[Senate Report 114-98]
[From the U.S. Government Publishing Office]


                                                      Calendar No. 177
114th Congress    }                                      {      Report
                                 SENATE
 1st Session      }                                      {      114-98

======================================================================



 
         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.
---------------------------------------------------------------------------
    \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]
--------------------------------------------------------------------------------------------------------------------------------------------------------
   2015        2016        2017        2018        2019        2020        2021        2022       2023       2024       2025      2016-20      2016-25
--------------------------------------------------------------------------------------------------------------------------------------------------------
                   0           1           2           2           2           2          2          2          2          3            7           18
--------------------------------------------------------------------------------------------------------------------------------------------------------
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.
---------------------------------------------------------------------------
    \2\Pub. L. No. 93-344.
---------------------------------------------------------------------------

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).

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                      By fiscal year, in millions of dollars----
                                                             -------------------------------------------------------------------------------------------
                                                               2016   2017   2018   2019   2020   2021   2022   2023   2024   2025  2016-2020  2016-2025
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                               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
--------------------------------------------------------------------------------------------------------------------------------------------------------

    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
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                   By fiscal year, in millions of dollars----
                                                      --------------------------------------------------------------------------------------------------
                                                        2015   2016   2017   2018   2019   2020   2021   2022   2023   2024   2025  2015-2020  2015-2025
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                               NET INCREASE IN THE DEFICIT
 
Statutory Pay-As-You-Go Impact.......................      0      0      1      2      2      2      2      2      2      2      3         7         18
--------------------------------------------------------------------------------------------------------------------------------------------------------

    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).

                                  [all]