Outpatient Therapy Modernization and Stabilization Act

I 116TH CONGRESS 2D SESSION H. R. 7154 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. IN THE HOUSE OF REPRESENTATIVES JUNE 11, 2020 Mr. BRENDAN F. BOYLE of Pennsylvania (for himself, Mr. BUCHANAN, Mr. MICHAEL F. DOYLE of Pennsylvania, Mr. PASCRELL, Mr. SOTO, Mrs. BEATTY, Ms. SHERRILL, Ms. BLUNT ROCHESTER, and Mr. RUSH) intro- duced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to improve and ensure ongoing Medicare beneficiary access to out- patient therapy services, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Outpatient Therapy 4 Modernization and Stabilization Act’’. 5 VerDate Sep 11 2014 19:19 Jun 29, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H7154.IH H7154 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 7154 IH SEC. 2. MODERATING ANNUAL MEDICARE REIMBURSE- 1 MENT CHANGES. 2 (a) WAIVING CERTAIN RULES WITH RESPECT TO IM- 3 PLEMENTATION OF ADJUSTMENTS OF RELATIVE VALUE 4 UNITS FOR EVALUATION AND MANAGEMENT CODES.— 5 Section 1848(c)(2) of the Social Security Act (42 U.S.C. 6 1395w–4(c)(2)) is amended— 7 (1) in subparagraph (B)(ii)(II), by inserting 8 after ‘‘Subject to clauses (iv) and (v)’’ the following: 9 ‘‘and subparagraph (P)’’; 10 (2) in subparagraph (F), in the matter pre- 11 ceding clause (i), by striking ‘‘The’’ and inserting 12 ‘‘Subject to subparagraph (P), the’’; and 13 (3) by adding at the end the following new sub- 14 paragraph: 15 ‘‘(P) EVALUATION AND MANAGEMENT 16 CODES.—The Secretary shall not apply sub- 17 paragraph (B)(ii)(II) (relating to limitation on 18 annual adjustments in relative values) or sub- 19 paragraph (F) (relating to budget neutrality 20 adjustments) with respect to the implementa- 21 tion of adjustments of relative value units for 22 the evaluation and management codes described 23 in the final rule published by the Secretary in 24 the Federal Register on November 15, 2019 25 VerDate Sep 11 2014 19:19 Jun 29, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H7154.IH H7154 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 7154 IH (84 Fed. Reg. 62568, 62847–62860), for 2021 1 and each subsequent year.’’. 2 (b) INCREASE IN UPDATE FACTOR.—Paragraph (19) 3 of section 1848(d) of the Social Security Act (42 U.S.C. 4 1395w–4(d)) is amended to read as follows: 5 ‘‘(19) UPDATE FOR 2020 THROUGH 2025.—The 6 update to the single conversion factor established in 7 paragraph (1)(C) for 2020 and each subsequent 8 year through 2025 shall be as follows: 9 ‘‘(A) For 2020, 0.0 percent. 10 ‘‘(B) For 2021, 1.0 percent. 11 ‘‘(C) For 2022 and 2023, 0.5 percent. 12 ‘‘(D) For 2024 and 2025, 0.0 percent.’’. 13 SEC. 3. HELPING OUTPATIENT PROVIDERS THROUGH THE 14 COVID–19 PANDEMIC. 15 (a) CLARIFICATION.—The third proviso of the third 16 paragraph under the heading ‘‘Office of the Secretary— 17 Public Health and Social Services Emergency Fund’’ in 18 division B of the Coronavirus Aid, Relief, and Economic 19 Security Act (Public Law 116–136) is amended by insert- 20 ing ‘‘(including physicians, physical therapists, occupa- 21 tional therapists, speech language pathology therapists, 22 audiologists, psychologists, social workers, and any other 23 supplier enrolled through part B of the Medicare program 24 under title XVIII of the Social Security Act (42 U.S.C. 25 VerDate Sep 11 2014 19:19 Jun 29, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H7154.IH H7154 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 7154 IH 1395 et seq.))’’ after ‘‘Medicare or Medicaid enrolled sup- 1 pliers’’. 2 (b) EFFECTIVE DATE.—The amendment made by 3 subsection (a) shall take effect as if included in the enact- 4 ment of the Coronavirus Aid, Relief, and Economic Secu- 5 rity Act (Public Law 116–136). 6 SEC. 4. MAKING APPROPRIATE THERAPY SERVICES ACCES- 7 SIBLE THROUGH THE MEDICARE TELE- 8 HEALTH PROGRAM. 9 (a) MEDICARE BENEFICIARY ACCESS TO THERAPY 10 SERVICES DURING NATIONAL HEALTH EMERGENCIES.— 11 (1) PERMITTING QUALIFIED THERAPISTS TO 12 PROVIDE MEDICARE TELEHEALTH THERAPY SERV- 13 ICES.—Notwithstanding any other provision of law, 14 with respect to Medicare telehealth therapy services 15 furnished on or after March 1, 2020, with respect to 16 an emergency period during 2020, a physical thera- 17 pist, an occupational therapist, or a speech language 18 pathologist who is enrolled under the Medicare pro- 19 gram under title XVIII of the Social Security Act 20 (42 U.S.C. 1395 et seq.), or a facility that is partici- 21 pating in such program, may furnish Medicare tele- 22 health therapy services to Medicare beneficiaries 23 during such emergency period under the same terms 24 and conditions as Medicare telehealth services may 25 VerDate Sep 11 2014 19:19 Jun 29, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H7154.IH H7154 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 7154 IH be furnished by physicians or practitioners pursuant 1 to the COVID–19 interim final rule. 2 (2) DEFINITIONS.