APTA: Working for You

Medicare Payments for PTs to be Cut in 2010 Unless Congress Steps In  

Unless Congress takes action through health care reform legislation, payments for physical therapy services under the Medicare physician fee schedule will be reduced by 19.2% in 2010. In issuing its final rule for calendar year 2010, the Centers for Medicare and Medicaid Services last week announced a negative 21.2% update for providers. For PTs, this negative update would be offset by a 2% positive adjustment in 2010 due to practice expense changes, resulting in an aggregate impact of negative 19.2%. The amount of payment for each service would vary depending on the CPT code.

APTA has prepared a detailed highlights document of provisions in the final rule that will have an effect on physical therapy. They include:

• An increase in the dollar amount of the therapy caps in 2010 to $1,860. Both the House and Senate reform proposals include a 2-year extension of the therapy cap exceptions process, which is set to expire December 31.  
• A new comprehensive pulmonary rehabilitation program (PR) and an expansion of the current cardiac rehabilitation (CR) program to contain services for intensive cardiac rehabilitation. The rule contains a brief discussion on how to bill for certain patients with therapy needs that are outside of the treatment plan appropriate for PR, CR or Intensive cardiac rehabilitation.
• Plans for continuation of the Physician Quality Reporting Initiative (PQRI). In 2010, physicians and other health care providers, including physical therapists, who successfully participate in the PQRI program will receive a bonus payment equal to 2.0% of the estimated total allowed charges for all services in 2010. Physical therapists will be able to use claims-based and registry-based reporting.
• A final proposal to change the status indicator for canalith repositioning from B (Bundled) to I (Invalid). The rule notes that physical therapists can continue to bill for this service with CPT code 97112 (neuromuscular reeducation).

CMS Releases MDS 3.0

On October 30, the Centers for Medicare and Medicaid Services (CMS) released the final data specification files and tracking documents for the Skilled Nursing Facility Minimum Data Set version 3.0 (MDS 3.0). The Resident Assessment Instrument (RAI) Manual will be made available sometime later this month. CMS states that it will start training on the new MDS 3.0 provisions this spring 2010. Implementation is planned for October 1, 2010. The final documents can be accessed on CMS' Web site.

Final HH PPS Rule Contains Caps on Outlier Payments, Increase in Base Rates

The calendar year (CY) 2010 Home Health PPS final rule issued last week by the Centers for Medicare and Medicaid Services (CMS) contains a 2.0% market basket update to Medicare's home health prospective payment system (HH PPS) rates and modifications to the home health outlier policy. Specifically, CMS will cap home health outlier payments at 10% per HHA and target total aggregate outlier payments at 2.5% of all HH PPS payments. The current (2009) target for aggregate outlier payments is 5% of total HH PPS expenditures. By lowering the total outlier payment target to 2.5%, this final rule increases home health base rates by 2.5% for CY 2010.

In addition, CMS will continue its current policy of a 2.75% reduction to national standardized 60-day episode payment rates and non-medical supply factors in CY 2010. The CY 2010 reduction is the third year of a four-year phase-in of HH PPS rate adjustments, which were made final in the HH PPS Refinement and Rate Update for the CY 2008 final rule.

The final rule also contains implementation of new payment and enrollment safeguards, including an improved version of OASIS, called OASIS-C, to collect data on all episodes of care beginning January 1, 2010. This data will document important aspects of the patient's health status including clinical condition, functional abilities, and service needs. 

In CY 2010, CMS will publicly report 12 nationally accepted and approved quality measures plus 13 new process measures on its CMS Home Health Compare Web site. HHAs that submit required quality data will receive payments based on the full home health market basket update of 2.0% for CY 2010. The home health market basket index percentage will be reduced by 2 percentage points to 0.0 percent for CY 2010 for those HHAs that do not submit the required quality data. 

For CY 2012, CMS will require HHAs to report, as part of the required home health quality measures, the Consumer Assessment of Healthcare Providers and Systems Home Health Care Survey for Medicare and/or Medicaid beneficiaries.

