****APTA LEGISLATIVE ACTION ALERT****

On Thursday, March 29, Congressman Edolphus “Ed” Towns (D-NY) introduced Medicare Access to Physical Medicine and Rehabilitation Services Improvement Act (HR 1846). This legislationwould overturn the current Medicare “incident-to” rule and recognize athletic trainers and lymphedema therapists as covered providers under Medicare.  

APTA strongly opposes this legislation (HR 1846) and supports Medicare’s ability to require qualification standards for therapy services provided “incident to” a physician’s professional services. It is the position of the American Physical Therapy Association (APTA) that physical therapists are the qualified professionals who provide physical therapy examinations, evaluations, diagnoses, prognoses, and interventions. Interventions should be represented and reimbursed as physical therapy only when performed by a physical therapist or by a physical therapist assistant under the direction and supervision of a physical therapist.

In November 2004, the Centers for Medicare and Medicaid Services (CMS) included provisions in the final rule for the 2005 Medicare physician fee schedule that established qualifications and clinical preparation standards for individuals who provide physical therapy services “incident to” a physician’s professional services. These provisions implement requirements adopted by Congress in 1997 to protect patient safety, ensure the appropriate use of Medicare resources, and guarantee the delivery of physical therapy services by qualified physical therapists. Opponents of these regulations were unsuccessful in their attempts to have CMS rescind the rule implemented in May 2005. These organizations also filed a federal lawsuit attempting to force their withdrawal, and a US Court of Appeals upheld a district court decision dismissing the litigation. 

Patient Safety - The “incident to” regulations standardize existing Medicare requirements that physical therapy services must be delivered by qualified personnel in all outpatient settings. There is no evidence that these standards have restricted the delivery of physical therapy in physician offices. Without enforcement of appropriate qualification standards, it would be impossible to ensure that Medicare beneficiaries receive and the Medicare program pays for an appropriate level of safe and effective care delivered by an individual qualified to provide physical therapy. HR 1846 jeopardizes the health, safety and welfare of Medicare beneficiaries by allowing non-qualified individuals to provide therapy services.

Cost-effectiveness - In a report issued in May 2006, the Office of Inspector General (OIG) of the Department of Health and Human Services found that 91% of physical therapy services billed by physicians under the old “incident to” rules in the first 6 months of 2002 failed to meet program requirements, resulting in improper Medicare payments of $136 million. The Inspector General found that the total payments for physical therapy claims from physicians skyrocketed from $353 million in 2002 to $509 million in 2004, and that the number of physicians billing the program for more than $1 million in physical therapy more than doubled in that two-year period.

This follows a report done in 1994 by the OIG that estimated that more than $47 million in unnecessary therapy services were delivered in physician offices under the old “incident to” rules. As a result of the 1994 report, Congress passed the Outpatient Physical Therapy Standards Act of 1997 as part of the Balanced Budget Act. This legislation established a standard for physical therapy delivered in a physician’s office consistent with that in all other outpatient settings, and the regulations promulgated by CMS in 2004 implement these standards in keeping with the intent of Congress.  HR 1846 is fiscally irresponsible and will cost taxpayers due to inappropriate billing of therapy services by non-qualified individuals.

Quality Care - Medicare beneficiaries deserve a consistent standard of care that ensures that providers who deliver these services have attained the level of education and qualification necessary to provide them safely and effectively. Without appropriate personnel standards for individuals delivering highly skilled and recognized Medicare services such as physical therapy, the standard of quality is jeopardized.  HR 1846 dilutes the quality of care for Medicare beneficiaries by allowing non-qualified individuals to deliver therapy services.

Contact your Senators and ask them to OPPOSE HR 1846 TODAY!

CALL: Contact your House Representative by calling the Capitol switchboard at 202/224-3121. Please ask your House Representative to OPPOSE HR 1846.

EMAIL/WRITE: Utilize APTA’s Legislative Action Center to send an email or letter to your House Representative.

If you have any questions or need additional information regarding HR 1846, contact Mike Matlack at 1/800-999-2782, ext. 3163, michaelmatlack@apta.org. Thanks for your help in getting the message through to Congress!