Report on Bipartisan Therapy Bill “SMART Act” Paves the Way for Congressional Action

New Report Identifies Potential Medicare Cost Savings by Changing Supervision Requirement; Underscores Critical Role of Therapy Assistants in Rural and Underserved Areas

Alexandria, VA – The results of a new independent, nonpartisan study, commissioned by a coalition of health care provider groups, show Medicare could save between $168 million and $242 million over 10 years by reducing administrative burdens on physical therapists and occupational therapists. These savings could help offset urgently needed changes necessary to improve access to therapy services for Medicare beneficiaries and to provide relief to rural and medically underserved areas of the country experiencing therapy workforce shortages. The win-win findings underscore the urgent need for Congress to pass pending legislation that would make those improvements possible.

The study, conducted by Dobson DaVanzo & Associates, looked at the potential financial impact of the Stabilizing Medicare Access to Rehabilitation and Therapy Act, or SMART Act (H.R. 5536), introduced in the U.S. House of Representatives by Rep. Bobby Rush, D-Ill., and Rep. Jason Smith, R-Mo. The bill aims to exempt rural or underserved areas from a 15% Medicare payment cut implemented earlier this year when services are provided by an occupational therapy assistant or physical therapist assistant. That cut was implemented on Jan. 1, 2022, and applies to OTA and PTA services under Medicare Part B.

“Many seniors and Medicare recipients rely on physical and occupational therapy services to maintain their independence and stay healthy and mobile after illness or injury,” said Rep. Bobby Rush, D-Ill. “These misguided pay cuts will cause severe harm to older Americans in underserved communities and to physical and occupational therapy assistants — many of whom are people of color.”

“Through the SMART Act we can improve access to physical and occupational therapy services while cutting red tape in Washington,” said Rep. Jason Smith, R-Mo. “I’m proud to co-lead this legislation with Representative Rush that will not only expand seniors’ access to treatment, especially in rural and underserved areas, but will also preserve the functional therapy community for future generations of Medicare patients.”

In addition, the legislation would bring supervision requirements of OTAs and PTAs under Medicare Part B in private therapist practices in line with state licensure laws, as well as all other settings where Medicare beneficiaries receive therapy services.

The study projects costs and savings associated with both provisions of the SMART Act. Results show that the cost savings generated through the change in supervision for OTAs and PTAs in the outpatient setting could help pay for the elimination of the 15% assistant payment cut in rural or underserved areas, which is estimated to cost CMS from $741 million to $1.58 billion over 10 years.

These provisions of the SMART Act would make therapy services more accessible to millions of Americans experiencing challenges accessing these services in rural or underserved areas, where beneficiaries are 50% more likely to receive therapy from an OTA or PTA. The standardization of general supervision requirements for private practices is cost-effective and would reduce administrative burden while implementing common-sense consistency with state laws and across all other Medicare settings.

The research was commissioned by the American Physical Therapy Association, American Health Care Association, American Occupational Therapy Association, Alliance for Physical Therapy Quality and Innovation, National Association of Rehabilitation Providers and Agencies, National Association for the Support of Long-Term Care, and APTA Private Practice, a section of the American Physical Therapy Association. The report can be accessed online at: Dobson | DaVanzo & Associates, LLC - Health Care Consulting - Publications (dobsondavanzo.com)

Fiscal Year 2021 (July 1, 2021-June 30, 2022)

APTA Private Practice's legislative and advocacy priorities for the 117^th Congress (2021 and 2022) were determined in December 2020 by the Board of Directors and the Government Affairs Committee (GAC).  The Section’s lobbyist uses these priorities to guide advocacy efforts on behalf of APTA Private Practice membership—through communications to Congress, the White House, and Agencies such as the Centers for Medicare and Medicaid Services (CMS).  We continually remind policy makers that physical therapists should be seen as a primary care provider for neuromusculoskeletal dysfunction and promote the physical therapy profession as a point of entry into the medical model for movement disorders. 

Lobbying and advocacy efforts focused on the core goal of permanently mitigating Medicare payment policies that undermine the importance and value of a physical therapist and physical therapist assistant care as well as its impact on patients and their communities:

Pursued legislation to improve payment and reduce obstacles to patient care:

- Prevented a cumulative 9.9% cut with the enactment of the Protecting Medicare and American Farmers from Sequester Cuts Act in December 2021:

     > A 3% payment adjustment to the conversion factor (CF) for CY2022;

     > Instituted a phased-in return of the sequester (a 1% sequester from April 1 to June 30, 2022 and a return of      the full 2% sequester on July 1, 2022); and

     > Waived the 4% PAYGO cut.

- Supporting Medicare Providers Act (H.R. 6020) to provide a 1-year reprieve from CMS cuts.

- Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act (H.R.5536) to mitigate the impact of the PTA differential by exempting PTAs and OTAs working in rural and medically underserved areas from the payment differential. 

- Prevent Interruptions in Physical Therapy Act (S. 2612/H.R. 1611) to expand the locum tenens provision of Medicare to allow physical therapists practicing all communities to hire a qualified substitute on a per-diem basis; this builds on our 2016 success of enacting a law to enable the use of locum tenens in rural, medically underserved, and health professional shortage areas.

- Medicare Sequester COVID Moratorium Act (H.R.315) to hold off the Medicare sequester for the duration of the PHE; achieved full reprieve from May 2020 to April 2022.

- Medicare Patient Empowerment Act (S.826/H.R.3322) to increase patient choice of both providers and settings for Medicare beneficiaries; enactment of this legislation would achieve the Section’s goal of allowing physical therapists in private practice to opt-out of Medicare and privately contract with Medicare patients.

- Primary Health Services Enhancement Act (H.R.5365) would allow CHCs to expand their offerings to include physical therapy provided by a physical therapist; private practice physical therapists could contract to provide this care.

Pursued legislation and regulatory changes to reduce administrative burdens:

- Improving Seniors’ Timely Access to Care Act (H.R.3173) to reduce administrative burden by requiring a streamlined and standardized process by which MA plans use prior authorization.

- Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act (H.R.5536) to also reduce administrative burden and increase practice flexibility by requiring Medicare to change its direct supervision requirement of therapy assistants in private practice settings to general supervision.

- Met with the Biden Administration and submitted recommendations to replace direct supervision of PTAs with general supervision.

- Met with and submitted recommendations to Biden Administration to remove plan of care signature requirement.

Advocated for legislative and regulatory changes to provide coverage of physical therapy via telehealth:

- Expanded Telehealth Access Act (H.R.2168) to permanently add physical therapists, PTAs, and other rehabilitation therapists to the statutory list of distant site providers that Medicare pays for telehealth.

- Telehealth Extension Act (H.R.6202) to extend current PHE-related telehealth waivers for an additional 2 years and remove originating site and geographic limitations from the statute.

- Advancing Telehealth Beyond COVID-19 Act (H.R. 4040) to extend current PHE-linked coverage of telehealth and flexibility in originating sites through December 31, 2024.

- Achieved authorization for PTs and PTAs to provide physical therapy care via telehealth for an additional 151 days after the PHE expires.

- Argued to allow for general supervision of PTAs; achieved approval to use audio/visual technologies to satisfy direct supervision requirement through the end of the year in which the PHE ends.

Communicating the Section’s Advocacy Priorities to Congress

In addition to one-on-one meetings with Members of Congress and their staff, between July 2021 and June 2022, APTA Private Practice joined with coalitions to send 6 advocacy letters to lawmakers:

• - PPS and 6 other rehabilitation therapy organizations' joint Statement for the Record to House Energy and Commerce Subcommittee on Oversight and Investigations for the hearing entitled, "Protecting America's Seniors: Oversight of Private Sector Medicare Advantage Plans" (June 2022)

• - PPS urges Congress to keep 2% Medicare sequester on hold for the rest of the Public Health Emergency (February 2022)

• - PPS and 95 other organizations urge Congressional health care committees to examine potential reforms to the Medicare Physician Fee Schedule (February 2022)

• - PPS and rehabilitation stakeholders urge Congressional leaders to include the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act (H.R. 5536) in the upcoming Continuing Resolution

• - PPS and 16 other rehabilitation therapy organizations send a letter of support to Reps. Bobby Rush (IL) and Jason Smith (MO) thanking them for introducing the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act which seeks to mitigate the impact of the impending Medicare 15% payment differential for services furnished by physical therapist assistants (PTA) and occupational therapy assistants (OTA) beginning on Jan. 1, 2022. (October 2021)

• - PPS and 108 other stakeholders urge Congressional leadership to maintain stability within the MPFS by retaining 2021's 3.75% increase to the conversion factor through at least 2022 and 2023 (July 2021)

APTA Private Practice’s strong relationships on Capitol Hill have inspired Members of Congress to weigh in on behalf of physical therapists:

• - Rep. Tonko (NY-20) calls on Energy & Commerce Committee colleagues to include the Prevent Interruptions in Physical Therapy Act (S.2612/H.R.1611) in CURES 2.0 legislative package (March 2022)

• - Record-making 247 Representatives urge House Leadership to address looming Medicare payment cuts to physical therapists and other health care providers (October 2021)

Communicating the Section’s Advocacy Priorities to Regulatory Agencies

All official advocacy and comment letters filed are posted on APTA Private Practice’s advocacy page.  On behalf of the membership APTA Private Practice submitted 3 advocacy letters to the Centers for Medicare and Medicaid Services (CMS) at the Department of Health and Human Services:

• - PPS, APTA and other rehabilitation therapy stakeholders request waiver from HHS to put off PTA/OTA differential for one year (or longer if the PHE extends into 2023) (January 2022)

• - APTA Private Practice, as a member of PARCA called on CMS to put the No Surprises Act of 2020’s Good Faith Estimate (GFE) regulations on hold for a year, to exempt small practices, and then bring in stakeholders for feedback in order to redo the regulation. The letter was also shared with Congressional concerned with the implementation of the GFE.  (January 2022)

• - PPS comments on the 2021 Medicare Physician Fee Schedule, including challenging proposed 3.75% reimbursement cuts and implementation of the PTA differential while recommending general supervision for PTAs and removal of administrative burdens such as signature on a plan of care (September 2021)

Join the Advocacy Efforts—Be an APTA Private Practice Key Contact!

As constituents, business owners, and providers, APTA Private Practice members are encouraged to participate in these advocacy efforts.  By June 2022, the Section had 507 Key Contacts—adding 72 since June 2021.  Join the chorus of Key Contacts who are effectively educating Members of Congress about the value of physical therapy provided in a private practice setting. The most effective advocacy is that which reaches as many lawmakers as possible, then maintains the rhythm of conversation through follow-up and continued engagement.  The more people a given lawmaker hears from the more likely they are to act upon the request.  Follow prompts from APTA Private Practice to use APTA’s Action Center to write to your Members of Congress or check the Advocacy Blog for the most recent call to action.  Be sure to remind lawmakers that their support for the Section’s priority policies will enable you to serve your patients, support your impactful community-based business, and provide good jobs for their constituents.

Advocate for nationwide access for PTs to hire a locum tenens

Background:

When you need to be away from your practice, does your clinic have enough credentialed PTs to be able to rearrange schedules so that all of your Medicare patients are able to be seen, without delay?  If not, then your practice and your patients would benefit if you were able to hire a locum tenens—a qualified substitute PT—to fill in for the short time you are not able to be in the clinic.

Our previous advocacy efforts resulted in a law which allows private practice physical therapists practicing in designated Health Professional Shortage Areas, medically underserved, and rural areas to retain a locum tenens when they need to be absent from their clinic. 

S.2612/H.R.1611 seeks to expand this policy to all areas of the U.S. because, as you know, the need to hire a locum tenens in order to prevent an interruption in care is based on how many credentialed providers a clinic has and its Medicare patient mix—not where that practice is located.

Thank you Rep. Tonko (NY-20) for calling on your Energy & Commerce Committee colleagues to include the Prevent Interruptions in Physical Therapy Act (S.2612/H.R.1611) in the CURES 2.0 legislative package!

Advocacy Opportunity

Ask your lawmakers to cosponsor the Prevent Interruptions in Physical Therapy Act (S.2612/H.R.1611) which would enable all physical therapists to utilize locum tenens arrangements under Medicare.  We need your help making sure your legislator understands the necessity of continuity of therapy services as well as the impact this bill would have on being able to keep your doors open, see patients, and remain a viable business and employer in your community.

If you are on social media, tweet or create a Facebook post tagging your legislator and #PPSAdvocacy.  TEMPLATE TWEET: “Prevent Interruptions to PT care. Cosponsor bipartisan S.2612/HR1611. [@Representative/Senator twitter handle] #PPSAdvocacy”

Check out these tips for advocacy. For information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

Thank you.  Your voice makes an impact.  Together we can make a difference.

TEMPLATE EMAIL:

Subject line: Continuity of care is key to physical therapy.  Cosponsor S.2612/H.R.1611 to ensure interrupted access to care.

Dear Representative/Senator ____________,           

I am a physical therapist in private practice, and a member of the Private Practice Section (PPS) of the American Physical Therapy Association.  Thank you for your previous efforts in support of access to physical therapy services.  On behalf of myself and PPS, I’m asking you to cosponsor the Prevent Interruptions in Physical Therapy Act (S.2612/H.R.1611). 

The Prevent Interruptions in Physical Therapy Act would support small businesses like mine and protect Medicare beneficiary access to physical therapy by allowing all physical therapists, regardless of their geographic location, to be able to hire a qualified substitute on a short-term basis to ensure their patients have continued, uninterrupted access to care. Physical therapists are the only providers whose use of locum tenens is limited geographically and that the crux of the issue is the number of providers credentialed in a clinic and that clinic’s Medicare patient mix, not the physical location of the practice.

[Include an 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, jury duty, and more.  If you are located in a one of the geographic regions where PTs are allowed to use locum tenens, please share an example of when you used this privilege to ensure your Medicare patients had uninterrupted access to physical therapy.]

As your constituent and a small business owner in your district, I ask you to please cospoonsor this non-controversial, bipartisan bill.

Thank you,       

[Name, credentials]

Member, Private Practice Section of the American Physical Therapy Association

[Practice Name]

[Practice Address]

[Practice phone number]

The Omnibus Federal Spending bill signed into law by President Biden provides funding for the federal government until September 30, 2022.

The law also includes a 151 day (~5 month) extension of Medicare coverage for real-time, face-to-face services provided by physical therapists and physical therapist assistants via telehealth after the Public Health Emergency (PHE) expires. Without this legislation, the ability for private practice PTs and PTAs to provide services via telehealth would have been cut off when the PHE expires.

The current expiration date of the PHE is April 16. However, the administration has promised a 60-day "heads up" if it doesn’t plan to renew the PHE; therefore, it is anticipated that the PHE will be renewed in April for another 90 days and then end in mid-July. Should the PHE terminate this July, the 151 days extension will expire in November. This would provide Congress the opportunity to address the issue after the General Election.

The PPS COVID-19 State of Affairs document is updated regularly, with the newest information highlighted in red, to help you keep abreast of the most recent legislative and regulatory updates.

Background:

By law, a 15% payment differential for therapy assistants went into effect on January 1, 2022. We need your help asking lawmakers to provide relief.

