S.B. 204 Physical Therapy Payment Amendments: transcript

So you'll need to Thank you, Mr. Chair. Um, to seated to my left is a gentleman by the name of Rick Libert. He's gonna present with me and a, and answer some of the questions. Um, Rick is, is the operator and kind of founder of Mountain Land Physical Therapy. Um, right now, mountain Land Physical Therapy has 74 clinics, but he, he's here on behalf of Physical Therapy Association. And I've had a chance to review some of their concerns and work with them today. And what, what we've got is, is a bill that deals with, with copays. And, and the concern is when you go to your physical therapist, they are a specialty provider. And because of that, you pay an increase in your, in your copay. And, and you can see in the PHP, um, fiscal note that there is a, a cost to the state plan. And that's because the, the cost in their plan goes up about about $10. Um, this, this doesn't seem like much, but when you compound that over 10, 12, 20 visits, it's, it's significant. And, and the concern that we're trying to resolve is when, when that cost exceeds a certain threshold, some folks say, well, just give me an o opioid rather than doing physical therapy. And they never, they never quite heal. Um, this, this is a bill that would, would help that situation. But without, I, I, I want Rick to be able to talk and, and describe and describe the situation, and then we'll take questions on the bill.

Chair members, thank you for the opportunity to speak.

Bet. Thanks. My name is Rick Libert and I live in Saratoga Springs, and I'm representing the American Physical Therapy Association, Utah Chapter. Um, as Senator Mikel mentioned, um, I'm the CEO and a physical therapist of Mount Land Physical Therapy, and we treat about 50,000 patients a year. And, um, the, the cost to the patients is significant, such that oftentimes it gets in the way of them attending physical therapy or finishing their physical therapy. This past year, we passed legislation where physical therapists were recognized as primary care. However, the copays associated with attending physical therapy remain at the specialty level. Um, as Senator Senator Mikel mentioned, that can be for PEHP, that's $10, sometimes it's $50 difference. And oftentimes, physical therapy is not just one visit. It's oftentimes six 10, could be 20, depends on the situation, and it becomes a real issue of access to care. Um, it, the irony is, physical therapy is the best deal in town for the payers. It, it is really inexpensive relative to the other options such as opioids and injections and, uh, surgery and imaging studies. And unfortunately, patients don't complete their plan of care or even attend physical therapy once they find out what it's gonna cost. And I, I think it's, you know, it's an argument is, well, it's only $10, but I think it's the multiple of that plus the relative option, oh, I can just get a prescription for this much lower cost, let's just go that route. And unfortunately, these patients end up not recovering as efficiently as they can and ultimately end up with more expensive care in the long run. And, and Mr. Chair, the other thing I wanna add there is some opposition to this bill, certainly, and some of the opposition is this would open the door to others wanting to, wanting to be a primary care provider. Um, I I, I'm not as persuaded by that, but it's a concern that we're gonna look at if this, if this committee will send this bill out. But I I, I, I just see this different than going to an orthopedic surgeon or going to a cardiologist where you're, you're limited in scope. I mean, physical therapy is kind of the frontline of getting people back, back to work, back to school, um, back to those activities, back, back to the golf course for, for at least three members of this, of this committee. But with that, we're, we're open for questions.

I, that's the problem we're trying to solve.

Thank you. Um, by my count, there's about 12 house bills and eight Senate bills already numbered this session that would impose insurance mandates. Um, is there any effort, um, to look at if we just pass all of these mandates willy-nilly, what that's going to do to insurance companies in Utah

And Senator? Well, I just respond and say, I, I haven't looked at those bills, but I would love to visit with you offline that I think that's a legitimate concern. I think we need to be careful. I think the, the argument for physical therapy, especially where they were recognized in this setting last session, um, it makes it more appropriate here. But, but I think that's a fair concern.

One other question. Um, uh, have you considered some type of opt out for plans that have a, uh, low or no, uh, cost copay plan?

We've, we've got some language that has been submitted to me that, that I just, I need, I need to look at. I got it today, and I want to, I do wanna look at that language and see if it, if it makes sense.

