[Senate Report 114-98]
[From the U.S. Government Publishing Office]
Calendar No. 177
114th Congress } { Report
SENATE
1st Session } { 114-98
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PREVENT INTERRUPTIONS IN PHYSICAL THERAPY ACT OF 2015
_______
July 30, 2015.--Ordered to be printed
_______
Mr. Hatch, from the Committee on Finance,
submitted the following
R E P O R T
[To accompany S. 313]
The Committee on Finance, to which was referred the bill
(S. 313) to amend title XVIII of the Social Security Act to add
physical therapists to the list of providers allowed to utilize
locum tenens arrangements under Medicare, having considered the
same, reports favorably thereon with an amendment and
recommends that the bill, as amended, do pass.
I. LEGISLATIVE BACKGROUND
The Committee on Finance, to which was referred the bill
(S. 313), to amend title XVIII of the Social Security Act to
add physical therapists to the list of providers allowed to
utilize locum tenens arrangements under Medicare, having
considered the same, reports favorably thereon with an
amendment, and recommends that the bill, as amended, do pass.
Background and need for legislative action
Under current law, physicians who are absent from their
practices (for reasons such as illness, pregnancy, vacation, or
continuing medical education) may retain substitute physicians
to take over their practices temporarily. The regular physician
may bill and receive payment for the substitute physician's
services as though he/she performed them; the regular physician
generally pays the substitute physician a fixed amount on a per
diem or similar fee-for-time basis, with the substitute
physician having the status of an independent contractor rather
than of an employee. These substitute physicians are generally
called ``locum tenens'' physicians.
Section 125(b) of the Social Security Act Amendments of
1994 authorized regular physicians to bill Medicare for the
services of a locum tenens physicians beginning January 1,
1995. The current Medicare statute (Section 1861(r)) defines a
physician as a doctor of medicine or osteopathy, licensed in
the state where he or she practices. In addition, for certain
purposes and within limitations, a doctor of dental surgery or
of dental medicine, a doctor of podiatric medicine, a doctor of
optometry, or a chiropractor is also considered a physician.
Health care professionals not included in this list are not
physicians under the Medicare program and therefore unable to
serve locum tenens.
In many parts of the country, physical therapists are solo
practitioners or in small group practices. Patients rely on
them for care and when those therapists are absent from their
practices, patients may not have access to other providers and
therefore may have breaks in care that could be harmful or
delay progress in care.
II. EXPLANATION OF THE BILL
PRESENT LAW
In general
Under title XVIII of the Social Security Act,\1\ Section
125(b) authorizes regular physicians to bill Medicare for the
services of a locum tenens physicians beginning January 1,
1995. Current Medicare statute (Section 1861(r)) defines a
physician as a doctor of medicine or osteopathy, licensed in
the state where he or she practices. In addition, for certain
purposes and within limitations, a doctor of dental surgery or
of dental medicine, a doctor of podiatric medicine, a doctor of
optometry, or a chiropractor is also considered a physician.
Health care professionals not included in this list are not
physicians under the Medicare program and therefore unable to
serve locum tenens.
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\1\Pub. L. No. 74-271.
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REASONS FOR CHANGE
The Committee recognizes the importance of allowing
Medicare beneficiaries who live in rural areas or areas where
there is a shortage of health professionals or are medically
underserved to have access to physical therapy care. The bill
allows physical therapists the same flexibility to bill under a
locum tenens arrangements that physicians currently enjoy.
EXPLANATION OF PROVISION
Under the provision, solely for areas defined as rural,
health professional shortage areas, or medically underserved
areas, physical therapists will be able to retain substitute
therapists to take over their practices when the originating
therapist is absent due to illness, pregnancy, vacation, or
continuing education. Medicare payments remain the same whether
for the originating provider, or the substituting provider.
EFFECTIVE DATE
The provision applies to services furnished after the date
of enactment of this Act.
III. BUDGET EFFECTS OF THE BILL
A. COMMITTEE ESTIMATES
In compliance with paragraph 11(a) of rule XXVI of the
Standing Rules of the Senate, the following statement is made
concerning the estimated budget effects of the revenue
provisions of the ``Prevent Interruptions in Physical Therapy
Act of 2015'' as reported.
The bill is estimated to have the following effects on
Federal budget receipts for fiscal years 2015-2025:
[Fiscal years--millions of dollars]
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2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2016-20 2016-25
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0 1 2 2 2 2 2 2 2 3 7 18
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Note: Details do not add to totals due to rounding.
Source: Estimate provided by the staff of the Congressional Budget Office.
B. BUDGET AUTHORITY AND TAX EXPENDITURES
Budget authority
In compliance with section 308(a)(1) of the Congressional
Budget and Impoundment Control Act of 1974 (``Budget Act''),\2\
the Committee states that no provisions of the bill as reported
involve new or increased budget authority.
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\2\Pub. L. No. 93-344.
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Tax expenditures
In compliance with section 308(a)(1) of the Budget Act, the
Committee states that the revenue-reducing provisions of the
bill involve increased tax expenditures (see revenue table in
Part A, above).
