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Calling current rules "bad policy," a group of eight members of the U.S. House of Representatives is pushing for an influential House subcommittee to address Medicare's burdensome supervision requirements for PTAs and occupational therapy assistants in outpatient private practice settings. Specifically, the lawmakers are calling for an end to direct supervision requirements in favor of general supervision — the type permitted in every other setting covered under Medicare.

Led by Rep. Bobby Rush, D-Ill., the house members drafted a letter to leaders of the House Subcommittee on Labor, Health and Human Services, Education, and Related Agencies requesting that the subcommittee make it clear that when Congress set out parameters of supervision requirements under Medicare, it intended to create a level playing field.

That's not the case now. For all settings except outpatient, Medicare permits general supervision of PTAs and OTAs, an approach that gives supervisors more latitude such as non-face-to-face interactions. PTAs and OTAs in private practice settings, on the other hand, are required to receive direct supervision, a more complicated, time-consuming approach that pulls both the assistant and the supervisor away from actual patient care.

In the letter, the lawmakers characterize the tighter supervision requirements as a change "imposed unilaterally" by the U.S. Centers for Medicare & Medicaid Services, and one in conflict with the agency's own enabling statute. Making matters worse, they add, the policies "are impeding timely access to outpatient care … and imposing additional costs on therapy providers."

"The current Medicare supervision policies in the private practice settings are harmful to Medicare beneficiaries' long-term functional outcomes and quality of life," the letter states. It later adds that the change would "better promote unrestricted, timely access to physical and occupational therapy interventions."

The Same Concept Is Part of a Bill Addressing the PTA Differential

The push for the supervision change isn't a new one: The same idea is included in APTA-backed legislation introduced in the House that seeks to correct serious deficiencies in a Medicare rule, implemented this year, that imposes a 15% payment differential for services delivered by a PTA or OTA.

Known as the Stabilizing Medicare Access to Rehabilitation and Therapy Act, or SMART Act (H.R. 5536), the legislation sponsored by Rush and Jason Smith, R-Mo., would not only require the general supervision shift, but would also delay implementation of the payment differential for a year, and create exemptions for rural and underserved areas. The legislation doesn't eliminate the differential system — something CMS claims it is statutorily bound to do — but does soften some of its effects. APTA and multiple other provider and patient organizations continue to advocate for the legislation, which remains in play on Capitol Hill.

The recent letter supporting the supervision change helps to shine a light not only on the SMART Act, but on the broader issue of unreasonable administrative burden, according to Justin Elliott, APTA's vice president of government affairs.

"CMS repeatedly tells the public that it wants to decrease burdensome requirements that get in the way of care — here's a perfect opportunity to actually do something," Elliott said. "By simply adopting this common-sense change to a requirement that unfairly penalizes private practices, PTAs, OTAs, and their supervisors could devote more time to their patients with zero reduction in quality."


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