On October 30th, the bipartisan CONNECT for Health Act (H.R.4932/S.2741) was introduced in both the House and the Senate.
 

This legislation seeks to lift current restrictions that providers, including physical therapists, face for coverage of care provided to Medicare beneficiaries via telehealth while also seeking to reduce the financial burden on Medicare by:

     - Allowing Medicare enrolled providers or suppliers to be reimbursed for care provided via telehealth when the quality of the care is the same or better and certain cost-effectiveness criteria met. This would enable Medicare enrolled physical therapists to provide qualifying care via telehealth.

     - Requiring HHS to review and improve the process for adding telehealth services to those which are covered by Medicare.  This could be a path that would enable physical therapists to furnish covered telehealth services to Medicare beneficiaries; and 

     - Authorizing CMS' Center for Medicare and Medicaid Innovation (CMMI) models to allow additional health professionals, including physical therapists, to furnish telehealth services.

 

TAKE ACTION TODAY

Contact your lawmakers (both of your senators and your representative) and ask them to cosponsor the CONNECT for Health Act of 2019 (H.R.4932/S.2741) to expand access, promote cost savings, and ensure quality care in Medicare through the use of telehealth and remote patient monitoring. A one-pager can be found on PPS Advocacy tab.
 
Send an email and tweet to your lawmakers using these talking points:

     - Only a portion of the care physical therapists provide is manual therapy.  While the use of telehealth would not wholly replace in-person visits, using telehealth can reduce disparities in care as well as provide high-quality care without increasing costs.

     - Studies have shown that physical therapists' use of telehealth for telerehabilitation can result in cost-savings, improved outcomes, increased access, and higher patient satisfaction

     - This bipartisan legislation would enable physical therapists to provide assessments, care, and interventions via telehealth-this type of care could prevent falls, reduce functional decline, avoid costly emergency room visits, and reduce hospital admissions as well as readmissions.

     - Cosponsor H.R.4932/S.2741 in order to allow PTs to provide quality care to Medicare beneficiaries via telehealth.

We often talk about how policies that impact physical therapy don’t often get passed as stand-alone bills, but instead are placed into “vehicles” or larger pieces of legislation that are moving towards passage. In late 2016, Congress passed such a vehicle known as the 21st Century Cures Act; a provision of that larger bill was a technical fix that now requires Medicare to allow outpatient physical therapists located in Health Professional Shortage Areas by HRSA (https://data.hrsa.gov/tools/shortage-area), medically underserved, and rural areas to be able to use a locum tenens. As of June 13, 2017, private practice physical therapists practicing in these designated areas were thereby permitted to retain—for up to 60 days in a row—substitute physical therapists when they need to be absent for a short time due to illness, pregnancy, jury duty, vacation, continuing medical education, or the like. 

This spring, two of the bill’s sponsors, Rep. Ben Ray Luján (NM-3) and Rep. Gus Bilirakis (FL-12) requested that CMS report the number of private practice physical therapists who used a locum tenens and how many patients were ensured uninterrupted access to care as a result. CMS recently provided information for 2018 stating, “For calendar year 2018, there were 219 physical therapists in private practice who billed substitute services with the appropriate modifier on Medicare claims. There were 2,465 beneficiaries receiving such services from these substitute therapists, totaling $935,495 in Medicare allowed charges.”

Impact of this policy

As a reminder, if your outpatient physical therapy clinic is located in a rural, medically underserved, or Health Professional Shortage Area, you as a private practice physical therapist may use a locum tenens to provide care to your clients who are Medicare beneficiaries. 

Share your locum tenens stories

We are working on the introduction of legislation which would allow for nationwide application of this policy. To that end, PPS needs anecdotes from urban and suburban PTs illustrating how the inability to use locum tenens impacts patient care as well as the effect it has on PTs themselves as small business owners. Our goal is to have at least one story from each state. Please send PPS Lobbyist Alpha Lillstrom Cheng ([email protected]) a brief (up to 200 words) example of how your practice and patient care has been impacted when you or one of your colleagues has been unable to hire a qualified substitute (locum tenens) to provide care when you are unavoidably absent because of illness, pregnancy, continuing education, and more. In the past, these stories have been quoted by Members of Congress during debates on the issue. Your anecdotes can make an important difference in PPS’s advocacy efforts.

Where are your Members of Congress?

Congress was in session from September 9th through September 27th.  The next planned recess is for the first two weeks of October.  This means Members of Congress are likely to be back in their home districts participating in events and meetings, between September 30th and October 14th

Advocacy Opportunity 1:

If you see your lawmaker be sure to say hello, hand them your business card and invite them to come to visit your clinic before the end of the year.  Remember, one of the goals of the PPS Key Contact program is that the Member of Congress you are assigned to will come to associate you with the profession of physical therapy, the local economic impact of your small business, and seek you out as a trusted touchstone for whether or not legislation proposed would be favorable to private practice physical therapists. 

Reach out to the district office to request a meeting with staff and offer a site visit to either them or the lawmaker themselves.  When planning your meeting with your legislator or their staff, please refer to the “Nuts and Bolts of In-District Advocacy” document on the PPS advocacy page for tips.  Use social media to thank (and tag) your lawmakers anytime you get to talk to them about private practice physical therapy issues.  Please tag PPS using #PPSAdvocacy as well as a hashtag to point out that you are small business owner and a constituent, try something like #SmallBizOwner[then write the state and district] (for example #SmallBizOwnerNY12).  Get creative!

In-Person Advocacy on Capitol Hill

PPS sponsored a targeted fly-in and Key Contact Training for 68 select members of the PPS Key Contact team in Washington D.C. on September 23rd and 24th.  Participants had meetings in 164 offices on Capitol Hill and talked to their Member of Congress or staff about PPS’ top advocacy priorities. 

Expanding Access to Care in Health Professional Shortage Areas

The bipartisan Physical Therapist Workforce and Patient Access Act (H.R.2802/S.970) is gaining momentum.  H.R.2802 currently has 57 cosponsors—14 cosponsors have been added since the August recess (which means it was likely a result of you and your fellow Key Contacts making the ask).  S.970 now has 7 cosponsors having gained Senators Cindy Hyde-Smith (MS) and Doug Jones (AL) since the beginning of August.  Check the hyperlinks to see if your legislators have cosponsored this important bill.

These bills seek to add physical therapists to the National Health Service Corps (NHSC).  As you know, the NHSC allows for the placement of certain health care professionals in areas designated as a health care professional shortage area (HPSA).  In exchange for serving at least two years in these areas, eligible health professionals are provided up to $50,000 towards the cost of their education.  Adding physical therapists to the NHSC will enable patients in underserved areas have better access to nonpharmacological options for the prevention, treatment, and management of pain. 

Advocacy Opportunity 2:

Help amplify the in-person advocacy of the fly-in by reaching out to your lawmakers.  If your lawmaker has already signed onto the bill, be sure to thank them.  If not, extend the reach of the PPS fly-in by calling or emailing your lawmaker and their healthcare policy staff and ask for your Senator/Representative to cosponsor the Physical Therapist Workforce and Patient Access Act (S.970/H.R.2802) to add physical therapists to the list of providers eligible to participate in the National Health Service Corps.  Check here to see if your clinic is located in a HPSA, if so make sure to let your legislator know.  A one-pager that you can refer to and share with your Members of Congress and their legislative staff is available on the PPS advocacy page.  If you are on social media, follow up with a tweet or facebook post tagging your legislator as well as PPS using #PPSAdvocacy. 

Use the following talking points:

  • Adding physical therapists to the National Health Service Corps (NHSC) will increase patient access to PT care and rehabilitation in underserved communities across America.

  • Cosponsor S.970/H.R.2802 in order to improve access to nonpharmacological options for the prevention, treatment, and management of pain—either to prevent opiate abuse or to help those who are already struggling with addiction to opiates. 

  • This bipartisan effort could improve lives of those in pain while also encouraging PTs to practice in rural and underserved areas.

  • In 2012, the NHSC had an 82% retention rate for providers within the program. (We want lawmakers to hear about this incredible Return on Investment for federal program dollars)

  • Student loan debt often forces physical therapists to turn down opportunities to join private practices and open small businesses. Banks charge higher interest rates for small business loans if that person also carries student loan debt.  This additional expense adds to the challenges of opening a private practice.

On September 18, 2019, PPS, as a member of the Alliance for Integrity in Medicare (AIM) – a broad coalition of medical specialty, laboratory, radiation oncology, and medical imaging groups committed to ending the practice of inappropriate physician self-referral – sent a letter to the House Ways & Means Committee and the House Energy & Commerce Committee asking for committee action on The Promoting Integrity in Medicare Act (H.R. 2143), which seeks to remove physical therapists and others from the In-Office Ancillary Services Exception (IOASE). 

Here's the link to the document on the PPS website.

Face-to-Face with your Members of Congress

Members of Congress have left Washington D.C. for the summer recess.  This at-home work period will last through all of August as well as the first week of September following Labor Day.  This is the time of year when lawmakers plan to spend a significant amount of time visiting with and hearing from their constituents.  Make the most of it! 


Advocacy Opportunity 1:

Mark an August 1st deadline on your calendar to request meetings and offer site visits to your legislators and their staff during the month-long August (and the first week of September) recess.  If you schedule a site visit, please reach out to your PPS Lobbyist Alpha Lillstrom Cheng for planning support.  

When the staff or Member of Congress visits your clinic, it will enable these policymakers to mentally reference what they learned from you, and solidify their association of you with the profession of physical therapy and the local economic impact of your small business.  As a result, they may then seek you out as a trusted touchstone on whether proposed legislation would be favorable to private practice physical therapists.


Advocacy Opportunity 2:

Jump at any opportunities to attend public town halls, community meetings or fundraisers so that you can talk to your legislators about the PPS legislative priorities and the impact you have on your community.  Post photos of you attending these events and tag your legislator on social media platforms, please also tag PPS using #______ [Mariesa, please fill this in]

When you see your lawmaker, be sure to introduce yourself as a private practice physical therapist, hand them your business card, and then follow up with a call to the district office to request a meeting with staff.  When planning your meeting with your legislator or his/her staff, please refer to the “Nuts and Bolts of In-District Advocacy” document on the PPS advocacy page for tips. 


Supporting the Physical Therapist Workforce in Underserved Areas

Your advocacy efforts asking for Members of Congress to cosponsor the Physical Therapist Workforce and Patient Access Act  (S.970/H.R.2802) have been effective.  Twenty cosponsors have been added to the House bill since the last legislative update!  H.R.2802 now has 43 cosponsors in the House and S.970 has 5 cosponsors in the Senate.  Check the hyperlinks in the last sentence to see if your Representative or Senators have yet to cosponsor the bills.

These bills seek to add physical therapists to the National Health Service Corps (NHSC).  As you know, the NHSC allows for the placement of certain health care professionals in areas designated as a health care professional shortage area (HPSA).  In exchange for serving at least two years in these areas, eligible health professionals are provided up to $50,000 towards the cost of their education.  Adding physical therapists to the NHSC will enable patients in underserved areas have better access to nonpharmacological options for the prevention, treatment, and management of pain.  


Advocacy Opportunity 3:

Keep up the good work and help increase the number of cosponsors!  If your lawmaker has already signed onto the bill, be sure to thank them.  If not, call or email your lawmaker and their healthcare policy staff and ask for your Senator/Representative to cosponsor the Physical Therapist Workforce and Patient Access Act (S.970/H.R.2802) to add physical therapists to the list of providers eligible to participate in the National Health Service Corps.  A one-pager that you can refer to during meetings and share with your Members of Congress and their legislative staff is available on the PPS advocacy page.  If you are on social media, follow up with a tweet or facebook post. 

