Calls proposal ‘a bad plan’
Last Friday, the APTA crafted a rebuttal to the U.S. Centers for Medicare and Medicaid Services’ (CMS) proposed physician fee schedule rule for 2020, which includes provisions that would require providers to navigate a complex system intended to identify when outpatient therapy services are furnished by a physical therapist assistant (PTA) or occupational therapy assistant (OTA).
“In short, the system is rooted in total minutes of service, and would require the use of the applicable modifier that would indicate when a PTA or OTA provided outpatient therapy services for 10% or more of the total time spent furnishing the service,” the response clarified.
Calling the proposal ‘more than just problematic’, the APTA warned that patient access to care would be in jeopardy and cause a burdensome level of paperwork. Moreover, the Association feels CMS in overstepping their authority.
One main objection is to the provision where CMS states, “When the PTA participates in the service concurrently with the PT for a portion of total time, the modifier should be used when the minutes furnished by the therapy assistant are greater than 10% of the total minutes spent by the therapist furnishing the service, which means that the entire service would be subject to the 15% payment adjustment in 2022. This is being done to comply with Section 1834(v) of the Social Security Act.”
“The intent of the therapist assistant provisions in the Social Security Act was to better align payments with the cost of delivering therapy services given that therapist assistant wages are typically lower than therapist wages,” reads the response. “It was not meant to apply an adjustment to a PT’s services furnished when the therapist assistant provides a “second set of hands” to the therapist for safety or effectiveness.”
View the entirety of APTA’s response.
SOURCE: APTA
