Telehealth Debate Heats Up — Looming Deadline Approaching
APTA
Over the past month, Congress has taken major steps toward advancing telehealth legislation that could impact millions of Medicare beneficiaries and health care providers. APTA and many other health care organizations are urging Congress to move on this issue as quickly as possible to avoid the looming “telehealth cliff” that could happen at the end of this year.
Unless Congress acts, many of Medicare’s pandemic-era telehealth policies, including those that reimburse PTs and PTAs for telehealth services, are scheduled to expire on Dec. 31. A lack of congressional action means that Medicare will not be able to cover a beneficiary’s visit to a PT via telehealth after that date, potentially eliminating a critical benefit to millions of Medicare patients.
However, recently, both the House Energy and Commerce Health Subcommittee and the House Ways and Means Committee unanimously voted to approve a two-year extension of all current Medicare telehealth policies, meaning that if this measure is approved, PTs and PTAs could be authorized providers of telehealth in the Medicare program until Dec. 31, 2026.
To date, the Senate has not yet acted, although the Senate Finance Committee is examining this issue and is expected to act soon. While the recent actions taken by the committees in the House are positive developments and steps in the right direction, APTA remains focused on ensuring that PTs and PTAs are permanent authorized providers of telehealth in Medicare by ensuring passage and enactment of H.R. 3875/S.2880 — the Expanded Telehealth Access Act.
To build support for the bill, APTA and our partner associations recently provided a briefing on Capitol Hill to inform and educate congressional staff on how PTs and PTAs use telehealth to treat patients and why maintaining these Medicare telehealth flexibilities is crucial to beneficiaries and providers. APTA members can also help with this effort by urging their members of Congress to co-sponsor H.R. 3875/S. 2880 by going to APTA’s Legislative Action Center. |
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CMS: Home Healthcare Spending Estimated to Grow by 7.1 Percent from 2025 to 2026, Surpassing Other Sectors
McKnight’s Home Care | ByAdam Healy
National spending on home healthcare is projected to grow faster than any other health sector in the years ahead, according to newly published data from the Centers for Medicare & Medicaid Services’ Office of the Actuary.
Between 2025 and 2026, national spending on home health care is expected to increase by 7.1%, a data analysis published Wednesday in HealthAffairs revealed. Projected spending growth in home health care should outpace all other categories including hospital care services (4.9%), physician and clinical services (4.8%) and nursing homes care (4.8%), and it is expected to grow even faster during the following years. Between 2027 and 2032, the sector will see spending growth of 8.1%, compared to hospital spending (5.6%), physician and clinical services (5.5%) and nursing home care (6%).
In 2022, home health spending increased by roughly 6%, CMS disclosed in a previous report.
Despite the pace of growth, home healthcare remains a relatively small spending category. CMS’ projections indicated that roughly $177.5 billion will be directed toward the segment in 2026. That compares to larger categories such as hospital care ($1.7 trillion), physician services ($1.1 trillion) and nursing home care ($237.6 billion). By 2032, home healthcare is expected to benefit from $282.7 billion in healthcare spending, while hospitals and nursing homes could see $2.3 trillion and $337.4 billion, respectively…
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Long COVID's Toll Outlined in New Report
HealthDay | By Robin Foster
Long COVID continues to plague millions of Americans as the health costs of the pandemic linger four years later, a new report warns.
In a hefty document released Wednesday, the National Academies of Sciences, Engineering and Medicine, a nongovernmental group that advises federal agencies on science and medicine, detailed the damage that Long COVID has wrought.
“Diagnosing, measuring and treating Long COVID is complicated. This disease, which has existed in humans for less than five years, can present differently from person to person and can either resolve within weeks or persist for months or years,” Dr. Paul Volberding, chair of the committee that wrote the report, said in a news release announcing the findings.
“Our report seeks to offer a clear summary of what research has found so far about diagnosing Long COVID, and what the disease can mean for an individual’s ability to function in their daily lives,” added Volberding, who is also a professor emeritus in the department of medicine at the University of California, San Francisco.
