Legislative Update: Locum Tenens and Medicare Therapy Caps

There have been some recent developments regarding legislation which should be of interest to physical therapists.  First, the “Prevent Interruptions in Physical Therapy Act of 2014” (S.2818) was introduced in the Senate on 9/16/14 and subsequently referred to the Committee on Finance.  The bill aims to amend title XVIII of the Social Security Act to add physical therapists to the list of providers allowed to utilize locum tenens arrangements under Medicare.  Locum tenens provisions, which allow health care providers to bring in another licensed provider to treat Medicare patients and bill Medicare through the practice provider number during temporary absences, currently extend only to doctors of medicine, osteopathy, dental surgery, podiatric medicine, optometry, and chiropractic.  As a result, patients receiving physical therapy must often face potential gaps in care when therapists are absent as a result of pregnancies, vacations, illness, continuing education, etc.

The proposed legislation is a companion bill to H.R. 3426 which was introduced in the House in October of 2013 and referred to the Committee on Ways and Means and to the House Energy and Commerce Subcommittee on Health.  The addition of locum tenens provisions for physical therapists would be a significant change as locum tenens arrangements not only allow providers to bill and receive payment for a replacement provider’s services but, more importantly, ensure the continuity of care for patients.

In other legislative news, a bill aimed at repealing the Medicare therapy caps has now reached 221 co-sponsors, surpassing the 218-member majority threshold.  The “Medicare Access to Rehabilitation Services Act of 2013” (H.R. 713), introduced in February of last year, would permanently repeal the yearly caps for physical, occupational, and speech therapy.  A vote is not expected on the bill until after the fall elections and possibly not until 2015.  Earlier this year, the “Protecting Access to Medicare Act of 2014” extended the therapy cap exceptions process at $1,920 and the manual medical review process at $3,700 through March 31st, 2015. Additional legislation will be required to either extend the exceptions process beyond 3/31/2015 or to repeal the therapy caps altogether.

A permanent repeal of the therapy caps is long overdue and would certainly be received positively by the therapy community.  However, a complete repeal may come with some additional stipulations which may present additional challenges for clinicians.  One possible scenario would be that, in the absence of a true cap, the threshold for manual medical review would be set at a much lower amount than the present $3,700 mark.  Revisions to the manual medical review process might also include the reestablishment of a prior authorization component similar to what CMS used from October through December of 2012 in which therapists had to submit formal requests for additional visits to their respective MACs prior to continuing care.

Time will tell what the final determination will be in regard to the therapy caps, but it is unlikely that a complete repeal of the caps would occur without some other type of cost containment measure to ensure that therapy services are medically necessary and require the skilled services of a licensed therapist.  Stay tuned for more details.