1. So, You Want To Keep Your Job? How the CMS Decision Affects You January 2006

2. Impact of CMS Decision on Athletic Trainers More than 1,000 athletic trainers have lost their jobs 800 outreach/clinical ATs (high school and college based) 300 physician extenders ATs (physician office based) These were jobs in core athletic training settings…not necessarily “reimbursement jobs.”

3. Why Is CMS Recognition Important? CMS sets the national health care agenda—almost 50% of every health care dollar! Drives who can practice where By default, credentials who is qualified Commercial insurance follows its rules (usually) Sets reimbursement rates Gatekeeper to patient access Gatekeeper to quality health care for all ages (youth through seniors)

4. If You Can’t Bill, You Can’t Do Therapy CMS “Therapy-Incident To” rule says that only physical therapists, occupational therapists and speech/language therapists are qualified to provide therapy. CMS rule implies that all others are unqualified to provide therapy and rehabilitation services. CMS rule implies that athletic trainer education is inadequate. CMS rule includes all “physical medicine and rehabilitation services.” Athletic training services are “physical medicine and rehabilitation services.”

5. If You Can’t Do Therapy, You Must Not Be Qualified The CMS rule is based on educational qualifications (not licensing). It says that in order to be reimbursed when providing therapy services, you must have graduated from a PT program (or OT/SLP). It essentially says that athletic trainers are not qualified to provide therapy services. Did you waste your education? Will you have to go back to school to get a new degree to practice what you’ve been doing?

6. If You Are Not Qualified, Then Someone Else Is If Medicare doesn’t recognize that you are qualified, then who is qualified to do your job? Professionals and therapists are reimbursable. Aides are not reimbursable. For collegiate and high school ATs, it is not about reimbursement, it’s about qualifications.

7. APTA Response to NATA Efforts … I wanted to email you today to clarify that this briefing is not being coordinated by the American Physical Therapy Association and to give you more background information on the subject matter…..about the delivery of services by those who are not trained and educated as physical therapists that would like to provide their services within a physician office under special “incident to” rules given that their services are not recognized as an established benefit under the Medicare program…. The basic issue is whether a Medicare beneficiary should have to question whether their physical therapy services, provided in a physician office or any other practice setting under Medicare, are provided by qualified professionals. CMS and APTA believe that the patient should not have to question this point given that physical therapy is a covered benefit under the Medicare program. …CMS and APTA felt this standard was not in line with requirements for other Medicare practice settings and sought to protect beneficiaries by requiring the use of qualified physical therapists to deliver physical therapy services in physician offices…. there is more…

8. What’s Been Done to Reverse the Therapy-Incident To Rule Aggressive work on CMS policy on restricting who can provide therapy services “incident to.” Continued negotiations with the Centers for Medicare and Medicaid Services (CMS) -- ongoing Grassroots campaigns to members of Congress Targeted campaigns to selected members of Congress Federal lawsuit – now on appeal at the Fifth Circuit Court of Appeals. Appeal hearing expected in second or third quarter 2006 Established Coalition to Preserve Patient Access to Physical Medicine and Rehabilitation Services (24 members) Wide variety of members outside of sports medicine has made it less of a turf battle, has broadened grassroots and congressional reach.

9. How You Can Help Know and understand that this is both a patient’s access to quality of care issue as well as athletic training jobs issue. Sign up for the NATA Legislative Alert Center. (http://www.nata.org/members1/login-members.cfm)http://www.nata.org/members1/login-members.cfm Write and CALL your members of Congress – both Senators and Representative. Be sure they understand the issue is not the “physical therapy cap” or “physical therapy direct access” issue. Keep after them until they “get it.” Get your AT friends to write and call their legislators. Get your physicians to write their legislators about the issue. Get local and state chapters of the medical societies, patient advocacy groups to support our cause. Alert the media – get talking points and help from NATA.

10. Key Contacts Marje Albohm, NATA Vice President mjalbohm@aol.com Cate Brennan Lisak, NATA Director of External Affairs catel@nata.org Teresa Foster Welch, NATA Assistant Executive Director teresa@nata.org

11. THANK YOU