Use the following talking points: 

  1. Adding physical therapists to the National Health Service Corps (NHSC) will increase patient access to PT care and rehabilitation in underserved communities across America.
  2. Physical therapy is an essential component of the multidisciplinary undertaking that will be required to improve both patient outcomes and alter the trajectory of the current opioid crisis.  
  3. Cosponsor S.970/H.R.2802 in order to improve access to nonpharmacological options for the prevention, treatment, and management of pain.  This increased access will both prevent opiate abuse and help those who are already struggling with addiction to opiates.  
  4. This bipartisan effort could improve lives of those in pain while also encouraging PTs to practice in rural and underserved areas.

For information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

Congressional At-Home Work Period:

Congress will be in recess for the Memorial Day holiday from May 27-31st.  This means Members of Congress are likely to be back in their home districts participating in events and meetings, between May 24th and June 2nd.  

Advocacy Opportunity 1:

On May 27th you are likely to see your legislators at Memorial Day events around the district.  One of the goals of the PPS Key Contact program is that the Member of Congress you are assigned to will come to associate you with the profession of physical therapy, the local economic impact of your small business, and seek you out as a trusted touchstone on which legislation proposed would be favorable to private practice physical therapists.  If you see your lawmaker, be sure to say hello, hand them your business card, and then follow up with a call to the district office to request a meeting with staff.  Also, take the opportunity to offer a site visit to your clinic during the scheduled 4th of July recess (July 1st-5th).  When planning your meeting with your legislator or his/her staff, please refer to the “Nuts and Bolts of In-District Advocacy” document on the PPS advocacy page for tips.  

Supporting the Physical Therapist Workforce in Underserved Areas

Just this month, Reps. DeGette (D-CO) and Shimkus (R-IL) introduced the House companion bill (H.R.2802) to the Senate bill (S.970) introduced by Senators Tester (D-MT), Wicker (R-MS), and King (I-ME)—the Physical Therapist Workforce and Patient Access Act.  This legislation seeks to add physical therapists to the list of providers eligible to participate in the National Health Service Corps.  The language is largely the same as years past except for adding a hook that specifically mentions that physical therapists could provide non-pharmacological intervention for pain in order to prevent opioid abuse or to help those who are already struggling with addiction to opioids.  A one-pager that you can refer to during meetings and share with Congressional staff has been posted on the PPS advocacy page.  As of Friday May 24th, the bill has 3 Senate cosponsors and 6 cosponsors in the House.  Pitch in and help us increase that number!

Advocacy Opportunity 2:

Call or email your lawmaker and their healthcare policy staff and ask for your Senator/Representative to cosponsor the Physical Therapist Workforce and Patient Access Act (S.970/H.R.2802) to add physical therapists to the list of providers eligible to participate in the National Health Service Corps.  If you are on social media, follow up with a tweet or facebook post.

Use the following talking points: 

  1. Adding physical therapists to the National Health Service Corps (NHSC) will increase patient access to PT care and rehabilitation in underserved communities across America.
  2. Cosponsor S.970/H.R.2802 in order to improve access to nonpharmacological options for the prevention, treatment, and management of pain—either to prevent opiate abuse or to help those who are already struggling with addiction to opiates.  
  3. The National Health Service Corps is due to be reauthorized this fall so it is ever more important for legislators to signal their support by cosponsoring the legislation.  
  4. This bipartisan effort could improve lives of those in pain while also encouraging PTs to practice in rural and underserved areas.

Thank you for your continued advocacy! nFor information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

At its core, being an advocate for PPS’ legislative priorities means communicating with your Member of Congress asking for him or her to cosponsor or vote for a bill that responds to the needs of private practice physical therapists and the patients you serve.  As PPS Key Contacts, you are assigned a Member of Congress to whom you hope to become the face of physical therapy and a trusted touchstone on which legislation proposed would be favorable to private practice physical therapists.  This month we have made great progress in getting legislation reintroduced.

Exempting Physical Therapists from the In-Office Ancillary Services Exception (IOASE)
As a member of the Alliance for Integrity in Medicine (AIM) Coalition (made up of APTA, PPS, American Clinical Laboratory Association, Association for Quality Imaging, American Society for Radiation Oncology, American Society for Clinical Pathology, College of American Pathologists, and Radiology Business Management Association), PPS signed a letter of support written for Rep. Jacky Speier’s (D-CA) bill to remove physical therapists from the In-Office Ancillary Services Exception (IOASE).  Reps. Speier and Dina Titus (D-NV) introduced H.R. 2143, the Promoting Integrity in Medicare Act on April 9th.  This bill has only been introduced in the House of Representatives.  A one-pager is available on the PPS advocacy page.

Advocacy Opportunity 1:
Please call or email your Representative (and their healthcare policy staff) to ask your legislator to cosponsor H.R. 2143, the Promoting Integrity in Medicare Act.

Use the following talking points:

  • The “in-office ancillary services exception” (IOASE) to the Stark Law was originally created to allow physicians to render non-complex services like x-rays and simple blood tests in their offices during the same patient office visit. 
  • The exception was never intended to include physical therapy and other services rarely provided or completed at the time of the patient’s initial office visit. 
  • Cosponsor H.R.2143 to ensure that incentives driving medical decisions are based solely on patients’ best interests, while reducing unnecessary and inappropriate services and costs to Medicare.

Supporting the Physical Therapist Workforce in Underserved Areas
On April 1st, Senators Tester (D-MT), Wicker (R-MS), and King (I-ME) reintroduced their perennial, bipartisan bill, the Physical Therapist Workforce and Patient Access Act (S.970) to add physical therapists to the list of providers eligible to participate in the National Health Service Corps.  Reps. DeGette (D-CO) and Shimkus (R-IL) are planning to introduce the House companion bill soon.  The language is largely the same as years past except for adding a hook that specifically mentions that physical therapists could provide non-pharmacological intervention for pain in order to prevent opioid abuse or to help those who are already struggling with addiction to opioids.  An action alert was issued on Monday April 8th, and a one-pager has been posted on the PPS advocacy page.

Advocacy Opportunity 2:
Please call or email your Senators (and their healthcare policy staff) to ask for the Senator to cosponsor the Physical Therapist Workforce and Patient Access Act (S.970) to add physical therapists to the list of providers eligible to participate in the National Health Service Corps.

Use the following talking points:

  • Adding physical therapists to the National Health Service Corps (NHSC) will increase access to PT care and rehabilitation in underserved communities across America.
  • Cosponsor S.970 in order to improve access to nonpharmacological options for the prevention, treatment, and management of pain.
  • This bipartisan effort could improve lives of those in pain while also encouraging PTs to practice in rural and underserved areas.

In addition to engaging with Members of Congress in the D.C. offices, remember that in-district advocacy is also very effective.  Check out the new “Nuts and Bolts of In-District Advocacy” document on the PPS advocacy page for ideas for how to make the most of these types of opportunities. 

Thank you for your continued advocacy!

 

For information on PPS’s legislative priorities and activities,

visit the Advocacy section at www.ppsapta.org

Advocacy can come in many forms.  One of which is sharing examples of how existing policy limits your ability to provide the best care for your patients.  As we progress through the 116th Congress, please consider sharing with your PPS lobbyist examples of how current healthcare laws impact or impede the care you can provide.  As a PPS Key Contact, you will be invited to share some of those stories with your legislators so that they can understand how the legislation they are presented with would impact their constituents—you and your patients.

Telehealth

Last Congress the CONNECT for Health Act (H.R.2556/S.1016) was a bill that provided a tailored approach to expanding coverage for care provided to Medicare beneficiaries through telehealth.  As you know, a few provisions of that bill became law.  As a result, the sponsors of the legislation are working on more ideas to include in the version of the legislation that will be introduced this Congress.  To that end, the Co-chairs of the Congressional Telehealth Caucus released a Request of Information that asks for input from stakeholders as they seek to craft a revised, comprehensive approach to legislation that will provide for increased federal payment for care provided via telehealth.  The response is due April 1st.

ADVOCACY OPPORTUNITY 1: URGENT

Please send to [email protected] by COB Thursday March 28th examples of how you use, or would use, telehealth in a way that would align with the following policy objectives that have been identified by the Congressional Telehealth Caucus:
1. Expand access to telehealth, especially in rural or otherwise underserved communities;
2. Improve patient outcomes or ease the day-to-day patient experience;
3. Encourage easier and expanded use of existing telehealth technologies; and
4. Reduce healthcare costs for both patients and federal programs, including Medicare.

To further support PPS’ lobbying efforts, we are preparing a survey to determine how PPS members are currently utilizing and billing for telehealth for cash pay and with private payers.  The questions will allow practitioners to report how they are providing care via telehealth and also inform us about which private payers are reimbursing for care provided utilizing telehealth and the rates PPS members are receiving for that care.  We also hope to get a sense of how many PPS members don’t currently use telehealth but are interested in doing so. 

ADVOCACY OPPORTUNITY 2:

In the next few weeks you will receive a survey that asks more detailed questions about how you are utilizing and billing for telehealth and what rates you are receiving for that care.  Please fill out the survey so that we will be armed with data to support our lobbying efforts to increase opportunities for physical therapists to provide care via telehealth.

Other Legislative Priorities

We are working with the previous legislative sponsors of our advocacy priorities to get those bills reintroduced in this the 116th Congress.  We will let you know when those bills are reintroduced so that you may begin to ask your legislators for their support.  In the meantime, make sure you have reached out and shared the Section’s Legislative and Advocacy priorities with them.

Thank you for your continued advocacy!

 

For information on PPS’s legislative priorities and activities,

visit the Advocacy section at www.ppsapta.org

Advocating for PPS members requires engaging with both the Executive and Legislative branches of government. Your role as a PPS Key Contact focuses on the policy changes that can be made by Legislative branch and Members of Congress. Our other efforts focus on Executive Agencies which issue regulations to implement the laws passed by Congress.

 

VA Working on Regulations to Allow Physical Therapist Assistants (PTAs) to care for TRICARE Beneficiaries

The Department of Defense (DoD) published the proposed regulations to add PTAs and OTAs to the TRICARE program.  PPS commented on the proposed rule.  In the interest of administrative simplification, PPS supported DoD’s proposal to tie the qualifications of PTAs under the TRICARE program to Medicare’s requirements. In its comments, PPS took the opportunity strongly recommend that the DoD clarify that the “direct supervision” requirement is met when the supervising physical therapists is in the same office suite as the PTA at the time of service, and that the supervising physical therapist is not required to be in the same room with the PTA at the time the service is performed. While the DoD proposed to tie reimbursement rates of PTAs in TRICARE to those of Medicare, PPS instead suggested that the rates for PTAs be the same as for PTs—as a way to preemptively avoid the inevitable 85% payment differential for PTAs under Medicare that is required by law. Finally, in light of the time that has passed since the DoD was granted this rulemaking authority, PPS strongly encouraged the DoD to promulgate the regulations as soon as possible, with an effective date that immediately follows the publication of the final rule. The final DoD regulations on PTAs under TRICARE is likely to be published before the end of the summer, so if all goes smoothly, coverage of PTAs under TRICARE should become effective by January 2020 at the latest.