Advocacy Opportunity: 

Ask your Representative to cosponsor the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act (H.R.5536) in order to suspend the Medicare payment differential for services furnished by PTAs and OTAs and reduce the supervision burden. We need your help making sure your legislator understands the impact the payment differential and supervision standard has on your ability to keep your doors open, see patients, and remain a viable business and employer in your community.

If you are on social media, tweet or create facebook post tagging your legislator and #PPSAdvocacy. TEMPLATE TWEET: “Ensure access to PT care. Suspend the PTA/OTA payment differential. Cosponsor HR5536. [@Representative Twitter handle] #PPSAdvocacy”

Check out these tips for advocacy. For information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

Thank you. Your voice makes an impact. Together we can make a difference.

TEMPLATE EMAIL:

Subject line: PTAs enable my practice to meet the physical therapy needs of my community—especially during COVID. Suspend Medicare cuts so I can stay in business.

Dear Representative ____________,

I am your constituent, a physical therapist in private practice, and a member of the Private Practice Section (PPS) of the American Physical Therapy Association. On behalf of myself and PPS, I’m asking you to cosponsor the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act (H.R.5536).

The SMART Act would support small businesses like mine and protect Medicare beneficiary access to physical therapy by suspending the physical therapist assistant (PTA) differential for a year while also designating PTAs working in rural and Medically Underserved Areas (MUAs) exempt from the 15% payment differential. The SMART Act also seeks to allow the supervision standard for PTAs by physical therapists to be determined by state law. In 44 states, that would mean that PTA supervision in Medicare Part B settings would be general supervision—the same as all other practice types.

As your constituent and a small business owner in your district, I ask you to please cosponsor the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act and push for the legislation to be added to the Continuing Resolution that Congress must pass in February.

Thank you for your previous efforts to prevent Medicare cuts. Given the current instability in the health care system, now is not the time to reduce payment to Medicare providers which will hinder patient access to care—especially in rural and underserved areas. Please act to help me keep my clinic doors open—to not only serve our patients but also to provide jobs in our town.

Thank you,

[Name, credentials]

Member, Private Practice Section of the American Physical Therapy Association

[Practice Name]

[Practice Address]

[Practice phone number]

Ask your Senator to pass S.610, to drastically reduce Medicare cuts

Background:

Unless Congress acts, all health care professionals are facing cuts to Medicare payment on January 1, 2022. Over the past 22 months--thanks to efforts from PPS and APTA members and other stakeholders--we have made great strides in educating Members of Congress about these Medicare cuts and their effect on physical therapists and Medicare beneficiaries’ access to care. Congress has been responsive to our efforts; however, there is still work to be done!

Last night the House passed an end-of-year package that provides significant relief to the impending Medicare cuts. It is now up to the Senate to pass the bill so it can become law.

We ask all PPS members to respond to this action alert and send this message to your Senators TODAY, even if you have previously responded to APTA action alerts. This targeted message highlights your concerns as a small business owner and employer in your community, and it is important that your Senators hear this message.

Additionally, we encourage you to share the language of the email template with your patients, staff, and family, and friends. Your Senators need to hear from every member of your community!

Use social media to tweet or create a Facebook post tagging both your Senators and #PPSAdvocacy. Template tweet: “Pass S.610 to prevent Medicare cuts so I can stay in business; Medicare reimbursement IS my bottom line. [@SenatorA Twitter handle @SenatorB Twitter handle] #PPSAdvocacy”

New to engaging with your lawmaker or need a refresher? Check out these tips for advocacy. For information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

Thank you. Your advocacy can get this policy across the finish line!

TEMPLATE:

Subject line: My patients need physical therapy. Pass S.610 to prevent Medicare cuts so I can stay in business.

Dear Senator ____________,

I am a physical therapist in private practice and a member of the Private Practice Section (PPS) of the American Physical Therapy Association. On behalf of myself and PPS, I’m asking you to prevent deep cuts to Medicare providers that are slated to take effect on January 1, 2022.

As your constituent and a small business owner, I’m asking you to pass S.610, the end-of-year package that the House passed on December 7. This bill would significantly reduce the impending Medicare cuts and delay the return of sequestration.

Your vote to pass this crucial bill will support access to health care while providers such as myself are still recovering from economic impact of COVID-19. Please act to help me keep my physical therapy clinic doors open—to not only serve our patients but also to provide jobs in our town.

Thank you,

[Name, credentials]
Member, Private Practice Section of the American Physical Therapy Association
[Practice Name]
[Practice Address]
[Practice phone number]

Ask your Representative to Cosponsor H.R.6020, to Keep 3.75% Payment Adjustment for 2022

Background:

Unless Congress acts, all health care professionals are facing cuts to Medicare payment on January 1, 2022. 

Advocacy Opportunity:

Ask your Representative to cosponsor the Supporting Medicare Providers Act (H.R. 6020) in order to maintain the 3.75% Medicare payment adjustment for one year.  Make sure your legislator understands that you need their help in order to keep your doors open, see patients, and maintain the jobs of those who support your work.

Use social media to tweet or create facebook post tagging your legislator and #PPSAdvocacy.  Template tweet: “Cosponsor H.R.6020 to keep the 3.75% Medicare payment adjustment for 2022; Medicare reimbursement IS my bottom line.  [@Representative twitter handle] #PPSAdvocacy”

New to engaging with your lawmaker or need a refresher?  Check out these tips for advocacy. For information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

Thank you.  Your advocacy can make an impact on your bottom line.

TEMPLATE:

Subject line: My patients need physical therapy.  Cosponsor H.R.6020 to extend 3.75% Medicare payment adjustment so I can stay in business.

Dear Representative ____________,        

I am your constituent, a physical therapist in private practice, small business owner, and a member of the Private Practice Section (PPS) of the American Physical Therapy Association. 

I’m writing to ask you to cosponsor the Supporting Medicare Providers Act (H.R. 6020) which would maintain the Consolidated Appropriations Act’s 3.75% Medicare payment adjustment for one year to support access to healthcare while providers are still recovering from economic impact of COVID-19. 

All Medicare providers are facing payment reductions.  Effective January 1, 2022, CMS is planning a significant reduction to the Medicare conversion factor and the Medicare sequester will return.  Also on the horizon is a 4% Medicare payment cut due to PAYGO, which was triggered by the passage of the American Rescue Plan. 

The only way to prevent drastic cuts to Medicare payment on January 1, 2022 is for Congress to intervene.  Now is not the time to reduce payment to Medicare providers.  On behalf of myself and PPS, I’m asking you to cosponsor H.R.6020 and act to help me keep my clinic doors open—to not only serve our patients but also to provide jobs in our town.

Thank you,       

[Name/Info generated via APTA online form]

Or

[Name, credentials]

Member, Private Practice Section of the American Physical Therapy Association

[Practice Name]

[Practice Address]

[Practice phone number]

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MEDICARE PHYSICAN FEE SCHEDULE (MPFS)

CMS uses the MPFS to set the reimbursement rates for Medicare-eligible providers for services provided to Medicare beneficiaries.  Each year CMS proposes some new fee updates as well as regulations that govern what providers must do in order to receive payment.  

Fee Schedule

Fee schedule changes from proposed rule to final rule:
-    Therapists and other qualified healthcare professionals will now be able to bill remote therapeutic monitoring (RTM) codes.  Payment for these RTM codes is being finalized for CY 2022, and CMS is now designating the five RTM CPT codes as “sometimes therapy” codes.
-    An update to clinical labor input in practice expenses has been changed from a phase-in over 2 years to a 4-year implementation. 
In most cases, the final rule does not stray from the CY2022 MPFS proposed rule.
-    The conversion factor will be $33.59 for CY2022.
-    Because the law requires it, the 15% differential for care provided in whole or in part (de minimis standard) by PTAs or OTAs will be implemented on January 1, 2022.  There will be no delays or exceptions for rural or medically underserved areas.
-    CMS clarified that the 15% therapy assistant differential will be deducted from the 80% paid by CMS (that remains after the 20% patient portion is deducted).
-    CMS declined to change the PTA supervision standard for private practice settings.
-    CMS put off making a decision about allowing A/V communications to achieve direct supervision on a permanent basis (currently allowed under Public Health Emergency (PHE) waiver until January 1, 2023).  
-    Telehealth: CMS maintained their position that physical therapy and other rehabilitation therapy are not to be added as provider types who will be able to provide for care to Medicare beneficiaries via telehealth after the PHE is lifted.
-    The CY 2022 KX modifier threshold amount will be $2,150 for PT and SLP services combined and $2,150 for OT services. The targeted medical review threshold is $3,000 for PT and SLP services combined and $3,000 for OT services (this threshold will remain the same until CY 2028).
 

Merit-Based Incentive Payment System (MIPS)

-    As proposed, small practices, excluding those participating in MIPS as part of a virtual group, must submit data as a group to indicate that they wish to be scored as a group for Medicare Part B claims.
-    For the 2022 performance/2024 payment year, MIPS eligible clinicians will need to achieve a final score equal to 75 points in order to receive a neutral MIPS payment adjustment.
-    CMS will move forward with its first 7 MIPS Value Pathways beginning with 2023 performance year/2025 payment year; the "Improving Care for Lower Extremity Joint Repair" MVP is one of the seven.
-    CMS responded to PPS' concerns about the removal of Quality measure 154 by stating, "The removal of measure Q154 would not impede a clinician’s ability to submit measure Q155 as the denominator criteria of screening for future fall risk (CPT II code 1100F) could still be submitted on the Medicare Part B claims form if utilizing the Medicare Part B Claims Measure Specification collection type."
-    CMS agreed with PPS and noted that Q50: urinary incontinence: plan of care for urinary incontinence was inadvertently included in the removal table.  The correction has been made and Q50 has been moved to the "measures finalized for addition" for the PT/OT specialty set.

Legislative advocacy efforts are ongoing to mitigate the PTA differential and improve PTA supervision (the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act, H.R.5536); as well as to enable PTs, PTAs, and other rehabilitation therapists to provide care via telehealth to Medicare beneficiaries (the Expanded Telehealth Access Act, S.3193/H.R.2168).  Additionally, 247 Representatives are on record calling for an extension of the 3.75% increase to conversion factor for another year; legislation to do so is anticipated.  Please join us in our advocacy efforts and reach out to your lawmakers about these bills.
 

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VACCINE MANDATES

The two vaccine regulations that were released by the Executive Branch on November 4, 2021 were intentionally drafted so that the CMS regulation would be primary for healthcare providers. If your clinic is not included in the reach of the CMS vaccine regulations, but your business employs 100 or more people you will be impacted by the OSHA vaccine regulations.  However, if your business is smaller than 100 employees, you will be impacted by any state or local vaccine regulations but not these two federal-level rules.  Here is a brief overview of the regulations.  The PPS State of Affairs will be updated and contain more detailed information.

Centers for Medicare and Medicaid Services (CMS)

Independent private practice physical therapy clinics are not included in the reach of these CMS’ vaccine regulations.  However, those PPS members who work in comprehensive outpatient rehabilitation facilities (CORFs), home health agencies, or rehabilitation agencies are covered by the CMS regulations, effective November 5, 2021.

CMS has made it clear that the regulation and the requirements "only apply to providers and suppliers regulated under the CMS Conditions of Participation (CoPs)” and CMS' "authority does not extend to certain facilities nor independent physicians/clinicians".

CMS’ regulations require vaccination and do not include a testing option for unvaccinated staff:

- Two deadlines are included for facilities covered by this regulation:

     - December 5, 2021: all eligible staff must have received the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine prior to providing any care, treatment, or other services.

     - January 4, 2022: all eligible staff must have received the necessary shots to be fully vaccinated – either two doses of Pfizer or Moderna or one dose of Johnson & Johnson.

 - This guidance means that booster shots are not required.

 - Exemptions from vaccination are allowed–based on recognized medical conditions or religious beliefs, observances, or practices.

Occupational Safety and Health Administration (OSHA)

If your clinic is not included in the reach of the CMS vaccine regulations, but you employ 100 or more people, effective November 5, 2021 you will be impacted by the OSHA Emergency Temporary Standard (ETS) that requires your employees to be fully vaccinated or subject to weekly testing for COVID-19

Determining if your business meets the threshold of 100 employees:

     - Calculation must include all employees across all of your U.S. locations, regardless of employees’ vaccination status or where they perform their work.

     - Part-time employees count towards the company total, but independent contractors do not.

     - For a single corporate entity with multiple locations, all employees at all locations are counted for purposes of the 100-employee threshold.

     - Once an employer has come within the scope of this ETS, the standard continues to apply for the remainder of the time the ETS is in effect, regardless of fluctuations in the size of the employer’s workforce.

     - Two or more related entities may be regarded as a single employer if they handle safety matters as one company, in which case employees of all entities making up the integrated single employer must be counted.

OSHA provides two options for an employer of 100 or more employees:

     - Establish and implement a mandatory vaccination policy for all employees; or

    - Establish, implement, and enforce written policy allowing employees to choose either to: (1) be fully vaccinated against COVID-19 or (2) provide proof of regular testing for COVID-19 and wear a face covering at work.
 

 - For those employees who decline to be vaccinated:

     - Requires diagnostic/screening tests
          - At least once every 7 days
          - Using FDA approved NAATs (nucleic acid amplification tests) or antigen tests (including at-home kits)
          - Pooling of tests is allowed.  However, if the pooled test comes back positive, individual tests of all those in the pool must be administered.
    - Employers can make non-vaccinated employees pay for this testing.
     - A test may not be both self-administered and self-read unless observed by the employer or an authorized telehealth proctor.
     - Employers can select the testing scenario and logistics that is most appropriate for their workplace. 
     - Non-vaccinated employees must wear face coverings.

Record keeping and employer responsibilities
    - Employers must:
          - Preserve acceptable proof of vaccination for each employee who is fully or partially vaccinated; and 
          - Maintain a roster of each employee’s vaccination status (e.g. fully vaccinated, partially vaccinated, exempt).  
      - Written records or copies of vaccine cards of fully vaccinated employees which were collected prior to November 5, 2021 count as compliance with this recordkeeping requirement.   
     - Keep a record of each test result for each employee.
     - Maintain vaccination records, the vaccination roster and record of test results while the ETS is in effect.
     - Notify employees about the ETS and its requirements, OSHA non-discrimination and retaliation provisions, and criminal penalties for knowingly supply false statements or documentation.
     - Provide employees a copy of the CDC’s document, “Key Things to Know About COVID-19 Vaccines.”
      - Report work-related COVID-19 fatalities within 8-hours and work-related COVID-19 in-patient hospitalizations within 24-hours.

Accommodations:
 - Exemptions from vaccination policies are allowed–based on recognized medical conditions or religious beliefs, observances, or practices.
         - But those employees will be required to be tested and masked just like all other unvaccinated employees
               - Employers must support employees who seek to be vaccinated
               - Must provide reasonable time, including up to four hours of paid time, to receive each primary (non-booster) vaccination dose; and 
               - Must provide reasonable time and paid sick leave to recover from side effects experienced following each primary vaccination dose.
 

