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Latest Efforts and Resources

Advocacy

Scope of practice expansion is a long-standing, continuous, and complex concern in the health care field. AAPM&R is aware of the various concerns specifically plaguing physiatrists, from non-physicians to non-physiatrists, intent on expanding their scope of practice beyond their level of education, training, and experience. 

AAPM&R is taking action.

Your Academy remains vigilant about ongoing efforts by non-physician and non-PM&R providers to expand their scope of practice beyond their level of training, which may threaten the health and safety of patients and impact the livelihood of physiatrists.

AAPM&R's Scope of Practice Workgroup

Recognizing the growing concern of non-physician (and non-PM&R) scope of practice expansion, your Academy is addressing this issue through multiple committees, including a new Scope of Practice Workgroup. This workgroup is comprised of representatives from the Quality, Practice, Policy, and Research (QPPR) Committee, the Health Policy and Legislation (HP&L) Committee, and the Reimbursement and Policy Review Committee (RPRC), and AAPM&R’s representative to the AMA Scope of Practice Partnership (SOPP).

Scope of Practice Partnership with the American Medical Association (AMA)

Your Academy, as a member of the AMA Scope of Practice Partnership (SOPP), actively engages in the collaborative effort of the AMA, American Osteopathic Association (AOA), national medical societies, state medical associations and state osteopathic medical associations to oppose scope of practice expansions by non-physician providers that threaten the health and safety of patients. The SOPP achieves this goal through legislative activities, regulatory activities, judicial advocacy, and programs of information, research and education. Active participation in this collaborative ensures physiatry is represented and contributes to SOPP’s goal to protect the health and safety of patients whose well-being may be threatened by health care practitioners who lack the education, training or experience to perform procedures for which they seek licensure or recognition.

Protecting Physiatry’s Leadership Within Rehabilitation Hospitals

In 2019, the Centers for Medicare and Medicaid Services (CMS) released the Proposed CY 2020 Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) Rule, including a proposal to amend the definition of a rehabilitation physician to clarify that the determination as to whether a physician qualifies as a rehabilitation physician (that is, a licensed physician with specialized training and experience in inpatient rehabilitation) is made by the IRF.” In response to this proposal, AAPM&R convened an ad hoc Rehabilitation Physician Workgroup and submitted a strongly worded letter to CMS urging CMS not to finalize its proposal to weaken the definition of rehabilitation physician and requesting that CMS delay any changes to current regulations until stakeholders can develop a consensus approach for protecting the quality and integrity of IRF care. In additional to several additional advocacy actions, AAPM&R secured support from 40 prestigious organizations representing patients, physicians, and large inpatient rehabilitation hospitals on a stakeholder letter to CMS.

In July 2020, CMS finalized the IRF PPS Rule for 2020. In the final rule, CMS deferred to the IRF to define and assess the definition of “rehabilitation physician.” Despite this outcome, we are immensely proud of the work more than 1,100 of our members put into advocating against this proposal. Our members demonstrated that physiatrists are advocates for their patients, in and out of the treatment setting. We know it will take time and perseverance to be successful, but we are stepping up and planning a long-term, strategic initiative. We are making physiatrists’ voices heard. We are advocating for physiatry’s value in medicine.

Click here to read the full timeline of our past efforts.

Click here to read about AAPM&R’s leadership in scoring an enormous advocacy win for the FY 2021 IRF PPS Proposed Rule.

Resources

From ongoing collaborations with the American Medical Association (AMA) to a full toolkit of position statements, we plan to continue developing tangible resources to assist physiatrists in addressing scope of practice issues.

Your Academy's Latest Efforts to Defend Physiatrists' Scope of Practice


View the full list of AAPM&R advocacy letters.


The No Surprises Act Aims to Increase Patient Health Care Cost Transparency Through Good Faith Estimate (GFE) Requirements

May 15, 2023

In December 2020, Congress passed the Consolidated Appropriations Act, 2021, which included the No Surprises Act, banning patient “surprise bills” for emergency and certain non-emergency services. Throughout 2021, the Department of Health and Human Services (HHS) along with the Departments of Labor and Treasury (“the Departments”) engaged in rulemaking implementing the provisions of the No Surprises Act for these statutory requirements that were set to be effective by January 1, 2022. Individuals with insurance through group (employer) health plans, federal and state-based ACA Marketplaces, and federal employees are covered by these provisions. However, these provisions do not apply to individuals with coverage through programs such as Medicare, Medicaid, the Indian Health Service, Veterans Affairs Health Care, or TRICARE. These federal programs already protect beneficiaries against surprise billing.

