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.
Ending the Medicare therapy cap and repealing the flawed sustainable growth rate (SGR), contributing to a White House discussion on aging, supporting research on rehabilitation and child health, and staying on top of the latest issues in health care competition are all part of what is turning out to be a very busy week for APTA advocates and staff on Capitol Hill.
This week in Washington, DC, association representatives are bringing the profession's transformative vision for health care to multiple fronts by speaking with legislators and policymakers, and seeing to it that physical therapy has a place at the table for some of the most important discussions around the future of health care.
"The events happening this week are a fantastic opportunity for APTA to bring its message of the power of physical therapy to transform society," said Justin Moore, PT, DPT, APTA executive vice president of public affairs. "The association's vision is on point with many of the issues being discussed, and we're fortunate to have so many advocates who are passionate about sharing that vision. We're very excited about being able to contribute in these varied ways."
APTA is bringing its voice to:
In an APTA video dispatch recorded at the start of the week, Rockar described the current activities as part of a "really important week" that is allowing APTA to bring physical therapist issues to the fore. "If we're really going to transform society, we have to influence and educate people about policy that's going to help us provide care to our patients in this evolving health care environment," he said.
Terry Brown, PT, DPT, president of the PPS, stressed the importance of broad participation, both in-person and by way of participation through action alerts and other communications from PPS and APTA. "It's enormously important that other people get involved," Brown said. "We need each and every therapist at home to become involved."
There's more work to be done in Washington for the profession and the public it serves: make plans to join hundreds of other APTA members for PT Day on Capitol Hill, June 3–4. The event coincides with the 2015 NEXT Conference and Exposition being held in nearby National Harbor, but attendance at NEXT is not required for participation.
Legislation that recognizes the ability of physical therapists (PTs) to make return-to-play decisions for youth sports participants has been reintroduced in the US Senate and House of Representatives.
Called the Supporting Athletes, Families, and Educators to Protect the Lives of Athletic Youth Act (SAFE PLAY Act), S. 436/H.R. 829 was introduced by Sen Robert Menendez (D-NJ) and Reps Bill Pascrell (D-NJ) and Lois Capps (D-CA). Supporters, including APTA, believe the legislation could lead to better management and awareness of some necessary aspects of sports safety, including concussions among student athletes, their families, and their coaches.
In addition to including PTs among the health care providers qualified to make return-to-play decisions, the bill provides for education, awareness, action plans, training, and further research related to health issues associated with sports—including cardiac conditions, concussions, and heat advisories—in which PTs play a role.
The bill was first introduced in August 2014 but not taken up before Congress adjourned that year.
The SAFE PLAY Act calls for school districts to have concussion management action plans that teach students, parents, and school personnel how to prevent, recognize, and respond to concussions, including assistance in the safe return of student athletes to academic and athletic performance. The legislation encourages the development of guidelines consistent with those to be developed by the US Centers for Disease Control and Prevention's (CDC) Pediatric Mild Traumatic Brain Injury Guideline Work Group, a group supported by APTA that includes 2 APTA members.
Concussion prevention and management has been a particular focus of APTA over recent years, with the association advocating for continued support of the CDC work group as well as for other legislation addressing these injuries. APTA continues to educate policymakers on how PTs are qualified to detect and manage concussions. 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.
For information on federal and state legislation, and APTA's position on the role of physical therapists in concussion management, visit APTA's Concussions webpage. Find more resources on the Traumatic Brain Injury webpage, and direct patients and clients to the Physical Therapist's Guide to Concussion on APTA's MoveForwardPT.com consumer website.
The US Centers for Medicare and Medicaid Services (CMS) is using a revised manual medical review process that takes a stepped approach to Additional Documentation Requests (ADRs) for outpatient therapy claims over $3700. The new postpayment review system will allow Recovery Audit Contractors (RACs) to request documentation for increasing percentages of claims over time, beginning with 1 claim and advancing to 100% of remaining eligible claims by the fifth ADR issued, according to CMS.
The review process applies to outpatient physical therapy, occupational therapy, and speech language pathology claims that exceeded $3700 from March 1-December 31, 2014. The review of these claims had been temporarily halted due to delays in the transition to new RACs.
The new process, begun in mid-January of this year, doesn't alter the RAC cycle of 45 days between ADR letters, and prevents RACs from requesting review of a large percentage of a provider's claims at one time. Instead, it establishes a system that will enable RACs to review 100% of provider claims above the $3700 therapy cap within 5 cycles, depending on how many ADRs are sent to a provider during that period. The 100% review rate was mandated by Congress in 2014.