What did the report discover?
“Long COVID can impact people across the life span, from children to older adults, as well as across sex, gender, racial, ethnic and other demographic groups,” it stated.
And the damage it inflicts can be widespread and complicated.
“Long COVID is associated with a wide range of new or worsening health conditions and encompasses more than 200 symptoms involving nearly every organ system,” the report added.
Here are some of the key findings from the committee of 14 doctors and researchers, as reported by the New York Times...
Read Full Report
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APTA-Backed Bill Supports Medicare Patients in Need of Orthoses, Prostheses
Medicare beneficiaries who require orthotics or prosthetic devices could find it easier to access care while being better protected from fraud if APTA-supported legislation now on Capitol Hill makes its way into law. In addition to sparing patients from being required to see many providers and prohibiting direct-to-consumer "drop shipping," the bipartisan bills, introduced in both the U.S. Senate and House of Representatives, would also make it easier for beneficiaries to receive replacement devices when they need them.
Known as the Medicare Orthotics and Prosthetics Patient-Centered Care Act (S. 3977 /H.R. 5315), the legislation is designed to eliminate loopholes and burdensome regulations that make it more difficult — and riskier — for patients to acquire needed equipment. The Senate version of the bill was introduced by Sens. Mark Warner, D-Va., and Steve Daines, R-Mont. In the House, Reps. Glenn Thompson, R-Pa., Mike Thompson, D-Calif., Brett Guthrie, R-Ky., Angie Craig, D-Minn., and Pete Sessions, R-Texas, introduced the measure. The House version has an additional 37 co-sponsors.
Among the major provisions in the legislation:
- Greater availability of replacement devices. Medicare would no longer be permitted to deny coverage of replacement orthotics within what it deems the device's "reasonable use lifetime," even if the device is damaged or a patient's needs change. These restrictions currently force Medicare beneficiaries to wait for a period of time, often five years, before they are eligible for Medicare coverage of a replacement orthosis. Instead, Medicare would be required to pay for the replacement, provided the patient meets certain conditions.
- Easier access to O&P care. Under the proposed legislation, the exemption in statute from competitive bidding would be expanded to include physical therapists, occupational therapy therapists, and orthotists and prosthetists when providing off-the-shelf orthoses to Medicare beneficiaries, allowing these providers to furnish those types of orthoses without a competitive bidding contract.
- The elimination of "drop shipping." Current Medicare provisions allow reimbursement for direct-to-consumer shipping of orthoses and prostheses without any clinical intervention by a qualified provider, such as a physical therapist. The loophole leaves consumers vulnerable to fraud and creates more waste within the Medicare system. If passed into law, the legislation would eliminate this option.
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Home Health “Hand Off” Directive Causes Confusion
NAHC Report
NAHC has been receiving questions about an article posted on the PalmettoGBA website, intended for participants in the Home Health Review Choice Demonstration (RCD), regarding a requirement that home health agencies must have a physician-signed statement of a “hand off” occurring when a physician recertifies home health. However, PalmettoGBA applied the requirement to all home health claims under review as did the other Medicare Administrative Contractors (MACs).
There is not a requirement for a physician-signed “hand off” under any circumstance in home health. As soon as NAHC became aware of the situation we reached out to CMS (Center for Medicare & Medicaid Services). Since then, the article has been taken down and, in a meeting, earlier this week where PalmettoGBA and CGS representatives were present, they confirmed that they are not applying the “hand off” requirement as part of RCD or medical review of claims. We understand that the same is true for NGS, but we have reached out to them for confirmation.
CMS as well as PalmettoGBA has indicated that all MACs will be posting a revised article. No expected timeline has been given. Based upon discussion at the meeting earlier this week, we anticipate that any reference to a physician-signed “hand off” will be removed from the article. Home health agencies that have had claims denied due to the lack of a “hand off” should appeal those denials. Likewise, home health agencies participating in the pre-claim review option for RCD that have had non-affirmations for this reason, should submit the Document Control Number (DCN) to PalmettoGBA for correction. |
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