Active Legislation

Active Legislative Updates from ASHT

 

ASHT Legislative Alert re: Medicare Cuts and the REDUCE Act (H.R. 7279)

The American Society of Hand Therapists (ASHT) has been busy representing your interests before policymakers in Washington, DC. Constituent voices are always the most impactful when it comes to advocating with lawmakers, and we need your help to reinforce ASHT’s federal advocacy work on two important issues.

Medicare Cuts Impacting Hand Therapists and Patients

First, as you know, hand therapists have battled Medicare reimbursement cuts for several years due to outdated Medicare budgetary requirements. While ASHT has successfully urged Congress to mitigate these cuts in recent years, we are advocating with lawmakers to address the additional cuts currently in effect for 2024. Congress is working on a solution that we hope will be included as part of a large, upcoming legislative package, so it is critical that Congress hear from you too about how this will impact your practice and patients.

Co-Sponsor the REDUCE Act (H.R. 7279)

The second opportunity to weigh in with Congress relates to a brand-new piece of legislation that would cut red tape for hand therapists in private practice. Specifically, the bipartisan Remove Duplicative Unnecessary Clerical Exchanges (REDUCE) Act (H.R. 7279), would eliminate the requirement that therapists obtain a referring provider’s signature on a plan of care certification. This bill was recently introduced by Reps. Don Davis (D-NC) and Lloyd Smucker (R-PA). Please contact your Representative to let them know how important this bill is for patients and providers and ask them to sign on as a cosponsor.

It takes only a few minutes to make your voices heard and make a difference in our profession. Please contact your members of Congress TODAY!

Also, did you know non-members can also utilize our Legislative Action Center? Please share this link with any non-ASHT members with an interest in supporting this bill.


ASHT Legislative Alert re: Medicare Orthotics and Prosthetics Patient-Centered Care Act (H.R. 4315)

Hand therapists have long been besieged by problematic Medicare denials of medically necessary orthotic devices due to application of Reasonable Useful Lifetime restrictions. The American Society of Hand Therapists is happy to report new action on the legislative front to address this challenge.

Recently, a bipartisan group of legislators introduced H.R. 4315, the Medicare Orthotics and Prosthetics Patient-Centered Care Act. One section of the bill, led by Reps G.T. Thompson (R-PA), Mike Thompson (D-CA), Brett Guthrie (R-KY) and Angie Craig (D-MN), would increase Medicare beneficiary access to custom-fitted and custom-fabricated orthoses by removing application of Reasonable Useful Lifetime restrictions in many routinely encountered instances.

Please contact your Representative to let them know how important this bill is for patients and providers and ask them to sign on as a cosponsor.

It takes only a few minutes to make your voices heard and make a difference in our profession. Please contact your members of Congress TODAY!

Also, did you know non-members can also utilize our Legislative Action Center? Please share this link with any non-ASHT members with an interest in supporting this bill.


Action Alert • Issue Brief
PROTECT HAND THERAPISTS’ MEDICARE REIMBURSEMENT IN 2023 AND BEYOND (H.R. 8800)
October 13, 2022

Hand therapists and many other health care providers have faced problematic Medicare reimbursement cuts over the past couple of years. Unfortunately, this threat once again looms, as additional reimbursement cuts are currently slated to take effect in January of 2023. Specifically, the 2023 Medicare Physician Fee Schedule (MPFS) proposed rule includes a 4.42-percent reduction in the conversion factor that negatively impacts provider reimbursement. Medicare providers also face an additional 4-percent reimbursement reduction due to the Statutory Pay-As-You-Go (PAYGO) Act requirements that legislation may not increase the federal deficit. ASHT has been and will continue to remain at the forefront of efforts to combat these misguided reimbursement cuts, and your voices have been crucial in ensuring previous support from Congress to mitigate them.

ASHT is thrilled that Representatives Ami Bera (D-CA) and Larry Bucshon (R-IN) have introduced the Supporting Medicare Providers Act of 2022 (H.R. 8800), which would boost the MPFS conversion factor by 4.42% for 2023. This legislation also expresses that it is the sense of Congress that the Department of Health and Human Services and Congress should commit to take administrative and legislative actions to ensure financial stability and predictability in the Medicare program. ASHT is supportive of broader reforms to Medicare provider reimbursement that would prevent the continuation of these annual payment reductions. ASHT is also urging Congress to waive the PAYGO cuts in order to prevent the additional 4-percent reimbursement reduction.

ASHT encourages you to write a letter – ask your U.S. Representative and request that they co-sponsor and support enactment of H.R. 8800 by the end of the year in order to once again mitigate reimbursement cuts for hand therapists.

It takes only a few minutes to make your voices heard and make a difference in our profession. Please contact your members of Congress TODAY!

Also, did you know non-members can also utilize our Legislative Action Center? Please share this link with any non-ASHT members with an interest in supporting this bill.


Call to Action: Allied Health Workforce Diversity Act of 2021 (H.R. 3320)
October 29, 2021

The Allied Health Workforce Diversity Act of 2021 (H.R. 3320) would provide grant funding to colleges and universities to make physical therapy, occupational therapy, respiratory therapy, audiology and speech-language pathology programs more accessible to underrepresented communities, including racial and ethnic minorities. This legislation is being considered by the House Energy and Commerce Health Subcommittee during a legislative hearing this week. The bill is led by Representatives Bobby Rush (D-IL) and Markwayne Mullin (R-OK) in the House, and also has a Senate companion.

ASHT encourages you to contact your U.S. representatives and ask them to cosponsor this important legislation and ensure their underrepresented constituents have greater access and more grant funding in the fields of OT and PT. Please send a letter to your member of Congress. It takes only a few minutes to make your voices heard and make a difference in our profession. Please contact your members of Congress TODAY!

Also, did you know non-members can also utilize our Legislative Action Center? Please share this link with any non-ASHT members with an interest in supporting this bill.


Call to Action: Fight Cuts to Medicare Therapy Reimbursement
October 10, 2021

ASHT has been engaged in a multi-year effort to prevent harmful cuts to Occupational Therapy and Physical Therapy Medicare reimbursement. While ASHT is working with Congress and other stakeholders facing Medicare cuts to develop and implement long-term solutions to the reimbursement challenges stemming from the Medicare Physician Fee Schedule (PFS), it is imperative to provide short-term stability and prevent cuts from taking effect in January 2022. You will recall that Congress acted in late 2020 to mitigate these cuts, including by providing a 3.75% payment adjustment for all PFS services; however, this payment adjustment is set to expire at the end of 2021.

To help raise awareness about the need to prevent these cuts, Reps. Ami Bera (D-CA) and Larry Bucshon (R-IN) are circulating a bipartisan Congressional sign-on letter to House leadership requesting Congress “act before the end of the year to avert the imminent cuts, including extending the 3.75% payment adjustment, and provide continued stability for physicians and other health care professionals.” 

While ASHT is thrilled that over 180 Representatives have already signed the letter, we need your help to successfully advocate that over 200 House members sign onto the Bera-Bucshon letter before next Wednesday, October 13th. Achieving this amount of support would send a tremendously strong message to House leadership and signal vast support for preventing these cuts.

Take Action

If your Representative does not appear on the list, please use the Legislative Action Center issue 'Fight Cuts to Medicare Therapy Reimbursement - - By Asking Your Member of Congress to Sign'

If your Representative appears on the list, please use the Legislative Action Center issue 'Fight Cuts to Medicare Therapy Reimbursement - -Thanking Your Member of Congress if They Have Signed'
 


Call to Action: Help End Medicare Coverage Denials of Medically Necessary Orthoses
December 22, 2020

Hand Therapists providing therapy services in Medicare have an opportunity to submit comments to the Centers for Medicare and Medicaid Services (CMS) on the 2021 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Proposed Rule.

The CMS proposed rule, released in November, fails to address the concerning pattern of Medicare denials of medically necessary custom-fabricated low temperature thermoplastic orthotics and prefabricated orthoses for the upper extremity. ASHT has been advocating that CMS address these denials, and feedback from practitioners is essential to convey the urgency of this issue.

Comments are due by January 4, 2021. To submit a comment, please follow the link here and click the “SUBMIT A FORMAL COMMENT” button on the top right-hand corner of the screen. ASHT is also submitting a comment letter on the proposed rule.

ASHT has prepared a suggested comment letter template for you to modify and personalize based on your personal practice experiences when submitting your letter. Please go to our Legislative Action Center (LAC) to send your comment today!

Also, did you know that nonmembers can utilize our LAC? Please share this link with any non-ASHT members who have an interest in commenting!


