49–010 

Calendar No. 177 

114TH CONGRESS REPORT " ! SENATE 1st Session 114–98 

PREVENT INTERRUPTIONS IN PHYSICAL THERAPY ACT 

OF 2015 

JULY 30, 2015.—Ordered to be printed 

Mr. HATCH, from the Committee on Finance, 

submitted the following 

R E P O R T 

[To accompany S. 313] 

The Committee on Finance, to which was referred the bill (S. 

313) to amend title XVIII of the Social Security Act to add physical 

therapists to the list of providers allowed to utilize locum tenens 

arrangements under Medicare, having considered the same, reports 

favorably thereon with an amendment and recommends that the 

bill, as amended, do pass. 

I. LEGISLATIVE BACKGROUND 

The Committee on Finance, to which was referred the bill (S. 

313), to amend title XVIII of the Social Security Act to add physical 

therapists to the list of providers allowed to utilize locum tenens 

arrangements under Medicare, having considered the same, reports 

favorably thereon with an amendment, and recommends that the 

bill, as amended, do pass. 

Background and need for legislative action 

Under current law, physicians who are absent from their practices (for reasons such as illness, pregnancy, vacation, or continuing 

medical education) may retain substitute physicians to take over 

their practices temporarily. The regular physician may bill and receive payment for the substitute physician’s services as though he/ 

she performed them; the regular physician generally pays the substitute physician a fixed amount on a per diem or similar fee-fortime basis, with the substitute physician having the status of an 

independent contractor rather than of an employee. These substitute physicians are generally called ‘‘locum tenens’’ physicians. 


rfrederick on DSK6VPTVN1PROD with HEARING
2 

1Pub. L. No. 74–271. 

Section 125(b) of the Social Security Act Amendments of 1994 authorized regular physicians to bill Medicare for the services of a 

locum tenens physicians beginning January 1, 1995. The current 

Medicare statute (Section 1861(r)) defines a physician as a doctor 

of medicine or osteopathy, licensed in the state where he or she 

practices. In addition, for certain purposes and within limitations, 

a doctor of dental surgery or of dental medicine, a doctor of 

podiatric medicine, a doctor of optometry, or a chiropractor is also 

considered a physician. Health care professionals not included in 

this list are not physicians under the Medicare program and therefore unable to serve locum tenens. 

In many parts of the country, physical therapists are solo practitioners or in small group practices. Patients rely on them for care 

and when those therapists are absent from their practices, patients 

may not have access to other providers and therefore may have 

breaks in care that could be harmful or delay progress in care. 

II. EXPLANATION OF THE BILL 

PRESENT LAW

In general 

Under title XVIII of the Social Security Act,1 Section 125(b) authorizes regular physicians to bill Medicare for the services of a 

locum tenens physicians beginning January 1, 1995. Current Medicare statute (Section 1861(r)) defines a physician as a doctor of 

medicine or osteopathy, licensed in the state where he or she practices. In addition, for certain purposes and within limitations, a 

doctor of dental surgery or of dental medicine, a doctor of podiatric 

medicine, a doctor of optometry, or a chiropractor is also considered 

a physician. Health care professionals not included in this list are 

not physicians under the Medicare program and therefore unable 

to serve locum tenens. 

REASONS FOR CHANGE

The Committee recognizes the importance of allowing Medicare 

beneficiaries who live in rural areas or areas where there is a 

shortage of health professionals or are medically underserved to 

have access to physical therapy care. The bill allows physical therapists the same flexibility to bill under a locum tenens arrangements that physicians currently enjoy. 

EXPLANATION OF PROVISION

Under the provision, solely for areas defined as rural, health professional shortage areas, or medically underserved areas, physical 

therapists will be able to retain substitute therapists to take over 

their practices when the originating therapist is absent due to illness, pregnancy, vacation, or continuing education. Medicare payments remain the same whether for the originating provider, or the 

substituting provider. 


rfrederick on DSK6VPTVN1PROD with HEARING
3 

2Pub. L. No. 93–344. 

EFFECTIVE DATE

The provision applies to services furnished after the date of enactment of this Act. 

III. BUDGET EFFECTS OF THE BILL 

A. COMMITTEE ESTIMATES

In compliance with paragraph 11(a) of rule XXVI of the Standing 

Rules of the Senate, the following statement is made concerning 

the estimated budget effects of the revenue provisions of the ‘‘Prevent Interruptions in Physical Therapy Act of 2015’’ as reported. 

The bill is estimated to have the following effects on Federal 

budget receipts for fiscal years 2015–2025: 

[Fiscal years—millions of dollars] 

2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2016–20 2016–25 

0 1 2 2 2 2 2 2 2 3 7 18 

Note: Details do not add to totals due to rounding. 

Source: Estimate provided by the staff of the Congressional Budget Office. 

B. BUDGET AUTHORITY AND TAX EXPENDITURES

Budget authority 

In compliance with section 308(a)(1) of the Congressional Budget 

and Impoundment Control Act of 1974 (‘‘Budget Act’’),2 the Committee states that no provisions of the bill as reported involve new 

or increased budget authority. 

Tax expenditures 

In compliance with section 308(a)(1) of the Budget Act, the Committee states that the revenue-reducing provisions of the bill involve increased tax expenditures (see revenue table in Part A, 

above). 

S. 313—Prevent Interruptions in Physical Therapy Act of 2015 

Summary: S. 313 would allow physical therapists in areas with 

a shortage of health professionals, medically underserved areas, 

and rural areas to utilize substitute physical therapists, in what 

are known as locum tenens arrangements, under the Medicare program. 

