Too often, public and private insurance programs include barriers to care that result from unnecessary regulatory, legal and payment policies. This can mean that Medicare beneficiaries sometimes lose access to their physicians and other providers. Physical therapy, including in-home therapy, has been particularly impacted because many providers are listed as nonparticipating.
The Medicare Patient Empowerment Act of 2021 would allow Medicare beneficiaries to select the health care professional of their choice and enter into a contract with that professional—regardless of whether the professional is a participating or nonparticipating provider. Current policy allows providers to contract with individuals, but they must opt out of the Medicare program for two years. If passed, the act will remove that requirement.
A Medicare beneficiary must sign a contract stating that they will pay for a Medicare-covered item or service, and they must also submit a claim for Medicare payment. However, a beneficiary may negotiate to have the professional file claims on the beneficiary’s behalf.
If a professional is considered nonparticipating, payment will be made as if the professional were participating.
Dual-eligible beneficiaries are excluded from the act.
The bill was introduced by Rep. Pete Sessions (R–Texas) and Sen. Paul Rand (R–Kentucky) early in 2021. It is currently in committee.
ELIGIBLE PROFESSIONALS
- Physician
- Physician assistant
- Nurse practitioner
- Clinical nurse specialist
- Certified registered nurse anesthetist
- Certified nurse-midwife
- Clinical social worker
- Clinical psychologist
- Registered dietitian
- Nutrition professional
- Physical or occupational therapist
- Qualified speech-language pathologist
- Qualified audiologist
WHAT HAPPENS NEXT?
The American Physical Therapy Association is urging members to contact their senators and representatives to cosponsor the bill. More information and advocacy language can be found at apta.org.
DID YOU KNOW?
In 2019, the average total payment for an inpatient hospital stay was $14,234, based on Medicare reimbursement and beneficiary cost share. —Source: cms.gov
Track this bill at congress.gov.
