that are now engrained in the current health care system. These include value-based care by linking payment with performance, focus on chronic disease and disparities, encouraging use of medical homes, improvements to public health, enhancing the health care workforce, addressing fraud and abuse, reauthorizing the Older Americans Act, and creating and funding the Patient-Centered Outcomes Research Institute.

In short, it would be nearly impossible to extricate the ACA from the American health care system.

The Case Pending Before the Court Filed in February 2018, California v. Texas made its way through a District Court in Texas to the Fifth Circuit Court of Appeals.

The judges at both levels held that, without a tax penalty, the constitutional premise of the ACA individual mandate was no longer valid. They argued, therefore, the individual mandate must be struck down. And because the ACA legislative history (and even some of the legislative text) asserts that the individual mandate is integral to the functioning of the entire law, including pre-existing condition protections and all the insurance protections, the whole 1,000-page law would have to be struck down as well. The impact of this ruling was “stayed” while the case moved to the US Supreme Court.

The arguments in California v. Texas focuses on three main issues, whether the individual and state plaintiffs have “standing” (i.e., capacity to sue under the law), the merits of the case itself, and whether the individual mandate, if deemed unconstitutional, can be severed from the remainder of the massive law while preserving the ACA. Standing The standing issue raised concerns with some of the Justices.

Standing ensures that the person suing has suffered sufficient

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Other Justices noted that the absence of a current penalty for failure to comply with the individual mandate does not mean the law is inappropriately based on Congress’ taxing authority, as Congress could decide at a future time to impose a tax penalty for failure to comply with the mandate.

Severability Even if the Court finds the ACA individual mandate is unconstitutional, the issue of severability could determine the fate of the overall law. Three interesting lines of questioning, all by conservative Justices, suggested a willingness to sever the mandate and maintain the larger law. Justice Roberts stated that Congress passed the 2017 tax law eliminating the individual mandate tax but did not even try at that point to repeal the law itself. He noted this was persuasive evidence that Congress intended the law should remain in effect.

Justice Samuel Alito, a solid conservative vote on the Court, stated that since the 2017 law eliminating the tax penalty, the ACA marketplaces have been stable. He suggested that it appears the individual mandate is not integral to the overall design of the law and that the subsidies and generous benefits offered under ACA plans and Medicaid expansion states incentivize Americans to sign up for coverage. This suggests an openness to severing the individual mandate from the rest of the law, if deemed unconstitutional.

In addition, Justice Brett Kavanaugh, another conservative Justice, fairly explicitly stated that he believed this was a strong case under the legal precedents on severability. With three liberal Justices remaining on the Court, only two conservative Justices would have to join the liberal block for the ACA to survive.

Although oral arguments during a Supreme Court hearing are traditionally unreliable indicators of how the Court may ultimately decide, the oral arguments and reaction of constitutional scholars indicate the ACA may survive yet another existential challenge.

Impact of the Court’s Decision A decision in the case is not expected until 2021 and could come as late as next June. If the case successfully strikes down the entire ACA, the decision would cause chaos in the health care sector. Congress would need to intervene to restore fundamental elements of the law. Given the partisan environment and passion around health care issues, the prospects of this occurring are

unclear. If unsuccessful, the case may represent the final attempt to legally or legislatively invalidate the law. The ACA has gained popularity over the past decade and many millions of Americans now seem to recognize its importance in their lives and the lives of their families.

Answers to AMRPA’s Most Frequently Asked Questions Visit our regularly updated webpage for answers to questions about: Answers to Questions About: • Blanket waivers across the Medicare program • Flexibilities granted to IRFs • Financial relief available to providers • Coding and billing issues www.amrpa.org/FAQ

AMRPA Magazine / December 2020 11

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Changes in Centers for Medicare and Medicaid Services (CMS) Documentation Requirements

When the FY21 Inpatient Rehabilitation Facility (IRF) Prospective Payment System Final Rule went into effect on October 1, 2020, it included changes to some documentation elements that were once required for Medicare patients. These changes impact the pre-admission screening and the post-admission physician evaluation (PAPE).

Lisa Werner, MBA, MS, SLP Director of Consulting Services, Fleming-AOD, Inc.

The pre-admission screening, completed by a licensed clinician approved by the facility’s medical director, includes an array of required items. A standard document is not required, so providers may use their own form or one that is available through an electronic medical record vendor or eRehabData®. There are specific items to document to ensure that medical necessity is established, thus indicating the patient’s stay was reasonable and necessary. These elements include: • Patient’s prior level of function (prior to the event or condition that led to the patient’s need for intensive rehabilitation therapy) • Expected level of improvement • Expected length of time required to reach that level of improvement • Evaluation of the patient’s risk for clinical complications • Conditions that caused the need for rehabilitation • Combination of treatments needed (one of which must be physical or occupational therapy) • Anticipated discharge destination The items eliminated from the list of requirements include expected frequency and duration of therapy services, anticipated post-discharge needs, and other information relevant to the care needs of the patient.

CMS no longer requires the rehabilitation physician to complete the Post-Admission Physician Evaluation (PAPE). The PAPE was required within 24 hours of the patient’s arrival to the inpatient rehabilitation unit or hospital. The PAPE document required that the provider: • Document the patient’s status on admission to the IRF • Compare it to that noted in the pre-admission screening documentation • Begin development of the patient’s expected course of treatment that will be completed with input from all interdisciplinary team members in the overall plan of care

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• Identify any relevant changes that may have occurred since the pre-admission screening • Provide guidance as to whether it is safe to initiate the patient’s therapy program • Support the medical necessity of the IRF admission • Include a documented history and physical (H&P) exam, and a review of the patient’s prior and current medical and functional conditions and comorbidities Each provider has a hospital policy or bylaws that require an H&P. The policy likely states the amount of time the clinician has to complete and sign the H&P, and what it should include. Changes in the CMS requirements do not impact those policies. Make sure that your physicians understand the need to comply with hospital

policy regardless of recent changes to CMS requirements. The information typically included by the physician in the H&P is instrumental in providing direction to clinicians on how best to care for patients.

The H&P contains the substance of the functional and medical plan of care. It may appear that the relaxed PAPE requirements do not address changes in the patient’s status between preadmission screening and admission, or provide guidance on whether it is safe to initiate the therapy program. However, these elements are implicit in the physician’s H&P. Therefore, the only thing removed (without compromising the quality of care or patient safety) is a timeframe that a CMS auditor could use against you in a chart review.

JOIN TODAY!

Advocating. Educating. Connecting.

AMRPA: Working Together to To Preserve Preserve Access To Medical Rehabilitation AMRPA: Working Together Access to Medical Rehabilitation Maggie Ramirez · VP of Membership Services · 347-573-3732 · mramirez@amrpa.org

Elizabeth Katsion, AMRPA Member Services Coordinator, ekatsion@amrpa.org, 202-207-1102.

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AMRPA Engages with Centers for Medicare and Medicaid Services to Improve Important Patient Care Tool

Kate Beller, JD, AMRPA Executive Vice President for Government Relations and Policy Development

In January, the Centers for Medicare and Medicaid Services (CMS) announced an initiative to “combine and standardize” its eight Compare tools (IRF, Nursing Home, Home Health, Hospital, Dialysis Facility, Long-Term Care Hospital, Physician and Hospice Compare) through the creation of a Medicare Care Compare website. The following month, CMS officials invited AMPRA staff to review the initiative changes and share specific considerations for the inpatient rehabilitation hospital section of the new site. Following that outreach, and after delays tied to the COVID-19 pandemic, CMS officially launched Care Compare in September 2020. The new Care Compare site provides a single landing page for the eight CMS Compare tools, and AMRPA carefully assessed the changes made to each of the Compare sites under the new format.