Call to Action: Help Preserve Telehealth Access
November 23, 2020

ASHT is pleased to report on an exciting telehealth policy development and requests your help in building support for this promising new proposal. Earlier this year, your advocacy was instrumental in ensuring that CMS used its authority to allow OTs and PTs to bill Medicare for services provided via telehealth during the Public Health Emergency (PHE). However, this ability only lasts as long as the PHE, which has currently been extended through January 20, 2021. Congress must make statutory changes to allow OTs and PTs to provide services to Medicare beneficiaries beyond the PHE, and recently introduced legislation in the U.S. House of Representatives will do just that!

Representatives Mikie Sherrill (D-NJ) and David McKinley (R-WV) have introduced the Expanded Telehealth Access Act (H.R. 8755), which would enable OTs and PTs to continue providing therapy to Medicare patients via telehealth after the PHE expires. The bill already enjoys strong bipartisan support, as it was introduced by Reps. Sherrill and McKinley along with 12 bipartisan cosponsors; however, we need your help to continue building momentum and support!

ASHT urges you to contact your U.S. representative and ask them to cosponsor this important legislation and ensure their constituents continue to have access to therapy services provided via telehealth. Please go to our Legislative Action Center (LAC) to send a letter to your member of Congress. It only takes a few minutes to make a difference in our profession and make our voices heard. Please contact your members of Congress TODAY!

Also, did you know that nonmembers can utilize our LAC? Please share this link with any non-ASHT members who have an interest in supporting this bill!
 


Outpatient Therapy Modernization and Stabilization Act (H.R. 7154)
August 4, 2020

On August 3, 2020, the Centers for Medicare and Medicaid Services (CMS) released its proposed 2021 Medicare Physician Fee Schedule. The rule recommends significant payment reductions to more than three dozen health care professions, including occupational and physical therapy. 

CMS is using the revenue from these cuts to offset an increase in payments for physicians. These cuts are the result of a Medicare statutory requirement known as "budget neutrality" which requires that any increase in costs to the Medicare program must result in decreased spending elsewhere in the Medicare program. The CMS proposal would cut reimbursement for Medicare Part B therapy codes (including 97165, 97110 and 97161 for example) by an estimated 9 percent. 

ASHT, the American Occupational Therapy Association and the American Physical Therapy Association have been actively raising concerns with Congress and CMS about the impact these cuts on providers and patients in need of care, particularly amidst the COVID-19 pandemic. 

Fortunately, bipartisan legislation has been introduced in the House of Representatives (H.R. 7154, the Outpatient Therapy Modernization and Stabilization Act). by Reps. Boyle (D-PA) and Buchanan (R-FL) that would prevent these proposed reimbursement cuts by waiving the statutory budget neutrality requirements. 

ASHT will continue to advocate against these cuts with CMS, but we need you to take action now by asking your members of Congress to intervene to stop these payment reductions. 

Stay tuned to ASHT's Legislative Action Center for updates on this issue. 


CMS Telehealth Update
June 5, 2020

Submitted by: ASHT Leadership

As reported in April, the Centers for Medicare & Medicaid Services (CMS) announced the inclusion of occupational and physical therapy practitioners as Medicare telehealth service providers retroactive to March 1, 2020, for the duration of the coronavirus pandemic. We still have work to do to have telehealth permanence beyond the current public health emergency.

On June 1, 2020, ASHT submitted comments to Centers for Medicare & Medicaid Services (CMS) in response to the inclusion of occupational and physical therapy practicioners as medicare telehealth service providers.

Read ASHT response letter

ASHT Practice Division welcomes suggestions from members. Please use asht@asht.org or the Practice and Reimbursement Group on the E-community to submit your comments. 


April 30, 2020
Submitted by: ASHT Leadership

CMS Announces Inclusion of OT and PT Practitioners as Medicare Telehealth Service Providers

We did it!

In response to COVID-19, Congress and the Administration took swift action to expand telehealth services. Although therapy CPT codes were added to the list of eligible telehealth services, CMS did not explicitly recognize therapists as eligible telehealth providers.

During this time, AOTA, APTA and ASHT continued to advocate for telehealth to be expanded in order to recognize therapists as eligible providers.

ASHT asked for your help to get across the finish line. Nearly 500 members took action on ASHT’s Legislative Action Center to urge CMS to add occupational and physical therapists as eligible Medicare telehealth providers.

WE DID IT!! Today CMS announced inclusion of occupational and physical therapy practitioners as Medicare telehealth service providers retroactive to March 1, 2020, for the duration of the coronavirus pandemic.

The professional impact of this announcement is immeasurable. During this unprecedented time, the ability for hand and upper extremity therapists to continue to work with patients has been critical. The ability to access our population remotely without risking exposure to the virus is profound. We couldn’t have done it without your advocacy.

We still have work to do to have telehealth permanence beyond the current public health emergency. But today, we have a victory and I couldn’t be prouder of us.

Thank you for your teamwork!!!

Mojca “Mo” Herman, MA, OTR/L, CHT
2019-2020 ASHT President


Relief Payments Made to Medicare Providers and OT Recognized in Home Health
April 13, 2020

Direct Relief Payments:

On April 10th, the Department of Health and Human Services initiated the first phase of CARES Act (P.L. 116-136) relief funding. As part of the new law’s Public Health Service Emergency Fund (PHSEF), HHS delivered $30 billion in direct deposits to providers, including therapists, and facilities based on their share of 2019 Medicare FFS billing. Importantly for Hand Therapists receiving payment through the PHSEF, you will not be asked to repay any of the distributed funds.

Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The portal for signing the attestation will be open the week of April 13, 2020 and will be linked from hhs.gov/providerrelief.

Visit hhs.gov/providerrelief for additional information.

OT and Home Health:

On April 9th, the Centers for Medicare & Medicaid Services (CMS) utilized new authorities under the recently passed pandemic response law to allow Occupational Therapists to open Medicare home health cases.

ASHT has long advocated for changes that would allow Occupational Therapists to perform the initial assessment for any home health patient with a plan of care that includes therapy. ASHT appreciates CMS’ efforts ensure Medicare beneficiaries, during this period, can access home health in a timely and efficient manner.

Please stay tuned for additional updates on these and other critical COVID-19 related topics.
 


Practice Division Briefing
CMS Releases Final 2020 Medicare Physician Fee Schedule
November 2019
- Submitted by
 Danielle Grace Sparks, DHS, MOT, OTR, CHT, Advocacy Committee Chair

On November 1, 2019, CMS posted a fact sheet outlining its final rule. This included updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) effective January 1, 2020.

According to CMS, this PFS for the calendar year 2020 “reflects an Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.” Their goal is also to reduce the burden on the provider and valuing time spent with patients.

Some key points specific to occupational therapists and physical therapists

  • CMS is aligning with AMA on CPT coding for physicians. It is anticipated that beginning in 2021 Evaluation and Management rates for physicians and other providers will increase, especially in specialty areas.
  • Due to budget neutrality, there have been discussions about 8% payment cuts to occupational and physical therapy codes. CMS has not specified details yet.
  • CQ and CO Therapy Modifiers are established to identify therapy services furnished by assistants. CMS set a de minimus 10% standard for when these modifiers will apply to specific services.
  • When an OT or PT is involved in the entire duration of the service and the OTA or PTA provides skilled therapy alongside, the modifier isn’t required.
  • When the same service code is furnished completely separately by the OT/PT and OTA/PTA, the de minimus will be applied to each 15-minute unit of codes, not the total time of service, allowing the separate reporting on different claim lines with or without the modifier accordingly.
  • No documentation requirements.
  • Opioid Use Disorder Treatment Services
    • Increased support of opioid treatment programs (medications, counseling, individual and group therapy)
    • Required certification of opioid treatment programs
    • Payment for drugs and bundled payment rates
    • Zero beneficiary copayment for 2020
  • Physicians Assistants
    • PAs to get greater flexibility to practice more broadly in the current health care system within state law and scope of practice. Physicians should supervise by having a working relationship with the PA.
  • KX modifier threshold increased from $2,040 to $2,080.
  • Dry needling codes have been added, but not covered by CMS.
  • Negative wound pressure gets coding values [97607] and [97608].

References:

Centers for Medicare and Medicaid Services, Newsroom retrieved on November 4, 2019
https://www.cms.gov/newsroom/fact-sheets/finalized-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar

APTA, PT in Motion news retrieved on November 4, 2019
http://www.apta.org/PTinMotion/News/2019/11/04/PFSFinalRule/

AOTA, Federal Regulatory Affairs news retrieved on November 4, 2019
https://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/News/2019/CY2020-Medicare-Physician-Fee-Schedule.aspx


Practice Division Update
New Worker's Compensation guidelines for PT/OT in New York state
November 2019
- Submitted by Ann Marie Feretti, EdD, OTR/L, CHT​, ASHT Federal & State Regulations Committee Chair

Occupational and physical therapists will now be able to submit their own medical reports and bills without the signature of a supervising physician. 

