Telehealth:
The use of telehealth to provide a wide array of services, including occupational therapy, has grown exponentially since 2020 when Congress enacted waivers to expand the list of practitioners that can provide these services to Medicare beneficiaries to include occupational therapists and occupational therapy assistants (OTPs). These waivers have been extended through 2024; however, they are set to expire on December 31 unless Congress acts. The House Energy and Commerce and Ways and Means Committees have already voted to extend these waivers through December 31, 2026, but the full Congress must act to extend the telehealth practitioner waivers before the year ends, or OTPs will no longer be able to provide services via telehealth under Medicare on January 1, 2025. The bi-partisan draft legislation, would extend these telehealth waivers through December 31, 2026
Medicare Payments for Outpatient Therapy:
The 2025 Medicare Physician Fee Schedule (MPFS), which sets payment rates for outpatient occupational therapy services, included a 2.8% reduction to the “conversion factor.” The conversion factor is a number used by CMS to determine how much every provider is paid, and this reduction decreases the payment rate for all healthcare clinicians providing Medicare outpatient services.
This cut represents the fifth straight year of cuts to Medicare payments which have hit occupational therapy especially hard. Although in each of these 5 years, Congress has reduced the proposed cuts, they have never eliminated them. This year, AOTA advocacy helped to secure a small increase to payment rates specific to occupational therapy, but the overall cut to Medicare payments means that OT services are facing a 2% reduction in payment for 2025. The bi-partisan draft legislation would increase the conversion factor by 2.5%. If this legislation were to pass, OT services would see an average of a 0.5% increase in reimbursement for 2025.
Join our efforts:
With your help, our advocacy has been successful. Now Congress needs to cross the finish line and pass the bi-partisan healthcare package before the end of the year. They must hear from their constituents that these issues are of critical importance!