Legislation News

Kansas Becomes 44th State to Achieve Direct Access!

Q & A ON SB 11 – Limited Direct Access for Physical Therapists and Wellness Services

On May 10th Governor Sebelius signed into law a limited PT access bill that will allow the public the right to see a PT without a referral in certain situations. After years of hard work and contributions of hundreds of PT’s and PTA’s, Kansas is now the 44th state with some form of direct public access to a Physical Therapist. House Bill 2483 was unanimously passed out of house and senate health committees and the full house and senate chambers before being sent to the Governor for final approval packaged up within Senate Bill 11.

There will be more information being sent out from the KPTA regarding the specifics of the bill and its implementation. The new law will go into affect on July 1, 2007. To review the exact provisions of the practice act changes log onto www.kslegsilature.com and search for bill number 2483. The major components of the bill can be found in within 65-2901, in new section 3-b, c & d. Thanks to the cooperation of the all the other health care provider groups and our tremendous membership involvement within the legislative and election processes, we were able to take the first step towards unrestricted access public access to a PT for physical therapy services. Thank you to the KPTA BOD’s and Legislative Committee members for all of their hard work. Special thanks go out to Bud Burke, the KPTA lobbyist, for all of his timely work and advices throughout this sometimes arduous and finicky process at the capitol!

Talking Points for Direct Access 2007-2008
Click here for Direct Access Talking Points 2007/08

Legislation Introduced to Extend the Therapy Cap Exceptions Process

Yesterday, Senators John Ensign (R-NV) and Blanche Lincoln (D-AR) and Congressmen Phil English (R-PA), Frank Pallone (D-NJ), Roy Blunt (R-MO), and Ben Cardin (D-MD) introduced legislation (S. 3912/HR 6132) to extend the current therapy cap exceptions process for one year. This effort does not replace the repeal legislation but offers an additional vehicle for Members of Congress to continue to press the therapy cap with leadership and their colleagues on the Committees of jurisdiction. Please communicate now with your Members of Congress and their staff the importance of physical therapy to your Medicare patients and the harmful results if a hard therapy cap is reinstituted in 2007. Congress must act before the election to address the therapy cap!

History of the Therapy Cap
The $1500 therapy cap on physical therapy and speech language pathology services was originally authorized as part of the Balanced Budget Act of 1997. Since that time, Congress has placed a moratorium on its enforcement three separate times. In 2006, as part of the Deficit Reduction Act (DRA), Congress passed a provision to allow the therapy caps to go into effect with a one-year exceptions process. The exceptions process was aimed to ensure access for the estimated 15-20% of beneficiaries needing care above the therapy cap and curb possible over-utilization and abuse in therapy services. Without congressional action this year, the therapy caps will go back into effect without an exceptions process on January 1, 2007.

APTA strongly supports and maintains its position on the full repeal of the therapy caps once and for all. In addition, APTA supports Congressional efforts to ensure that the therapy caps do not return on January 1, 2007 and that the current exceptions process is at a minimum extended one year. APTA encourages Congress to address the therapy caps prior to its recess for the election later this month. Furthermore, APTA commends Senators Ensign, Lincoln, and Reps English, Pallone, Cardin and Blunt for their continued leadership in ensuring that Medicare beneficiaries' maintain access to needed rehabilitation services provided by physical therapists.

Talking Points
The exception process is a clinically based process that provides the physical therapists with the clinical judgment and decision making to ensure seniors and persons with disabilities continue to receive the physical therapy they need.

Since the exceptions process was only authorized for 2006, additional time is needed to collect data and make an assessment if this process is working.

Extending the exceptions beyond 2006 is supported by over forty provider and patient groups.

What You Can Do
Contact your Members of Congress and request their support to extend the therapy cap exceptions process beyond 2006 by cosponsoring HR 6132/S. 3912.

CALL: Contact your Members of Congress by calling the Capitol switchboard at 202/224-3121. Please ask your Members of Congress to make sure that the therapy cap exceptions process is extended beyond 2006.

EMAIL/WRITE: Utilize APTA’s Legislative Action Center to send an email or letter to your Members of Congress.

ASK YOUR PATIENTS TO HELP: Have your patients call their Members of Congress at the above number or e-mail/write their Members of Congress by visiting APTA’s new Patient Legislative Action Center .

