Bipartisan Group of 99 Lawmakers Calls on CMS to Rethink 8% Therapy Payment Cut

A group of 99 U.S. representatives, consisting of both Republicans and Democrats, this week asked the Centers for Medicare & Medicaid Services (CMS) for more information about a rule that could have a major impact on nursing home residents who receive therapy services.

Under the 2020 Physician Fee Schedule (PFS) final rule, CMS implemented a blanket 8% payment cut for physical therapy under Medicare Part B, which covers long-term residents of skilled nursing facilities and other care sites.

That reduction is slated to take effect in January 2021, and while the rule has been finalized, the lawmakers asked CMS administrator Seema Verma for more detail about how regulators arrived at the calculations — and whether CMS would consider the impact the rule would have on beneficiaries.

In addition to the therapy cuts, the fee schedule also provides for payment boosts in certain other categories such as physician outpatient visits and “evaluation and management” codes, or E&M. That shift has prompted some advocacy groups — such as the National Association for the Support of Long-Term Care (NASL) and the American Physical Therapy Association (APTA) — to argue that the government is sacrificing therapy services to fund the increases elsewhere.

“Therapy is one of the victims to offset those increases,” NASL executive vice president Cynthia Morton told SNN in November. “Our patients can’t take this cut. There’s no reason why rehab therapy for these frail patients should sustain a cut.”

The letter, sent Wednesday on the letterhead of Republican Rep. Earl “Buddy” Carter of Georgia, explicitly asks for an explanation of the math behind the shifts.

“Concerns about whether the implementation of certain aspects of this rule will reduce access to health services have been raised to us,” the officials wrote in their letter, addressed directly to Verma. “To better respond to these concerns, we are requesting additional information regarding the process by which CMS reached the decision to reduce the reimbursement for services furnished by certain providers in 2021 to accommodate for the increase to the values of the office/outpatient evaluation and management (E/M) codes.”

The lawmakers asked Verma to respond to two broad questions — one about the methodology and data behind the new calculations, and another about the additional information CMS will consider when developing the 2021 fee schedule — by February 21.

“What additional information is most valuable to CMS?” the lawmakers wrote. “Will CMS take into consideration how these changes may impact beneficiary access to each specialty? If so, how?”

Rep. Lisa Blunt Rochester, a Democrat from Delaware, worked with Carter to organize the bipartisan group, according to APTA, which publicized the letter in a dispatch to its members.

While the skilled nursing industry has been focused on Part A therapy reimbursement shifts under the new Patient-Driven Payment Model (PDPM), advocates have argued that an 8% cut to Part B services could have just as much of an impact on residents and nursing home finances.

For long-term residents dually covered under Medicare Part B and Medicaid, therapy services can help reduce costly hospital readmissions, which serves the dual benefit of preserving resident care while also lowering the chances of financial penalties under new payment models that incentivize the reduction of hospital visits.

“The skilled nursing and rehab provider side of margins are thin, and an 8% cut will be a major impact — a major hit to resident care and the whole rehabilitation industry itself,” Madhu Krish, chief operating officer of Paragon Rehabilitation, told SNN last year.