MEDICARE PAYMENT REFORM

Medicare payment reform has been heating up on Capitol Hill. There is talk that there could be a draft proposal possibly released later this summer from a special senate workgroup, comprised of six senators (three Republicans and three Democrats), on a package of first steps toward Medicare payment reform. APTA was invited to a roundtable with the senate workgroup in May. We outlined the various challenges that physical therapy is currently facing, not only with decreased payment and inflationary pressures but also the need to reduce administrative burden and paperwork, as well as the need to provide support and flexibilities to address the current workforce challenges.

Policy Principles for Outpatient Therapy Reform under the Medicare Physician Fee Schedule (apta.org)

PRIOR AUTHORIZATION

 APTA-supported legislation is being reintroduced in the U.S. Congress in June to address the issue of prior authorization. The Improving Seniors’ Timely Access to Care Act is bipartisan legislation that will tackle the overuse and abuse of prior authorization by Medicare Advantage plans, which threatens access to patient care and increases provider administrative burden.

APTA-Backed Bill Supports Medicare Patients in Need of Orthoses, Prostheses

Medicare beneficiaries who require orthotics or prosthetic devices could find it easier to access care while being better protected from fraud if APTA-supported legislation now on Capitol Hill makes its way into law. In addition to sparing patients from being required to see many providers and prohibiting direct-to-consumer “drop shipping,” the bipartisan bills, introduced in both the U.S. Senate and House of Representatives, would also make it easier for beneficiaries to receive replacement devices when they need them. Known as the Medicare Orthotics and Prosthetics Patient-Centered Care Act (S. 3977/H.R. 5315), the legislation is designed to eliminate loopholes and burdensome regulations that make it more difficult — and riskier — for patients to acquire needed equipment.

 APTA SUPPORTED BILLS

Text – H.R.2474 – 118th Congress (2023-2024): Strengthening Medicare for Patients and Providers Act | Congress.gov | Library of Congress

Position Paper: EMPOWER Act | APTA

Position Paper: Remove Duplicative Unnecessary Clerical Exchanges Act | APTA

APTA Legislative Update – 118th Congress Bill Status

Contact our Federal Affairs Liaison, Amanda Packard

One way that you can easily advocate and take an active role in the PT profession at the federal and state level is to download the APTA Action app.  While we encourage everyone to support the PT profession through their membership with APTA, you do not need to be an APTA member to use the app and have a voice.  Taking action via the app typically takes 1-2 minutes and has the latest information on legislation that affects you.  Below is the link to download the app:

https://apps.apple.com/us/app/apta-action/id727008540   

Payment and Legislative Updates

Advocacy Makes a Difference!!! Please join us in asking members of congress to cosponsor the Empower Act and support PTAs.

Medicare permits general supervision of physical therapist assistants by physical therapists in all settings — except for outpatient private practice under Part B, which requires direct supervision. Physical therapists and physical therapist assistants are governed by their state’s practice act and must follow their state licensure requirements if they are more stringent than Medicare’s. However, 49 states permit “general supervision” of physical therapist assistants in outpatient practices, making Medicare’s direct supervision requirement in that setting more burdensome than most state licensure requirements.

Please use the link below to add your voice by connecting to your congressional representatives and asking for their support. The link below will take you to the APTA Patient Action Center. Thank you in advance for taking action to further our profession and support PTAs.

https://www.apta.org/advocacy/take-action/patient-action-center

Contact APTA NH Board Member, Tracie Adams

State Legislative

The NH state legislature is in session and actively working through hundreds of proposed bills.  APTA NH has been closely following many of these bills and at this point in the session were are down to following about 20 bills. This month, we would like to highlight one bill in particular that could have a potentially significant impact on physical therapy practice in NH.

HB1676-FN: Establishing a Sunset Commission to Evaluate Various Occupational Boards and Commissions, and Sunsetting Various Boards and Commissions.  In its current form, this bill could convey the legislative authority to “sunset” a significant number of professional boards, including the Physical Therapy Governing Board in 2030. 

The protection of our patients is paramount.  This bill could alter the ability for therapists to practice critical self-governed oversight.  There is no entity better positioned to oversee the appropriate application of the education, training and conduct of physical therapists and physical therapist assistants in the State of NH than a board of our peers, the Physical Therapy Governing Board. 

Shortly, APTA NH will be asking for you to join us in opposing this bill through communication and outreach to your NH representatives. If you haven’t already, this is a great time to download the APTA Action App that will afford access and information related to important issues affecting the physical therapy profession in our state. 

Finally, pertaining to the recent correspondence from OPLC that updated the regulations surrounding continuing competence as part of license renewal, we are working with contacts at the state to determine a definitive answer regarding the acceptance of distance/online courses. 

For more information on this and other pending bills, go to www.nh.gov , put your cursor over the “Government” tab at the top of the webpage and click on NH State Legislature from the dropdown list.  You can enter bill numbers like the one above or do a keyword search for bills to access more information. Please feel free to reach out to us at www.nhapta.org for more information or to get involved.  

APTA NH State Legislative Committee contact, Mark Mailloux   

 Federal Legislation

Regulatory Review | Prior Authorization Win: CMS Finalizes Tighter Payer Rules | APTA 

Medicare Fee Schedule 

APTA Patient Action Center | APTA

*Use this link to get to the APTA Patient Action Center or the Legislative Center.

Articles of Interest:

 2023 Year in Review | APTA

News | 2024 Fee Schedule Calculator Now Available to APTA Members | APTA

Perspective | A Closer Look at the New Medicare Advantage Rule: Coverage Criteria and Prior Authorization | APTA

Contact our Federal Affairs Liaison, Amanda Packard