Committees of Healthcare Jurisdiction in the House

In the House there were many changes made to the rosters of the committees of healthcare jurisdiction.  The Democrats now hold the majority of seats on each committee and a large number of Republicans serving on these committees retired or lost their reelections.  Check out the full rosters below and look for the name of your Representative.  Red font indicates that the member is a new addition to that committee.

House of Representatives

Advocacy Opportunity:

It is important that the members serving on the House Ways & Means and Energy & Commerce Committees (which have jurisdiction over healthcare issues) hear from their constituents.  Check the above committee membership rosters for the House Ways & Means and Energy & Commerce Committees and see if your Representatives has been assigned to either the main committee or the health subcommittee.  If so, please reach out to his/her offices via their websites (the standard naming convention is “lastname.house.gov”), sign up for their newsletters, and share the PPS legislative priorities with their staff. 

As staffing is completed for those members who have been assigned to committees of relevant jurisdiction, you will hear from me with individual contact information. 

Thank you for your continued advocacy!

For information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

LEGISLATIVE & ADVOCACY PRIORITIES for the 116th CONGRESS
The Legislative & Advocacy Priorities for the 116th Congress were developed in December by the Government Affairs Committee and endorsed by the Board of Directors.  Check it out on the PPS website so that you review it and print it out to share with your legislators and their staff.

As you review the document you will notice that some issues such as access to private contracting with Medicare beneficiaries (aka opt-out), achieving nationwide access to use a locum tenens to treat Medicare patients when their regular PT can’t be in the office, as well as supporting expansion of policy to allow for reimbursement for care provided via telehealth remained on the list of priorities.  The “ACA Reform” category was removed because unlike last Congress, healthcare repeal or the replacement of the Affordable Care Act is not at the top of the Congressional agenda this Congress.  However, the principles of promoting physical therapy as an essential health benefit in all insurance plans and retaining guaranteed access to insurance for those with pre-existing conditions as well as protect the ban on the rescission of insurance for those who do have coverage were retained in the new category of “Health Coverage Principles”.  The goal of addressing physical therapy workforce issues including cost of education and pursuing federal programs to reduce student loan burden remained on the list.  New to this Congress, the GAC chose to include a focus on the use of physical therapist services as non-pharmacological treatment options in response to the opioid crisis as well as three priorities focused on population health.  If you have any questions, please reach out.

Advocacy Opportunity 1:
Help us build a strong argument for lawmakers to support our efforts to allow PTs to opt-out of Medicare and receive cash pay from patients who are Medicare beneficiaries.  Please send me a description of a situation where you have been approached to provide care to a Medicare beneficiary but would have preferred to utilize an opt-out option and contract directly with the patient for payment.  Your names will not be disclosed to policy makers so please provide as much detail as you can so that it can be a strong illustration of the issue. 

COMMITTEES OF JURISDICTION in the SENATE

Due to the retirement of long-time chairman Orrin Hatch, the Finance Committee is now chaired by Sen. Chuck Grassley (R-IA); the Ranking Member will remain Ron Wyden (D-OR).  The Senate Small Business committee is now chaired by Marco Rubio (R-FL) while Ben Cardin (D-MD) retains his spot as Ranking Member.  The Health Education Labor and Pensions (HELP) Committee leadership will not change—it will continue to be chaired by Lamar Alexander (R-TN) and Patty Murray (D-WA) will remain the Ranking Member.  The Senate Veterans committee will also remain the same with Johnny Isakson (R-GA) at the helm and Jon Tester (D-MT) as Ranking Member.  Check out the full rosters below.  Red font indicates that the member is a new addition to that committee.

 

Committee

Republicans

Democrats

Finance         

Chuck Grassley (IA) Chair

Ron Wyden (OR) Ranking Member

(handles Medicare issues)

Mike Crapo (ID)

Debbie Stabenow (MI)

 

Pat Roberts (KS)

Maria Cantwell (WA)

 

Mike Enzi (WY)

Bob Menendez (NJ)

 

John Cornyn (TX)

Tom Carper (DE)

 

John Thune (SD)

Ben Cardin (MD)

 

Richard Burr (NC)

Sherrod Brown (OH)

 

Johnny Isakson (GA)

Michael Bennet (CO)

 

Rob Portman (OH)

Bob Casey (PA)

 

Pat Toomey (PA)

Mark Warner (VA)

 

Tim Scott (SC)

Sheldon Whitehouse (RI)

 

Bill Cassidy (LA)

Maggie Hassan (NH)

 

James Lankford (OK)

Catherine Cortez Masto (NV)

 

Steve Daines (MT)

 

 

Todd Young (IN)

 

 

 

 

Health, Education, Labor & Pensions

Lamar Alexander (TN) Chair

Patty Murray (WA) Ranking Member

(handles healthcare issues related to workforce, education and community-based care)

Mike Enzi (WY)

Bernie Sanders (VT)

 

Richard Burr (NC)

Bob Casey (PA)

 

Johnny Isakson (GA)

Tammy Baldwin (WI)

 

Rand Paul (KY)

Chris Murphy (CT)

 

Susan Collins (ME)

Elizabeth Warren (MA)

 

Bill Cassidy (LA)

Tim Kaine (VA)

 

Pat Roberts (KS)

Maggie Hassan (NH)

 

Lisa Murkowski (AK)

Tina Smith (MN)

 

Tim Scott (SC)

Doug Jones (AL)

 

Mike Braun (IN)

Jacky Rosen (NV)

 

Mitt Romney (UT)

 

 

 

 

Small Business

Marco Rubio (FL) Chair

Ben Cardin (MD) Ranking Member

 

Jim Risch (ID)

Maria Cantwell (WA)

 

Rand Paul (KY)

Jeanne Shaheen (NH)

 

Tim Scott (SC)

Ed Markey (MA)

 

Joni Ernst (IA)

Cory Booker (NJ)

 

James Inhofe (OK)

Chris Coons (DE)

 

Todd Young (IN)

Mazie Hirono (HI)

 

John Kennedy (LA)

Tammy Duckworth (IL)

 

Mitt Romney (UT)

Jacky Rosen (NV)

 

Josh Hawley (MO)

 

 

 

 

Veterans Affairs

Johnny Isakson (GA) Chair

Jon Tester (MT) Ranking Member

 

Jerry Moran (KS)

Patty Murray (WA)

 

John Boozman (AR)

Bernie Sanders (VT)

 

Bill Cassidy (LA)

Sherrod Brown (OH)

 

Mike Rounds (SD)

Richard Blumenthal (CT)

 

Thom Tillis (NC)

Mazie Horono (HI)

 

Dan Sullivan (AK)

Joe Manchin (WV)

 

Marsha Blackburn (TN)

Kyrsten Sinema (AZ)

 

Kevin Cramer (ND)

 

Advocacy Opportunity 2:
Check the above committee membership rosters for the Senate committees and see if your Senator(s) have been assigned to any of the four committees.  If so, please reach out to their offices via their websites (the standard naming convention is “lastname.senate.gov”) and share the PPS legislative priorities with their staff. 

As staffing is completed for those members who have been assigned to committees of relevant jurisdiction, key contachs will hear from me with individual contact information.  Thank you for your continued advocacy!

For information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

Thank you for your efforts during this year of successful advocacy!

 

HIGHLIGHTS OF SUCCESS

Repeal Therapy Cap
In February 2018, after 20 years of advocacy and grassroots engagement we repealed the arbitrary per-beneficiary therapy cap on outpatient rehabilitation covered by Medicare, effective January 1, 2018.  For CY 2019, the KX modifier will need to be applied to claims upon reaching $2040 in spending.  By applying the KX modifier to the claim, the therapist or therapy provider is confirming that the services are medically necessary as justified by the appropriate documentation in the medical record.  Should the KX modifier not be used appropriately, claims could be denied.  Until 2028, claims exceeding $3000 for combined spending for PT and speech-language pathologist (SLP) services, and $3000 for stand-alone OT services are subject to targeted medical review; however, not all claims exceeding the threshold will be subject to review as they once were.

Functional Status Reporting Requirements for Outpatient Therapy are Discontinued
Since January 2013 all providers of outpatient therapy services have been required to include functional status information on claims for therapy services.  This November, the Center for Medicare and Medicaid Services (CMS) decided that due to the repeal of the therapy cap and stakeholder input arguing against the burden of reporting, the requirements for the reporting and documentation of functional reporting status for outpatient therapy claims will be eliminated for services furnished on or after January 1, 2019.

Merit-Based Incentive Payment System (MIPS)
Effective for reporting year 2019 and payment year 2021, physical therapists have been added to the list of Medicare-eligible providers who could be required to participate in MIPS.  Recognizing that low-volume providers such as private practice physical therapists will have difficulty participating in MIPS, CMS established three separate criteria under which a MIPS-eligible clinician could claim a low-volume threshold exemption.  Clinicians or groups are not obligated to participate in MIPS if any of these three thresholds apply to them:

1. If they have less than $90,000 in Part B allowed charges for covered professional services;

2. If they provide care to 200 or fewer Part-B enrolled individuals who are furnished MPFS services; or

3. If they provide 200 or fewer covered professional services under the MPFS.  A professional service is considered to be a billed unit of service. 

At the same time, CMS seeks to encourage even small volume providers or group practices to participate, so starting in Year 3 clinicians or groups would be able to opt-in to MIPS if they meet or exceed at least one but not all, of the low-volume threshold criteria.

Telehealth
While supporting efforts for the Medicare Telehealth Parity Act (H.R.2550) as well as the tailored approach of expanding coverage for telehealth by way of the CONNECT for Health Act (H.R.2556/S.1016), we achieved passage of two provisions of the CONNECT for Health Act.  The first grants Medicare Advantage plans the authority to expand their basic benefit coverage to include reimbursement for telehealth services and the second (FAST Act (H.R.1148/S.431)) allows for the use of telehealth to assess strokes regardless of patient’s geographic location.  These wins will provide us a solid foundation upon which to build in the 116th Congress.

GETTING READY FOR THE 116TH CONGRESS

The new members of the 116th Congress will be sworn in on January 3, 2019.  In the House of Representatives every member of the Chamber will be sworn in—both new members as well as those who won re-election.  In the Senate the one-third of members whose seats were up for re-election will be sworn in on January 3rd.  Additionally, Martha McSally (the candidate for the 2018 Arizona senate race who did not win on November 6th) has been appointed by the governor of Arizona to fill the remaining two years of the deceased Sen. John McCain’s term.  McSally will also be sworn in on January 3rd

 

In the House of Representatives
In the 2018 midterm general election, Democrats won 235 seats and Republicans won 199 seats.  As a result, the Democrat will make the most of their sizable majority in the House for the 116th Congress by bringing up and introducing bills on issues that were sidelined this past Congress.  On January 3rd all of the Members of the 116th Congress will elect a Speaker of the House.  Since the Democrats will be the majority party, the position Majority Leader will be held by a Democrat and the position of Minority Leader will be held by a Republican.  After many internal negotiations which included leadership term limits, Nancy Pelosi (D-CA-12) won the internal, member-elect Democrat-only election in November.  As a result, it is widely expected that she will clinch the Speaker of the House election.  The Majority Leader is expected to be long-time number two Steny Hoyer (D-MD-5).  Former Speaker of the House Paul Ryan (R-WI-1) did not run for re-election, so his long-time number two, Kevin McCarthy (R-CA-23) is expected to be Minority Leader. 