Ask Your Representative to Cosponsor H.R.5536 to Protect payment for PTAs

Background:

Unless Congress intervenes, the Medicare 15% payment differential for services furnished in whole or in part by physical therapist assistants (PTA) and occupational therapy assistants (OTA) will go into effect on January 1, 2022.

Advocacy Opportunity:

Ask your Representative to cosponsor the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act (H.R.5536) which seeks to mitigate the impact of the impending Medicare 15% payment differential for services furnished by PTAs and OTAs. We need your help making sure your legislator understands that you need their help in order to keep your doors open, see patients, and remain a viable business and employer in your community.

If you are on social media, tweet or create a Facebook post tagging your legislator and #PPSAdvocacy. TEMPLATE TWEET: “Intervene to prevent PTA/OTA payment differential; Medicare reimbursement IS my bottom line. [@Representative Twitter handle] #PPSAdvocacy”

New to engaging with your lawmaker or need a refresher? Check out these tips for advocacy. For information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

Thank you. Your voice makes an impact. Together we can make a difference.

TEMPLATE EMAIL:

Subject line: PTAs enable my practice to meet the physical therapy needs of my community. Prevent Medicare cuts so I can stay in business.

Dear Representative ____________,

I am your constituent, a physical therapist in private practice, and a member of the Private Practice Section (PPS) of the American Physical Therapy Association. On behalf of myself and PPS, I’m asking you to cosponsor the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act (H.R.5536) in order to mitigate the 15% payment differential for care provide by PTAs that is slated to take effect on January 1, 2022. Given the current instability in the health care system, now is not the time to reduce payment to Medicare providers which will hinder patient access to care—especially in rural and underserved areas.

H.R.5536 would support small businesses like mine and protect Medicare beneficiary access to physical therapy by providing a one-year delay in the implementation of the PTA differential while exempting those PTAs working in rural, Health Professional Shortage Areas (HPSAs), and Medically Underserved Areas (MUAs) from the 15% therapy assistant differential.

The bill also seeks to allow for general supervision of PTAs by physical therapists in outpatient settings (where allowed by state law) under Medicare Part B. This change would make it so that PTA supervision in Part B settings would be the same as all other settings.

As your constituent and a small business owner in your district, I ask you to please cosponsor the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act (H.R.5536). This bipartisan bill has been endorsed by 17 provider and patient groups. I am grateful for your previous efforts to prevent Medicare cuts. Please act to help me keep my clinic doors open—to not only serve our patients but also to provide jobs in our town.

Thank you,

[Name, credentials]

Member, Private Practice Section of the American Physical Therapy Association

[Practice Name]

[Practice Address]

[Practice phone number]

On June 16^th, PPS’ Key Contact Subcommittee hosted a webinar to teach PPS Key Contacts how to request and schedule an in-clinic visit with Members of Congress during the August recess. Attendees learned how to convey the value of their practice to the community to their elected officials—both in terms of providing physical therapy care as well as the importance of restoring patients' physical function. If you missed it or want to watch it again, click here and head over to the "Grassroots Advocacy" tab.

Throughout the year, your lawmakers hear from hundreds of different healthcare providers, so it’s important to help them visualize you, your private practice outpatient clinic, as well as the patients you serve. This is something that all PPS members are invited to do. If you aren’t sure who your representative is or whose district your clinic is located in, check here. The in-person, in-clinic meetings that take place in August will start the conversation about the value of physical therapy by spotlighting the issues that directly impact private practice. Then in September, APTA’s advocacy event will act as a continuation of that conversation.

Key Dates:

• June 23 – obtain the scheduler’s email
• July 1 – email the scheduler and request an in-clinic visit

Download our Template Outreach Letter Here

Ask Your Representative to Cosponsor Legislation to Make Provider Relief Funds Non-taxable

In response to the Public Health Emergency (PHE), Congress earmarked money for Provider Relief Fund grants as well as created and modified the Paycheck Protection Program (PPP). These programs were enacted to support not only the healthcare industry, but also small businesses which are the engine of the economy.

Through the advocacy of PPS, APTA, and other stakeholders, the forgiven PPP expenses are now able to be deducted as business expenses. However, we have not yet been able to overcome the IRS’ position that the provider relief grants are taxable. PPS has been lobbying Members of Congress and Congressional leadership to fix this issue, but your legislators also need to hear from you—their constituents—about what they need to do to support you, your employees, and your small business.

Advocacy Opportunity:

Use this template (or your customized link via the APTA Action Center) to thank your lawmakers for creating the provider relief funds as well as acting to provide tax relief for those who received a PPP loan, while also reminding them that these economic supports must be tax-free in order to provide the maximum impact.

New to engaging with your lawmaker or need a refresher? Check out these tips for advocacy.

Thank you for your continued advocacy. Together we can make a difference!

If you are on social media, follow up your request with a tweet or Facebook post tagging your legislator as well as PPS using #PPSAdvocacy.

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

TEMPLATE:

Subject line: Provider Relief Funds have been a lifeline, but taxing them diminishes impact. Please help.

Dear Representative __________,

Thank you for passing legislation in response to the PHE that provided healthcare providers and small business owners access to much-needed capital. Without the Provider Relief Funds and the Paycheck Protection Program (PPP) I might have had to close my doors. As a small business owner, I am truly appreciative.

I am a physical therapist in private practice and a member of the Private Practice Section of the American Physical Therapy Association. My outpatient therapy clinic is located in your district. My small business of therapists and support staff is a vital part of our local economy. The programs enacted and modified over the past year have helped us keep serving our community and continue to provide our patients with access to safe, quality care throughout the COVID-19 crisis.

However, taxation of these relief programs reduces the economic impact of these funds. Access to truly tax-free grants is still critical for my businesses. In December 2020 the law was changed to allow forgiven PPP expenses to be deductible business expenses, but the taxation of the Provider Relief Fund (PRF) was not addressed.

Please cosponsor the bipartisan Eliminating Provider Relief Fund Tax Penalties Act (H.R.2079) to ensure that PRF assistance will not be taxable and expenses attributable to PRF assistance will be also treated as tax deductible. Doing so will align the tax treatment of the PRF with the forgiven expenses of the PPP loans. Should these grants be tax-free, they will be more effective tools to reimburse for healthcare related expenses or lost revenues attributable to COVID-19.

I ask for you to support this legislation which will override the IRS ruling and support small businesses.

Sincerely,

[Name, credentials]

Member, Private Practice Section of the American Physical Therapy Association

[Practice Name]

[Practice Address]

[Practice phone number]

Relief From the -2% Medicare Sequestration Reduction Is Restored

Finally, after multiple advocacy pushes since March 2020, Congress acted to restore protection from the -2% Medicare sequestration reduction—this relief will be in place for the rest of 2021. PPS members responded to the multiple PPS and APTA Action Alerts and engaged with your Representatives and Senators to tell them how crucial it was that they address this issue. As you can see, your voices made a difference.

In response to the COVID-19 pandemic, Congress has now acted three times to pause the -2% reduction to the reimbursement that a participating provider would receive directly from Medicare. The first time was a 9-month reprieve granted in March 2020. Then, when it was clear that the economic impact of the pandemic was ongoing, that policy was renewed in December 2020 with an expiration date of April 1, 2021.

For the first few months of this 117^th Congress, PPS and other stakeholders focused advocacy efforts on the bipartisan Medicare Sequester COVID Moratorium Act (H.R.315/S.748) which was seeking to delay reinstatement of the automatic Medicare sequester for the duration of the public health emergency (PHE). The PHE is currently set to expire on April 21, 2021, but the Biden Administration has stated that it plans to extend the PHE (which, unless extended, automatically expires after 90 days) repeatedly for the rest of 2021.

For the past month Congress has been working on passing legislation to delay reinstatement of the policy to automatically remove (or "sequester") a portion of Medicare reimbursements. Instead of tying this expensive policy change to a fluid end-date that would be decided by the Executive Branch, lawmakers chose to again specify an expiration date—December 31, 2021. This approach is not surprising as it is common for federal spending policies to have expiration dates. Furthermore, because of the Administration’s projection that PHE will be in place for the rest of the year, the expiration of the Medicare sequester moratorium and the termination of the PHE will likely coincide with one another.

Unfortunately, the chambers did not pass identical legislation to implement relief from the sequester until April 13. As a result, protection from the -2% reduction officially expired on March 31. However, in line with precedent, on March 30, the Centers for Medicare and Medicaid Services (CMS) released a statement “In anticipation of possible Congressional action to extend the 2% sequester reduction suspension, we instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow…the MACs will automatically reprocess any claims paid with the reduction applied if necessary.”

Now that the reprieve from the -2% reduction of Medicare reimbursement has been restored, effective April 14 by the enactment of this law, CMS will process the claims it has been holding.

Thank you again for joining our successful advocacy efforts. Members of Congress heard the chorus of voices asking for Members of Congress to extend the relief at a time when many of you are still experiencing economic impacts from the pandemic.

As a result of the pandemic, the utilization of telehealth has soared in some practices and the interest in this mode of providing healthcare has increased significantly.  Furthermore, for the duration of the Public Health Emergency (PHE) physical therapists and physical therapist assistants in private practice will continue to be paid for providing care via telehealth due to the temporary PHE-related Medicare regulatory waivers.  However, outside of the waivers provided by the CARES Act and linked to the PHE, CMS does not have regulatory authority to reimburse physical therapists for telehealth.  Therefore, PPS’ legislative and regulatory advocacy priorities for the 117^th Congress includes, “pursuing legislation to include physical therapists and physical therapist assistants among those non-physician providers who are authorized to be paid for providing care to Medicare beneficiaries using telehealth”.  We are making progress towards that goal.

Representatives Mikie Sherrill (D-NJ) and David McKinley (R-WV) reintroduced their bipartisan Expanded Telehealth Access Act (H.R.2168) on March 23^nd with 14 additional original cosponsors.  The intent of this bill is to change the statute to permanently add physical therapists, physical therapist assistants, and other rehabilitation therapists to the list of providers that Medicare pays for care provided via telehealth.  Please use APTA’s Action Center and ask your Representative to cosponsor this important bill.

You might also have heard that the Telehealth Modernization Act (S.368/ H.R.1332) has been introduced in both the House and Senate.  This bill would also make certain PHE-related telehealth flexibilities under the Medicare program permanent.  However, instead of specifying which types of providers are to be included, it empowers the Secretary of HHS to make that determination.  While this is a step in the right direction, it does not achieve our goal of guaranteed payment to physical therapists and physical therapist assistants for telehealth-based care provided to Medicare beneficiaries.  Simply put, should this bill become law it would grant CMS the regulatory authority to add physical therapists and physical therapist assistants to the list of providers paid for providing telehealth care and we would then need to focus our advocacy efforts on the agency instead of achieving it legislatively.  In addition to the challenges of regulatory advocacy, policies made by rulemaking are subject to change with each new Administration.  This is why our advocacy efforts are prioritizing the statutory inclusion sought by the Expanded Telehealth Access Act mentioned above.

As we seek permanent coverage for telehealth, we will continue to follow the PPS’ legislative and regulatory advocacy priorities of promoting the use of a hybrid model where physical therapist services may be provided in person and via telehealth but ensuring that payment for physical therapist services provided via telehealth requires that an in-person physical therapy visit is available to all patients.  Our goals also include achieving legislation to provide parity for both coverage and payment for telehealth services as well as the utilization of electronic health records and the use of technological innovations in healthcare.  Our final priority within the telehealth sphere is to pursue policy that requires that physical therapy that is provided “incident to” must be provide by a licensed physical therapist.

Ask Your Senators To Vote To Support Healthcare Providers and Small Businesses

Advocacy Opportunity:

On Tuesday, March 16th, the House passed H.R.1799 to extend the PPP program to June 30, 2021 and it is soon to vote on whether or not to delay the return of 2% Medicare sequestration until January 1, 2022 and waive PAYGO requirements that would impact Medicare reimbursement (H.R.1868). These bills will soon be considered in the Senate. Let your Senators know how important it is for them to vote YES, and that doing so will protect your economically fragile business.

If you are on social media, tweet or create a Facebook post tagging your legislator and use #PPSAdvocacy. Template tweet: “Vote YES to delay return of 2% Medicare sequestration, waive PAYGO, and extend the PPP so I can continue providing cost effective physical therapy and maintain a vital business in our community. [@Senator Twitter handle] #PPSAdvocacy”

Thank you. Your voice matters!

EMAIL TEMPLATE:

Subject Line: My patients need physical therapy. Delay return of 2% Medicare sequestration, waive PAYGO, and extend the PPP so I can stay in business.

Dear Senator ___________,

This past year my practice has been juggling the economic impact of both the COVID-19 public health emergency and cuts to Medicare reimbursement. If reinstating the 2% Medicare sequestration cut is not delayed, on April 1 Medicare payment for physical therapy will be reduced to -5.6% when compared to April 2020. We also cannot afford any additional cuts to Medicare, so it is crucial that the PAYGO requirement be waived.

I am a physical therapist in private practice and a member of the Private Practice Section of the American Physical Therapy Association. Along with the therapists and support staff I employ in your district, my outpatient clinic is a vital small business and an important part of our local economy.

Our community-based physical therapy clinic received Paycheck Protection Program (PPP) loans, used tax credits, and has benefitted from the favorable tax treatments that have been provided in the American Rescue Plan Act and the proceeding COVID-19 relief bills. These policies have enabled us to remain a viable small business and keep providing patients with access to safe, cost-effective physical therapy throughout the public health emergency. However, our clinic is still navigating economic challenges.

Please vote to delay return of 2% Medicare sequestration, waive PAYGO, and extend the PPP so I can continue providing cost-effective physical therapy and maintain a vital business in our community. On behalf of myself and PPS, I make this request so that our physical therapy clinic can keep its doors open—to not only serve our patients but also to provide jobs in our town.

Thank you,

[Name, Credentials]

Member, Private Practice Section of the American Physical Therapy Association

[Practice Name]

[Practice Address]

[Practice Phone Number]

Ask Your Representative to vote to delay the return of 2% Medicare sequestration and waive PAYGO

Advocacy Opportunity:

In response to the COVID-19 pandemic in March 2020, lawmakers paused the 2% Medicare sequestration reduction until December 31, 2020.  As a result of the lobbying from PPS and other stakeholders, in December 2020 Congress delayed reinstating the Medicare sequester through April 1, 2021. 

On Tuesday March 16^th, the House will be voting on whether or not to delay the return of 2% Medicare sequestration and waive PAYGO requirements that could impact Medicare reimbursement.  Let your Representative know how important it is for them to vote YES, and that doing so will protect your economically fragile business.

If you are on social media, tweet or create facebook post tagging your legislator and use #PPSAdvocacy.  Template tweet: “Vote YES to delay return of 2% Medicare sequestration and waive PAYGO so I can continue providing cost effective physical therapy and maintain a vital business in our community. [@Representative twitter handle] #PPSAdvocacy”

New to engaging with your lawmaker or need a refresher?  Check out these tips for advocacy. For information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

Thank you.  Your efforts can make a difference!

