APTA Regulatory Issues: Take Action

APTA comments on federal regulations and draft guidance based on the Public Policy Priorities of the American Physical Therapy Association, established every 2 years with extensive input from members. APTA's comments are made on behalf of the membership and the physical therapy profession as a whole. However, there is strength in numbers, and if you or your practice may be impacted by a proposed regulation, you also can share your individual comments with the agency to make your voice heard. We encourage members and nonmembers to provide their individual feedback, as these perspectives are critical to policy development. Keep in mind that your comments do not represent the association; they represent you as an individual physical therapist, physical therapist assistant, or student. See "APTA's Current Regulatory Advocacy Efforts" below to see which issues the association currently is addressing.

There are also issues that fall outside of our public policy priorities, and we encourage physical therapists, physical therapists, and students to provide their individual feedback on any of those issues that affect you. Browse the proposed regulations and policies listed under "Additional Regulatory Advocacy Opportunities" that may apply to you.

APTA's Current Regulatory Advocacy Efforts

APTA staff are currently reviewing and submitting comment on the following proposed regulations. If you wish to submit individual comments, click the applicable proposal and use the Regulatory Advocacy Template Letter as a guide. Review this timeline to keep current on when rules are expected and when you can take action (during commenting period).

• CMS 2020 Home Health Payment System Proposed Rule: The Centers for Medicare and Medicaid Services (CMS) issued its proposed rule on the home health payment system for 2020, which includes routine updates to payment rates and a review of the new case-mix adjustment methodology, the Patient-Driven Groupings Model, which becomes effective January 1, 2020. CMS also proposes to modify the home health plan of care regulation text and to allow therapist assistants to furnish maintenance therapy under a maintenance program established by a therapist. CMS further proposes to phase out the split payment approach for alerting CMS’ claims processing system that a beneficiary is under a home health episode of care and instead requiring HHAs to submit a Notice of Admission within 5 days of the start of care—APTA was instrumental in advocating for this change. APTA and the Home Health Section will provide comments, and individuals may submit comments independently using APTA's unique template letter (link below).
  Deadline for Comments: Monday, September 9, 2019
  Review proposed rule (.pdf)
  Review fact sheet
  Take Action: Submit comments | Submit comments using APTA's unique template letter (.docx)
  
  
• CMS Methods for Ensuring Access to Covered Medicaid Services - Proposed Rule: The Centers for Medicare & Medicaid Services (CMS) is proposing revisions to Medicaid regulations that require states to document whether Medicaid payment levels in fee-for-service systems are sufficient to enlist enough providers to ensure beneficiary access to covered Medicaid services. Due to the high administrative burden associated with compliance, and the fact that large portions of the Medicaid population are enrolled in plans from managed care organizations rather that the fee-for-service program, CMS proposes to no longer require states to develop and make publicly available an access-monitoring review plan that considers beneficiary needs, availability of care and providers, and changes to beneficiary utilization of covered services. APTA will provide comments, and individuals may submit comments independently using APTA's template letter (link below).
  Deadline for Comments: Tuesday, September 13, 2019
  Review proposed rule (.pdf)
  Review fact sheet (.pdf)
  Take Action: Submit comments | Submit comments using APTA's template letter (.doc)
  
  
• CMS LTC Facilities Efficiency and Transparency Proposed Rule: The Centers for Medicare and Medicaid Services (CMS) has released its proposed rule for promoting efficiency and transparency in long-term care (LTC) facilities, removing requirements deemed unnecessary, obsolete or excessively burdensome. CMS is seeking comments on proposals that would further reduce burden on LTC facilities and create cost savings, while also preserving quality of care and resident health and safety. Of note to physical therapists, CMS is requesting additional feedback regarding the need for residents to receive contact information for providers responsible for their care outside of their primary care physician, such as a physical therapist or psychiatrist. APTA will provide comments, and individuals may submit comments independently using APTA's template letter (link below).
  Deadline for Comments: Monday, September 16, 2019
  Review Proposed Rule (.pdf)
  Review Fact Sheet
  Take Action: Submit comments | Submit comments using APTA's template letter (.doc)
  