All occupational and physical therapists who treat injured workers, whether employed by a physician practice and treating injured workers under physician supervision or practicing independently, must obtain their own Board-authorization to continue treating injured workers after January 1, 2020.

OTs and PTs must complete training and complete the authorization process to continue treating injured workers after January 1, 2020.

More information: 

https://files.constantcontact.com/342345b3701/dd8fb4f4-e19a-4828-a95f-51e6b12200a8.pdf?fbclid=IwAR1hx306bxo5vZK2x2Ru17iZBQWX_8n5ZVTpiqWeDOq22hvzaWResgQCt8k  

http://www.wcb.ny.gov/newprovider/


CMS Orthoses Denials
August 2019

In response to the multiple concerns that we have received from various members across the country regarding the recent denials on custom-fabricated orthoses under the same or similar policy, ASHT continues to communicate with CMS. The Practice Division appreciates and would like to thank all ASHT members, the ASHT E-community, ASHT Board members and the ASHT Practice Division Committee members for sharing their expertise, inputs, denial scenarios and examples. 

Read ASHT response letter

ASHT Practice Division welcomes suggestions from members. Please use asht@asht.org or the Practice and Reimbursement Group on the E-community to submit your comments. 
 


Pain Management Best Practices Inter-Agency Task Force Draft Final Report
May 2019

In 2016, Congress passed critical legislation aimed at stemming the nation’s opioid epidemic. The Comprehensive Addiction and Recovery Act (P.L.114-198) included provisions establishing the Pain Management Best Practices Inter-Agency Task Force. Earlier this month, the taskforce comprised of the Departments of Health and Human Services, Veterans Affairs, and Defense, issued its Draft Final Report.

In March, ASHT submitted comments to the agencies in response to their initial draft report. We are pleased to see language included in the final report that acknowledges the critical role of “restorative therapies,” including physical therapy (PT) and occupational therapy (OT). The taskforce’s work to explore best practice models for acute and chronic pain management also identified a number of barriers to accessing care. These items represent opportunities for hand therapists to educate payers, health systems, networks and other providers about the value of our specialty to patients suffering with pain.

Ultimately, the report included an entire section on “Restorative Therapies.” The section identified a general lack of understanding about which restorative therapies are indicated for the various pain syndromes as a significant barrier. The taskforce recommended investments in research and data to help inform the inclusion of restorative therapies in more multidisciplinary models.

The report also emphasized the importance of minimizing reimbursement barriers for modalities, such as OT and PT, with long-demonstrated benefit to patients suffering from pain. As such, recommendations called on CMS and private payers to:

  • develop appropriate reimbursement policies to allow for a multimodal approach to acute pain;
  • minimize insurance coverage delays for clinically appropriate care;
  • restore reimbursement to non-hospital sites of service to improve access and lower the cost of interventional procedures.

The agencies and Congress will be looking closely at the Pain Management Best Practices Inter-Agency Task Force’s report and what policies can be implemented or passed to improve pain management care across the country.

ASHT will be working to educate lawmakers and the agencies about barriers that are preventing patients from accessing hand therapy and quality pain management treatment.


House Appropriations Committee Update
May 2019

Last week, the House Appropriations Committee approved its fiscal year 2020 Labor, Health and Human Services, Education, and Related Agencies (L-HHS) funding bill. The House Appropriations bill includes an increase of nearly $12 billion over 2019 levels and an $8.5 billion increase for HHS alone, which supports many of the nation’s most critical healthcare programs.

ASHT supports key initiatives funded by the L-HHS funding bill and is pleased to see that the legislation makes critical investments in rehabilitation research, assistive technology and alternatives to opioids for pain management. More specifically, the bill included language on a number of relevant topics for ASHT members, including:

  • The Committee made key recommendations on research and included $108,970,000 for the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR), representing an increase of nearly $18.6 million for rehabilitation-focused institute over FY19 levels.
  • The Committee also made important research policy recommendations that would allow the National Institutes of Health (NIH) Director to transfer funds for activities related to opioid addiction, opioid alternatives, pain management and addiction treatment.
  • Lawmakers further emphasized the importance of exploring the full range of non-opioid alternatives for pain management, including chronic pain therapies like rehabilitation. The Committee included the following language to underline their intent for HHS:

Fifty million Americans suffer from chronic pain; living with chronic pain can be life-altering, deeply impacting people on many levels. The current state of chronic pain management is often inadequate for many patients and places an economic burden on the health care system, costing the U.S. $560 billion annually. Management of chronic pain often requires both non-pharmacological treatment as well as medicines. Unfortunately, the current pharmacological options do not meet the needs of all patients, and additional treatments are needed. The Committee requests in the Fiscal Year (FY) 2021 Congressional Justification an update on the progress of the development and advancement of non-opioid chronic pain therapies.

  • The Committee also sought to make investments in assistive technology, with a goal toward bolstering support for assistive technology needs for individuals with disabilities. The Committee emphasized that its goal is to increase awareness of and access to assistive technology devices and services that may help with education, employment, daily activities and inclusion of people in their communities. The Committee recommended $37,000,000 for these important programs, an increase of $1 million.
  • The Committee recommends $4,000,000 for the Limb Loss Resource Center, which is $500,000 above FY19 levels. The Limb Loss Resource Center supports a variety of programs and services for those living with limb loss, including a national peer support program, educational events, training for consumers and healthcare professionals and information and referral services.
  • The Office of Workers’ Compensation Programs (OWCP) administer programs that provide eligible injured and disabled workers and their survivors with compensation, medical benefits and services including rehabilitation, supervision of medical care and technical and advisory counseling. The Committee’s recommendation included an increase of $3 million over FY19 levels.

Congress will aim to complete its work on the remaining appropriations bills and bring them to the House and Senate floor for consideration before the end of the Fiscal Year in September. As the process moves forward, we will continue to keep you apprised of key developments. Be sure to check back for updates.


Pain Management Task Force Comments
April 2019

Hand therapists have long been recognized for their role in helping patients manage acute and chronic upper extremity pain. In response to the opioid epidemic, the search for non-pharmacologic alternatives has elevated the profile of therapy as a critical part of the solution.

ASHT has been a vocal advocate for the role of hand therapy in stemming the crisis over the past year, weighing in on legislation and commenting on agency initiatives. Most recently, the Pain Management Best Practices Inter-Agency Task Force issued a draft report on the gaps and recommendations on acute and chronic pain management. The draft report highlighted the role of ‘restorative therapies’ in providing effective pain management.

The task force, which is overseen by the Departments of Health and Human Services (HHS), Veterans Affairs (VA) and Defense (DoD), was established with the passage of the Comprehensive Addiction and Recovery Act of 2016 (P.L. 114-198, CARA). CARA required the task force to develop a report and propose recommendations for best practices in pain management.

During the open comment period, ASHT took the opportunity to provide feedback on the report and commend the task force for recognizing the role of therapy and rehabilitation in pain management. In our comments, we also elaborated further on the role hand therapists play in developing, coordinating and executing pain treatment programs, as well as how those plans help patients successfully manage their pain without the use of opioids.

Importantly, the draft report also emphasized the need for additional research in therapy. ASHT member research is vital to the development of best practice standards and the delivery of quality evidence-based care. With that in mind, ASHT will continue advocating for rehabilitation research funding during Congress’ fiscal year 2020 appropriations debate and utilize the recommendations in this report to make the case.

The comment period for the draft report ended on April 1. The task force will review all comments and publish a final report in the coming months. ASHT will monitor updates related to the report and will continue to participate in discussions related to pain management and therapy.


2018-2016 Active Legislative Updates from ASHT
 

Opioid Crisis Response Act of 2018 (H.R. 6) - Bill Signing
October 26, 2018

This week, President Donald Trump signed into law the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (H.R. 6). The new law represents the culmination of an intense year-long legislative effort to stem the opioid crisis.

During the debate, ASHT emphasized with lawmakers the importance of helping people find non-opioid alternatives to managing their pain, including hand therapy. We are pleased that the final agreement adopted a number of key policies that could benefit the hand therapy profession and the clients you serve, including provisions that would:

Direct CMS to issue guidance to states for treating and managing Medicaid beneficiaries’ pain through non-opioid pain treatment and management options, including coverage and reimbursement recommendations.

Require the Secretary of HHS to submit a report on ways to improve reimbursement and coverage for multi-disciplinary, evidence-based non-opioid chronic pain management.

Require the Secretary of HHS to develop guidance and a toolkit on pain management and opioid use disorder prevention for hospitals receiving payment under Part A of the Medicare program.

Update the scope of the Interagency Pain Research Coordinating Committee to identify, among other things, advances in pain care research supported or conducted by the federal government, including information on best practices for the utilization of non-pharmacologic treatments.