The Democrats have decided that Richard Neal (D-MA-1) will chair the House Ways & Means Committee, Frank Pallone (D-NJ-26) will chair the House Energy & Commerce Committee, Nydia Velazquez (D-NY-7) will chair the House Small Business Committee, and Mark Takano (D-CA-41) will be the new chair of the House Veterans Committee.  Republicans have shifted former committee chairs to the role of Ranking Member: Greg Walden (R-OR-2) to be the Ranking Member of the Energy & Commerce Committee, similarly Kevin Brady (R-TX-8) to be Ranking Member of the Ways & Means Committee, Steve Chabot (R-OH-1) to be Ranking Member of the Small Business Committee, and Phil Roe (R-TN-1) to be Ranking Member on the Veterans Committee.

In the Senate
As expected, the Republicans retained control of the Senate, winning 53 seats.  Democrats won 47 seats.  Senator Mitch McConnell (R-KY) will retain his position of Majority Leader.  Sen. Chuck Schumer (D-NY) has been elected by his colleagues to continue as Minority Leader.  Each party has identified who will lead their caucus as committee chairs and ranking members.  Relevant to PPS, at this point it looks like the Finance Committee will be chaired by Sen. Chuck Grassley (R-IA) and the Ranking Member will remain Ron Wyden (D-OR).  The Health Education Labor and Pensions (HELP) Committee leadership will not change—it will continue to be chaired by Lamar Alexander (R-TN) and Patty Murray (D-WA) will remain the Ranking Member.  The Senate Veterans committee will also remain the same with Johnny Isakson (R-GA) at the helm and Jon Tester (D-MT) as Ranking Member.  Finally, the Senate Small Business committee will stay the same as well with Marco Rubio (R-FL) as Chair and Ben Cardin (D-MD) as Ranking Member.

We will have a lot of work to do to educate the new members of Congress and their staff about the value of physical therapy.  For this year-end edition, there are no assignments, but you will hear from me in the new year with ideas and opportunities for engaging with your legislators.

Thank you for your continued advocacy and for a great 2018!

For one-pagers, talking points, and information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

 

A PPS KEY CONTACT IS NOT PARTISAN

The general election in November resulted in many newly elected Representatives and Senators. We would love for you to continue in your role as a PPS Key Contact—for whomever represents your district—whether it is the incumbent or a newly-elected Member of Congress. The only exception would be if you were the PPS Key Contact for a member of the House of Representatives who has won a seat in the Senate, we'd like you to "follow" them to the Senate in order to sustain the relationship you have been building with the Senator-elect since you became their PPS Key Contact.

Remember, the role of a PPS Key Contact is not a partisan one. The person elected to represent your district or state represents you, regardless of your or their political preferences or affiliation. You are their constituent and they need to hear from you about the legislative and advocacy priorities of private practice physical therapists. Please reach out to Alpha, the PPS lobbyist, if you have any questions or concerns.

Advocacy Opportunity 1: Please look through your photo archives and send us photos that you have taken either with a Member of Congress or when a Member of Congress or legislator-elect visited your clinic. We’d like to post them on the PPS advocacy webpage as examples of how our PPS Key Contacts are engaging with legislators.

ELECTION RESULTS

Because this is the end of the legislative year and we are not anticipating any legislation that will impact rehabilitation therapy to be passed between now and the end of the year this update will focus instead on the impact the election will have on the 116th Congress which will be sworn in on January 3, 2019.

In the House of Representatives
So far Democrats have won 233 seats and Republicans have won 200 seats. As of this writing, the winners of 2 seats (NY-22, and NY-27) have to be determined. However, even before the results of those races are known, the Democrats have won enough seats to claim a sizable majority in the House for the 116th Congress and will have access to all the power that goes with that. The Speaker of the House will be a Democrat (likely to be Nancy Pelosi, but not necessarily). Also, the portion of Democrats and Republicans sitting on each of the committees will change. This is because the number of members on a committee and the ratio of majority/minority members will be determined by the Democrats who will be the majority party.

Additionally, each committee has its own professional staff. By House rules, two-thirds of those staff are selected by the majority committee members and one-third is selected by the minority members. While it has yet to be determined who will be hired to staff positions for the Committees, some of the personal office health policy staffers you know may become Committee staff. If so, those relationships could enable us to have better access to information and more influence in pursuit of policies which impact physical therapy.

In the Senate
As expected, the Republicans retained control of the Senate. Four of the seats which switched from Democrat to Republican control were in those states (Florida, Indiana, Missouri, and North Dakota) were in states won handily by President Trump in 2016. As of this writing, the Republicans have won 52 seats; the Democrats have secured 47 seats.

One Senate race remains undecided. In Mississippi, there will be a runoff election on Tuesday, November 27th because neither Cindy Hyde-Smith (R) or Mike Espy (D) received over 50% of the votes cast on Election Day. Regardless of who wins these two races, the Republicans will remain in the majority—it just remains to be seen what the proportion will be.

Impact on Relevant Committees of Jurisdiction
In addition to the sixteen known vacancies on House committees of jurisdiction due to retirements and primary election losses, there will be additional shuffling of committee memberships because the Democrats will now be the majority in the House of Representatives. As a result, some Republicans who have served on these committees will lose their spots and be replaced by Democrats. It is also likely that each committee of jurisdiction will be assigned some new members who have little or no background in healthcare policy. This provides a great opportunity to educate those new members about the value of physical therapy.

Here’s how it breaks down:
House of Representatives
On the House Ways & Means Committee a minimum of 14 members will change from the 115th Congress roster to the 116th Congress roster. On the Energy & Commerce Committee a minimum of eight members will change. Additionally, one sitting member of the E&C Health Subcommittee, Rep. Chris Collins (R-NY-27), has yet to know whether or not he will win re-election; however, he has also been indicted for insider trading, so even if he wins his re-election bid, he may not serve his full term in the 116th Congress. A minimum of five members will change on the House Veterans Committee and a minimum of three members will change on the Small Business Committee.

Senate
At least four members of the Senate Finance Committee will change. The current Finance Committee Chair Orrin Hatch retired and while Mitt Romney won his seat, he won’t necessarily be placed on the Senate Finance Committee; that decision will be made by Majority Leader McConnell and the Republican leadership. Due to election losses, the roster of the Health Education Labor and Pensions (HELP) Committee, the Veterans Committee and the Small Business Committee will each change by at least one member.

IMPACT ON LEGISLATION in the 116th CONGRESS
As a result of the “split” of political affiliation, the House of Representatives and Senate will be pitted against one another for the 116th Congress. Democrats in the House are eager to stand up to what they see as the Administration’s efforts to dismantle the Affordable Care Act. They will do so by pushing provisions to shore up protections for those with pre-existing conditions, protecting the required inclusion of Essential Health Benefits in commercial insurance products, and funding health insurance subsidies. It is also likely that there will be a discussion of Medicare for All; however, because there is a range of political opinions within the caucus of Democrats, we anticipate that will not gain much traction beyond the introduction of bills and perhaps some committee hearings.

House Democrats will do this even though it’s not likely they will be able to turn those bills and policy ideas in to law. This is because the Senate is still controlled by the Republicans, and the upper chamber is under no obligation to respond to the House’s efforts and will pursue their own legislative agenda. As you know, in order to become law, a bill needs to pass both chambers, then if there are differences between the House-passed and Senate-passed bills those discrepancies must be reconciled before the language is sent to the President for his signature. The policies which have the best chance to become law will be those with strong bi-partisan support.

Advocacy Opportunity 2:
The Government Affairs Committee (GAC) is meeting on December 3rd and 4th to determine the PPS legislative and advocacy priorities for the 116th Congress. Email Alpha or any GAC member with policy suggestions. Tell us what PPS should be focusing on for the next two years - to serve your needs - and the needs of your patients.

Thank you for your continued advocacy!

For one-pagers, talking points, and information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org 

Election Day is Tuesday, November 6th

It is now barely a week until the election! Verify with the local election board that you are registered to vote and make a plan for when you will cast your ballot. Your vote is a very powerful way to participate in policy-making.

 

Advocacy Opportunity 1:

Be sure to complete the ultimate act of civic engagement—voting for those who represent you and your interests. Please don’t miss the voting booth because you have a full day at the office or if you are in-transit to the PPS Annual Conference! PPS encourages those who will be traveling to the PPS Conference on Election Day to vote using an absentee ballot or in-person if early-voting is available in your state. Deadlines to apply for an absentee ballot vary by state, but can be due as early as 3 weeks prior to election. Visit your state election office websiteto apply for an absentee ballot before it’s too late!

 

Speaking Up on Behalf of Private Practice Physical Therapists

TAX POLICY

In December 2017, the Tax Cuts and Jobs Actprovided for a permanent flat 21% tax rate for corporations. Under the law, qualified trades or businesses such as private practice physical therapists who pay their business taxes through their individual tax returns may be able to utilize a 20% tax deduction on qualified business income.

 

The Department of Treasury released a proposed rule that sought to add physical therapists to the list of Specified Service Trades or Businesses (SSTB), which would remove them from the general category of Qualified Trade or Business. If categorized as an SSTB, a physical therapist would NOT be eligible for the 20% Code Section 199A tax deduction UNLESS their income was below $157,500 as an individual or $315,000 if married filing jointly. Once the income passes these initial thresholds, the deduction phases out for those whose incomes are between $315,000 and $415,000 formarried taxpayers who file jointly, or between $157,500 and $207,500 for single taxpayers. Furthermore, no deduction would be available for those whose income exceeds $415,000 (if married filing jointly).

 

On October 1st, PPS commented on the proposed rule, arguing that physical therapists should be treated as general qualified trades or businesses and not be added to the SSTB definition. Should the final rule notmake the changes proposed by the Administration, a larger number of private practice section members would be able to utilize the 20% pass through tax deduction. Please consult your tax professional for advice, as this tax policyimpacts the current tax year (beginning January 1, 2018).

 

ANTI-KICKBACK STATUTE

PPS’ legislative priorities call for us to address and mitigate the negative effects associated with physician self-referral.In August, PPS filed formal comments in response to CMS’ RFI on physician self-referral. On October 26th, PPS filed formal comments with the Department of Health and Human Services’ Office of Inspector General urging both limits to the use of beneficiary incentives as well as transparency if providers are offering incentives to retain or induce patients to choose a particular provider. In both comments, PSS urged the prompt removal of PT from the IOASE and requesting increased accountability and transparency for referrals made utilizing the IOASE.

 

Engage with Candidates for Elected Office

Election day is fast approaching, candidates are spending a lot of time in public meeting with voters. As a PPS Key Contact, you are well prepared to make this into a dialogue instead of a monologue. Keep engaging with your legislator as well as the candidate(s) running for the seat in Congress. With each engagement you enhance a candidate’s understanding of the unique value of physical therapy provided in a private practice setting.

 

All seats in the House of Representatives and one-third of the Senate seats will be contested this fall. Remember that whether or not you engage could impact the laws passed by those in Congress—in order to serve you and the needs of your patients they need to know and understand the legislative and advocacy priorities of the Section. The conversations your fellow PPS Key Contacts have been having with their Members of Congress have worked. This past month we added 4 new cosponsors to the CONNECT for Health Act(H.R.2556/S.1016)—Reps. Bruce Poliquin (ME-2), Brian Higgins (NY-26), Grace Napolitano (CA-32), and Ann Kuster (NH-2). Additionally, Representative Brian Fitzpatrick (PA-8) signed onto the Physical Therapist Workforce and Patient Access Act(H.R.1639/S.619) as a cosponsor.

