Outpatient Therapy Modernization and Stabilization Act

To amend title XVIII of the Social Security Act to improve and ensure ongoing Medicare beneficiary access to outpatient therapy services, and for other purposes. 1. Short title This Act may be cited as the Outpatient Therapy Modernization and Stabilization Act 2. Moderating annual Medicare reimbursement changes (a) Waiving certain rules with respect to implementation of adjustments of relative value units for evaluation and management codes Section 1848(c)(2) of the Social Security Act ( 42 U.S.C. 1395w–4(c)(2) (1) in subparagraph (B)(ii)(II), by inserting after Subject to clauses (iv) and (v) and subparagraph (P) (2) in subparagraph (F), in the matter preceding clause (i), by striking The Subject to subparagraph (P), the (3) by adding at the end the following new subparagraph: (P) Evaluation and management codes The Secretary shall not apply subparagraph (B)(ii)(II) (relating to limitation on annual adjustments in relative values) or subparagraph (F) (relating to budget neutrality adjustments) with respect to the implementation of adjustments of relative value units for the evaluation and management codes described in the final rule published by the Secretary in the Federal Register on November 15, 2019 (84 Fed. Reg. 62568, 62847–62860), for 2021 and each subsequent year. . (b) Increase in update factor Paragraph (19) of section 1848(d) of the Social Security Act ( 42 U.S.C. 1395w–4(d) (19) Update for 2020 through 2025 The update to the single conversion factor established in paragraph (1)(C) for 2020 and each subsequent year through 2025 shall be as follows: (A) For 2020, 0.0 percent. (B) For 2021, 1.0 percent. (C) For 2022 and 2023, 0.5 percent. (D) For 2024 and 2025, 0.0 percent. . 3. Helping outpatient providers through the COVID–19 pandemic (a) Clarification The third proviso of the third paragraph under the heading Office of the Secretary—Public Health and Social Services Emergency Fund Public Law 116–136 (including physicians, physical therapists, occupational therapists, speech language pathology therapists, audiologists, psychologists, social workers, and any other supplier enrolled through part B of the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 Medicare or Medicaid enrolled suppliers (b) Effective date The amendment made by subsection (a) shall take effect as if included in the enactment of the Coronavirus Aid, Relief, and Economic Security Act ( Public Law 116–136 4. Making appropriate therapy services accessible through the Medicare telehealth program (a) Medicare beneficiary access to therapy services during national health emergencies (1) Permitting qualified therapists to provide Medicare telehealth therapy services Notwithstanding any other provision of law, with respect to Medicare telehealth therapy services furnished on or after March 1, 2020, with respect to an emergency period during 2020, a physical therapist, an occupational therapist, or a speech language pathologist who is enrolled under the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 (2) Definitions In this subsection: (A) COVID–19 interim final rule The term COVID–19 interim final rule Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID–19 Public Health Emergency (B) Emergency period The term emergency period 42 U.S.C. 1320b–5 (C) Facility The term facility 42 U.S.C.1395 l (D) Medicare telehealth therapy services defined The term Medicare telehealth therapy services 42 U.S.C. 1395m(m) (E) Occupational therapist The term occupational therapist 42 U.S.C. 1395x(g) (F) Physical therapist The term physical therapist 42 U.S.C. 1395x(p) (G) Speech language pathologist The term speech language pathologist qualified speech-language pathologist 42 U.S.C. 1395x(ll)(4)(A) (3) Implementation Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement this subsection by program instruction or otherwise. (b) Services furnished beginning in 2021 (1) In general Section 1834(m) of the Social Security Act ( 42 U.S.C. 1395m(m) (A) in paragraph (1)— (i) by striking or a practitioner (described in section 1842(b)(18)(C)) , a practitioner (as defined in paragraph (4)(E)), or a facility (as defined in paragraph (4)(G)) (ii) by striking individual physician or practitioner individual physician, practitioner, or facility (B) in paragraph (2)— (i) in subparagraph (A)— (I) by inserting after located at a distant site , or a facility that is a distant site, (II) by striking such physician or practitioner