Report on Bipartisan “SMART Act” Will Help Pave the Way for Congressional Action
Since its introduction in October of 2021, AOTA and a coalition of health care provider groups have worked to ensure passage of the Stabilizing Medicare Access to Rehabilitation and Therapy Act, or SMART Act (H.R. 5536) through Congress. This bill, introduced in the U.S. House of Representatives by Rep. Bobby Rush (D-IL) and Rep. Jason Smith (R-MO), aims to reduce the impact of a 15% Medicare payment cut to services provided by an occupational therapy assistant (OTA) or physical therapist assistant (PTA), implemented on January 1st, 2022.
As a crucial step in convincing Congress to pass the SMART Act, AOTA and six coalition partners commissioned a study to look at the potential financial impact of the legislation on government spending. The results of the new independent, nonpartisan study, show Medicare could save between $168 and $242 million over 10 years by changing Medicare supervision requirements in private practice settings from “direct” to “general” supervision. This savings could help offset the cost of urgently needed changes that would ensure access to therapy services for Medicare beneficiaries and provide relief to rural and medically underserved areas of the country experiencing therapy workforce shortages. The win-win findings underscore the urgent need for Congress to pass pending legislation that would make those improvements possible.
The bill would exempt rural or underserved areas from the 15% Medicare payment cut for OTA and PTA outpatient services. In these areas, a higher percentage of therapy services are provided by assistants. Additionally, the legislation would bring supervision requirements of OTAs and PTAs under Medicare Part B in private therapist practices in line with state licensure laws, as well as all other settings where Medicare beneficiaries receive therapy services.
The study projects both costs and savings associated between these provisions of the SMART Act. Results show that the cost savings generated through the change in supervision requirements in private practice settings could help pay for the elimination of the OTA and PTA payment cuts in rural or underserved areas, which is estimated to cost Medicare from $741 million to $1.58 billion over 10 years.
These provisions of the SMART Act would make therapy services more accessible to millions of Americans experiencing challenges accessing therapy services in rural or underserved areas, where the proportion of services provided by assistants is 50% higher; occupational therapy assistants and physical therapy assistants provide 36% of all OT and PT services in rural and underserved areas - compared to 24% of OT and PT services in all other areas. The standardization of general supervision requirements for private practices is cost effective and would reduce administrative burden while implementing common-sense consistency with state laws and across all other Medicare settings.
The research was commissioned by the American Physical Therapy Association, American Health Care Association, American Occupational Therapy Association, Alliance for Physical Therapy Quality and Innovation, National Association of Rehabilitation Providers and Agencies, National Association for the Support of Long-Term Care, and the Private Practice Section of the American Physical Therapy Association.
The report can be accessed online at: Dobson | DaVanzo & Associates, LLC - Health Care Consulting - Publications (dobsondavanzo.com)