S. 313--Prevent Interruptions in Physical Therapy Act of 2015
Summary: S. 313 would allow physical therapists in areas
with a shortage of health professionals, medically underserved
areas, and rural areas to utilize substitute physical
therapists, in what are known as locum tenens arrangements,
under the Medicare program.
CBO estimates that enacting the legislation would increase
direct spending by $18 million over the 2016-2025 period.
Because the legislation would affect direct spending, pay-as-
you-go procedures apply. Enacting the bill would not affect
revenues.
S. 313 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
Estimated cost to the Federal Government: The estimated
budgetary effect of S. 313 is shown in the following table. The
costs of this legislation fall within budget function 570
(Medicare).
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By fiscal year, in millions of dollars----
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2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2016-2020 2016-2025
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CHANGES IN DIRECT SPENDING
Estimated Budget Authority.................................. 0 1 2 2 2 2 2 2 2 3 7 18
Estimated Outlays........................................... 0 1 2 2 2 2 2 2 2 3 7 18
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Basis of estimate: Since January 1, 1995, physicians
participating in the Medicare program may retain substitute
(locum tenens) physicians to take over their professional
practices when they are absent. Under a locum tenens
arrangement, the physician who is normally scheduled to see a
patient may bill and receive payment for the substitute
services as though she or he had performed them. The regular
physician then pays the locum tenens physician as if that
physician were an independent contractor (not an employee).
S. 313 would allow physical therapists participating in the
Medicare program to utilize locum tenens arrangements in areas
with a shortage of health professionals, medically underserved
areas, and rural areas. CBO estimates that enacting S. 313
would increase direct spending for Medicare by $18 million over
the 2016-2025 period.
Companies that specialize in locum tenens staffing already
exist. The Bureau of Labor Statistics estimates that in 2012
about one in four physical therapists worked part-time. Part-
time physical therapists could be a ready pool of substitutes
for physical therapists who participate in the Medicare
program. Based on information provided by the American Physical
Therapy Association and an analysis of the use of locum tenens
for physicians' services, CBO expects that utilization and
spending would increase over time as awareness of the policy
grew and the marketplace for providing such staffing developed.
Taking into account the proportion of spending in rural and
underserved areas (about 30 percent), CBO estimates that the
legislation would result in an increase in utilization and
spending for physical therapy services furnished to Medicare
patients of about 0.07 percent by 2019, adding about $2 million
to the roughly $3 billion in spending for such services
projected under current law.
Pay-As-You-Go considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget-reporting and enforcement
procedures for legislation affecting direct spending or
revenues. The net changes in outlays that are subject to those
pay-as-you-go procedures are shown in the following table.
CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR S. 313, THE PREVENT INTERRUPTIONS IN PHYSICAL THERAPY ACT OF 2015, AS ORDERED REPORTED BY THE SENATE COMMITTEE
ON FINANCE ON JUNE 24, 2015
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By fiscal year, in millions of dollars----
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2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2015-2020 2015-2025
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NET INCREASE IN THE DEFICIT
Statutory Pay-As-You-Go Impact....................... 0 0 1 2 2 2 2 2 2 2 3 7 18
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Intergovernmental and private-sector impact: S. 313
contains no intergovernmental or private-sector mandates as
defined in UMRA and would impose no costs on state, local, or
tribal governments.
Estimate prepared by: Federal Costs: Jamease Kowalczyk;
Impact on State, Local, and Tribal Government: J'nell Blanco
Suchy; Impact on the Private Sector: Amy Petz.
Estimate approved by: Holly Harvey, Deputy Assistant
Director for Budget Analysis.
IV. VOTES OF THE COMMITTEE
In compliance with paragraph 7(b) of rule XXVI of the
Standing Rules of the Senate, the Committee states that, with a
majority present, the ``Prevent Interruptions in Physical
Therapy Act of 2015,'' as modified, was ordered favorably
reported on June 24, 2015 as follows:
Final Passage of ``The Prevent Interruptions in Physical
Therapy Act of 2015,'' as modified--approved by a voice vote.
V. REGULATORY IMPACT AND OTHER MATTERS
A. REGULATORY IMPACT
Pursuant to paragraph 11(b) of rule XXVI of the Standing
Rules of the Senate, the Committee makes the following
statement concerning the regulatory impact that might be
incurred in carrying out the provisions of the bill as amended.
Impact on individuals and businesses, personal privacy and paperwork
The bill is not expected to impose additional
administrative requirements or regulatory burdens on
individuals. The bill is expected to reduce administrative
requirements and regulatory burdens on some businesses.
The provisions of the bill do not impact personal privacy.
B. UNFUNDED MANDATES STATEMENT
This information is provided in accordance with section 423
of the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104-
4).
The Committee has determined that the bill does not contain
any private sector mandates. The Committee has determined that
the bill contains no intergovernmental mandate.
VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
In the opinion of the Committee, it is necessary in order
to expedite the business of the Senate, to dispense with the
requirements of paragraph 12 of rule XXVI of the Standing Rules
of the Senate (relating to the showing of changes in existing
law made by the bill as reported by the Committee).
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