APMA FEDERAL LEGISLATIVE MILESTONES
From: Public Health and Podiatric Medicine
Principles and Practice Second Edition, Arthur
E. Helfand, Editor, American Public Health
Association, Washington, DC 2006.
Since 1963, a number of Congressional
legislative changes in the field of public
health helped restructure the clinical and
educational aspects of podiatric medicine. They
include the following:
1963 Health Professions Educational Assistant
Act of 1963 Public Law 88-129 launched two
major programs (matching grants to health
professional schools for the construction of new
facilities and grants to schools for student
loans and scholarships) that included podiatric
medicine among the eligible health professions
(Medicine, Dentistry, Osteopathic Medicine,
Pharmacy, Podiatric Medicine, Optometry, and
Nursing). Special project grants also became
available for curriculum and faculty development
and improvement.
1967 Medicare, Section 1861r, Title XVIII,
Social Security Act Added podiatrists to
Section 1861, Title XVIII of the Social Security
Act under the definition of physician, for the
purposes of payment for equal services.
1972 Medicare Recognizes Podiatric Medical
Residencies Via the Social Security Amendments
of 1972 Public Law 92-601 - Congress
authorized teaching hospitals to include in
their Medicare graduate medical education
reimbursement requests the costs associated with
approved postdoctoral training programs in
podiatric medicine and surgery.
1973 Health Maintenance Organization Act of
1973, Public Law 93-222 Enacted The law states
that any services, which a podiatrist is
licensed, to provide under applicable state law
may be provided through a HMO, and may be
considered to be physician services. The HMO is
authorized to employ podiatrists and other
health specialties to meet the needs of its
enrollees.
1974 Housing and Community Development Act
qualified doctors of podiatric medicine to
secure loan guarantees under FHA for the Group
Medical Practice Facilities program.
1975 Federal Employees Compensation Act
(FECA) Amended Pursuant to a 1974 Act of
Congress; FECAs definition of a physician was
expanded to include the podiatrist, to fully
participate in the Federal Compensation program.
Subsequently, the US Department of Labor by
regulation authorized podiatrists to likewise
participate in all remaining federally
supervised compensation programs (Longshoremen
and Harbor Workers, District of Columbia
Compensation Act, Defense Base Act, Title IV of
the Outer Continental Shelf Lands Act, and the
Federal Coal Mine and Safety Act).
1976 Federal Compensation Programs Further
Improved Subsequently, the US Department of
Labor by regulation authorized podiatrists to
likewise participate in all remaining federally
supervised compensation programs (Longshoremen
and Harbor Workers, District of Columbia
Compensation Act, and the Federal Coal Mine and
Safety Act).
1976 Veterans Omnibus Health Care Act of 1976
President Gerald Ford signed Public Law 94-581
which placed podiatric medicine in the
Department of Medicine and Surgerys Title 38
pay and classification system, established a
Podiatry Service in the Veterans Administration
Central Office (Department of Veterans Affairs)
to coordinate and direct an expanded foot health
program for veterans, created the position of
Director for the new service, and authorized 100
new podiatric hires, to be acquired at the rate
of 20 each year through fiscal year 1981, in
order to improve the VA podiatry program.
1976 Health Professions Educational Assistance
Act of 1976 PL 94-484 included Podiatric
Medicine in its eligibility criteria for student
loans.
1978 Senate Appropriations Bill Stresses Foot
Care The Senate appropriations Committee
recommended $75 million for the National Health
Service Scholarships, an increase of $15 million
over the budget request and $15 million over the
comparable 1978 appropriation to accommodate
podiatrists in the corps.
1978 Podiatrists Commissioned in United States
Public Health Service The US Office of
Personnel Management announced that the US
Public Health Service is hereafter authorized to
commission doctors of podiatric medicine.
1979 Department of Health, Education, and
Welfare Awards National Health Service Corps
Scholarships The Department of Health,
Education, and Welfare (Health and Human
Services) awards 106 National Health Corps
Scholarships for the 1979-1980 school year to
students of podiatric medicine
1980 Senate Department of Veterans Affairs
Bill Stresses Foot Care Responding to a
Congressional directive the Department of
Veterans Affairs Central Office allocated
$100,00 to launch a podiatric medical residency
program. The first ten residents were in place
by mid 1981.
1980 Omnibus Budget Act and Medicare
Improvements Mandates deletion from Title
XVIII any reference to chiropody and
substituting doctor of podiatric medicine ;
authorizes podiatrists as physicians for the
purpose of making the required certification and
re-certification of the medical necessity for
outpatient physical therapy services, inpatient
hospital care, skilled nursing and home health
care; permits podiatrists to serve as physician
members of hospital utilization committees; and
adds plantar warts as a Medicare benefit.
