EMPOWER Act introduced in Congress to support OT assistants

This week, the bipartisan Enabling More of the Physical and Occupational Workforce to Engage in Rehabilitation (EMPOWER) Act was introduced in both the House of Representatives and the Senate. This legislation would change the Medicare supervision requirement for occupational therapy assistants (OTAs) and physical therapist assistants (PTAs) in private practice, from “direct” supervision to instead match state standards which require only “general” supervision of OTAs by OTs in forty-nine states. The legislation would also require the Government Accountability Office (GAO) to conduct a study on how the 15% reimbursement cut for OTAs and PTAs under Medicare Part B has impacted access to occupational therapy and physical therapy services in rural and medically underserved areas.

The EMPOWER Act was introduced by Representatives Debbie Lesko (R-AZ) and Annie Kuster (D-NH) in the House (H.R.4878) and Senators Tom Carper (D-DE) and John Barrasso (R-WY) in the Senate (S. 2459). The standardization of Medicare supervision requirements to match state regulation is a cost-effective way to reduce administrative burden for private practice while recognizing the expertise and value of occupational therapy assistants. Under current law, all Medicare outpatient settings, except private practice, must follow a “general” supervision requirement for therapy assistants. The EMPOWER Act would prohibit the Centers for Medicare & Medicaid Services from requiring a supervision standard that is “different than any such requirement under applicable State law.”

In addition, if passed, the bill would examine the impact of the 15% reimbursement reduction for services provided by OTAs and PTAs in Medicare outpatient settings which took effect in 2022. Since this payment policy was enacted, AOTA has warned Congress that it will limit access to occupational therapy services in rural and medically underserved areas where the proportion of services provided by assistants is 50% higher than in other geographic areas.