Some major advocacy pushes for the profession are getting attention: A bipartisan bill introduced into the U.S. House of Representatives targets several big legislative issues being worked on by APTA, including a proposed severe cut to Medicare payments and permanent continuation of physical therapy delivered via telehealth. If adopted and signed into law, the legislation could mark a major win for the profession and its patients.
Known as the Outpatient Therapy Modernization and Stabilization Act (H.R. 7154), the legislation covers a lot of ground and already has received solid bipartisan support in the House. The bill was introduced by Reps. Brendan Boyle,D-Penn., and Vern Buchanan, R-Fla.
Here are the issues covered in the legislation.
A Reprieve From Damaging Medicare Cuts in 2021
The legislation prevents proposed steep cuts to Medicare in 2021 by providing a one-time exemption from budget neutrality rules. That's important, because CMS is citing those constraints as the reason it's planning on cutting payment for more than three dozen professions to offset the cost of increases to the office/outpatient Evaluation and Management codes, known as E/M codes, used primarily by physicians. The cuts would take the form of payment reductions to codes commonly used by other professions, with physical therapy, occupational therapy, and speech-language pathology projected to receive an estimated 8% cut. The bill would give CMS a one-year exemption from budget neutrality rules around the office/outpatient E/M code increases.
A Permanent Policy Solution on Telehealth for Therapy
If signed into law, the legislation would permanently allow PTs, OTs, SLPs, and facilities that provide outpatient therapy to bill Medicare for outpatient therapy services furnished via telehealth. Early on in the COVID-19 public health emergency, CMS enacted waiver provisions that ultimately led to telehealth allowances for therapy, but those permissions are set to expire when the public health emergency ends (no word yet on when that will be). A permanent change in telehealth policy is beyond the authority of CMS, hence the need for legislative action.
Small Boosts in the Fee Schedule Through 2023
Also included in the bill: a series of adjustments to the Medicare physician fee schedule conversion factor, a change intended to help providers recover from the COVID-19 pandemic. Beginning in 2021, those adjustments would trigger a 1% increase in payment, followed by 0.5% increases in 2022 and 2023. Currently there are no scheduled increases in the fee schedule conversion factor until 2026, when conversion factors will be based on whether the clinician is participating in the Merit-based Incentive Payment System or an Advanced Alternative Payment Model.
Some Administrative Burden Relief
The legislation would make paperwork a little less onerous by clarifying that either a physician referral or a certified plan of care is required for Medicare-covered outpatient therapy services — but not both. Currently, therapists who treat Medicare beneficiaries also must obtain certification of the patient’s plan of care within 30 days of the first date of treatment, even if an order is present in the medical record.
APTA will share new information as it becomes available, including opportunities to advocate in support of the bill.