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There could be a temporary reprieve in the works for the startup of the PTA payment differential — and a possible exemption for rural and underserved areas — thanks to a bipartisan bill introduced in the U.S. House of Representatives. APTA has been strongly advocating for congressional action to mitigate the proposed 15% reduction in Medicare payment for services delivered by PTAs and occupational therapy assistants.

The bill, called the Stabilizing Medicare Access to Rehabilitation and Therapy Act, or SMART Act (H.R. 5536), was introduced by Reps. Bobby Rush, D-Ill., and Jason Smith, R-Mo. (Read the press release issued from Rep. Bobby Rush’s office.) If signed into law the legislation would delay implementation of the payment differential until Jan. 1, 2023, and provide an exemption to the differential for rural and underserved areas. APTA and other advocates have criticized the differential for having a disproportionately harmful effect on patient access to needed therapy services in these areas.

The proposed legislation would also institute a change long-advocated by APTA: allowing for general supervision of PTAs in outpatient settings under Medicare Part B. Medicare currently allows for general supervision of PTAs by physical therapists in all settings — except for outpatient practice under Part B, which requires direct supervision. Currently 44 states allow for general supervision of physical therapist assistants, making this Medicare regulation more burdensome than most state requirements.

APTA offers a quick, easy way for individuals to contact their legislators to urge support of the bill by way of the APTA Patient Action Center.

"APTA has been urging CMS to implement these policy changes to mitigate the PTA payment differential," said Justin Elliott, APTA vice president of government affairs. "But now we need Congress to intervene. We're grateful to representatives Rush and Smith for their leadership on this legislation to ensure continued patient access to therapy services provided by PTAs."

Along with APTA, the legislation has been endorsed by a number of other provider and patient groups, which expressed their gratitude in a recent letter of support to the bill's sponsors.

In the letter, the groups note that the rehab therapy sector has yet to recover from the impact of the COVID-19 pandemic, writing that the differential "hits hardest where therapy assistants are needed most — in underserved areas in both rural and urban communities." The letter also points out that rehab therapy is an effective approach to the management of acute and chronic pain and a way of reducing or eliminating the use of opioids. "These treatment options will not be available if we do not have the therapy providers to furnish these services," the groups write.

"The legislation introduced is a beginning pathway to prevent the disruption in therapy services under Medicare to those that need it the most — a need that will only increase as our population ages," said David Harris, PTA, MBA, chief delegate of the APTA PTA Caucus "PTS and PTAs are critical to providing these skilled and much-needed therapy services, especially in rural and underserved areas, and continuous Medicare cuts only create roadblocks to quality patient care. I applaud this effort to protect patient access to these services."

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