• Wednesday, April 15, 2015RSS Feed

    Senate Approves SGR Repeal, Keeps Therapy Cap and Exceptions Process

    The US Senate voted Tuesday to approve a bill that repeals the flawed sustainable growth rate (SGR) and moves toward payment systems based on quality, but, despite a concerted, historic grassroots advocacy effort, does not end the Medicare outpatient therapy cap. The therapy cap repeal amendment was defeated by a 58-42 vote, coming up just short of the 60 votes needed for passage.

    Instead of a full repeal, the therapy cap exceptions process will extend until December 31, 2017.

    The vote on the SGR ends a flawed system for payment that would have resulted in 21% reductions in Medicare payments to providers. The bill approved by the Senate passed with an overwhelming 92-8 vote, and President Barack Obama has stated that he will sign it into law. The bill was approved by the House in late March.

    Among the most significant features of the bill are the ways it sets the stage for a transition to value-based health care services, and away from the fee-for-service model—a shift strongly supported by APTA.

    The effort to include an amendment to end the therapy cap was championed by Sen Ben Cardin (D-MD) along with Sen David Vitter (R-LA), and was the focus of an intensive effort by APTA, its members, supporters, and other organizations to urge senators to vote in favor. In the end, the amendment was 1 of only 6 allowed to be considered, and among those 6, garnered 1 of the highest number of votes in favor.

    "Ending the SGR is good news not just because it ends a flawed policy, but because it's helping to transform payment models," said Justin Moore, PT, DPT, APTA executive vice president of public affairs. "We are of course disappointed that the therapy cap repeal effort was not successful, but thanks to the hard work of APTA members and supporters, we were able to seize an historic moment and move this issue closer to the goal line than at any time in the 18-year history of the cap. We will capitalize on this energy, unity, and momentum, and will never stop working for the best interests of patients."

    APTA will provide further information and resources on the provisions passed in the SGR bill over the coming weeks and will continue to influence its implementation with the Centers for Medicare and Medicaid Services.


    Wednesday, April 08, 2015RSS Feed

    Blogs and Tweets and Posts Oh, My: Support for Therapy Cap Repeal Gets Creative

    APTA members and supporters are keeping the pressure on the US Senate to consider an amendment that would end the therapy cap, and, true to the profession, doing it with plenty of energy and creativity.

    In addition to APTA’s own grassroots efforts to ensure that a therapy cap repeal amendment is included in legislation to end the sustainable growth rate (SGR), Joseph Brence, PT, DPT, FAAOMPT, used his "Forward Thinking PT" blog to urge physical therapists (PTs) to contact their senators, and he compiled a list of social media handles that makes it easy to post to legislators' and staffers' Twitter accounts. The list also includes links to each senator's Facebook page.

    Many PT and physical therapist assistant (PTA) students are answering APTA's request for phone calls, but with a twist: yesterday, they began answering a challenge from APTA to document their phone calls to senators by posting photos on Twitter. You can check out the photos through this Storify page. Great stuff.

    The grassroots efforts are aimed at capitalizing on what has been described as the best chance of obtaining a permanent repeal of the Medicare outpatient therapy cap since it was imposed 18 years ago. This chance, in the form of an amendment from Sen Ben Cardin (D-MD), would end the cap in the same legislation that ends the SGR.

    But the Senate needs to allow the amendment to be put up for consideration first. Visit APTA's Medicare Therapy Cap webpage for more information, and make 2 calls today.

    Not sure how to get in touch with your senator? The US Senate's website offers a contact lookup feature for phone numbers and email addresses. When you call, consider sharing the following message:

    "Senator Cardin is pushing for an opportunity to offer an amendment to fully repeal the therapy cap. I strongly urge you to (1) support his efforts to get a vote on the amendment and (2) then to vote for this critical amendment. Since Congress established the arbitrary cap on Medicare outpatient therapy services, Congress has acted 12 times to prevent the cap's implementation. Continual extensions of the therapy cap exceptions process costs significantly more in the long run than addressing a permanent solution NOW."


    Tuesday, April 07, 2015RSS Feed

    Wide Support for Therapy Cap Repeal; Your Voice Needed Now

    With friends like this, you could make therapy cap history.

    As APTA, its members, and supporters continue to engage in a full-court press to urge US senators to allow an amendment to permanently repeal the Medicare outpatient therapy cap, they can take heart in one important fact: they're not alone. According to APTA, no fewer than 24 other organizations also back the idea of putting an end to the cap.

