Medicare and Direct Access

Medicare Direct Access Legislation Re-introduced!

The American Physical Therapy Association (APTA) strongly supports the re-introduction of the Medicare Patient Access to Physical Therapist Act of 2009 (HR 1829).   This legislation would allow Medicare beneficiaries to directly access physical therapists for outpatient services as authorized by state law.  Congressmen Earl Pomeroy (D-ND) re-introduced HR 1829 on March 31, 2009.  Currently, HR 1829 has 56 original cosponsors. Building on this number of cosponsors is essential to sustaining momentum on this issue.
The Medicare Patient Access to Physical Therapist Act (HR 1829) recognizes the ability of licensed physical therapists to evaluate and treat beneficiaries requiring outpatient physical therapy services under Part B of the Medicare program without a physician referral or certification of the plan of care, if direct access is authorized by state law in the state in which the therapist practices.  Requiring a referral is unnecessary and limits timely access to medically necessary physical therapists’ services.   APTA believes improving access to care for beneficiaries is critical as Congress looks to reform the Medicare program.
 

• Access:   The major objective of this access is to improve access to physical therapists under Medicare.  Currently, patients are required to see a physician prior to the initiation of physical therapist treatment, causing delay and at times denial of needed rehabilitation care provided by physical therapists.
• State Rights:   This legislation eliminates a Medicare regulation that exceeds the state standard regarding access to physical therapists.  State licensure laws govern health care professionals and Medicare should not limit access to safe, qualified providers with more burdensome requirements than state law.
• Cost-Effectiveness:  This legislation has the potential to decrease costs by eliminating unnecessary physician visit for the sole purpose of obtaining a referral, provide more timely access to care and reduce the number of visits or duration of care needed to treat an individual, and give patients a choice in their rehabilitative care.  
• Choice:   Currently, Medicare beneficiaries are limited in their ability to choose physical therapy as a treatment option.  This leads to limited choices in health care and the potential for greater costs.
• Safety:   This legislation would not jeopardize patient safety.  In the 48 states with direct access to PT evaluation and the 44 with direct access to PT evaluation and treatment, there has been no increase in claims to liability carriers or state boards regulating physical therapy when the referral mandate was eliminated.

Contact your Representative to request his/her support through co-sponsorship of the Medicare Patient Access to Physical Therapist Act (HR 1829) or to thank him/her for their support if they are currently a cosponsor.  
 ** To see if your Representative is already a cosponsor of HR 1829 CLICK HERE.  You can also access the information by visiting http://thomas.loc.gov/ and typing in  bill number HR 1829 under "Search Bill Summary and Status."
CALL:            Contact personalized Representative at U.S. Capitol phone number. You can also call your U.S. Representative’s office by calling the switchboard at (202) 224-3121. When connected to the office, ask to speak with the health care legislative assistant and ask your Representative to cosponsor HR 1829.
EMAIL/WRITE:        Utilize APTA’s Legislative Action Center to send an email to your Representative.  You can also access the legislative action center by visiting www.apta.org/advocacy.
GO THE NEXT STEP:         Call your Representative’s local offices and schedule meetings with them to discuss this issue directly with your elected official.  Legislators will be home for two weeks starting next week for their spring recess April 6 – 17, a great time for you to schedule a meeting!  Attend your Representative’s district events such as health care forums and town hall meetings to develop a relationship and support for this issue.  Visit Grassroots Resources in the Legislative Action Center at www.apta.org/advocacy to see if your Representative is hosting a town hall!
If you have any questions or need additional information regarding HR 1829, contact Government Affairs at 1/800-999-2782, ext. 8533.  Thanks for your help in getting the message through to Congress!