Legislation to Help Protect Occupational Therapy Assistants From Effects of Pending Medicare Cuts Introduced in the House of Representatives

Today, the “Stabilizing Medicare Access to Rehabilitation and Therapy Act” (SMART Act) was introduced by Rep. Bobby Rush (D-IL) and Rep. Jason Smith (R-MO) in the United States House of Representatives. This legislation would delay and mitigate the impact of a looming 15% cut to Medicare Part B services provided by occupational therapy assistants, set to begin in January 2022. These cuts are a threat to occupational therapy assistants and may leave many seniors—especially those in underserved and rural areas—with less access to critical occupational therapy services.

What Does the SMART Act do?

“Occupational therapy assistants, in partnership with occupational therapists, are a critical component of the occupational therapy workforce,” said Wendy C. Hildenbrand, PhD, MPH, OTR/L, FAOTA, President of AOTA. “This collaborative partnership ensures that Medicare beneficiaries have access to necessary occupational therapy services. The SMART Act will ensure that beneficiaries in medically underserved and rural communities can receive the occupational therapy services they need to regain or maintain function and maximize independence.” In order to support occupational therapy assistants and preserve access to therapy services for Medicare beneficiaries, this bill works to reduce the impact of the upcoming Medicare Part B payment cut in 3 ways:

• Provides an exemption to the 15% payment differential for rural areas. Rural and underserved areas tend to rely more heavily on occupational therapy assistants to provide access to occupational therapy services.
• Reduces the burdensome requirements for direct supervision of therapy assistants in private practice settings by aligning supervision with state requirements. Medicare allows for "general supervision" of occupational therapy assistants in all settings—except for private practice—placing an unnecessary burden on small therapy private practices, and failing to recognize the expertise of occupational therapy assistants.
• Delays the payment differential to January 1, 2023. COVID-19 continues to impact occupational therapy practitioners and providers, with practitioners reporting high rates of burn out. Now is not the time to implement a cut of this magnitude for occupational therapy assistants.

Join us in Asking Congress to Protect Occupational Therapy Assistants

Introduction of the SMART Act is the first step. We need to build support for this legislation within Congress by gaining more cosponsors for this bill. You can visit AOTA’s legislative Action Center and contact your member of Congress to ask them to cosponsor the legislation. Although Congress has told us they will not repeal this payment differential, this legislation will help reduce the impact of these cuts and help preserve Medicare beneficiaries’ access to occupational therapy services. 

Background on the need for Legislation

While AOTA successfully kept Congress from including the OTA differential in legislation prior to 2018, Congress chose to include this policy as part of the Bipartisan Budget Act of 2018 (BBA2018). The Act requires the Centers for Medicare & Medicaid Services (CMS), by January 1, 2022, to reduce payment for services “furnished in whole or in part” by an OTA. This 15% reduction follows the payment differential precedent set for payments for nurse practitioners and physician assistants who are also paid at 85% the rate of physicians.

Since passage of the BBA2018, AOTA has been in federal offices, meeting with Congress and the CMS every step of the way. The original interpretation of this law by CMS was extremely restrictive, applying a cut if any minute of service was by an OTA. Through comments and advocacy, AOTA and other stakeholders have convinced CMS their interpretation of the policy was too restrictive.

AOTA has also worked to convince CMS that it had the authority to delay implementation of the differential, exempt rural areas from this policy, and change the current burdensome supervision requirements. Because CMS has declined to implement any of these policies, our Congressional champions introduced the SMART Act to require CMS to implement these policies and reduce the impact of these cuts.

Current Support for the Legislation

This bill is a supported by a large group of stakeholders, including large employers of occupational therapy practitioners and patient advocacy groups, in addition to associations like the American Occupational Therapy Association, the American Physical Therapy Association, the National Association of Rehab Providers & Agencies, and the National Association for Skilled Living. The list of supporters continues to grow, as many stakeholders are concerned about the impact of this provision on occupational therapy and physical therapist assistants, and access to care for Medicare Beneficiaries.

About our Congressional Champions

Reps. Bobby Rush and Jason Smith are long-standing champions for occupational therapy. Rep. Bobby Rush is also leading the Allied Health Workforce Diversity Act along with Rep. Markwayne Mullin, and Rep. Smith led the Home Health Flexibility Act, which was signed into law at the end of 2020, with Rep. Doggett.

Rep. Bobby Rush (D-IL) on the SMART Act: “Many seniors and Medicare recipients rely on physical and occupational therapy services to maintain their independence and stay healthy and mobile after illness or injury. These misguided pay cuts will cause severe harm to older Americans in underserved communities and the physical and occupational therapy assistant workforce, many of whom are people of color. I thank my colleague Rep. Smith for joining me in introducing a bipartisan solution to mitigate the worst impacts of these looming changes and postpone their implementation.”

Rep. Jason Smith (R-MO) on the SMART Act: “Having access to physical and occupational therapy is a vital resource for our nation’s seniors and patients with mobility issues. Medicare cuts to these services will reduce access to care, which is why I’m proud to work with Congressman Bobby Rush to ensure these patients— particularly those in rural areas— continue having these services available.”