Friday, April 26, 2019 Congressional Roundup: What's on APTA's Legislative Advocacy Radar Believe it or not, there's much more going on in Washington, DC, than the stuff that becomes fodder for late-night talkshow hosts. Important legislation is being considered, and APTA and its members are there to advocate for changes that help the physical therapy profession's ability to deliver patient-centered care, and improve patient care overall. Here's a roundup of recent federal legislative activity on APTA's radar. Better coverage for kids under Medicaid is now law. On April 18, President Donald Trump signed a law that includes APTA-supported provisions to expand a state option for health homes for children under Medicaid. That particular provision, known as the Advancing Care for Exceptional (ACE) Kids Act of 2019, is included the Medicaid Services Investment and Accountability Act of 2019 signed by Trump. The ACE Kids Act addresses existing challenges facing children with medically complex conditions by expanding access to patient-centered, pediatric-focused coordinated care models tailored for these children across multiple providers and services, and by easing access to out-of-state care. The legislation builds off of current law to establish specially designed health homes for children with medically complex conditions beginning Oct. 1, 2022. Participation is voluntary for children and their families, providers and states; however, states that opt to create these health homes will receive a higher federal matching rate for 6 months. The broader legislative package also provides $20 million for the Money Follows the Person demonstration for fiscal 2019. The demonstration is aimed at transitioning Medicaid beneficiaries from facilities to community-based long-term support services. A bill to end the physician self-referral loophole under Medicare is back. Reps Jackie Speier (D-CA) and Dina Titus (D-NV) have introduced a bill, known as the Promoting Integrity in Medicare Act (PIMA) of 2019 (HR 2143), that seeks to close Medicare self-referral loopholes for physicians. That loophole allows physicians to refer Medicare patients for physical therapy and other services to a business that has a financial relationship with the referring provider, a gap that has been a target of APTA advocacy efforts for several years. The proposed legislation would tighten up self-referral prohibitions under federal law (known as the “Stark Law”) to remove physical therapy, advanced imaging, radiation oncology, and anatomic pathology from the so-called "in-office ancillary services" exception. And it's not without supporters: in addition to APTA's advocacy for the change, previous versions of PIMA have received support from AARP and the Alliance for Integrity in Medicare, a coalition that includes APTA. The 2019 PIMA has been referred to the House Energy and Commerce Committee as well as the Ways and Means Committee. Student debt relief options are being considered again. It's back: APTA-supported legislation that would list PTs among the professions included in a federal program to provide greater patient access to health care in rural and underserved areas has been reintroduced in the Senate. If passed into law, the program could open up access to a student loan repayment program for participating PTs—and help address the nation's opioid crisis in areas that have been especially hard-hit. The bill (S.970) would allow PTs to participate in the National Health Service Corps (NHSC) loan repayment program, an initiative that repays up to $50,000 in outstanding student loans to certain health care professionals who agree to work for at least 2 years in a designated Health Professional Shortage Area (HPSA). An estimated 11.4 million Americans are served by the NHSC. The bill was introduced by Sens John Tester (D-MT), Roger Wicker (R-MS), and Angus King (I-ME). And that's not all—by a long shot. APTA's government affairs staff is tracking and speaking out in support of multiple pieces of legislation at various stages of consideration, all of which are consistent with the association's recently adopted public policy priorities.. [Editor's note: want to know how you can get involved in advocacy? Be sure to sign up for APTA’s PTeam, a vital grassroots link to APTA's work on Capitol Hill. All PTeam members receive a quarterly newsletter on legislative activity on Capitol Hill as well as Legislative Action Alerts on federal legislative issues. The alerts let you know when you to contact your members of Congress on particular issues of concern to your patients and the physical therapy profession.] These include: IDEA Full Funding Act (HR 1878/S 866). This bill would increase spending over the next decade to bring the federal share of funding for special education up to 40%, the amount committed when the law was first enacted in 1975. Critical Access Hospital Relief Act of 2019 (HR 1041/S 586). This legislation repeals the 96-hour physician certification requirement for inpatient critical access hospital services under Medicare. Lymphedema Treatment Act (HR 1948/S518). The bill provides for the coverage of lymphedema compression treatment items under Medicare. Disability Integration Act of 2019 (HR 555/S 117). The proposal would prohibit discrimination against individuals with disabilities who need long-term services and supports. Home Health Payment Innovation Act of 2019 (S 433). The bill would require Medicare to implement adjustments to home health reimbursement rates only after behavioral changes by home health agencies that affect Medicare spending actually occur, instead of assuming changes might happen. Community and Public Health Programs Extension Act (S 192) This bill provides funding extensions for community health centers and the National Health Service Corps through 2024. Improving Access to Medicare Coverage Act of 2019 (HR 1682/S 753). The proposal would define an individual receiving outpatient observation services in a hospital as an inpatient for purposes of satisfying the 3-day inpatient hospital-stay requirement related to Medicare coverage of skilled nursing facility services. PHIT Act of 2019 (HR 1679/S 680). The PHIT (Personal Health Investment Today) Act would allow a medical care tax deduction for up to $1,000 ($2,000 for a joint return or a head of household) of qualified sports and fitness expenses per year. The bill defines "qualified sports and fitness expenses" as amounts paid exclusively for the sole purpose of participating in a physical activity, including fitness facility memberships, physical exercise or activity programs, and equipment for a physical exercise or activity program. Concussion Awareness and Education Act of 2019 (HR 280). This legislation provides for research and dissemination of information on sports-related and other concussions, and establishes a Concussion Research Commission. Mobile Health Record Act of 2019 (HR 1390) This bill requires CMS to establish a program that enables Medicare enrollees to connect claims data with "trusted applications, services, and research programs." The program must allow an enrollee to access claim information through a mobile health record application that is chosen by the enrollee and approved by CMS. Geriatrics Workforce Improvement Act (S 299). The proposed law would reauthorize the Geriatric Workforce Enhancement Program (GWEP), which provides grants to geriatric education centers to educate and train health care professionals in the care and treatment of older people. The bill would extend the GWEP for another 5 years, with authorized funding increased to $45 million per year. Home Health Care Planning Improvement Act of 2019 (HR 2150/S 296). This proposal would allow Medicare payment for home health services ordered by a nurse practitioner, a clinical nurse specialist, a certified nurse-midwife, or a physician assistant. Currently, coverage is provided only for services ordered by a physician. Rural Hospital Regulatory Relief Act of 2019 (S 895). The bill would create a permanent extension of instructions issued by CMS to not enforce the supervision requirements for therapeutic services provided to outpatients in Critical Access Hospitals and small rural hospitals. Those instructions are set to expire on December 31, 2019. Veterans' Access to Child Care Act (HR 840). This bill would provide child care assistance to veterans receiving certain medical services and includes a provision to include Deparmtnet of Veterans Affairs-provided physical therapy for a service-connected disability. Protecting Access to Complex Rehab Manual Wheelchairs Act (HR 2293). This proposal would permanently exempt complex rehab manual wheelchairs from the Medicare Competitive Bidding Program and also would stop Medicare from applying competitive bidding payment rates to critical components (accessories) of complex rehab manual wheelchairs for 18 months. There's more to come. APTA is awaiting introduction of key legislation later this summer that would expand the use of telehealth under Medicare to include physical therapy, and a bill that would add PTs as primary health care providers in community health centers. 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