Federal Legislative Agenda

2018 Federal Legislative Update 

On February 9, 2018 the looming threat of a hard cap on physical therapy services under Medicare Part B was eliminated. Congress enacted a permanent solution to the problematic hard cap on outpatient physical therapy services under Medicare Part B, ending a 20-year cycle of patient uncertainty and wasteful short-term fixes.  APTA has worked tirelessly towards this effort.

However, it’s not all good news. Congress chose to offset the cost of the permanent fix (estimated at $6.47 billion) with a last-minute addition of a payment differential for services provided by physical therapist assistants (PTAs) and certified occupational therapy assistants (COTAs) compared with payment for the same services provided by physical therapists (PTs) and occupational therapists (OTs), respectively. The payment differential, which was strongly opposed by APTA and other stakeholders, states that PTAs and OTAs will be paid at 85% of the Medicare physician fee schedule beginning in 2022.  While this is somewhat comparable to the payment differential between physician assistants and physicians, it was not part of the 2017 bipartisan agreement legislators had reached in 2017 and was not part of the discussions or negotiations on Capitol Hill prior to February 8, 2018.

“Stopping the hard cap is a victory for our patients, and for our dedicated advocates,” said APTA President Sharon L. Dunn, PT, PhD, board-certified orthopaedic clinical specialist. “For 2 decades we have held back the hard cap through repeated short-term fixes—17 in total—that were achieved each time only through significant lobbying efforts by APTA and other members of the Therapy Cap Coalition. In that time, the hard cap was a genuine and persistent threat to our most vulnerable patients, a threat we saw realized earlier this year when Congress failed to extend the therapy cap exceptions process. Today that threat has been eliminated.”

Dunn said the January 1, 2022, implementation date for the opposed PTA payment cut provides time to explore solutions with the Centers for Medicare and Medicaid Services (CMS) as it develops proposed rules.

“APTA will leverage its congressional champions, the APTA Public Policy and Advocacy Committee, and the PTA Caucus on strategies to address the CMS activities,” Dunn said. “Our collective efforts will drive the association’s work to ensure that guidance to implement the new policy is favorable to PTAs and the profession, while ensuring access is not limited for those in need of our services.”

Here are the highlights of provisions included in this new policy:

  • Claims that go above $2,010 (adjusted annually) still will require the use of the KX modifier for attestation that services are medically necessary.
  • The threshold for targeted medical review will be lowered from the current $3,700 to $3,000 through 2027; however, CMS will not receive any increased funding to pursue expanded medical review, and the overall number of targeted medical reviews is not expected to increase.
  • Claims that go above $3,000 will not automatically be subject to targeted medical review. Instead, only a percentage of providers who meet certain criteria will be targeted, such as those who have had a high claims denial percentage or have aberrant billing patterns compared with their peers.
  • For home health, the deal includes positives related to rural add-ons, a market basket update increase of 1.5% in 2020, and use of home health medical records for determining eligibility. However, it also requires a switch from a 60-day to a 30-day episode in 2020 and eliminates the use of therapy thresholds in case-mix adjustment factors.

Read more here: http://www.apta.org/PTinMotion/News/2018/02/09/TherapyCapRepeal/

Want more quick tips about this new legislation? Read here: http://www.apta.org/PTinMotion/News/2018/02/16/BudgetDeal5Things/



APTA’s Action App brings Advocacy to your fingertips! Available in both the Apple and Google Play App Stores, it allows you to donate to the PT-PAC, find out about current issues and includes talking points to contact your legislators, along with their contact info.  Grassroots tools have never been easier! Check out this app and the APTA News app on your phone or tablet today! 

Sign up for PTeam on the APTA website at: http://www.apta.org/PTeam/. You’ll receive a quarterly newsletter on legislative activity on Capitol Hill and Legislative Action Alerts on Federal legislative issues. Through the alerts, we ask you to contact your Members of Congress on particular issues of concern to your patients and the physical therapy profession.

Want to become a better advocate for your profession? Check out the videos on http://www.apta.org/Advocacy/Involvement/Tools/ and other resources offered. Reach out to your Federal Affairs Liaison Ami Faria PT, DPT for support as well: ami.faria@genesishcc.com.



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