One last question if I could, um, how would this affect PEHP?

Um, you'll, you'll see the PHP in, in the fiscal note, and I know I, I, I know that Che Loft is, is, is here, it's probably a better question for him, but it mm-hmm. Isn't fiscal fiscal note shows, uh, net all funds 55,001 time, 110,000 ongoing. Oh, wait a minute. Am I reading that right? Ongoing, 75,001 time. 3 7 5. Yeah. Oh, 75,000 And I, and I know I, if I read That right, Che, if I messed that up, Che, can it come up correct? I, I think it was 9,000, 9,000 folks multiplied by about about 10 bucks. But I, I know, I know Chet's here, so if we need to get it right, he's here.

Thank you, Mr. Chair. Thank you. Any other questions?

Hi, thank you, Kim Frost. I'm with Regions Blue Cross Blue Shield of Utah. We represent about 700,000 members in our, in the state. Um, we just wanna recognize the important role that physical therapists play in patient care, but this bill sets a concerning precedent that, um, we'll have signi significant unintended consequences for Utah Utah's healthcare system and the small employers and Utah families that we serve. Health insurers carefully design cost sharing structures based on clinical evidence, utilization patterns, and the strategic role that different providers play within our care continuum. Primary care providers serve as the foundation of preventative care and coordination, which is why many plans incentivize their use through lower cost sharing. Mandating identical cost sharing for specialist services undermines this evidence-based approach and opens the door to a cascade of similar mandates. If we establish this precedent for physical therapists, every specialty could rightly demand the same treatment, creating a patchwork of mandates that ultimately will, um, limit our ability to des design effective benefit structures and contain rising healthcare costs. Increased costs are passed directly to small employers and Utah families through higher premiums. This legislation reduces our flexibility to manage costs, effects effectively, potentially increases over health, over all healthcare spending, and makes coverage less affordable for those who need it most. As a reminder, the state only regulates the fully insured market, not the ERISA self-funded plans. So this mandate will only impact 20% of the market, primarily small businesses that are already struggling to offer health insurance to their employees. Thank you.

My name is Howard Quackenbush. I'm a physical therapist in Delta, Utah. And I am asking that we favorably recommend this, this bill, particularly due to the fiscal note. I know that, uh, there's some concerns about the overall cost and potential cost increase, and with the fiscal note stating that there will be a cost increase due to the copays, that that is legitimate. But there's the other end of the stick. When, um, PEHP in particular, they ensure the county employees, the city employees, the state employees, the highway patrol, they lift, they sit, they carry, they wrestle, and they do end up with back pain. Now, I did a quick little review. The average cost of a lumbar discectomy is 15 to $30,000. If you end up with a discectomy plus a fusion, your cost for that, that surgery is anywhere between 80 to $150,000. If, if a patient can get to physical therapy first. And if we can prevent one or two of these surgeries for PEHP in the long run, we've saved them money. We've saved them the cost plus the potential of failed surgeries, opioid addiction challenges down the road. Obviously we can't do it for everybody, but we can do for a lot. And the great thing is, is as a therapist in Delta, Utah, I'm sure I can do one or two per year for you, but imagine what all the physical therapists at the state of Utah could do for not just PHP, but all private insurers. Thank you, Mr. Chair. Thank you.