CMS has indicated that both the new Care Compare site and the former platform will be available through autumn, enabling the public to compare and comment on the two interfaces. AMRPA, in close consultation with its Quality Committee, drafted comprehensive comments on both the inpatient rehabilitation component of the site and broader policy considerations for CMS as it refines its patient education and engagement tools Highlights of AMRPA’s comments include urging CMS to consider the impact of the COVID-19-related Quality Reporting Program (QRP) data freeze on IRF Compare; a request to refer to IRFs as inpatient rehabilitation hospitals rather than facilities; expanding the number of providers that can be compared from three to five; and using icons and graphics that better reflect the acute-level care provided in our hospitals.

While CMS plans to continue refining the site over the coming months, AMRPA’s suggested updates to the site will likely be made within the coming weeks. CMS has also reached out to AMRPA with a request for additional meeting regarding the Compare site and its broader patient education efforts. We will continue sharing updates on these discussions and future developments with AMPRA members.

AMRPA's complete comments on the Care Compare website are available on the following pages.

AMRPA Magazine / December 2020 15

November 11, 2020 Dear Dr. Schreiber, Ms. Adams and Ms. Rivi, The American Medical Rehabilitation Providers Association (AMRPA) applauds the Centers for Medicare and Medicaid Services (CMS) for your work in launching the new Care Compare site, and the agency’s broader efforts to help patients make informed decisions about their healthcare.

AMRPA supports CMS efforts to make all Compare sites – particularly the Inpatient Rehabilitation Facility (IRF) Compare site – easier for both patients and caregivers to use from a content and formatting perspective. We also greatly appreciate CMS’ outreach to the Association throughout its work on the development and refinement of CARE Compare, and we value the opportunity to provide comments on the current version of CARE Compare during the initial launch phase.

AMRPA is the national trade association representing more than 650 freestanding inpatient rehabilitation hospitals and rehabilitation units of general hospitals, referred to by Medicare as inpatient rehabilitation facilities (IRFs). The vast majority of our members are Medicareparticipating providers and in 2018, IRFs served 364,000 Medicare beneficiaries with more than 408,000 inpatient IRF stays.1 Our member hospitals have actively engaged in the development of Care Compare and support efforts to better educate patients and their families about the value of inpatient rehabilitation and provide the appropriate quality-related data in a read-friendly and clear format.

Based on our correspondence with CMS, we understand that input is being sought on technical aspects of Care Compare – such as descriptions of the care settings and the supplementary information provided to users as part of treatment decisions. Our comments will therefore focus on content and format-related components of Care Compare. However, we ask CMS to be mindful of several broader policy implications as it considers future changes to the site in order to ensure it facilitates appropriate post-acute (PAC) placements, such as: •

CMS should continue its current approach of maintaining different Compare sites for the different PAC settings. AMRPA strongly believes that CMS’ approach is appropriate in light of the key differences in clinical competencies, quality, staffing, and resources across PAC settings, and avoids the confusion that would inevitably result from allowing cross-site comparison

•

AMRPA has consistently encouraged CMS to ensure that the most salient information related to a hospital’s quality, safety and clinical performance is posted on Care Compare – such as functional outcome measures. With CMS planning to post a number of new functional outcomes, safety and process-related measures on Care Compare beginning December 2020,2 AMRPA encourages CMS to ensure that this information is appropriately highlighted in the future and that users receive appropriate information to help to utilize the data for their treatment decisions.

•

While AMRPA supports CMS’ efforts to improve price transparency across the health care industry, AMRPA believes that providing cost-related information that is meaningful to patients in the short-term and long-term is a complex undertaking. For example, providing patients with information on the price that Medicare pays for any service has little bearing to the patient’s out-of-pocket costs and would not necessarily represent the difference in intensity and volume of services provided across settings. AMRPA therefore supports CMS’ decision not to include charge-related data at this stage in any of the hospital Compare sites.

Moreover, we urge CMS to closely engage with hospital stakeholders and proceed through a formal notice-and-comment process before adding this type of information in the future.

16 AMRPA Magazine / December 2020

•

Finally, in light of the current public health emergency and the reporting waivers granted by CMS, the data on Care Compare is scheduled to be frozen for the December 2020, March 2021 and June 2021 IRF Compare refreshes. While AMRPA greatly appreciates the quality reporting waivers that were furnished at the beginning of the public health emergency, the resulting reporting lag will exacerbate the existing issues tied to the nearly two-year time-lag tied to the data driving a hospital’s IRF Compare score and the year in which their performance is reflected on the Compare site.

Now, as a result of the reporting waivers, a hospital’s Care Compare scores in 2021 and 2022 will reflect performance from 2019. AMRPA urges CMS to ensure this data lag is disclosed to users. Additionally, AMRPA encourages CMS to consider whether this delay warrants consideration of whether and how Compare data should be required to be provided to patients vis-à-vis the hospital discharge planning requirements in the upcoming calendar quarters.

AMRPA appreciates CMS’ consideration of these policy implications as it considers longer-term changes to the underlying data included in Care Compare. For more immediate purposes, AMRPA provides the following recommendations on the current content and format of Care Compare that we believe will improve functionality and make the site more user-friendly for patients, particularly those in need of inpatient rehabilitation: Content-Related Recommendations • References to Inpatient Rehabilitation Hospitals vs.

Facilities: AMRPA has long urged CMS to adopt the term “inpatient rehabilitation hospitals,” rather than “inpatient rehabilitation facility” (IRF) to more accurately reflect that inpatient rehabilitation is provided in hospitals or units of hospitals. While AMRPA believes that this change is also necessary across the Medicare program (for example, in yearly payment rules), the use of the more accurate “hospital” term is even more important in a consumerfacing educational tool. Continued use of “IRF” on Care Compare could result in our hospitals being confused with skilled nursing facilities, despite the significant differences in the competencies and level of services provided in those settings.

•

Icons Changes to More Accurately Reflect Inpatient Rehabilitation Hospital Settings: Unlike the clear hospital icons associated with short-term acute care hospitals and long-term care hospitals, the icon for inpatient rehabilitation is a patient using parallel bars. We ask CMS to consider using an icon more consistent with the other hospital settings, and with our aforementioned request for an update to terminology.

•

Setting Descriptions: Given the breadth of information relayed on Care Compare, we understand CMS’ approach to using concise language and descriptions of each care setting. However, AMRPA believes patients would benefit from additional language that conveys more specific features of each PAC setting to help them better distinguish PAC providers. For inpatient rehabilitation hospitals, this could include references to the rehabilitation physician supervision requirements and therapy-intensive environment.

•

Measure Descriptions: As discussed in the February 2020 focus group meeting on Care Compare, AMPRA encourages CMS to reconsider the elements included under the “Effective Care” section. Currently in IRF Compare, this section includes process measures such as the percentage of patients whose functional abilities are assessed and functional goals that were included in their treatment plan.

AMRPA questions whether process measures like these really reflect “effective care” in the way it would be interpreted by patients and caregivers. We recommend that CMS move such process measures under the heading “Compliance with Reporting Rules,” and keep only measures that reflect patient outcomes in the “Effective Care” section.

