AOTA joins coalition calling on Congress to end Medicare policy that has cut occupational therapy pay for 15 years

AOTA has joined nine other national organizations, including the American Physical Therapy Association and the American Speech-Language-Hearing Association, in formally asking Congress to repeal the Multiple Procedure Payment Reduction (MPPR), a Medicare payment policy that has reduced occupational therapy reimbursement for 15 years. The letter was to the Senate Finance Committee and the House Energy and Commerce Committee, which oversees Medicare legislation.

The MPPR automatically reduces the practice expense (PE) portion of payment for therapy services by 50% when a patient receives more than one therapy service in a day. This reduction to the PE results in an overall estimated 16% reduction in payment for occupational therapy services. This policy was permanently locked in by Congress in 2013 to help “pay for” a short-term fix for larger Medicare issues. It was not based on an analysis of what therapy services actually cost to deliver, or what costs may actually overlap when multiple services are provided in a day. It has never been updated or revisited.

This cut directly affects what providers are paid for their services. And because Medicare rates serve as the benchmark most private insurers use to set their own rates, the MPPR's impact reaches well beyond Medicare beneficiaries.

In the press release about this letter, AOTA CEO Katie Jordan, OTD, MBA, AOTR/L, FAOTA, stated:

Occupational therapy practitioners are being paid less in real dollars today than they were in 2009 — and the multiple procedure payment reduction is a major reason why. MPPR cuts payment for therapy simply because a beneficiary receives more than one 15-minute unit of service in a day. Small practices in rural and underserved communities are struggling to stay open. If Congress wants older Americans to have access to the occupational therapy they need to stay independent, repealing the MPPR has to be part of the answer.

In addition to reducing payments for each therapy discipline, the MPPR also applies across disciplines. If a patient sees an occupational therapy practitioner and a physical therapist on the same day (i.e., two separate clinicians using different equipment and treating different conditions), reimbursement for every service billed, except one, is reduced. This occurs even though there is virtually no overlap in practice expenses, which include items such as the time required to clean equipment and the cost of equipment used.

The coalition making this ask spans all three therapy professions as well as groups representing therapy employers: AOTA, APTA, ASHA, APTA Private Practice, the Alliance for Physical Therapy Quality and Innovation, the American Health Care Association, the National Center for Assisted Living, the National Association of Rehabilitation Providers and Agencies, Athletico, Select Medical, and ADVION. This letter is a unified signal that support for the repeal of the MPPR is broad and shared.

AOTA and the coalition are working to build congressional support for legislation that would repeal, or at a minimum reduce, the MPPR. This letter is a key step in that process.

For more information on AOTA's Advocacy, visit the Advocacy News section of AOTA.org.