—In this subsection: 3 (A) COVID–19 INTERIM FINAL RULE.— 4 The term ‘‘COVID–19 interim final rule’’ 5 means the interim final rule entitled ‘‘Medicare 6 and Medicaid Programs; Policy and Regulatory 7 Revisions in Response to the COVID–19 Public 8 Health Emergency’’ and published in the Fed- 9 eral Register by the Centers for Medicare & 10 Medicaid Services on April 6, 2020 (85 Fed. 11 Reg. 19230 et seq.). 12 (B) EMERGENCY PERIOD.—The term 13 ‘‘emergency period’’ means the COVID–19 14 emergency period (as described in subsection 15 (g)(1)(B) of section 1135 of the Social Security 16 Act (42 U.S.C. 1320b–5)) or any other subse- 17 quent emergency period during 2020 with re- 18 spect to which an emergency declaration de- 19 scribed in subsection (g)(1)(A) of such section 20 is made. 21 (C) FACILITY.—The term ‘‘facility’’ means 22 an agency, clinic, facility, hospital, and entity 23 described in section 1833(a)(8) of the Social 24 VerDate Sep 11 2014 19:19 Jun 29, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H7154.IH H7154 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 7154 IH Security Act (42 U.S.C. 1395l(a)(8)) that fur- 1 nishes Medicare telehealth therapy services. 2 (D) MEDICARE TELEHEALTH THERAPY 3 SERVICES DEFINED.—The term ‘‘Medicare tele- 4 health therapy services’’ means services identi- 5 fied by HCPCS codes 92507–92508, 92521– 6 92524, 92526, 92601–92604, 92607–92610, 7 92626–92627, 92630, 92633, 96105, 96125, 8 97110, 97112, 97116, 97129–97130, 97150– 9 97158, 97161–97168, 97530, 97535, 97542, 10 97750, 97755, 97760, and 97761–97763 (and 11 as subsequently modified by the Secretary of 12 Health and Human Services), and which may 13 be furnished to Medicare beneficiaries through 14 telehealth under section 1834(m) of the Social 15 Security Act (42 U.S.C. 1395m(m)) pursuant 16 to the COVID–19 interim final rule. 17 (E) OCCUPATIONAL THERAPIST.—The 18 term ‘‘occupational therapist’’ means a qualified 19 occupational therapist as that term is used in 20 section 1861(g) of the Social Security Act (42 21 U.S.C. 1395x(g)). 22 (F) PHYSICAL THERAPIST.—The term 23 ‘‘physical therapist’’ means a qualified physical 24 therapist as that term is used in section 25 VerDate Sep 11 2014 19:19 Jun 29, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H7154.IH H7154 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 7154 IH 1861(p) of the Social Security Act (42 U.S.C. 1 1395x(p)). 2 (G) SPEECH LANGUAGE PATHOLOGIST.— 3 The term ‘‘speech language pathologist’’ has 4 the meaning given the term ‘‘qualified speech- 5 language pathologist’’ in section 1861(ll)(4)(A) 6 of the Social Security Act (42 U.S.C. 7 1395x(ll)(4)(A)). 8 (3) IMPLEMENTATION.—Notwithstanding any 9 other provision of law, the Secretary of Health and 10 Human Services may implement this subsection by 11 program instruction or otherwise. 12 (b) SERVICES FURNISHED BEGINNING IN 2021.— 13 (1) IN GENERAL.—Section 1834(m) of the So- 14 cial Security Act (42 U.S.C. 1395m(m)) is amend- 15 ed— 16 (A) in paragraph (1)— 17 (i) by striking ‘‘or a practitioner (de- 18 scribed in section 1842(b)(18)(C))’’ and 19 inserting ‘‘, a practitioner (as defined in 20 paragraph (4)(E)), or a facility (as defined 21 in paragraph (4)(G))’’; and 22 (ii) by striking ‘‘individual physician 23 or practitioner’’ and inserting ‘‘individual 24 physician, practitioner, or facility’’; 25 VerDate Sep 11 2014 19:19 Jun 29, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H7154.IH H7154 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 7154 IH (B) in paragraph (2)— 1 (i) in subparagraph (A)— 2 (I) by inserting after ‘‘located at 3 a distant site’’ the following: ‘‘, or a 4 facility that is a distant site,’’; and 5 (II) by striking ‘‘such physician 6 or practitioner’’ and inserting ‘‘such 7 physician, practitioner, or facility’’; 8 and 9 (ii) in subparagraph (C), by striking 10 ‘‘as determined by the’’ and inserting ‘‘as 11 determined by a’’; 12 (C) in paragraph (3)(A)— 13 (i) in the subparagraph heading, by 14 striking ‘‘PHYSICIAN AND PRACTITIONER’’ 15 and inserting ‘‘PHYSICIAN, PRACTITIONER, 16 AND FACILITY’’; and 17 (ii) by striking ‘‘a physician or practi- 18 tioner receiving payment’’ and all that fol- 19 lows through the period