    The combined efforts are now being applied to an historic opportunity to end the cap as part of a bill that would repeal the flawed sustainable growth rate (SGR); specifically, to convince the Senate to allow consideration of an amendment from Sen Ben Cardin (D-MD) to put permanent repeal of the cap in the bill. APTA is urging members and patients to contact their senators using the messaging available on the Medicare Therapy Cap webpage.

    For APTA, the fight to end the cap began almost as soon as it was created nearly 18 years ago. Along the way, other groups have recognized that temporary "fixes" that allow exceptions to the cap should be replaced with a once-and-for-all approach that truly serves people in need of care.

    The list of groups supporting therapy cap repeal now includes the American Association of Retired Persons, the ALS Association, the American Heart Association/American Stroke Association, the Arthritis Foundation, Easter Seals, the National Disability Rights Network, the Brain Injury Association of America, Parkinson's Action Network, and the National Multiple Sclerosis Society. In addition, several years ago APTA, the American Speech-Language-Hearing Association, and the American Occupational Therapy Association created a coalition to work together for repeal.

    "It's wonderful to have such widespread support, and it's great that we all share the opinion that the therapy cap is not in the best interest of patients," said Mandy Frohlich, APTA's vice president of governmental affairs. "But what makes a difference on Capitol Hill is when individual members take personal action and call legislators. Now more than ever, that's what needs to happen."

    Not sure how to get in touch with your senator? The US Senate's website offers a contact lookup feature for phone numbers and email addresses. Consider sharing the following message:

    "Senator Cardin is pushing for an opportunity to offer an amendment to fully repeal the therapy cap. I strongly urge you to (1) support his efforts to get a vote on the amendment and (2) then to vote for this critical amendment. Since Congress established the arbitrary cap on Medicare outpatient therapy services, Congress has acted 12 times to prevent the cap's implementation. Continual extensions of the therapy cap exceptions process costs significantly more in the long run than addressing a permanent solution NOW."


    Monday, April 06, 2015RSS Feed

    Possible Therapy Cap Repeal Amendment Could Make History; Every PT Can Help Shape the Vote

    A permanent repeal of the Medicare outpatient therapy cap could be closer than ever if Congress allows one senator's proposed amendment to be considered. Now it's time to make that possibility a reality, according to APTA.

    Last week, Sen Ben Cardin (D-MD) announced that he is prepared to lead the way in the fight to end 18 years of temporary fixes to the therapy cap by ending the cap completely. The historic change would come through an amendment to a bill, passed by the House of Representatives and awaiting Senate consideration, that seeks to end the flawed sustainable growth rate (SGR).

    The challenge? Senators need to agree to allow a vote on Cardin's amendment. APTA is calling on its members and supporters to contact their senators as soon as possible to urge them to support Cardin's effort to get a vote on the amendment—and then to vote in favor of it. The Senate is anticipated to take up the entire SGR repeal bill early next week after it returns from adjournment on April 13.

    APTA is urging members and patients to contact their senators using the messaging available on the Medicare Therapy Cap webpage. The US Senate's website offers a contact lookup feature for phone numbers and email addresses.

    APTA isn't the only organization working for an end to the therapy cap: in addition to coalition partners the American Speech-Language-Hearing Association and the American Occupational Therapy Association, the long list of supporters includes the American Association of Retired Persons (AARP) and the American Heart Association.


    Friday, April 03, 2015RSS Feed

    CMS Offers Update on Therapy Cap, SGR in Wake of March 31 Expirations

    While APTA, its members, and supporters continue to press legislators to include a permanent repeal of the Medicare therapy cap in a proposed bill to end the flawed sustainable growth rate (SGR), the US Centers for Medicare and Medicaid Services (CMS) has posted an update on where things stand now that an important deadline has passed.

    A special edition of the Medicare Learning Network's provider enews recaps changes that kicked in when SGR and therapy cap exceptions expired on March 31.

    In the newsletter, CMS states that it is "taking steps to limit the impact on Medicare providers and beneficiaries by holding claims for a short period of time." The resource also outlines the current state of the therapy cap, ambulance services, and other areas.

    Congress adjourned before the Senate voted on a measure, passed by the House of Representatives, that would repeal the SGR but does not contain a permanent end to the therapy cap. Senate leaders have promised that the bill will be taken up soon after Congress reconvenes on April 13.

    APTA urges members to take action to advocate for therapy cap repeal through both the association's legislative action center and the APTA Action App. The association also encourages members to reach out to patients and colleagues to make contacts as well, and provides a patient action center to help them.