TEMPLATE:

Subject line: My patients need physical therapy.  Delay return of 2% Medicare sequestration and waive PAYGO so I can stay in business.

Dear Representative ____________,

This past year my practice has been juggling the economic impact of both the COVID-19 public health emergency and cuts to Medicare reimbursement.  If reinstating the 2% Medicare sequestration cut is not delayed, on April 1 Medicare payment for PT will be reduced to -5.6% when compared to April 2020.  We also cannot afford any additional cuts to Medicare, so it is crucial that the PAYGO requirement be waived.

I am a physical therapist in private practice and a member of the Private Practice Section of the American Physical Therapy Association.  Along with the therapists and support staff I employ in your district, my outpatient clinic is a vital small business and an important part of our local economy. 

Our community-based physical therapy clinic received PPP loans, used tax credits, and have benefitted from the favorable tax treatments that have been provided in the American Rescue Plan Act and the proceeding COVID-19 relief bills.  These policies have enabled us to remain a viable small business and keep providing patients with access to safe, cost-effective physical therapy throughout the public health emergency.  However, our clinic is still navigating economic challenges.

Please vote to delay return of 2% Medicare sequestration and waive PAYGO so I can continue providing cost effective physical therapy and maintain a vital business in our community.  On behalf of myself and PPS, I make this request so that our physical therapy clinic can keep its doors open—to not only serve our patients but also to provide jobs in our town.

Thank you,

[Name/Info generated via APTA online form]

President Biden’s first legislative priority was a pandemic relief bill, the American Rescue Plan Act of 2021 which was signed into law on March 11, 2021.

Portions of the bill most relevant to PPS in the enacted legislation are:

-An additional $7.25 billion to be disbursed through the PPP program (which expires on March 31, 2021).

-Targeted Economic Injury Disaster Loan (EIDL) Advance program

          -Provides emergency grants of $5000 to small businesses with fewer than 10 employees and located in low-income communities that have suffered more than 50% economic loss.

          -EIDL Advance funds (for both individuals and S corps) shall not be taxable as gross income and no deductions related to those funds shall be denied due to its non-taxable status.

-Extension of the existing paid sick and paid family leave tax credit (100% refundable for those with fewer than 500 employees) through September 31, 2021.

-Employee retention tax credit (ERTC):

          -Small businesses with fewer than 500 employees can elect for any calendar quarter to receive an advance payment of the ERTC of up to 70% of the average quarterly wages paid by the employer in calendar year 2019.

          -This new policy applies to wages paid between July 1, 2021-December 31, 2021.

-Stimulus/relief checks

          -Full $1,400 for individuals with an adjusted gross income (AGI) of up to $75,000, that amount is phased out at an AGI of $80,000; limits are doubled for couples. Heads of households will also receive $1,400 but the income thresholds are different; the phaseout will begin at an AGI of $112,500 and be capped at AGI of $120,000.

          -Each child and adult dependent (including disabled adults and college students who weren’t eligible for the first two rounds of checks) would also be eligible for the full $1,400/person.

-Unemployment Insurance

          -Extend supplemental unemployment benefits at the current amount of $300/week until September 6, 2021.

          -The first $10,200 in unemployment assistance will be tax-free for individuals with adjusted gross incomes under $150,000 beginning in tax year 2020.

- A temporary boost to income-based subsidies for customers using the Affordable Care Act’s Marketplace exchanges; this is intended to enable more people to purchase private health insurance. For 2021 and 2022:

          -A sliding scale of maximum percent of income that can be charged for health insurance premiums from 0 to 8.5%.

(Table from American Rescue Plan Act, pp.462)

 -Those making up to 150% above the federal poverty level can have their health insurance fully subsidized if they purchase it through an ACA Exchange.

-Premium assistance to cover 100% of COBRA costs for eligible individuals and families through September 30, 2021.

Not included in the legislation:

-No additional money for the Provider Relief Fund

-The deadline for the return of the 2% sequestration was not extended (currently set to return on April 1, 2021)

In response to the COVID-19 pandemic in the spring of 2020, lawmakers put a pause on the 2% Medicare sequestration reduction until December 31, 2020.  As a result of the lobbying from PPS and other stakeholders, Congress delayed reinstating the Medicare sequester through April 1, 2021, as part of the Consolidated Appropriations Act, 2021 which was enacted on December 27, 2020.  The Medicare Sequester COVID Moratorium Act (H.R.315) has been introduced this Congress and is seeking to further delay the 2% Medicare sequester for the duration of the public health emergency.  There is not yet a Senate companion bill.

Advocacy Opportunity:  
Your legislators need to hear directly from you--their constituent--about the stark economic landscape you are experiencing and the impact an additional 2% reduction in your Medicare payment will have on your business.
 
If you are on social media, tweet or create Facebook post tagging your legislators and use #PPSAdvocacy.  Template tweet: “Include in COVID package: delay return of 2% Medicare sequestration until the PHE is over so I can continue providing cost effective physical therapy and maintain a vital business in our community.  [@Representative/Senator Twitter handle] #PPSAdvocacy” 
  
 
EMAIL TEMPLATE:
Subject line: My patients need physical therapy.  Delay the reinstatement of the 2% Medicare sequestration cut until the end of the Public Health Emergency so I can stay in business.
 
Dear Representative ____________, 
 
Despite a year of unrelenting pushback—coupled with the COVID-19 public health emergency—CMS’ implemented its plans for an E&M code payment boost paid for by reducing payment to other providers.  Legislation enacted on 12/27/2020 reduced the cut for physical therapy to about -3.6% for CY2021.  Unless reinstating the 2% Medicare sequestration cut is delayed, effective April 1, 2021, the Medicare payment for PT will be reduced another 2% when compared to 2020.
 
My name is _________________ and I am a physical therapist in private practice.  I am a member of the Private Practice Section of the American Physical Therapy Association.  My clinic is in __________.  I see _____ patients a year, ___ percent of whom are Medicare patients.  There are ___ therapists in my practice.  We also employ ___ support staff.  We have been an important part of our local economy and small business community for ___ years.  
 
Our community-based physical therapy clinic received a PPP loan and provider relief funds which have enabled us to remain a viable small business and keep providing patients with access to safe, cost-effective physical therapy throughout the public health emergency.  However, our clinic is still navigating economic challenges. 
 
As you consider what should be included in the next legislative package in response to the COVID-19 pandemic, please cosponsor H.R.315 and include that language in the package in order to delay the reinstatement of the 2% Medicare sequestration cut until the end of the Public Health Emergency.  On behalf of myself and PPS, I make this request so that our physical therapy clinic can keep its doors open—to not only serve our patients but also to provide jobs in our town. 
 
Thank you,
 
 
[Name, credentials]
Member, Private Practice Section of the American Physical Therapy Association
[Practice Name]
[Practice Address]
[Practice phone number]

Thank you.  Your efforts can make a difference! 
 

In response to the COVID-19 pandemic in the spring of 2020, lawmakers put a pause on the 2% Medicare sequestration reduction until December 31, 2020. As a result of the lobbying from PPS and other stakeholders, Congress delayed reinstating the Medicare sequester through April 1, 2021, as part of the Consolidated Appropriations Act, 2021 which was enacted on December 27, 2020. The Medicare Sequester COVID Moratorium Act (H.R.315) has been introduced this Congress and is seeking to further delay the 2% Medicare sequester for the duration of the public health emergency. There is not yet a Senate companion bill.

Advocacy Opportunity:

Your legislators need to hear directly from you--their constituent--about the stark economic landscape you are experiencing and the impact an additional 2% reduction in your Medicare payment will have on your business.

If you are on social media, tweet or create facebook post tagging your legislators and use #PPSAdvocacy. Template tweet: “Include in COVID package: delay return of 2% Medicare sequestration until the PHE is over so I can continue providing cost effective physical therapy and maintain a vital business in our community. [@Representative/Senators twitter handle] #PPSAdvocacy”

EMAIL TEMPLATE:

Subject line: My patients need physical therapy. Delay the reinstatement of the 2% Medicare sequestration cut until the end of the Public Health Emergency so I can stay in business.

Dear Representative ____________,

Despite a year of unrelenting pushback—coupled with the COVID-19 public health emergency—CMS’ implemented its plans for an E&M code payment boost paid for by reducing payment to other providers. Legislation enacted on 12/27/2020 reduced the cut for physical therapy to about -3.6% for CY2021. Unless reinstating the 2% Medicare sequestration cut is delayed, effective April 1, 2021, the Medicare payment for PT will be reduced another 2% when compared to 2020.

My name is _________________ and I am a physical therapist in private practice. I am a member of the Private Practice Section of the American Physical Therapy Association. My clinic is in __________. I see _____ patients a year, ___ percent of whom are Medicare patients. There are ___ therapists in my practice. We also employ ___ support staff. We have been an important part of our local economy and small business community for ___ years.

Our community-based physical therapy clinic received a PPP loan and provider relief funds which have enabled us to remain a viable small business and keep providing patients with access to safe, cost-effective physical therapy throughout the public health emergency. However, our clinic is still navigating economic challenges.

As you consider what should be included in the next legislative package in response to the COVID-19 pandemic, please cosponsor H.R.315 and include that language in the package in order to delay the reinstatement of the 2% Medicare sequestration cut until the end of the Public Health Emergency. On behalf of myself and PPS, I make this request so that our physical therapy clinic can keep its doors open—to not only serve our patients but also to provide jobs in our town.

Thank you,

[Name, credentials]

Member, Private Practice Section of the American Physical Therapy Association

[Practice Name]

[Practice Address]

[Practice phone number]

Thank you. Your efforts can make a difference!

Welcome to the 117th Congress!

Many of you who are PPS Key Contacts have existing connections with your legislators and will continue to build upon them.

However, 47% of members of the House of Representatives are in their first or second term so there is a real need to educate your lawmakers about the value of physical therapy and the impact your small business has on your community. With 61 new members of the House this year, a number of you will be starting from scratch. Similarly, seven of the new Senators do not have Congressional experience, so it is critical that they hear from you in order to better grasp the important role you play for your patients’ physical function as well as the economic impact federal policies can have on your business.

Additionally, with a new administration, a swap of political power in the Senate, and some changes in committee assignments in both chambers there will be new opportunities to pursue while advocating for policies which will improve payment and reduce administrative burden while ensuring patient access to care at your private practice physical therapy clinic.

New Members of Congress are still in the process of hiring their policy staff. Those who are assigned to committees of healthcare jurisdiction are likely to hire those specific staffers sooner, but it can take as long as the end of March before these offices are fully staffed. In many cases new Members of Congress will hire staff which have Hill experience—so it’s quite likely that the legislative assistant you work with will be significantly more familiar with our issues than your lawmaker. As policy staff are hired for your legislator, I will send you the relevant contact information directly.

If you are not a PPS Key Contact but are interested in serving, let us know and we will see if your Member of Congress is available for pairing.

Keep an eye on your inbox for the upcoming release of the 117th Congress Legislative and Advocacy Priorities document that you will be asked to share with your lawmaker.

Thank you!

Attn: PPS Members whose are represented by Republicans in Congress:

In addition to asking for Congress to mitigate the 9% cut, PPS has been advocating for Congress to delay the reinstatement of the 2% Medicare sequestration cut until the end of the Public Health Emergency.  We have been hearing that the Medicare sequester moratorium extension is in danger of not being included due to concerns from Republican leadership.

Therefore, we urge you to do the following:
1) Email your legislators, and ask them to reach out to Leader McConnell or Leader McCarthy

Template message:
Please encourage Majority Leader McConnell/Leader McCarthy to delay the reinstatement of the 2% Medicare sequestration cut until the end of the Public Health Emergency.  Doing so will help my community-based outpatient physical therapy clinic--which is barely hanging on through the joint impact of the public health emergency and economic crisis--to continue to serve my patients and keep my clinic open.

2) Use your social media presence to urge the House and Senate leadership to include the moratorium in the end-of-year legislative package. Sample tweet: ".@SpeakerPelosi, @GOPleader, @senatemajldr, & @SenSchumer continue supporting patient access and their physical therapists through the end of the #COVID19 public health emergency.  Extend the Medicare Sequester Moratorium!"

Your engagement can make a real difference!  Thank you!

ALERT: We now also have a Senate bill (S.5007) that is seeking to provide 2 years of  hold harmless payments to those who will be impacted by the 9% Medicare cut

This is probably the last week that Congress will be in session until they have to start over for the 117^th Congress.  These next few days are key for advocacy.

Please continue to reach out to your Members of Congress and ask them for help—even if you’ve done it before.  The stakes are high and they are not off the hook yet. 

Here’s an email template to use (or to cut down for when you call the office instead) and list of what we are working for, in order of priority:

TEMPLATE

As you consider what should be included in the next legislative package that will be passed before the end of the year, please act to prevent drastic cuts to Medicare payment in 2021 while also ensuring tax-free status for federal grants so that our physical therapy clinic can keep its doors open—to not only serve our patients but also to provide jobs in our town. 

Please enact the following legislative fixes to support small businesses who are also healthcare providers:

1. Prevent the drastic cuts to Medicare reimbursement that will go into effect on January 1, 2021 by enacting H.R.8702/S.5007 or another equally effective policy.  If CMS proceeds to cut physical therapy reimbursement by 9% as planned, many community-based outpatient physical therapy clinics who are barely hanging on through the joint impact of the public health emergency and economic crisis will go out of business.
2. Delay the reinstatement of the 2% Medicare sequestration cut until the end of the Public Health Emergency by enacting H.R.8840.
3. Enact H.R.7777/S.4117 to allow for efficient forgiveness of PPP loans of $150,000 or less.
4. Override the IRS guidance which stated provider relief fund grants are taxable so that these grants will be tax-free and more effective tools to reimburse providers for healthcare related expenses or lost revenues attributable to COVID-19.
5. Allow physical therapists and physical therapist assistants to bill and be paid for care provided to Medicare beneficiaries via telehealth by enacting the language of H.R.8755.
6. Allow tax-free forgiven PPP expenses to also be deductible business expenses—in line with the Congressional intent of the CARES Act.

Each of these policy changes will enable me to better serve my patients and keep my clinic open.  On behalf of myself and PPS, will you please include these policies in legislation passed before the end of the year?

Consider me a resource.  I look forward to speaking with you about this and other issues that are important to maintain access to quality care for my patients and which significantly impact the practices of myself and my colleagues who are private practice physical therapists. 

Best regards,

(Name, credentials)

Member, Private Practice Section of the American Physical Therapy Association

(Practice Name)

(Practice Address)

(Practice phone number)

The year is coming to a close, as is the end of the 116^th Congress.  This is a time of high stakes which also means a time of a flurry of advocacy opportunities. 

You will be receiving requests from PPS and APTA to reach out to your Members of Congress and ask them for help.  Here’s an email template to use (or to cut down for when you call the office instead) and list of what we are working for, in order of priority:

As you consider what should be included in the next legislative package that will be passed before the end of the year, please act to prevent drastic cuts to Medicare payment in 2021 while also ensuring tax-free status for federal grants so that our physical therapy clinic can keep its doors open—to not only serve our patients but also to provide jobs in our town. 

