Advocate: Promote an Advantageous Payment, Regulatory, and Business Environment

Fiscal Year 2021 (July 1, 2021-June 30, 2022)

APTA Private Practice's legislative and advocacy priorities for the 117^th Congress (2021 and 2022) were determined in December 2020 by the Board of Directors and the Government Affairs Committee (GAC).  The Section’s lobbyist uses these priorities to guide advocacy efforts on behalf of APTA Private Practice membership—through communications to Congress, the White House, and Agencies such as the Centers for Medicare and Medicaid Services (CMS).  We continually remind policy makers that physical therapists should be seen as a primary care provider for neuromusculoskeletal dysfunction and promote the physical therapy profession as a point of entry into the medical model for movement disorders. 

Lobbying and advocacy efforts focused on the core goal of permanently mitigating Medicare payment policies that undermine the importance and value of a physical therapist and physical therapist assistant care as well as its impact on patients and their communities:

Pursued legislation to improve payment and reduce obstacles to patient care:

- Prevented a cumulative 9.9% cut with the enactment of the Protecting Medicare and American Farmers from Sequester Cuts Act in December 2021:

     > A 3% payment adjustment to the conversion factor (CF) for CY2022;

     > Instituted a phased-in return of the sequester (a 1% sequester from April 1 to June 30, 2022 and a return of      the full 2% sequester on July 1, 2022); and

     > Waived the 4% PAYGO cut.

- Supporting Medicare Providers Act(H.R. 6020) to provide a 1-year reprieve from CMS cuts.

- Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act (H.R.5536) to mitigate the impact of the PTA differential by exempting PTAs and OTAs working in rural and medically underserved areas from the payment differential. 

- Prevent Interruptions in Physical Therapy Act(S. 2612/H.R. 1611) to expand the locum tenens provision of Medicare to allow physical therapists practicing all communities to hire a qualified substitute on a per-diem basis; this builds on our 2016 success of enacting a law to enable the use of locum tenens in rural, medically underserved, and health professional shortage areas.

- Medicare Sequester COVID Moratorium Act (H.R.315) to hold off the Medicare sequester for the duration of the PHE; achieved full reprieve from May 2020 to April 2022.

- Medicare Patient Empowerment Act (S.826/H.R.3322) to increase patient choice of both providers and settings for Medicare beneficiaries; enactment of this legislation would achieve the Section’s goal of allowing physical therapists in private practice to opt-out of Medicare and privately contract with Medicare patients.

- Primary Health Services Enhancement Act (H.R.5365) would allow CHCs to expand their offerings to include physical therapy provided by a physical therapist; private practice physical therapists could contract to provide this care.

Pursued legislation and regulatory changes to reduce administrative burdens:

- Improving Seniors’ Timely Access to Care Act (H.R.3173) to reduce administrative burden by requiring a streamlined and standardized process by which MA plans use prior authorization.

- Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act(H.R.5536) to also reduce administrative burden and increase practice flexibility by requiring Medicare to change its direct supervision requirement of therapy assistants in private practice settings to general supervision.

- Met with the Biden Administration and submitted recommendations to replace direct supervision of PTAs with general supervision.

- Met with and submitted recommendations to Biden Administration to remove plan of care signature requirement.

Advocated for legislative and regulatory changes to provide coverage of physical therapy via telehealth:

- Expanded Telehealth Access Act (H.R.2168) to permanently add physical therapists, PTAs, and other rehabilitation therapists to the statutory list of distant site providers that Medicare pays for telehealth.

- Telehealth Extension Act (H.R.6202) to extend current PHE-related telehealth waivers for an additional 2 years and remove originating site and geographic limitations from the statute.

- Advancing Telehealth Beyond COVID-19 Act (H.R. 4040) to extend current PHE-linked coverage of telehealth and flexibility in originating sites through December 31, 2024.

- Achieved authorization for PTs and PTAs to provide physical therapy care via telehealth for an additional 151 days after the PHE expires.

