Low participation among physical therapists (PTs), physical therapist assistants (PTAs), and their supporters could diminish legislator interest in permanent repeals of the therapy cap and sustainable growth rate (SGR) formula, which are set to be discussed in Congress. APTA urges its members to take any of the easy steps available to make their voices heard at this critical point in the process.
Though it only takes a few minutes to participate, only 1% of APTA members have joined the grassroots effort to date, and time is running out. The Senate Finance and House Ways and Means Committees will be discussing legislative framework for a permanent solution to the sustainable growth rate (SGR) formula next week. During these committee meetings, legislators will also be reviewing Medicare extenders, like the therapy cap. It is essential that a full repeal of the cap is included in the SGR packages.
Now is the time to contact legislators. If you are tired of the yearly extension system, you can help put an end to this unstable and unpredictable practice by taking action now. If the voices of PTs aren't strong enough, physical therapy could get lost in the shuffle of SGR reform.
Everyone can get involved and help ensure patient access to outpatient therapy services for the long term by e-mailing their legislators. APTA members can use the Legislative Action Center and patients/non-members can use the Patient Action Center. You can also take action from your smart phone by downloading the free APTA Action app.
After more than 2 years of work by APTA and the Maryland Chapter, the fee schedule for Maryland's Medicaid program has been expanded to include additional procedure codes directly related to physical therapy.
The additional CPT codes went into effect on December 1 for the Maryland Medical Assistance Program (MMA) and include a range of codes that more appropriately describe the services provided by physical therapists (PTs). Previously, the program's fee schedule was limited to 4 codes: PT evaluation, therapeutic exercise, unlisted therapeutic procedure, and manual therapy. APTA and the Maryland Chapter voiced concerns over the limitations of the codes.
The added codes will strengthen increased patient access to physical therapy services achieved through the expansion of Medicaid under the Affordable Care Act (ACA). The new fee schedule can be found in the MMA provider manual (.pdf). Editor's note: some users may have to click "cancel" and "ok" to access the document.
Physical therapists (PTs) who contract with Humana have been finding out about the managed care company's shift to the multiple procedure payment reduction (MPPR) policy the hard way—by being notified that they have to reimburse the company for payments they've already received. Humana has informed APTA that it plans on moving away from its practice of retroactive "overpayment recovery" and is working to fix errors in how the policy has been applied and calculated, but the insurer warns that it may be some time before all changes are in place.
Earlier this year, Humana began applying the MPPR policy on Medicare Advantage and commercial insurance plan payments for physical therapy, a change that resulted in reductions in payments to PTs. APTA wrote a letter (.pdf) to the company in early October outlining concerns over both the flawed MPPR policy and Humana's implementation of it. Among the concerns APTA voiced were issues around lack of provider notification, the burden placed on PTs through overpayment recovery, the inappropriate ways Humana applies MPPR on a per-visit basis, and inaccuracies in Humana's overpayment recovery calculations.
In its response letter (.pdf) to APTA, Humana acknowledged that it intended for the policy to be applied only to fee-for-service arrangements and identified 5 per-visit claims that it had incorrectly processed. The company also admitted that errors were made in MPPR calculations for some claims, and reported that it is reviewing all calculations and completing any corrections by the end of the year.
Humana described its overpayment recovery system as "not ideal" and wrote that "it takes time to make the necessary changes to apply this payment policy on initial claims processing." However, the company provided no timeline for when it would make the shift away from retroactive reductions.
APTA remains concerned about the administrative burden on providers subjected to MPPR through overpayment recovery instead of on initial payment and will continue to discuss this issue with Humana representatives in the coming weeks. Your direct experiences and documentation can support this discussion: send an e-mail to firstname.lastname@example.org with your name, member ID, and contact information for staff follow-up.
A full repeal of the Medicare therapy cap could become part of congressional discussions on the sustainable growth rate (SGR)—but your voice is needed now to ensure that the repeal remains a priority on Capitol Hill.
APTA has been meeting with the Senate Finance and House Ways and Means Committees to urge members to include a full repeal of the Medicare therapy cap in the SGR reform package currently under discussion. With less than 30 days until the expiration of the therapy cap exceptions process, grassroots involvement is more important than ever.
There are several easy ways to take action right away:
Legislators only have until December 31 to permanently repeal the cap or extend the exceptions process.
New APTA resources available online are helping members understand health care reform and giving them a way to communicate their experiences in this changed—and changing—landscape.
The association's efforts to keep physical therapists (PTs) and physical therapist assistants (PTAs) informed are centered at the Health Care Reform webpage, where members can access detailed information on the health insurance marketplaces, Medicaid expansion, new delivery models, payment changes, and program integrity efforts under the Affordable Care Act (ACA). Resources touch on everything from collaborative care models to managing a Medicare claims audit under the new law.
PTs and PTAs can also get a handle on how some of the components of health care reform affect physical therapy through APTA's Making Sense of Health Care Reform series. This set of articles highlights pressing issues including essential health benefits, "grace period" provisions, and the Small Business Health Options program. Each article provides background and explanation of the issue, implications and tips for practice, and links to more resources.
In addition to background and context, members can let APTA know how reform is affecting them by way of the APTA Feedback Form, a quick and easy way to share complaints, problems, and questions with association staff—and, when appropriate, with the Centers for Medicare and Medicaid Services (CMS). Feedback provided by PTs and PTAs will help to inform APTA's future advocacy efforts on these issues.
The Center for Medicare and Medicaid Services (CMS) is nearing its November 27 deadline for issuing rules on the 2014 Physician Fee Schedule, and APTA will be posting information on the provisions in the final rule impacting physical therapy as soon as possible after release.
