Legislative & Advocacy Highlights | January 2025

FAL Briefing Memo January 2025

Commercial Payers

• UHC MA Prior Auth: On January 8, 2025, UnitedHealthcare (UHC) updated the prior authorization requirement for physical, speech and occupational therapy and chiropractic services that became effective Sept. 1, 2024, for UnitedHealthcare Medicare Advantage individual and group retiree members. UHC announced in August 2024 that it was expanding prior authorization requirements within certain plans for follow-up PT visits when services are provided in office and outpatient hospital settings, effective Sept. 1, 2024. APTA aggressively advocated against this policy change, including multiple meetings with UHC, as well as with CMS. The January 8, 2025, revision of UHC’s Medicare Advantage prior authorization requirements will now allow for an initial 6 visits without conducting a clinical review.
  The change applies to new authorization requests starting on or after Jan. 13, 2025. Up to six visits of a member's initial plan of care will be covered without UHC conducting a clinical review when the first six visits take place within eight weeks. Only plans of care requesting more than six visits or exceeding eight weeks will be assessed for medical necessity. The initial consultation still does not require prior authorization.
  While this is a step toward ensuring that early access to services is not disrupted, it did not go far enough in removing the burdensome prior authorization process or guaranteeing seniors all the care they were promised under the Medicare program.
  Announcement: Medicare Advantage: Updates to prior authorization requirement for outpatient therapy and chiropractic services | UHCprovider.com
  FAQs: Changes to prior authorization requirement for Medicare Advantage outpatient therapy services Jan. 2025 - UnitedHealthcare Medicare Advantage plans

U.S. Congress 

• Telehealth Extension: On Dec. 19, 2024, the U.S. House of Representatives passed a slimmed down year-end legislative package to fund the federal government until March 14, 2025. The U.S. Senate subsequently passed the bill, and President Biden signed it into law on Dec. 20. The package included an extension of telehealth flexibilities that were set to expire on Dec 31. PTs can continue to provide telehealth services until March 31, 2025. An extension for telehealth for the remainder of 2025 or later will be on the table for inclusion in the March 2025 congressional package.
• 119th U.S. Congress: The 119th U.S. Congress was sworn in on Friday, January 3, 2025. Republican Rep. Mike Johnson of Louisiana won reelection as speaker of the House on Friday, emerging victorious after a pair of GOP members switched their votes to deliver him a majority and open the 119th Congress. Lawmakers are tackling controversial cabinet nominations and a reconciliation package -- or packages -- to advance incoming President Donald Trump’s immigration and tax priorities, with key decisions on the Affordable Care Act tax credits and potential Medicaid cuts hanging in the balance. They also must craft a spending package before government funding and a slate of health extenders expire March 14, 2025. How lawmakers plan to deal with additional health policies included in a package leadership agreed to in mid-December before it was scuttled by Elon Musk and excluded from December’s skinny Continuing Resolution is unclear.
• 119th U.S. Senate: The Senate Finance Committee is set to see five new Democratic members including Senators Ben Ray Lujan (D-NM), Tina Smith (D-MN), Rev. Raphael Warnock (D-GA), and Vermont Sens. Bernie Sanders (I) and Peter Welch. On the Republican side, Kansas physician Roger Marshall is set to join the committee. The Senate Finance Committee will be chaired in the 119th Congress by Sen. Mike Crapo of Idaho, with Sen. Ron Wyden (D-OR) serving as Ranking Member. For the Senate Health Committee (HELP) three newly elected Democratic senators have been appointed to the committee: Andy Kim (NJ), Angela Alsobrook (MD), and Lisa Blunt Rochester (DE). On the Republican side Senators Tim Scott (SC), Josh Hawley (MO), Jim Banks (IN), Crapo, and Marsha Blackburn (TN) will be joining the HELP Committee. The Senate HELP Committee will be chair by Sen. Susan Collins (R-ME), with Sen. Bernie Sanders (I-VT) serving as Ranking Member.
• 119th U.S. House: Rep. Brett Guthrie (R-KY) is the new Chair of the House Energy & Commerce Committee; Rep. Frank Pallone (D-NJ) will serve as Ranking Member. Rep. Buddy Carter (R-GA) is set to be the new Chair of the House Energy & Commerce Committee’s Subcommittee on Health, with Rep. Diana DeGette (D-CO) serving as Ranking Member.

Federal Agencies

• Telehealth Billing: On Dec. 19, 2024, Congress extended telehealth flexibilities under the 
  Medicare program until March 31, 2025. CMS is communicating to the Medicare Administrative 
  Contractors regarding telehealth claims processing. Therapists who bill telehealth services 
  should be on the lookout for communications from their MAC.  

Advocate Engagement Opportunities

• Public Policy Priorities, 2025-2026: The next edition of the APTA Public Policy Priorities, 2025-
  2026, will be rolled out to members, policymakers, and the public beginning the week of 
  February 3, 2025. Hard copies will be available at the PT-PAC booth at CSM 2025 in Houston, TX. 

APTA Articles of Interest 

• APTA National Advocacy Dinners | APTA
• UHC Lessens Prior Authorization Burden for PT Visits Under Many MA Plans | APTA
• 2025 Medicare Fee Schedule Calculator Now Available to Members
• Top APTA News Articles of 2024 | APTA
• Congress Scrambles to Pass Year-End Legislation to Fund the Government | APTA
• Medicare's New Exception to the Plan of Care Certification Requirement | APTA
• How Do Physicians Perceive Physical Therapy? We Asked Them | APTA

Author: Kim Parker-Guerrero, PT, DPT, APTA Pelvic Health Director of Practice