Medicare/CMS needs to hear from physical therapists, occupational therapists, and speech therapists about the proposed rule before the comment period closes on September 11 at 11:59pm EST.

As you have read the newsletters from CMS, it is that time of year when CMS proposes changes for 2024 to the Medicare Physician Fee Schedule (MPFS) to adjust payment rates and policies and propose modifications to the Quality Payment Program (QPP).

Despite years of opposition from bipartisan lawmakers and a broad group of healthcare stakeholders, the Centers for Medicare & Medicaid Services (CMS) is once again trying to impose cuts to physical and occupational therapy in the Proposed Physician Fee Schedule (PFS) Rule for CY 2024.

THE BAD – The proposed rule includes a 3.36% conversion factor cut to providers in CY 2024. This cut comes on top of a nearly 10% reduction in the conversion factor over the last five years.

THE GOOD – CMS is requesting comments on the supervision requirements for therapy assistants in the private practice setting. By changing the supervision requirement for therapist assistants to bring it in line with other settings and state practice acts, CMS has an opportunity to expand access to therapy services for seniors across the country.

Here are some points you can make when contacting your CMS. Use the following as talking or writing points when contacting.

• Express that you are concerned by the proposed 3.36% cut to the conversion factor for 2024. Increasing payment to a select group of providers at the expense of others is short sighted and will ultimately restrict access to care. As a provider, you have experienced a nearly 10% reduction in the conversion factor over the last 5 years, while the expenses to run and staff a therapy clinic have soared. Just look at the increases inflation has brought.

• Therapy services represent one of the best values in health care and are the type of care CMS should be supporting instead of restricting through cuts. Especially with an aging population.

• Ask that CMS delay implementation of the G2211 code beyond 2024.

• On a positive note: Thank CMS for requesting comments on supervision requirements of therapist assistants in the private practice setting. For years, the private practitioner has had the burden of requiring direct supervision for therapist assistants (those of you who use assistants know this burden), while other settings such as rehabilitation agencies do not. This requirement definitely results in restricted access to care, especially in underserved and rural areas. Urge CMS to change the supervision requirement for therapist assistants in the private practice setting to bring it in line with other settings and state practice acts.

• Support the proposal to change the supervision requirement to general for therapist assistants performing Remote Monitoring (RTM) services. Again this will help those that have mobility issues and/or rural areas where access is hard to find or not possible to get.

• Agree with CMS that Multiple Procedure Payment Reductions (MPPR) have been incorrectly applied to the clinical labor time for 19 different therapy codes.

• Know that CMS has requested the AMA RUC HCPAC recommendations from 2017 be reviewed (which is good). However, it is not sufficient to merely have the codes classified as misvalued in 2024. By CMS’ own admission, therapists have been underpaid since 2018 due to this error. Since it will take another 1-2 years for the AMA RUC to revalue the clinical labor times, I urge CMS to use its enforcement discretion and suspend the 50% PE reduction due to MPPR from the 19 therapy codes until the AMA RUC has completed its work.

• Thank CMS for recognizing the importance of adding codes for caregiver training services. These codes will allow me to address patient goals with caregivers in situations when the patient has a cognitive deficit, displays disruptive behavior, or to facilitate the patients’ functional performance in their home and community relating to activities of daily living.

For those required to do MIPS, or think of doing MIPS:

Writing or talking points:

• [If your practice has 16 or more clinicians] Under the proposed rule, CMS will no longer exempt practices like mine that have 16 or more clinicians from the “ promoting interoperability” (PI) category of MIPS. To date, rehabilitation therapists have been exempted from the use of a certified electronic health record technology (CEHRT) and therapists have not received any financial incentives or support for implementing EHR. Therefore, it would be inappropriate to require us to be scored on the PI category beginning in CY 2024 performance year. The score for PI should not be a factor in a rehabilitation therapist’s QPP final score until they have access to federal financial support for such an investment. Please reconsider reweighting of the PI scores for rehabilitation therapists from the promoting interoperability (PI) category for CY 2024 performance/CY 2026 payment year.

• If CMS still plans to require PI category data in CY 2024, please continue to accept applications for reweighting the PI performance category to zero percent due to extreme and uncontrollable circumstances, insufficient internet connectivity, lack of control over the availability of a CEHRT, or as a result of a decertification of an EHR that is currently in place for those who must report PI data. If rehabilitation professionals score zero in this category, it makes it very difficult for us to achieve a score of 82 points or higher to avoid a negative payment adjustment.

• CMS is proposing to increase the Performance Threshold to 82 points. This means that for the CY 2024 performance/CY 2026 payment year, MIPS eligible clinicians will need to achieve a final score equal to 82 points to receive a neutral MIPS payment adjustment. I do not support the increase to 82 points for the 2024 performance year (up from 75 points) to avoid a payment penalty in 2026. Again, if I am unable to score points in PI category, it makes it very difficult for me to achieve a score of 82 points or higher overall to avoid a negative payment adjustment.

• CMS is proposing to incorporate a new Rehabilitative Support for Musculoskeletal Care as a new MIPS Value Pathways (MVPs) for physical and occupational therapists to use. While this is a good start to including rehabilitation providers in value-based care initiatives, CMS must do more to include financial assistance to upgrade EHR systems, increase funding for the development of cost measures and reduce the administrative burden on private practices.

How Can You Comment on the CY 2024 Proposed Rule? The proposed rule includes directions for submitting comments. CMS must receive comments within the 60-day comment period. When commenting, refer to file code: CMS-1784-P. CMS won’t accept FAX transmissions.

Use one of the 3 following ways to officially submit your comments:

1. Electronically: https://www.regulations.gov/commenton/CMS-2023-0121-1282 Follow the “Submit a comment” instructions. Due no later than 11:59 pm ET on September 11, 2023.

2. Regular mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1784-P, P.O. Box 8016, Baltimore, MD 21244-8016. Due no later than 5:00 pm ET on September 11, 2023.

3. Express or overnight mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1784-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850. Due no later than 5:00 pm ET on September 11, 2023.

Thank you for taking the time to send CMS your comments! Together we can make a difference.