Repeal of the Medicare Cap on Outpatient Therapy and amendment for Physical Therapists to Opt Out of Medicare

Repeal of the Medicare Cap on Outpatient Therapy and amendment for Physical Therapists to Opt Out of Medicare

On my mind today:

Following is a list of the Members of the Ways and Means Subcommittee on Health. We need to contact these folks to ask them to support H.R. 1546 (112th): Medicare Access to Rehabilitation Services Act of 2011. This will amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. By repealing the outpatient rehabilitation caps we will allow patients with chronic illnesses and complicated recoveries to continue to access the care they need to live a full and functional life. If your representative is not on this list, please contact them anyway. Every representative matters.

Ways and Means Subcommittee on Health

Rep. Kevin Brady, TX, Chairman

Rep. Sam Johnson, TX
Rep. Paul Ryan, WI
Rep. Devin Nunes, CA
Rep. Peter Roskam, IL
Rep. Jim Gerlach, PA
Rep. Tom Price, GA
Rep. Vern Buchanan, FL

Rep. Adrian Smith, NE

Rep. Jim McDermott, WA, Ranking Member
Rep. Mike Thompson, CA
Rep. Earl Blumenauer, OR
Rep. Ron Kind, WI
Rep. Bill Pascrell, NJ

Contact Info:

Ways and Means Committee Office
1102 Longworth House Office Building
Washington D.C. 20515
P: 202-225-3625
F: 202-225-2610

We also need to ask our representatives to amend Section 1802(b)(5)(B) of the Social Security Act, which currently prohibits physical therapists from entering into private contracts with Medicare patients to provide services. Because the current law does not allow physical therapists to “opt out” of Medicare, small physical therapist owned private practices that do not participate with Medicare are prohibited from treating Medicare patients. This prohibits a significant portion of the population from seeking physical therapy care from the provider of their choice. Nearly all other healthcare providers and physicians are able to “opt out” and many service providers (massage therapists and personal trainers) are not restricted from working with Medicare patients because they are not in a position to take Medicare as payment for services.

Thanks to Tim Richardson, PT for providing this explanation of the wording we seek to have inserted into the amendment:

To accomplish this change, we recommend that Section 1802(b)(5)(B) of the Social Security Act be amended as follows: Section 1802(b)(5)(B) (42 U.S.C. 1395a(b)(5)(C)) is amended by striking “the term practitioner has the meaning given such term by section 1842(b)(18)(C)” and inserting “In this subparagraph, the term “practitioner” means an individual defined at section 1842(b)(18)(C) or an individual who is qualified as a physical therapist.”

Please show your support for outpatient physical therapy by following up on these issues. We need to make our voices heard, for the benefit of our patients.

  1. Ann: After seeing your blog post, I contacted our advocacy staff for their input. That said, some background on this issue for you and your readers:

    APTA has long supported allowing physical therapists to “opt out” of the Medicare program and privately contract with Medicare beneficiaries. APTA believes that Medicare beneficiaries should be empowered to select the health professional of their choice and would support legislative change to allow for physical therapists and other health care professionals to privately contract with beneficiaries.

    In the previous Congress, APTA advocated for language to be included in legislation by Congressman Tom Price (HR 3000 in the 112th Congress) that would allow physical therapists to opt out of Medicare. The bill was a larger comprehensive health care bill that included provisions on a number of topics not related to the opt-out. APTA supported the Congressman’s provisions on opt-out.

    APTA advocacy staff has already reached out to the Congressman’s office to begin discussions on follow up legislation for the 113th Congress, which could include both the larger comprehensive reform bill and another separate bill specific to reform the opt-out provision for providers under Medicare.

    In addition, APTA is currently advocating for Congress to address the issue of opt-out for physical therapists in legislation that may be considered this year regarding reforming the Sustainable Growth Rate (SGR or “doc fix”). APTA has included this recommendation in formal comments to the House Ways and Means Committee and the House Energy and Commerce Committee, which are due on February 25.

    At this time, APTA’s primary legislative focus continues to be on averting MPPR cuts scheduled to take effect April 1, but in the near future there will be opportunities to support legislation that would allow physical therapists the ability to opt out. (APTA members should sign up for PTeam to be alerted to opportunities to take action.)

    Stay tuned to for upcoming opportunities to support these advocacy efforts.


    Jason Bellamy
    Director, Web & New Media, APTA

  2. Jason,

    Thanks so much for passing along that background information. So, if I am understanding correctly, the situation remains that as of right now, physical therapists can NOT opt out of Medicare;but,APTA is working with Congressman Tom Price to discuss follow up legislation for the 113th Congress. Is that correct?
    I will pass along this information to interested therapists.
    Thank you for commenting,

  3. Ann: That is correct, and, additionally, APTA is encouraged by the potential opportunity for this type of provision to looked at during SGR reform discussions this summer.

  4. It’s great to hear that APTA is focusing on this issue. Please keep me posted and I will update readers.

  5. This is great news! We need to continue to put the pressure on our legislators to get SGR and “PT opt-out” legislation passed. Our seniors deserve the ability to access the Physical Therapist of their choice. For too long, cash based PTs have been limited by this arbitrary and unfair law that restricts our ability to practice and earn a living. Thank you to the APTA for continuing to address legislative fixes for the issues our profession is facing.

  6. Chris,
    Thank you for commenting. I agree wholeheartedly – the restrictions do limit my ability to practice and earn a living. The fact that I have to turn Medicare patients away all the time, only to have them say “Ok, I’ll just keep working with my personal trainer/massage therapist/Reiki practitioner/etc” is a tragedy.

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