By Gail Zitterkopf, PT,DPT, CLT, CKTP
The American Physical Therapy Association holds an annual Federal Advocacy Forum to update physical therapists on Medicare and Medicaid billing, train them in lobbying skills, and learn new technologies.
The 2016 forum drew nearly 260 therapists to Washington, DC, April 3-5 to learn about and educate legislators and Capitol Hill staff on three main issues: (1) a Therapy Cap Repeal; (2) the Physical Therapy Workforce and Patient Access Act (including student loan forgiveness); and (3) Medicare Locum Tenens (allowing a therapist to cover the work of a therapist out on family or medical leave, vacation, or other reasons in a private practice). The following are highlights of each. More specifics can be located in the APTA Advocacy app (downloadable from www.apta.org/advocacy) or on APTA’s Advocacy website at www.apta.org/advocacy
Medicare Access to Rehabilitation Services Act (S. 539/H.R. 775)
On April 15, 2015, the U.S. Senate passed the Medicare Access and CHIP Reauthorization Act (H.R. 2) legislation to repeal and reform the Sustainable Growth Rate (SGR) formula. The act extends the Medicare therapy cap exceptions process through December 31, 2017, with provisions to allow CMS to better target manual medical reviews.
Last year, 58 Senators supported the Cardin/Vitter Amendment to the SGR legislation to fully repeal the Medicare therapy cap ; this would permanently remove the arbitrary $1,920 therapy max on Medicare patients. Despite falling short by two votes, the effort showed the broad bipartisan support for this patient access issue.
Although we made the greatest progress in the last 18 years, APTA believes this was a missed opportunity for a long-term solution and puts beneficiaries at further risk when the extension expires December 31, 2017. Thus, therapists asked representatives to co-sponsor legislation to repeal the Medicare therapy cap, since the therapy cap is arbitrary and does not take clinical condition into account. Sadly, the therapy cap affects those who need therapy the most.
Prior to the forum, there were 223 co-sponsors in the U.S. House of Representatives. APTA members’ legislative visit to Capitol Hill resulted in positive movement, with 22 new cosponsors added to the three main bills: therapy cap, locum tenens, and student loan repayment.
Please communicate your support for this bill to your elected officials! Form letters can be found on the PTaction app (on your mobile device) or online in the Legislative Action Center, http://www.apta.org/TakeAction/.
Physical Therapist Workforce and Patient Access Act (H.R. 2342/S. 1426)
This bill would include physical therapists in the National Health Service Corps (NHSC) and is legislation that matches the corps’ goals and mission . Basically, it would help alleviate demand on other primary care providers to increase those served by providing greater patient access to rehabilitation, which is currently not part of the program.
The NHSC allows medical service providers to apply to work in an underserved rural area; in exchange, the corps will provide up to two years of loan forgiveness. The NHSC has an 82% retention rate (PTs who go to work in these areas often remain in these areas), which would help meet the workforce needs of underserved areas. Demand for physical therapy continues to grow faster than other primary care disciplines. Most importantly, this legislation is budget- neutral, e.g., it does not cost the government nor taxpayers any money!
Prevent Interruptions in Physical Therapy Act (H.R. 556/S. 313)
This legislation allows physical therapists to enter into locum tenens arrangements under Medicare . Under current law, private practice PTs participating in the Medicare program are not able to bring in another licensed physical therapist to their professional practices when they are temporarily absent due to illness, pregnancy, vacation, or continuing medical education.
Currently, physicians are able to bring a provider who is certified by Medicare in their practice to cover for them during such absences. Without this agreement the therapist must choose between providing free care to the patient or placing the patient’s care on hold during the absence.
Locum tenens arrangements benefit both patients and providers, since care is continued short-term by another licensed qualified provider. Because rural areas have a greater density of private practices, local tenens disproportionately affects rural areas, where there are greater shortages of providers . An interruption in PT care can lead to patient regression and higher costs to the health care system over time.
AUTHOR: Gail Zitterkopf, PT,DPT,CLT, CKTP, is the Section’s Federal Government Affairs Chair.