Please enact the following legislative fixes to support small businesses who are also healthcare providers:

1. Prevent the drastic cuts to Medicare reimbursement that will go into effect on January 1, 2021 by enacting H.R.8702 or another equally effective policy.  With a 9% cut to physical therapy reimbursement effective January 1, 2021, many community-based outpatient physical therapy clinics who are barely hanging on through the joint impact of the public health emergency and economic crisis will go out of business.
2. Delay the reinstatement of the 2% Medicare sequestration cut until the end of the Public Health Emergency by enacting H.R.8840.
3. Enact S.4117/H.R.7777 to allow for efficient forgiveness of PPP loans of $150,000 or less.
4. Override the IRS guidance which stated provider relief fund grants are taxable so that these grants will be tax-free and more effective tools to reimburse providers for healthcare related expenses or lost revenues attributable to COVID-19.
5.  Allow physical therapists and physical therapist assistants to bill and be paid for care provided to Medicare beneficiaries via telehealth by enacting the language of H.R.8755.
6. Allow tax-free forgiven PPP expenses to also be deductible business expenses—in line with the Congressional intent of the CARES Act.

Each of these policy changes will enable me to better serve my patients and keep my clinic open.  On behalf of myself and PPS, will you please include these policies in legislation passed before the end of the year?

Consider me a resource.  I look forward to speaking with you about this and other issues that are important to maintain access to quality care for my patients and which significantly impact the practices of myself and my colleagues who are private practice physical therapists. 

Best regards,

(Name, credentials)

Member, Private Practice Section of the American Physical Therapy Association

(Practice Name)

(Practice Address)

(Practice phone number)

Advocacy Opportunity:

Your voices were heard! 229 Members of the House of Representatives signed onto the September 24th letter led by Reps. Bera and Buchon. This bipartisan letter publicly requested that Speaker Pelosi and Minority Leader McCarthy include a fix to the Medicare cuts in legislation that is passed before the end of the year.

Now there is a bill to get behind. These same lawmakers—Reps. Bera and Buchon—have introduced a bill that would negate the looming (9% to PT) cuts that are set to go into effect on January 1, 2021. The legislation wants to provide an extra payment to specialties who receive cut under the final 2021 Physician Fee Schedule. The bill calls for the “hold harmless” payment to be made for 2 years (2021 and 2022).

This is a new advocacy request and it is important that your Representative and their staffer hear from you—even if you have already written to them about this issue. Use the template below to ask your Representatives to cosponsor H.R.8702 in order to protect physical therapy from a 9% cut in Medicare reimbursement.

Check here to see if your legislator was one of the 229 Representatives on record in support of a legislative fix before the end of the year—if so, please include the line (below in the template) in your email. If not, please delete that sentence.

Remember your legislators need to hear directly from you—their Key Contact—multiple times about the stark economic landscape you are experiencing and the impact a 9% cut would have on your business.

While this effort is focused on the House, the Senate doesn’t get a pass. If you are on social media, tweet or create a Facebook post tagging your legislator and both your Senators and using #PPSAdvocacy. Template tweet: “Cosponsor HR8702. Pass legislation to stop the 9% cut so I can keep my doors open, continue providing cost effective physical therapy, and maintain a vital business in our community. [@Represenative/Senator twitter handle] #PPSAdvocacy”

New to engaging with your lawmaker or need a refresher? Check out these tips for advocacy. For information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

Thank you. Your efforts are making a difference!

TEMPLATE:

Subject line: My patients need physical therapy. Cosponsor HR8702 to stop the 9% cut so I can stay in business.

Dear Representative ____________,

Despite a year of unrelenting pushback by stakeholders, providers, patients, and Members of Congress—coupled with the COVID-19 public health emergency—in the 2021 MPFS proposed rule CMS proceeded to move forward with plans for an E&M code payment boost ranging between 1% and 17%. This has resulted in cuts ranging from -1% to -11% for over 35 types of healthcare providers. Physical therapy is projected to receive a 9% cut. These cuts are to go into effect on January 1, 2021.

Thank you for being one of the 229 Members of Congress who signed the September 24th letter to Congressional leadership asking for legislative action to prevent these cuts.

Representatives Bera and Bucshon have introduced H.R.8702, the Holding Providers Harmless From Medicare Cuts During COVID-19 Act, which would negate the looming Medicare cuts that are set to go into effect on January 1, 2021. The legislation would provide an extra payment to those specialties who are slated for cuts under the 2021 PFS proposed rule. This “hold harmless” payment will be made for 2 years (2021 and 2022). Here is a one-pager which provides more details and background. Please cosponsor H.R.8702 so that Speaker Pelosi and Minority Leader McCarthy can bring it to the floor for passage before the end of the year.

I am a physical therapist and member of the Private Practice Section of the American Physical Therapy Association. Along with the ___ therapists and support staff I employ, my outpatient clinic is a vital small business and has been an important part of the [town/county name] economy for ___ years. Our community-based physical therapy clinic has been providing patients with access to safe, cost-effective care throughout the public health emergency.

If Congress doesn’t act to prevent CMS from cutting physical therapy reimbursement by 9%, many community-based outpatient physical therapy clinics, who are barely hanging on through the joint impact of the public health emergency and economic crisis, will go out of business. We need your help so that our physical therapy clinic can keep its doors open—to not only serve our patients but also to provide good jobs in our town.

Please contact Colleen Nguyen in Rep. Bera’s office or Dylan Moore in Rep. Bucshon’s office to cosponsor H.R.8702.

Thank you,

[Name, credentials]

Member, Private Practice Section of the American Physical Therapy Association

[Practice Name]

[Practice Address]

[Practice phone number]

Advocacy Opportunity:

158 Members of the House of Representatives wrote to CMS stating their disapproval of cuts to Medicare reimbursement for specialists such as physical therapists.  Another sign-on letter is being circulated that would put pressure on Speaker Pelosi and Minority Leader McCarthy to include a fix to the Medicare cuts in legislation that is passed before the end of the year. 

While you have already written to your legislator about this issue, this is a new request and it is important that they hear from you again.  Use this template to ask your Representatives to sign the letter to Congressional Leaders pressuring them to act to protect physical therapy from a 9% cut in Medicare reimbursement.

Remember your legislators need to hear directly from you—their Key Contact—multiple times about the stark economic landscape you are experiencing and the impact a 9% cut would have on your business.

While this effort is focused on the House, the Senate doesn’t get a pass.  If you are on social media, tweet or create facebook post tagging your legislator and both your Senators and using #PPSAdvocacy.  Template tweet: “Congress must act to stop the 9% cut so I can keep my doors open, continue providing cost effective physical therapy, and maintain a vibrant small business in our community.  [@Represenative/Senator twitter handle] #PPSAdvocacy”

New to engaging with your lawmaker or need a refresher?  Check out these tips for advocacy. For information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

Thank you.  Your efforts can make a difference!

TEMPLATE:

Subject line: My patients need physical therapy.  Please pass legislation to stop the 9% cut so I can stay in business.

Dear Representative ____________,

My name is ____________ and I am a physical therapist and member of the Private Practice Section of the American Physical Therapy Association. Along with the ____ therapists can support staff I employ in your district, my outpatient clinic is a vital small business and an important part of the [town/county name] economy for ___ years. Our community-based physical therapy clinic has been providing patients with access to safe, cost-effective care throughout the public health emergency. However, our clinic is facing economic challenges and struggling to keep our doors open.

Despite strong and unequivocal pushback by stakeholders, providers, patients, and Members of Congress since August 2019, in the 2021 MPFS proposed rule CMS proceeded to move forward with plans for an E&M code payment boost ranging between 1% and 17%, paired with a cut of 9% for physical therapy.  Over 35 types of healthcare providers are projected to receive cuts ranging from -1% to -11%.  These cuts are to go into effect on January 1, 2021. 

Representatives Bera and Bucshon are leading a bipartisan sign-on letter which asks Speaker of the House Nancy Pelosi and House Minority Leader Kevin McCarthy to commit to passing legislation before the end of the year which would prevent these looming Medicare payment cuts.

If Congress doesn’t act to prevent CMS from cutting physical therapy reimbursement by 9%, many community-based outpatient physical therapy clinics, who are barely hanging on through the joint impact of the public health emergency and economic crisis, will go out of business.  We need your help so that our physical therapy clinic can keep its doors open—to not only serve our patients but also to provide good jobs in our town. 

Please contact Colleen Nguyen in Rep. Bera’s office or Dylan Moore in Rep. Bucshon’s office to sign on to the letter. 

Thank you,

[Name, credentials]

Member, Private Practice Section of the American Physical Therapy Association

[Practice Name]

[Practice Address]

[Practice phone number]

Advocacy Opportunity:

Use this template to ask your Representatives to act to protect physical therapy from a 9% cut in Medicare reimbursement. Your legislators need to hear directly from you—their Key Contact—multiple times about the stark economic landscape you are experiencing and the impact a 9% cut would have on your business.

If you are on social media, follow up your request with a Tweet or Facebook post tagging your legislator and using #PPSAdvocacy.  Template Tweet: “Please stop the 9% cut so I can stay in business—providing cost effective physical therapy and maintaining a vibrant small business in our community [@Rep/Senator twitter handle] #PPSAdvocacy”

New to engaging with your lawmaker or need a refresher?  Check out these tips for advocacy. For information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

Thank you.  Together we can make a difference in what is included in the upcoming COVID-19 package!

TEMPLATE:

Subject line: My patients need physical therapy.  Please stop the 9% cut so I can stay in business.

Dear Representative/Senator,

My name is                                       and I am a physical therapist and member of the Private Practice Section of the American Physical Therapy Assocaition. The outpatient physical therapy clinic that I work in is a vital small bsuiness and an important part of the local economy. Our community-based physical therapy clinic has been providing patients with access to safe, cost-effective care througout the public health emergency. However, our clinic is navigating economic challenges as a result. 

CMS, despite strong and unequivocal pushback by stakeholders, providers, patients, and Members of Congress since August 2019, released the 2021 MPFS proposed rule which included plans to move forward with the E&M code payment boost ranging between 1% and 17%, paired with a cut of 9% for physical therapy.  34 more specialists are projected to receive cuts ranging from -1% to -11%.

Representatives Marshall and Wenstrup are leading a bipartisan sign-on letter which asks HHS Secretary Azar and CMS Administrator Verma, where possible, to engage with stakeholders in establishing fair and equitable payment solutions that address Medicare payment cuts at this time, while at the same time moving forward with policies to increase payments to primary care and other office-based specialties. The letter also acknowledges that legislative action is required to fully address this issue, but requests CMS to take immediate actions to delay or mitigate these cuts while allowing the scheduled increases to go into effect. 

Congress must intervene to prevent this drastic cut.  Please do these two things:

1. Include at least a 2-year waiver of the budget neutrality requirement that is forcing CMS to cut the reimbursement of some providers in order to pay for an increase in Evaluation and Management (E&M) Codes. 
2. Join Congressional sign-on letter to CMS during public comment period.  The sponsors of the letter believe it’s important that Congress submits their position to the Administration. The letter will be open through Wednesday, September 23^rd.  A link to the letter is here.  To sign the letter, offices can complete the google form here.

If CMS proceeds to cut physical therapy reimbursement by 9% as planned, many community-based outpatient physical therapy clinics, who are barely hanging on through the joint impact of the public health emergency and economic crisis, will go out of business.  We need your help so that our physical therapy clinic can keep its doors open—to not only serve our patients but also to provide jobs in our town. 

Thank you,

[Name, credentials]

Member, Private Practice Section of the American Physical Therapy Association

[Practice Name]

[Practice Address]

[Practice phone number]

The 2021 MPFS proposed rule (https://www.regulations.gov/document?D=CMS-2020-0088-0001) includes a -9% cut to PT reimbursement.  This is unacceptable.

Please send the following email to your Representative as soon as you can--asking them to join a letter requesting that the next COVID package include a 2-year waiver of the budget neutrality requirement that is forcing CMS to pay for an increase in Evaluation and Management (E/M) Codes on the backs of PTs and other specialists who don't bill E/M codes.  The deadline for signing onto the letter is this Friday.

--TEMPLATE letter [please customize these fields]

In June, PPS and 52 other organizations (including the American Medical Association) sent a letter to Congressional leadership asking for legislation to waive budget neutrality requirements to prevent the deep cuts to non E/M code billing providers (https://ppsapta.org/sl_files/6C6B7B63-BCAF-EE06-1EF80FE063EF5B43.pdf).

Despite a full year of significant Congressional and stakeholder pushback since this cut was proposed last July (not to mention that we are in the midst of a public health and economic crisis), CMS's proposed 2021 MPFS further deepens those cuts (https://www.regulations.gov/document?D=CMS-2020-0088-0001).  CMS is proposing to cut physical therapy by -9%.

Will Rep. [____________] be willing to sign onto  Rep. Rush's Dear Colleague (see below) seeking to include a waiver of budget neutrality on the E/M codes for 2 years in the next COVID-19 package? The deadline for signature is this Friday, Aug 7.  As you know, waiving the budget neutrality requirements within the MPFS would prevent these drastic cuts to this large swath of critical health care providers--including physical therapists--who can't absorb such a cut during this joint public health emergency and economic crisis.

Please contact Lauren Citron in Rep. Rush’s office to sign on.

Thank you for your consideration,
[Name, credentials]
Member, Private Practice Section of the American Physical Therapy Association
[Practice Name]
[Practice Address]
[Practice phone number] 

Ask Your Legislators to support small businesses in next COVID-19 package

Ask your Senators to include small business-focused access to tax-free federal support in the next COVID-19 legislative package.

In the laws enacted this spring, Congress created and modified the Paycheck Protection Program (PPP) in order to support not only the health care industry but also small businesses which are the engine of the economy.  

Regulations established have determined that recipients of PPP loans will not be able to deduct forgiven business expenses and that the Provider Relief Fund dollars they received will be taxed as income.  This regulatory position can only be overridden by Congress.  PPS has been lobbying Members of Congress and Congressional leadership to fix both of these issues as well as to intervene to prevent the looming 8% cut to reimbursement that CMS is planning.

Now is the time for your legislators to hear directly from you—their constituents—about what they need to do to support you, your employees, and your small business.

Advocacy Opportunity:

PPS is providing you an opportunity to reiterate the APTA-wide priorities of preventing the 8% cut and the extension of telehealth coverage through the end of 2021 as well as highlight small business-specific priorities for upcoming legislation.  Use this template to thank your legislators for setting aside the provider relief funds as well as creating and modifying the PPP while also being clear about the need to provide tax relief in the next legislative response to COVID-19 in order to make sure those economic supports are truly tax-free and provide the maximum impact.  PPS is also advocating for small businesses to be able to apply for a second PPP loan. 

If you are on social media, follow up your request with a tweet or facebook post tagging your legislator and using #PPSAdvocacy.  Template tweet: “PPP and Relief Funds are a lifeline for my small business, but taxing them diminishes the impact.  Please fix this in the next COVID package. [@Rep/Senator twitter handle] #PPSAdvocacy”

New to engaging with your lawmaker or need a refresher?  Check out these tips for advocacy. For information on PPS’s legislative priorities and activities, visit the Advocacy section at www.ppsapta.org

Thank you.  Together we can make a difference!

