The year is almost over so I figured it would be most appropriate to close things out with a little legislative update. There are some BIG, extremely positive things happening in congress. Now, I’ll preface that with a warning because not everything is quite over the finish line. I seriously CANNOT stress enough just how big a few of these are. A couple of them are absolute game changers. Keep reading to find out what has been going on and how you can help
#1.) CMS Set to Increase Reimbursement IF Important Bills Pass
Surprise, surprise, the initial 2025 Medicare Physician Fee Schedule proposed cuts across the board. What actually is a surprise though is that some potential legislation could actually turn what should have been a 2.8% cut to PT reimbursement into a 1.9% increase for 2025.
The Medicare Patient Access and Practice Stabilization Act of 2024 and the H.R. 2474, the Strengthening Medicare for Patients and Providers Act are very popular bipartisan legislations. They’ve been backed by APTA and other large medical organizations, including the American Medical Association. The bills propose ideologies such as inflationary increases in reimbursement and fixing budget neutrality.
I don’t want to get overly excited, but I definitely need to stress how HUGE it would be if this legislation makes it through Congress. Not only would it be the first increase in reimbursement in years but would ensure increases year over year. You’ve probably read on other blogs, articles, or social media comments that our poor pay comes from poor reimbursement. Well, this is a step in the right direction.
So what’s holding it back? Well, political gridlock before Congress is dismissed for the year is possible. This would push this legislation back to 2025, which means things wouldn’t actually change until 2026.
What can we do? Unfortunately not a ton, obviously if a gridlock happens it will be for a lot of reasons. BUT there is one, simple, easy, non-time consuming thing we can all do. Send an electronic letter to your representative through APTA action center and don’t you dare roll your eyes at me. Santa is watching. I know you might not think this does anything, but it does, trust me. Send the damn letter and remind your representative what’s on the table here.
Seriously though this is the kind of legislation we dream of. It will benefit both us and our patients. If congress does gridlock at the bills get pushed back so be it. At least we’ll know we did everything we could do instead of skipping one VERY simple action. If you don’t care about this I seriously can’t help you. Here’s the link so effing do it.
#2.) Prior Authorization Reforms Under Medicare Advantage Plans
The Improving Seniors’ Timely Care Act (H.R. 8702/S. 4532) doesn’t eliminate prior authorization for seniors under Medicare Advantage plans, but it certainly simplifies it by streamlining processes and removing a lot of the red tape. The bill has been introduced in both house and senate and championed by a team of both democrats and republicans (glad we can all agree on something). It’s popularity is also high with several co-sponsors in both house and senate.
Like I said, it doesn’t get rid of authorizations, but it proposes several promising reforms. The bills calls for an electronic prior auth process for routine things that are typically approved to ensure patients get the care they need when they need it. It would also require CMS to complete detailed reporting on how prior auths are used. This would include denials, approvals, AND the average time for approvals.
My favorite part of the bill is it specifically asks for more input from healthcare providers in the process and decision making on prior authorizations. Imagine that?! Someone who actually works in healthcare getting a say in how it’s done. Makes almost too much sense (insert eye roll here).
#3.) Decreased Direct Supervision of PTAs
PTAs you’ll have special interest in this one, but it’s good for all of us. Thanks to APTA efforts through the language of the EMPOWER Act, the excessive direct supervision requirement of PTAs under Medicare Part B will be updated to general supervision. In the past, PTAs required direct supervision under Medicare Part B for private outpatient PT practices. All other settings only required general supervision.
As a reminder direct supervision means the PT is onsite while a PTA is treating the patient. In general supervision the PT does not have to be present only reachable by phone.
Not only was this a completely outdated requirement, but it honestly hindered patients’ ease of access to physical therapy services. It also unjustly jeopardized job opportunities for PTAs. This elimination of this honestly DUMB rule will make things easier for PTs, PTAs, staffing, and patients. You honestly love to see it when simplifying things by getting rid of silly regulations helps everyone out.
#3.) The Personal Health Investment Today (PHIT) Act (H.R. 1582/S. 786)
This last one is more PT adjacent versus directly related to PT, but I thought it was very interesting. This bill sponsored by Rep Mike Kelly of PA allows for a tax deduction of up to $1,000 from money spent on fitness expenses.This includes fitness memberships, physical exercise or activity, or equipment for a fitness or activity program.
This deduction could incentivize more people to become physically active but also decrease the financial burden. This tax deduction would count toward gym memberships, some home gym equipment, and organized sports teams.
As PTs a bill like this could help lead patients to a healthier lifestyle. Honestly, I’m invested for personal reasons as well! Getting a little tax break for all the money I spend for my gym membership sounds pretty nice. So far it’s only been introduced but I’ll definitely be interested to see where it goes. It already has several co-sponsors as well. You can find more details on the PHIT Act here. Hopefully we’ll see some more progress on this in 2025.
Thanks for reading this legislative update! Don’t forget to send that letter! And don’t forget to share with your friends to help spread the word!
What do you think about these four updates? Which one interests or excites you the most? Drop it in the comments section.
This is actually the last blog post for the year. The PT Page will be back with a new post the second week of January. Hit the “subscribe” button below to get notified when the first post of 2025 goes up!
No need to worry though. If you’ve missed any posts you can read them by visiting the blog page to get all caught up by the new year! Now is also a great time to follow the_pt_page on Instagram and Threads to get new content over the holidays. You didn’t think I’d totally leave you hanging did you?
Thanks to everyone reading and following The PT Page! Wishing you and your families a Merry Christmas and Happy New Year!
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