End-of-year legislation includes three-month Medicare telehealth extension for occupational therapy

On Friday, Congress enacted a short-term spending package that included 3-month extension of Medicare telehealth flexibilities through the end of March and funded the federal government through March 14, 2025. This short-term spending bill was passed after larger bi-partisan legislation was made public, but never voted on due to disagreements over the funding portion. This larger legislation included multiple healthcare provisions for which AOTA had advocated over the last year, including a reduction to schedule cuts to Medicare outpatient payments and the reauthorization of important behavioral healthcare programs. However, only telehealth and a handful of other healthcare provisions were included in the short-term spending package passed by Congress.

As the bill only funds the federal government through March 14, 2025, we will have the opportunity to advocate for Congress to enact the healthcare provisions, included in the original larger legislation, early next year. Here is more information on what healthcare provisions were included in the original bi-partisan legislation vs what was included in the final short-term funding bill passed by Congress.

Waivers allow OT via telehealth to continue in Medicare through March 2025

The final year-end package includes a provision that extends waivers that allow occupational therapy practitioners (OTPs) as well as PTs and SLPs to continue to utilize telehealth to provide services to Medicare beneficiaries through March 31, 2025. AOTA strongly lobbied for a two-year extension after it became clear that permanent telehealth legislation would not be enacted this year. While a two-year extension was included in the original bi-partisan legislation, however, Congressional impasse over spending priorities resulted in only a brief waiver extension at this time.

The House Energy and Commerce and Ways and Means Committees had voted earlier this year to extend telehealth waivers for 2 years; however, final Congressional approval was dependent on identifying other policy changes that could be used to cover the extension as well as political considerations related to the contents of the end-of-year package. AOTA will focus immediately in January on urging Congress to extend waivers through the end of 2026 as approved by the committees of jurisdiction.

AOTA has endorsed and lobbied to enact the Expanded Telehealth Access Act (H.R.3875/S.2880) which would establish OTPs and other therapists as permanent telehealth providers as well as the Telehealth Modernization Act (H.R.7623/S.3967) which would do the same while also including a myriad of other policy changes that must be made for telehealth to continue in Medicare for all healthcare providers. We will continue to work with Congressional champions as permanent telehealth policy is considered in the next Congress after waivers are further extended.

Bill scrapped by Congress would have reduced cuts to the Medicare Physician Fee Schedule – occupational therapy would have seen a slight increase in Medicare Part B payments for 2025

The 2025 Medicare Physician Fee Schedule (MPFS), the reimbursement system through which OTPs are paid for outpatient therapy services, included a 2.83% reduction to its conversion factor (CF) which impacts all healthcare professionals paid through the MPFS. During the last year, AOTA worked closely with a coalition of healthcare providers including surgeons, primary care physicians, and other therapy organizations to advocate for Congress to prevent these cuts to the CF. The larger legislative package would have increased the CF by 2.5%, mitigating all but 0.33% of the reduction.

We are hopeful that when Congress resumes in January, they will vote on legislation to reduce these 2025 payment cuts. In 2024, AOTA successfully advocated for an increase to the practice expense portion of 16 OT billing codes. Because of this increase to the PE for 16 OT billing codes, occupational therapy services should be cut slightly less than the fee schedule overall in 2025. The American Medical Association (AMA) has estimated that instead of receiving a 2.83% cut to reimbursement, OT services will be cut by roughly 2.0% in 2025. That means, if this legislation had been adopted, overall OT services would have been increased by 0.5% in 2025 compared to 2024 Medicare rates.

Substance use disorder loan forgiveness and behavioral health workforce grant programs would have been extended through 2029

The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act was a bi-partisan bill that established multiple government programs to address the opioid epidemic and support behavioral health services. These programs expire at the end of 2024 and would have been extended through 2029 had the larger legislation passed. There is wide bi-partisan agreement to reauthorize these programs, which include two of importance to occupational therapy. The first is the Substance Use Disorder Treatment and Recovery Loan Repayment Program (STAR LRP). This program provides up to $250,000 in student loan forgiveness for health care professionals, including occupational therapists, who provide direct treatment or recovery support for patients with, or in recovery from, a substance use disorder. The second program is the Behavioral Health Workforce Education Training Grant (BHWET) program. The BHWET program provides funding to academic institutions to recruit and train behavioral health professionals, including occupational therapists.

We believe that Congress will act quickly at the start of the new year to pass legislation to continue the SUPPORT Act and other public health legislation early in 2025.

Congress must revisit mental health and concerns with Medicare Advantage prior authorization in 2025

There are two pieces of legislation that had broad support and were voted on by key committees, but were not included in the larger legislation, that we expect Congress to revisit next year. It was rumored that the bipartisan Improving Seniors’ Timely Access to Care Act of 2024 (H.R.8702/S.4532) was under serious consideration, but it was not included in the final legislative package. The bill is designed to streamline and standardize how Medicare Advantage plans use prior authorization with a specific focus on defining and allowing the CMS to implement and enforce a “real-time decision” process for “routinely approved services.”

Provisions of the bill would allow the secretary of the U.S. Department of Health and Human Services to enforce real-time prior authorization processes for routinely approved services and issue tighter timelines for health plans to make utilization management decisions, such as 24 hours for emergent services. The bill also includes provisions related to uniform prior authorization technical standards; would bar the use of faxes or proprietary payer portals; and includes transparency requirements.

AOTA members have noted that Medicare Advantage plans, including most recently plans run by United HealthCare, have implemented the use of prior authorization for even routine OT and other therapy services and that this is having a significant impact on patient access. AOTA’s regulatory affairs department along with representatives of other therapy professions and providers continue to engage with United HealthCare as well as CMS to address these issues. AOTA notes that denials and delays cause real harm for Medicare beneficiaries, and that reforms including those in the Seniors Timely Access Act are essential. We will continue to support legislative and regulatory actions to address this issue.

AOTA had also hoped that the Occupational Therapy Mental Health Parity Act (H.R. 8220/S.1592) might be included in end-of-year legislation. This bill would ensure that Medicare beneficiaries with a mental health diagnosis have access to occupational therapy services by requiring CMS to provide education and guidance that occupational therapy is an allowable service. Earlier in this Congress, the bill was included in larger mental health legislation passed by the Senate Finance Committee. Unfortunately, while Congress included provisions to reauthorize the SUPPORT Act, the only mental health legislation included in the final package was reauthorization of the Behavioral Health Workforce Education and Training grant program. AOTA will continue to work towards passage of the Occupational Therapy Mental Health Parity Act in the next Congress.

Work continues into 2025

Congress should address these and other crucial issues early in 2025, ahead of the March 14 government funding deadline. AOTA will continue to advocate for a long-term extension of telehealth waivers, reduction of the 2025 Medicare Fee Schedule cuts and passage of the SUPPORT Act once Congress returns. You can join our advocacy efforts and tell Congress that they must address these policies, but visiting our Legislative Action Center at www.aota.org/takeaction.