August 2021 Federal Advocacy Update

2022 Medicare Physician Fee Schedule Proposed Rule

  • 3.75% reduction in conversion factor
  • $34.89 to $33.58
  • Attributable to expiration of the $3 billion (3.75%) in additional funding provide by Congress for 2021.
  • Some codes saw increase in RVU, mitigating impact
    • Evals and re-evals no change in payment
    • Other codes decreased
    • Not enough to completely offset conversion factor
    • 2022 Total Impact Estimate: 3.5% (PT), 3.8% (SLP), and 3.9% (OT).
  • PTA Differential
    • CMS moving forward on differential.
    • No discussion on delay or exempting rural areas.
    • Application of CQ modifier updated in response to APTA advocacy
    • 1 remaining unit and 2 remaining unit scenarios
    • Permanent direct supervision through virtual presence considered.
  • Telehealth
    • Therapy codes not added to list of permanent telehealth codes.
    • All “temporary codes” to remain authorized until end of 2023.
    • Caveat: PTs still need PHE to be authorized providers.
  • RTM codes considered, but technical issue bars PT use.
  • Fee Schedule advocacy efforts
    • Two-pronged advocacy effort on Fee Schedule: CMS & Congress.
    • EM Coalition letter to Capitol Hill sent last week.
    • Discussions with Rep. Buchson & Bera’s office on legislation.
  • Variables: family physicians (AAFP) position. MACRA reform. Unified voice – no competing legislative proposals.
  • Letter to Congress should be brought up during August Recess; talking points and letter to be sent to Key Contacts and FALs soon.
  • PTA/OTA Differential Asks
  • Provide an exemption to the 15% payment differential for rural/underserved areas.
    • Reduce the burdensome requirements for direct supervision of therapy assistants in private practice settings.
  • Delay the payment differential to Jan. 1, 2023.
  • Resources
  • Please review and share the below resources with your chapter/section:

Congressional Update:

  • Possible introduction of companion bills in the Senate (hopefully before September!)
    • Telehealth
    • Locum tenens
    • National Health Service Corps
    • Prior Authorization
  • Lymphedema Treatment Act
    • Has over 213 House cosponsors; hoping for movement of this bill
  • IDEA Act position paper is now available.
  • APTA supports the Dr. Lorna Breen Healthcare Provider Protection Act (H.R. 1667/S. 610)
    • For support to providers dealing with mental health, burnout, substance abuse, etc.


Regulatory Update:

  • Earlier this month, CMS released its proposed rule for its hospital outpatient and ambulatory surgical center payment and quality reporting for calendar year 2022.
    • This rule increases civil monetary penalties for hospitals that are in noncompliance with the Hospital Transparency final rule that became effective Jan. 1
    • The proposed rule also calls for greater health equity quality reporting, and more input on the newly created facility category known as emergency rural hospitals.
  • CMS is seeking comment on the future adoption of a standardized patient-reported outcome-based performance measure for elective total hip arthroplasty and total knee arthroplasty. APTA commented on CMS’ proposal for the adoption of a similar measure in the inpatient hospital proposed rule released earlier this year.
    • Once finalized, this rule will be effective at the start of fiscal year 2022, which is Jan. 1.
    • APTA will be submitting comments, which are due to CMS on Sept. 17.
    • We encourage you to visit our website for a story on this rule, as well as a blurb on the rule in our regulatory action center.
  • On July 19, HHS Secretary Becerra extended the Public Health Emergency for another 90 days, to expire on Oct 19.
    • Unofficially, we have heard that HHS plans to extend the PHE to mid-2022 at least. With this extension, PTs’ flexibilities under Medicare are also extended, which include: Performing telehealth under Medicare; Performing certain initial visits in home health; and Direct supervision of PTAs by virtual presence.
    • We are working to make these flexibilities permanent, but the PHE extension is good news in the interim
    • We will continue to monitor the PHE and its application to PT in Medicare, and will keep you posted