TEMPLATE:

Subject line: PPP and Relief Funds are a lifeline, but taxing them diminishes impact.  Please help.

Dear Representative/Senator __________,

Thank you for passing legislation this spring to give healthcare providers and small business owners access to much-needed capital.  As a small business owner who has received a PPP loan and a provider relief fund grant, I am truly appreciative.  Without these funds, I might have had to close my doors already.

I am a physical therapist in private practice and a member of the Private Practice Section of the American Physical Therapy Association.  Along with the therapists and support staff I employ in your district, my outpatient clinic is a vital small business and an important part of our local economy.  The laws enacted in response to the COVID-19 crisis (including allowing Medicare coverage of telehealth) have helped us to keep serving our community despite the public health emergency and have enabled us to continue to provide our patients with access to safe, quality care.

As you consider what should be included in the upcoming COVID-19 relief package, please act to maximize the economic impact of federally allocated funds. Access to truly tax-free grants at this time is critical for my business and those I employ.  In order to do so please include the following legislative fixes that will support small businesses who are also healthcare providers:

1. Allow tax-free forgiven PPP expenses to also be deductible business expenses—in line with the Congressional intent of the CARES Act.
2. Override the IRS guidance which stated provider relief fund grants are taxable so that these grants will be tax-free and more effective tools to reimburse providers for healthcare related expenses or lost revenues attributable to COVID-19.
3. Allow small business owners to apply for a second round of PPP loans.

Thank you ahead of time for supporting legislation that will override these IRS rulings and provide much-needed, continued support for small businesses as well as responding to the APTA priorities of preventing the looming 8% cut to physical therapists under the Medicare Physician Fee Schedule and extending telehealth waivers through the end of 2021. 

Sincerely,

[Name, credentials]

Member, Private Practice Section of the American Physical Therapy Association

[Practice Name]

[Practice Address]

[Practice phone number]

Tell Your Members of Congress How They Can Support Access to Physical Therapy

(If you don’t know who your Representative is, check here.)

Ask your Representative to modernize how outpatient physical therapy is accessed and paid for

PPS’ legislative and advocacy priorities include advocating for fair and equitable payment, Medicare coverage for care provided via telehealth, and reducing administrative burdens.  While often we have to pursue these goals separately, we now have the bipartisan Outpatient Therapy Modernization and Stabilization Act (H.R. 7154) which addresses all three! 

Advocacy Opportunity:

Ask your Representative to cosponsor the Outpatient Therapy Modernization and Stabilization Act (H.R. 7154).  They need to hear from you about bipartisan solutions which would support you both as a physical therapist and a small business owner.  Use this template:

SUBJECT LINE: Please cosponsor Outpatient Therapy Modernization and Stabilization Act (H.R. 7154)

My name is _________________ and I am a physical therapist in private practice and a member of the Private Practice Section of the American Physical Therapy Association.  My clinic is [near ________________landmark/in ___________ community, Town, State].  There are ___ therapists in my practice.  We also employ ___ support staff.  We have been an important part of our local economy and small business community for ___ years.  We have been proud to serve our community throughout the COVID-19 crisis by continuing to provide our patients with access to safe, quality care.

Thank you for the flexibility you gave to CMS in the Coronavirus Aid, Relief, and. Economic Security (CARES) Act.  After significant pressure, CMS used that authority to waive restrictions and allow physical therapists to provide and be reimbursed for care provided via telehealth for the duration of this public health emergency.  Many private payers are also covering telehealth visits.  However, using telehealth to receive timely and appropriate medical care should not be limited to this type of public health emergency.  On behalf of myself, my patients and other members of the Private Practice Section, I am asking for your support to make this important policy permanent. 

The Outpatient Therapy Modernization and Stabilization Act (H.R. 7154) would allow PT, OT, and SLP professionals, and facilities that provide outpatient therapy to bill Medicare for outpatient therapy services furnished via telehealth. 

This bill would also address two other legislative priorities of the Private Practice Section by:

• Modifying the plan of care certification requirement in order to reduce administrative burden and delays in care; and
• Preventing CMS’ proposed steep cuts to Medicare in 2021 by providing a one-time exemption from the currently mandated Medicare Physician Fee Schedule budget neutrality rules triggered by the reweighting of the office/outpatient Evaluation & Management (E/M) Codes. 

Each of these three policy changes will enable me to better serve my patients and keep my clinic open.  Will you please cosponsor H.R.7154?

Thank you for your time and attention to this valuable policy,

[Name, credentials]

Member, Private Practice Section of the American Physical Therapy Association

[Practice Name]

[Practice Address]

[Practice phone number]

If you are on social media, follow up your request with a tweet or facebook post tagging your legislator as well as PPS using #PPSAdvocacy. 

New to engaging with your lawmaker or need a refresher?  Check out these tips for advocacy 

Thank you for your continued advocacy.  Together we can make a difference!

For information on PPS’s legislative priorities and activities,

visit the Advocacy section at www.ppsapta.org

PPS along with APTA and 12 other organizations request that CMS permanently extend the policy that allows telehealth services furnished by all outpatient occupational therapy, physical therapy, speech-language pathology, and audiology providers to be reimbursed under Medicare, as well as make permanent the flexibilities associated with the originating site geography, authorized originating site, and audio-visual technology to allow all Medicare beneficiaries to receive telehealth services from their home, whether that home is in the community or part of an institutional setting.  

LEARN MORE

As many of you know, in March Congress created the Paycheck Protection Program (PPP) to provide loans to qualified businesses. In the original law, an 8-week portion of those loan amounts were eligible for forgiveness. 

However, in response to challenges with using a PPP loan as well as the clear need for more flexibility as the public health crisis and its economic impact dragged on, Congress acted to create and pass the Paycheck Protection Program Flexibility Act (PPPFA), aka H.R. 7010 to enact changes to the PPP that allow it greater support employers and their employees.

DISCLAIMER: Please note that this article is not intended to, and does not, serve as legal advice to the reader but is for general information purposes only. Nothing in this article constitutes nor substitutes for specific legal advice that takes into account your organization’s specific jurisdiction(s) or circumstances. Please seek legal counsel if you need specific guidance. 

Key Provisions of the PPPFA

With the exemption of the extension of the maturity period, the legislation is retroactive and applies to all PPP loans made pursuant to the CARES Act.

PPP Loan Forgiveness

     - PPP loan forgiveness period is extended from 8 to 24 weeks from the date of the loan origination OR to December 31, 2020, whichever is earlier. However, those who already have PPP loans, can elect to maintain the 8-week forgiveness period.
     - Recognizing the realities of a slow-to-recover economy, the PPPFA includes new provisions that exempt a borrower from a reduction in the forgiven amount of the PPP loan if a borrower has difficulty rehiring employees or hiring new qualified employees to meet the employee retention threshold. The amount of the loan forgiven will not be impacted if the borrower has a reduction in the number of full-time equivalent employees IF the borrower can certify in good faith ONE of the following:
          - Documented inability to rehire employees who worked for the borrower on February 15, 2020;
          - Documented inability to hire similarly qualified employees for unfilled positions on or before December 31, 2020;
          - Documented inability to return to the same level of business activity as before February 15, 2020 due to standards established by HHS, the CDC, or OSHA from March 1-December 31, 2020 related to sanitation, social distancing, and other COVID-19 safety requirements.
     - The PPPFA modifies the 75%/25% CARES Act ratio and now requires that a minimum of 60% of the forgiven loan amount must be used toward payroll which allows for up to 40% of the forgiven amount to be used for other eligible forgivable expenses of rent, mortgage interest payments, utilities and the like.  The legislation does not change CARES Act parameters for how unforgiven proceeds of the loan must be used. 

PPP Loan Terms
     

     - The maturity period for PPP loans received after the PPPFA is enacted is extended from 2 years to 5 years. While the extended maturity period is NOT automatically retroactive for existing PPP loans, the legislation does allow borrowers and lenders to negotiate the maturity period of existing loans to conform with the 5-year maturity period provided by the PPPFA. 
     - The covered period of the PPP loan is extended from June 30, 2020 to December 31, 2020. The legislation maintains the requirement to rehire employees to be eligible for forgiveness, extends the safe harbor rehiring deadline to December 31, 2020. As noted above, there are also factors under which the rehiring requirements may be reduced in your case. 
     - The deferral date of the loan is extended. The CARES Act allowed for a 6-month deferral before payments towards the remaining PPP loan amount were required. Under the PPPFA, borrowers are now not required to make any loan payments until their loan forgiveness amount is determined by the SBA. If a borrower fails to apply for forgiveness within 10 months of the last day of the covered period of the loan, the borrower must start making payments of principal, interest, and fees beginning after 10 months of the last day of the covered period.
     - PPP borrowers who have the loans forgiven are now also eligible for deferring payroll taxes as per CARES Act. 

It is important to remember that these changes to the program will likely require the Small Business Administration (SBA) to rewrite some regulations that were promulgated in response to the CARES Act which created the program. Given that the PPPFA also makes changes to the forgiveness policy, please ask your lender to share the revised forgiveness application when it becomes available.

Tell Your Senators What You Need!

(If you need your Senator's contact info, click here.)

On May 15, the House passed the Heroes Act—a $3 trillion House Democrats’ legislative wish-list.  While a number of the policy proposals have been dismissed outright by the Senate Republican leadership, the Democrats’ intent was to make their priorities public (for both policy and political reasons) so that the Senate Republicans are prompted to respond. Senators are currently evaluating and debating what policy to include in their legislative package which means they need your input.

Ask your Senators to improve the Paycheck Protection Program

PPS has identified key small business provisions of the Heroes Act which would be most useful for PPS members—especially those who have received a Paycheck Protection Program (PPP) loan.  Please ask your Senators to include PPP modifications in their upcoming legislative package.  They need to hear from you about bipartisan solutions which would support you, your employees, and your small business.

Advocacy Opportunity:

Ask both of your Senators to fix the PPP in their next legislative response to COVID-19.  Thank them for creating the PPP and be frank about its shortcomings so they understand the importance of modifying this crucial program.  Use this template:

SUBJECT LINE: PPP is a lifeline, but covered period needs to be extended

Thank you for creating the Paycheck Protection Program (PPP).  As a small business owner who has received a PPP loan, I am very appreciative. 

My name is _________________ and I am a physical therapist in private practice and a member of the Private Practice Section of the American Physical Therapy Association.  My clinic is [near ________________landmark/in ___________ community, Town, State].  There are ___ therapists in my practice.  We also employ ___ support staff.  We have been an important part of our local economy and small business community for ___ years.  [Explain what the PPP loan has allowed you to do (maintain __ staff, make student loan payments for employees, etc.)]. 

Unfortunately, in my community the recovery will take longer than 8 weeks.  Therefore, I am asking you to consider moving the deadline for rehiring to previous levels from June 30 to December 31, 2020.  Those additional six months will allow me to provide sustainable long-term employment as opposed to being at risk of having to furlough employees after 8 weeks should patients continue to stay home and business income remain limited.

Also, please consider the following PPP improvements that were included in the House-passed bill:

1. 1. Include a legislative fix to allow tax-free forgiven PPP expenses to also be deductible business expenses—in line with the CARES Act Congressional intent 
   2. Extend both the covered period for PPP loans and the rehiring deadline for the forgiveness-eligible portion of a PPP loan from June 30 to December 31, 2020
   3. Lengthen the minimum maturity term of the PPP loan from 2 to 5 years
   4. Allow for payment deferral for up to 1 year (instead of 6 months)

Thank you for considering how to improve this valuable program.

Sincerely,

[Name, credentials]

Member, Private Practice Section of the American Physical Therapy Association

[Practice Name]

[Practice Address]

[Practice phone number]

If you are on social media, follow up your request with a tweet or facebook post tagging your legislator as well as PPS using #PPSAdvocacy. 

New to engaging with your lawmaker or need a refresher?  Check out these tips for advocacy 

 Together we can make a difference!

For information on PPS’s legislative priorities and activities,

visit the Advocacy section at www.ppsapta.org

The IRS released regulations on April 30 which classified the expenses covered by the forgivable portion of a Paycheck Protection Program (PPP) loan as non-deductible business expenses. Tell your Member of Congress that if you are able to deduct these expenses, the PPP would contain a benefit much more powerful than loan forgiveness alone, allowing a truly tax-free benefit at a time that is critical for your business. Ask them to override the IRS ruling and support the viability of your small business.

TEMPLATE letter to Member of Congress:

[Month Day, Year]

The Honorable [First name Last name]

RE: IRS Notice 2020-32, guidance regarding the deductibility for Federal income tax purposes of certain otherwise deductible expenses incurred in a taxpayer’s trade or business when the taxpayer receives a loan (covered loan) pursuant to the Paycheck Protection Program under section 7(a)(36) of the Small Business Act (15 U.S.C. 636(a)(36).

Dear [Congressman/Senator Last name]:

My name is [your first and last name] and I am a small business owner who resides in your district. The Paycheck Protection Program (PPP) loan I received on [date of origination] has provided a lifeline to my small business and allowed our [__] employees to remain at work. However, with the April 30 IRS Notice 2020-32, what was promised to small businesses has changed dramatically.

IRS Notice 2020-32 takes the position that the forgivable portion of the PPP loan is non-deductible because it triggers IRS code section 265 which denies the deductibility of any expenses applicable to exempt income. As a result, the impact and value of the loan is significantly diminished. It also defies the intent of Congress, as has been publicly stated by Senator Grassley and Representative Neal.

If these forgivable PPP expenses are not deductible then in effect business owners are paying tax on this loan. For example:

          - Business owner A incurs $100,000 of qualified expenses eligible for forgiveness
          - The forgiveness of the $100,000 of PPP loan is tax free for federal income tax purposes.
          - As result of the IRS Notice 2020-32 position, business owner A loses their deduction for the qualified payroll and overhead that is forgiven in the PPP loan.
          - Accordingly, Business owner A is in the same position as if the loan forgiveness were taxable. 

If we are able to deduct these expenses, the PPP would contain a benefit much more powerful than loan forgiveness alone, allowing a truly tax-free benefit at a time that is critical for our business.

I ask that you support action to override the IRS ruling and support small businesses.

Sincerely,

[Name, credentials]
[Practice Name]
[Practice Address]
[Home address if in different Congressional District or state]

We know you are worried about how COVID-19 will impact your businesses, adjusting to providing care via telehealth, or bridging the gap of reduced patient volume.  You can help us formulate stronger arguments in support of private practice PTs, your small businesses, and the methods through which you can provide quality care by sharing your stories with PPS.

Here are four ways you can make a difference through completing our COVID-19 Survey:

1. Give examples of how and when you are using telehealth to care for your Medicare beneficiaries during this public health emergency.  Provide us stories about patients whose outcomes are improved because they are now able to receive care via telehealth.  Be sure to include details to paint a vivid picture of the value of access to care for that patient (i.e. mobility concerns, fall-risk mitigation, comorbidities, etc.).

2. PPS and APTA have asked CMS to waive the Plan of Care signature requirement and to allow for general supervision of PTAs during the public health emergency declaration.  If you have experiences with either of those issues that you’d like to share, please provide them.

