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March 11, 2022: Beating a March 11 deadline by one day, Congress approved a $1.5 trillion spending package that will fund the federal government through Sept. 30. Support for the plan was bipartisan in both chambers, with the House of Representatives passing the legislation by wide majorities, and the U.S. Senate approving the measure 68 to 31, with 18 Republicans siding with all Democrats in the vote. The package is headed to the desk of President Joe Biden, who is expected to sign it.

Major media outlets such as the New York Times, The Wall Street Journal, and Reuters have published overviews of the entire package, which includes $13.6 billion in aid for Ukraine, reauthorization of the Violence Against Women Act, and $782 billion in military spending, among other provisions. Here are some facets of the package of special interest to the physical therapy community.

The SMART Act wasn't included (but that doesn't mean the fight is over).
Despite bipartisan support and pressure from multiple professional and patient advocacy organizations including APTA, legislation that aims to address the PTA and occupational therapy assistant payment differential was not included in the final package. The Stabilizing Medicare Access to Rehabilitation and Therapy Act — SMART, for short — would pause the payment differential until 2023, create a permanent exemption for rural and underserved areas, and relax direct supervision requirements for PTAs under Medicare.

While advocates for the bill were disappointed that the legislation was not part of the spending plan, the SMART Act remains on the table for consideration by Congress, according to APTA Vice President of Government Affairs Justin Elliott.

"The reality is that H.R. 5536, The SMART Act, still exists as a piece of legislation and continues to gain cosponsors, which means we will continue to press for its passage through this session of Congress," Elliott said. "Our push to preserve patient access to needed care and ease administrative burden is far from over, and there will be other opportunities this year to advance the bill."

Telehealth for PTs and PTAs lives on.
In a significant piece of good news, the package includes a provision that allows PTs to continue providing services via telehealth under Medicare for an additional five months past the end of the public health emergency. Prior to the pandemic, therapists were not included in the list of authorized providers under Medicare to provide services via telehealth, but those restrictions have been temporarily waived as part of the health emergency.

Along with including PTs, occupational therapists, speech pathologists, and audiologists as telehealth providers, the 151-day extension also applies to relaxed requirements around where patients and providers must be located for telehealth services. During the emergency, rules were changed to include telehealth services to Medicare beneficiaries in their homes and across all geographic regions.

Elliott says the extension has an additional benefit — namely, it allows extra time for advocates to make the case for the temporary telehealth provisions to be made permanent, and for PTs and PTAs to continue to demonstrate their effectiveness as telehealth providers.

"Indications are that the public health emergency could end as early as July, which would mean that the five-month extension would stretch into mid-December of 2022," Elliott said. "The extra time gives us a significant opportunity to continue to build momentum and support around making telehealth permanent for PTs and PTAs under Medicare."

Elliott adds that the push for permanent change also could be helped along by another provision in the package that requires the Medicare Payment Advisory Commission to provide a report to Congress on how well telehealth worked during the pandemic.

Sequestration cuts will return — for now.
The spending package comes up short on another provision advocated by APTA and multiple other organizations including the American Medical Association and the American Nurses Association: the continuation of the temporary moratorium on federally mandated sequestration cuts. Lawmakers failed to extend the moratorium, paving the way for the return of the reductions, albeit in a phased-in approach that will levy a 1% cut in April before restoring the full 2% cut in July.

Supporters of the continued moratorium argued that it's too soon for sequestration to return and that the temporary relief provided since April 2020 in response to the pandemic — essentially a 2% payment increase — should continue until it's clear that the challenges caused by the pandemic are waning.

Elliott says that while it's possible that lawmakers could still reconsider this idea in future legislation, time is running out.

"Unfortunately, with the first phase of the sequestration returning in less than a month, it doesn't seem likely that the relief that dozens of provider groups pushed for will come to pass," Elliott. "This is just another indication that there's an even bigger problem that needs to be addressed by Congress — the entire physician fee schedule, which plainly isn't working for patients, providers, or the lawmakers themselves."

APTA and 95 other organizations underlined that sentiment in a recent letter to the chairs and ranking members of the Finance, Ways and Means, and Energy and Commerce committees in the Senate and House. The letter calls on lawmakers to address "systemic" issues that plague the fee schedule as well as the Medicare Access and CHIP Reauthorization Act's Quality Payment Program, which includes the Merit-based Incentive Payment System.

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