CBO estimates that enacting the legislation would increase direct spending by $18 million over the 2016–2025 period. Because 

the legislation would affect direct spending, pay-as-you-go procedures apply. Enacting the bill would not affect revenues. 

S. 313 contains no intergovernmental or private-sector mandates 

as defined in the Unfunded Mandates Reform Act (UMRA). 

Estimated cost to the Federal Government: The estimated budgetary effect of S. 313 is shown in the following table. The costs of 

this legislation fall within budget function 570 (Medicare). 


rfrederick on DSK6VPTVN1PROD with HEARING
4 

By fiscal year, in millions of dollars—— 

2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2016– 

2020 

2016– 

2025 

CHANGES IN DIRECT SPENDING 

Estimated Budget Authority ...................... 0 1 2 2 2 2 2 2 2 3 7 18 

Estimated Outlays ..................................... 0 1 2 2 2 2 2 2 2 3 7 18 

Basis of estimate: Since January 1, 1995, physicians participating in the Medicare program may retain substitute (locum 

tenens) physicians to take over their professional practices when 

they are absent. Under a locum tenens arrangement, the physician 

who is normally scheduled to see a patient may bill and receive 

payment for the substitute services as though she or he had performed them. The regular physician then pays the locum tenens 

physician as if that physician were an independent contractor (not 

an employee). 

S. 313 would allow physical therapists participating in the Medicare program to utilize locum tenens arrangements in areas with 

a shortage of health professionals, medically underserved areas, 

and rural areas. CBO estimates that enacting S. 313 would increase direct spending for Medicare by $18 million over the 2016– 

2025 period. 

Companies that specialize in locum tenens staffing already exist. 

The Bureau of Labor Statistics estimates that in 2012 about one 

in four physical therapists worked part-time. Part-time physical 

therapists could be a ready pool of substitutes for physical therapists who participate in the Medicare program. Based on information provided by the American Physical Therapy Association and 

an analysis of the use of locum tenens for physicians’ services, CBO 

expects that utilization and spending would increase over time as 

awareness of the policy grew and the marketplace for providing 

such staffing developed. Taking into account the proportion of 

spending in rural and underserved areas (about 30 percent), CBO 

estimates that the legislation would result in an increase in utilization and spending for physical therapy services furnished to Medicare patients of about 0.07 percent by 2019, adding about $2 million to the roughly $3 billion in spending for such services projected 

under current law. 

Pay-As-You-Go considerations: The Statutory Pay-As-You-Go Act 

of 2010 establishes budget-reporting and enforcement procedures 

for legislation affecting direct spending or revenues. The net 

changes in outlays that are subject to those pay-as-you-go procedures are shown in the following table. 

CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR S. 313, THE PREVENT INTERRUPTIONS IN PHYSICAL THERAPY ACT OF 2015, AS ORDERED REPORTED BY THE SENATE COMMITTEE ON FINANCE 

ON JUNE 24, 2015 

By fiscal year, in millions of dollars—— 

2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2015– 

2020 

2015– 

2025 

NET INCREASE IN THE DEFICIT 

Statutory Pay-As-You-Go Impact .... 0 0 1 2 2 2 2 2 2 2 3 7 18 


rfrederick on DSK6VPTVN1PROD with HEARING
5 

Intergovernmental and private-sector impact: S. 313 contains no 

intergovernmental or private-sector mandates as defined in UMRA 

and would impose no costs on state, local, or tribal governments. 

Estimate prepared by: Federal Costs: Jamease Kowalczyk; Impact on State, Local, and Tribal Government: J’nell Blanco Suchy; 

Impact on the Private Sector: Amy Petz. 

Estimate approved by: Holly Harvey, Deputy Assistant Director 

for Budget Analysis. 

IV. VOTES OF THE COMMITTEE 

In compliance with paragraph 7(b) of rule XXVI of the Standing 

Rules of the Senate, the Committee states that, with a majority 

present, the ‘‘Prevent Interruptions in Physical Therapy Act of 

2015,’’ as modified, was ordered favorably reported on June 24, 

2015 as follows: 

Final Passage of ‘‘The Prevent Interruptions in Physical Therapy 

Act of 2015,’’ as modified—approved by a voice vote. 

V. REGULATORY IMPACT AND OTHER MATTERS 

A. REGULATORY IMPACT

Pursuant to paragraph 11(b) of rule XXVI of the Standing Rules 

of the Senate, the Committee makes the following statement concerning the regulatory impact that might be incurred in carrying 

out the provisions of the bill as amended. 

Impact on individuals and businesses, personal privacy and paperwork 

The bill is not expected to impose additional administrative requirements or regulatory burdens on individuals. The bill is expected to reduce administrative requirements and regulatory burdens on some businesses. 

The provisions of the bill do not impact personal privacy. 

B. UNFUNDED MANDATES STATEMENT

This information is provided in accordance with section 423 of 

the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104–4). 

The Committee has determined that the bill does not contain any 

private sector mandates. The Committee has determined that the 

bill contains no intergovernmental mandate. 

VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS 

REPORTED 

In the opinion of the Committee, it is necessary in order to expedite the business of the Senate, to dispense with the requirements 

of paragraph 12 of rule XXVI of the Standing Rules of the Senate 

(relating to the showing of changes in existing law made by the bill 

as reported by the Committee). 

Æ 


rfrederick on DSK6VPTVN1PROD with HEARING