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Physical therapists tell Senate committee federal Medicaid coding changes threaten home visits, small practices
Summary
Representatives of Vermont’s chapter of physical therapists told the Senate Health & Welfare committee that federal Medicaid evaluation-code changes will reduce reimbursements and could force private practices to stop Medicaid home visits and limit care for infants and rural patients.
Physical therapists representing the Vermont chapter of the American Physical Therapy Association told the Senate Health & Welfare committee on March 19 that federal changes to Medicaid evaluation coding risk cutting reimbursements for services they have billed for 15 years, threatening home-based early-intervention care and the viability of small private practices.
The therapists asked the committee to consider ways the state could cover nonbillable work — travel, team meetings and administrative coordination — and to explore grant or budget options to sustain services that keep children out of more intensive and more expensive school-based special-education placements.
“Heidi,” introduced to the committee as a Middlebury private-practice physical therapist and chapter president, said the federal changes will force her to alter her business model. “I’m going to have to change my priorities, and I’m no longer gonna be able to take just Medicaid,” she said, adding that she likely could no longer provide home visits to infants and young children if payment drops. She told the panel she routinely takes Vermont Medicaid for birth-to-3 early-intervention work and that providing services in homes is expensive.
The witnesses said that when infants and toddlers miss early therapy, their needs can grow and shift costs to school systems. “If these babies don’t get their therapies — PT, OT and speech — when they’re little, those services and their needs are gonna go up tremendously,” a presenter said, pointing to likely increases in special-education costs if early intervention becomes harder to access.
Committee members asked whether therapists participate on community health or primary-care teams and whether state programs — including rural health transformation or workforce grants — could help pay for coordination time and travel. The therapists said some practices operate inside federally qualified health centers and that payment and administrative rules remain the main barriers in many settings.
The presenters also warned about workforce retention: private practitioners reported higher insurance and staffing costs and clinicians leaving the state because they cannot sustain small practices. One witness said her business’s insurance costs had risen by about 3.5 percent of revenue compared with a year earlier and that small practices were being offered buyouts or shutting down.
The committee asked the witnesses for written testimony and data to quantify the problems and suggested staff and sponsors may consider drafting statutory or budget language to offset anticipated cuts. The therapists said they represent hundreds of providers across sectors and offered to provide numbers and concrete policy recommendations to the committee.
The panel did not take a vote on policy during the session; the committee asked the witnesses to supply follow-up materials and said staff would explore whether provisions could be included in upcoming bills or the budget.
