Members of the U.S. Senate and House of Representatives are headed to their home states and districts for the August congressional recess, which means more opportunities to meet in person and advocate for policies important to the physical therapy profession and its patients. And there's no shortage of things to talk about.
To help you prepare for that town hall, office visit, or random coffee shop encounter, here's a rundown of some of the top issues and APTA-supported legislation to discuss with your congressperson.
You don't have to cover all the topics listed here. But if you see any that resonate with you, your practice, or the patients and clients you serve, consider sharing your perspective with your legislators while they're back home.
(For a listing of APTA's legislative advocacy targets, visit the association's Legislative Action Center; to keep up with APTA's advocacy efforts, sign up for the APTA Advocacy Network, a free, members-only service that sends you special legislative updates and action alerts so you're up to speed and ready to act.)
1. The proposed fee schedule needs a short-term fix — and a long-term overhaul.
In its proposed 2023 physician fee schedule, the U.S. Centers for Medicare & Medicaid Services is once again including a sweeping 4.4% cut to the conversion factor used in determining payment for codes used under Medicare. The reductions would impact a wide range of providers, not just PTs and PTAs.
These cuts would be on top of the federally mandated 2% reductions — the so-called "sequester" cuts — that have been happening (with one exception during the worst of the pandemic) since 2013. And don't forget that CMS is moving full-steam ahead with a 15% reduction to payment for services rendered by PTAs and occupational therapy assistants, also known as the PTA/OTA differential.
Bottom line: The proposed 2023 cuts must be addressed, but it's also time to rethink the ways providers are paid under Medicare, period. Let's face it: The physician fee schedule is broken.
When talking to a House member: Ask your representative to intervene to provide short-term relief for the impending cut, as Congress did in 2020 and 2021. But be sure to request that Congress also take a hard look at the fee schedule system and work toward a less-antiquated, more patient-centered approach. To help underscore the idea that there's momentum behind an overhaul, share a copy of a recent letter sent to Congress by APTA and 100 other health care organizations.
When talking to a senator: Same message as above.
2. Protect access to PTAs, especially in rural and underserved areas.
The Balanced Budget Act of 2018 required CMS to implement a 15% payment differential for services delivered by PTAs and OTAs, similar to differentials that exist for other provider disciplines. This will hurt patient access to needed care, particularly in underserved areas, while doing nothing to alleviate ongoing administrative burden.
The differential hurts patient access, but some of the damage could be lessened by a bill that's already been introduced in the House. Known as the SMART Act, H.R. 5536 would provide for exemptions to the differential in rural and underserved areas, and lift the burdensome requirement for direct supervision of PTAs in outpatient private practices — the only setting in which that type of supervision is required in physical therapy.
Bottom line: The SMART Act needs to pass to ensure access to PTAs and relieve administrative burden.
When talking to a House member: Ask your representative to cosponsor H.R. 5536 — or thank them if they've already signed on.
When talking to a senator: Ask your senator if they'd be willing to sponsor a Senate version of H.R. 5536.
3. Let's bring care to where it's needed — and help relieve student debt.
It's called The Physical Therapist Workforce and Patient Access Act (S. 2676 / H.R. 3759) — legislation that would list PTs among the professions included in a federal program to provide greater patient access to health care in rural and underserved areas. If enacted, the program could open up access to a student loan repayment program for participating PTs — and help address the nation's opioid crisis in areas that have been especially hard-hit.
The bill would allow PTs to participate in the National Health Service Corps, or NHSC, loan repayment program, an initiative that repays up to $50,000 in outstanding student loans to certain health care professionals who agree to work for at least two years in a designated Health Professional Shortage Area. An estimated 11.4 million Americans are served by the NHSC.
Bottom line: It's time to pass the Physical Therapist Workforce and Patient Access Act.
When talking to a House member: Ask your representative to cosponsor H.R. 3759 — or thank them if they've already signed on.
When talking to a senator: Ask your senator to cosponsor S. 2676 — or thank them if they've already signed on.
4. We can make our health care workforce more diverse and improve outcomes for all.
One of the association's strategic goals is to foster a physical therapy profession as diverse as the society it serves. At the same time, APTA is committed to addressing health inequities. One major bill now in the Senate encompasses both.