Formatting & Technical Features • User Feedback Feature: To ensure that the new Care Compare provides patients with the type and amount of information they require, AMRPA encourages CMS to include a post-visit survey or other type of feedback tool.

Given the importance of a site like Care Compare to patients and caregivers, we believe it is essential to learn about potential sources of confusion or usability issues directly from the users of the site.

•

Sorting Capabilities: Within the current inpatient rehabilitation section of Care Compare, inpatient rehabilitation hospitals can be sorted by two features: distance and ownership status (for-profit, non-profit, or government-owned). AMRPA urges CMS to consider expanding the sorting features to allow patients and their families to sort by a specific condition or a hospital’s Star Rating status.

•

Increasing Hospital Comparison Counts: Consistent with the current version of IRF Compare, the inpatient rehabilitation section of Care Compare allows users to compare three hospitals at a time. AMRPA encourages CMS to explore changes that would enable users to compare up to five hospitals at once to more easily compare the specialties of inpatient rehabilitation hospitals, and other clinical or geographic considerations.

•

Improving the Visibility and Availability of Quality Data: AMRPA believes the inpatient rehabilitation section of Care Compare would be bolstered by two quality-related technical changes: (1) allow hospitals to add a footnote (or other hospital-specific data) regarding their emergency preparedness capability or other efforts undertaken to improve quality performance in response to the COVID-19 public health emergency; and (2) change the current Care Compare site to enable users to view all quality measures at once, rather than clicking on each individually. These collective changes would provide users with easily digestible and comprehensive information about a hospital’s quality performance before and during the public health emergency.

AMRPA stands ready to work with CMS as it contemplates future changes to Care Compare, and to ensure that this important tool is effective in helping patients and their families make patientcentered treatment decisions. More than ever, AMRPA believes it is critical that patients and their families have the information

AMRPA Magazine / December 2020 17

they need to make PAC placement decisions based on clinical and environmental needs and the quality of the providers under consideration. While Care Compare is a critical step in this direction, AMRPA appreciates CMS’ consideration of the aforementioned policy and technical considerations to improve the use and long-term outcomes of this important tool.

recommendations, email Kate Beller, JD, AMRPA Executive Vice President for Government Relations and Policy Development, or phone +1-202-207-1132.

Sincerely,

*** AMRPA welcomes continued opportunities to collaborate with the Department of Health and Human Services and CMS on these matters. If you have any questions about AMRPA’s

Robert Krug, MD AMRPA Board Chair

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Hospital Price Transparency Requirements Set to Take Effect in January

In 2019, the Centers for Medicare and Medicaid Services (CMS) finalized regulations requiring all hospitals, including inpatient rehabilitation facilities (IRFs), to begin publicly disclosing a wide array of price information. All of these requirements go into effect January 1, 2021, and include two major requirements: 1) the posting of machinereadable files containing all third-party negotiated rates, and 2) a consumer-friendly website for common “shoppable services.”

Jonathan Gold, JD, AMRPA Director of Government Relations and Regulatory Affairs

In its final regulations, CMS defined hospitals subject to the new rule as those other than federally owned facilities, such as Veterans Affairs (VA) hospitals. In the notice-andcomment discussion, CMS affirmed that specialty hospitals such as IRFs were included in the definition of applicable hospitals. The agency also stated that each hospital that operates under its own separate license must separately comply with the requirements.

Under the first major requirement of the rule, hospitals must post a machine-readable file that includes standard charge information for all items and services they provide.

This includes service packages or bundled rates for an episode of care. The standard charge information must include the following for all items and services: • Gross charges, as reflected on the hospital’s charge master • Discount cash prices offered to self-pay patients • Payer-specific negotiated charges for all third-party payers • De-identified minimum and maximum negotiated charges This information must be updated at least once annually to meet the CMS requirements.

Under the second major provision of the new rule, hospitals must post the same standard charge information for at least 300 “shoppable services,” in a consumerfriendly format on its website. Services designated as shoppable must be available for scheduling in advance by the consumer. CMS has designated 70-specific services that must be included, and allows hospitals to choose the additional 270 services to include.

If a hospital does not offer 300 total shoppable services, it must post as many items and services as are available. CMS is also permitting hospitals to create a cost-estimator tool on websites in lieu of a list of 300 shoppable services. This information must also be updated at least once annually.

CMS has also granted itself enforcement authority under this regulation. CMS stated that it plans to audit hospital websites, and investigate complaints submitted from the

AMRPA Magazine / December 2020 19

public. If CMS determines that a hospital is out of compliance and a material violation exists, it will issue a written warning and request a corrective action plan. Following these initial actions, the agency will issue civil monetary penalties of up to $300 per day for continued non-compliance.

In addition to pushing back on these new requirements and their application to IRFs, AMRPA held informational calls to provide information on the new rules to member hospitals. There are also several recently enacted price transparency regulations

20 AMRPA Magazine / December 2020

that are similar, but that do not apply to IRFs. These include the requirement for acute-care hospitals to disclose negotiated rates on Medicare cost reports, and a requirement for insurers to disclose negotiated rates effective in 2022.

If you or your hospital has questions about these new regulations, contact the AMRPA policy team for assistance. AMRPA has also posted helpful resources on the Price Transparency requirements on its website, within the Policy Resources section.

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Medicare Payment Advisory Commission Launches Meeting Cycle with Full Docket

The Medicare Payment Advisory Commission (MedPAC) began their 2020 – 2021 meeting cycle virtually in September, and focused primarily on the impact of COVID-19 on the Medicare program, the ongoing transition to value-based care, rural health care issues and telehealth expansion. It is likely that discussion of these issues will continue throughout the remainder of the meeting cycle. In addition, a discussion of payment update recommendations will be included in the December meeting. The following highlights are from the September, October and November MedPAC meetings.

Remy Kerr, MPH, AMRPA Health Policy and Research Manager

September – The Coronavirus Pandemic and Medicare, Context for Medicare Payment Policy and Expansion of Telehealth in Medicare MedPAC initiated their 2020 – 2021 meeting cycle on Sept. 3 by addressing the profound effect the COVID-19 public health emergency (PHE) has on the Medicare program, Medicare insolvency projections, and permanent expansion of telehealth in Medicare.

The Coronavirus Pandemic and Medicare session addressed the impact of COVID-19 on Medicare from beneficiary and provider standpoints. MedPAC reported that 80% of COVID-19 deaths are among ages 65 and older, with 40% among nursing home and assisted living residents. COVID-19 impacts beneficiary access to care and utilization, with many delaying or foregoing care due to fear of infection or because of temporary provider closures. The overall effect on patient outcomes is yet unknown. For provider impact, MedPAC shared an overview of: (1) volume changes during Q2 2020 for acute and post-acute care providers; (2) acute hospital margins and the impact of PHErelated policy changes; and (3) CARES Act funding distributions, based on an unnamed sample of non- and for-profit acute care hospital systems. Much discussion focused on the need for greater data on disbursement of relief funds in COVID-19 impacted areas. Commissioners expressed specific concerns with how Medicare funds are dispersed, and with the number of COVID-19 Medicare patients who receive treatment at funded hospitals. There was agreement that the impact of COVID-19 on utilization and margins across settings be considered when making future payment update recommendations.

