Prime Mover - Spring 2009

By Gretchen Johnson, PT and Sahreem Luergan, PT

Summary of the New Mexico Legislative Session

The Physical Therapy Practice Act Renewal Bill, HB 286, championed by Rep. Jeannette Wallace of Los Alamos passed the House and Senate by a unanimous vote. This bill extends the PT Practice Act through July 1, 2015.

The "Super board" Bill (HB 585/SB 174), would have created another layer of bureaucracy to deal with any changes with practice acts of NM medical professionals. We opposed this bill because we felt that it was duplicitous, would drive up costs, and would allow physicians and others to make decisions about our practice environment. The bill was resoundingly defeated at its first committee hearing, and was dropped for the session. We will need to still keep our ears to the ground for it to resurface at later sessions, and we will be ready to again voice our opposition. Thanks to the efforts of our active PT constituents and our Lobbyist Bryan Ortiz for helping to prevent this bill from going forward.

The Health Care Authority Act, HB 267, passed the New Mexico House of Representatives by a 60-2 vote on March 7th and was held up in the Senate Finance Committee when the session ended and never made it to the Senate floor. Sponsored by Representative Mimi Stewart, the bill would have created an independent Health Care Authority charged with developing a comprehensive plan to achieve sustainable, accessible and affordable health care for New Mexicans by September 1, 2010.

New Mexico has the 2nd highest number of uninsured residents in the country. A study completed in 2006 indicated that the cost of taking no action towards health care reform in New Mexico would result in a $2 billion increase in cost by 2011 and the number of uninsured residents would continue to rise. Steadily increasing health care costs place a significant burden on local businesses, further exacerbating the situation and directly impacting the State's economy. APTA supports the rights of all citizens in the US to have access to high-quality, affordable healthcare.

Local Advocacy: On March 17th, NMAPTA sponsored a Physical Therapy Students at the Legislature Day which was a great success in helping the students understand the legislative process and encouraging them to become involved in the future. Thanks to Pat Bartels, PT OCS and Sue Queen, PT, PhD for making this happen.

For questions or comments on state issues: email Gretchen Johnson at santafejohnsons@cnsp.com.

FEDERAL UPDATE

On the federal level, our focus has been to identify new physical therapy "Key Contacts" for each member of the Congressional delegation and to educate our membership and the legislators about current issues affecting physical therapy and our patients.

This winter and spring, we have conducted office visits, attended round table discussions, and provided written materials to members of congress and will be going to Washington, DC May 17-19 to meet with them on Capitol Hill. We have asked for New Mexico APTA members to take action and call or email members of congress about current legislation and we really need you all to follow through on this in order to encourage them to co-sponsor bills that we need support on or to defeat bills that may be harmful to PT practice.

Summary of Federal Issues

Support Medicare Direct Access

The American Physical Therapy Association (APTA) strongly supports the re-introduction of the Medicare Patient Access to Physical Therapist Act of 2009 (HR 1829). This legislation would allow Medicare beneficiaries to directly access physical therapists for outpatient services as authorized by state law. Congressmen Earl Pomeroy (D-ND) re-introduced HR 1829 on March 31, 2009. This legislation had 157 House cosponsors during the 110th Congress in 2007 and 2008. Currently, HR 1829 has 56 original cosponsors. Building on this number of cosponsors is essential to sustaining momentum on this issue. Currently, no New Mexico Representatives are signed on as co-sponsors.

The Medicare Patient Access to Physical Therapist Act (HR 1829) recognizes the ability of licensed physical therapists to evaluate and treat beneficiaries requiring outpatient physical therapy services under Part B of the Medicare program without a physician referral or certification of the plan of care, if direct access is authorized by state law in the state in which the therapist practices. Requiring a referral is unnecessary and limits timely access to medically necessary physical therapists' services. APTA believes improving access to care for beneficiaries is critical as Congress looks to reform the Medicare program.

Support Medicare Therapy Cap

January 6 Update: Legislation to Repeal Therapy Caps Introduced.
Congressmen Xavier Becerra (D-CA), Mike Ross (D-AR), and Roy Blunt (R-MO), and Senators John Ensign (R-NV) and Blanche Lincoln (D-AR) introduced The Medicare Access to Rehabilitation Services Act (HR 43/S 46). This legislation will repeal the cap on therapy services for Medicare beneficiaries once and for all. If Congress does not take action by December 31, 2009, the therapy cap will again be imposed on Medicare-covered physical therapy, occupational therapy, and speech language pathology services.

Support Student Loan Repayment

Recently, U.S. Representatives Marion Berry (D-AR) and Jo Ann Emerson (R-MO) introduced legislation to enable physical therapists to participate in the National Health Service Corps (NHSC) Loan Repayment Program, the Physical Therapist Student Loan Repayment Eligibility Act (HR 988).

APTA needs you to assist in building support for student loan repayment for physical therapists that choose to practice in rural and urban underserved areas. At this time there is not a Senate version of the legislation - so please focus your efforts on your United States Representative.

SUMMARY OF THE LEGISLATION (HR 988)

The bill adds physical therapy to the definition of the National Health Service Corps' primary health services by amending Section 331(a)(3)(D) of the Public Health Service Act (42 U.S.C. 254d(a)(3)(D).

The bill adds physical therapists to the National Health Service Corps Loan Repayment Program to the list of eligible providers by amending Section 338B of the Public Health Service Act (42 U.S.C. 254l-1).

The bill adds the following to the Loan Repayment Program's eligibility requirements by amending Section 338B of the Public Health Service Act (42 U.S.C. 254l-1):

receipt of a doctoral or master's degree in physical therapy;
enrollment in a physical therapy graduate training program; and
enrollment as a full-time student in a course of a study or program leading to a degree in physical therapy.

Oppose HR 1137

On Monday, February 23, Congressman Edolphus "Ed" Towns (D-NY) introduced HR 1137. This legislation would overturn the current Medicare "incident-to" rule and recognize athletic trainers as covered providers under Medicare.

APTA strongly opposes this legislation (HR 1137) 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.

Background

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.

Our Concerns:

Patient Safety - HR 1137 jeopardizes the health, safety and welfare of Medicare beneficiaries by allowing non-qualified individuals to provide therapy services. 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.

Cost-effectiveness - HR 1137 is fiscally irresponsible and will cost taxpayers due to inappropriate billing of therapy services by non-qualified individuals. 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.

Quality Care - HR 1137 dilutes the quality of care for Medicare beneficiaries by allowing non-qualified individuals to deliver therapy services. 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.

If you have not contacted your legislators on these issues, now is the time! We would like to have their support before we go to Washington DC in May. They will be in their legislative districts for spring break April 3-17, 2009. This is also a great time for your patients to let them know what a difference physical therapy makes in their lives.

Contact information for all the legislators is available on the NMAPTA website or through the APTA website under Advocacy. Please contact me with federal legislative questions or comments at sahreeml@yahoo.com.