Essentially a 5-step process, the first ADR sent to a provider will focus on only 1 claim, but after that, RACs can request a gradually increasing percentage of claims for the second (up to 10% of total eligible claims), third (up to 25%), and fourth (up to 50%) ADR. The fifth ADR issued to a provider can cover 100% of the remaining claims.
The review process only applies to claims made by outpatient therapy facilities—for example, skilled nursing facilities, outpatient hospitals, rehabilitation agencies, and comprehensive outpatient rehabilitation facilities—and for the time being, is limited to claims handled by existing RACs during the March – December, 2014 time period. CMS has not yet finalized the process for new RACs, and for claims made in 2015.
APTA developed a resource that helps explain the new process (.pdf) in more detail and provides examples of how the new system works.
President Barack Obama has included a proposal to eliminate exceptions to physician self-referral laws in his 2016 budget released today, a change that the administration says would create savings of $6.02 billion over 10 years.
As in previous years, Obama is proposing the elimination of loopholes in the Stark law that prohibit referral to most in-office ancillary services (IOAS) under Medicare. The current law contains exceptions that allow physicians to refer patients for certain services—including physical therapy—to a business that has a financial relationship with the referring provider.
Elimination of the IOAS exceptions remains one of APTA's public policy priorities, and was the focus of wider attention late last year when the American Association of Retired Persons voiced its official support for restricting the practice.
The Obama proposal around IOAS was applauded by the Alliance for Integrity in Medicare (AIM) a coalition of organizations, including APTA, that has been advocating for an end to the exceptions. Other professions impacted by the current exceptions include anatomic pathology, advanced diagnostic imaging, and radiation therapy.
The $3.9 trillion budget proposal is on its way to Capitol Hill, where it is likely to meet with opposition in both chambers of Congress. APTA will continue to analyze provisions in the spending plan and inform its members of additional proposals that could impact the profession.
Find out more about the IOAS exceptions on APTA's self-referral webpage, and take action now by asking your legislators to close the self-referral loophole. Contact the APTA advocacy staff for more information.
The ability of physical therapists (PTs) in private practice to improve continuity of care for their patients is a step closer to becoming a reality: this week, companion bills were introduced in the US House of Representatives and the Senate that would extend so-called "locum tenens" provisions to PTs.
Known as the Prevent Interruptions in Physical Therapy Act (H.R. 556/S.313), the identical bills would allow a PT to bring in another licensed provider to treat Medicare patients and bill Medicare through the practice provider number during temporary absences for illness, pregnancy, vacation, or continuing medical education.
While current law extends locum tenens to doctors of medicine, osteopathy, dental surgery, podiatric medicine, optometry, and chiropractic, PTs in private practice must avoid absences or risk gaps in patient and client care.
The efforts are led in Congress by Reps Gus Biliraikis (R-FL) and Ben Ray Lujan (D-NM) in the House, and by Sens Charles Grassley (R-IA) and Bob Casey (D-PA) in the Senate. APTA and its Private Practice Section (PPS) collaborated on pressing for the legislation.
“This small but important technical correction to Medicare law is long overdue," said Terence Brown, PT, APTA Private Practice Section (PPS) president. "Even short interruptions in a Medicare beneficiary’s therapy can cause the patient to regress. For small or solo physical therapy practices across the country, this means Medicare beneficiaries can continue their treatment uninterrupted in pursuit of restoring their functional goals. PPS urges broad support for this change."
APTA has advocated for this issue as an easy technical fix bill that should be linked to larger Medicare reforms that are moving through congress. Achievement of locum tenens for PTs is one of the goals identified in the association's recently released list of public policy priorities.
Justin Moore, PT, DPT, APTA executive vice president of public affairs, characterized the bill as a good fit with the association's broad vision to transform patient access to care. ”Work on this legislation upholds the association’s commitment to eliminating unnecessary regulatory barriers," he said. "We will continue to identify ways for this and other policy priorities to gain traction in the 114th Congress.”
APTA will monitor the progress of the bills and post updates to its locum tenens webpage. Resources on the website include a podcast on the importance of this legislation and information on how PTs can get involved in advocating for its passage.
With the health care landscape evolving into a system built around patient-centered, coordinated care, APTA believes it's time that insurance laws catch up to ensure that networks provide the kind of coverage that will make this transformation possible.