If you have any questions or need additional information regarding the therapy cap exceptions process, contact Justin Moore at 1/800-999-2782, ext. 3162, justinmoore@apta.org or Mike Matlack at 1/800-999-2782, ext. 3163, michaelmatlack@apta.org . Thanks for your help in getting the message through to Congress!

Talking Points for Direct Access 2007-2008
Click here for Direct Access Talking Points 2007/08

Medicare Direct Access Re-introduced!

The American Physical Therapy Association (APTA) strongly supports the re-introduction of the Medicare Patient Access to Physical Therapist Act of 2005 (HR 1333 and S 647). This legislation would allow Medicare beneficiaries to directly access physical therapists for outpatient services as authorized by state law. Congresswoman Melissa Hart (R-PA) and Congressman Earl Pomeroy (D-ND) and other bipartisan Members of Congress re-introduced HR 1333 on March 16, 2005. Senators Blanche Lincoln (D-AR), Arlen Specter (R-PA), Mary Landrieu (D-LA), and John Ensign (R-NV) introduced the Senate companion (S 647) on March 17, 2005. This legislation had 187 House cosponsors and 17 Senate cosponsors during the 108th Congress in 2003 and 2004. Building on this number of cosponsors is essential to sustaining momentum on this issue.

The Medicare Patient Access to Physical Therapist Act (HR 1333 and S 647 ) recognizes the ability of licensed physical therapists to evaluate and treat beneficiaries requiring outpatient physical therapy services under Part B of the Medicare program without a physician referral, if direct access is authorized by state law in the state in which the therapist practices. Requiring a referral is unnecessary and limits timely access to medically necessary physical therapists' services. APTA believes improving access to care for beneficiaries is critical as Congress looks to reform the Medicare program.

KEY POINTS

Direct access eliminates the burden of unnecessary visits to physicians in order to access physical therapy. The referral requirement can cause delays and denials of services provided by physical therapists. Delays in care result in higher cost, decreased functional outcomes, and frustration for patients.
Direct access to physical therapists improves the accessibility of rehabilitation services.
Direct access to physical therapists does not promote over-utilization of services or increase the cost of health care. A 1994 study on the cost-effectiveness of direct access to physical therapists found that the costs incurred for physical therapy visits were 123% higher when patients were first seen by a physician than when they went directly to a physical therapist. The total paid claims averaged $2,236 for physician referral episodes as compared with $1,004 for direct access episodes. This study also showed that physician referral episodes generated 67% more physical therapy claims and 60% more office visits than did episodes in which the patient went directly to the physical therapist without a physician referral.
Licensed physical therapists are well qualified to provide services independent of referral from physicians. Physical therapists are educated at the post-baccalaureate level and receive extensive education and clinical training to be able to practice without a referral. Currently, forty-eight (48) states and the District of Columbia currently do not require a referral for physical therapist evaluation. Thirty-nine (39) of those states have some form of direct patient access to licensed physical therapist evaluation and treatment. It is time that Medicare beneficiaries have the same access to physical therapists as non-Medicare beneficiaries.
Liability insurers and the Federation of State Boards of Physical Therapy affirm that direct access does not jeopardize the health, safety, or welfare of the patient/clients seeking physical therapists' services without referral. Health Providers Service Organization, the leading liability insurer of physical therapists in the United States, states in a January 13, 2005 letter, "that direct access is not a risk factor that we specifically screen for in our program because it has not negatively impacted our claims experience in any way. In addition, we do not have a premium differential for physical therapists in direct access states."

For additional information, log on to APTA's website at http://www.apta.org/Govt_Affairs.

WHAT YOU CAN DO

CONTACT: Contact your Senators and Representative and request their support through co-sponsorship of the Medicare Patient Access to Physical Therapist Act (HR 1333 and S 647). If you don't know if your Members of Congress are currently cosponsors please access the following list: http://www.apta.org/Govt_Affairs/federal/CurrentIssues/Medicare_DirectAccess/resources.

CALL: Contact your U.S. Senators and House Representative by calling the Capitol switchboard at (202) 224-3121. Please ask your Senators and Representative to cosponsor immediately.

EMAIL/WRITE: Utilize APTA's Legislative Action Center at http://www.apta.org/Govt_Affairs to send an email or letter to your Members of Congress.

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Kansas Legislative Services Home Page

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