and inserting ‘‘a 20 physician, practitioner, or facility receiving 21 payment under this subsection to the same 22 extent as they apply to physicians, practi- 23 tioners, or facilities under such sections.’’; 24 (D) in paragraph (4)— 25 VerDate Sep 11 2014 19:19 Jun 29, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H7154.IH H7154 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 7154 IH (i) in subparagraph (A), by inserting 1 before the period the following: ‘‘, or a fa- 2 cility that furnishes a telehealth service to 3 an eligible telehealth individual via a 4 telecommuniciations system’’; 5 (ii) in subparagraph (E), by inserting 6 before the period at the end the following: 7 ‘‘, and also includes, for purposes of this 8 subsection, a physical therapist, an occupa- 9 tional therapist, and a speech-language pa- 10 thologist’’; 11 (iii) in subparagraph (F)(i)— 12 (I) by striking ‘‘and office psychi- 13 atry’’ and inserting ‘‘office psychi- 14 atry’’; and 15 (II) by inserting before ‘‘, and 16 any additional’’ the following: ‘‘, ther- 17 apy services (identified as of April 1, 18 2020, by HCPCS codes 92507– 19 92508, 92521–92524, 92526, 92601– 20 92604, 92607–92610, 92626–92627, 21 92630, 92633, 96105, 96125, 97110, 22 97112, 97116, 97129–97130, 97150– 23 97158, 97161–97168, 97530, 97535, 24 97542, 97750, 97755, 97760, and 25 VerDate Sep 11 2014 19:19 Jun 29, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H7154.IH H7154 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 7154 IH 97761–97763 (and as subsequently 1 modified by the Secretary))’’; and 2 (iv) by adding at the end the following 3 new subpragraph: 4 ‘‘(G) FACILITY.—The term ‘facility’ means 5 an agency, clinic, facility, hospital, and entity 6 described in section 1833(a)(8) of the Social 7 Security Act (42 U.S.C. 1395l(a)(8)) that fur- 8 nishes therapy services described in paragraph 9 (4)(F)(i).’’; and 10 (E) by adding at the end the following new 11 paragraph: 12 ‘‘(9) TREATMENT OF TELEHEALTH THERAPY 13 SERVICES.—The geographic requirements described 14 in paragraph (4)(C)(i) shall not apply with respect 15 to telehealth services that are therapy services de- 16 scribed in paragraph (4)(F)(i).’’. 17 (2) EFFECTIVE DATE.—The amendments made 18 by paragraph (1) shall take effect on the date of the 19 enactment of this Act and apply to telehealth serv- 20 ices furnished under the Medicare program on or 21 after January 1, 2021. 22 VerDate Sep 11 2014 19:19 Jun 29, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H7154.IH H7154 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 7154 IH SEC. 5. REDUCING UNNECESSARY PAPERWORK IN THE DE- 1 LIVERY OF THERAPY SERVICES. 2 (a) IN GENERAL.—Section 1835(a) of the Social Se- 3 curity Act (42 U.S.C. 1395n(a)) is amended by adding 4 at the end the following new sentence: ‘‘The requirement 5 for review of a plan of care described in paragraphs 6 (2)(C)(ii) and (2)(D)(ii) for outpatient physical therapy 7 or outpatient occupational therapy services or speech-lan- 8 guage pathology services, respectively, for an individual 9 under the care of a physician shall be deemed to be met 10 if either of the following is included in the individual’s 11 medical record: an order for such outpatient physical ther- 12 apy or outpatient occupational therapy services or speech- 13 language pathology services, as the case may be, signed 14 by a physician under whom the individual is receiving care; 15 or a certification of the individual’s plan of care signed 16 by a physician under whom the individual is receiving 17 care.’’. 18 (b) CONFORMING AMENDMENT.—Section 1861(p) of 19 the Social Security Act (42 U.S.C. 1395x(p)) is amended 20 by adding at the end the following new sentence: ‘‘The 21 requirement for review of a plan of care described in para- 22 graph (2) for physical therapy services furnished to an in- 23 dividual under the care of a physician (as so defined) shall 24 be deemed to be met if either of the following is included 25 in the individual’s medical record: an order for such phys- 26 VerDate Sep 11 2014 19:19 Jun 29, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H7154.IH H7154 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 7154 IH ical therapy services signed by a physician under whom 1 the individual is receiving care; or a certification of the 2 individual’s plan of care signed by a physician under whom 3 the individual is receiving care.’’. 4 Æ VerDate Sep 11 2014 19:19 Jun 29, 2020 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6301 E:\BILLS\H7154.IH H7154 pamtmann on DSKBC07HB2PROD with BILLS