The association delivered this message by way of comments to a draft managed care plan network adequacy model act (.pdf) developed by the National Association of Insurance Commissioners (NAIC). The model will be a template to help federal and state lawmakers and regulators develop changes to actual laws and regulations.
APTA's recommendations for the draft focus on real changes that counter some insurance company trends toward more narrow networks that make it difficult for consumers and patients to get the services they need. The APTA recommendations include:
The decision to revise the model—a document that hasn't changed since 1996—was driven by the Patient Protection and Affordable Care Act (ACA), which is built around care systems that are at odds with a growing number of narrow provider networks. The overhaul even extends to the name of the model, which will be released as the "Health Benefit Plan Network Access and Adequacy Model Act."
"The health care world is changing in ways that demand better patient access to a wide range of effective care, which clearly includes access to physical therapy," said Carmen Elliott, senior director of payment and practice management at APTA. "APTA's work with NAIC is aimed at helping to make this access not just possible, but a part of baseline standards for all consumers covered under insurance."
The association voiced the same network adequacy concerns to the US Centers for Medicare and Medicaid Services (CMS) in response to a proposed rule on payment parameters. That rule specifically stated that CMS was waiting to implement certain changes until after the final NAIC model was released.
The final NAIC model act is expected to be released later this year. APTA will continue to work with NAIC through the development process.
A true transformation of health care through reform can only occur if insurance networks provide adequate coverage—for more information on this issue, visit the webpage of APTA's Making Sense of Health Care Reform Series.
There may be some new faces and a shift in power in Congress, but APTA's commitment to advocacy for the transformative power of physical therapy will remain as strong as ever on Capitol Hill.
Tuesday, January 6, marked the opening day for the 114th Congress in the wake of a midterm election that shifted Senate power to the Republicans and solidified the party's hold on the House of Representatives.
APTA staff members were on Capitol Hill on opening day to meet with new and returning legislators and their staff, and to let lawmakers know that the association is committed as ever to working with congress on its bipartisan policy priorities.
"There is no better way to transform health care than by continuing to show the value that physical therapist services deliver, and the association plans to carry that message to the Hill every day," said Justin Moore, PT, DPT, chief public affairs officer for APTA. "We’re excited about engaging with the new Congress to move our priority issues forward."
APTA has refined its 2015 policy priorities and will release its list soon.
With changed dynamics in Congress, it is more important than ever for members to stay informed by joining APTA’s PTeam email list to receive updates and Action Alerts when members should contact their legislators on issues. In addition, PT-PAC has initiated a $20 campaign for APTA members, citing if every APTA member donated $20 each year, the physical therapy profession would have the largest health care provider PAC in the country. Learn more about this campaign here.
Elections have come and gone. Congress is reconvening this week. Many state legislatures are already in session, or will be soon.
So what does it all mean for physical therapists and physical therapist assistants?
APTA members can get the latest insights on the legislative scene during a free 90-minute webinar on Thursday, January 15, 2015, beginning at 2:00 pm. APTA staff experts will fill in listeners on legislative initiatives such as the Medicare therapy cap, self-referral, the sustainable growth rate, and congressional payment reform. Key state legislative initiatives such as fair copays, scope of practice, and direct access will also be discussed.
Members can register for free at the APTA Learning Center.
Coming soon: find out how APTA will approach advocacy for the profession when the association releases its 2015 policy priorities.
If you were intrigued by the 2014 McMillan Lecture on the future of physical therapist education, then you'll want to listen in as lecturer James Gordon, PT, EdD, FAPTA, joins colleagues Elizabeth Dumboldt, PT, EdD, FAPTA, and PTJ Editor-in-Chief Rebecca Craik, PT, PhD, FAPTA, in this new PTJ podcast that explores ways to strengthen academic physical therapy.
Gordon stated in his lecture that physical therapist education programs have a tripartite mission: education, research and scholarship, and clinical practice. These education programs form the core of academic physical therapy, which Gordon placed at the center of the profession's knowledge creation infrastructure. However, Gordon contended that too many education programs do not have research and scholarship as a core part of their mission, which threatens future knowledge creation and jeopardizes the profession's future. Questions to ponder: Can programs have a greater focus on education or clinical practice, or must there be a balance among all 3 parts of the mission? Is there evidence that faculty members engaged in research are better educators? Listen in to find out what these academic leaders think.
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