Impact of the election on therapy issues
More than 47% of the eligible voting population voted in this year’s midterm election, a 52-year high! As a result, the Republicans expanded their majority in the Senate and the Democrats regained control of the House of Representatives.
During the remainder of the current “lame duck” session, no significant issues that would affect therapy directly are expected to be brought up. Congress will be focusing on spending bills for agriculture, flood insurance, and other issues.
Moving into next year, as a result of the split of political affiliations, the House and Senate will be pitted against one another for the 116th Congress. Democrats in the House of Representatives are eager to stand up to what they see as the Administration’s efforts to dismantle the Affordable Care Act. They will do so by pushing provisions to shore up protections for those with pre-existing conditions while trying to protect Essential Health Benefits, funding health insurance subsidies, and more. House Democrats will do this even though it’s not likely they will be able to turn those bills and policy ideas into law. This is because the Senate is still controlled by the Republicans, who will either ignore the House’s efforts or actively work to water down or perhaps not even consider the House’s more liberal policies.
Policies with the best chance will be those with strong bi-partisan support. A perfect example is the growing support for telehealth policies. This year, two provisions of the CONNECT for Health Act became law, allowing for stroke assessment via telehealth and for Medicare Advantage plans to offer telehealth coverage. The bill also gained record cosponsors in both chambers. An updated bill is expected to be reintroduced for the 116th Congress.
Some of legislative issues that impact therapists are supported predominantly by one party or the other. A prime example is the bill to remove PTs from the In-Office Ancillary Services Exception (IOASE), which basically means doctors can have PTs in their office. This bill was supported exclusively by Democrats and thus went nowhere this session. With the Democrats in charge in the House, there is a much higher chance of the topic being discussed in the House Energy & Commerce or Ways & Means Committees. Additionally, as policy makers consider how to modernize the Stark Law and the anti-kickback statute to allow for care coordination and bundled payments, they are going to have to re-evaluate the IOASE too. This provides therapists with an opportunity to push the issue and work to remove PTs from the exception.
Many policy makers think that in order to move towards payment for value-using bundled payment and care-coordination, the strict prohibitions against shared financial incentives found in both the physician self-referral and anti-kickback laws need to be modified. This past summer, CMS posted a request for information (RFI) on physician self-referral to which PTPN responded. Then, in the fall, the Department of Health and Human Services Office of Inspector General posted an RFI asking for input on factors to consider when modernizing the Anti-Kickback Statute. As regulators tackle these issues, there could be an opportunity to argue for the prompt removal of PT from the IOASE, while also requesting increased accountability and transparency for referrals made utilizing the IOASE.
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