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  • 9 Conversations to Have With Your Legislators While They're Back Home in August

    Members of the US Senate and House of Representatives are headed to their home states and districts during the August congressional recess, which means more opportunities to meet in-person and advocate for policies important to the physical therapy profession and its patients. And the timing couldn't be better, because it's been a particularly active year for the introduction of legislation that could affect physical therapists (PTs), physical therapist assistants (PTAs), and students on multiple fronts.

    Bottom line; there's lots to talk about. To help you prepare for that town hall, office visit, or random coffee shop encounter, here's a rundown of some of the top APTA-supported legislation to discuss with your congressperson. [Editor's note: for a listing of APTA's legislative advocacy targets, visit the association's Legislative Action Center; to receive information and legislative action alerts, sign up for PTeam and download the APTA Action App on your mobile phone.]

    You don't have to cover all 9 topics. But if you see any that resonate with you, your practice, or the patients and clients you serve, consider sharing your perspective with your legislators while they're back home.

    1. Let's bring care to where it's needed—and help relieve student debt
    It's called The Physical Therapist Workforce and Patient Access Act (S. 970 / HR 2802)—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. 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 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 is cosponsored by Sens Kyrsten Sinema (D-AZ), Kevin Cramer (R-ND), and John Boozman (R-AR). The House version was introduced by Rep Diana DeGette (D-CO) and John Shimkus (R-IL). That bill has 43 cosponsors.

    2. Let's strengthen care by increasing educational opportunities
    One of the association's strategic goals is to foster a physical therapy profession as diverse as the society it serves, and The Allied Health Workforce Diversity Act of 2019 (HR 3637) could add momentum to that effort. The proposed legislation would set aside money in the Health Resources and Services Administration specifically for use by accredited education programs in physical therapy, occupational therapy, audiology, and speech-language pathology. Those programs would in turn issue scholarships or stipends to students from underrepresented populations including racial or ethnic minorities and students from disadvantaged backgrounds including economic status and disability. The bill was introduced by Reps Bobby Rush (D-IL) and Cathy McMorris Rogers (R-WA).

    3. We can help the right care happen faster (while relieving administrative burden)
    The Improving Seniors' Timely Access to Care Act of 2019 (H.R. 3107), is aimed at improving access to health care for older Americans through, among things, reducing administrative burdens on providers—specifically by scaling back the use of prior approval. The bill was introduced into the US House of Representatives by Reps Suzan DelBene (WA), Mike Kelly (PA), Roger Marshall (KS), and Ami Bera (CA).

    4. Let's remove obstacles to skilled nursing facility care
    Current Medicare rules require a 3-day inpatient observation period before allowing a patient to be transferred to a skilled nursing facility (SNF)—an unnecessarily complicated and costly process. The Improving Access to Medicare Coverage Act (HR 1682/S 753) would ease that restriction by allowing for an individual receiving outpatient observation services to qualify under the same 3-day rule. The bill was introduced by Rep Joe Courtney (CT) in the House and by Sen Sherrod Brown (OH) in the Senate.

    5. We can respond to the student debt crisis
    In 2011, the Budget Control Act cut off graduate student access to federal direct subsidized loans, which tend to offer lower interest rates and more flexible repayment terms. The Protecting Our Students by Terminating Graduate Rates that Add to Debt (POST-GRAD) Act would end that ban. Rep Judy Chu (CA) introduced the bill, which is endorsed by APTA and a range of other professional and education groups. Cosponsors include Reps Peter DeFazio (OR), Jan Schakowsky (IL), Suzan DelBene (WA), Darren Soto (FL), Scott Peters (CA), Juan Vargas (CA), Grace Napolitano (CA), Raul Grijalva (AZ), Brenda Lawrence (MI), Julia Brownley (CA), Eric Swalwell (CA), Gwen Moore (WI), Derek Kilmer (WA), Dina Titus (NV), Linda Sanchez (CA), and Barbara Lee (CA-13).

    6. Children with disabilities deserve full educational funding under the IDEA
    More than 40 years ago, Congress passed the Individuals with Disabilities Education Act (IDEA) to help ensure that children with disabilities received full educational opportunities, but it never lived up to its funding promise that the federal government would pay 40% of the additional cost to educate IDEA-eligible students. The IDEA Full Funding Act (S 866 / HR 1878) would mandate that level of funding. The bill was introduced in the Senate by Sen Chris Van Hollen (MD) and in the House by Rep Jared Huffman (CA). The House bill has 113 cosponsors; the Senate version has 10.

    7. We can improve home health
    Two separate legislative efforts are focusing on different areas of home health.

    The Home Health Payment Innovation Act (S 433 / HR 2573) aims to shore up a potential source of instability in the new Patient-Driven Groupings Model payment system set to begin in 2020 by requiring the US Centers for Medicare and Medicaid Services (CMS) to base payment adjustments on provider data. That's different from the system as proposed, which would use "behavioral assumptions" as the basis for adjustments. APTA and other supporters of the legislation view the proposed approach as arbitrary and potentially harmful to patient access to care. The bill was introduced by Sen Susan Collins (ME) in the Senate and by Rep Terri Sewell (AL) in the House.

    The Home Health Planning Improvement Act (S 296 / HR 2150) is designed to eliminate an overly restrictive requirement in the way patients are deemed eligible for home health care—namely, by loosening up a rule that limits eligibility certifications to physicians only. Instead, the legislation would permit nurse practitioners, physician assistants, and other advanced practice nurses to certify Medicare beneficiary eligibility for home health services. The bill was introduced by Sen Susan Collins (ME) in the Senate and by Rep Janice Schakowsky (IL) in the House.

    8. Medicare should do more around lymphedema
    As unbelievable as this sounds, Medicare currently doesn't cover compression treatment items for beneficiaries with lymphedema. The Lymphedema Treatment Act (S 518 / HR 1948) would change that. The bill was introduced in the Senate by Sen Maria Cantwell (WA) and has 62 cosponsors. Its companion bill was introduced in the House by Rep Janice Schakowsky (IL) and has 311 cosponsors.

    9. Patient choice is important
    It's 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.

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    • Could you also include cosponsor H.R. 2293/S. 1223 and H.R. 2408 This legislation is needed to protect access for people with significant disabilities who rely on Complex Rehab Technology (CRT) - ie custom manual and power wheelchairs. For more information see www.protectmymobiltiy.org Thank you!

      Posted by Cathy Carver -> =MY[=L on 8/1/2019 11:27 AM

    • You need to make sure that PTs realize PIMA only covers urban areas it is very misleading to give the impression that it affects all PT’s.

      Posted by Jay Shaver on 8/1/2019 2:57 PM

    • Jay, Did you mean to say “PIMA?” This is legislation related to loopholes that allow physicians to make financial gain via their PT referral patterns. My apologies if I’m wrong, but I believe you were referring to “The Physical Therapist Workforce and Patient Access Act.” I also believe you meant rural, rather than urban. Yes, this legislation is only for PTs working in HSA (health shortage areas), but this is the whole justification for the bill: incentivize PTs to work in areas where they are most needed. I can’t see any motive to provide debt relief for PTs in general, unless you argue that there is a significant shortage of PTs in all settings that would justify investing in discharge of student loan debt for all PTs to incentivize more people to pursue careers in PT. It would be necessary to explain the fairness of this approach to those who have self-financed their PT education; perhaps, basing debt discharge on financial need at time of study in a manner similar to Pell grants? This would be complicated by virtue of being a retrospective approach which would complicate the finacial qualification process.

      Posted by Bill on 8/17/2019 8:46 AM

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