Medicare Services

New Legislation Prompts Hope for Medicare Services

Medicare Services

Outpatient Therapy Modernization and Stabilization Act (H.R. 7154) May Be The Good News We Have All Been Looking For Regarding Medicare Services

Looking for some good news for Medicare services? After months of hearing about upcoming cuts and negative changes there is some new legislation that could lead to some major positive changes for therapists and their patients. A bipartisan bill in the House of Representatives could lead to coverage for telehealth to continue after the pandemic, as well as reduced cuts to payment.

Referred to as the Outpatient Therapy Modernization and Stabilization Act (H.R. 7154), this legislation covers a lot of ground and has received solid bipartisan support in the House. Here are a few of the highlights that pertain to therapy:

A reprieve from the 2021 cuts in Medicare reimbursement

There are drastic cuts in reimbursement on the horizon. This legislation prevents these by providing a one-time exemption from the budget neutrality rules. CMS has been citing these constraints as rationale for the reduction in payment for more than three dozen professions to offset the increases to outpatient evaluation and management codes/office codes (referred to as E/M codes) which are used primarily by physicians. The cuts would mean reimbursement reductions to codes frequently used by other professionals such as physical therapists, speech therapist, and occupational therapist. The cuts would net an estimated eight percent reduction in payments. This bill would give CMS a one-year exemption from budget neutrality rules as they pertain to office/outpatient E/M code increases.

Relief of some administrative requirements

Under this act paperwork may become a little less burdensome. This act clarifies that either a physician referral or a certified plan of care is required for outpatient therapy services (not both). Currently the certification of the plan of care is needed within 30 days of the first treatment, even in the presence of a signed order or script.

Telehealth would become permanent

When COVID-19 became a public health emergency CMS enacted waiver provisions that allowed therapy coverage for telehealth services during the public health emergency. This will expire when the emergency ends. If signed into law telehealth will be permanently covered for physical, occupational and speech therapy. 

Increases in payment for services through 2023

Adjustments to Medicare physician fee schedule conversion factor that are intended to assist providers to recover from the pandemic is billed in this bill. These changes would take place at the start of 2021 and would increase payments by one percent. Then in 2022 and 2023 there would be an increase of .5 percent each year. 

Keep in mind that positive changes in our profession happen when groups such as the American Physical Therapy Association advocate and act. From the APTA website:

“APTA provides a consistent lobbying presence with members of Congress, regulatory agencies, and commercial payers. Adding your voice strengthens our efforts.”

They offer many ways to support these efforts:

Advocacy App

Advocacy does not get easier than this! Members and nonmembers can send prewritten messages to their legislators with a few screen taps. You can even donate to PT-PAC from the app. Search “APTA Advocacy” in your Apple or Google app stores. It is free!

Legislative Action Center

APTA members can log in to the Legislative Action Center to send prewritten messages to their legislators.  

Patient Action Center

Nonmembers and the public can use the Patient Action Center to send prewritten messages to their legislators.

Regulatory Action Center

Congress is not the only group that needs to hear from you. Use the Regulatory Action Center to access template letters for contacting the Centers for Medicare & Medicaid Services and other regulators.