The PREVENT Pandemics Act (S. 3799) incorporates language from pending bills for the Allied Healthcare Workforce Diversity Act and the Improving Social Determinants of Health Act. The workforce diversity bill would create a system to set aside money in the Health Resources and Services Administration specifically for use by accredited education programs in physical therapy, occupational therapy, audiology, and speech-language pathology. Those programs would in turn issue scholarships or stipends to students from underrepresented populations such as racial or ethnic minorities and students from disadvantaged backgrounds including economic status and disability. The social determinants legislation would require the U.S. Centers for Disease Control and Prevention to coordinate efforts to improve health outcomes and reduce health inequities.
Bottom line: Several health care needs can be addressed by the passage of the PREVENT Pandemics Act.
When talking to a House member: Ask your representative to support the PREVENT Pandemics Act and vote yes if the bill comes before the House.
When talking to a Senator: Ask your senator to cosponsor S. 3799 — or thank them if they've already signed on.
5. Postpartum care can be strengthened.
Understanding of the importance of postpartum pelvic health — and the role of pelvic health physical therapy — is growing and could get a boost in Medicaid, thanks to a bill introduced in the House.
Known as the "Optimizing Postpartum Outcomes Act" (H.R. 8181), the bill directs the Secretary of the Department of Health and Human Services to develop several provisions that would significantly strengthen Medicaid's emphasis on pelvic care for mothers in the postpartum period. In a win for the profession, the legislation includes pelvic floor physical therapy among the pelvic floor services that would be covered under Medicaid and the Children's Health Insurance Program, or CHIP. The bill also instructs the U.S. Centers for Medicare & Medicaid Services to develop and issue guidance on best practices, financing options, screenings, referrals, and access, as well as terminology and diagnostic codes.
Additionally, if the law passes, HHS would be required to educate health professionals and postpartum individuals on the importance of pelvic health and pelvic health physical therapy.
Bottom line: Passing the Optimizing Postpartum Outcomes Act will make a difference in individuals' and children's lives postpartum.
When talking to a House member: Ask your representative to cosponsor H.R.. 8181 — or thank them if they've already signed on.
When talking to a senator: Ask your senator to sponsor a Senate companion to the Optimizing Postpartum Outcomes Act.
6. Continuity in outpatient PT care is within reach.
Right now, only PTs in rural and underserved areas can bring in another licensed PT to treat Medicare patients to cover for them during an absence and bill through the absent PT's provider number. The Prevent Interruptions in Physical Therapy Act (H.R. 1611 / S. 2612) would extend what’s known as locum tenens to all qualifying outpatient PTs.
Bottom line: It's important to maintain continuity of care in physical therapy. Passing the Prevent Interruptions Act will help to ensure that continuity.
When talking to a House member: Ask your representative to cosponsor H.R. 1611 — or thank them if they've already signed on.
When talking to a senator: Ask your senator to cosponsor S. 2612 — or thank them if they've already signed on.
7. We can help the right care happen faster (while relieving administrative burden).
The Improving Seniors' Timely Access to Care Act (H.R, 3173 / S. 3018) is aimed at improving access to health care for older Americans through, among things, reducing administrative burdens on providers — specifically by scaling back the use of prior approval in Medicare Advantage plans. Among other provisions, the bill aims to require MA plans to make regular reports to CMS on use of prior authorization, rates of denials, and average time for approval. The legislation would also require the U.S. Department of Health and Human Services to establish a process for "real-time decisions" for services that are routinely approved, and require MA plans to engage in more consultation with stakeholders and professional organizations around approval guidelines that are evidence-based.
The legislation wouldn't eliminate prior authorization in MA, but it does represent a good first step toward better transparency and accountability.
Bottom line: We owe it to our older Americans to address prior authorization problems in Medicare Advantage.
When talking to a House member: Ask your representative to vote yes on H.R. 3173 when it comes before the House for a full vote later this fall.
When talking to a senator: Ask your senator to cosponsor of S. 3018 — or thank them if they've already signed on.