In a key victory for physical therapists and some three dozen other health professions, Congress has officially passed APTA-supported legislation aimed at offsetting most of a planned 3.75% cut to the conversion factor under Medicare Part B. The changes also avert across-the-board budget cuts and delay the return of the 2% "sequester" reduction next year.

[Note: the bill was signed into law by President Biden a few hours after this article was published.]

The win effectively blunts the worst, but not all, of the cuts finalized by the U.S. Centers for Medicare & Medicaid Services in its 2022 physician fee schedule rule, and marks another historic advocacy push by APTA, its members, and a long list of other provider and patient organizations.

"Our members consistently stepped up when APTA called for action — those contributions were absolutely invaluable to this legislation being passed," said Laura Keivel, APTA grassroots affairs and political affairs specialist. "Lawmakers heard our voices loud and clear. APTA members should congratulate themselves on their efforts."

What Will Change

The legislation was first passed by the House of Representatives on Dec. 7, with its companion bill approved in a 59-35 bipartisan vote in the U.S. Senate on Dec. 9. The bill sets out three major (but temporary) relief provisions:

• CMS will receive a 3% appropriation for 2022 to partially offset its planned 3.75% cut to the conversion factor used to set payment for codes used by providers.
• Implementation of a looming 4% across the board "pay as you go" cut mandated through budget rules will be postponed until 2023.
• A temporary moratorium on the 2% Medicare sequestration cut required by law since 2011 as part a deficit spending mechanism will be continued through part of 2022. The moratorium will last until April, when a 1% sequestration will return, with the full 2% sequestration reduction beginning in July. Given that sequestration cuts are baked into the Medicare system, the temporary reprieve has amounted to a small payment increase for providers since the moratorium was put in place in 2020.

More Work To Do

Much like the adjustments made by Congress in 2020, the legislation approved this year only applies to the upcoming calendar year. And the changes don't address another key advocacy priority for APTA and other groups: the PTA and occupational therapy assistant payment differential that would implement a 15% payment cut for services delivered by a PTA or OTA.

That means there's more work to be done, according to Justin Elliott, APTA vice president of government affairs.

"Members of Congress are becoming aware that these eleventh-hour relief provisions are not sustainable, and that the physician fee schedule system itself needs to be repaired or replaced to better reflect the value of our services and reduce administrative burden," Elliott said. "APTA and other organizations have maintained for some time that the fee schedule system isn't working for patients, and we're hoping that lawmakers will seize this opportunity to make broader long-term systemic changes."

The PTA differential wasn't addressed in the last-minute legislative package approved by Congress, and time is running out for lawmakers to consider the Stabilizing Medicare Access to Rehabilitation and Therapy Act, or SMART Act (H.R. 5536), a bill that delays implementation of the system until 2023, provides exemptions to rural and underserved areas, and changes the current direct supervision requirement of PTAs to general supervision. With Congress set leave town with a long list of unfinished business, the likelihood of the SMART Act being passed  is dwindling.

While the timeline on Capitol Hill isn't ideal for passage of the SMART Act before the end of the year, that doesn't mean the fight's over. Congress could take up the issue in 2022, and supporters are still urged to use the APTA Patient Action Center to make their voices heard on the issue.

"There's a bipartisan recognition that CMS' approach to implementing the differential is problematic, to say the least," Elliott said. "Lawmakers will return in early 2022 to address myriad critical issues they were unable to get to before the end of 2021. We are already working with our congressional allies to push for passage of the SMART Act in early 2022. The fight is not over by any means.”