    To add real-life urgency to the issue, APTA is also asking for members to contact its advocacy staff with their stories of how the therapy cap impacts their ability to provide adequate services to patients, and the risks involved with arbitrary limits on outpatient therapy reimbursements. Send your stories to advocacy@apta.org.


    Friday, March 27, 2015RSS Feed

    Senate Doesn't Move on SGR Repeal: What's Next for Therapy Cap?

    The US Senate's decision to adjourn without taking up the sustainable growth rate (SGR) repeal bill passed by the House on Wednesday gives physical therapists (PTs) and their supporters more time to press lawmakers for a repeal of the Medicare outpatient therapy cap. That's the good news.

    The not-as-good news? The current extension for SGR and exceptions to the therapy cap expire on March 31, and the Senate doesn't reconvene until April 13.

    So where does that leave PTs—and patients—who could face a $1,940 limit on reimbursement on outpatient physical therapist services beginning April 1? And what about the SGR-related 21% cuts set to kick in?

    What you need to know about the March 31 therapy cap deadline
    The bottom line is that if a PT's patient in Medicare part B exceeds the $1,940 therapy cap after March 31 and Congress has not passed legislation extending the therapy cap exceptions process, Medicare will not pay for the services above the cap.

    Gayle Lee, JD, APTA senior director of health finance and quality, advises PTs to consider issuing an advance beneficiary notice of noncoverage (ABN) form to any patient likely to exceed the $1,940 cap after March 31, just in case.

    The ABN provides the patient with a warning that services may not be provided for under Medicare, and allows the patient to choose whether to continue treatment (and pay out of pocket) or to stop treatment before the cap is exceeded. Background information on the ABN (.pdf), as well as forms and instructions, are available online from the Centers for Medicare and Medicaid Services (CMS).

    "The ABN process is an important one until there is resolution on this issue," said Lee. "Having an ABN in place allows PTs to collect payment from the patient for services above the cap—if the ABN isn't issued to the patient, and Medicare doesn't pay the claim, the provider is liable for the services and can't collect payment from the beneficiary."

    Lee suggests that in addition to the ABN, PTs should consider waiting things out.

    "There is a strong likelihood that Congress will adopt legislation addressing the therapy cap in the coming weeks," she said. "In the interim, PTs may want to also consider holding claims that exceed the cap and give Congress the time to make changes."

    Where things stand with the SGR (and therapy cap) in Congress, including payment cuts
    On Thursday, March 26, by a 392-13 vote, the House approved a bill that would permanently end the SGR, and sent the legislation to the Senate. As reported earlier in PT in Motion News, the House bill does not include a permanent repeal of the therapy cap, instead extending the exceptions process through 2017. The separation of therapy cap repeal from SGR repeal is a "risky approach for Medicare beneficiaries," according to a coalition of organizations, including APTA, that has been advocating for an end to the cap.

    On Friday, March 27, the US Senate adjourned for its spring recess without taking up the bill, with Senate leader Mitch McConnell telling Reuters that "we'll return to it very quickly when we get back" on April 13. APTA is urging its members to capitalize on the break by redoubling efforts to contact senators and their staffs.

    Because no Senate action was taken on the bill and Congress has not approved a temporary "patch" to the SGR, Medicare payment rates are scheduled to be cut by 21% after March 31.

    Providers, however, may not experience those cuts. Recently, CMS issued guidance that under current law they hold claims for 14 calendar days—enough time to allow Congress an opportunity to reach agreement on both the SGR and therapy cap when members return.

    What happens now, and what you can do
    For APTA members, the uncertainty over what happens during the congressional break is tempered by the possibility that the extra time will lead to an even better SGR bill, one that includes an end to the therapy cap. But much will depend on grassroots efforts.

    "We believe there is a very real opportunity for a permanent solution," said Mandy Frohlich, APTA vice president for government affairs. "APTA will work with legislators over the next 2 weeks to push for a full repeal of the therapy cap in a final SGR package, but we need direct involvement from our members."

    APTA is offering assistance for members through both the association's legislative action center and the APTA Action App. The association also encourages members to reach out to patients and colleagues to make contacts as well, and provides a patient action center to help them.

    To add real-life urgency to the issue, APTA is also asking for members to contact its advocacy staff with their stories of how the therapy cap impacts their ability to provide adequate services to patients, and the risks involved with arbitrary limits on outpatient therapy reimbursements. Send your stories to advocacy@apta.org.

    "We're at a critical juncture," Frohlich said. "We need members to keep up the drumbeat with legislators."