3. Share with PPS whether you utilized any of the loan or grant opportunities (such as PPP or EIDL) provided by COVID-19 legislation.  Send stories of success as well as frustrations so that we can inform Congress about how those programs were or were not useful to small business owners who were also health care providers.

4. If you have any suggestions for legislation or regulatory relief to ask Congress for during this public health crisis, please share them.

Please visit our COVID-19 Survey to use your personal experience to make a difference.  Thank you for your assistance in our advocacy efforts during this challenging time. 

PPS and APTA sent a letter to HHS Secretary Azar and CMS Administrator Verma to strongly encourage HHS and CMS to immediately take additional steps to ensure patient safety and protect health care providers by waiving two additional program requirements:

1. Eliminate the plan of care signature requirement during the COVID-19 pandemic.  This is necessary because during normal circumstances compliance with the physician signature requirement imposes a significant logistical and administrative burden for both therapy providers and physicians, taking valuable time and resources away from delivering patient care.  Waiting for a plan of care certification can force delays of clinically significant care.

2. Recognize the value and benefit of modifying the supervision requirement from direct to general supervision for physical therapist assistants in private practice settings, as such modification would better promote unrestricted, non-delayed access to therapy interventions.  Without a waiver of this limitation, a PTA may treat Medicare beneficiaries only during the hours when the physical therapist is present.  Therefore, during the COVID-19 crisis, a private practice is severely limited if the supervising physical therapist is sick or in quarantine. Furthermore, this prevents staff from practicing a form of social distancing where only some staff physically attend work each day, because the policy requires the physical presence of the physical therapist in order for the physical therapist assistant to do their job.

As of April 16^th, the Paycheck Protection Program has no more money to lend.  Use these templates to ask your Senator to infuse another $250 billion into the PPP program.

Template letter

My name is _______________ and I am a physical therapist in private practice.  I am the owner of ​[company name] located in [town/city, State].  We have __ clinics and employ ____ people. [Share brief story of how your clinic has been financially impacted by COVID-19]. 

Thank you for the policies enacted which support small businesses and health care providers during this public health crisis—especially the Paycheck Protection Program (PPP) loans.

As a small business owner, I am thrilled to be qualified for the PPP, but as of April 16^th, there is no more money to lend.  Without this loan, [describe the impact of not being able to obtain these funds—on patient access, on your business, as well as the local economy].

Please Senator __________, I (as well as my employees and my patients) desperately need you and your colleagues to enact legislation which will infuse another $250 billion into the PPP program.

Thank you for your attention to this urgent matter.

Respectfully,

Name, credentials

Member: Private Practice Section of the American Physical Therapy Association (APTA)

Cell: ____________

Email: ____________

Talking points

• Thank you for enacting the Paycheck Protection Program (PPP) loans to help us small businesses keep our employees on payroll.

• As of April 16^th, there is no more money to lend.  Without this loan, [describe the impact of not being able to obtain these funds—on patient access, on your business as well as the local economy]

• Please Senator __________, I (as well as my employees and my patients) desperately need you to enact legislation which will infuse another $250 billion into the PPP program.

• As a voter and a small business owner, I thank you for your help!

Template FB post

As of April 16^th, the PPP has no more money to lend.  [tag Senator __________ on Facebook], I (as well as my employees and my patients) desperately need you to add another $250 billion to the PPP program.  Without this loan, [describe the impact of not being able to obtain these funds—on patient access, on your business as well as the local economy].  As a voter and a small business owner, I thank you for your help!

Template Twitter post

As of April 16^th, the PPP has no more money to lend. [Use Senator’s twitter handle: @Senator __________, I (as well as my employees and my patients) desperately need you to add another $250 billion to the PPP program. As a voter and a small business owner, I thank you for your help! #PPSAdvocacy

Advocacy: Use letter, talking points and Facebook post templates to ask your Member of Congress to contact CMS and urge them to expand coverage and payment for telehealth to include PTs and PTAs. We hear that CMS is strongly considering this, and an extra push now could make the difference. If you've already engaged your member of Congress, please treat this as a follow-up. If you've not yet engaged, please do so now!

Template letter

My name is _______________ and I am a physical therapist in private practice. I am the owner of ​[company name]. We have __ clinics located in _________ and employ ____ people. Our practice serves over ____ patients a year, approximately __% percent of whom are Medicare patients.  Thank you for your efforts to support small businesses and health care providers in the 3 bills passed in March.  [Share brief story of how your clinic is impacted by COVID-19 or tell Member of Congress what your state is now requiring in terms of private payer and/or Medicaid coverage for telehealth.] We provide physical therapy care both in-person and via telehealth.  [share a success story of providing care via telehealth].

The CARES Act signed into law on March 27, 2020 expands CMS’ 1135 waiver authority.  On March 30^th, CMS released regulations that expanded the list of digital codes physical therapists can use, however those regulations were written before the CARES Act became law. Therefore, even though CMS now allows PTs to use telehealth codes, it still does not enable physical therapists to be paid for telehealth services. This is because, as CMS noted on page 35 of the rule “that the statutory definition of distant site practitioners under section 1834(m) of the Act does not include physical therapists, occupational therapists, or speech-language pathologists, meaning that it does not provide for payment for these services as Medicare telehealth services when furnished by physical therapists, occupational therapists, or speech-language pathologists.”

Please [Rep. ___________/Senator ___________], compel CMS to immediately act to broaden coverage of Medicare telehealth services by issuing a blanket waiver under its 1135(b)(8) waiver authority, amended by the CARES Act, and allow PTs to be classified as distant site practitioners and therefore able to bill for these telehealth codes. Doing so would make it possible for Medicare beneficiaries to receive health care services from physical therapists and physical therapist assistants via telehealth. If CMS continues to decline to use its full waiver authority, the mere fact of being a Medicare beneficiary is a barrier to receiving timely and appropriate medical care.

Thank you for your attention to this urgent matter.

Respectfully,

Name, credentials

Member: American Physical Therapy Association (APTA), Private Practice Section of the APTA

Cell: ____________

Email: ____________

Talking points

• Since the Coronavirus Aid, Relief, and Economic Security (CARES) Act was signed into law March 27, 2020, CMS has had the ability to take immediate steps to ensure patient safety and protect health care providers by using expanded authority granted to it under Social Security Act 1135(b)(8).

• CMS should issue a blanket waiver to expand the list of providers eligible to furnish and be reimbursed for telehealth services under Medicare during the COVID-19 public health emergency to include physical therapists and physical therapist assistants.

• In [State], [state-level requirements for coverage for care via telehealth].  It is critical that HHS and CMS waive additional regulatory restrictions governing Medicare coverage of telehealth—the flexibilities previously granted to PTs and PTAs by CMS are insufficient to address the needs of our patient population.

• If CMS does not use its full waiver authority, the mere fact of being a Medicare beneficiary is a barrier to receiving timely and appropriate medical care.

• Therefore, I am asking you to urge CMS to act now to broaden coverage of Medicare telehealth services by issuing a blanket waiver under its current 1135(b)(8) waiver authority, so that beneficiaries can receive health care services from physical therapists and physical therapist assistants via telehealth.

Facebook Post:

The CARES Act granted CMS the authority under Social Security Act 1135(b)(8) to expand coverage and payment for telehealth during COVID-19 to physical therapists and physical therapy assistants.  If CMS declines to use its full waiver authority, merely being a Medicare beneficiary means you won’t be able to access timely and appropriate medical care. Will you contact CMS to compel them to immediately broaden coverage of Medicare telehealth services by issuing a blanket waiver under its 1135(b)(8) waiver authority, so that beneficiaries can receive health care services from physical therapists and physical therapist assistants via telehealth?

Advocacy is Crucial in Times of Crisis!

Everyone is busy trying to figure out how to adjust and plan their response to this unprecedented public health crisis.  While three federal laws were passed in March in direct response to the COVID-19 crisis, the work there is far from done.  Lawmakers are currently working on a fourth package and they need to hear from you about what you need to weather this storm.

Ask your legislator to delay the 8% cut

In November 2019, the Center for Medicare and Medicaid Services (CMS) finalized their proposal to reduce reimbursement for physical therapy in 2021.  On March 20^th, PPS and 29 other providers sent a letter to Senate Majority Leader McConnell and Speaker of the House Pelosi urging them to "waive the budget neutrality requirements stipulated in Section 1848(c)(2) of the Social Security Act for the finalized [evaluation and management] code proposal for a period of no less than five years" as they move forward with crafting additional COVID-19 relief packages. Should Congress do as we requested and remove the budget neutrality requirement that the increase in value for evaluation and management (E/M) codes be paid-for, the result would be a five-year delay in the implementation of the upcoming 8% cut.  This is because the cut to physical therapy and other specialties who don’t bill E/M codes was earmarked to pay for the increase in the value of the E/M codes.

Advocacy Opportunity #1:

Ask your Representative and both Senators to include a delay in the cut to PT reimbursement in legislation being developed to address COVID-19.  Tell them how your small business is being harmed by COVID-19 and explain how an 8% cut to Medicare reimbursement in 2021 will further impact your practice. 

Use this template:

Subject line: Include delay of 8% cut in upcoming COVID-19 package

Thank you for your quick response to the COVID-19 pandemic.  As a small business owner, I have benefited from the programs that were included in the three laws passed in March.  However, I still need help. 

My name is _________________ and I am a physical therapist in private practice.  My clinic is [near ________________landmark/in ___________ community, Town, State].  There are ___ therapists in my practice.  We also employ ___ support staff.  We have been an important part of our local economy and small business community for ___ years.  [Explain how you have changed staffing, or plan to use the Paycheck Protection Program or Economic Injury Disaster Loans to access emergency funding].

At this time of year, I generally care for _____ patients a week.  Instead, since the beginning of March, I have seen an average of ___ patients each week. 

Last fall, CMS finalized regulations which would increase the value of E/M codes and pay for it by cutting the reimbursement for specialist providers—physical therapy was cut 8%!  Physical therapists don’t bill E/M codes so we are unable to balance out this drastic cut.  Even before the COVID-19 crisis, the margins at my private practice physical therapy clinic were tight and an 8% cut in reimbursement in 2021 would [briefly describe impact on your practice—would you lay off an employee, close doors, stop accepting Medicare patients, etc.  If you are comfortable disclosing your profit margin and it is at or below 8%, please do.]  Please delay this cut by including in the next COVID-19 relief package a waiver of the budget neutrality requirements stipulated in Section 1848(c)(2) of the Social Security Act for CMS’ finalized E/M code proposal for no less than five years.

Thank you,

[Name, credentials]

[Practice Name]

[Practice Address]

[Practice phone number]

If you are on social media, follow up your request with a Tweet or Facebook post tagging your legislator as well as PPS using #PPSAdvocacy. 

Further efforts to push CMS to use its full waiver authority

Advocacy Opportunity 2:

Since you have already sent CMS a letter yourself, now's the time to ask your Representative and both Senators to reach out to CMS to encourage them to utilize the waiver authority granted to them by the CARES Act so that physical therapists can be reimbursed for care provided via telehealth during the COVID-19 publich health emergency. 

Use this template:

Subject line: Compel CMS to use full telehealth waiver authority

My name is _________________ and I am a physical therapist in private practice.  My clinic is [near ________________landmark/in ___________ community, Town, State].  There are ___ therapists in my practice.  We see _____ patients a year, ___ % of whom are Medicare patients.  Through my work with them [share a success story of your work with a Medicare beneficiary patient that could be done via telehealth].

Thank you for including additional waiver authority for CMS in the CARES Act which empowered CMS to further waive restrictions limiting payment for telehealth by providers such as physical therapists. 

On March 30th CMS released regulations that expanded the list of digital codes physical therapists can use, however those regulations were written before the CARES Act became law.  Therefore, even though CMS now allows PTs to use telehealth codes, it still does not enable physical therapists to be paid for telehealth services. This is because, as CMS noted on page 35 of the rule “that the statutory definition of distant site practitioners under section 1834(m) of the Act does not include physical therapists, occupational therapists, or speech-language pathologists, meaning that it does not provide for payment for these services as Medicare telehealth services when furnished by physical therapists, occupational therapists, or speech-language pathologists.”
Please Representative _____________/Senator _____________, contact CMS and encourage them to use their CARES authority immediately and allow PTs to be classified as distant site practitioners and therefore able to bill for these telehealth codes. 

Thank you for your attention to this urgent matter.

Sincerely,

[Name, credentials]

[Practice Name]

[Practice Address]

[Practice phone number]

If you are on social media, follow up your request with a tweet or Facebook post tagging your legislator as well as PPS using #PPSAdvocacy. 

Empower your patients too

Advocacy Opportunity 3:

Ask your patients to write to their Member of Congress to ask them to include both long term access to telehealth and a 5-year delay in the E/M code increases in the next COVID-19 emergency package. 

Send them this APTA template to use: https://www.votervoice.net/APTA/Campaigns/73113/Respond

Thank you for your continued advocacy.  Together we can make a difference!

For information on PPS’s legislative priorities and activities,

visit the Advocacy section at www.ppsapta.org

It is unknown when or if limitations prohibiting the use of telehealth to provide physical therapy care will be lifted, but advocacy can change that.  You can help us formulate an ever-stronger argument in support of physical therapists using telehealth by sharing information with PPS.

Here are three ways you can make a difference:

1. Keep track of the number of cancelled appointments and patient volume compared with this time last year. Your PPS Lobbyist, Alpha Lillstrom Cheng, will then share those impact statements with Members of Congress as we continue our advocacy for passage of telehealth legislation that will include PT reimbursement for care provided via telehealth. Be prepared to share that information with PPS at the end of March.
2. Share information about any private payers who are reimbursing for care provided via telehealth with the PPS.  Send names of payers as well as any information regarding policies or codes (including site of service codes or modifiers) used to info@ppsapta.org.
3. Send examples of how and when you could be using telehealth to care for your Medicare beneficiaries during this public health emergency to info@ppsapta.org.  Include examples of patients who would be well cared for via telehealth as well as those whose outcomes will likely be affected as a result of delayed access to care.

Thank you for your assistance in our advocacy efforts during this very trying time. 

For further information and resources that may be useful as you and your practice manage the impact of COVID-19, check out the PPS website: https://ppsapta.org/physical-therapy-covid-19.cfm

Share your perspective to increase the power of advocacy!

We have three timely opportunities to advocate on behalf of the profession. Keep reading for a summary of these opportunities and information about how you can get involved.

Advocacy Opportunity #1:

Illustrate impact of an 8% cut

In November 2019, the Center for Medicare and Medicaid Services (CMS) finalized their proposal to reduce reimbursement for physical therapy in 2021.  PPS is working closely with APTA and a coalition of other impacted providers to challenge these cuts.  The most effective advocacy includes impact statements illustrating how policy proposals will cause harm or reduce access to care.  Please share your stories with PPS so that we may bolster our advocacy with these vivid examples.

