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LOW VISION REHABILITATION
Medicare Demonstration Project ended 3/31/2011
The project designed to examine the impact of standardized Medicare coverage for vision rehabilitation services concluded on 3/31/11. While consumers may still receive EOB’s for billable services that occurred on or before 3/31/11, bills will not be submitted to Medicare for services that occur after that date. Medicare will continue to cover services provided by our low vision optometrist and occupational therapist.
Background
The Secretary of the Department of Health and Human Services was directed to carry out an outpatient vision rehabilitation demonstration project as part of the Fiscal Year 2004 appropriations conference report to accompany Public Law HR 2673. This demonstration project was designed to examine the impact of standardized Medicare coverage for vision rehabilitation services provided in the home, office, or clinic, under the general supervision of a physician. The services could be rendered by the following:
- Physicians;
- Occupational therapists (OT);
- Certified Low Vision Therapists (CLVT);
- Certified Orientation and Mobility Specialists (O&M); and
- Certified Vision Rehabilitation Therapists (CVRT).
Under the terms of this Low Vision Rehabilitation Demonstration, Medicare extended coverage under Part B for the same rehabilitation services to treat vision impairment that would be otherwise payable when provided by an occupational or physical therapist if they were now provided by a certified vision rehabilitation professional under the general supervision of a qualified physician. All services covered under this demonstration were one-on-one, face-to-face services. Group services were not covered.
Payment
Payment for these services were made under the Medicare Physician Fee Schedule (MPFS) even when such services were billed by a facility. They were not subject to bundling under the Outpatient Prospective Payment System (OPPS). Under this Low Vision Rehabilitation Demonstration, Medicare covered low vision rehabilitation services to people with a medical diagnosis of moderate to severe vision impairment that was not correctable by conventional medicine or surgical procedure (i.e., cataracts).
Plan of Care
Services were provided under an individualized, written plan of care developed by a qualified physician or qualified Occupational Therapist in Private Practice (OTPP) that was reviewed every 30 days by a qualified physician. The plan of care attested that vision rehabilitation services were medically necessary and the beneficiary receiving vision rehabilitation was capable of receiving and deriving benefit from such services. Rehabilitative services were conducted within a three-month period of time, in intervals deemed appropriate for the patient’s rehabilitative needs, and would not exceed a total of 9 hours. (That was later adjusted to a limit of 12 hours.) Typically, patients received therapeutic sessions once or twice per week and no less than bi-weekly, with each session lasting 30-60 minutes. Rehabilitative services were judged completed when the treatment goals had been attained and any subsequent services would be for maintenance of a level of functional ability, or when the patient had demonstrated no progress on two consecutive visits.
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