While much attention has been dedicated to the requirements that seek to protect patients from surprise bills for emergency services and ancillary services (e.g. anesthesiology, radiology, pathology, assistants-at-surgery, etc.) as well as for non-emergency services furnished by out-of-network providers furnished at in-network facilities (see here for more information on how such changes could affect physiatrists), it is important for AAPM&R members to be aware of additional No Surprises Act requirements for cost transparency, obligating physicians, including physiatrists, to provide patients with good faith estimates (GFE) for scheduled services and upon patient request in certain situations. 

Good Faith Estimates (GFEs) for Uninsured and Self-Pay Patients

As part of of the No Surprises Act, providers who schedule services for uninsured or self-pay patients at least 3 days in advance are required to provide patients GFEs for all reasonably expected charges associated with that service. Providers are also obligated to provide the GFE upon request from a patient, even if the service is not scheduled. To assess your potential obligations under these requirements, it is important to understand key terms created under the regulations:

  • “Convening Provider” or “Convening Facility”: This is defined as “the provider or facility who receives the initial request for a good faith estimate from an uninsured (or self-pay) individual and who is or, in the case of a request, would be responsible for scheduling the primary item or service.”
  • “Co-Provider” or “Co-Facility”: This is defined as “a provider or facility other than a convening provider or a convening facility that furnishes items or services that are customarily provided in conjunction with a primary item or service.”

Under the regulations, the “convening provider” (or facility) is responsible for providing the expected charges to the uninsured or self-pay patient, including the expected charges from “co-providers” or “co-facilities.” While its use not required, the Departments provided an example GFE form that physicians and facilities can utilize when complying with these requirements.

Because of the compliance burdens associated with these new requirements, the Departments have articulated that they will exercise enforcement authority that allows “convening providers” and “convening facilities” to provide GFEs without the expected charges for “co-providers” and “co-facilities,” pending the release of additional rulemaking. For the most recent extension of this enforcement authority, see the December 2, 2022 FAQ.

Understanding the timing, content, and other requirements for GFEs for uninsured and self-pay patients is critical for complying with obligations created under these regulations. For more information, you may find the additional resources helpful:

  • Centers for Medicare and Medicaid Services (CMS) Uninsured/Self-Pay GFE Slides: Link here
  • U.S. Department of Health and Human Services December 21, 2021 Uninsured/Self-Pay GFE Memorandum: Link here
  • Uninsured/Self-Pay GFE FAQs Part 1 (December 1, 2021): Link here
  • Uninsured/Self-Pay GFE FAQs Part 2 (April 5, 2022): Link here
  • Uninsured/Self-Pay GFE FAQs Part 3 (December 2, 2022): Link here
  • Uninsured/Self-Pay GFE FAQs Part 4 (December 27, 2022): Link here

To the extent that billed charges exceed the amounts included in the GFE by $400 or more per provider, patients may access a Patient-Provider Dispute Resolution Process to contest excess billed amounts. For more information on when this process applies, find additional information from the Centers for Medicare and Medicaid Services (CMS) here.

Good Faith Estimates (GFEs) for Insured Patients

The No Surprises Act establishes a new requirement for health care providers to submit a GFE of expected charges for services scheduled at least 3 days in advance for services to insured patients (or upon request by such patients) as well. This version of the GFE is not submitted to the patient, but rather, to the patient’s health plan in order for the health plan to generate an Advanced Explanation of Benefits (Advanced EOB). Advanced EOBs are furnished by health plans to their enrollees to help patients better understand their potential out-of-pocket expenses after what is covered and paid for by their health insurance coverage. 

While the No Surprises Act specified that this requirement take effect on January 1, 2022, the Departments have continued to delay provider and health plan compliance with these provisions because of the expected burden associated with meeting these requirements. The Departments have sought input on how they might leverage existing data to streamline the provision of this information to patients or otherwise reduce the compliance burden on providers and health plans.   While the eventual compliance date is unknown at the time of this publication, pending issuance of proposed and final rulemaking, it is important for PM&R physicians to know that this obligation is in statute and will be enforced at some point in the future. Please contact healthpolicy@aapmr.org with any questions.