Carper, Barrasso Introduce Legislation to Provide Greater Accessibility to Physical and Occupational Therapy Services for Underserved Americans

WASHINGTON, D.C. — U.S. Senators Tom Carper (D-Del.), senior member of the Senate Finance Committee, and John Barrasso (R-Wyo.) today introduced legislation to make it easier for Medicare Part B beneficiaries to see a licensed physical therapy assistant (PTA) or occupational therapy assistant (OTA).

Millions of Americans, specifically those in rural and underserved areas, currently face unnecessary administrative challenges when seeking physical and occupational therapy services. That’s because right now, PTAs and OTAs working in private practice cannot see their patients without their supervisors physically on site at all times. The Carper/Barrasso legislation would enable these skilled professionals to continue to care for their patients, even if their supervisor cannot be there in person. This means more therapy care teams can help people get the services they need right when they need it.

“Medicare Part B beneficiaries in Delaware—and every state—should have ample access to physical and occupational therapy services. Yet unnecessary administrative burdens stand in the way of ensuring millions of Americans, especially those in rural and underserved areas, get the care they need,” said Carper.“By making Medicare’s requirements for skilled physical and occupational therapy assistants consistent with state laws, patients in Delaware will see improved timely access to care. Our bipartisan bill will do just that, and I look forward to working with my colleagues to get this legislation passed as soon as possible.”

“As an orthopedic surgeon, I’ve seen firsthand the importance of therapy services for my patients,” said Barrasso. “Our bill makes it easier for patients in Wyoming to access physical and occupational therapy. I will continue finding bipartisan solutions so patients, especially seniors on Medicare, can get the care they need.”

“The American Physical Therapy Association is grateful to Senators Carper and Barrasso for their leadership on this bipartisan legislation to improve patient access to care, especially in rural and underserved areas,” said APTA President Roger Herr, PT, MPA.“According to an independent, non-partisan study published by the firm Dobson Davanzo & Associates, the cost savings this legislation will bring are projected to be as much as $271 million. The changes will also reduce administrative burden and provide helpful flexibilities for physical therapists in small businesses. Lastly, changing supervision requirement allows physical therapist assistants to practice at the top of their license, recognizing the valuable role they play in the health care system and providing critical support to therapy clinics.”

“APTA Delaware greatly appreciates Sen Carper’s support for the physical therapy profession and the patients we serve.  We applaud his sponsorship of this common-sense legislation that will improve timely access to therapy services for Delawareans, and support small therapy businesses throughout the state,” said Stephen Rapposelli, PT, OCS, president of APTA Delaware.

“I would like to thank Senator Carper and Senator Barrasso for introducing this legislation, which recognizes the expertise and value that occupational therapy assistants bring to the occupational therapy process and the services they provide across all settings,” said American Occupational Therapy Association President Alyson Stover.“This legislation makes supervision requirements under Medicare consistent across practice settings and with state law, ending the unnecessarily strict supervision requirement for occupational therapy assistants providing services in private practice. Occupational therapy assistants are a cornerstone to ensuring access to high quality occupational therapy services, especially in rural and medically underserved areas.”


Physical therapy assistants (PTAs) and occupational therapy assistants (OTAs) provide patient care under the direction and supervision of licensed physical or occupational therapists, respectively, making PTAs and OTAs an integral part of therapy services care teams. Currently, “direct supervision” of PTAs by licensed physical therapists and OTAs by licensed occupational therapists is required in the private practice setting for Medicare Part B patients. “Direct supervision” requires the supervising therapist to be physically present in the providing facility at the time of service.

However, in other outpatient provider settings (e.g. hospital outpatient departments, outpatient rehabilitation agencies), “general supervision” of PTAs and OTAs is permitted for Medicare payment. Under “general supervision,” supervising therapists are not required to be on-site.

PTAs and OTAs are licensed or certified in all U.S. jurisdictions and are regulated by their state’s licensure board. To date, only New York and the District of Columbia require “direct supervision” of PTAs. Similarly, only one state, Kentucky, requires “direct supervision” of OTAs. 

Yet, despite PTAs and OTAs in private practice across other jurisdictions having the ability to practice under “general supervision,” Medicare still requires “direct supervision” for payment in this setting. This requirement contradicts state discretion in setting scope-of-practice policy and undermines access to physical therapy services for individuals in rural and underserved areas.