Joe, re: legislation to allow ATs to bill for therapy under Medicare We are working against this legislation. See: http://capwiz.com/aota/issues/alert/?alertid=9424141&type=CO Chuck Action Alert Oppose Legislation Permitting "Incident-to" Billing for Therapy Services by Non-Qualified Therapists: Protect Occupational Therapy's Scope of Practice
History: The Access to Physical Medicine and Rehabilitation Services Improvement Act was introduced in the 109th Congress. Legislators in the Senate and House of Representatives are now debating introducing this legislation for the 110th Congress. This legislation would allow non-qualified therapists to bill the Medicare program for therapy services "incident-to" the physician's professional services, thereby eroding the May 2005 Centers for Medicare and Medicaid Services (CMS) regulations that restrict the billing of therapy services under Medicare to those qualified to deliver physical therapy, occupational therapy, and speech language pathology services. This legislation would allow the billing of services provided by athletic trainers and lymphedema services at 80% of the physician fee schedule and would apply the therapy cap limitations to these services. In the 2005 Medicare Physician Fee Scheduled rule, CMS determined that occupational therapy services provided in a physician's office incident to a physician's professional services be furnished by personnel who meet certain standards. This rule meets the intent of Section 4541(b) as passed by Congress in the Balanced Budget Act of 1997. The rule established qualifications and clinical preparation standards for those providing "incident to" occupational therapy services, implementing the requirements adopted by Congress in 1997 which were designed to protect patient safety, ensure the appropriate use of Medicare resources, and guarantee the delivery of occupational therapy services by qualified occupational therapists. In the past, a number of provider groups (i.e., athletic trainers, massage therapists, low-vision specialists, and others) have been paid "incident to" occupational therapy services. Since CMS published this rule, these provider groups have formed a coalition <http://www.coalitiontopreservepatientaccess.org/> to support reversing the changes outlined in the "incident to" rule legislatively. AOTA's Position: AOTA strongly supports Medicare's qualifications standards. Services reimbursed as occupational therapy should be provided by an occupational therapists or an occupational therapy assistant under the supervision of an occupational therapist. AOTA has monitored the issue closely and will continue to work with all members of Congress to uphold the intent of Section 4541(b) in the Balanced Budget Act of 1997. This legislation, and the corresponding rule by CMS, eliminates the abuse of nonqualified individuals providing services that were billed to the Medicare program, and ultimately will help protect the scope of occupational therapy and ensure beneficiaries that the services they receive are of the highest possible quality. Action Needed: In order to ensure that this legislation does not gain any traction, contact your Representatives (one member of the House of Representatives and 2 Senators) to urge their opposition to this legislative issue. If you have any questions, please contact the AOTA Federal Affairs Department at [EMAIL PROTECTED] or 1-800-SAY-AOTA.
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