We are the association that, uh, of insurance employee benefits advisors who represent small businesses, employees, and individuals across the state. Uh, first I wanna say that I appreciated Senator Weiler's comment. That is something that we're concerned about as well. Um, we understand that we need a, a fair space of insurance, but, uh, this year we have faced historic rate increases. This has been, uh, uh, a year where across the country, but Utah's been no exception. We've been looking at 10 to 15% rate increases as the kind of thing you hear reported in the news. What you don't hear reported in the news are the edge cases that go well beyond that. So rate increases are historic, and while we are aware that patients are struggling under the cost of care members who are also patients are struggling under the cost of, of premiums for healthcare, the the one thing that we have to bear in mind when we look at these, these regulations is that at a state level, we have a very limited scope of who we can actually regulate. We can regulate fully insured, uh, private insurers who operate in this space. Most commonly that's going to be insurance companies like Select Health Regents, blue Cross Blue Shield, and a and a few others. Uh, employers have started a transition that began a couple of years ago to escape state mandates fleeing to ERISA plans. And that's a fancy way of saying they're taking solutions that are no longer state offered and are regulated at the federal level so that they can, uh, sort of back themselves up, uh, uh, against state man or federal mandates as opposed to the ones that we impose here in the state. What that means in, in pure numbers is we are talking about solutions that will be imposed upon really less than 20% of the market in the state of Utah. And it's less and less every single year. Kaiser has reported that the small group market may be, uh, completely abolished in the next three years, simply because employers are fleeing, uh, uh, due to, to costs, and they're fleeing to these ERISA plans. The last thing that I think I'd like to address is, is just a, a simple point that if, if, if a member is opting to take a, a, a drug as opposed to take a treatment on a plan, those drugs have copays as well. And oftentimes those copays for the drugs are, are multiples higher than what the added specialty is. So a typical specialty for a plan that has what we would call first dollar coverage, might say $25 for a primary care physician, $50 for a family, you could double that for edge case plans or plans that are on that sort of, that, that lower tier. So say $50 for primary care, a hundred dollars for specialty, that's a drop in the bucket to the copays that we see on prescriptions. So if people are fleeing to prescriptions, they're not doing it for cost. So thank you.

Michelle MCC with the Utah Medical Association. I actually wasn't gonna testify until I heard some of the testimony because, um, we could argue that orthopedic surgeons would be primary care too, in the same sense that physical therapists are, and actually orthopedic surgeons don't just, uh, prescribe opioids, and they don't just do surgery. They can do the same types of physical ex exercises with a patient that physical therapists can do, and they do. I have a sister that's an orthopedic surgeon, and she often does many of the same things. So I just wanted to put in a plug for, you know, orthopedic surgeons who don't just prescribe prescriptions and don't just do surgery and do many of the same exercises. And we would argue that they're primary care then too. Thank you.

Hello, can you hear me? I can. Do you have your camera on? Yes. Just have a delay. Trying to pull it up now. There you go. Okay. Thank you. Yes, Taylor Turner from Select Health, Utah based health insurer, and I'm in Salt Lake City. And good afternoon. We wanted to note three main concerns with the approach taken by this bill, echoing some previous comments. Um, select health offers health insurance plans with similar cost sharing or primary care and physical therapy services, along with plans that have higher cost sharing for physical therapy services. And if forced to equalize the cost sharing for all plans, that would increase premium costs for those purchasing insurance. It would also reduce choice for consumers and businesses looking for different plan options. And as has been mentioned, it would put an additional burden on the insured plan market compared to self-insured health plans and government programs that wouldn't be forced to follow this approach. Thank you.

Yeah, if a motion would be appropriate, Mr. Chair, I'd move that we recommend SB 2 0 4 physical therapy payment amendments.

I'd like to speak to that if I could please. Uh, I, I, heaven forbid one should be pragmatic up here, but I'm just gonna give you a pragmatic experience for me. I see my dentist once a year. I see my, my doctor twice a year. I see a skin doctor once a year. I see a physical therapist over the past five years, an average of 20 times a year. So it, it's pretty pragmatic for me just because I've had, uh, three replaced joints in the past five years. So I, I know I'm not the norm, but that's the reality that I face. So from a purely pragmatic perspective of a, of a, of a insurance user and a one that uses, I think doctors on the norm, um, this, this, my physical therapy has become more of a primary physician than my primary physician. So I think that there's a pragmatic part to this that we need to consider. Thank you.

Yeah, I plan on voting yes, but I think some of the issues that have been raised might be, might be prudent to, to look at, you know, may maybe we need to establish some principles of, you know, what you know of these bills, what are the principles where we say yes on some and no on others. And, and I think that warrants further discussion. And so, uh, with, but with that, I'll vote yes.