    Tuesday, March 24, 2015RSS Feed

    SGR Repeal…Without Therapy Cap Repeal? APTA Calls for Urgent Action

    March 25, 2015: This story was expanded from its original March 24 version to include quotes from the APTA president as well as links to a press release and updated information on the APTA website.

    Legislation now introduced in the US House of Representatives that would end the flawed sustainable growth rate (SGR) is missing a permanent repeal of the therapy cap. According to APTA advocacy staff, it's a troubling omission for physical therapists (PTs), and one that has sparked renewed calls for member action from APTA.

    The bill ready for House consideration repeals the SGR, but only includes a 2-year extension of the therapy cap exceptions process. Supporters of therapy cap repeal believe that the best chance of ending the cap exists when it's tied to an SGR repeal bill.

    Although APTA supports SGR repeal and other features of this particular bill, "We don't view a 2-year extension of this policy as a win," said Mandy Frohlich, APTA vice president of government affairs. "It separates the therapy cap repeal from the SGR repeal, which is problematic."

    In an action alert issued on March 24, APTA warned that the exclusion of a permanent therapy cap repeal in the SGR legislation "is a missed opportunity for a long-term solution and puts beneficiaries in a dire situation when this [proposed 2-year] extension expires." Members are being urged to contact their legislators to call for a permanent repeal of the cap to be included with any bill that would repeal the SGR. APTA has posted the latest information on the issue at the association's therapy cap webpage.

    The association also joined the American Occupational Therapy Association and the American Speech-Language-Hearing Association in issuing a news release that calls the separation of a permanent repeal of the SGR from a permanent therapy cap repeal "a risky approach for Medicare beneficiaries." Occupational and speech-language-hearing therapies are also impacted by the therapy cap.

    "If Congress fails to include a permanent solution for the therapy cap in this bill, it will have purposely missed the only significant opportunity in almost 20 years to fix this critical patient issue," said APTA President Paul Rockar Jr, PT, DPT, MS, in the joint news release. "A bipartisan solution has been negotiated. These policies were created together. They should be fixed together."

    In the (likely) event that Congress does not complete its work on this bill before it recesses on March 28, it is unclear how lawmakers will respond to a looming March 31 deadline that would trigger 21% cuts in Medicare payments via the SGR. It is possible that legislators would approve a short-term extension of the current fixes, but no formal proposals have been released.

    Even if the SGR bill is approved by the House in the coming days, the Senate would be pressed to take it up before Congress recesses. The break, coupled with some Democrats' concerns about other provisions in the legislation, could open a window that would allow grassroots and lobbying efforts to have a greater impact.

    Though the current SGR legislation lacks the crucial therapy cap element, it does include some provisions that are generally supported by APTA. Among them:

    • Positive changes to the competitive acquisition program for Medicare durable medical equipment, prosthetics, orthotics, and supplies
    • The inclusion of the Protecting Integrity in Medicare Act, which bolster's Medicare's ability to fight fraud

    However, the lack of a permanent repeal of the therapy cap represents a glaring flaw in the legislation, according to Frohlich.

    "It's more important than ever for members to speak up on this issue," said Frohlich. "We will continue to work with Senate champions to slow this down to correct this policy."

    The legislative landscape around the SGR and therapy cap continues to change. APTA will monitor the situation and update members as events warrant; however, the need for grassroots efforts on the therapy cap remains urgent. Find out how you can take action.


    Thursday, March 19, 2015RSS Feed

    Therapy Cap Repeal Could be 'In Jeopardy': Action Needed

    Repeal of the flawed sustainable growth rate (SGR) may be closer than ever to becoming reality, but will a permanent fix to the therapy cap be left behind? APTA and a coalition of providers and consumers have ramped up calls for grassroots action to make sure that doesn't happen.

    Late last week, House Speaker John Boehner and Democratic Leader Nancy Pelosi announced that they were working together on legislation that would permanently end the SGR formula instead of working out yet another temporary "doc fix" and punting the issue for another year. If Congress doesn't act on the SGR by March 31, Medicare providers would face a 21% cut to Medicare payments.

    The final bill has not been introduced in the House, and APTA and other organizations have received conflicting reports about whether the proposed legislation would include full repeal of the therapy cap provisions or just an extension of the therapy cap exceptions process. Repeal of the therapy cap is a central focus of the association's advocacy efforts.

    In an action alert issued this week, APTA's advocacy staff described therapy cap repeal as "in jeopardy" and urged members to take immediate action by contacting their legislators and telling them to insist that repeal of the therapy cap be included in any legislation that would end the SGR.

