****APTA LEGISLATIVE ACTION ALERT****

Ensuring that Qualified Physical Therapists
Provide Medicare Physical Therapy Services
Oppose HR 1846 Today!


On Thursday, March 29, Congressman Edolphus "Ed" Towns (D-NY)
introduced Medicare Access to Physical Medicine and Rehabilitation
Services Improvement Act (HR 1846). This legislation would overturn
the current Medicare "incident-to" rule and recognize athletic
trainers and lymphedema therapists as covered providers under
Medicare.

APTA strongly opposes this legislation (HR 1846) and supports
Medicare's ability to require qualification standards for therapy
services provided "incident to" a physician's professional services.
It is the position of the American Physical Therapy Association
(APTA) that physical therapists are the qualified professionals who
provide physical therapy examinations, evaluations, diagnoses,
prognoses, and interventions. Interventions should be represented
and reimbursed as physical therapy only when performed by a physical
therapist or by a physical therapist assistant under the direction
and supervision of a physical therapist.

Background

In November 2004, the Centers for Medicare and Medicaid Services
(CMS) included provisions in the final rule for the 2005 Medicare
physician fee schedule that established qualifications and clinical
preparation standards for individuals who provide physical therapy
services "incident to" a physician's professional services. These
provisions implement requirements adopted by Congress in 1997 to
protect patient safety, ensure the appropriate use of Medicare
resources, and guarantee the delivery of physical therapy services
by qualified physical therapists. Opponents of these regulations
were unsuccessful in their attempts to have CMS rescind the rule
implemented in May 2005. These organizations also filed a federal
lawsuit attempting to force their withdrawal, and a US Court of
Appeals upheld a district court decision dismissing the litigation.

Talking Points

Patient Safety - The "incident to" regulations standardize existing
Medicare requirements that physical therapy services must be
delivered by qualified personnel in all outpatient settings. There
is no evidence that these standards have restricted the delivery of
physical therapy in physician offices. Without enforcement of
appropriate qualification standards, it would be impossible to
ensure that Medicare beneficiaries receive and the Medicare program
pays for an appropriate level of safe and effective care delivered
by an individual qualified to provide physical therapy. HR 1846
jeopardizes the health, safety and welfare of Medicare beneficiaries
by allowing non-qualified individuals to provide therapy services.

Cost-effectiveness - In a report issued in May 2006, the Office of
Inspector General (OIG) of the Department of Health and Human
Services found that 91% of physical therapy services billed by
physicians under the old "incident to" rules in the first 6 months
of 2002 failed to meet program requirements, resulting in improper
Medicare payments of $136 million. The Inspector General found that
the total payments for physical therapy claims from physicians
skyrocketed from $353 million in 2002 to $509 million in 2004, and
that the number of physicians billing the program for more than $1
million in physical therapy more than doubled in that two-year
period.

This follows a report done in 1994 by the OIG that estimated that
more than $47 million in unnecessary therapy services were delivered
in physician offices under the old "incident to" rules. As a result
of the 1994 report, Congress passed the Outpatient Physical Therapy
Standards Act of 1997 as part of the Balanced Budget Act. This
legislation established a standard for physical therapy delivered in
a physician's office consistent with that in all other outpatient
settings, and the regulations promulgated by CMS in 2004 implement
these standards in keeping with the intent of Congress. HR 1846 is
fiscally irresponsible and will cost taxpayers due to inappropriate
billing of therapy services by non-qualified individuals.

Quality Care - Medicare beneficiaries deserve a consistent standard
of care that ensures that providers who deliver these services have
attained the level of education and qualification necessary to
provide them safely and effectively. Without appropriate personnel
standards for individuals delivering highly skilled and recognized
Medicare services such as physical therapy, the standard of quality
is jeopardized. HR 1846 dilutes the quality of care for Medicare
beneficiaries by allowing non-qualified individuals to deliver
therapy services.

What You Can Do

Contact your House Representative and ask them to OPPOSE HR 1846
TODAY!

CALL: Contact your House Representative by calling the Capitol
switchboard at 202/224-3121. Please ask your House Representative
to OPPOSE HR 1846.

EMAIL/WRITE: Utilize APTA's Legislative Action Center to send an
email or letter to your House Representative.

If you have any questions or need additional information regarding
HR 1846, contact Mike Matlack at 1/800-999-2782, ext. 3163,
michaelmatlack@.... Thanks for your help in getting the message
through to Congress!