The Context for Medicare Payment Policy session focused on the outlook for the Medicare Trust Fund and recommendations to prevent insolvency. Estimates show Medicare spending doubling within the next decade, with the Hospital Insurance Trust Fund (Part A) projected to be insolvent by 2026. However, the Congressional Budget Office projects that Part A will be insolvent by 2024 due to COVID-19. MedPAC provided data related to Medicare Advantage (Part C), and reported that spending per beneficiary in Medicare Advantage is growing faster than original Medicare or

AMRPA Magazine / December 2020 23

Medicare Part D. To address shortfalls, MedPAC recommended a 0.8% increase in payroll tax, or decrease Part A spending through a decrease of $1,000 per beneficiary per year, which Commission Chair Michael Chernew cautioned might exceed MedPAC’s scope. During the discussion, commissioners suggested that bold action is required to solve the Medicare program financial crisis. They also expressed interest in examining the impact of disparities on spending in the Medicare program and evaluating how beneficiary health status influences spending.

The Expansion of Telehealth in Medicare session covered temporary telehealth policy changes granted due to the pandemic, and recommendations for permanent implementation of the changes at the conclusion of the PHE. MedPAC recommended maintaining many of the temporary telehealth flexibilities within the advanced Alternative Payment Model (A-APM) program, and also recommended that expanded fee-for-service (FFS) telehealth would need several safeguards against potential fraud, waste and abuse. Additionally, MedPAC proposed that reimbursement for telehealth services should not remain at the same level as in-person visits at the conclusion of the PHE, and that all telehealth services continue to meet HIPAA requirements (penalties for HIPAA compliance have been waived during the PHE). Many commissioners supported expanding telehealth services related to mental health in the FFS space, with several supporting telehealth for chronic disease management. To manage fraud, waste and abuse concerns, commissioners suggested that protections present for in-person services be utilized for telehealth, and that standard cost sharing rules in place prior to the PHE be continued after (clinicians are permitted to waive cost sharing during the PHE). Some commissioners also asserted that certain services, such as those for durable medical equipment, require in-person visits.

October – The Evolution of Medicare’s Advanced Alternative Payment Models The October 2 MedPAC meeting focused on the Advanced Alternative Payment Model (A-APM) program. MedPAC asserted that A-APMs have not yielded the desired results since their development, based upon testing by the Center for Medicare and Medicaid Innovation, and that even the most successful programs provide only modest savings for the Medicare program. MedPAC recommended areas for improvement, including: strengthening financial incentives for providers through increased shared savings/loss percentages, lowering or slowing growth benchmarks, limiting risk score influence and increasing episode target prices and withholds. It also recommended that more models have mandatory participation and provide beneficiaries with information on “high-value” providers, and acknowledged the need for improved evaluation of payment models.

In the discussion, Commissioners recognized that the A-APM topic is wide-ranging and will likely take place over many meeting cycles. However, there were areas of consensus, including the number of models with significant overlap. Many suggested that a smaller number of models would improve testing capabilities. Commissioners also raised concerns that overlap between models could create conflicting incentives, that social determinants of health disparities be a major focus of A-APMs, 24 AMRPA Magazine / December 2020

and that A-APM benchmarks align with Medicare Advantage.

There was agreement for increased mandatory participation in models, and that model durations should be longer.

November – Expansion of Telehealth in Medicare and Congressional Request: Medicare Beneficiaries’ Access to Care in Rural Areas (Interim Report) MedPAC’s public meeting on November 9-10 covered permanent telehealth expansion within Medicare and rural health care access issues. It was the second MedPAC session on telehealth this year, and the issue will likely be addressed in subsequent meetings. The session on rural health care was requested by the House of Representatives Ways and Means Committee to update MedPAC’s 2012 report on the issue. An interim report is due in June 2021 with a final report due by June 2022.

In the telehealth-focused session, there was substantial dialogue on areas of telehealth expansion, particularly audioonly services (building on the September meeting discussion).

Commissioners suggested that continuing reimbursements for audio-only services creates opportunities for significant abuse and overutilization. Others urged that audio-only telehealth services reimbursements continue after the conclusion of the PHE to prevent disparities, and to ensure that beneficiaries without broadband internet access or video-capable devices continue receiving telehealth services. There was additional discussion of whether “high-touch services” continue to be reimbursed after the PHE, with some supporting the proposal and others opposed. During a focus group on the issue, participants expressed concerns that in telehealth therapy, a patient could sustain a fall and a therapist would be unable to assist. However, one commissioner asserted that telehealth therapy could improve access for beneficiaries in need of highly specialized care. Lastly, the role cost sharing in telehealth services was discussed, and if “incident to” billing should be prohibited in certain circumstances. It was cautioned that cost sharing could become burdensome for providers, and that if cost sharing were implemented the amount would need to balance, not reduce, access for beneficiaries and not create burdens for providers.

The Access to Care in Rural Areas session centered on recommendations for data to include in the interim report due to Congress in June 2021. MedPAC compared 2010 data to 2018 data in evaluating clinician service use between rural and urban beneficiaries. In its determination, MedPAC used Evaluation and Management (E/M) encounter data from the Physician Fee Schedule, rural health clinics, federally qualified health centers (FQHC) and critical access hospitals. In both 2010 and 2018, urban beneficiaries had more E/M encounters with clinicians than did rural beneficiaries. 2018 data suggests that fewer rural E/M encounters are the result of fewer encounters with specialists.

According to MedPAC, a greater number of rural beneficiaries are dependent upon hospitals to receive health care services (between 2010 and 2018), than are urban beneficiaries. MedPAC stressed that this increasing dependence is occurring due to an increase in rural hospital closures.

To address these concerns, MedPAC recommended implementing global budgets or increasing stand-alone emergency departments and FQHCs. Commissioners generally

supported further consideration of global budgets, and expressed concern that MedPAC’s data was not risk-adjusted despite known differences in health status between urban and rural beneficiaries that impact utilization. Commissioners stated that ongoing workforce challenges need to be addressed in any recommendations related to rural health care access. Of particular interest to AMRPA, Commissioner David Grabowski urged exploration of rural access issues related to post-acute care (PAC), specifically mentioning that skilled nursing facilities have faced closures and that such closures may be further exacerbated by the PHE.

Looking ahead, AMRPA expects COVID-19 and associated impacts will continue to be a major point of discussion for MedPAC, and will telehealth expansion and Medicare’s impending insolvency. MedPAC’s next public meeting is scheduled for December 3 and 4, when the Commission will discuss payment update recommendations, including those for IRFs. AMPRA will continue to update its members on relevant updates through the AMRPA Access blog, and its weekly newsletter, Off the Record. Additionally, full MedPAC memorandums summarizing monthly meetings are now available to AMRPA members here.

All presentation slides and transcripts from the aforementioned meetings can be found here. ***

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03406

Interoperability and Information Blocking: What Rehabilitation Providers and Health IT Developers Need to Know about New Enforcement Timelines Key Points • On May 1, 2020, the ONC Interoperability, Information Blocking, and Health IT Certification Program Final Rule and the CMS Interoperability and Patient Access Final Rule were published in the Federal Register, marking the start of the implementation timetables for these major regulations.

Martha M. Kendrick, Esq.,Partner, Akin Gump Strauss Hauer & Feld LLP

• Due to the COVID-19 pandemic, CMS and ONC have delayed compliance dates for the new patient event notification Condition of Participation, information blocking regulations, certain health IT certification criteria, and the Conditions and Maintenance of Certification requirements under the Health IT Certification Program.