Incentivize the treatment of individuals with substance use disorders by establishing a loan repayment program for eligible health care professionals working in shortage areas or counties that have been hardest hit by drug overdoses.

The hard work, however, has just begun. The agencies will soon initiate the rulemaking process, develop parameters for incentivizing non-pharmacological treatments, and examine critical reimbursement incentives. With that in mind, ASHT is preparing to engage CMS and other key agencies as they seek input in the coming months. We will continue to keep you updated on any new developments.


2019 Medicare Physician Fee Schedule
October 2018

On September 10, 2018, ASHT submitted a letter to the Centers for Medicare and Medicaid Services (CMS) in response to the proposed 2018 Medicare Physician Fee Schedule and related policies included in the proposed rule. 

View the full letter here


Opioid Crisis Response Act of 2018 (H.R. 6)
September 28, 2018

Today, the House of Representatives passed the SUPPORT for Patients and Communities Act (H.Res.1099) to stem the nation's opioid crisis. This bipartisan, bicameral compromise contains a number of ASHT priorities and clearly recognizes the importance of your role in helping people find non-opioid alternatives to managing their pain. Your calls and emails, combined with our advocacy efforts in Washington, have helped to shape this important legislation. 

The final agreement includes a number of key policies for hand therapists and their clients, including provisions that would:

  • Direct CMS to issue guidance on states' options for treating and managing Medicaid beneficiaries' pain through non-opioid pain treatment and management options.
  • Require the Secretary of HHS to submit a report on ways to improve reimbursement and coverage for multi-disciplinary, evidence-based non-opioid chronic pain management. 
  • Require the Secretary of HHS to develop guidance and a tool-kit on pain management and opioid use disorder prevention for hospitals receiving payment under Part A of the Medicare program. 
  • Update the scope of the Interagency Pain Research Coordinating Committee to identify, among other things, advances in pain care research supported or conducted by the federal government, including information on best practices for the utilization of non-pharmacologic treatments. 
  • Incentivize the treatment of individuals with substance use disorders by establishing a loan repayment program for eligible health care professionals working in shortage areas or counties that have been hardest hit by drug overdoses. 

For additional details, please see the section-by-section summary as well as the full text of the bill. 

We expect the Senate to consider the bill within the first two weeks of October. Please contact your Senators and urge a YES vote on the SUPPORT for Patients and Communities Act.


Congress Faces Packed September Work Schedule
August 2018

Opioid Legislation and Looming Funding Battle Await

Following House passage of the Support for Patients and Communities Act (H.R. 6) in June, the Senate has worked to craft a legislative package of its own with negotiations hitting a key milestone last week. Republican leadership announced at an August 28 press conference that GOP Senators have reached consensus on underlying opioid legislation and hope to bring a bill to the floor shortly upon their return this month. Senate Democrats, led in negotiations by Senator Patty Murray (D-WA), continue to study the proposal and the Senate ultimately will need to reconcile key provisions of its bill with differences in H.R. 6. Yet the two proposals share some elements in common.

Like H.R. 6, the Senate bill would encourage the use of non-opioid alternatives to pain management and would emphasize multi-modal approaches across settings and reimbursement structures. The bill would also seek to expand access to substance use disorder treatment, support research, and prevent drug diversion.

Hand therapists have a crucial role to play in addressing the opioid epidemic. Whether rehabilitating an upper extremity injury, assisting with recovery post-surgery, or helping manage a chronic condition, hand therapists provide safe, quality, and effective pain care management for their clients.

Please call your Senators to urge them to pass comprehensive opioid legislation, and tell them to make therapy and rehabilitation part of the response to our nation’s substance use crisis.

While the House recessed last month, the Senate also considered the Fiscal Year 2019 Labor, Health and Human Services, Education, and Related Agencies (LHHS-ED) appropriations bill. This is Congress’ largest funding bill and has jurisdiction over virtually all federal health care programs. Passage of the LHHS-ED bill is noteworthy, as in recent years, it has served as a magnet for controversial health policy amendments.

The Senate passed this critical spending bill in an 85-7 vote with overwhelming bipartisan support. As passed, the bill would provide significant new investments in our nation’s current health care priorities and represents a departure from President Trump’s proposal to cut $12.5 billion in spending. These new investments include: $5 billion over Fiscal Year 2017 for the National Institutes of Health, $3 billion over Fiscal Year 2017 to combat the opioid crisis, and $2.3 billion over Fiscal Year 2017 to increase college affordability. While the House did not call up its own bill for a floor vote, Representatives on September 4 agreed to combine the LHHS-ED and Defense spending bills and negotiate a final package with the Senate. Some House conservatives objected to withholding a separate vote on LHHS-ED but Republicans generally are optimistic about the bill’s likelihood of passing.

Two upcoming dates add pressure to Congress to reach an agreement on Fiscal Year 2019 spending as well as on opioids legislation: the expiration of current government funding on September 30 and the 2018 midterm elections on November 6. ASHT will continue to keep you updated on these and other key issues as Congress acts in these last weeks of the year.


2019 Medicare Physician Fee Schedule
July 2018

The 2019 Medicare Physician Fee Schedule proposed rule is out and will, undoubtedly, impact hand therapy services under Medicare Part B. ASHT is examining these proposals closely with your practice in mind. The following provides an overview of important changes on the horizon for hand therapy:

Functional Limitation Reporting (FLR)

Among the most important and welcoming changes for hand therapists is the proposal by CMS to eliminate FLR. Since 2013, OTs and PTs have been required to assign G-codes to their claims for the purposes of fulfilling CMS’ pursuit of value-based payment. ASHT is pleased that CMS has acknowledged the shortcoming of this data collection and the unnecessary burdens and complexities associated with the documentation mandate.

Quality Payment Program (QPP)

CMS is proposing that OTs and PTs providing services under Medicare Part B join the QPP by participating in either the Merit-based Incentive Payment Program (MIPS) or an Alternative Payment Model (APM) beginning in 2019.

The QPP consists of two participation pathways – MIPS, which measures performance in four categories to determine an adjustment to Medicare payment, and APMs, in which clinicians may earn an incentive payment as well as an exemption from MIPS reporting requirements.

Under MIPS, data is collected in four key areas: quality, resource use, clinical practice improvement activities, and interoperability of electronic health records. These categories are combined to determine your Composite Performance Score. The total score ultimately determines whether providers are eligible for a payment bonus or payment reduction.

While OTs and PTs have not been eligible participants to date, therapists have been allowed to voluntarily report data as a means of gathering feedback in anticipation of eventually being required to meet the program’s reporting requirements.

Low Volume Exemption: MIPS includes an exemption for smaller private practices through a Low Volume Threshold policy. The policy states that if any one (1) of the following applies, the practitioner is not required to report under MIPS: the practitioner has Medicare-allowed charges of less than or equal to $90,000; provides covered services to 200 or fewer beneficiaries; or provides 200 or fewer services to beneficiaries.

Therapy Cap Repeal Implementation

The passage of the Bipartisan Budget Act of 2018 ended the long-fought battle over Medicare’s Part B therapy cap. The repeal of the cap also included a number of additional provisions that are addressed in the recently released MPFS proposed rule, including requirements to continue the use of the KX modifier for claims exceeding $2,010 for OT and for PT and speech-language pathology (SLP) services combined. While affixing the KX modifier is still required, all claims above that threshold will not be subject to review.

Perhaps the most surprising provision in the Bipartisan Budget Act of 2018 was language aimed at OTAs and PTAs. The MPFS addresses this provision by proposing the use of modifiers when PTAs or OTAs are providing outpatient services. Ultimately, the modifiers will be utilized to implement a reduction in reimbursement for OTAs and PTAs. The legislation calls for such services to be paid at 85% of the fee schedule beginning in 2022. Voluntary reporting could begin as soon as 2019, according to the proposed rule. ASHT has significant concerns with this proposal and will be exploring legislative and regulatory remedies to reverse this policy.


Opioid crisis takes center stage as Congress prepares for upcoming Memorial Day recess
June 1, 2018

Congress continues to take aim at the opioid epidemic with hopes of passing a comprehensive legislative package before lawmakers leave for August recess. Across the political spectrum, members of Congress recognize the importance of alternative treatments for pain. As hand therapists, your daily efforts to minimize client pain and maximize function offers a true alternative to opioids, and Congress agrees!

Last week, the House Ways and Means Committee approved the Medicare and Opioid Safe Treatment (MOST) Act (H.R. 5776) with overwhelming bipartisan support. Among other things, H.R.5776 would require the Secretary of Health and Human Services to examine avenues to improve access to services such as cognitive behavioral interventions, physical therapy, occupational therapy and physical medicine.

