The American Occupational Therapy Association (AOTA), Bethesda, Md, is working with allies on Capitol Hill, at the Centers for Medicare & Medicaid Services (CMS), and with the Administration to express strong opposition about a proposal to significantly—and, in AOTA’s view, inappropriately—cut payment for Medicare Part B therapy services. The proposed cuts, announced by CMS in June, and reprinted in the Federal Register on July 13, call for cutting payment for multiple service units provided on the same day.

The cuts would go into effect on January 1, 2011, unless CMS is convinced to change the policy. This would follow a more than 21.3% payment cut on December 1, 2010, if Congress does not take action before then to fix the underlying problems in how the fees for physicians and other health care professionals—including occupational therapy providers—are paid.

“The combined potential cuts would harm Medicare beneficiaries’ access to needed occupational therapy and other services, and are based on highly questionable assumptions by CMS,” says Florence Clark, PhD, OTR/L, FAOTA, AOTA's president. “AOTA will vigorously oppose these reductions.”

AOTA has a detailed report of the specific proposal. Comments are due to CMS by August 24, and members can use this sample letter to assist in developing comments. AOTA will submit comments to CMS on behalf of the Association.

“We are working with a coalition of other professions, industry organizations, and leading providers because this requires a rapid and targeted response,” says Fred Somers, AOTA's executive director.

The “same day” cuts would result in lower payments for all units of therapy or modalities after the first unit. It does not differentiate among the three therapies, and would affect vulnerable clients the most.

“This approach is very dangerous for several reasons, not the least of which is that CMS is trying to muddle the distinctions among occupational therapy, physical therapy, and speech-language pathology services,” says Somers. “It also tries to change the whole system of how values or prices for codes are determined.”

The AMA/Specialty Society Relative Value Scale Update Committee (RUC), in which AOTA participates as a society, makes recommendations to CMS and has approved the therapy code values understanding the nature of therapy practice that involves multiple units of time. “We have worked for many years with AMA to develop solid values for therapy codes,” Somers noted. She acknowledges that the fee schedule process is complicated but notes the vigorous data analysis and review by the AMA RUC to determine fair values.

While more and more people need and use therapy, Medicare spending for outpatient services continues to bring scrutiny by CMS and with it, policies that can stem growth.

“We have to frame the issue clearly for policymakers so they understand the implications for beneficiaries and for the economy,” Somers said. “That’s why AOTA is putting the full force of our federal and reimbursement resources toward fighting this proposal. Our members and their clients deserve nothing less.”

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