Robert Hall

The State Payment Advocacy Resource Consortium (SPARC) is launching an ambitious, coordinated strategy for 2026 to help chapters strengthen their payer relations work, improve payment, and expand access to physical therapy. The goals fall into three connected areas: reducing administrative burden, improving commercial payment, and elevating Medicaid advocacy.

To better attack administrative burden, SPARC plans to help chapters convene payer meetings in 25 states, support fair copay legislation in 10 states, and work with BUCAH (Blues plans, United Healthcare, CIGNA, Aetna [now CVS/Aetna], and Humana) plans to align credentialing with Medicare processes in 10 states. A major focus will be pushing BUCAH plans to use clinical practice guidelines (CPGs) as the basis for medical necessity determinations. To support this shift, SPARC will create CPG-to-CPT crosswalks and lead 10 direct meetings with national BUCAH teams to negotiate adoption.

To help PTs across the country improve payment rates, SPARC is aiming to train 500 PTs in payer contract negotiation, helping chapters develop private payer advocacy plans in 20 states, and working with at least 20 payers to eliminate MPPR. Another major priority is establishing inflationary updates to payment rates. SPARC is supporting chapters to introduce legislation in 10 states and to secure inflationary adjustments in at least three commercial contracts.

Medicaid will play an elevated role in 2026. SPARC is setting goals to move Medicaid payment above 90% of Medicare in targeted states, increase Medicaid utilization by 20%, and grow the number of private practices accepting Medicaid by 20%. SPARC aims to also work on model legislation defining network adequacy, assist pediatric providers with targeted policy proposals, and publish a new report outlining each state’s Medicaid fee schedule determination timeline and the optimal windows for advocacy.

Together, these goals represent SPARC’s most coordinated national-to-state strategy yet. By aligning chapters, strengthening negotiation skills, engaging payers directly, and advancing proactive state-level legislation, SPARC aims to create a more predictable, evidence-based, and sustainable payment environment for physical therapists and the patients who rely on them.