A detailed highlights document can be found on APTA's Web site.

FTC Delays 'Red Flags' Rule

The Federal Trade Commission (FTC) has delayed the enforcement of the "Red Flags" Rule until June 1, 2010, in response to a request from members of Congress. The Red Flags Rule requires that certain entities develop and implement written identity theft prevention and detection programs to protect consumers from identity theft. The FTC has stated that physicians, physical therapists, and other health care providers must comply with the Red Flag Rules if they accept insurance and bill patients after services are provided. Originally scheduled for a November 1, 2008, compliance date, the FTC has extended the compliance date three times previously -- to May 1, 2009, August 1, 2009, and November 1, 2009. 

The FTC has provided guidance though materials posted on a dedicated Red Flags Rule Web site, including a template that enables low risk entities to create an identity theft program with an on-line form. While APTA continues to object to the application of the red flags rules to physical therapists, APTA has prepared guidance to assist members in developing an identity theft program, which is available on APTA's Web site.

APTA continues to seek legislative action to prevent application of the Red Flags Rule to PTs. HR 3763, a revised version of the APTA-supported bill HR 2345, was passed by the US House of Representatives on October 20 and referred to the Senate Committee on Banking, Housing, and Urban Affairs. This bill would exclude health care practices with fewer than 20 employees from being interpreted as creditors as outlined in the Red Flags Guidelines. 

House Scheduled to Vote on HR 3962; Reid Says Senate Not Bound to Timelines    

The House of Representatives is scheduled to vote Saturday on HR 3962, the Affordable Health Care for America Act. This bill contains similar important provisions for PTs as the former House health care reform bill (HR 3200) released in the summer, though the provision on the sustainable growth rate was removed and is now a standalone bill, HR 3961, Medicare Physician Payment Reform Act. HR 3962 would extend the therapy caps exceptions process for an additional 2 years, list rehabilitative services as minimum benefits, create a new student loan program for health care providers (including PTs) who serve in an area of need, creates a center for comparative effectiveness research, and ensures that state enacted protections, including provider non-discrimination laws, will continue to help guarantee that patients are afforded access to the health providers of their choice, including PTs.

The Senate continues to work on the merger of its two bills and with the Congressional Budget Office (CBO) to obtain a reasonable cost of the measure. This week, Senate Majority Leader Harry Reid (D-NV) said that the Senate was not bound to any timelines to pass health care reform this year, despite push from the White House to have a bill signed into law by the end of the year.

During these crucial weeks as the House and Senate debate their reform proposals, APTA encourages PTs, PTAs, and students to urge their members of Congress to support provisions that are critical to physical therapy patients. Recently, a group of physical therapists from Connecticut met with their member of Congress, Jim Himes (D-CT), to discuss the importance of direct access and the elimination of arbitrary caps. The roundtable, part of Himes' "health care listening tour," was featured on Connecticut's News 12 program.           

Addendum

The article "APTA Joins Leaders in Bone and Joint Health at International Conference"  published last week in PT Bulletin Online (PTB) failed to recognize Carol Oatis, PT, PhD, a panelist during the Experts in Arthritis public education session that was part of the Bone and Joint Decade Global Network Conference Advocacy Day, held in Washington, DC. Oatis, the only non-physician represented on the international panel of seven experts, spoke on the importance of movement, exercise, and physical therapy intervention in restoring and promoting maximal physical function for people with arthritis.

Educators Lead the Way for Students in PT-PAC Competition

For the second year in a row, educators at the Educational Leadership Conference won the Educator/Student PT-PAC Challenge over their students who attended APTA's National Student Conclave. For the challenge, which began last year, registrants of each conference aim to have the highest PT-PAC participation at their respective conference. Last year educators won the challenge by a margin of 6% (56 to 50%); this year educators won by 20% (58 to 38%). Participation in the challenge was particularly important during this crucial health care year. For more information about PT-PAC, visit www.ptpac.org.