CMS Proposes 9% Cut to Medicare Therapy Rates, Threatening PT, OT, Speech Services in Nursing Homes

The federal government is proposing a range of reductions to Medicare reimbursement for various Part B therapy services as part of its Medicare Physician Fee Schedule for the calendar year 2021, including physical, occupational and speech-language services in skilled nursing facilities.

The fee schedule was announced by the Centers for Medicare & Medicaid Services (CMS) as part of a proposal to permanently extend some telehealth waivers.

The formal announcement came on Monday, in conjunction with an executive order from President Trump requiring the Department of Health and Human Services to review all the telehealth waivers implemented as part of the COVID-19 public health emergency.

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Under the proposed fee schedule, Medicare Part B reimbursement for physical therapy (PT) and occupational therapy (OT) would see an overall reduction of 9%, and though it’s not clear where speech would fall under the changes, it’s concerning for therapists already grappling with the pandemic, according to Cynthia Morton, executive vice president for the National Association for the Support of Long-Term Care (NASL).

This will affect therapists providing services for patients in skilled nursing facilities who have finished their Medicare Part A coverage and have their services covered by Medicare Part B, while either private pay or Medicaid covers room and board.

“CMS … as far as we can tell, hasn’t really taken into account that nursing facilities bill the majority of PT and OT and speech therapy codes,” Morton told Skilled Nursing News on Tuesday. “Of all the settings that bill Part B therapy, nursing facilities bill the most.”

According to Morton, the 9% cut is actually an increase over an earlier estimate where the cut came in at 8%. The cut to Part B therapy rates stems from the need to keep the Physician Fee Schedule budget-neutral, meaning that CMS can only spend a certain amount on services paid under the schedule per year.

The agency proposed the cuts to offset increases to payments for primary care physicians, according to a release from the American Physical Therapy Association (APTA), the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASHA).

The three groups said they “strongly oppose” the cuts, which are slated to take effect on January 1, 2021, and called on Congress and CMS to implement the increases to primary care in a way that does not reduce payments for other providers.

“Physical therapy providers, occupational therapy providers, speech-language pathologists, and audiologists are facing between a 7% and 9% cut to Medicare payment, despite ongoing advocacy with Congress, the Department of Health and Human Services, CMS, and the Office of Management and Budget,” the groups said.

In its own release, ASHA noted that speech-language pathologists face a 9% cut, “which would translate into significant reductions in therapy services for a range of communication, cognition, and swallowing problems common in seniors.”

There were some upsides for therapists within the proposal: If finalized, maintenance therapy can be provided by therapy assistants, Morton noted, a move that would making permanent a pandemic-era waiver. CMS is asking for comment on whether some of the therapy codes that could be provided through telehealth during the public health emergency should continue to be allowed through that method for the rest of the year.

The NASL has asked for a postponement of the cuts, Morton said, as the SNF sector cannot sustain the cuts to therapy that the proposed reduction would entail.

“Right now, we’re struggling to find therapists,” she said. “We want to keep people safe. We’ve been trying to, in many instances, utilize telehealth in order to keep the avenue of access open to patients, to keep services flowing to get them better. This cut is going to make that very, very difficult.”

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