It’s been awhile since a legislative update. The last time we took a look at what’s going on with PT legislation was right at the end of 2024. Since we’re a third of the way into the year already, I figured it was time for a little legislative update. You’ll see some familiar pieces of legislation that followed us into 2025 as well as a few new ones we haven’t talked about before. Let’s get right into it and see what’s been going on in Congress.
Decreased Medicare Reimbursements Stand
In March Congress passed a budget reconciliation bill to fund the government through September. Notably left out was anything to address the 2025 Medicare Fee Schedule cuts. Several healthcare organizations were disappointed and frustrated with this outcome as it was the second time Congress had failed on their promise to address the cuts.
APTA and other healthcare organizations have continued to support the Medicare Access and Stabilization Act (H.R. 879) in future spending packages. If you need a refresher, the bill prevents harmful cuts by adjusting Medicare reimbursements for inflation. If passed, the bill would actually result in a slight increase in PT reimbursement versus the 2.8% cuts we’re currently looking at.
It seems congress and health organization leaders remain in discussions of how to address the cuts. Different options have been thrown out including a third promise to look at it in the next spending package. The Stabilization Act continues to gain bipartisan support. Continue to reach out through the APTA or your own means to encourage your representatives to sponsor the bill.
Cuts to Medicaid to have Big Implications
Medicaid is also looking at some cuts which have some potential big implications for our younger patients. The cuts to Medicaid leave states with difficult choices about how to offset the loss in funding. It will most likely result in decreased access to some services (including therapy) for some vulnerable populations.
Speech, occupational, and physical therapy are considered related services under The Individuals with Disability Education Act (IDEA). It’s a law that ensures children with disabilities have access to services that allow them to receive a proper education.
But wait, school funding is separate from Medicaid right? Well actually, Medicaid is a huge source of funding for school-based health programs. It sometimes helps pay for therapists, nurses, and counselors. These professionals sometimes work with all students too, not just one’s with disabilities.
If the cuts don’t result in total elimination of services it will likely result in decreased staff. That means kids may wait longer to receive services or see reduced quality and quantity of services. Early intervention services are at risk too. Medicaid dollars helps fund these as well. These programs provide resources to families whose babies and toddlers are diagnosed with a disability before they’re school aged and have resources through the schools. These resources are anything from therapy to equipment in order to help with early childhood development.
At the end of March, APTA and many other organizations involved in the Patient Access to Responsible Care Alliance group sent a letter to Congress to avoid cuts to Medicaid. We can join them by continuing to advocate against cuts and urging our representatives to do the same. If the cuts do go through, our youngest patients are likely to suffer. It’s also likely many allied health professionals will lose their jobs or see salary cuts. Sounds like a lose-lose situation to me.
If you’re a pediatric therapist, especially in the school system, I’d love to hear your story. Please share in the comments how cuts could affect your patients and even yourself. Also share what the rest of us can do to help!
Medicare Telehealth Extended
While the cuts to Medicaid and Medicare are still under discussion, one thing that’s not is the extension of coverage for Medicare telehealth visits! This is an issue I’ve talked about in previous legislative updates because it was set to expire in March. Well in March, this was extended to the end of September 2025.
The APTA and many other professional organizations continue to advocate for the permanent approval of telehealth visits for Medicare patients. There are several bills out there supporting this. The Expanded Telehealth Act (H.R. 3875/S.2880) is the primary bill supported by the APTA and other allied health professionals. The bill has already been brought to the appropriate committees. Now we need to push for its mark-up and co-sponsors before September. Reach out to your state representatives. Encourage them to co-sponsor or at least vote in favor of this bill.
I think telehealth visits, especially for Medicare patients make perfect sense. They’re a population that getting and keeping in contact with their providers is vital. However, it’s also a little harder sometimes for them to get out of the house. They may not drive anymore, but can’t always get a ride. During the winter in the Midwest it’s not always safe for 85 year old Mr. Smith with bad eyesight and poor balance to get to his appointments.
This population has everything to gain and nothing to lose from telehealth. Reach out to your representatives. It would be great to get a permanent solution for this versus relying on extensions.
Optimizing Postpartum Outcomes Act (H.R. 2480)
Apparently this bill was introduced to Congress awhile ago, but for some reason I’m just now hearing about it. This isn’t maybe a true “update”, but I wanted to give some awareness to it. Like I said, I didn’t know it existed till recently, but I think it’s a great bill!
This bill would require CMS to improve awareness, guidance, and coverage for pelvic health services postpartum. It would also require the government to compose a report on gaps in coverage for pelvic health and other postpartum care. Lastly, the government would also have to develop a program to educate healthcare providers and patients on the benefits of pelvic healthcare and other postpartum screenings.
For someone who doesn’t have kids or specialize in pelvic health, I still find the state of maternal healthcare in the U.S. deeply interesting. I have lots of opinions, but I’ll try to keep it to just the PT part. I honestly don’t understand why every postpartum woman is not referred to pelvic PT. To me it should be standard. So many women are out here peeing their pants among other issues after giving birth and ITS NOT NORMAL.
I’ve been lucky enough to be friends with some really great pelvic PTs and moms that have opened my eyes to all the gaps and holes in womens’ healthcare – pre and postpartum. It seems the needle needs to be moved. Getting CMS on board sounds like a good place to start. Right now, you can contact your elected officials and spread info about the bill to offer your support. What do you think of this bill? Especially if you’re a pelvic PT I’d love to know your thoughts.
No Fees or EFTs Act (H.R. 6487/S. 3805)
Similar to the previous bill, I did not know this bill existed! It was introduced to its committee at the end of 2024. I also didn’t know that under the Affordable Care Act, insurances are required to offer practices the option to receive reimbursement electronically. The problem is that insurances frequently charge a 2-5% fee for electronic reimbursement.
Just when we thought it couldn’t get more messed up than it already was. To recap, insurances are one, denying what they owe us A LOT of the time. Also two, are always decreasing how much they’ll pay us. Now three, are taking a percentage of what they owe us. . . That’s like me owing you for a service, but then paying you less because you decided you wanted to be paid through Venmo. . . WHAT?!
Well the No Fees or EFTs Act would make it so insurances couldn’t impose those 2-5% charges. Fun fact, this is also a bipartisan bill. We love to see it when we can all agree on something. The passing of the bill could save healthcare providers major bucks and give some relief from the always decreasing reimbursements. Reach out to your elected officials to support the bill and spread the word to other healthcare providers!
What do you think about some of the legislative updates out there right now? Which one makes you the most excited . . . or the most pissed. I’d love to hear your thoughts on some of these. Any other legislation you know of that I didn’t discuss? Drop that in the comments as well. If you don’t want to miss future legislative updates or anything else on The PT Page – hit that subscribe button to stay up to date on all things PT.
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