In October, CMS announced that it would extend its deadline for release of the rules because of the 16-day government shutdown that began earlier that month. The rules will affect Medicare payment rates, payment policies for critical access hospitals, and procedures related to the Physician Quality Reporting System, among other areas.
APTA staff remains in close contact with CMS and will share information on the basics of the new rules as they are made available. More detailed summaries will be available through APTA in the days after the initial announcement.
The Centers for Medicare and Medicaid Services (CMS) is proposing that Medicare coverage be expanded to cover cardiac rehabilitation (CR) for patients with chronic heart failure (CHF).
The proposed CMS decision memo issued November 21 outlines the process that the agency took to research outcomes around CR. Counter to its 2009 finding that "there was little evidence in the existing literature that supported CR," the latest review conducted by CMS definitively concludes that "exercise intervention is beneficial and can be safely performed by selected patients with CHF."
APTA submitted comments that supported access to rehabilitation for CHF patients, but advocated that physical therapy be made available outside the CR program and covered under the existing Medicare outpatient therapy benefit. This allowance would ensure that patients with CHF "have access to the most clinically effective rehabilitation services at the appropriate time, in the appropriate setting, and by the most appropriate provider," according to the APTA comments.
CMS is accepting public comments on the proposed decision memo until December 21, 2013. APTA plans to submit additional comments on the proposal.
Legislation that would end the sustainable growth rate (SGR) will soon be discussed in a Senate committee, and grassroots efforts could play a big role in how that discussion takes shape. The Senate Finance Committee will be considering the proposed legislation on December 12, making the next 2 weeks a crucial time for communicating physical therapy's position on both SGR and the therapy cap to lawmakers and the public.
The advancement of the SGR legislation provides an opportunity for addressing the importance of also ending the therapy cap. APTA is calling on all physical therapists (PTs), physical therapist assistants (PTAs), students, patients/clients, and others to contact their legislators on Monday, December 2, and ask them to include a full repeal of the cap in the SGR legislation.
APTA recommends 2 ways to get involved in the efforts to fix these flawed policies that harm patients and restrict access to therapy services:
For more information about the grassroots campaign on December 2, e-mail email@example.com.
Members, patients, and supporters of physical therapy can now stay up-to-date on the latest legislative and regulatory news by downloading the free APTA Action app. The smartphone app was designed to help providers and patients stay engaged in APTA’s advocacy efforts and will be a valuable tool in grassroots efforts to end the therapy cap and fix the sustainable growth rate (SGR).
The APTA Action app allows individuals to:
The app debuts at a crucial time in the efforts to end the therapy cap and fix the SGR. APTA will launch the next grassroots push to stop the therapy cap on December 2, 30 days from the expiration of the exceptions process. Supporters who download the app and join PTeam by December 1 will be able to easily contact legislators on December 2 using the app's "Take Action" button.
The free app can be downloaded by searching “APTA Action” in the iTunes or Google Play stores. For more information about the APTA Action app and how to get involved in the Stop the Therapy Cap campaign, visit APTA’s grassroots webpage or e-mail firstname.lastname@example.org.
APTA wants to see where you use your APTA Action app. Take a photo using the app in fun, creative places and post it on Twitter using the hashtag #PTAdvocacy. Let’s get a photo from every state to show members across the country getting involved.
Important concussion legislation supported by APTA has been reintroduced in Congress. Developed with input from the association, the Protecting Student Athletes From Concussions Act (HR 3532) establishes guidelines around prevention, identification, treatment, and management of concussions in school-age children, and acknowledges the role that physical therapists (PTs) have in evaluating and treating these injuries.
The legislation has been reintroduced by Reps Tim Bishop (D-NY) and George Miller (D-CA), and would require states to implement concussion safety and management plans that include return-to-play requirements and academic supports. Additionally, the bill requires that any student who suffers a concussion be immediately removed from any participation in school sports until he or she receives a written release from a health care professional. Physical therapists (PTs) are explicitly listed as one of the professionals qualified to make these return-to-play decisions. APTA advocated for the legislation when it was initially introduced in 2011 and worked with members of Congress on the recent reintroduction.
Related work continues around the reintroduction of a similar piece of legislation, the Concussion Treatment and Care Tools Act (ConTACT) (HR 3113/S 1516) introduced by Sen Robert Menendez (D-NJ) and Rep Bill Pascrell (D-NJ). Though not passed into law when it was first introduced, the ConTACT bill helped to establish a workgroup within the Centers for Disease Control and Prevention (CDC) assigned to developing guidelines for mild traumatic brain injury (MTBI). APTA members Anne Mucha, PT, DPT, MS, NCS, and John DeWitt, PT, DPT, SCS, represent the role of PTs on the CDC workgroup.
The latest iteration of the ConTACT Act bill calls for the establishment of national guidelines drawn from the CDC workgroup recommendations on best practices for diagnosis, treatment, and management of MTBI in school-aged children. The legislation also provides for grants to help states implement these guidelines. APTA will continue to advocate for these pieces of legislation as opportunities arise to support the CDC workgroup recommendations and the role of the PT in concussion management.
APTA believes that concussion should be managed and evaluated by a multidisciplinary team of licensed health care providers that includes a PT and offers multiple resources. The association has developed policy resources at both state and federal levels, while practice-focused online concussion resources include a series of podcasts, a PT's guide to concussions, and access to evidence-based practice research through the PT Now webpage.
American Physical Therapy Association | 1111 North Fairfax Street, Alexandria, VA 22314-1488 703/684-APTA (2782) | 800/999-2782 | 703/683-6748 (TDD) | 703/684-7343 (fax)
Contact Us | For Advertisers & Exhibitors | For Media | Follow APTA
All contents © 2013 American Physical Therapy Association. All Rights Reserved.