IRG Legislative Update – November 2020

Nov 24

With the year coming to a close and the publishing of the 2021 Medicare Physician Fee Schedule Final Rule just around the corner, providers have been turning their attention toward legislative activities addressing the pending Medicare reimbursement cuts that were included in the Proposed Rule.  Through its affiliation with the Alliance for Physical Therapy Quality and Innovation (APTQI), IRG has committed resources to lobbying and advocacy efforts to help fight these cuts.  In addition, IRG continues to stay abreast of legislative developments that would have a significant impact on therapy providers if passed.  A quick summary of several pieces of legislation of interest which IRG will continue to monitor in the coming weeks and months:

H.R. 8702 (“Holding Providers Harmless From Medicare Cuts During COVID-19 Act OF 2020”)

On October 30th, Reps. Ami Bera (D-CA) and Larry Bucshon (R-IN) introduced legislation (H.R. 8702) in the House of Representatives which would add funding to Medicare and direct CMS to essentially reset payment to 2020 levels for providers facing reimbursement cuts.  Known as the “Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020”, this bipartisan legislation would enable pay increases for primary care and other providers who often provide E/M services, while avoiding devastating, corresponding cuts for millions of other providers due to Medicare’s budget neutrality requirements.  If passed, the legislation would effectively freeze payments at 2020 rates for services scheduled to be cut in 2021 for a period of two years while allowing the planned E/M increases to take place as scheduled.  In a nutshell, if a code billed in 2021 carried a higher reimbursement in 2020, the provider would be still be paid at the lower rate established for 2021 plus an additional payment in order to level the total payment to the 2020 rate.  There has been some concern if the bill were to pass as written that other payers who adopt the Medicare fee schedule would reference the 2021 Conversion Factor and RVUs as finalized but not make similar adjustments to offset the cuts.

H.R. 8505

Earlier in October, Michael Burgess (R-TX) and Bobby Rush (D-IL) introduced H.R. 8505, a bill that would establish a one-year delay of implementation of the cuts, paid for through the Pandemic Provider Relief Fund.  If passed, this bipartisan legislation would temporarily waive budget neutrality adjustments under the Medicare Physician Fee Schedule. By waiving Medicare’s budget neutrality rule for one year, the legislation would give the Department of Health and Human Services and CMS the ability to immediately delay or mitigate the proposed cuts while allowing the scheduled payment increases to go into effect for primary care and other physician office visits.  While a one-year delay offset by $10b from provider relief funds would not provide a long-term fix, it would allow time for affected specialties to lobby for a permanent consensus plan going forward.

H.R. 7154 (“Outpatient Therapy Modernization and Stabilization Act”)

In June, Reps. Brendan Boyle (D-PA) and Vern Buchanan (R-FL) introduced H.R. 7154, also known as the “Outpatient Therapy Modernization and Stabilization Act” in the House.  The bill targets the proposed 2021 reimbursement cuts as well as several other key issues relevant to the therapy profession.  In regard to the cuts, the bill would provide a one-year budget neutrality exemption so that payment increases for other providers do not force payment cuts for other specialties.  In addition, the legislation includes an amendment to the telehealth provisions of the Medicare statute that would permanently allow physical, occupational, and speech therapy providers to bill for services furnished via telehealth as well as adjustments to the Medicare Physician Fee Schedule that would result in payment increases of 1% in 2021 and 0.5% in 2022 and 2023.  The bill would also reduce administrative burdens by clarifying that either a physician’s signed order/referral for therapy services OR a signed plan of care would satisfy certification requirements but not both, as is currently the case.

H.R. 8755 (“Expanded Telehealth Access Act”)

Reps. Mikie Sherrill (D-NJ) and David McKinley (R-WV) introduced the Expanded Telehealth Access Act (H.R. 8755) in the House on November 16th, 2020.  The bill proposes to add physical, occupational, and speech therapists to the list of providers that are eligible to provide telehealth services to Medicare beneficiaries.  CMS has indicated that it does not have the authority to extend the current telehealth therapy provisions under the PHE without Congressional action.  This legislation would make permanent the reimbursement eligibility for PTs, OTs, and SLPs and permits the Secretary of the Department of Health and Human Services to expand this list.  While the proposed legislation may face challenges as a stand-alone bill, there is hope that several similar bills could be grouped in a bipartisan package and/or possibly included in a future stimulus package.