Skip to main content

New, proposed, and revised rules from the Centers for Medicare and Medicaid Services (CMS) can come in waves, and when they do, it's easy to feel awash in a sea of new regulations. Fortunately, APTA has resources to help you navigate your way to safe harbor: fact sheets that provide members with context and details on many of the final and proposed rule changes from CMS.

Here's a quick rundown of some recent additions. Note: the links will take you to a general webpage on a particular topic—to access the members-only fact sheet, scroll down to the "APTA Fact Sheets and Summaries" header.

Home Health Conditions of Participation Final Rule
CMS brought its home health participation rule out of the 1990s by issuing its first revision to the rule in more than 20 years. The new rule establishes minimum standards for home health agencies that want to serve Medicare and Medicaid beneficiaries.

Episodic Payment Model Final Rule
"Episodic payment" is CMS-speak for bundled payment systems. The new rule includes requirements for bundling programs related to cardiac care in 98 metropolitan areas, and expands the range of activities covered under the Comprehensive Care for Joint Replacement (CJR) model that required bundling for total knee and total hip arthroplasties.

Orthotics and Prosthetics Proposed Rule
This fact sheet covers a proposed rule from CMS that would include physical therapists (PTs) among the providers who could furnish and bill for custom orthotics and prosthetics—provided the PTs meet certain qualifications.

Medicaid Appeals Final Rule
CMS has added provisions to improve coordination between Medicaid, the Children's Health Insurance Program (CHIP), and health exchanges under the Affordable Care Act. In turn, the rules governing how consumers contest eligibility decisions have changed.

The latest APTA fact sheets join information on the 2017 physician fee schedule, outpatient payment, and home health payment. APTA regulatory affairs staff continually monitors developments at CMS and publishes fact sheets as new rules are proposed or implemented.

Need information on getting through Medicare fraud and abuse probes? Check out this APTA "flipped classroom" course on audits and review—listen to a prerecorded presentation, then join a live Q-and-A session on February 9 to get your questions answered.

You Might Also Like...


Online Event to Explore Report on Virtual MSK Care

Jun 10, 2024

Join us June 27 for a live online discussion on the recently released report confirming that virtual health technologies, when guided by a PT, deliver

Open Access

Improved Outcomes With PT-Guided Virtual MSK Care

Jun 5, 2024

The independent evaluation supports APTA’s position that digital physical therapy services only be performed or directed by licensed PTs.


PHTI's Report on Virtual Musculoskeletal Solutions Health Technology Assessment

Jun 5, 2024

The following statement was released today by American Physical Therapy Association President Roger Herr, PT, MPA.