In signing the 21st Century Cures Act into law on December 13, 2016, President Barack Obama ensured that physical therapists (PTs) would gain something APTA has been working on for several years—the ability to provide care continuity for patients in the PT's absence through a provision known as "locum tenens."
Now the law of the land, the Cures Act contains a provision that includes PTs among the health care professionals who may use locum tenens, allowing a PT to bring in another licensed physical therapist to treat Medicare patients and bill Medicare through the practice provider number during temporary absences for illness, pregnancy, vacation, or continuing medical education.
The original legislation introduced in 2015 was freestanding, called the "Prevent Interruptions in Physical Therapy Act." Senators Charles Grassley (R-IA) and Bob Casey (D-PA) introduced the bill in the Senate, with Representatives Gus Bilirakis (R-FL) and Ben Ray Lujan (D-NM) doing the same in the House. During Senate Finance Committee hearings at the time, Grassley stated that "physical therapists provide important and much needed services to their patients, and should have the ability to ensure continuous care for their patients when a period of short-term care is needed."
As is usually the case, compromise was part of the process. While APTA originally pressed for locum tenens to be extended to all PTs, the final version of the legislation applies only to PTs in non-metropolitan statistical areas, medically underserved areas (MUAs), and health professions shortage areas as defined by the US Department of Health and Human Services. The scaling back happened after some legislators voiced concerns about a Congressional Budget Office report on the potential costs of implementing the law as written.
The Centers for Medicare and Medicaid Services (CMS) has issued a change request transmittal updating the Medicare Claims Processing Manual, Chapter 1, to implement Section 16006 of the 21st Century Cures Act, which allows outpatient physical therapy services furnished by PTs in a HPSA, MUA, or rural area to be billed under "reciprocal billing and fee-for-time compensation arrangements" (locum tenens) in the same manner as for physicians, effective June 13, 2017.
To determine if an area is a HPSA or an MUA, visit HRSA's website. A rural area is any area that is outside of a metropolitan statistical area (or a metropolitan division when a metropolitan statistical area is divided into metropolitan divisions), as defined by the Executive Office of Management and Budget. To determine if an area is rural, consult the Crosswalk of Counties to Core-Based Statistical Areas in the most current Inpatient Prospective Payment System (IPPS) final rule. Any area that is not designated as urban in the crosswalk is rural. To access the crosswalk, go to the FT2017 IPPS final rule webpage, then scroll down and click on: County to CBSA Crosswalk File and Urban CBSAs and Constituent Counties for Acute Care Hospitals File to open the Excel spreadsheet. Areas left blank in the Excel sheet are designated as rural.
Locum tenens arrangements may be utilized if a physical therapist (PT) is absent for a limited period of time for vacation, disability, continuing education, etc. Under the new law, PTs can bill Medicare for services performed by a locum tenens PT under the regular PT's NPI as long as the following conditions are met:
- The PT is unavailable.
- The locum tenens PT is compensated on a per diem or similar fee-for-time basis.
- The Medicare beneficiary seeks to receive the services from the regular PT.
- The regular PT does not bill for the services of a locum tenens PT for a continuous period of longer than 60 calendar days. If, after returning to work for a brief period of time, the regular PT must be absent again, the same locum tenens PT may be re-hired, and a new 60-day period begins.
- Regarding billing of the services, the PT uses a modifier to indicate that the services were provided by a locum tenens PT.
Advocating for Locum Tenens
Sandra Norby, PT, DPT, describes the fight to achieve locum tenens provisions in Iowa.