    "For anyone who understands how the therapy cap impacts patient access to necessary rehabilitation services, now is the time for action," said Mike Matlack, APTA director of grassroots and political affairs. "If a full repeal of the therapy cap isn't included with a full repeal of the SGR, over 1 million beneficiaries will face a very real obstacle to receiving adequate care."

    Although the proposal under discussion will likely emerge in the House first, APTA and the Therapy Cap Coalition are calling for supporters of therapy cap repeal to contact legislators in both the House and the Senate—and to stress the importance of talking with House and Senate leaders.

    "Right now, House and Senate leaders are the primary drivers of the negotiations around this issue," said Matlack. "It's important that supporters request that their legislators weigh in with those leaders and voice their support for a full, permanent repeal of the therapy cap."

    The need for grassroots efforts on the therapy cap is urgent. Find out how you can take action.


    Monday, March 16, 2015RSS Feed

    APTA Joins the Capitol Hill Conversation on Brain Injury Prevention and Management

    APTA advocates and staff are back on Capitol Hill—this time to provide a physical therapy perspective on brain injury as part of Brain Injury Awareness Month.

    On Tuesday, March 17, the association partners with the American Psychological Association, the National Association of County and City Health Officials, the American College of Preventive Medicine, and other organizations to host a congressional briefing on how data can be used to prevent injuries and violence, including traumatic brain injury (TBI). Two speakers from the US Centers for Disease Control and Prevention will join researchers and public health experts to look at existing injury and violence surveillance efforts, and how those efforts inform research and policy.

    The next day, APTA will participate in the Brain Injury Awareness Month Fair sponsored by the Congressional Brain Injury Task Force. The fair serves as a 1-stop information shop for legislators and staff, and the association's exhibit will combine materials on brain injury with resources on the physical therapist's (PT's) and physical therapist assistant's (PTA's) roles in management.

    APTA's participants will also use their time at the Fair to advocate for the SAFE PLAY Act—legislation now in congress that seeks to improve concussion management in schools, and includes PTs among the professionals qualified to make return-to-play decisions for students.

    The same day, association advocates and staff will attend another congressional briefing on "post-injury supports and services that make a difference." Speakers will include representatives from the US Public Health Service's Traumatic Brain Injury Team and the medical director of the inpatient TBI program at Walter Reed National Military Medical Center, as well as a TBI survivor and a caregiver for an individual with TBI.

    "Physical therapy's power to truly transform lives is evident every day in the work PTs and PTAs do with individuals who have suffered brain injury," said Mandy Frohlich, APTA vice president of government affairs. "Awareness events like these help us to keep physical therapy at the forefront in policy discussions about brain injury, and that's key, because the profession brings a unique and essential perspective to the table."

    APTA's efforts to educate policymakers on the role of PTs in TBI are ongoing. Last year, the association attended an invitation-only White House summit on concussions; additionally, concussion management awareness was the focus of a student-led Flash Action Strategy in 2014, which resulted in the largest concussion-related grassroots effort in APTA history.

    Find more resources on APTA's Traumatic Brain Injury webpage, read the clinical summary on concussion available for free to members at PTNow, and direct patients and clients to the Physical Therapist's Guide to Concussion on APTA's MoveForwardPT.com consumer website.


    Thursday, February 26, 2015RSS Feed

    Repeal of Therapy Cap Back in Congress

    Legislation calling for the repeal of the Medicare outpatient therapy cap has been reintroduced in both the US Senate and House of Representatives.

    This week, Sens Ben Cardin (MD) and Susan Collins (ME) introduced the Medicare Access to Rehabilitation Services Act (S. 539), which calls for an end to Medicare's payment ceiling for certain outpatient services including physical therapy. A companion version of the bill was introduced in the House in early February (H.R. 775).

    The introduction of the legislation in the Senate comes during a busy week on Capitol Hill for APTA advocates and staff, who not only spoke with legislators and policymakers on the therapy cap, but participated in meetings at the White House, the Federal Trade Commission, and the National Institutes of Health to bring the profession's voice to the table on a variety of issues.

    The therapy cap issue remains a policy priority for APTA, which sent out an action alert this week to encourage members to contact their representatives about the legislation now in Congress. Additionally, Mandy Frohlich, APTA vice president of government affairs, was featured in an episode of Comcast Newsmakers explaining why repeal of the therapy cap is a crucial to transforming health care for consumers and providers.

    APTA will continue to monitor the progress of the legislation and provide members with updates.


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