 

Advocacy Opportunity 2:

See the July Legislative Update for templates, talking points, and scripts to use when engaging with candidates. Please take a photo of your meeting and tweet it as a thank you to the Member of Congress/candidate for the meeting, be sure to add #_________ so we can retweet it!

 

Thank you for your continued advocacy and engagement!

 

 

For one-pagers, talking points, and information on PPS’s legislative priorities and activities,

visit the Advocacy section at www.ppsapta.org

Election Day is Tuesday, November 6th

Only 6 weeks left until the mid-term elections held on November 6th! Verify with the local election board that you are registered to vote and make a plan for when you will cast your ballot.


ADVOCACY OPPORTUNITY #1

Be sure to complete the ultimate act of civic engagement—voting for those who represent you and your interests. Please don’t miss the voting booth during your travel to the PPS Annual Conference! PPS encourages those who will be traveling to the PPS Conference on election day to apply for an absentee ballot. Deadlines to apply for an absentee ballot vary by state, but can be due as early as 3 weeks prior to election. Visit your state election office website to apply for an absentee ballot before it’s too late!


Speaking Up on Behalf of Private Practice Physical Therapists

On September 10th, PPS filed official comments regarding the 2019 Medicare Physician Fee Schedule (MPFS) proposed rule. PPS comments supported the elimination of functional status reporting requirements, but asked for that elimination to be effective on the date the final rule is published (expected in November), instead of January 1, 2019. Additionally, PPS supported the expansion of the Merit-based Incentive Payment System (MIPS) eligible clinicians to include physical therapists while also praising CMS for maintaining the low-volume thresholds under which most PPS members will be exempt from participating in MIPS at this time.

In the first year of MIPS participation, PTs are only going to be scored in two of the Quality Payment Program (QPP) categories—quality and practice improvement activities. The proposed rule suggested that the weights of the two categories not required will be zeroed out and the weights of the quality portion (at 45%) and performance activities (at 15%) will be redistributed. PPS recommended that the quality category account for 70% of the score and the practice improvement activities make up the additional 30% because this would better enable private practice physical therapists to earn credit for their valuable improvement activities and achieve overall scores that reflect overall quality of care they provide. Additionally, because the Year 3 scoring threshold for achieving neutral payment is 30—ten times that of year one, PPS requested CMS allow those providers added in Year 3 to be granted the same lower performance threshold that was in place for those clinicians participating in MIPS in the first two years.

As you remember, one of the pay-fors in the therapy cap repeal law in February 2018 was a reduction of the payment rate for therapy assistants. The law requires that payment for services furnished in whole or in part by a therapy assistant be 85% of the applicable Part B payment amount for the service, effective January 1, 2022. PPS pushed back and encouraged CMS to consider the manner in which physical therapy services are typically provided when both a physical therapist and a physical therapist assistant are involved in all or part of the patients care and pointed out that requiring the modifier to be applied when any minute of outpatient therapy is delivered by the PTA has serious implications for beneficiary access to care. PPS recommended that CMS hold off and not finalize the definition of “in part” until CY 2020 rulemaking—after it had more robust with rehabilitation therapy stakeholders.

 

Engage with Candidates for Elected Office

Campaigns are in full swing. The airways are full of campaign ads and you are probably receiving phone calls asking you to vote for a specific candidate. As a PPS Key Contact, you are well prepared to make this into a dialogue instead of a monologue. Keep engaging with your legislator as well as the candidate(s) running for the seat in Congress. With each engagement you enhance a candidate’s understanding of the unique value of physical therapy provided in a private practice setting.

 

All seats in the House of Representatives and one-third of the Senate seats will be contested this fall. Remember that whether or not you engage could impact the laws passed by those in Congress—in order to serve you and the needs of your patients they need to know and understand the legislative and advocacy priorities of the Section. The conversations your fellow PPS Key Contacts have been having with their Members of Congress have worked. This past month we added 4 new cosponsors to the CONNECT for Health Act (H.R.2556/S.1016)—Senator Dan Sullivan (AK) and Representatiaves Kathleen Rice (NY-4), Kyrsten Sinema (AZ-9), and Dutch Ruppersberger (MD-2).


ADVOCACY OPPORTUNITY #2

See the July Legislative Update for templates, talking points, and scripts to use when engaging with candidates. Please take a photo of your meeting and tweet it as a thank you to the Member of Congress/candidate for the meeting, be sure to add #PPSAdvocacy so we can retweet it!


Thank you for your continued advocacy and engagement! For one-pagers, talking points, and information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

Keep up the good work! Your efforts continue to enhance your relationship with your legislator and their understanding of the value of physical therapy provided in a private practice setting. 

 

Speaking Up on Behalf of Private Practice Physical Therapists 

Modernizing the Physician Self-Referral Policy 

With a goal of accelerating the transition to a value-based system, the Department of Health and Human Services (HHS) and the Center for Medicare and Medicaid Services (CMS) are seeking to implement regulations to remove what they see as unnecessary government obstacles to team-based care. For example, they see the self-referral prohibitions of the Stark Law to be a hindrance to coordinated care. CMS posted a Request for Information (RFI) seeking public input for how to modernize the physician self-referral law (also known as the “Stark law”). 

PPS responded to the RFI arguing three primary points. The first is that PT should be removed from the In-Office Ancillary Services Exception (IOASE) and that because a physician is allowed to self-refer physical therapy patients to providers with which he/she has a financial relationship, he/she has no real incentive to refer patients to independent rehabilitation professionals who have clinical expertise specific to the outcome desired for their patients, may be more cost-effective, and achieve higher functional outcomes for their patient populations. Secondly, PPS argued that value-based care and bundled-payment arrangements are also relevant to other Medicare enrolled providers and suppliers, including physical therapists and therefore encouraged CMS to allow physical therapists to participate in alternative payment models (APMs) on a risk-sharing basis. Finally, PPS urged CMS to consider how modernizations explored would impact the care Medicare beneficiaries receive from non-physician health care providers and suppliers. PPS pointed out that the goal of balancing the physician self-referral law’s restrictions while modernizing the regulations to support value-based reimbursement can be met while also protecting a Medicare beneficiary’s right to receive quality care from the provider of their choice—in many cases that will be from independent, private practice physical therapy practitioners. 

Medicare Physician Fee Schedule Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) has issued its proposed rule for calendar year 2019. Within the fee schedule portion, CMS proposes to eliminate functional limitation reporting and establish two new therapy modifiers to identify outpatient therapy services furnished in whole or in part by PTAs and OTAs. In the Quality Payment Program portion of the proposal, physical therapists were added to the list of Medicare-eligible providers who could be required to participate in the Merit-Based Incentive Payment System (MIPS). The agency also proposes to exempt providers who are below the low-volume threshold from participation in MIPS, but at the same time allow them to opt-in to the program so that more providers are able to participate. To promote participation in APMs, CMS is increasing flexibility for the All-Payer Combination Option and Other Payer Advanced APMs for non-Medicare payers to participate in QPP. APTA and PPS will both submit comments.


ADVOCACY OPPORTUNITY #1

You too can submit comments to CMS about how the 2019 Medicare Physician Fee Schedule proposed rule will impact you and your patients. APTA has prepared a template letter that you can modify to reflect your perspective. The deadline for comments is Monday, September 10, 2018. 


Engage with Candidates for Elected Office 

Being an active advocate in an election season is easy to do and is more important than ever. Candidates are crisscrossing their districts eager to talk to potential voters and community leaders. Fundamental to effective advocacy and representative democracy is the act of educating the policymaker. Whether or not you engage could impact the laws passed by those in Congress—in order to serve you and the needs of your patients they need to know and understand the legislative and advocacy priorities of the Section. All seats in the House of Representatives and one-third of the Senate seats will be contested this fall. This is a prime time for you meet to talk about the impact of healthcare policy and also reinforce the message of the important role you play in the local economy. With each engagement you enhance a candidate’s understanding of the unique value of physical therapy provided in a private practice setting. 


ADVOCACY OPPORTUNITY #2

See the July Legislative Update for templates, talking points, and scripts to use when engaging with candidates. 


 

Thank you for your continued advocacy and engagement! For one-pagers, talking points, and information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

Keep up the good work! Your advocacy efforts are much appreciated and with each engagement you enhance your relationship with your legislator and their understanding of the value of physical therapy provided in a private practice setting.


Interest in Modernizing the Physician Self-Referral Policy

With a goal of accelerating the transition to a value-based system, the Department of Health and Human Services (HHS) and the Center for Medicare and Medicaid Services (CMS) are prioritizing implementing regulations to remove what they see as unnecessary government obstacles to team-based care. They see the self-referral prohibitions of the Stark Law to be a hindrance to coordinated care and the use of bundled payments and thus are seeking to modify the regulations. CMS has posted a Request for Information (RFI) seeking recommendations and input from the public on how to address any undue impact and burden of the physician self-referral law (also known as the “Stark law”).

 

ADVOCACY OPPORTUNITY # 1: 

Respond to CMS’ Request for Information to educate the agency about the harm created by the In-Office Ancillary Services Exception (IOASE) loophole which allows physicians to self-refer to physical therapists which they employ or whose practice they have a financial interest in. APTA has created a helpful template to use for drafting and submitting a response the Stark Law RFI—use this opportunity to add to the chorus of voices advocating for removing physical therapy from the IOASE. The deadline for submission is August 24, 2018.

 


Engage with Candidates for Elected Office

Being an active advocate in an election season is easy to do and more important than ever. While Members of Congress are not particularly focused on legislating or cosponsoring bills, they are eager to appear engaged with their electorate. Candidates for office are crisscrossing their districts eager to talk to potential voters and community leaders. Fundamental to effective advocacy and representative democracy is the process of educating the policymaker. How you engage with them could change the make-up of the incoming Congress and impact the laws it passes. All seats in the House of Representatives and one-third of the Senate seats will be contested this fall. This is a prime time for you meet and reinforce the message of the important role you play in the local economy. With each engagement you enhance a candidate’s understanding of the unique value of physical therapy provided in a private practice setting.

 

ADVOCACY OPPORTUNITY #2: 

Please call your both your incumbent legislator and the opposing candidate’s local offices this week and follow up with an email to request a meeting with your Member of Congress or the candidate in August. If you don’t get a response within a week, reach out again. Customize your communications by filling in the blanks in the scripts below and following the prompts in red:

 

Phone:

“Hello, my name is ___________. I am a voter, small business owner, and physical therapist. I’m calling to request a meeting with Representative/Senator __________/(candidate’s name). Thank you.”

 

You may be told the Member or candidate’s schedule is full. If so, ask when you can meet with the local staff and offer 2 or 3 dates and times that work for you.

 

Once you have someone on the phone, also ask for the email address of the scheduler so that you may also send an email request using the template below.

 

Voicemail:

“Hello, my name is ___________. I am a voter, small business owner, and physical therapist living/working in [town]. I’m calling to request a meeting with Representative/Senator __________/(candidate’s name) in August. My email is _____________, my cell phone number is _________. I look forward to hearing back from you so we can set up a time for me to come meet with you. Thank you.”

 

Email:

“Dear Representative/Senator __________/(candidate’s name);

I am a voter, small business owner, and physical therapist. My ___ person practice is located in [town]. [#] percent of my patients are Medicare beneficiaries.

I am writing to request a meeting with you, Representative/Senator __________/(candidate’s name) when you are in the area this summer or early fall. I understand that your schedule is very busy during election season, but I hope you can spare a few minutes to meet with me to discuss the important role physical therapy plays in the local economy, health care and wellness, as well as the role federal legislation plays in ensuring access to care.