• Enforcement timelines remain unclear, as HHS has yet to make any proposal regarding enforcement against providers, and the HHS Office of Inspector General has yet to issue a final rule on how it will enforce the information blocking provisions against health IT vendors, health information exchanges, and health information networks.

Kelly M. Cleary, Akin Gump Strauss Hauer & Feld LLP

Jo-Ellyn Sakowitz Klein, Akin Gump Strauss Hauer & Feld LLP

Mallory A. Jones, Akin Gump Strauss Hauer & Feld LLP

Just days before President Trump’s declaration of a national emergency on March 13, 2020, the U.S. Department of Health and Human Services (HHS) rolled out two significant final regulations aimed at bolstering the accessibility and exchange of electronic health information (EHI). These final regulations were published in the Federal Register on May 1, 2020, marking the start of the implementation timetables. While the administration remains committed to this regulatory regime, various delays have been announced in light of the pandemic crisis.

On April 21, HHS announced it would delay enforcement of these final rules, which otherwise were set to become effective June 30, 2020, to allow compliance flexibility in response to the COVID-19 public health emergency. On October 29, HHS issued an interim final rule further extending certain compliance dates and timeframes due to the ongoing pandemic (the “Interim Final Rule”).

For the new information blocking penalties, the enforcement timetable will depend on when HHS finalizes regulations implementing its new enforcement authorities. On April 21, HHS took an important step toward implementing its new civil monetary penalty (CMP) authority. The HHS Office of Inspector General (OIG), charged by Congress with investigating the information blocking practices of providers, health information technology (“health IT”) developers, health information exchanges (HIEs) and health information networks (HINs), issued a proposed rule that would, among other things, allow the OIG to impose CMPs—up to $1 million per violation—on certain actors found to have knowingly interfered with the access, use or exchange of EHI.

AMRPA Magazine / December 2020 27

This article highlights important information for rehabilitation providers and health IT developers regarding the new enforcement timelines.

Overview of Recent Regulatory Activity The ONC Interoperability, Information Blocking and Health IT Certification Program Final Rule (“ONC Final Rule”) On March 9, 2020, the Office of the National Coordinator for Health Information Technology (ONC), which is charged with supporting the adoption of health information technology, released long-awaited regulations implementing certain provisions of the 21st Century Cures Act (the “Cures Act”) meant to advance interoperability and support the access, exchange and use of EHI, including significant changes to ONC’s Health IT Certification Program.

One key component of the Final Rule is the implementation of Section 4004 of the Cures Act, which created new federal penalties to deter the practice of information blocking. Broadly speaking, information blocking is any practice that may interfere with the use, access or exchange of EHI and that is not “reasonable and necessary.” The Final Rule establishes key definitions around the individuals and entities that are “covered actors” subject to penalties for information blocking, including health care providers. It also finalizes exceptions to the definition for activities are “reasonable and necessary,” including a “content and manner” exception that will allow covered actors to restrict content to a more limited set of EHI. Compliance with these regulations was initially required by November 2, 2020. In the Interim Final Rule, ONC pushes back the compliance date until April 5, 2021.

Importantly, the Final Rule also gives covered actors an additional 18 months after the initial compliance date during which they will only be required to provide data elements represented in the U.S. Core Data for Interoperability (USCDI) in response to a request to access, exchange or use EHI, rather than the full scope of EHI. To maintain this transition period, in the Interim Final Rule, ONC updates the date by which actors must provide all EHI in response to a request to October 6, 2022. The scope of data included in the USCDI is significantly more limited than the full definition of EHI, which includes all individually identifiable health information transmitted or maintained in electronic form that would be included in a designated record set under HIPAA, regardless of whether the records are used or maintained by or for a covered entity (with certain exceptions). The USCDI, on the other hand, is a defined set of data elements within certain overarching categories, including clinical notes, patient demographics, and vital signs.

The Final Rule also establishes new Conditions and Maintenance of Certification requirements for health IT developers under the ONC Health IT Certification Program, and standards for the voluntary certification of health IT for use by pediatric health care providers. Among other conditions, the ONC Final Rule requires as Conditions of Certification that a health IT developer not take any action that constitutes “information blocking” and that a health IT developer provide assurances to the agency that it will not take any such action (unless for certain legitimate purposes)

28 AMRPA Magazine / December 2020

or any other action that may inhibit the appropriate exchange, access and use of EHI. ONC also adds new API Conditions of Certification that address the practices developers of certified health IT should engage in, such as minimizing the “special effort” necessary to access, exchange and use EHI via certified API technology. Compliance with these Conditions of Certification was initially required by November 2, 2020. However, in the Interim Final Rule, the agency pushes back the compliance date to April 5, 2021.

CMS Interoperability and Patient Access Final Rule (“CMS Final Rule”) Centers for Medicare and Medicaid Services (CMS) issued a final regulation in tandem with the ONC Final Rule geared toward interoperability and patient access to health information. The CMS Final Rule creates new data-sharing standards for payers participating in Medicare Advantage (MA), Medicaid, CHIP and the Federally-facilitated Exchanges (FFEs). Two of the new requirements to implement and maintain standards-based APIs (for claims and encounter information and provider directory information) are due to take effect on January 1, 2021, but CMS said it will delay enforcement for six months, until July 1, 2021.

CMS has also modified its Medicare Conditions of Participation (CoPs) to require hospitals, including inpatient rehabilitation hospitals, psychiatric hospitals and critical access hospitals, to send electronic patient event notifications of a patient’s admission, discharge and/or transfer to another healthcare facility or to another community provider or practitioner, if the hospital uses an EHR system with the technical capacity to generate information for patient event notifications. According to CMS, these measures will improve care coordination by allowing a receiving provider, facility or practitioner to reach out to the patient and deliver appropriate follow-up care in a timely manner.

These CoPs will be applicable May 1, 2021, or 12 months after publication of the Final Rule.

CMS also finalized its proposal to publicly report the names and National Provider Identifiers (NPIs) of providers who have not input their digital contact information in the National Plan and Provider Enumeration System (NPPES) beginning in late 2020.

OIG Civil Monetary Penalty Rule On April 21, OIG issued a proposed rule implementing new CMP authorities, including the Cures Act CMP authority at Section 4004. Section 4004 of the Cures Act added Section 3022 to the Public Health Service Act (PHSA), which, among other provisions, provides OIG the authority to investigate claims of information blocking and authorizes the Secretary to impose CMPs against health IT developers of certified health IT, HINs and HIEs that OIG determines committed information blocking. In the proposed rule, OIG proposes to implement Section 3022(b)(2)(C) by adding the information blocking CMP authority to the existing regulatory framework for the imposition and appeal of CMPs, assessments and exclusions.

The proposed rule also explains OIG’s anticipated approach to enforcement and coordination within HHS to implement

the information blocking authorities. OIG explains that it will likely focus its enforcement efforts on conduct that: (i) resulted in, is causing, or had the potential to cause patient harm; (ii) significantly impacted a provider’s ability to care for patients; (iii) was of long duration; (iv) caused financial loss to federal health care programs, or other government or private entities; or (v) was performed with actual knowledge. OIG further explains that it will “closely coordinate” with ONC given its separate authority under the PHSA to regulate information blocking and its expertise on the information blocking regulations. Furthermore, OIG will be referring information blocking claims to OCR if consultation regarding HIPAA regulations would “resolve” an information blocking claim.

