November 17, 2022 | Net Health

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​Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act (H.R.5536)

On January 1, 2022, a 15% Medicare payment reduction went into effect for care provided “in-whole or in-part” by a physical therapy assistant (PTA) or occupational therapist assistant (OTA).  Since the Bipartisan Budget Act of 2018 (BBA)1 required this cut be implemented, CMS and stakeholders worked together to develop regulations around this policy.  CMS regulations state that the payment differential is to be triggered when more than 10% of the therapy service is furnished by the PTA or OTA.  This threshold is also referred to as a “de minimis” standard.

As introduced in 2021, the bipartisan Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act (H.R.5536)2 sought to push back the implementation of the cut until January 2023.  As it is now almost the end of 2022, that provision of the bill has been set aside.  The two remaining elements of the SMART Act are being discussed with lawmakers and their staff.  One provision seeks to respond to the reality that therapy assistants play crucial roles in providing care to patients in underserved and rural communities.  Due to a number of factors, it is both a financial and recruitment challenge to staff a physical therapy clinic in these types of communities.  The bill therefore seeks to exempt PTAs and OTAs who provide care in rural or medically underserved areas from the 15% differential.

The SMART Act also addresses the therapist assistant supervision standard.  Current Medicare rules require direct supervision of therapist assistants in outpatient clinical settings, while in all other settings, general supervision is sufficient.  Should H.R.5536 be enacted, it would prohibit Medicare from requiring direct supervision in private practice settings if the state law allows for general supervision.  Currently only New York and Washington D.C. require full direct supervision of PTAs and only Kentucky requires direct supervision for OTAs in outpatient clinical settings.

It is possible for this bill to be part of an end-of-year legislative effort.  If this bill would help your bottom line or reduce your administrative burdens, reach out to your Representative and ask them to cosponsor the SMART Act (H.R.5536).



1Bipartisan Budget Act of 2018, Public Law 115–123 (02/09/2018).

2Text of Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act (H.R.5536):

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