With a March 11 deadline looming for passage of legislation to keep the federal government running, APTA and other organizations are pressing lawmakers to include two major initiatives that could have a significant impact on payment for physical therapy: continuation of the pause placed on so-called sequestration cuts, and inclusion of a bill that would address the PTA payment differential system.

The most recent advocacy efforts come by way to two letters sent to Congress that spell out the need for relief — one on the sequester cuts signed by 50 professional and patient organizations, another on the PTA and occupational therapy assistant differential from six bipartisan members of the U.S. House of Representatives. Though aimed at different topics, the letters share the common theme that now is not the time to squeeze providers and threaten patient access to care.

Both letters arrive on Capitol Hill just as lawmakers stare down a March 11 deadline to craft a spending package to keep the government running.

PTA Differential: "A significant and detrimental impact"
In a March 2 letter to House Speaker Nancy Pelosi, D-Calif., and Minority Leader Kevin McCarthy, R-Calif., the bill’s lead sponsors Rep. Bobby Rush, D-Ill., and joined by Reps. G.K. Butterfield, D-N.C., Kurt Schraeder, D-Conn., David McKinley, R-W.V., Debbie Lesko, R-Ariz., and Tom O'Halleran, D-Ill., make the case for including the legislation, which is strongly supported by APTA. The bill responds to the implementation of the 15% cut in payment for services delivered by a PTA or occupational therapy assistant under Medicare Part B that began on Jan. 1, 2022. All five representatives who joined the letter are cosponsors of the bill and sit on the House Energy & Commerce Committee.

Known as the Stabilizing Medicare Access to Rehabilitation and Therapy Act — SMART Act, for short — the legislation would suspend the payment differential until 2023, create a permanent exemption from the cuts for rural and underserved areas, and relax Medicare's direct supervision requirements for PTAs in private practice settings. APTA is urging members and supporters to contact legislators to support inclusion of the SMART Act in the upcoming omnibus package.

In their letter, the authors characterize the differential as having a "significant and detrimental impact" on care, and describe the legislation as "a commonsense fix" that would not only protect patient access to care but also reduce administrative burden by aligning supervision requirements with those in other Part B settings. Adoption of the SMART Act is "particularly important because rehabilitation therapy provides an alternative to opioids for dealing with acute and chronic pain," they write. "However, these treatment options depend on having a therapy workforce to furnish these services."

A Hold on Sequestration Cuts: "Critical Relief"
In an effort aimed more broadly, 50 organizations including APTA have signed on to a letter to House and Senate leaders urging lawmakers to press "pause" on the return of across-the-board sequestration cuts, which would phase in a 1% cut in April and reinstate the full 2% cut in July. The phase-in would mark a return to federally mandated annual reductions set in place in 2013 as part of the 2011 Budget Control Act. Those cuts have been suspended during the coronavirus public health emergency, resulting in a temporary 2% boost in payment for providers.

The letter calls on Congress to extend the sequester moratorium for the duration of the health emergency, and to do it before April — ideally, as part of the omnibus package. The moratorium "has provided critical relief in our ongoing battle against COVID-19 and its variants … and enabled health care providers across the country to continue serving their patients and communities," according to the letter, which adds that "the resumption of the Medicare sequester payment reductions before the end of the PHE would unnecessarily hinder our caregiving abilities, especially when the emergence of a new, potentially more dangerous and/or contagious variant continues to loom."

In addition to APTA, organizations that signed on to the letter include the American Medical Association, the American Academy of Physicians, the American Association of Orthopaedic Surgeons, and the American Nurses Association, among others.  

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