What Rehabilitation Providers Need to Know Health care providers, including hospitals, skilled nursing facilities, and other long-term care facilities, are “covered actors” under the information blocking rules, but HHS has yet to propose a specific enforcement mechanism.

A health care provider is a “covered actor” under the information blocking rules and may be subject to sanction if found to have knowingly engaged in any practice that “is unreasonable and is likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information.” Notably, HHS elected to use the broad definition of “health care provider” in the PHSA, which includes facilities like rehabilitation hospitals, skilled nursing facilities, and other long-term care facilities, as well as individual practitioners like physicians and pharmacists.

OIG is charged with investigating allegations of information blocking, and determining whether a violation has occurred.

However, unlike other covered actors subject to the information blocking rules, health care providers are not subject to the $1 million-per-violation CMPs under Section 4004 of the Cures Act. Rather, Congress directed OIG to refer provider violations to “the appropriate agency to be subject to appropriate disincentives using authorities under applicable federal law, as the Secretary sets forth through notice and comment rulemaking.” HHS has yet to identify the agency or agencies that will handle information blocking referrals, and also has yet to identify the “disincentive” that will apply to providers that engage in information blocking.

While a provider-specific information blocking enforcement policy is being developed, health care providers may still be subject to other adverse action if practices violate HIPAA right of access or Medicare payment rules.

While the provider-specific information blocking enforcement mechanism will take time to develop and implement through rulemaking, other authorities already in existence could serve as a basis for the sanction of health care providers.

For covered actors that are also covered entities under HIPAA, some conduct that constitutes information blocking could potentially be punishable as a violation of a patient’s right of access under existing authority. The HHS Office for Civil Rights (OCR) investigates alleged HIPAA violations, and has the authority to impose CMPs of up to almost $1.8 million

per violation. Many OCR investigations end in a settlement agreement accompanied by a corrective action plan—the highest settlement payment to date is $16 million.

For covered actors that participate in the Medicare Quality Payment Program or Medicare and Medicaid Promoting Interoperability Program, engaging in practices that are considered information blocking could affect performance scores and payment adjustments under those programs. Further, CMS has said that it would begin publicly reporting providers that may be failing to comply with certain information sharing expectations in “late 2020.” The agency explained that it will name providers who do not list or update their digital contact information in the NPPES. CMS will also report eligible clinicians, hospitals, and critical access hospitals that may be information blocking based on how they attested to certain Promoting Interoperability Program requirements in data collected for the 2019 performance year.

Health care providers that meet the definitions of HINs or HIEs may be subject to CMPs, but not before OIG finalizes its proposals.

Notably, in the ONC Final Rule, ONC emphasized that the definitions of HIE and HIN are functional definitions, meaning that they will include any individual or entity that performs certain functional activities. In its proposed rule, OIG pointed out that some health care providers may meet the definition of an HIN or an HIE. In cases where a health care provider is acting in its capacity of one of these other “covered actors,” the provider may be subject to CMPs under the Cures Act. For example, if a large health care provider leads an effort to establish a network that facilitates the movement of EHI between itself and a group of smaller health care providers through health IT, the large health care provider could come within the definition of an HIN or HIE. For providers subject to the new Medicare Conditions of Participation, enforcement will be delayed 12 months (until May 1, 2021).

The CMS Final Rule requires, as a condition of participation in the Medicare program, that hospitals, including inpatient rehabilitation hospitals, psychiatric hospitals and critical access hospitals, send electronic notification of a patient’s admission, discharge or transfer to another health care facility, community provider or other practitioner, if the hospital uses an EHR system with the technical capacity to generate information for patient event notifications. Failure to meet a condition of participation could ultimately result in the termination of a hospital’s Medicare provider agreement. This requirement was originally set to take effect six months after the rule was published in the Federal Register. CMS has extended this implementation timeline to 12 months after the rule is published, or May 1, 2021.

AMRPA Magazine / December 2020 29

Below are some of the key compliance and effective dates related to interoperability and information blocking for providers: Provision

Compliance Date

Information Blocking – 45 C.F.R. Part 171

April 5, 2021

CoP – Patient Event Notifications

Definition of EHI limited to USCDI data elements until October 6, 2022 May 1, 2021

What Health IT Developers Need to Know Health IT developers and other entities that offer certified health IT are “covered actors” under the information blocking rules, and will be subject to CMPs once the OIG’s CMP rule is finalized and becomes effective.

Developers of health IT, entities offering certified health IT, HIEs, HINs, and, as noted above, health care providers, are among the individuals and entities that Congress identified as “covered actors” subject to penalty for information blocking.

Such entities are therefore subject to OIG investigation and (except for providers) CMPs for engaging in practices that the entities know or should know are likely to interfere with, prevent or materially discourage access, exchange or use of EHI. Once OIG determines that an individual or entity has engaged in information blocking, the Cures Act mandates a penalty of up to $1 million per violation for covered actors other than health care providers.

In its proposed rule, the OIG stated that it would not begin enforcing the information blocking CMPs until the final rule is issued and the regulations become effective (likely 60 days from the date of publication of a final rule).

For developers of certified health IT, compliance with the new Conditions of Certification for information blocking and APIs are delayed until April 5, 2021.

Developers of certified health IT will need to comply with the new ONC standards for obtaining and maintaining certification.

The regulations establishing these standards technically became effective on June 30, 2020, but ONC delayed the compliance date for many of the new requirements in the ONC Final Rule.

In the Interim Final Rule, ONC again pushes back certain compliance dates until April 5, 2021.

Below are some of the key compliance and effective dates for the new certification conditions related to interoperability and information blocking for certified health IT: Initial Compliance Date (Final Rule)

New Compliance Date (Interim Final Rule)

Condition of Certification (CoC) – Information Blocking

November 2, 2020

April 5, 2021

CoC – Assurances – Will not take any action that constitutes information blocking or actions that inhibit access, exchange and use of EHI

November 2, 2020

April 5, 2021

CoC – API – Compliance by Certified API Developers with health IT certified to current API criteria

November 2, 2020

April 5, 2021

CoC – API – Rollout of new standardized API functionality

May 1, 2022

December 31, 2022

Condition

Definition of EHI limited to USCDI data elements until May 2, 2022

Definition of EHI limited to USCDI data elements until October 6, 2022

1

.S. Dept. of Health and Human Services (HHS), Office of the National Coordinator for Health Information Technology (ONC), 21st Century Cures Act: U Interoperability, Information Blocking, and the ONC Health IT Certification Program, Final Rule, 85 Fed. Reg. 25,642 (May 1, 2020), https://www.govinfo. gov/content/pkg/FR-2020-05-01/pdf/2020-07419.pdf [hereinafter “ONC Final Rule”].

2

I n the Interim Final Rule, ONC explains that it will refer to this date as the “applicability date,” instead of the “compliance date.” HHS ONC, Information Blocking and the ONC Health IT Certification Program: Extension of Compliance Dates and Timeframes in Response to the COVID-19 Public Health Emergency, Interim Final Rule with Comment Period, 85 Fed. Reg. 70,064 (Nov. 4, 2020), https://www.govinfo.gov/content/pkg/FR-2020-11-04/pdf/202024376.pdf.

