RECOVER Act would end arbitrary cut to occupational therapy payments

The bill would end the multiple procedure payment reduction (MPPR). Ask your Member of Congress to support this legislation.

On April 20, 2026, Rep. Deborah Ross (D-NC) introduced legislation to repeal the multiple procedure payment reduction (MPPR) that is applied to all Medicare outpatient therapy services. H.R. 8386, the Removing Excessive Cuts to Outpatient and Vital Essential Rehabilitation (RECOVER) Act, would repeal this arbitrary cut to therapy services, which has been in place permanently since 2013.

Summary:

• The MPPR reduces total payments for therapy services by an estimated 16% and was never based on an analysis of what those services actually cost to deliver.
• Since 2021, additional Medicare payment cuts—unrelated to OT—have further reduced therapy payments. Therapy services received some of the largest cuts as an "unintended consequence" of these Medicare changes, compounding the impact of the MPPR.
• This combination of cuts has made payment rates unsustainable. The 2021 changes were not meant to hurt therapy providers; the RECOVER Act is how Congress can fix it.
• Repealing the MPPR requires an act of Congress, but CMS may have authority to make some changes on its own. AOTA is pursuing both advocacy paths to change the policy.
• Take action: Go to AOTA's legislative action center to let your Member of Congress know about the impact of these cuts and ask them to support H.R. 8386.

What is the MPPR?

The MPPR is a Medicare payment policy passed by Congress to help “pay for” an extension of other health policies, after the Centers for Medicare & Medicaid Services (CMS) raised concerns about potential duplication of payments when multiple therapy services are provided in a single day. The MPPR reduces payment for the practice expense (PE) portion of each billed unit of any “always therapy” code by 50%, except for the one most expensive code billed. This reduction to PE applies to all therapy services billed in a day and results in an estimated 16% reduction in the total payment for therapy services. CMS originally suggested a 25% MPPR, but Congress chose to implement a 50% reduction to practice expense in order to pay for other policies. Setting the MPPR at 50% was not based on an analysis of what therapy services actually cost to deliver or of costs that may overlap when multiple services are provided in a day.

The MPPR applies to all outpatient Medicare Part B settings, including private practices, hospital outpatient departments, and long-term care skilled nursing facilities. Additionally, many state Medicaid programs and private insurance plans have followed Medicare’s lead by implementing similar cuts to payments for occupational therapy (OT) services.

How recent payment cuts have compounded the problem

Since they first took effect, the cuts under the MPPR have been an issue. However, the impact of this arbitrary cut to therapy services has been felt more strongly since 2021, when major changes to the Medicare Physician Fee Schedule (MPFS)—unrelated to OT—reduced payments for therapy services. Beginning in 2021, CMS implemented a large increase in payments for primary care services to improve Medicare beneficiaries’ access to primary care and to close the gap between payments for primary care and other specialty medical care. Because of the way the MPFS is structured, payment increases for one set of services necessitate reductions in payments for other services. While no one intended to cut payments for therapy services, we received among the largest cuts as an “unintended consequence” of the inflexible formula used to calculate MPFS payment rates. In total, a roughly 9% cut to therapy services was phased in between 2021 and 2025. These cuts, layered on top of the MPPR, have led to the current unsustainable payment rates for OT services.

Why the RECOVER ACT is the only complete solution

Currently, many healthcare organizations, including AOTA, are working with Congress to fix the flaws in the Medicare Physician Fee Schedule. Fixes to the MPFS would include implementing an annual payment increase and safeguards to prevent the large payment swings we saw in 2021. We believe these efforts are crucial to payment stability in the future. However, in order to stabilize payments for therapy services, the MPPR must be repealed. Only a small group of organizations representing therapy providers is focused on this issue, so repeal of the MPPR is AOTA’s primary focus for MPFS reform.

When Congress passed the MPPR into law, it specified that the rate must be 50%, that it would be permanent starting April 1, 2013, and that it would be applied outside of budget neutrality—meaning the savings would go to the federal government and not increase payments for other healthcare specialties. AOTA believes that Congress left CMS with the authority to make certain changes to the implementation of the MPPR. First, it could apply the reduction to each discipline separately rather than across therapy disciplines. This would allow each discipline to have at least one code paid in full. Second, we believe that CMS may have the authority to apply the MPPR only when multiple units of the same code are billed in the same session, thereby dramatically reducing the policy's impact.

In the end, while CMS could make tweaks, only Congress can remove the MPPR entirely or lower the rate from 50%, which is why the RECOVER Act is critical to finally ending the MPPR.

AOTA’s legislative strategy

Historically, bills like the RECOVER Act have been difficult to pass because they carry a high price tag, and Congress rarely passes legislation that increases healthcare spending for a single group of services. In the first few years after Congress put the MPPR in place, we worked to repeal the MPPR or reduce the PE reduction, and to split the disciplines, with no success. For this reason, AOTA focused on advocating to CMS to use its authority to change how the MPPR is implemented. CMS continues to state that it lacks the authority to make these changes, but has not provided any further explanation for its conclusion.

Given the current state of payment for therapy services, AOTA and our coalition partners believe it is time for Congress to repeal the arbitrary MPPR to specifically increase payments for therapy services. While we support and benefit from general increases in the MPFS, they do not offset the magnitude of the cuts we have received. Repealing the MPPR is the simplest way to help occupational therapy practitioners. Because of the way the MPPR is structured, no other specialties would be cut if the RECOVER Act were signed into law, so there should be no opposition beyond the bill's cost.

We know that bills like the RECOVER Act may take a long time to pass. But the introduction of the bill has helped start a broader conversation in Congress about how payment for therapy services differs from other MPFS payments, and it has highlighted the arbitrary cut that other providers do not face. Members of Congress can show their support for fair payment for therapy services by cosponsoring the RECOVER Act. Building this cosponsor list is the next crucial step towards seeing the bill signed into law one day.

How the RECOVER Act advances our regulatory advocacy

We also hope that the introduction of the RECOVER Act will encourage CMS to make the changes to the MPPR that we believe it has the authority to implement on its own. This dual strategy of legislative advocacy through bill introduction and regulatory advocacy through communication with CMS has been successful in the past. In the 2025 MPFS, CMS changed the supervision requirement for OTAs working in private practice and removed the requirement that a physician sign the therapy plan of care when there is a physician referral. Both decades-old policies were finally changed by sustained advocacy by AOTA with CMS and a Congressional signal of approval through bill introduction. We hope that the introduction of the RECOVER Act will have the same effect. The FY27 proposed rule for the MPFS is where CMS would propose changes to how it implements the MPPR. The proposed rule will be released around the beginning of July.

Tell your story

Physicians are on Capitol Hill discussing the challenges they face in today’s healthcare environment. Our story is important too. Their voices are loud, so we need yours and your story so that Congress knows what has happened to payments for occupational therapy services and why access to occupational therapy is so crucial for Medicare beneficiaries. Go to AOTA’s legislative action center and write to your member of Congress today!

Please personalize your letter to share the challenges you face due to multiple cuts to OT services and their impact on beneficiaries' access to care.