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Congressional Budget Deal Has Good News for Outpatient PT but Significant Bad News for Home Health

Monday, February 12, 2018   (0 Comments)
Posted by: Robin Childers
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Excerpted from PTinMotion News. Read the full article here.

As part of a sprawling bipartisan budget deal passed on Friday, Congress enacted a permanent solution to the problematic hard cap on outpatient physical therapy services under Medicare Part B, ending a 20-year cycle of patient uncertainty and wasteful short-term fixes.

Ending the hard cap has been a high priority for APTA since its introduction in 1997 as part of the Balanced Budget Act. Legislators' backing for repeal reached a tipping point in 2017, when lawmakers developed a bipartisan, bicameral agreement to end the cap. Congress failed to enact that deal in 2017, but elements of the plan are included in the 2-year budget that was approved today.

That's the good news. The bad news is that Congress chose to offset the cost of the permanent fix (estimated at $6.47 billion) with a last-minute addition of a payment differential for services provided by physical therapist assistants (PTAs) and certified occupational therapy assistants (COTAs) compared with payment for the same services provided by physical therapists (PTs) and occupational therapists (OTs), respectively. The payment differential, which was strongly opposed by APTA and other stakeholders, states that PTAs and OTAs will be paid at 85% of the Medicare physician fee schedule beginning in 2022.

That pending payment differential under Medicare is somewhat comparable to that between physician assistants and physicians, but it was added to the budget bill late and without warning. It wasn’t part of the 2017 bipartisan agreement legislators reached, nor was it part of any discussions or negotiations on Capitol Hill since then.

When the proposed differential was added to the budget deal late the night of February 5, the association quickly reached out to congressional offices with proposed amendments. None were accepted. Friday morning, Congress passed the massive budget legislation that includes increases for military and domestic spending, adding an estimated $320 billion to the federal budget deficit.

APTA President Sharon Dunn, PT, PhD, board-certified orthopaedic clinical specialist said the January 1, 2022, implementation date for the opposed PTA payment cut provides time to explore solutions with the Centers for Medicare and Medicaid Services (CMS) as it develops proposed rules.

For home health, the deal includes positives related to rural add-ons, a market basket update increase of 1.5% in 2020, and use of home health medical records for determining eligibility. However, it also requires a switch from a 60-day to a 30-day episode in 2020 and eliminates the use of therapy thresholds in case-mix adjustment factors.

Both APTA and the Home Health Section are still digesting the details of the budget deal. We expect to provide additional information to members later this week.

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