3

HIPAA” refers to the regulations implementing the Health Insurance Portability and Accountability Act of 1996 and the Health Information Technology for “ Economic and Clinical Health Act of 2009, codified at 45 C.F.R. Parts 160, 162 and 164.

4

HS, ONC, United States Core Data for Interoperability (USCDI), Version 1 (July 2020 Errata) at 4, https://www.healthit.gov/isa/sites/isa/files/2020-10/ H USCDI-Version-1-July-2020-Errata-Final_0.pdf.

30 AMRPA Magazine / December 2020

5

he 21st Century Cures Act directed ONC to develop Maintenance of Certification requirements, which require certified health IT vendors to demonstrate T continued compliance with certain standards after initial certification.

6

enters for Medicare & Medicaid Services (CMS), Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability and C Patient Access for Medicare Advantage Organization and Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-facilitated Exchanges, and Health Care Providers, Final Rule, 85 Fed. Reg. 25,510 (May 1, 2020), https://www.govinfo.gov/content/pkg/FR-2020-05-01/pdf/2020-05050.pdf [hereinafter “CMS Final Rule”].

7

CMS Final Rule at 25,602–03.

8

CMS Final Rule at 25,584.

9

HS, Office of Inspector General (OIG), Grants, Contracts, and Other Agreements: Fraud and Abuse; Information Blocking; Office of Inspector General’s H Civil Monetary Penalty Rules, Proposed Rule, 85 Fed. Reg. 22,979 (Apr. 24, 2020).

10

42 U.S.C. § 300jj-52.

11

42 C.F.R. Parts 1003 and 1005.

12

42 U.S.C. § 300jj(3).

13

Id. § 300jj-52(b)(2)(B).

14

45 C.F.R. §§ 160.404, 102.3.

15

HS, ONC, Anthem pays OCR $16 Million in record HIPAA settlement following largest health data breach in history (Oct. 15, 2018), https://www.hhs.

H gov/hipaa/for-professionals/compliance-enforcement/agreements/anthem/index.html (last accessed Oct. 29, 2020).

16

5 Fed. Reg. at 22,981 (explaining that health care providers could be subject to civil monetary penalties if they meet the definition of one or more 8 “covered actor”).

17

ONC Final Rule at 25,801.

18

CMS Final Rule at 25,603.

19

he intent requirement for providers is different, and liability requires a showing that the conduct was both unreasonable and that the provider knew that T it was likely to interfere with, prevent or materially discourage access, exchange or use of EHI. 42 U.S.C. § 300jj-52(a)(1)(B)(ii).

AMRPA Magazine / December 2020 31

Trusted solutions for rehabilitation providers As the health care industry continues to undergo major shifts, rehabilitation care models of the future are dependent on partnerships, integrations, advanced intelligence, analytics and patient engagement tools. Together these offerings will help provide the right information at the right time to clinicians and help predict issues before there are real problems. The Cerner integrated rehabilitation EHR supports the clinical, regulatory and financial needs of your organization now, and into the future.

To learn more about Cerner rehabilitation solutions, visit cerner.com/rehab.

cerner.com | Š 2020 Cerner Corporation 32 Visit AMRPA Magazine / December 2020

AMRPA 2020 Virtual Fall Conference & Expo Roundup

As we all know, 2020 has posed many challenges and changes for AMRPA members. Despite them, AMRPA held an extremely success Virtual Fall Conference and Expo October 4-8. More than 1,100 people joined us this year from over 150 hospitals and health systems.

Thanks to the planning skills and hard work of our Education Committee, we were joined by thought leaders across the country, discussing the most important topics in medical rehabilitation – ranging from payment to diversity, equity and inclusion practices.

Despite the lack of face-to-face interaction, AMRPA still provided networking events, including the opening reception featuring Vinny DePonto is a mentalist and illusionist.

The 2020 AMRPA Fall Conference & Expo was the first time the AMRPA People's Choice Award was presented. This new award offers recognition to a Fall Conference poster presentation that best showcases an impactful and innovative program and/or project in the field of medical rehabilitation. The winning poster, Benefits of an Interdisciplinary Rehab Team Huddle, was presented by Jennifer Carotenuto, MPA, MS, CCC-SLP, CBIS, Manager of Inpatient Rehabilitation Services; Lisa Graham, MA, CCC-SLP, CBIS, Clinical Services Coordinator; and Emily Holmer, MPT, NCS, Clinical Services Coordinator, Tampa General Hospital.

Opening Reception featuring Vinny DePonto

Winning Poster presented by Jennifer Carotenuto, Lisa Graham and Emily Holmer

AMRPA Magazine / December 2020 33

AMRPA recognized and honored Kent Riddle, president and CEO of Mary Free Bed Rehabilitation Hospital, with the AMRPA National Leadership Excellence Award; and David E. Storto, president of Partners Continuing Care & Spaulding Rehabilitation Network, with the Edward A. Eckenhoff Memorial Award.

Congratulations to all of the winners on their awards.

AMRPA again extends its thanks to our generous sponsors this year: •

Diamond sponsor: Bioness

•

Platinum sponsors: Bionik, Casa Colina, eRehabData, MossRehab, Select Medical, and WellSky

•

Gold sponsors: Cerner, Hackensack Meridian Health JFK Johnson Rehabilitation Institute, Merz Therapeutics, REAL System by Penumbra, and Spaulding Rehabilitation Network

•

Silver sponsors: Good Shepherd Rehabilitation, Mary Free Bed, TIRR Memorial Hermann, Tyromotion, and UPMC Rehabilitation Institute

•

Bronze sponsors: Burke Rehabilitation Hospital and CARF International

Kent Riddle

And to our exhibitors: Amputee Coalition, AMRPA PAC, Brooks Rehabilitation, FAIR Fund, and Thera Trainer.

David E. Storto

34 AMRPA Magazine / December 2020

Did You Know?

All of our webinars are available online!

Missed out on a recent AMRPA webinar? Fear not!

All AMRPA webinars are available on demand for purchase almost immediately following its recording.

W Eour B selection I N A here: R Browse https://amrpa.org/Education/Webinars/OnDemand-Webinars *AMRPA members receive a discount on all webinar recordings.

AMRPA Magazine / December 2020 35

Patient Success Story: Stronger, Together

By Adam Robertson, AMRPA Marketing Communications Manager

Uncertainty.

That’s what Laurel DuPont felt when she found out she failed a routine temperature screen and started exhibiting symptoms of COVID-19.

Laurel is CEO of Northshore Rehabilitation Hospital, which at the time of her COVID diagnosis, had only been open for five months.

As with many other health care facilities at the beginning of the pandemic, her inpatient rehabilitation hospital was grappling with a number of questions, first and foremost how to maintain the safety of its patients and employees.

“We had built a very strong culture in those short five months, but now that would be put to the test,” said Laurel. “Would we truly live the values that we preached? Were we, a new employer in the area, going to have the ability to provide the necessary PPE while the nationwide supply was dwindling?”

Laurel and her team strove to maintain open channels of communication, sending daily emails and holding weekly town halls, and they set up enhanced sanitization protocols to take on the challenge of the exponential rise in COVID-19 cases.

AMRPA Seeking Member Submissions of Patient Success Stories and Testimonials We are currently soliciting patient and caregiver stories and testimonials from AMRPA member hospitals to better showcase the outstanding work of our industry and membership. If you are interested in submitting a success story or testimonial, please fill out the form on this page or email Julia Scott, AMRPA Communications Coordinator, at jscott@amrpa.org.

