Exploring the CMS Proposed Rule for Therapy Services in 2025: Key Changes and Implications

The Centers for Medicare & Medicaid Services (CMS) has unveiled a proposed rule for 2025 that introduces significant changes affecting therapy services under Medicare. This blog post explores the specific provisions of the proposed rule and discusses their potential implications for therapy providers and patients.

Key Provisions of the CMS Proposed Rule for Therapy Services in 2025:

• Telehealth Extension: CMS is proposing to extend telehealth coverage for therapy services through Dec 31, 2024, allowing greater flexibility in how and where these services can be provided. This could improve access for patients in rural or underserved areas.
• Value-Based Care Initiatives: The proposed rule emphasizes the shift towards value-based care models for therapy services. Providers may be incentivized to focus on patient outcomes and quality of care rather than the volume of services provided. Examples being new MIPS value pathways, and reimbursement for caregiver training.
• Payment Adjustments: CMS is considering adjustments to payment rates and methodologies for therapy services. A conversion factor of $32.36 or $0.93 reduction (2.80%) is being proposed currently.
• Regulatory Flexibilities: There are proposals for regulatory flexibilities aimed at reducing administrative & operational burdens on therapy providers. This could streamline oversight and documentation requirements, as well as improve operational efficiency. Under this provision a general PTA supervision is being proposed by CMS for 2025.

Implications for Therapy Providers:

• Opportunities for Expansion: Telehealth expansion could open new avenues for therapy providers to reach more patients and expand their service offerings.
• Financial Considerations: Providers will need to adapt to potential changes in reimbursement rates and methodologies, which could impact revenue streams and financial planning.
• Quality of Care: Emphasizing value-based care may lead to improvements in patient outcomes and satisfaction, but providers will need to invest in outcome measurement and care coordination strategies.

Implications for Patients:

• Improved Access: Expanded telehealth options could make it easier for patients to access therapy services, particularly for those who face barriers to in-person care. Additionally a general PTA supervision would allow for greater overall patient access to care.
• Focus on Outcomes: Patients may benefit from a stronger emphasis on quality and outcomes, potentially leading to better overall health outcomes and patient experiences.

Conclusion: The CMS proposed rule for therapy services in 2025 represents a significant shift towards modernizing how these essential healthcare services are delivered and reimbursed under Medicare. While the proposed changes aim to enhance access, quality, and efficiency in therapy care, they also pose challenges and opportunities for therapy providers and patients alike.

Stakeholders are encouraged to review the proposed rule and provide feedback during the comment period to help shape the final regulations. Understanding the specific provisions and potential implications of the CMS proposed rule is crucial for therapy providers preparing for potential changes in Medicare reimbursement and service delivery models.