The House Energy and Commerce Committee was also busy at work last week, approving 57 bills over a marathon two-day markup. Included among the bills was the Medicare Opioid Safety Education Act (H.R.5685), which seeks to bolster educational resources available to Medicare and Medicaid beneficiaries on pain management and alternative pain management treatments, like therapy. Bills like H.R.5776 and H.R.5685 represent prime opportunities for hand therapists to highlight the benefits of rehabilitation. We anticipate that the House could vote on a combined package of opioid bills as early as June 11.

Meanwhile in the Senate, the HELP Committee considered and approved S.2680: The Opioid Crisis Response Act of 2018, while the Senate Finance Committee followed suit with a legislative package consisting of 22 bipartisan policy proposals. The Senate hopes to bring the complement of bills to the Senate floor in the coming month for full consideration.

Members of Congress are currently back home this week for Memorial Day “recess,” and it’s a perfect time to let them know what you do, how you help your clients and how therapy and rehabilitation are vital solutions to the opioid epidemic. Your voice and experience are a critical piece of the puzzle.  In fact, we've even created a member survey so we can capture your experiences and better educate lawmakers.  Please take time to tell your story.  As you have conversations with members of Congress back home, be sure to let ASHT know so we can reinforce your message when members return to Congress in June.


ASHT Pain Management Survey
June 2018

As Congress continues to consider legislation to address the opioid epidemic, ASHT wants to hear from you!​

We want your voice and experience to resonate in this broader debate as ASHT continues to monitor these developments and work to shape policy to address the opioid epidemic. Knowing how you have helped clients manage chronic and acute pain through therapy and rehabilitation is a critical piece of the solution to this nationwide crisis. 

Thank you for taking the time to complete this brief survey examining the role hand therapists play in battling the opioid epidemic. The information gathered may be used and presented to physicians, insurers and legislators by ASHT.


Congress Considers Legislation to Address the Opioid Epidemic – Hand Therapy Part of the Solution
May 1, 2018 

Over the past few months, we’ve seen a flurry of debate on Capitol Hill around the opioid epidemic. This week marked the first significant steps taken this year toward advancing comprehensive legislation on this critical topic.

On April 24, the Senate Committee on Health, Education, Labor and Pensions (HELP) marked up S.2680: The Opioid Crisis Response Act of 2018. This bipartisan bill was a combination of 40 different policy proposals, cobbled together over seven bipartisan hearings on how to best address the opioid crisis. The Opioid Crisis Response Act of 2018 aims to accomplish many items, including:

Require the Secretary of HHS to provide technical assistance related to the use of alternatives to opioids, including for common painful conditions and certain patient populations, such as geriatric patients, pregnant women and children.

​Spur development and research on of non-addictive painkillers, and other strategies to prevent, treat and manage pain and substance use disorders through additional flexibility for the NIH.

Support the healthcare workforce by providing resources for pain care providers to assess, diagnose, prevent, treat and manage acute or chronic pain, as well as for the detection of early warning signs of opioid use disorders.

The Senate HELP Committee advanced S.2680 unanimously by a vote of 23-0. Chairman Lamar Alexander (R-KY) expressed his hopes that the full Senate will move the opioid legislation by this summer.

On April 30, the House Energy and Commerce Health Subcommittee concluded their opioid markup, advancing 56 opioid related bills to the full Energy and Commerce Committee. This full docket, comprised of introduced bills and draft legislation, offered a broad range of solutions to the crisis, across the areas of public health, behavioral health and Medicare and Medicaid reimbursement. According to Chairman Burgess (R-TX), the full committee markup is likely to take place in mid-May.

Among the drafts to advance was the Adding Resources on Non-Opioid Alternatives to the Medicare Handbook, which would direct CMS to compile educational resources for beneficiaries regarding opioid use, pain management and alternative pain management treatments. The legislation goes on to instruct CMS to include these resources in the “Medicare and You” handbook. Legislation like this gives ASHT the opportunity to emphasize the benefits of therapy as well as the work you do as therapists to minimize client pain and maximizing function.

As Congress continues to consider legislation like this to address the opioid epidemic, we want to hear from you! Knowing how you have helped clients manage chronic and acute pain through therapy and rehabilitation is a critical piece of the solution to this nationwide crisis.

We want your voice and experience to resonate in this broader debate as ASHT continues to monitor these developments and work to shape policy to address the opioid epidemic. Share your personal experiences, stories, and background to asht@asht.org, so we can tell Congress that Hand Therapy is part of the solution.  


Hand Therapy Practice and the Opioid Epidemic
April 6, 2018 

Hand therapists have a crucial role to play in addressing the opioid epidemic. Whether it is following an upper extremity injury, surgery, or helping manage a chronic condition, hand therapists provide safe, quality, and effective pain care management for their clients.

In recent months, Washington has turned its attention to the opioid epidemic, providing nearly $4 billion in new spending in the recent funding bill and debating dozens of bills to address the multi-faceted crisis. When Congress returns from recess next week, lawmakers will seek to continue the momentum.

On April 11th, the House Energy and Commerce Committee will hold a legislative hearing to examine a new slate of bills aimed at curbing opioid use by, among other things, addressing Medicare and Medicaid coverage barriers, tracking opioid prescribing patterns, requiring drug companies to alter packaging, and allowing providers to write smaller prescriptions. In addition, the Centers for Disease Control and Prevention and now Blue Cross Blue Shield are actively advocating for a new standard that emphasizes non-opioid alternatives as the first line of treatment for pain management over opioid prescribing.

As the debate unfolds over the coming months, ASHT will continue to educate lawmakers about the important role hand therapists play in safe, effective pain management. ASHT will also be emphasizing the importance of non-opioid alternatives to pain management and working to improve and support policies that embrace the benefits of therapy and rehabilitation.

Stay tuned to ASHT's Legislative Action Center for updates on this issue.


Victory! Repeal Becomes Law
February 9, 2018

This morning, February 9th, President Trump signed the latest stopgap funding bill into law, which included the Permanent Repeal of the Medicare Therapy Cap!

Today marks a huge victory for the profession that was twenty years in the making.  As a member of the American Society of Hand Therapists, we wanted to thank you, sincerely, for your steadfast commitment to addressing this critical issue. You have lent your voice to this cause many times, and today, your emails and phone call were finally heard. Today, we can finally say, “The Medicare Therapy Cap is repealed!”

As we look to the future, we recognize that this victory is one part of a larger journey to ensure people have access to therapy services and ultimately a chance at functioning fully.  We must now look to continue seeking improvements through the rulemaking and implementation phases of this permanent repeal.  Your voice will be vital to this process as we find the best path forward for the profession.

Thank you for all of your support and congratulations on a job well done!

Click here for therapy cap frequently asked questions. 


December 1, 2017

The Pain Management Best Practices Inter-Agency Task Force was launched by Health and Human Services (HHS) in August 2017. This task force was mandated by the 2016 Comprehensive Addiction and Recovery Act and includes HHS, Departments of Defense and Veteran Affairs, Office of National Drug Control Policy and various other stakeholders. The task force’s main role is to determine gaps or inconsistencies in the best practices of pain management. Many healthcare providers have expressed concerns that questions in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which is tied to hospital reimbursement, could be leading to an increase of opioid prescriptions across the nation. In response to these concerns by healthcare providers, starting October 1, 2017, the Centers for Medicare and Medicaid Services (CMS) will no longer link the HCAHPS pain management scores to hospital payment, which is under the Hospital Value-Based Purchasing Program. To also combat the opioid epidemic, the Center for Disease Control (CDC) has released guidelines for prescribing opioids and an Rx Awareness Campaign to increase awareness of the risks of inappropriate opioid use. 

For more information about this post click here.

For more information about HCAHPS click here.


Legislative Alert - The American Health Care Act of 2017
May 11, 2017

 

On May 4, 2017, the House of Representatives passed the American Health Care Act of 2017 (AHCA) H.R.1628 by a vote of 217-213. 

This legislation impacts coverage for therapy services by allowing states to opt out of requiring the essential health benefits for both Medicaid and the individual market as required by the Affordable Care Act (ACA).

Another notable change affects individuals with pre-existing conditions. Individuals with pre-existing conditions must be offered health insurance, but there is no limit on the cost of that insurance. The bill includes $8 billion in supports to help lower premiums for these individuals.

The bill also permits states to apply a work requirement for non-disabled, non-elderly, non-pregnant adults in order to receive Medicaid.

To date, the legislation has not been introduced in the Senate, where it is expected to be modified.