such physician, practitioner, or facility (ii) in subparagraph (C), by striking as determined by the as determined by a (C) in paragraph (3)(A)— (i) in the subparagraph heading, by striking Physician and practitioner Physician, practitioner, and facility (ii) by striking a physician or practitioner receiving payment a physician, practitioner, or facility receiving payment under this subsection to the same extent as they apply to physicians, practitioners, or facilities under such sections. (D) in paragraph (4)— (i) in subparagraph (A), by inserting before the period the following: , or a facility that furnishes a telehealth service to an eligible telehealth individual via a telecommuniciations system (ii) in subparagraph (E), by inserting before the period at the end the following: , and also includes, for purposes of this subsection, a physical therapist, an occupational therapist, and a speech-language pathologist (iii) in subparagraph (F)(i)— (I) by striking and office psychiatry office psychiatry (II) by inserting before , and any additional , therapy services (identified as of April 1, 2020, by HCPCS codes 92507–92508, 92521–92524, 92526, 92601–92604, 92607–92610, 92626–92627, 92630, 92633, 96105, 96125, 97110, 97112, 97116, 97129–97130, 97150–97158, 97161–97168, 97530, 97535, 97542, 97750, 97755, 97760, and 97761–97763 (and as subsequently modified by the Secretary)) (iv) by adding at the end the following new subpragraph: (G) Facility The term facility 42 U.S.C.1395 l ; and (E) by adding at the end the following new paragraph: (9) Treatment of telehealth therapy services The geographic requirements described in paragraph (4)(C)(i) shall not apply with respect to telehealth services that are therapy services described in paragraph (4)(F)(i). . (2) Effective date The amendments made by paragraph (1) shall take effect on the date of the enactment of this Act and apply to telehealth services furnished under the Medicare program on or after January 1, 2021. 5. Reducing unnecessary paperwork in the delivery of therapy services (a) In general Section 1835(a) of the Social Security Act ( 42 U.S.C. 1395n(a) The requirement for review of a plan of care described in paragraphs (2)(C)(ii) and (2)(D)(ii) for outpatient physical therapy or outpatient occupational therapy services or speech-language pathology services, respectively, for an individual under the care of a physician shall be deemed to be met if either of the following is included in the individual’s medical record: an order for such outpatient physical therapy or outpatient occupational therapy services or speech-language pathology services, as the case may be, signed by a physician under whom the individual is receiving care; or a certification of the individual’s plan of care signed by a physician under whom the individual is receiving care. (b) Conforming amendment Section 1861(p) of the Social Security Act ( 42 U.S.C. 1395x(p) The requirement for review of a plan of care described in paragraph (2) for physical therapy services furnished to an individual under the care of a physician (as so defined) shall be deemed to be met if either of the following is included in the individual’s medical record: an order for such physical therapy services signed by a physician under whom the individual is receiving care; or a certification of the individual’s plan of care signed by a physician under whom the individual is receiving care.

Summary: Outpatient Therapy Modernization and Stabilization Act This bill modifies payment and funding for certain outpatient therapy services under Medicare. Among other things, the bill specifically includes physicians, physical therapists, occupational therapists, and other specified practitioners who are enrolled as Medicare suppliers as eligible suppliers who may receive COVID-19 (i.e., coronavirus disease 2019) relief funds under the Public Health and Social Services Emergency Fund. The bill also permanently allows physical therapists, occupational therapists, and speech-language pathologists to provide telehealth services under Medicare, and includes specified therapy services as eligible Medicare telehealth services. (Currently, the Centers for Medicare & Medicaid Services is authorized to waive requirements for Medicare telehealth services during the public health emergency relating to COVID-19, and it has done so to allow all providers that are otherwise eligible to furnish in-person services under Medicare to also furnish telehealth services.)