You. And I appreciate the motion. I'd urge support, but I, I agree with what Senator Comore said, and I, and I think that's the concern that, um, Senator Weiler shared with, with eight to 12 bills doing some form of expansion. I think we, I think we should look at it, but, you know, I really struggle, I really struggle charging, you know, 15, 10 to $20 more typically 10 with PHP, maybe more with others for physical therapies that does compound o over time. And, and I agree with Senator Musselman that to me, my physical therapist is, is like a primary care physician and without Other support.

No Wave. Thank you.

I'm, I'm, I'm, I'm gonna vote. No, I, I, I, I've got, I've had two new replacements. I'm pro physical therapist. I think the bill needs, um, some work and some coordination with the other 19 insurance mandate bills that have already been numbered. And what I, what I don't want to do is have a unanimous vote and send a signal to the, uh, rest of the Senate that's not here. So I'm gonna vote no with the reservation that I'm hoping to bill to vote yes on the floor if I see some amendments.

Senator Sandall.

Thank you. Um, I'm gonna vote no for the same reasons that Senator Weiler just expressed, but I wanted to make sure that the vote count was so that we got this to the floor. I'm just being transparent. So I'm voting.

Thank you. And seated to my right. And just so Dr. Quackenbush knows he needs to introduce himself again. This is Howard Quackenbush. It's Friday, it's late in the afternoon. This is a simple bill. It drops copays. It's consumer friendly. There's no rulemaking in this bill. And what we do is we, we put a physical therapist as a primary care physician. Oftentimes your copay's $40, um, this should drop that copay about $20. When you do physical therapy, it's usually a treatment plan over a period of time, eight to eight to 20 visits, depending on the severity of your injury. And that adds up. And I think we should drop the copay. And when we drop the copay, people get physical therapy, they don't get surgery. And overall consumers win. And it's consumer friendly. We drop copays and no rulemaking. And with that, we're, uh, I'll give you a few minutes and then we're open for questions.

Uh, thank you. Senator McKell, uh, Mr. Chair Committee. I'm, my name is Howard Quackenbush. I'm a physical therapist in, uh, Delta and Fillmore, Utah. I'm here also representing the, uh, physical Therapy Association for Utah. Um, as Senator Raquel mentioned, uh, we are designated as primary care providers. Um, we're not physicians, but we're specialists in the musculoskeletal a, uh, portion of healthcare. The goal with that, when we were pursuing that, was to try to decrease the pressure on our physicians to give more patient access to the people that are ill and that are needing physicians. Oftentimes, people already understand if they need a physical therapist, they need their physician or who they need. And we're, we've been trying to fill that role. Unfortunately, all of us have probably been in the, the mode of being ill or sick or hurt. And then we look at our insurance policy and we say, oh, my in my copay is such, maybe I'll wait a few more days and see if I can get better. Eventually, we all end up, you know, seeing some sort of a provider. And if you go through the medical provider aspect, you end up with the diagnostics. Um, the potential of, uh, surgeries, um, MRIs, uh, additional testing, you know, things that are very, you know, can be very appropriate. However, in the musculoskeletal aspect, physical therapists are extremely qualified. There've been several studies showing that the only group that's better in diagnosing musculoskeletal injuries are orthopedic surgeons. We're second above primary care physicians. Ling care costs money and physical therapy saves us the whole system money in, uh, by, by not requiring all the steps to get there. 'cause eventually a lot of these people are gonna end up in physical therapy anyway. And if they've had to go through other, other realms to get there, we've spent those additional resources, time and effort. Um, insurance, um, insurance companies have expressed concern that there's only a small portion of the plans that would be applied to this, um, mostly on the commercial side, and that's probably true, but it is a help, it's a first step. It's a start. If we can give people more access to primary care in general, whether it be musculoskeletal or for our physicians', uh, health and wellness, we're going to save the system money. And we're gonna limit opioid over, over, uh, utilization. We're gonna, um, stop, uh, um, delayed time and problems that way. Thank you, Mr. Chair.