More information


Legislative Alert - American Health Care Act Update
March 29, 2017

The American Health Care Act (AHCA) of 2017 H.R.1628 was the House Republican’s proposal to repeal and replace the Affordable Care Act and prohibit federal funding for Planned Parenthood. However, on March 24, 2017, the vote on the AHCA was withdrawn, rather than having the bill defeated on the House floor. The withdrawal occurred because of several reasons, including the House Freedom Caucus pledging to oppose the AHCA due to the group believing the bill keeps too much of current legislation from the Affordable Care Act intact. There was also great push back from industry groups like the American Medical Association (AMA) and the American Hospital Association (AHA), which have both spoken out against the legislation. There were also many Democrats opposed to the AHCA due to the changes it would have on healthcare coverage for many Americans.

The bottom line with how the AHCA would have affected you depends on income, how you receive your health insurance and your healthcare needs. For example, older individuals with a low-income and health insurance from an individual market could have expected their premiums to increase. Individuals who utilize Medicaid would have faced few benefits with higher out-of-pocket costs. Additionally, if you receive benefits through your employer, your employer would have the right to stop providing coverage, which would have been likely to occur because tax credits would be eliminated for employers. There also would have been tax breaks for individuals with higher incomes.

Because the AHCA bill was withdrawn Friday, it appears any proposed changes to the Affordable Care Act will have to go back to the drawing board.

The ASHT Practice Division will continue to follow and provide regular updates on legislation relative to hand rehabilitation. If you have not yet had chance, please check out the Legislative Action Center, which is an easy-to-use tool that provides sample position letters, phone scripts and tweets that can be personalized by you to reach you elected representatives!


Legislative Alert - Advocacy Committee Report
October 26, 2016

Orthotics & Prosthetics Legislation:

S.2312 DME Access and Stabilization Act.
-No change from previous report
-20 cosponsors

S.829/H.R.1530 Medicare Orthotics and Prosthetics Improvement Act of 2015
-No change from previous report 
-1 cosponsors

H.R.1526: Medicare Audit Improvement Act of 2015
-No change from previous report
-4 cosponsors

H.R.5210/S.2736: Patient Access to Durable Medical Equipment Act of 2016 and PADME Act
-No change from previous report
-35 cosponsors

Rehabilitation Legislation:

S.539/H.R.775: Medicare access to Rehabilitation Services Act
Purpose:
A bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps.
Status: H.R.775: Introduced: Feb. 5, 2015; Sponsor: Charles Boustany Jr.; 237 cosponsors (132D, 104R, 1I)
S.539: Introduced: Feb. 24, 2105; Sponsor: Benjamin Cardin, 35 cosponsors (22D, 12R, 1I)
-H.R.775: Increased by 6 cosponsors
-S.539: Increased by 2 cosponsors

S.2409/H.R.4273: Medicare and Medicaid Improvements Act of 2015.
-No change from previous report
-S.2409: 2 cosponsors
-H.R.4273: 10 cosponsors

H.R.3727: Health Insurance Rate Review Act
Purpose:
To amend the Public Health Service Act to provide protections for consumers against excessive, unjustified or unfairly discriminatory increases in premium rates.
Status: Introduced: Oct. 8, 2015; Sponsor: Janice Schakowsky; 14 cosponsors (14D)
H.R.3727: Increased by 1 cosponsor

S.1849: Medicare Patient Empowerment Act
-No change from previous report
-6 cosponsors

H.R.3770 End surprise billing act of 2015
Purpose:
To amend title XVIII of the Social Security Act to prevent surprise billing practices, and for other purposes.
Status: Introduced: Oct. 20, 2015; Sponsor: Lloyd Doggett; 31 cosponsors (31D)
-H.R.3770: Increased by 5 cosponsors

S.800/H.R.1631/H.R.1469: Enhancing the Stature and Visibility of Medical Rehabilitation Research at the NIH Act
-No change from previous report*
-S.800: 7 cosponsors
-H.R.1631: 4 cosponsors
-H.R.1469: none

H.R.2646: Helping Families in Mental Health Crisis Act of 2015*
-No change from previous report
-H.R.2646: 207 cosponsors

Telehealth Legislation:

H.R.4155/S.2343 Telehealth Innovation & Improvement Act of 2015
-No change from previous report
-H.R.4155: 1 cosponsor
-S.2343: 1 cosponsor

H.R.2066 Telehealth Enhancement Act of 2015
-No change from previous report
-6 cosponsors

H.R.2948: Medicare Telehealth Parity Act of 2015
Purpose:
This House bill seeks to amend title XVIII of the Social Security Act. Under Medicare, the bill would allow for a gradual expansion of telehealth coverage.
Status: Introduced: July 7, 2015; Sponsor: Mike Thompson; 67 cosponsors (43D, 24R)
-H.R.2948: Increase by 5 cosponsors

H.R.4442/S.2484: CONNECT for Health Act*
Purpose:
This bill amends titles XVIII and XI of the Social Security Act to promote cost savings and quality care under the Medicare program to use telehealth and remote patient monitoring services, and for other purposes.
Status: H.R.4442: Introduced Feb. 3, 2016; Sponsor: Diane Black; cosponsors: 32 (21D, 11R)
S.2484: Introduced Feb. 2, 16; Sponsor: Brian Schatz; cosponsors: 18 (9R, 9D)
-H.R.4442: Increase by 3 cosponsors
-S.2484: Increase by 8 cosponsors

Lymphedema Legislation:

H.R.1608/S2373: Lymphedema Treatment Act
Purpose:
These companion House and Senate bills were introduced to amend title XVIII of the Social Security Act since Congress acknowledged that Medicare beneficiaries currently lack coverage for compression therapy. The goal is for Medicare to cover specific lymphedema compression treatment items and supplies as coverage benefits under durable medical equipment.
Status: H.R.1608: Introduced: March 25, 2015; Sponsor: David Reichert; 249 cosponsors (140D, 109R); S.2373: Introduced Dec. 8, 2015, Sponsor: Maria Cantwell; 28 cosponsors (19D, 9R)
-H.R.1608: Increase by 12 cosponsors
-S.2373: Increase by 7 cosponsors


Legislative Alert - Presidential Candidate Positions on Healthcare
August 4, 2016

In an effort to keep our members informed, the Advocacy Committee has reviewed the presidential candidates’ healthcare positions. We will provide updated information when/if it becomes available. This information is current as of 8/4/2016.

Democratic Nominee:

Hillary Clinton’s Perspectives on Healthcare and the Impact on Hand Therapy Services

Information adapted from Hillary Clinton’s Website:

https://www.hillaryclinton.com/issues/health-care/ 

Hillary Clinton's key agenda items that may touch upon hand therapy services:

  • "Defend and expand the Affordable Care Act." Secretary Clinton believes that expanding affordable coverage is necessary to provide services while decreasing costs. She states she will defend the Affordable Care Act (ACA), which may directly affect coverage of hand therapy and other rehabilitation services.
    • Impact on hand therapy: This policy could increase access to hand therapy services. With more Americans insured, this could help stabilize healthcare costs.
  • "Lower out-of-pocket costs like co-pays and deductibles.” the secretary believes this will help make services affordable.
    • Impact on hand therapy: These policies may influence affordability of hand therapy services for both individuals and families.
  • "Support new incentives to encourage all states to expand Medicaid.” According to Secretary Clinton, incentivizing states to help provide and expand Medicaid will help serve individuals who do not have access to services.
    • Impact on hand therapy: These policies could influence the number of insured clients seeking hand therapy services. Many individuals who previously did not have Medicaid coverage would now be covered.
  • "Expand access to affordable healthcare to families regardless of immigration status." Secretary Clinton believes that individuals and families who want to purchase health insurance should be able to do so regardless of immigration status.
    • Impact on hand therapy: These policies could influence the number of insured clients seeking hand therapy services. Many individuals who previously were not eligible to purchase coverage would now be covered. 
  • "Expand access to rural Americans, who often have difficulty finding quality, affordable healthcare." Secretary Clinton will take steps to expand telehealth reimbursement under Medicare and other programs in rural areas.
    • Impact on hand therapy: This could encourage passage of pending legislation designed to expand the eligibility of hand therapists to provide telehealth services and improve patient access to rural hand therapy services.

