AOTA endorses legislation that would require MA plans to address serious reimbursement issues for OT and other services
Reps. Lloyd Doggett (D-TX) and Greg Murphy, MD (R-NC) have introduced the Prompt and Fair Pay Act (H.R.4559) which would ensure that Medicare Advantage (MA) payments for OT and other services at least match Traditional Medicare Fee-for-Service (FFS) reimbursement levels while also requiring prompt payment of clean claims and enhanced transparency from MA organizations regarding questioned claims. Reps. Doggett and Murphy both referred to significant issues with MA reimbursement and administrative burden during a Ways and Means Health Subcommittee hearing on July 22.
AOTA has endorsed H.R.4559, which would address issues AOTA members have reported, including MA reimbursement levels set lower than FFS, delayed reimbursement, and erratic procedures for handling questioned claims. AOTA’s Chief Executive Officer, Katie Jordan, OTD, MBA, OTR/L, FAOTA, noted that “this legislation is critical to reduce the administrative burden related to processing claims, which would allow a greater focus on actual patient treatment.”
Rep. Doggett is the Ranking member of the House Ways and Means Health Subcommittee, of which Dr. Murphy is also a member. Rep. Doggett is also a co-lead of the Medicare Home Health Accessibility Act (H.R.2013), and Rep. Murphy has long championed the need to address problems with the Medicare Physician Fee Schedule. Rep. Doggett noted that “providers are having to choose between substantial reimbursement delays that are often less than what is truly owed, administrative burdens, and care denials, or an outright withdrawal from MA contracts.” Rep. Murphy added that healthcare providers who treat MA beneficiaries “not only experience major delays in reimbursement and senseless prior authorization denials but often receive less compensation for services rendered than they earn through traditional Medicare.”
AOTA will continue to engage with Medicare Advantage plans as part of coalition efforts to address specific issues with individual plans, while also working with CMS and Congress, which have the ultimate authority to require MA plans to provide fair reimbursement for occupational therapy and other services. Please contact Congress to advocate for passage of H.R.4559.