On Nov. 2, the Centers for Medicare & Medicaid Services issued a final rule that includes updates on policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after Jan. 1, 2022.
The calendar year 2022 PFS final rule is one of several rules that reflect a broader administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment and innovation.
How does this rule impact therapy services?
To begin, CMS stated they are completing implementation of section 53107 of the Bipartisan Budget Act of 2018, which requires CMS, through the use of new modifiers (CQ and CO), to identify and make payment at 85% of the otherwise applicable Part B payment amount for physical therapy and occupational therapy services furnished in whole or in part by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) ─ when they are appropriately supervised by a physical therapist (PT) or occupational therapist (OT), respectively ─ for dates of service on and after Jan. 1, 2022.
CMS defines services furnished in whole or in part by PTAs or OTAs as those for which the PTA or OTA time exceeds a de minimis threshold.
Overall, the de minimis standard would continue to be applicable in the following scenarios:
· When the PTA/OTA independently furnishes a service, or a 15-minute unit of a service “in whole” without the PT/OT furnishing any part of the same service.
· In instances where the service is not defined in 15-minute increments including: supervised modalities, evaluations/reevaluations, and group therapy.
· When the PTA/OTA furnishes eight minutes or more of the final 15-minute unit of a billing scenario in which the PT/OT furnishes less than eight minutes of the same service.
· When both the PTA/OTA and the PT/OT each furnish less than eight minutes for the final 15-minute unit of a billing scenario (the 10% standard applies).
In short, the 15% payment differential is set to take effect on Jan. 1, 2022.
Additionally, as you all recall in the 2021 Medicare Physician Fee Schedule (MPFS) final rule, CMS implemented changes to office/outpatient evaluation and management (E/M) procedure codes that resulted in payment increases for primary care services beginning in 2021.
Those increases would have resulted in significant cuts to reimbursement for therapists because CMS, by law, must ensure the total values for all procedure codes paid under the MPFS remain budget neutral.
Stakeholders supported efforts by Congress to significantly reduce those cuts in 2021.
However, the full cuts will return in 2022 without additional congressional action to provide further mitigation next year!
Time to think SMART — the “Stabilizing Medicare Access to Rehabilitation and Therapy Act” or SMART Act.
On Oct. 8, U.S. Reps. Bobby Rush (D-IL) and Jason Smith (R-MO) introduced the bipartisan legislation entitled the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act of 2021 (H.R.5536), which would provide for a temporary delay to a reimbursement reduction CY 2022 Medicare Physician Fee Schedule.
The goal of the bill is to protect beneficiary access to therapy services by mitigating the impact of the impending Medicare 15% payment differential for services furnished by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) beginning on Jan. 1, 2022.
Specifically, the bill would delay the implementation date of the Medicare 15% therapy assistant differential to Jan. 1, 2023.
In addition, the bill would also support therapy assistants, many of whom live and work in minority and rural communities, by reducing the requirements for direct supervision of therapy assistants in private practice settings and aligning supervision with state requirements; and providing an exemption to the differential for providers who serve patients in rural and underserved areas.
These small modifications to current policy would ensure unrestricted, timely access to therapy services for Medicare patients, especially those living in rural and underserved areas.
The time for advocacy on this issue is now as there is not much time left on the legislative calendar for Congress to act before this policy is implemented on January 1, 2022.
Ready to help?
Great news!
The American Occupational Therapy Association (AOTA), American Physical Therapy Association (APTA) and American Speech Language Hearing Association (ASHA), in addition to organizations including The National Association for Rehabilitation Providers and Agencies (NARA) and The National Association for the Support of Long Term Care (NASL), are here to support us!
All organizations have created take-action sites to allow for effective communication with US House Members.
American Occupational Therapy Association
American Physical Therapy Association
American Speech Language Hearing Association
National Association for Rehabilitation Providers and Agencies
National Association for the Support of Long Term Care
The time is now to SMART!
Thank you for your advocacy and support of the profession. #FightTheCuts
For more information on the Medicare Physician Fee Schedule Final Rule, please visit: https://www.federalregister.gov/public-inspection/current
Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty and is an advisor to the American Medical Association’s Current Procedural Terminology CPT® Editorial Panel. She can be reached at [email protected].
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