Republican Nominee:

Donald Trump’s Perspectives on Healthcare and the Impact on Hand Therapy Services

Information adapted from Donald Trump’s Website:

 https://www.donaldjtrump.com/positions/healthcare-reform

 https://www.donaldjtrump.com/positions/veterans-administration-reforms   

Donald Trump’s key agenda items that may touch upon hand therapy services:

  • Repeal the Affordable Care Act. A repeal of the Affordable Care Act would lift the legal requirement for all Americans to purchase health insurance and would return free market competition to the health insurance industry.
    • Impact on hand therapy: This policy could impact access to hand therapy services for uninsured clients.  For clients with insurance, free market competition could influence cost of coverage and subsequently the affordability of hand therapy services. Increased competition could bring down copayments or it could work in the reverse and plans could restrict visits or omit coverage altogether.  Insurers could do this directly within the health plan or indirectly by applying large copayments for therapy services.
  • Offer tax deductions on health insurance premiums. Allow Health Savings Accounts (HSA) for individuals.  HSAs provide tax-free payment options. Candidate Trump proposes that HSAs be allowed to accumulate value overtime, to be inherited as part of an estate without penalty, as well as to be used to cover any family member’s health expenses without penalty.
    • Impact on hand therapy: These policies may influence affordability of hand therapy services for both individuals and families.
  • Require price transparency from healthcare providers.
    • Impact on hand therapy: These policies would allow clients to have a better understanding of the costs associated with hand therapy services and allow them to “comparison shop” for providers.
  • Propose Medicaid Block Grants. Incentives would be offered to states that identify and eliminate Medicaid waste, fraud and abuse.
    • Impact on hand therapy: This policy may influence the stringency of Medicaid’s regulations and influence reimbursement for hand therapy services.
  • Allow eligible veterans access to any physician that accepts Medicare.
    • Impact on hand therapy: This policy may improve access for hand therapy services provided to veterans.
  • Create satellite VA clinics in rural and underserved areas.
    • Impact on hand therapy:  This policy may increase demand for hand therapists and improve access to hand therapy services in rural and underserved areas for veterans.

Legislative Alert - Active Legislative Update
July 13, 2016

Orthotics & Prosthetics Legislation:

S.2312 DME Access and Stabilization Act
-No change from previous report

S.829/H.R.1530 Medicare Orthotics and Prosthetics Improvement Act of 2015
-No change from previous report

H.R.1526: Medicare Audit Improvement Act of 2015
-No change from previous report

H.R.5210/S.2736: Patient Access to Durable Medical Equipment Act of 2016 and PADME Act
Purpose
: To improve access to durable medical equipment for Medicare beneficiaries under the Medicare program, and for other purposes.
Status: H.R.5210: Introduced to the House of Representatives 5/12/16, passed House 7/5/16; Sponsor: Tom Price; Cosponsors: 121 cosponsors (102R, 19D)
S.2736: Status: Introduced to Senate 3/17/16, passed Senate 6/21/16; Sponsor: John Thune; Cosponsors: 35 (22R, 12D, 1I)

Rehabilitation Legislation:

S.539/H.R.775: Medicare access to Rehabilitation Services Act
Purpose:
A bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps.
Status: H.R.775: Introduced: 2/5/15; Sponsor: Charles Boustany Jr; 231 cosponsors (128D, 102R, 1I)
S 539: Introduced: 2/24/15; Sponsor: Benjamin Cardin, 33 cosponsors (21D, 11R, 1I)

S.2409/H.R.4273: Medicare and Medicaid Improvements Act of 2015
Purpose:
To amend titles XVIII and XIX of the Social Security Act to improve payments for hospital outpatient department services and complex rehabilitation technology and to improve program integrity, and for other purposes.
Status: S.2409: Introduced: 12/16/15; Sponsor: Ron Wyden; 2 cosponsors (2D)
H.R.4273: Introduced 12/16/15; Sponsor: Gene Green; 10 cosponsors (10D)

H.R.3727: Health Insurance Rate Review Act
-No change from previous report

S.1849: Medicare Patient Empowerment Act
-No change from previous report

H.R.3770 End surprise billing act of 2015
-No change from previous report

S.800: Enhancing the Stature and Visibility of Medical Rehabilitation Research at the NIH Act
-No change from previous report

H.R. Helping Families in Mental Health Crisis Act of 2015
Purpose:
To ensure the availability of psychiatric, psychological and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes.
Status: Introduced 6/4/15, passed house 7/6/16; Sponsor: Tim Murphy, cosponsors: 207 (147R, 60D)

Telehealth Legislation:

H.R.4155/S.2343 Telehealth Innovation & Improvement Act of 2015
-No change from previous report

H.R.2066 Telehealth Enhancement Act of 2015
-No change from previous report

H.R.2948: Medicare Telehealth Parity Act of 2015
Purpose:
This House bill seeks to amend title XVIII of the Social Security Act. Under Medicare, the bill would allow for a gradual expansion of telehealth coverage.
Status: Introduced: 7/7/15; Sponsor: Mike Thompson; 62 cosponsors (42D, 20R)

H.R.4442/S.2484: CONNECT for Health Act
Purpose:
This bill amends titles XVIII and XI of the Social Security Act to promote cost savings and quality care under the Medicare program to use telehealth and remote patient monitoring services, and for other purposes.
Status: H.R.4442: Introduced 2/3/16; Sponsor: Diane Black; cosponsors: 29 (19D, 10R)
S.2484: Introduced 2/2/16; Sponsor: Brian Schatz; cosponsors: 10 (5R, 5D)

Lymphedema Legislation:

H.R.1608/S.2373: Lymphedema Treatment Act
Purpose:
These companion House and Senate bills were introduced to amend title XVIII of the Social Security Act since Congress acknowledged that Medicare beneficiaries currently lack coverage for compression therapy. The goal is for Medicare to cover specific lymphedema compression treatment items and supplies as coverage benefits under durable medical equipment.
Status: H.R.1608: Introduced: 3/25/15; Sponsor: David Reichert; 237 cosponsors (135D, 102R); S2373: Introduced 12/8/15, Sponsor: Maria Cantwell; 21 cosponsors (15 D, 6 R)


Legislative Alert - Legislation Cosponsor Updates
June 1, 2016

H.R.775: 228 cosponsors
S.539:    33 cosponsors

H.R.1528: 34 cosponsors

H.R.2948: 56 cosponsors

H.R.1608: 227 cosponsors
S.2373: 18 cosponsors


Legislative Alert - H.R.1526: Medicare Audit Improvement Act of 2015
April 29, 2016

This legislation amends the Medicare portion of the Social Security Act to modify payment policies in the Medicare program for DMEPOS:

  • All records of an orthotist or prosthetist who furnishes a prosthesis or orthosis to a Medicare beneficiary are considered part of the medical record to determine if the device is medically necessary
  • Medicare can deny payment if the supplier does not meet requirements for licensing or accreditation by a national board
  • Authorizes MAC and RAC review for supplier license or accreditation for DME     
  • Payments that have been made to those who do not meet O & P national board requirements will be recouped. RAC can review claims dating back four years
  • Patients are not liable for payment if the device is determined not reasonable or medically necessary
  • DOES NOT directly address those DME supplies provided by OTs, PTs, or physicians
  • DOES NOT apply to off-the-shelf orthoses
  • Directs the Secretary of HHS to review utilization of orthotics and prosthetics and develop utilization review criteria if necessary

Why this bill matters to hand therapists
This bill does not specifically include an exception to the orthotist licensing or accreditation requirement for therapists.

What you can do
Therapists residing in North Carolina should contact Representative Mark Meadows' office to explain the omission and urge him to include an exception in the bill for therapists. 

1024 Longworth HOB
Washington, DC 20515
Phone: (202) 225-6401
Fax: (202) 226-6422
Email: meadows@house.gov
https://meadows.house.gov/contact/offices


Legislative Alert - H.R. 775/S. 539: Medicare Access to Rehabilitation Services Act of 2015
April 20, 2016

These bills, introduced in their respective chambers in February 2015 would repeal the Medicare Rehabilitation Caps. To date, there are 225 bipartisan cosponsors in the House of Representatives and 32 bipartisan cosponsors in the Senate. On the House side, the bill has been assigned to the House Energy and Commerce Committee, which sent it to the Health Subcommittee, chaired by Rep. Joseph Pitts (Pennsylvania) and also to the House Ways and Means Committee Health Subcommittee, chaired by Rep. Patrick Tiberi (Ohio). On the Senate side, the bill is stuck in the Senate Finance Committee, chaired by Sen. Orrin Hatch (Utah). The respective committee chairs have the power to decide whether or not a bill is read and acted on by the committee. Both bills have been stalled for more than a year. A bill must be reported on by the committee before it can reach either chamber for a vote.

Despite both bills having the majority of bipartisan support, the respective committee chairs have not allowed action on these bills.

What this means for hand rehabilitation: Repeal of the Cap would remove the artificial restriction on Medically Necessary Rehabilitation Services and remove the burden from therapy providers of tracking the cap, initiating the exceptions process and facing manual medical review of claims exceeding $3,700. This also reduces stress on Medicare beneficiaries who often discontinue their therapy after reaching the cap for fear they will face large out-of-pocket costs if they continue or who put off surgery until the beginning of the calendar year in order to make sure they have enough therapy visits for post-surgical rehabilitation.

