CMS Finalizes 15% Cut to Therapy Assistant Services for 2022

The Centers for Medicare and Medicaid Services (CMS) on Tuesday finalized its Calendar Year (CY) 2022 Physician Fee Schedule (PFS), confirming a 1% cut to Medicare Part B physical and occupational therapy rates, down from the proposed 2% in July, and a 15% cut for services provided by therapy assistants.

CMS specified the 15% cut is for physical therapy and occupational therapy services provided “in whole or in part” by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) on and after Jan. 1, 2022.

These cuts follow a devastating 2021 calendar year, which included 9% in cuts to Part B before the Consolidated Appropriations Act of 2021 reduced reimbursement slashes to about 3%.

Providers had hoped Congress would pass another spending bill further offsetting cuts to net zero for 2022.

The National Association for the Support of Long-Term Care (NASL) is still working to “delay, stay or mitigate” further therapy cuts.

“We’re asking Congress to give us a one year delay on this policy,” said Cynthia Morton, executive vice president at NASL. “We’re not asking them to repeal the cut, we’re just asking them to give us another year because here’s CMS changing the policy, I believe, for a third time and it’s not clear. Here it is Nov. 2, and this goes into place in January.”

Providers like Aegis Therapies believe these cuts will affect how clinicians practice and access to care across the country.

“Any industry, any provider of any sort, even retail, who experiences a 15% reduction in revenue is likely to have to make some modifications to the way they do practice,” said Mark Besch, clinical officer at Aegis, in an August interview with Skilled Nursing News regarding the proposed rule. “That’s the number of people you employ, the frequency with which you can have them present in different locations. That’s where it becomes a beneficiary issue, (issues with) access to the care that they need. (It) could and likely will be diminished as a result of these cuts.”

Another rule to affect skilled nursing operators involves an update to clinical labor rates for the first time in 20 years, based on the amount of labor; increases will be spread out over a four-year transition period, CMS said.

As a result, primary care specialists that require more labor like geriatrics are expected to increase, CMS said in a statement.

The rule also incentivizes clinicians to deliver improved outcomes for patients with Medicare, CMS said, with key changes to the value-based Quality Payment Program (QPP).

Physicians will need to meet a higher performance threshold in order to be eligible for “positive payment incentives” under QPP, CMS said, introducing Merit-based Incentive Payment System (MIPS) Value Pathways.

Pathways will focus on the following clinical areas, some found in skilled nursing facilities: rheumatology, stroke care and prevention, heart disease, chronic disease management, lower extremity joint repair, emergency medicine and anesthesia.

The final rule expands pulmonary rehabilitation coverage under COVID-19 paid by Medicare Part B as well, and CMS’ Medicare Diabetes Prevention Program (MDPP) model, designed to help Medicare beneficiaries with prediabetes from developing Type 2 diabetes, under the rule.

Providers that apply to enroll as an MDPP supplier on or after Jan. 1 will have its Medicare enrollment fee waived, CMS said, and the services period is being shortened to a more sustainable one year from two years. Structured, coach-led MDPP sessions are approved by the Centers for Disease Control and Prevention (CDC).

MDPP suppliers will receive larger payments if participants reach milestones for attendance, CMS said.

The rule also maintains a payment rate of $40 per dose of the COVID-19 vaccine even after the public health emergency (PHE) ends, and promotes greater access to telehealth for behavioral health services.