 

My email is _____________, my cell phone number is _________. I look forward to hearing back from you so we can set up a time to meet. Thank you.”

 

--

In addition to scheduling in-office meetings, there are many other ways to engage with those running for office. Please attend town-hall and community meetings and introduce yourself to their staff. If you feel comfortable, consider volunteering for a campaign or attending a fundraiser—both are great ways to meet anyone running for elective office. Check out the “Advocacy in Action” article in the August issue of Impact for more details and ideas.

 

Once you schedule a meeting with your legislator, candidate, or their staff, check out the Nuts and Bolts of Lobbying for meeting tips such as preparing a good anecdote to share. Be sure to bring print-outs of the issue one-pagers to leave behind. At the end of the meeting ask to take a picture, then post that picture along with a “thank you for meeting with private practice physical therapists” message to your social media, tagging the candidate or Member of Congress. If you have any questions, please reach out directly to Alpha Lillstrom Cheng, the Section’s lobbyist.

Talking Points:

  • The Private Practice Section (PPS) of the American Physical Therapy Association (APTA) is an organization of nearly 4,300 physical therapists in private practice
  • Physical therapists use their expertise to restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities in patients with injury or disease.
  • Private practice PTs provide rehabilitative and habilitative care that:
    • Restores, maintains, and promotes overall fitness and health.
    • Is considered an Essential Health Benefit which is required to be offered as part of a qualified insurance plan as defined by the Patient Protection and Affordable Care Act.
  • As small business owners, we are interested in policies that will allow for access to affordable quality care for our patients who are Medicare beneficiaries.

 

Follow up your meeting with a handwritten note mailed to the district or campaign office. In that note, invite them and their staff to visit your clinic for a tour to see physical therapy in action. Let us know how we can help with planning the site visit.


Thank you for your continued advocacy and engagement!

For one-pagers, talking points, and information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

Your advocacy efforts are much appreciated and with each engagement you enhance your relationship with your legislator and their understanding of the value of physical therapy provided in a private practice setting. 

 

Members of Congress will be back in their districts for what is referred to as the “4th of July Recess” at some time between June 30th and July 6th.  In addition to attending parades and other public events on July 4th, they and their district staff will be eager to engage with their constituents.  This is a prime opportunity for you meet and reinforce the message of the important role you play in the local economy.

 

Please call your legislator’s local office today and follow up with an email to request a meeting with your Member of Congress when they are in town the first week of July.  Use the attached template letter to present a formal meeting request. Customize your communications by filling in the blanks and following the prompts in red:

 

Phone script:

“Hello, my name is ___________.  I am a constituent, small business owner, and physical therapist.  I’m calling to request a meeting with Representative/Senator __________ the first week of July. Thank you.”

 

You may be told the Member’s schedule is full.  If so, ask to meet with the district staff now and to schedule a meeting with the Member during the August recess.

 

If you get sent to voicemail, leave the following message:

“Hello, my name is ___________.  I am a constituent, small business owner, and physical therapist living/working in [town].  I’m calling to request a meeting with Representative/Senator __________ the first week of July.  My email is _____________, my cell phone number is _________.  I look forward to hearing back from you so we can set up a time for me to come meet with you.  Thank you.”

 

 

Email script:

“I am a constituent, small business owner, and physical therapist.  My ___ person practice is located in [town][#] percent of my patients are Medicare beneficiaries.

 

I am writing to request a meeting with Representative/Senator __________ when they are back home the first week of July.  I understand that Rep./Sen. ________’s schedule is very busy during recess, but I hope he/she can spare a few minutes to meet with me to discuss the important role physical therapy plays in the local economy, health care and wellness, and the role federal legislation plays in ensuring access to care.  My email is _____________, my cell phone number is _________.  I look forward to hearing back from you so we can set up a time for me to meet with Rep./Sen. ________.  Thank you.”

 

Once you schedule a meeting with your legislator or their staff, check out the Nuts and Bolts of Lobbying for tips on how to conduct the meeting.  Be sure to bring print-outs of the issue one-pagers to leave behind. 


BACKGROUND AND TALKING POINTS FOR MEETINGS


Adding physical therapists to the National Health Service Corps

Background: The Physical Therapist Workforce and Patient Access Act (H.R.1639/S.619) has 48 House cosponsors.  The Senate companion bill has three sponsors.  The National Health Service Corps (NHSC) addresses the health needs of more than 9.7 million underserved individuals across the nation.  The program allows for the placement of certain health care professionals in areas which are designated as a health care professional shortage area (HPSA).  This legislation authorizes physical therapists to participate in the NHSC Loan Repayment Program.  Download One-Pager.

Talking points:

  1. Currently, there is no rehabilitative care component in the National Health Service Corps and physical therapists are not eligible to participate in the program.
  2. Including physical therapists in the National Health Service Corps would save costs by increasing access to essential rehabilitation services for rural, remote, and medically underserved areas.
  3. In 2012, the National Health Service Corps had an 82% retention rate for providers within the program.
  4. Physical therapy clinics in HPSAs could use this program as a recruitment tool and simultaneously reduce their initial salary outlay as their business grows to support an additional physical therapist for the long-term.
  5. The bill does not authorize any new funding for the program. 

Medicare Opt-Out

Background: The Medicare Patient Empowerment Act (H.R.4133) has 4 cosponsors in the House.  We are seeking a Senator to lead the bill in the Senate.  The bill adds physical therapists to the short list of providers who would be able to opt-out of Medicare.  Additionally, this subset of providers could opt-out of Medicare on a case-by-case basis. Download One-Pager.

Talking Points:

  1. The bill would allow Medicare beneficiaries to receive treatment from their provider of choice.
  2. Medicare enrolled providers (including physical therapists) would be allowed to contract directly with their patients who are Medicare beneficiaries—on a case-by-case basis. 
  3. The decision to opt-out would not impact the entire practice, only the billing relationship between that patient and therapist. 
  4. The legislation prohibits entering into a contract at a time when the Medicare beneficiary is facing an emergency medical condition or urgent health care situation.
  5. Every time a beneficiary chooses not to bill Medicare it saves the program money.

Telehealth

Your work in support of the CONNECT for Health Act (H.R.2556/S.1016) has paid off.  Six Members of Congress have signed on recently.  The bill now has 25 Senate cosponsors and 39 House cosponsors. 

Background:  While the CONNECT for Health Act (H.R.2556/S.1016) addresses a number of ways telehealth can be used to increase access to care, the provision most significant to physical therapy would allow for any Medicare enrolled provider or supplier to be reimbursed for care provided via telehealth as long as the cost of that care is the same or less and has no negative impact on access to care or quality.  The legislation would also allow PTs to be reimbursed for telehealth if the care is provided as part of a bundled or global payment program. Download One-Pager.

Talking Points:

  1. This patient-centered policy will allow you to use technology to better serve your patients and your community. 
  2. The use of telehealth could reduce travel times and cancelled appointments due to transportation challenges.
  3. Increased compliance improves outcomes; telehealth can be used to encourage patients to successfully complete their home exercises.

Follow up your meeting with a handwritten note mailed to the district office.  In that note, invite your legislator and their staff to visit your clinic for a tour to see physical therapy in action.  Let us know how we can help with planning the site visit. 


Thank you for your continued advocacy and engagement! For one-pagers, talking points, and information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

Do you have problems getting paid for Medicare patients because they’ve received home health services? Do you ask your Medicare patients if they’ve received home healthcare and get told “no”, only to find out later the answer was “yes” when you were denied payment? You are not alone! We’ve heard from private practitioners over the years about this issue, and now we’d like to collect some data about the scope of this problem to try to address it. 

If this has been an issue for you, if you have received a Medicare initial denial of payment, or been asked to refund payment, because the Medicare patient was in a home health episode of care in the past two years, please do one or both of the following by June 29:

  1. Fill out the survey at https://www.surveymonkey.com/r/hhpt2018
  2. Send in your stories to the PPS Lobbyist Alpha Lillstrom Cheng ([email protected]) to help us illuminate the issue for policy makers. In your submission, please tell us how you checked to see if the patient had received (or was receiving) home healthcare services prior to delivering your therapy services, whether or not your appeals of denials or refunds were successful, and what best practices you have used in order to avoid this issue.

Thank you for helping us fight for you.

TELEHEALTH

The bipartisan PPS-endorsed CONNECT for Health Act (H.R.2556/S.1016) was included in the asks physical therapists took to Capitol Hill during the APTA Federal Advocacy Forum. S.1016 has   24 Senate cosponsors , but could have more. The leads of the Senate bill have decided to maintain an equal number of Democrats and Republicans on the bill. At this time, a least one more Democrat has asked to be added as a cosponsor, but is being kept waiting until another Republican signs on; if one or both of your Senators is a Republican, please reach out and ask for them to cosponsor S.1016. The House companion bill added 7 more cosponsors since last month and now has   35 cosponsors -17 Republicans and 18 Democrats. While the bill addresses a number of ways telehealth can be used to increase access to care, the provision most significant to physical therapy would allow for any Medicare enrolled provider or supplier to be reimbursed for care provided via telehealth as long as the cost of that care is the same or less and has no negative impact on access to care or quality. The legislation also allows PTs to be reimbursed for telehealth if the care is provided as part of a bundled or global payment program.

Two provisions of the CONNECT for Health Act  became law in February after they were included in the same legislation that repealed the therapy cap. The first provision allows for a patient to be assessed for stroke, using telehealth, regardless of the patient's geographic location (also known as the Furthering Access to Stroke Telemedicine or "FAST" Act). The second provision allows Medicare Advantage (MA) plans to expand their basic benefit coverage to include reimbursement for telehealth services . However, before MA plans can start offering telehealth as a basic benefit at comparable rates to in-person services beginning in 2020 , CMS must solicit comments from stakeholders in order to determine what types of care and which services should be considered eligible for telehealth coverage.

ADVOCACY OPPORTUNITY #1 

PPS intends to submit comments to CMS in support of including physical therapy as a type of care eligible for telehealth coverage as a MA plan basic benefit. Therefore, we are seeking to educate policy- makers and illustrate how physical therapists have used, or would use, technology in order to increase access to care for your patients. For example, what kind of therapy would you be able to provide via a video link or webcam setup? Please write up a short example and send it to your PPS Lobbyist at [email protected].

ADVOCACY OPPORTUNITY #2 

Reach out to your Representatives and Senators to ask them to cosponsor the CONNECT for Health Act (H.R.2556/S.1016). This patient-centered policy will allow you to use technology to better serve your patients and your community. Please include the one-pager found at the Advocacy section at www.ppsapta.org  with your outreach.

ADVOCACY OPPORTUNITY #3 

Your Member of Congress is likely to be back in the district this week following Memorial Day. Please attend any town-hall or community meetings and introduce yourself to their staff.  Beginning in July there will be more opportunities to engage with your legislator and their staff as they begin focusing on the general election. It is an election year so all seats in the House of Representatives and one-third of the Senate seats will be contested. Candidates who are seeking to join Congress are also looking for ways to engage with community leaders. Start off the election season by inviting all the candidates and their staff to visit your clinic for a tour to see not only physical therapy in action, but perhaps an opportunity for them to meet potential voters. Let us know how we can help with planning the visit.

Today, The Private Practice Section is pairing up with APTA for the Federal Advocacy Forum on Capitol Hill. PPS Key Contacts and advocates are working alongside APTA Key Contacts bringing our message to Members of Congress. We encourage PPS members who are not on the hill today, to magnify our advocates’ impact by calling or emailing your legislators before the end of the day. Talking Points and PPS One-Pagers are outlined in the April Legislative Update Below.