36 AMRPA Magazine / December 2020

“How could I have gotten COVID-19?”

“And then it got a lot more personal,” said Laurel. “It started with a cough.

Nothing deep. Just a cough. Maybe a little chest tightness, but I could explain that away with the cough.”

Then the symptoms worsened. She contacted her doctor and was tested the same day. That test, as expected, was positive.

Time seemed to stop.

Her first thought was “How could I have gotten COVID-19?”

Running through all the possible scenarios, she was in a unique position of having to think about not only the personal implications and how to protect her family but also what this would mean for her as CEO of an inpatient rehabilitation hospital.

“Now being in a very different place – not just as a leader who had to bring my team through this, but as a patient – all of the news and data were scary. I couldn’t run from it. I had to lead through it.”

That initial fear then turned into action.

“My strategic brain kicked on and said, ‘Now, what do I do from here?”

Fulfilling her obligations as CEO, she immediately informed her employees.

“We had already implemented full-time masking and distancing and – again – the process had worked. No one else became ill. We had kept each other safe.

That built trust.”

Her focus quickly shifted to her family, including her husband and three kids, and her own personal healthy and recovery, with the next six weeks presenting a myriad of symptoms and a fever that wouldn’t break. For the first three weeks, just walking from the bed to the bathroom was a challenge. After five weeks of separation from her family, she was able to reintegrate. Progress was slow. Everyday tasks at home were difficult and led to shortness of breath.

“It took me six weeks to stop running a fever. I still have symptoms. I still have not completely recovered,” Laurel said, and after that six-week period of acute infection and partial recovery, her functional recovery began to plateau.

In isolating herself and protecting her family while she was battling COVID-19, Laurel regularly used video calling to talk to her kids.

She contacted friends, her employees and professionals she knew operating in facilities partnered with Northshore, which is part of Select Medical, to ask for advice.

“Together, with everyone’s different level of expertise, I was on a path to build my endurance and improve my function back to my previous level.”

After her experience and speaking from her unique, dichotomous perspective as both a patient and medical rehabilitation leader, Laurel said, “I have a special place in my heart for any COVID recovery patient who can make it to us, and to watch them go from that rolling in day to watching them walking down the hall with therapy. It’s just such a unique and beneficial part of the continuum.”

With the interdisciplinary, patient-focused approach offered by inpatient medical rehabilitation playing an increasingly important role in COVID-19 recovery, Laurel underscores the immense benefits of this type of care, saying, “There is nowhere better to get as much functional recovery in such a short period of time than inpatient rehab.”

“I couldn’t run from it. I had to lead through it.”

AMRPA Magazine / December 2020 37

“Whatever happens to you happens, but the difference is taking the next step, even if the next step is sitting on the edge of the bed by yourself” Laurel's daughter got creative in communicating with her mom and made a special mailbox so her and her brothers could leave messages for her.

“As the CEO to step back and watch every single person giving their part and how they integrate from OT to PT to speech therapy to nursing to the physicians to the case managers, and all of these people fighting for this patient in the same direction, it truly warms my heart.”

In a year characterized by seemingly insurmountable odds, rapidly changing circumstances and great uncertainty, Laurel lives by a simple mantra: “One doesn’t drown by falling into the river but by staying submerged in it.”

Laurel's daughter got creative in communicating with her mom and made a special mailbox so her and her brothers could leave messages for her.

For her, that means “You just can’t give up. Just keep going.

Whatever happens to you happens, but the difference is taking the next step, even if the next step is sitting on the edge of the bed by yourself.”

And although this year has brought fear and even vulnerability into our lives, from personal experience Laurel remains confident in not only her and her team’s ability but humanity’s ability to “deal with the COVID situation stronger together.”

Learn more about Northshore Rehabilitation Hospital and its role as an essential step in the continuum of care.

Explore the #powerofmedicalrehab and find care by visiting AMRPA’s patient website and reading other inspiring stories of recovery. ***

“There is nowhere better to get as much functional recovery in such a short period of time than inpatient rehab.”

38 AMRPA Magazine / December 2020

Uniquely Insightful Analysis For almost 20 years, eRehabData has supported rehabilitation

providers with innovative technology and meaningful analysis, all while strengthening AMRPA’s advocacy mission with data and revenue.

SUBSCRIBE to eRehabData to get unrivaled data services and fortify the association that works for you.

Email Sam Fleming at sam@eRehabData.com or call us at (202) 588-1766 for more information. ÂŽ eRehabdata eRehabdataisisowned owned by

by AMRPA AMRPA

AMRPA Magazine / December 2020 39

TWO STEPS FORWARD, NO LOOKING BACK. To achieve proven outcomes, patients with spinal cord injuries need access to leading-edge rehabilitative technologies. MossRehab is the first rehab hospital in the region to offer a Locomotor Training Program, which allows many patients to walk. The program helps patients recover function faster than traditional methods. It’s just one of the many innovative treatments that have established us as a worldwide leader in spinal injury recovery.

40 AMRPA Magazine / December 2020

Y E ARS

Challenge Accepted.

Experience the REAL® System The REAL System offers the latest technology in rehabilitation with therapeutic activities focusing on physical and cognitive clinical applications. Built to empower and motivate patients, REAL is designed to support the patient’s course of rehabilitation.

www.realsystem.com

AMRPA 2020 For more information on the use of the REAL System, visit https://www.realsystem.com/usermanual.

Product availability varies by country. Rx only. Prior to use, please see User Manual for complete information, product indications, warnings, precautions, and potential adverse events. The product is intended to be used in a clinical environment and prescribed and supervised by a medical professional trained in rehabilitation therapy. A medical professional must be present at all times to provide direct supervision of the use of the product.

Copyright ©2020 Penumbra, Inc. All rights reserved. The REAL Hero logo and REAL are registered trademarks or trademarks of Penumbra, Inc. in the USA and other countries. All other trademarks are the property of their respective owners. 20156, Rev. A 09/20 USA

AMRPA Magazine / December 2020 41

Innovating Collaborating Defining best practices Driving patient outcomes

Together, we are transforming medical rehabilitation.

42 AMRPA Magazine / December 2020

selectmedical.com

Transforming the Art and Science of Rehabilitation Medicine About Spaulding

Spaulding Rehabilitation Network is proud to be a recognized leader in advocacy and public policy in the field of rehabilitation medicine. We offer world-class inpatient and outpatient care through a network of 4 inpatient facilities and 25 outpatient centers in Eastern Massachusetts. We are committed to providing exceptional patient care, promoting medical education, and advancing research in rehabilitation medicine.

Congratulations to Spaulding President David Storto, proud recipient of the Edward A. Eckenhoff Award at the 18th Annual AMRPA Educational Conference and Expo

• Ranked as the #2 rehabilitation hospital nationally by US News & World Report.

• PM&R Residency Program Ranked #1 in overall reputation by the Doximity Residency Navigator.

• The only provider currently selected by NIDILRR for all three model systems in Traumatic Brain Injury, Spinal Cord Injury and Burn Injury.

• Opened in April 2013, a state-of-the-art hospital hailed for LEED Gold Certification and inclusive design.

Member of

www.SpauldingRehab.org

@SpauldingRehab

AMRPA Magazine / December 2020 43

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44 AMRPA Magazine / December 2020