  
• CMS 2020 Physician Fee Schedule Proposed Rule: The Centers for Medicare and Medicaid Services (CMS) issued its proposed rule on the physician fee schedule and Quality Payment Program (QPP) for 2020. It outlines rules for applying modifiers when a PTA furnishes outpatient therapy services at least in part; sets reimbursement values for the new trigger point injection dry needling codes; and seeks feedback on opportunities to expand the concept of bundling to recognize efficiencies among services paid under the fee schedule. CMS also proposes revisions to QPP's MIPS program, including changes to the PT/OT measure set for 2020 and a new, simpler MIPS Value Pathways (MVPs) option starting in 2021 that would align activities across the 4 MIPS categories by specialties or conditions. APTA will provide comments, and individuals may submit comments independently using an APTA template letter developed specifically for the proposed rule (link below).
  Deadline for Comments: Friday, September 27, 2019
  Review proposed rule (.pdf)
  Review fact sheet
  Review press release
  Take Action: Submit comments | PTA Modifier Policy Template Letter for Clinicians (.docx) | Template letter for patients coming soon!
  
  
• CMS 2020 Proposed Rule on End-Stage Renal Disease (ESRD) and Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) payments: The Centers for Medicare and Medicaid Services (CMS) has released its proposed rule amending the regulations governing ESRD and DMEPOS payments. Of note to physical therapists, CMS proposes a framework to increase predictability of fees for new DMEPOS items, including a "price match" mechanism if the market price for a new item drops after the payment schedule has been established. Other proposals include: developing a single list of DMEPOS items potentially subject to a face-to-face encounter and written orders prior to delivery, and/or prior authorization requirements; rewarding specific suppliers for billing compliance; and changing the requirement for contract suppliers to notify CMS of a change of ownership from 60 days in advance to 10 days after the effective date. APTA will submit comments, and individuals may submit comments independently using APTA’s template letter (link below).
  Deadline for Comments: Friday, September 27, 2019
  Review Proposed Rule (.pdf)
  Review Fact Sheet
  Take Action: Submit comments | Submit comments using APTA's template letter (.doc)
  
  
• CMS 2020 Proposed Rule on Hospital Outpatient and Ambulatory Surgical Center Payment: The Centers for Medicare and Medicaid Services (CMS) has released its proposed rule regarding payment for hospital outpatient and ambulatory surgical center services. Of note to physical therapists, CMS proposes to change the generally applicable minimum required level of supervision for hospital outpatient therapeutic services from direct supervision to general supervision for services furnished by all hospitals, including critical-access hospitals. CMS also proposes to require prior authorization for 5 procedures, saying it will help ensure that these services are billed only when medically necessary; and to require hospitals to make payer-specific negotiated charges for at least 300 "shoppable services" publicly available and easily accessible, and to update the information at least annually. APTA will submit comments, and individuals may submit comments independently using APTA’s template letter (link below).
  Deadline for Comments: Friday, September 27, 2019
  Review Proposed Rule (.pdf)
  Review Fact Sheet
  Take Action: Submit comments | Submit comments using APTA's template letter (.doc)

Additional Regulatory Advocacy Opportunities

Below are proposed regulations and guidance that fall outside APTA's public policy priorities but may have an impact on you and your practice. If you wish to submit individual comments to an agency, follow the submission instructions provided in the proposed regulation and use the Regulatory Advocacy Template Letter as a guide.

Regulatory Advocacy Template Letter

APTA has created this template letter for you to use in submitting comments. Simply insert your individual information where indicated. As a reminder, your comments represent only you and your situation; they should not imply representation of the association. Access template letter (.doc).

Other Ways to Engage

Federal agencies frequently seek input from stakeholders and national experts on proposed payment and coverage policies, research agendas, quality measures, and more. The selection process for federal committees, task forces, panels, and commissions is competitive. Participation in these groups demonstrates both expertise in your field and a commitment to your profession, which will be reflected on your CV for years to come. Serving on such a committee allows you to make invaluable contributions to your area of expertise and raise recognition of the physical therapy profession. While serving requires a small time commitment, the time is well spent and is a great way to develop networks and make contacts with fellow experts from across the nation.

If you are interested in serving on a federal committee, task force, or advisory panel, please contact the advocacy team at [email protected] and provide your name, contact information, and a brief biographical sketch.