Describe how an 8% cut to Medicare reimbursement will impact your practice and your patients.  Send your impact statement to PPS at info@ppsapta.org

Use this template:

My name is _________________ and I am a physical therapist in private practice.  My clinic is [near ________________landmark/in ___________ community, Town, State].  I see _____ patients a year, ___ % of whom are Medicare patients.  Through my work with them [share a success story of your work with a Medicare beneficiary patient].

There are ___ therapists in my practice.  We also employ ___ support staff.  We have been an important part of our local economy and small business community for ___ years. 

CMS has finalized regulations which would increase the value of E/M codes and has proposed to pay for it by cutting the reimbursement for specialist providers—physical therapy was cut 8%!  Physical therapists don’t bill E/M codes so we are unable to balance out this drastic cut.  As a private practice physical therapist, my margins are tight and an 8% cut in reimbursement would [briefly describe impact on your practice—would you lay off an employee, close doors, stop accepting Medicare patients, etc.  If you are comfortable disclosing your profit margin and it is at or below 8%, please do.]

[Name, credentials]

[Practice Name]

[Practice Address]

[Practice phone number]

Legislative Advocacy

We are now in the Second Session of the 116^th Congress.  As with most election years, it is extremely likely that most of this year’s legislative activity will be completed before the 4^th of July, if not earlier.  Therefore, it is important that your Members of Congress hear from you regularly for the first six months of the year about legislation that has been introduced this Congress.  This month we will focus on removing physical therapy from the In-Office Ancillary Services exception.

Physician Self-Referral exception for In-Office Ancillary Services (IOAS)

Current law bars physicians from referring Medicare patients to certain health care services or providers in which they have a financial interest, with certain exceptions.  The “in-office ancillary services” (IOAS) exception 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 complex and costly advanced imaging services, physical therapy, radiation therapy, or biopsy testing—services rarely provided at the time of the patient’s initial office visit. 

Advocacy Opportunity 2:

Contact your Representative/their health LA* and ask them to cosponsor H.R. 2143, the Promoting Integrity in Medicare Act, to remove physical therapy from the in‐office ancillary services exception of the prohibition on physician self‐referral.

Use the following talking points:

          - Legislation is needed to curtail the expansive use of the IOAS exception because it undercuts the original purpose of the law, is harmful to some patients, and wastes billions of dollars in taxpayer funds.

          - This bill will restore the original intent of the self-referral law by prohibiting self-referral for complex services.

          - Cosponsor H.R.2143 to ensure that incentives driving medical decisions are based solely on patients’ best interests, thereby reducing unnecessary and inappropriate services and costs to Medicare.

*If you are in Missouri or Delaware, please remind your Member of Congress that your state forbids such referrals and that you would like them to cosponsor legislation to do the same.

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 your request with a tweet or Facebook post tagging your legislator as well as PPS using #PPSAdvocacy. 

Advocacy Opportunity 3:
Submit your locum tenens stories

When you need to be away from your practice, does your clinic have enough credentialed PTs to be able to rearrange schedules so that all of your Medicare patients are able to be seen, without delay?  If not, then your practice and your patients would benefit if you were able to bring in a locum tenens—a qualified substitute PT—to fill in for the short time you are not able to be in the clinic.

In order to support our efforts to secure cosponsors (and possible passage) of the Prevent Interruptions in Physical Therapy Act (H.R.5453), PPS needs anecdotes illustrating how the inability to use locum tenens negatively impacts patient care as well as the effect it has on PTs themselves as small business owners. Please send PPS Lobbyist Alpha Lillstrom Cheng (alpha@lillstrom.com) 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.  If you are located in a one of the geographic regions where PTs are allowed to use locum tenens, please send in an example of when you used this privilege to ensure your Medicare patients had uninterrupted access to physical therapy.  Please submit your story by March 31.

Thank you for your continued advocacy.  Together we can make a difference!

For information on PPS’s legislative priorities and activities,

visit the Advocacy section at www.ppsapta.org

Advocacy makes a difference—both to challenge regulations as well as to change laws. 

Legislative Advocacy

January 2020 starts the Second Session of the 116th Congress. As with most election years, it is extremely likely that most of the legislative activity before the general election will be completed before the 4th of July, if not earlier. Therefore, it is important that your Members of Congress hear from you regularly for the first six months of the year about legislation that has been introduced this Congress. This month we will focus on locum tenens.

Locum Tenens

While private practice physical therapists practicing in designated Health Professional Shortage Areas, medically underserved, and rural areas are permitted to retain a substitute physical therapist when they need to be absent from their clinic, the Prevent Interruptions in Physical Therapy Act (H.R.5453) would enable all private practice physical therapists to utilize locum tenens arrangements under Medicare. H.R.5453 would expand the policy nation-wide because, as you know, the need to use a locum tenens in order to prevent an interruption in care is impacted by how many credentialed providers a clinic has and its Medicare patient mix—not the location of that practice. Here’s the PPS one-pager on the issue.  

ADVOCACY OPPORTUNITY

Contact your Representative/their health LA and ask them to cosponsor the Prevent Interruptions in Physical Therapy Act (H.R.5453) to allow physical therapists across the nation to utilize a locum tenens to ensure uninterrupted access to care for their Medicare beneficiary patients. Use the following talking points:

          - Occasionally, a solo practitioner must be away for short periods for medical, professional, or family reasons. PTs need to be able to bring in a licensed and qualified substitute therapist to continue the Medicare patient’s care—uninterrupted.

          - Medicare currently does not allow all PTs to use locum tenens whereas all doctors, osteopaths, dentists, podiatrists, optometrists, and chiropractors are able to.

          - Locums arrangements are extremely beneficial to patients by preventing regression of progress due to delay in care.

          - Cosponsor this bipartisan technical fix (H.R.5453) to expand current law to all private practice physical therapists—regardless of location of clinic.

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 your request with a tweet or Facebook post tagging your legislator as well as PPS using #PPSAdvocacy.  

ADVOCACY OPPORTUNITY

Submit your locum tenens stories
When you need to be away from your practice, does your clinic have enough credentialed PTs to be able to rearrange schedules so that all of your Medicare patients are able to be seen, without delay? If not, then your practice and your patients would benefit if you were able to bring in a locum tenens—a qualified substitute PT—to fill in for the short time you are not able to be in the clinic.
 
In order to support our efforts to secure cosponsors (and possible passage) of the Prevent Interruptions in Physical Therapy Act (H.R.5453), PPS needs anecdotes illustrating how the inability to use locum tenens negatively impacts patient care as well as the effect it has on PTs themselves as small business owners. Please send PPS Lobbyist Alpha Lillstrom Cheng (alpha@lillstrom.com) 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. If you are located in a one of the geographic regions where PTs are allowed to use locum tenens, please send in an example of when you used this privilege to ensure your Medicare patients had uninterrupted access to physical therapy. Please submit your story by February 14.

In the past month, legislation has been introduced to address two of PPS’ top legislative priorities!

The House and Senate are only scheduled to be in session for the first two weeks of December before heading back home for the rest of the year.  To have the biggest impact, please make an effort to connect with their offices the first week of December.

Telehealth

On October 30^th a revised CONNECT for Health Act (H.R.4932/S.2741) was introduced in both the House and the Senate.  This bipartisan bill seeks to reduce the financial burden on Medicare by providing a tailored approach to lift current restrictions which providers, including physical therapists, face for coverage of care provided to Medicare beneficiaries via telehealth:

• 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 costeffectiveness 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.

Advocacy Opportunity 1:

Effective 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.  Anecdotes can vividly illustrate to policy makers why they need to act to improve conditions for their constituents—both your patients and you as a small business owner and provider. 

Please send examples and stories to alpha@lillstrom.com that tell me how you use, or would use, telehealth in a way that would align with the following policy objectives that are included in the CONNECT for Health Act:

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. Support easier and expanded use of existing telehealth technologies; and
4. Reduce healthcare costs for both patients and federal programs, including Medicare.

Advocacy Opportunity 2:

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 using the following talking points:

• Only a portion of the care physical therapists provide is manual therapy. While the use of telehealth would not wholly replace inperson 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 costsavings, 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—all features which save money in the long-run.
• Cosponsor H.R.4932/S.2741 in order to allow PTs to provide quality care to Medicare beneficiaries via telehealth.

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. 

Opt-out

On November 7^th, Sen. Rand Paul (R-KY) introduced the Medicare Patient Empowerment Act (S.2812) which seeks to modernize the Medicare statute by allowing a Medicare beneficiary to enter into a direct contract with an eligible professional (regardless of whether a participating or non-participating physician or practitioner) for any item or service covered by Medicare. The bill provides beneficiaries the option to submit a claim to, and be reimbursed by, Medicare for the amount that would be paid if the professional were a participating practitioner. The Act includes consumer protections by prohibiting private contracting with patients who are facing an emergency medical condition or urgent health care situation.  It also preempts state laws from limiting the amount of charges for physician and practitioner services for which Medicare payment is made.  At this time there is only a bill in the Senate.  A one-pager is available on the PPS website.

Advocacy Opportunity #3

Use these talking points when asking both of your senators to cosponsor the Medicare Patient Empowerment Act (S.2812):

• S.2812 is a patient-centric bill which allows Medicare beneficiaries to contract with any provider at Medicare rates or at rates established between the patient and physician or practitioner;
• Provides patients with greater choice of eligible professionals;
• Allows providers to continue as a participating or non-participating Medicare provider with respect to those patients or services not covered under the contract. 
• S.2812 empowers individual beneficiaries at no additional cost to the Medicare program.  In fact, every time a patient opts to not bill Medicare, it SAVES the program money.

Advocacy Opportunity #4

As mentioned above, anecdotes can help lawmakers better understand why a policy change is needed.  Please send examples to alpha@lillstrom.com of how being able to opt-out of Medicare would improve your ability to care for all members of your community.  The best examples highlight specific instances of the unintended and illogical consequences of the current policy forbidding PTs from opting out of Medicare. 

This Thanksgiving, I am grateful for all of your advocacy on behalf of PPS,

your profession, and your patients.  Thank you!

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

On November 1^st, the Centers for Medicare and Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) final rule. As you know, this summer PPS and APTA strongly encouraged our members to submit comments to CMS explaining how the proposed rule would harm their patients and their practices. As a result, CMS received 14,000 comments regarding physical therapy issues in the proposed rule.

When it came to how CMS was going to regulate the legally binding 15% reduction of payment for care provided “in whole or in part” by a therapy assistant, our feedback worked!

The final rule states that:

1. Only the minutes that the PTA/OTA spends independent of the therapist will require the CQ/CO modifier and count towards the 10% de minimis standard.  This means care furnished by a therapist and therapy assistant together will not be counted as PTA time.

2. CMS will allow the separate reporting—on two different claim lines—of the number of 15-minute units of a code to which the therapy assistant modifiers do apply, and the number of 15-minute units of a code to which the therapy assistant modifiers do not apply.  This means that when the same service/code is furnished separately by the PT and PTA, CMS will apply the de minimis standard only to the service/code with the CQ/CO modifier—not on the combined PT and PTA time of the service.

3. There will be no requirement of a narrative phrases in the medical record that says why a PTA was or was not used.  CMS agreed it was duplicative.

However, the MPFS final rule was not all good news. Unfortunately, our concerns with respect to the 8% cut were ignored.

In the proposed rule CMS proposed cuts to many specialties in order to offset the increases they were proposing for E/M codes. In the Final Rule, they made no changes (for any specialty) and decided to finalize their proposal which is a cut of 4% for work and 3% for practice expense RVUs for physical and occupational therapy. After rounding, this ends up an 8% cut in 2021.  While thousands of PTs and other stakeholders pushed back against these proposed cuts, CMS was unmoved and provided no explanation or rationale for its decision. 

Furthermore, the final rule also notes that the cuts are “for illustrative purposes only” so it remains unclear when the Agency will undertake an in-depth analysis of the issue.  PPS will be working closely with APTA over the next year ensure that CMS understands the impact these cuts would have upon patients and the profession, with the goal of CMS walking back the magnitude of the payment reduction.

Check out APTA’s PT in Motion article for additional information.

Opt-out legislation introduced!

Sen. Rand Paul has introduced the Medicare Patient Empowerment Act (S.2812) which permits direct contracting between Medicare beneficiaries and qualified health care professionals.

Under current law, physical therapists are not able to opt out of Medicare. Physicians and other eligible providers are allowed to do so, but they must wholly opt out of Medicare for a two-year (automatically renewable) period. 

The Medicare Patient Empowerment Act would modernize the Medicare statute by allowing a Medicare beneficiary to enter into a direct contract with an eligible professional* (regardless of whether a participating or non-participating physician or practitioner) for any item or service covered by Medicare. The bill provides beneficiaries the option to submit a claim to, and be reimbursed by, Medicare for the amount that would be paid if the professional were a participating practitioner.

The Act prohibits entering into a contract at a time when the Medicare beneficiary is facing an emergency medical condition or urgent health care situation. It also preempts state laws from limiting the amount of charges for physician and practitioner services for which Medicare payment is made.

*Eligible professionals will include: physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, certified nurse-midwives, clinical social workers, clinical psychologists, physical therapists, occupational therapists, qualified speech-language pathologists, qualified audiologist.

Take Action Today

Contact both of your senators and ask them to cosponsor the Medicare Patient Empowerment Act (S.2812).  A one-pager can be found on PPS’ Advocacy tab.

Send an email and tweet to your lawmakers using these talking points:

The Medicare Patient Empowerment Act (S.2812):

     - Provides patients with greater choice of eligible professionals;
     - Is a patient-centric bill which allows Medicare beneficiaries to contract with any provider at Medicare rates or at rates established between the patient and physician or practitioner.
     - Allows providers to continue as a participating or non-participating Medicare provider with respect to any patient or service not covered under the contract. 
     - Empowers individual beneficiaries at no additional cost to the Medicare program.  In fact, every time a patient opts to not bill Medicare, it SAVES the program money.
     - Contact Zach Bennet in Senator Paul's office to cosponsor
 

Thank you for your dedication to advocacy and role as a PPS Key Contact!

#PPSAdvocacy

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 (alpha@lillstrom.com) 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 9^th through September 27^th.  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 30^th and October 14^th. 

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 23^rd and 24^th.  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 1^st 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 24^th, 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 9^th.  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 1^st, 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 8^th, 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 116^th 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 1^st.

ADVOCACY OPPORTUNITY 1: URGENT

Please send to alpha@lillstrom.com by COB Thursday March 28^th 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 116^th 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 116^th CONGRESS
The Legislative & Advocacy Priorities for the 116^th 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.

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 116^TH CONGRESS

The new members of the 116^th 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 6^th) 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 3^rd. 

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 116^th Congress by bringing up and introducing bills on issues that were sidelined this past Congress.  On January 3rd all of the Members of the 116^th 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 6^th

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 1^st, 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 6^th

Only 6 weeks left until the mid-term elections held on November 6^th! 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 10^th, 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 “4^th of July Recess” at some time between June 30^th and July 6^th.  In addition to attending parades and other public events on July 4^th, 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 (alpha@lillstrom.com) 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 alpha@lillstrom.com.

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 alpha@lillstrom.com.

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 9^th, 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 (alpha@lillstrom.com) 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 (alpha@lillstrom.com) 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!