- Argued to allow for general supervision of PTAs; achieved approval to use audio/visual technologies to satisfy direct supervision requirement through the end of the year in which the PHE ends.

Communicating the Section’s Advocacy Priorities to Congress

In addition to one-on-one meetings with Members of Congress and their staff, between July 2021 and June 2022, APTA Private Practice joined with coalitions to send 6 advocacy letters to lawmakers:

• - PPS and 6 other rehabilitation therapy organizations' joint Statement for the Record to House Energy and Commerce Subcommittee on Oversight and Investigations for the hearing entitled, "Protecting America's Seniors: Oversight of Private Sector Medicare Advantage Plans" (June 2022)

• - PPS urges Congress to keep 2% Medicare sequester on hold for the rest of the Public Health Emergency (February 2022)

• - PPS and 95 other organizations urge Congressional health care committees to examine potential reforms to the Medicare Physician Fee Schedule (February 2022)

• - PPS and rehabilitation stakeholders urge Congressional leaders to include the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act (H.R. 5536) in the upcoming Continuing Resolution

• - PPS and 16 other rehabilitation therapy organizations send a letter of support to Reps. Bobby Rush (IL) and Jason Smith (MO) thanking them for introducing the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act which seeks to mitigate the impact of the impending Medicare 15% payment differential for services furnished by physical therapist assistants (PTA) and occupational therapy assistants (OTA) beginning on Jan. 1, 2022. (October 2021)

• - PPS and 108 other stakeholders urge Congressional leadership to maintain stability within the MPFS by retaining 2021's 3.75% increase to the conversion factor through at least 2022 and 2023 (July 2021)

APTA Private Practice’s strong relationships on Capitol Hill have inspired Members of Congress to weigh in on behalf of physical therapists:

• - Rep. Tonko (NY-20) calls on Energy & Commerce Committee colleagues to include the Prevent Interruptions in Physical Therapy Act (S.2612/H.R.1611) in CURES 2.0 legislative package (March 2022)

• - Record-making 247 Representatives urge House Leadership to address looming Medicare payment cuts to physical therapists and other health care providers (October 2021)

Communicating the Section’s Advocacy Priorities to Regulatory Agencies

All official advocacy and comment letters filed are posted on APTA Private Practice’s advocacy page.  On behalf of the membership APTA Private Practice submitted 3 advocacy letters to the Centers for Medicare and Medicaid Services (CMS) at the Department of Health and Human Services:

• - PPS, APTA and other rehabilitation therapy stakeholders request waiver from HHS to put off PTA/OTA differential for one year (or longer if the PHE extends into 2023) (January 2022)

• - APTA Private Practice, as a member of PARCA called on CMS to put the No Surprises Act of 2020’s Good Faith Estimate (GFE) regulations on hold for a year, to exempt small practices, and then bring in stakeholders for feedback in order to redo the regulation. The letter was also shared with Congressional concerned with the implementation of the GFE.  (January 2022)

• - PPS comments on the 2021 Medicare Physician Fee Schedule, including challenging proposed 3.75% reimbursement cuts and implementation of the PTA differential while recommending general supervision for PTAs and removal of administrative burdens such as signature on a plan of care (September 2021)

Join the Advocacy Efforts—Be an APTA Private Practice Key Contact!

As constituents, business owners, and providers, APTA Private Practice members are encouraged to participate in these advocacy efforts.  By June 2022, the Section had 507 Key Contacts—adding 72 since June 2021.  Join the chorus of Key Contacts who are effectively educating Members of Congress about the value of physical therapy provided in a private practice setting. The most effective advocacy is that which reaches as many lawmakers as possible, then maintains the rhythm of conversation through follow-up and continued engagement.  The more people a given lawmaker hears from the more likely they are to act upon the request.  Follow prompts from APTA Private Practice to use APTA’s Action Center to write to your Members of Congress or check the Advocacy Blog for the most recent call to action.  Be sure to remind lawmakers that their support for the Section’s priority policies will enable you to serve your patients, support your impactful community-based business, and provide good jobs for their constituents.