PHYSICAL THERAPY WORKFORCE

The PPS-endorsed Physical Therapist Workforce and Patient Access Act (H.R.1639/S.619) authorizes physical therapists to participate in the National Health Service Corps (NHSC) Loan Repayment Program. Should PT's be eligible to participate in the program, they could seek positions in health professional shortage areas in exchange for funds earmarked to repay student loans. From the clinic owner's perspective, they could use the program as a recruitment tool to attract new therapists and use the program as a financial on-ramp to supplement the salary outlays for the first few years while growing the practice to support the additional salary. The bill does not authorize any new funding for the program.

TALKING POINTS:

  1. The National Health Service Corps (NHSC) allows for the placement of certain health care professionals in areas which are designated as a health care professional shortage area (HPSA).

  2. While the NHSC was configured to address primary care needs in underserved communities, it has no rehabilitative care component and physical therapists are not eligible to participate in the program.

  3. 82% of NHSC providers stayed on in the communities after their service obligation expired; this is an example of an effective federal investment.

  4. Physical therapy clinics in HPSAs could use this program as a recruitment tool and simultaneously reduce their initial salary outlay as their business grows to support an additional physical therapist for the long-term while simultaneously improving patient access to essential physical therapy services.

     

ADVOCACY OPPORTUNITY #1

Reach out to your legislators and use the above talking points to explain how physical therapy is recognized as an essential part of recovering from physical injury and many surgeries and that rehabilitative care is akin to primary care, especially in communities where physical labor is the backbone of the economy. Ask for your Representative and Senators to cosponsor the Physical Therapist Workforce and Patient Access Act (H.R.1639/S.619). Please include the one-pager found at the Advocacy section at www.ppsapta.org with your outreach.

MEDICARE OPT-OUT:

One of PPS' top legislative and advocacy priorities is to support legislation that would allow PTs and other Medicare enrollees to opt out of Medicare on a case-by-case basis. In the House, the Medicare Patient Empowerment Act (H.R.4133) has 3 cosponsors; we need your help getting previous House cosponsors back on the bill. The bill language is the same as it was last Congress and would allow Medicare enrolled providers (including physical therapists) to contract directly with their patients who are Medicare beneficiaries. The decision to opt-out would not affect the entire practice, only the billing relationship between that patient and therapist.

TALKING POINTS:

  1. Allow providers to contract directly with their patients who are Medicare beneficiaries-on a case-by-case basis.

  2. Allow Medicare beneficiaries to contract with their choice of provider at Medicare rates or at rates established between the patient and physician or practitioner.

  3. Allow providers to continue as a participating or non-participating Medicare provider with respect to any patient or service not covered under the contract.

  4. Empower individual beneficiary choice at no additional cost to the Medicare program.

ADVOCACY OPPORTUNITY #2

Reach out to your Representatives and use the above talking points to explain how you would use the patient-centered policy to better serve your patients and your community, include an example if you have one. Ask for your Representative to cosponsor the Medicare Patient Empowerment Act (H.R.4133). Please include the one-pager found at the Advocacy section at www.ppsapta.org with your outreach.

 

Thank you for your continued advocacy and engagement.

For additional one-pagers and talking points for other PPS's legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

 

TELEHEALTH

Two provisions of the PPS-endorsed CONNECT for Health Act (H.R.2556/S.1016) became law after they were included in the February 9th government funding bill.  The first provision allows the use of telehealth to assess a patient for stroke regardless of the patient’s geographic location (also known as the Furthering Access to Stroke Telemedicine or “FAST” Act).  The second provision allows Medicare Advantage (MA) plans to expand their basic benefit coverage to include reimbursement for telehealth services.  However, before MA plans can start offering telehealth as a basic benefit at comparable rates to in-person services beginning in 2020, CMS must solicit comments from stakeholders in order to determine what types of care and which services should be considered eligible for telehealth coverage.  

ADVOCACY OPPORTUNITY #1

PPS intends to submit comments to CMS in support of including physical therapy as a type of care eligible for telehealth coverage as a MA plan basic benefit.  Therefore, we are seeking stories to illustrate how you have used, or would use, technology in order to increase access to care for any of your patients.  For example, what kind of therapy would you be able to provide via a video link or webcam setup?  Please write up a short example and send it to your PPS Lobbyist at [email protected].

MEDICARE OPT-OUT

One of PPS’ top legislative and advocacy priorities is to support legislation that would allow PTs and other Medicare enrollees to opt out of Medicare on a case-by-case basis.  In the House, the Medicare Patient Empowerment Act (H.R.4133) has 3 cosponsors; we are working on getting previous House cosponsors back on the bill.  The bill language remained the same as last Congress and would allow Medicare enrolled providers (including physical therapists) to contract directly with their patients who are Medicare beneficiaries.  The decision to opt-out would not affect the entire practice, only the billing relationship between that patient and therapist.  

TALKING POINTS:

  • Allow providers to contract directly with their patients who are Medicare beneficiaries—on a case-by-case basis.  
  • Allow Medicare beneficiaries to contract with their choice of provider at Medicare rates or at rates established between the patient and physician or practitioner.
  • Allow providers to continue as a participating or non-participating Medicare provider with respect to any patient or service not covered under the contract.
  • Empower individual beneficiary choice at no additional cost to the Medicare program.

 

ADVOCACY OPPORTUNITY #2

Reach out to your Representatives using the PPS "Find Your Rep" portal, and use the above talking points to explain how you would use the patient-centered policy to better serve your patients and your community, include an example if you have one.  Ask for your Representative to cosponsor the Medicare Patient Empowerment Act (H.R.4133). Please include the one-pager found on the PPS Advocacy Tools & Resources page with your outreach.  

Keep up the good work and remember, it is an election year so all seats in the House of Representatives and 1/3 of the Senate seats will be contested.  Your legislators need your vote and to hear from you.

Thank you for your continued advocacy and engagement.

THERAPY CAP

 

Two decades of grassroots pressure and advocacy worked—on February 9th, the permanent repeal of the therapy cap was included in the spending bill that was signed into law. Section 50202[1] of the bill repealed the long-standing therapy cap. The legislation eliminates the cap on physical therapy (PT) and speech-language pathology (SLP) services, and the separate cap on occupational therapy (OT).

 

THE NEW THERAPY POLICY:

 

Requires that the KX modifier indicating services are medically necessary must be included once PT/SLP or OT therapy spending reaches $2010 in 2018.

  1. This amount will be adjusted annually.
  2. Bills can be denied if the KX modifier is not used on claims which exceed the $2010 threshold.

Once spending reaches $3000 there is the potential for targeted medical review, triggered by factors such as:

  1. Being a new Medicare-enrolled provider,

  2. Aberrant billing as compared to peers, or

  3. Provider belongs to a practice whose partners have been flagged for aberrant billing.

  4. The $3000 amount will be adjusted annually by Medicare Economic Index (MEI) beginning in the year 2028.

New policy retroactively applied to therapy expenses incurred starting January 1, 2018.

Applies to any Medicare Part B outpatient facility: (hospital outpatient (HOPD), skilled nursing facilities (SNF) Part B, Home Health Part B, and outpatient clinics).

 

The budget deal also includes a pay-for that PPS does not support and worked hard to change after it was announced at the last minute—this pay-for would reduce payment for services in which a physical therapist assistant (PTA) is involved under Medicare Part B. Beginning January 1, 2022, payment for services provided by a PTA, as well as services provided by an occupational therapy assistant (OTA), would be paid at 85% of the Medicare fee schedule.

 

For record-keeping purposes, the bipartisan message bill to permanently repeal the arbitrary therapy cap—the Medicare Access to Rehabilitation Services Act (H.R.807/S.253)—topped out at 241 cosponsors in the House and 38 cosponsors in the Senate.

 


ADVOCACY OPPORTUNITY #1

Members of Congress really appreciate being thanked when appropriate. Use these links to see how your Representative and Senators voted on the Bipartisan Budget Act of 2018 (HR1892) which included the therapy cap repeal language:

House: http://clerk.house.gov/evs/2018/roll069.xml
Senate: https://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=115&session=2&vote=00031

If they voted against the Bipartisan Budget Act of 2018, it might have been for a reason other than the therapy cap repeal policy, so don't be afraid to ask why they voted the way they did.

 

ADVOCACY OPPORTUNITY #2

 

Please let us know if your clinic employs PTAs and how your business model would be impacted by the payment differential—share their stories so that we can hit the ground running in our advocacy efforts on this front.
 


Keep up the good work and remember, it is an election year so all seats in the House of Representatives and 1/3 of the Senate seats will be contested. Your legislators need your vote and to hear from you. Thank you for your continued advocacy and engagement—you have just experienced how it can work.

 

For one-pagers and talking points for other PPS’s legislative priorities and activities,visit the Advocacy section at www.ppsapta.org

 

 

BICAMERAL, BIPARTISAN LEGISLATIVE LANGUGAGE:

On October 26, 2017, lawmakers from the House Energy and Commerce Committee, the House Ways and Means Committee, and the Senate Finance Committee announced a bipartisan, bicameral agreement to end the hard cap through proposed legislation that would essentially codify the exceptions process. This legislation would to eliminate the arbitrary cap on physical therapy (PT) and speech-language pathology (SLP) services, and the separate cap on occupational therapy (OT). The current process for targeted post-payment medical review would continue, but with the current $3,700 threshold lowered to $3,000.

While we were disappointed that PT and SLP are still grouped together, we believe this proposed policy will provide appropriate oversight of therapy services, alleviate administrative burden, while most importantly eliminating the unnecessary and burdensome therapy caps. It is clear that if they were to separate PT and SLP that the cost of the bill would increase significantly and the legislation itself would no longer be viable.

 

PRESSING NEED:

A hard cap of $2010 on outpatient therapy services (PT/SLP combined, OT separate) applied as of January 1, 2018. The Medicare Extenders Package released by the House includes the above language to repeal the current Medicare therapy cap and the exemptions process and replace it with a policy that ensures access to care for those who need it but also implements a few stop-gap measures that are used to protect against fraud.

 

ARBITRARY THERAPY CAP REPEALED:

On February 9th, the President signed into law a budget deal that included a package of Medicare policies. Included in this package was a policy to repeal the arbitrary therapy cap and replace it with a policy that essentially codifies the exceptions process that had been in place. The new therapy policy requires that the KX modifier indicating services are medically necessary be included once PT/SLP or OT therapy spending reaches $2010 in a given year. This amount will be adjusted annually. Bills can be denied if the KX modifier is not used on claims which exceed the $2010 threshold. Instead of the exceptions process threshold of $3700, now at the $3000 level there is the potential of a targeted medical reviewed triggered by factors such as one is a new Medicare-enrolled provider, aberrant billing as compared to their peers, or the provider belongs to a practice whose partners have been flagged for aberrant billing. The $3000 amount will be adjusted annually by Medicare Economic Index (MEI) beginning in the year 2028.

This new policy will be retroactively applied to therapy expenses incurred starting January 1, 2018. If a patient has already exceeded the $2010 threshold but that billing does not include the KX modifier, those claims could be denied.

The most significant departure from the previous exemptions process is the lowering of the threshold from $3700 to $3000 for targeted medical review. This was done for scoring purposes. The other main provision that impacts the score is the requirement to use the KX modifier for claims at $2010 and above. The assumption is that some providers will fail to use the KX modifier when they are supposed to and this will allow CMS to deny claims; additionally, there is the thought that the KX modifier requirement will also deter bad actors from billing more than $2010 for fear of being more "visible". With this agreement we have avoided prior authorization.