Okay. Uh, good evening. I know it's Friday and everybody's, everybody's probably, uh, ready to, ready to be outta here. So I, I am Eric Cooney. I am with the, uh, national Association of Benefits and Insurance Professionals. We represent the community of employers, individuals who purchase their insurance and, uh, obviously access the services here. The, the first thing that I think needs to be said is that this is not a bill about whether or not physical therapy is a good thing or a bad thing. This is simply a bill that addresses whether or not we should be stepping into the business of dictating plan parameters to, uh, to health plans themselves. Should we be looking at health plans and telling them what it is they should be doing in terms of how they define their coverage? That that's the issue here. As was mentioned, the, the differential, when we look at plans that have copays, and you have to bear in mind that when we say we're talking about a shrinking population of, of individuals who are covered by these health plans, even within the health plans themselves, about two thirds at most of those plans even have copays before, uh, before deductibles. HSA plans, for example, uh, require members meet their deductible, uh, before these benefits are paid in the first place. So it doesn't even affect those plans. Um, the 20 i I can hear my time here. So the, the, the $20 copay is, uh, roughly at, at 10 20 visits. That's two to $400 per year. And when you look at the things that are affecting members, copays are just not, it. As an insurance professional, I don't have people coming into my office crying, and I do have tears because they can't afford their physical therapy copays. They're crying over their premiums. And so this bill increases premiums. We are opposed. We would hope you would consider, uh, our position. Thanks.

Uh, Kim Frost with Regions Blue Cross Blue Shield of Utah. Um, thanks for the opportunity to speak on this mandate today. This is actually one of 21 mandates that you and your colleagues have introduced in this legislative session. And, um, while we support access to physical therapy and recognize the important role that they play in our healthcare system, this mandate directly contradicts the legislature's stated goal of controlling healthcare costs. There is a cost to this bill every legislative session we're, we as insurers are asked to find innovative ways to control costs and make healthcare more affordable for Utahans. Um, in the case of physical therapy, we have invested significantly in a NOCO virtual platform that allows our members access to, uh, one-on-one sessions with licensed physical therapists with no copay, no co-insurance, no deductible, completely accessible from home. This service represents our commitment to both access and affordability. The dual goals that this legislature has consist consistently emphasized. Um, we've solved the access problem at zero cost to our members, but we have not limited access to in-person care. We still have affordable options available, including a NOCO share plan that employers can select at their discretion. But we believe that that decision should be made by small employers based on their employee's needs. Um, respectfully, we, you can't have it both ways. You can't simultaneously demand that we control costs while mandating coverage that guarantees cost increases, um, especially when we have already provided a zero cost alternative. Thank you for your consideration.

Thank you, Mr. Chair. I so respect that there is no rulemaking authority in this bill. However, I do not believe that this is a proper role of government in an US unnecessary regulatory overreach as much as I would really love this, but I will be unknown the

You, Mr. Chair. Motion to, uh, uh, make a favorable recommendation on SB 2 0 4 to the full house. That motion is an order.

Yeah. I thank you. And thank you Representative Shallenberger for agreeing to be the floor sponsor of this bill. It's a great bill. Um, it drops copays, it's pro-consumer, and, uh, pretty, pretty fantastic. Pretty fantastic. Bill. I, I would, I would take one, one comment. Um, there was a reference to playing with the parameters and, and we should never play with the parameters is the legislature. And if, if we didn't do that, I, I, I think of the years I've been up here, all of the countless things that would not be covered with your insurance and that list is long. That list is vast. And if we're going to have insurance, it needs to take care of people out in the public. So when we talk about, um, that the legislature should never, never review those parameters, I'd respectfully push back and urge support for this bill.

This this bill deals with physical therapies and, and payment. Um, what we're, what we're doing is classifying them as primary care providers that would drop the, the copay amount. Right. Right now when you go to physical therapy, your copay amount is about $10 higher than when you go to your primary care physician and doing a treatment plan of 10 to 15 visits. Some sometimes upwards of 20 visits, it adds up and this bill would reduce that. And there, there is a fiscal note. This would be one where I guess I'd have to fight for a little bit of funding. You'll see the fiscal notice is $75,000 ongoing and that that's going through PHPs numbers. With that, I'm open for questions.