What you can do:  If you live in Ohio, Pennsylvania or Utah, please contact the committee chairman and let them know this legislation is important to you and your patients and should have the opportunity to reach the floor for a vote.  You can check to see if your congressperson or senators have signed on to cosponsor this legislation. (Scroll down to the Details section of the page where the cosponsors are listed.) If your legislators have signed on, tweet or email to thank them; if they haven’t, send a tweet or email asking for their support of this legislation or schedule a visit with their local office to find out why they are hesitant to support the legislation. Please send any feedback you receive to asht@asht.org.


Legislative Alert - S. 800: Enhancing the Stature and Visibility of Medical Rehabilitation Research at the NIH Act
April 20, 2016

3/19/2015—Introduced in Senate

2/9/2016-Status: Sent to Senate floor to be voted on as part of a larger medical innovation package that hopes to join with legislation passed in the House.

This bill amends the Public Health Service Act to revise requirements for medical rehabilitation research.

The purpose of the National Center for Medical Rehabilitation Research (NCMRR) is revised to include coordination of research and research training.

The NCMRR must develop and periodically update a comprehensive research plan for medical rehabilitation research. Currently, this research plan is developed and updated by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The NCMRR must: (1) annually report on progress in achieving the objectives, benchmarks and guiding principles described in the research plan; and (2) develop guidelines governing the funding for medical rehabilitation research by the National Institutes of Health.

The Medical Rehabilitation Coordinating Committee must periodically host a scientific conference or workshop on medical rehabilitation research.

The Department of Health and Human Services must enter into interagency agreements to coordinate medical rehabilitation research.

More information about NIH MRCC comprehensive plan to support rehabilitation research can be found here.

What does this mean for therapists?

Help to improve the lives of people with disabilities and chronic conditions by enhancing medical research completed at NIH, and in doing so, this could improve the provision of rehabilitation services and devices.


Legislative Alert - Adapted summaries of bills: H.R.4155/ S.2343 Telehealth Innovation & Improvement Act of 2015; H.R.2066 Telehealth Enhancement Act of 2015; H.R.2948 Medicare Telehealth Parity Act of 2015, and; H.R.1608/S2373 Lymphedema Treatment Act
February 19, 2016

H.R.4155/ S.2343 Telehealth Innovation & Improvement Act of 2015
H.R.4155
: House Sponsor: Rep Diane Black [R-TN6]
Cosponsors as of February 14, 2016: NONE
Introduced: December 2, 2015
Referred to House Subcommittee: December 4, 2015
Status: Referred to Subcommittee on Health

S.2343: Senate Sponsor: Cory Gardner [R - CO4]
Cosponsors as of February 14, 2016: 1
Referred to Senate Committee: December 2, 2015
Status: Read twice and referred to the Committee on Finance

Summary: These companion bills will require the Center for Medicare and Medicaid Innovation to test the effect of telehealth services in Medicare healthcare delivery reform models for cost, effectiveness and improvement in quality of care without increased cost of delivery. The bill would expand Medicare coverage to telemedicine services in rural areas and allow those hospitals to evaluate the benefits of telehealth services.

Why is this bill important for hand therapists?
Giving the Center for Medicare and Medicaid Innovation and rural hospitals the ability to evaluate and test the impact of telehealth services may create an opportunity for expansion of future coverage for Medicare beneficiaries in hand therapy practices.

H.R.2066 Telehealth Enhancement Act of 2015
House Sponsor: Rep. Gregg Harper [R-MS3]
Cosponsors as of February 14, 2016: 6
Introduced: April 28, 2015
Referred to House Subcommittee: May 1, 2015
Status: Referred to the Subcommittee on Health

Summary: This bill was introduced for the purpose of expanding and promoting how telehealth is applied under Medicare and additional federal healthcare programs, as well as other purposes. Coverage would include (but not be limited to):

  1. Increasing hospital payments with better-than-expected outcomes
  2. Intertwining telehealth and remote patient monitoring into plans similar to Medicare Advantage and supplemental coverage
  3. Bundling payments for telehealth services and remote patient monitoring
  4. Including critical access hospitals, sole community hospitals, home telehealth sites, etc. as originating sites for telecommunication systems for eligible telehealth individuals
  5. Specifying that universal telecommunication service support must be provided to additional healthcare providers including occupational therapists and physical therapists.
  6. Enhancing healthcare provider access to advanced telecommunication and information services, disregarding provider location.

Why is this bill important for hand therapists?
Since this bill has multiple coverage and payment benefits, hand therapy practices would receive increased coverage benefits for clients and patients who receive telehealth services. The more telehealth is promoted within healthcare programs on the federal level, the more care options are available to Medicare beneficiaries.
 

H.R.2948: Medicare Telehealth Parity Act of 2015
House Sponsor: Rep. Mike Thompson [D-CA5]
Cosponsors as of February 14, 2016: 27
Introduced: July 7, 2015
Referred to House Subcommittee: July 10, 2015
Status: Referred to the Subcommittee on Health

Summary: This House bill seeks to amend title XVIII of the Social Security Act. Under Medicare, the bill would allow for a gradual expansion of telehealth coverage. Coverage expansion would include (but not be limited to):

  1. Expanding telehealth coverage in three phases
  2. Extending "originating site" for telehealth service payment to any federally qualified health center and any rural health clinic (with eligible telehealth individual is located at time of service via telecommunication system.)
  3. Authorizing additional telehealth providers to include occupational therapists and physical therapists
  4. Extending coverage of Medicare to remote patient management services for certain chronic health conditions

Why is this bill important for hand therapists?
Telehealth expansion will increase the ability for healthcare practitioners to offer increased services to their Medicare clients and/or patients. Occupational and physical therapists would be authorized providers for telehealth, which inevitably expands reimbursement for hand therapy services, especially in rural health clinics and for certain chronic health conditions.

H.R.1608/S2373: Lymphedema Treatment Act
H.R.1608
: House Sponsor: Rep. David Reichert [R - WA8]
Cosponsors as of February 14, 2016: 188
Introduced: March 25, 2015
Referred to House Subcommittee: March 27, 2015
Status: Referred to the Subcommittee on Health

S.2373: Senate Sponsor: Maria Cantwell [D - WA]
Cosponsors as of February 14, 2016: 10
Referred to Senate Committee: December 8, 2015
Status: Read twice and referred to the Committee on Finance

Summary: These companion House and Senate bills were introduced to amend title XVIII of the Social Security Act since Congress acknowledged that Medicare beneficiaries currently lack coverage for compression therapy. The goal is for Medicare to cover specific lymphedema compression treatment items and supplies as coverage benefits under durable medical equipment. Covered treatment items (as prescribed by a physician, physician assistance, nurse practitioner or clinical nurse specialist) are as follows: multilayer compression bandaging systems, custom or standard fit gradient compression garments, non-elastic and low elastic compression garments and compression wraps and directional flow pads and any other compression garments, bandaging systems, devices and aids determined to be effective in the prevention or treatment of lymphedema.

Why is this bill important to hand therapists?
Medicare coverage of certain compression treatment items and supplies will impact reimbursement for hand therapy practitioners. These expanded items will be able to be billable under durable medical equipment for any Medicare beneficiary receiving lymphedema hand therapy services.

Summaries Adapted From:
www.govtrack.us and
http://thomas.loc.gov/home/bills_res.html (The Library of Congress)


Legislative Alert - H.R. 3762: Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015
February 12, 2016

Feb 2, 2016 —The President vetoed this bill (1/8/2016). Congress then attempted to override the President’s veto. A vote to override the President’s veto failed in the House. This bill is now dead.

This bill would have repealed key parts of Obamacare including:

  • Restricted the federal government from operating healthcare exchanges
  • Phased out funding for subsidies to help lower- and middle-income individuals afford insurance through the healthcare exchanges
  • Eliminated tax penalties for individuals who do not purchase health insurance and employers with 50 or more employees who do not provide insurance plans
  • Eliminated taxes on medical devices and the so-called “Cadillac tax” on the most expensive healthcare plans
  • Phased out an expansion of Medicaid over a two-year period
  • Ended federal funding for Planned Parenthood

Legislative Alert - H.R. 105: Quality Health Care Coalition Act of 2015
February 12, 2016

1/6/2015 — Introduced in House.

Exempt healthcare professionals, including individuals and entities, from federal and state antitrust laws in connection with negotiations with a health plan regarding contract terms under which the professionals provide healthcare items or services for which plan benefits are provided.

This act (1) applies only to healthcare professionals excluded from the National Labor Relations Act; and (2) does not apply to negotiations relating to Medicare or Medicaid programs, the Children's Health Insurance Program, medical and dental care for members of the uniformed services, veterans' medical care, the federal employees health benefits program or the Indian Health Care Improvement Act.

How does this bill impact hand therapists?
Therapists will be allowed to legally negotiate reimbursement rates as a group, whereas now, it is a violation of anti-trust laws.