 

PAY-FOR:

The budget deal also includes a pay-for that PPS does not support and worked hard to change after it was announced at the last minute—this pay-for would reduce payment for services in which a physical therapist assistant (PTA) is involved under Medicare Part B. Beginning January 1, 2022, payment for services provided by a PTA, as well as services provided by an occupational therapy assistant (OTA), would be paid at 85% of the Medicare fee schedule. As you know, this policy was not part of any of the discussions or negotiations on Capitol Hill over the past year, nor was it included as part of the proposed package of pay-fors that were announced this past fall as part of the bipartisan, bicameral agreement. We worked with APTA and AOTA to provide alternative proposals to eliminate, reduce, or delay the PTA and OTA payment differential. Each of these legislative options was rejected. Going forward we will work with CMS and our Congressional champions to reduce the impact of this pay-for.

H.R.807/S.253:

For record-keeping purposes, the bipartisan message bill to permanently repeal the arbitrary therapy cap—the Medicare Access to Rehabilitation Services Act (H.R.807/S.253)—topped out at 241 cosponsors in the House and 38 cosponsors in the Senate.

SEND A THANK YOU TO YOUR REPRESENTATIVES:

Thank you for all of the calls, emails, and tweets you sent to your legislators asking for their support to repeal the arbitrary therapy cap. Members of Congress really appreciate being thanked when appropriate. Use these links to see how your Representative and Senators voted on the Bipartisan Budget Act of 2018(HR1892):

House
Senate

If they voted against the Bipartisan Budget Act of 2018, it might have been for a reason other than the therapy cap repeal policy, so don't be afraid to ask why they voted the way they did."

On midnight January 19, 2018, funding for the federal government expired.  The government shut down for 3 days, but reopened on Monday January 22nd when Congress passed a 3-week patch which included 6 years of funding for the Children's Health Insurance Program (CHIP).  Congress is now preparing another federal spending bill before the short-term patch expires on Feb. 8th.  We are hearing that this funding bill is likely to include the Extenders Package and the therapy cap repeal language.

 

LEGISLATION

Therapy Cap On November 15th, the House Ways and Means Committee released their Extenders Package which includes the language to repeal the therapy cap.  We have been told that this Extenders Package will be part of the government funding bill that must be considered before February 8th.  However, nothing is for certain so we are focusing our lobbying efforts on this important issue.

Members of Congress are showing their support for the bipartisan Medicare Access toRehabilitation Services Act (H.R.807/S.253) by continuing to join the bill as cosponsors.  The House bill gained seven more signatories since the beginning of January and has 236 cosponsors.  Senator Bill Nelson (D-FL) joined the bill on January 3rd so there are now 37 cosponsors in the Senate.  The current exceptions mechanism expired on December 31, 2017.

 

ADVOCACY OPPORTUNITY #1 

You received Advocacy Alerts in mid-January-thank you for your responsive outreach efforts.  It is important to keep up the pressure and reach out regularly to make sure your legislators understand how important it is to permanently repeal the therapy cap.  We are so close to the finish line! 

Continue to call, email, and use social media to contact your Representative and both Senators.  Ask them to cosponsor the Medicare Access toRehabilitation Services Act (H.R.807/S.253) if they haven't already; also request that they ask Congressional leadership to include the Extenders Package in any legislation that is moving. 

As part of the Therapy Cap Coalition, PPS is working on a "thunderclap" to build up the social media pressure and outcry regarding the therapy cap-the more people that participate, the more visibility the push gets.  Please sign up here by January 30th. 

We also need powerful stories that will compel members to fix this issue.  Please send examples of patients who have surpassed 2018's $2010 threshold.  For example:  What was the injury or disease process that resulted in your patient requiring so much care?  What was your experience with the exemptions process?  Please cc your lobbyist, Alpha Lillstrom Cheng ([email protected]) on the email to your legislators so that we may create a bank of powerful examples.

 

REGULATORY

Department of Health and Human Services On January 24th, the Senate confirmed Alex Azar to be the new Secretary of the Department of Health and Human Services (HHS).  Azar is familiar with the Agency, having formerly served as HHS Deputy Secretary and General Counsel under President George W. Bush and has deep Indiana connections having worked closely with both Vice President Pence and CMS Administrator Seema Verma. 

During Azar's January 9th appearance before the Senate Finance Committee, he stated his support for Affordable Care Act's innovation program and mandatory pilots to test new payment models.  He said, "we must make healthcare more affordable, more available, and more tailored to what individuals want and need in their care."  We will be monitoring the Agency's proposed regulations that impact private practice physical therapy and PPS members.

As always, thank you for your continued advocacy and engagement!

Below is the text of a recent announcement from CMS regarding outpatient therapy claims that are impacted by the Therapy Cap. The link to the CMS website with this announcement can be found HERE.

Also attached please find APTA’s FAQ document on the Therapy Cap.

PPS, along with APTA and our partners in the Repeal the Therapy Cap Coalition, continue to aggressively push Congress to include the bipartisan proposal to permanently repeal the hard therapy cap in the next congressional spending deal. Congress must pass a spending deal by the February 8 deadline or risk another government shut-down. Our ongoing grassroots, public relations, and social media campaign (#StopTheCap) will continue to ramp up over the next 10 days. In addition, our coalition partner AARP launched their national grassroots push this week on repealing the therapy cap, which you can read more about HERE.

Please stayed tuned for additional updates. Thank you for your continued advocacy and support.

Expired Medicare Legislative Provisions and Therapy Claims with the KX Modifier Rolling Hold

CMS is committed to implementing the Medicare program in accordance with all applicable laws and regulations, including timely claims processing. Several Medicare legislative provisions affecting health care providers and beneficiaries recently expired, including exceptions to the outpatient therapy caps, the Medicare physician work geographic adjustment floor, add-on payments for ambulance services and home health rural services, payments for low volume hospitals, and payments for Medicare dependent hospitals. CMS is implementing these payment policies as required under current law.

For a short period of time beginning on January 1, 2018, CMS took steps to limit the impact on Medicare beneficiaries by holding claims affected by the therapy caps exceptions process expiration. Only therapy claims containing the KX modifier were held; claims submitted with the KX modifier indicate that the cap has been met but the service meets the exception criteria for payment consideration. During this short period of time, claims that were submitted without the KX modifier were paid if the beneficiary had not exceeded the cap but were denied if the beneficiary exceeded the cap.

Starting January 25, 2018, CMS will immediately release for processing held therapy claims with the KX modifier with dates of receipt beginning from January 1-10, 2018. Then, starting January 31, 2018, CMS will release for processing the held claims one day at a time based on the date the claim was received, i.e., on a first-in, first-out basis. At the same time, CMS will hold all newly received therapy claims with the KX modifier and implement a “rolling hold” of 20 days of claims to help minimize the number of claims requiring reprocessing and minimize the impact on beneficiaries if legislation regarding therapy caps is enacted. For example, on January 31, 2018, CMS will hold all therapy claims with the KX modifier received that day and release for processing the held claims received on January 11. Similarly, on February 1, CMS will hold all therapy claims with the KX modifier received that day and release for processing the held claims received on January 12, and so on.

Under current law, CMS may not pay electronic claims sooner than 14 calendar days (29 days for paper claims) after the date of receipt, but generally pays clean claims within 30 days of receipt.

LEGISLATION

Healthcare Reform
This tax bill signed into law on December 22nd had pieces of healthcare policy tucked inside. The law repeals the individual mandate as of 2019. According to the Congressional Budget Office (CBO), without the individual mandate, healthy people may opt out of getting insurance, and the number of uninsured Americans would increase by 13 million by 2027, additionally premiums could rise 10 percent more per year than they would without this change. That is because healthier people would be most likely to drop insurance in the absence of a fine, so insurers would have to raise premiums to compensate for a sicker group of customers who would be left with fewer affordable choices. The law will allow people to deduct medical expenses above 7.5% of their income for 2017 and 2018. In 2019 the threshold will back up to 10%.

The law will grant some pass-through service business a tax break. "Service" business owners who pay business taxes through their individual tax returns will be able to access a 20% deduction—but only if their taxable income is less than $157,000 individually (or $315,000 if filing jointly). This is a brand-new provision in the reform bill that may apply to PTs in private practice. You should contact your tax professional for advice.

Therapy Cap
The bipartisan Medicare Access to Rehabilitation Services Act (H.R.807/S.253) continues to gain cosponsors. The House added 8 more cosponsors to reach 229 cosponsors. The Senate bill has exceed its historical high by 2 and now has 36 cosponsors. H.R.807/S.253 is a message bill which would permanently repeal the $1,980/year arbitrary therapy cap imposed on Medicare beneficiaries for 2017. The cap on therapy will increase to $2010 in 2018.

On December 13th, the House released their language for legislation to fund the government also known as the Continuing Resolution (CR). It been widely expected that the Medicare Extenders (which includes the language to permanently repeal the therapy cap that PPS, along with other stakeholders, agreed upon with the staff of the three committees of healthcare jurisdiction) would be part of this package, however the Medicare Extenders weren’t included in the legislation. The current exceptions mechanism expires on December 31, 2017; legislators left Washington without addressing this important issue. We will be working hard in early 2018 to continue our pursuit of a permanent therapy cap.

Advocacy Opportunity: Make sure your legislators understand how impactful it will be to permanently repeal the therapy cap. As was suggested in the recent Action Alert, reach out to your Representative and both Senators and follow up with an email to the Health LA where you reiterate how important it is to you and your patients that the therapy cap be repealed, and attach this letter which PPS and the Therapy Cap Coalition sent to Congressional leadership asking for swift action to repeal the therapy cap. Please share examples of patients who have surpassed the $1980 threshold and explain why the patient required so much care as well as share your experience with the exemptions process. Please cc your lobbyist, Alpha Lillstrom Cheng ([email protected]) on the email to your legislators.


REGULATIONS

Health and Human Services
On November 13th, President Trump nominated Alex Azar to be Secretary of Health and Human Services (HHS). His Senate confirmation hearing in front of the HELP Committee was on November 29th; the Finance Committee has yet to schedule their confirmation hearing. Azar formerly served as HHS Deputy Secretary and General Counsel under President George W. Bush and has deep Indiana connections having worked closely with both Vice President Pence and CMS Administrator Seema Verma.

Comprehensive Care for Joint Replacement (CJR)
On December 1st CMS published a final rule in which the expansion of CJR to SHFFT was officially cancelled. Furthermore, the program has been scaled back and now requires participation from hospitals in only 34 of the original 67 geographic areas that were selected for the CJR model that began in 2016. IPPS hospitals in the other 33 of the original 67 areas will be allowed to continue participating on a voluntary basis, but are required to send a participation election letter to CMS by January 31, 2018 in order to remain a part of the model. Once a hospital elects to voluntarily participate, they are locked in for the duration. The fifth and final performance year will end on December 31, 2020. Additional flexibility for episode costs is granted to those hospitals which are located in regions which experience severe weather events like the hurricanes and wildfires this summer and are designated as major disaster areas and granted authorized waivers by the Secretary of Health and Human Services (HHS).

For one-pagers and talking points for other PPS’s legislative priorities and activities,
visit the Grassroots Advocacy section of the PPS website at www.ppsapta.org

Thank you for a great year of engagement and advocacy!