I'll waive summation to move this bill. Be read for a third time.

I thank you again. This, this should be very easy. The good Senator from Woods Cross has a sub to introduce on this that I would love to get adopted and then we'll go ahead and circle it for the weekend. Uh, this bill is addressing some of the things we're, um, putting back in place from, uh, vape and other tobacco sales. And our committee had really good discussions about

This is just a common sense Bill that takes a physical therapist and rather than treating them as a specialist, treats them as a primary care provider and you do a physical therapy treatment plan, oftentimes that's 10, 10, 12 as many as 2020 visits and charging somebody a 40, $40, 30 to $40 copay every, every visit is, um, it, it adds up. Um, I think it's important to motivate people to do physical therapy, avoid surgery. I think this is the right kind of care that we should be incentivizing. So this would drop that copay by considering them primary care provider. With that, I'm open for questions. Thank You for the presentation.

Thank you Mr. President. Uh, question for the sponsor. If he'll yield, will You yield Senator McKell?

I guess yes, Go ahead.

Uh, has there been an analysis done that you're aware of how this would affect, uh, medical insurance rates?

Senator Mikel? Yeah, Great question. There, there has not, um, but there has been for P-H-P-P-H-P as you'll see it, it's, it's in the note and it's pretty minimal. So they did an evaluation and I would assume that the evaluation would be similar, but it was a very minimal impact. And, and I think it's minimal because when, when you do physical therapy, you avoid other types of treatment and other types of care as well.

Thank you. I'll move that this bill pass And the question is, shall Senate bill two zero four pass roll call vote.

Senator Vickers Baldy Aye. Lewin Aye. Ramer. Bus. Bus? Aye. Palmore Escamilla Fillmore? No. Grover. Aye. Harper, no. Kins Aye. Ipson Aye. Johnson Juab McKay Uh, Mikel Aye. Milner Juab Aye. Musselman Aye. Owens pitcher Plum rebe sandal Aye. Stevenson Stratton Bickers Aye. Er aye. Wilson Aye. Winterton President Adams

Senate Bill 2 0 4, physical Therapy Payment Amendments by Senator Mikel. This bill will assert in Economic Development and Workforce Services with vote 6 1 3. The House sponsors Representative Shallenberger.

Thank you. Motion to adopt First Amendment to House bill 2 0 4, Senate bill 2 0 4.

Uh, yes. This is, uh, setting up a timeline that will give any insurance companies, uh, that will be renewing or creating new insurance policies in 2027. Time to come in line with, uh, this change.

Thank you. Uh, this is a physical therapy amendment. This is dealing primarily with just physical therapy offices, and it's instead of treating them as specialty providers, this is then treating them as a primary care provider, which would bring their copay or deductible in line with a primary care provider, which is significantly less than a specialty provider, which would be x-rays, MRIs, specialty treatments, things like that. This would be dealing with musculoskeletal issues and, uh, help create an overall healthier person with lower out-of-pocket costs. That is it.

Senator Macl. Senator Macl. Thank you Mr. President. I move to Concur.

Yeah. We had a chance to work with stakeholders. One of the concerns was delaying the implementation, which we we've done in the bill. We got, we got that the industry to, to neutral. By doing that, they'd already submitted their plan for 27. So we're deferring this into the future, giving them a little more runway with that. It's a great bill and urge support.

Senator Vickers Baldry Aye. Lewin Brammer Bus Colmore Escamilla Fillmore Aye. Grover Harper. So ML just gave Me this Hankins Ipson Johnson Juab McKay Mikel. Why Milner Musselman Musselman Owens pitcher Plum Lincoln. He did Freebie Sandal Stevenson Stratton Stratton Vickers Weiler Wilson Winterton. President Adams Aye. Senate