Tuesday, October 02, 2018 APTA Continues PTA Advocacy: Pushback on PTA Differential, Timeline for TRICARE Startup, More Physical therapist assistants (PTAs) play a crucial role on the care delivery team, and APTA is bringing that message to multiple stakeholders. Here's a rundown of some of the latest happenings in the association's advocacy for PTAs. Now available: an estimated timeline for PTA inclusion in TRICARE. In December 2017, President Trump signed a National Defense Authorization Act that included a change long advocated by APTA: inclusion of PTAs in the TRICARE program used throughout the Department of Defense (DoD) health care system. However, like many federal-level policy changes, implementation wasn't immediate, and it wasn't clear just how or when this change would happen. APTA can now shed a little light on the process. Informed by discussions with DoD representatives and others, the association developed a timeline that provides a sense of just how long it might take for the TRICARE policy change to take effect (scroll down to "TRICARE" header). The process hinges on when the proposed rule is released to the US Office of Management and Budget (OMB) for review—possibly this fall or spring of 2019. That release triggers a timeline for a series of steps that involve publication in the Federal Register, a public comment period, and agency reviews. Because the OMB release hasn't happened yet, and because various actions could take place before their deadlines, it's hard to pin down a specific date for the end of the process. The only firm date associated with the change is that it has to happen by 2021. The APTA chart helps provide a sense of the length of different steps of the process and helps visitors track progress. APTA will provide updates on the regulatory process, and alert members once the public comment period on the proposed rule has begun. In the interim, APTA is working with congressional allies to keep the pressure on for an expedited process once the proposed rule is released [Editor's note: recently, Rep Rob Wittman (R-VA) submitted a letter to DoD asking when OMB will receive the proposed rule now that 9 months have passed since the legislation was signed into law.] Yes, PTAs are included in TriWest. APTA also has received clarification that TriWest, the entity that oversees administration of the Department of Veterans Affairs "Veterans Choice" health care program in specific regions of the country, does in fact allow for treatment by PTAs. Unlike the TRICARE change, the TriWest statement describes the current environment and is not dependent on any wait for adoption of new rules. APTA continues to push back on US Centers for Medicare and Medicaid Services (CMS) plans to adjust payment provided "in part" by a PTA. CMS is bound by law to establish PTA and occupational therapy assistant (OTA) coding modifiers that will go into effect on January 1, 2020 and include a Medicare payment differential beginning in 2022. The problem, in APTA's view, is that the CMS approach—to assign the modifier to services provided "in part" by a PTA or OTA—could significantly impact patient access to care, particularly in rural and underserved areas. The CMS approach is mentioned in its proposed 2019 physician fee schedule. APTA made its position clear in comments on the fee schedule, and encouraged members and other stakeholders to provide individual comments critical of the "in part" approach. Additionally, association representatives and representatives from the American Occupational Therapy Association (AOTA) met with CMS representatives in person to discuss the issue. At the same time, APTA and AOTA are advocating on Capitol Hill for Congress to commission a US Government Accountability Office study to examine how access to physical therapy and occupational therapy will be impacted by the pending 2022 Medicare payment differential. APTA and Laurel Road now offer an option for PTA student loan debt refinancing. News from the APTA Financial Solutions Center: PTAs now have another option for reducing their student loan debt. APTA has expanded its partnership with Laurel Road, a national lending and banking company, to include student loan refinancing for PTAs. Under the new offering, PTAs who have worked for at least 1 year in the profession are eligible to apply to refinance their student loans to a lower rate. "It's important to be a member of APTA and engaged on these critical issues that impact PTAs, the profession, and the patients we serve," said David Harris, PTA, BS, MBA, chief delegate of the PTA Caucus. "We all have a professional responsibility to do everything in our power to provide access to all those in need of physical therapy, and our APTA membership gives us all a voice on the national level. Advocacy strengthens with every membership voice."