1983 Federal Resources Appropriated for
Podiatric Education Public Law 98-139 provided
$1 million in Federal resources for colleges of
podiatric medicine to study and implement
programs, which will result in increased
enrollments.
1984 Deficit Reduction Act This act
recognized doctors of podiatric medicine as
Medicare physicians for purposes of
independently prescribing a plan for outpatient
physical therapy care and services, and
permitted podiatrists to participate in
Medicares ambulatory surgical service program.
1985 Omnibus Defense Authorization Act
directed the Department of Defense to improve
the potential for military retention of doctors
of podiatric medicine.
1987 Medicares Podiatric Physician Definition
Rewritten Passed as part of the Omnibus Budget
Reconciliation Act were provisions improving
Medicares physician definition as it pertains
to doctors of podiatric medicine. Serious
impediments affecting podiatrists ability to
certify and re-certify medical necessity for
patients hospital, skilled nursing, and home
health care were removed from the law.
1987 National Podiatric Medicine week
recommended by 224 members of the US House of
Representatives and 57 US Senators.
1989 Peer Review Organization (PRO)
Regulations Expanded the 1989 Budget
Reconciliation Act was expanded to include a
mandate that podiatrists be integrally involved
in Medicares peer review process.
1989 Medicare New Physician Payment System
Treats DPMs Equally The 1989 Budget
Reconciliation Act launched RBRVS payment system
for Medicare physicians services. Equal pay for
equal work would hereafter guide Medicares
payment mechanism.
1989 Primary Care Residency Programs Under
the auspices of the Health Professions
Assistance Act, Congress authorizes a $1 million
resident training program to train DPMs in
primary care.
1990 Defense Authorization Act A special
reenlistment pay benefit for military
podiatrists is authorized to aid in the
retention of board certified podiatrists on
active duty ($5,000 per year). The benefit is
implemented by the Department of Defense in
1994.
1990 Nurse Pay Act A special pay benefit for
Department of Veterans Affairs podiatrists is
also authorized to enable the Department, when
necessary, to raise salaries to retain qualified
podiatrists in the system.
1990 National Health Service Corps Program
Revitalized The NHSC Scholarship Program was
revitalized and the new authority recognized the
eligibility of podiatric medical students for
these benefits, as their services are needed.
1994 Defense Authorization Act Special pay
for military podiatrists, authorized to aid
recruitment and retention of board certified
podiatrists on active duty in December 1990, was
finally implemented by the Department of Defense.
1996 Bonus Pay for Public Health Service
Congress passes and the President signs into law
a proposal extending a $5,000 bonus pay benefit
to board certified commissioned podiatry
officers in the US Public Health Service.
1997 Balanced Budget Act Congress passes and
the President signed into law this act, in which
were contained a number of Medicare and tax
benefits affecting podiatrists. They were:
Graduate Medical Education (GME):
Medicare will hereafter support
allopathic and osteopathic residents but only at
the numerical level they were on December 31,
1996. A cost savings initiative, this CAP on MD-
DO residents does not apply to podiatric
medicine permitting Medicare to continue to
support new and/or expanded post doctoral
training programs in podiatric medicine and
surgery.
Nondiscrimination Against Providers:
Managed care plans participating in the Medicare
and Medicaid programs are hereafter prohibited
from discriminating against practitioners based
solely on the degrees after their names. This
was a major provision of HR 1415, the PARCA
Coalition, endorsed legislation
Skilled Nursing Facility (SNF)
Prospective Payment System: Physicians
services, including those rendered by DPMs, are
exempted from the prospective payment system
(consolidating billing) to be imposed on long
term care facilities effective January 1, 1999.
Loan Interest Deductions: A partial
restoration of the interest tax deduction
becomes law. Beginning in the year 2001, a
taxpayer with education indebtedness can deduct
up to $2,500 per year of the interest paid under
educational loans. Until that time, the
deduction will be phased in at lower amounts
($1,000, 1998; $1,500, 1999; and $2,000, in
2000).
Gag Rules, Emergency and Necessary Care;
Managed care plans are also hereafter required
to make medically necessary care available 24
hours a day, prohibit plans from restricting
providers advice about medical care or
treatment, known as the gag rule; require plans
to have grievance and appeals procedures; and
require plans to provide coverage that
a prudent layperson would deem necessary.
These provisions were also components of HT 1415.
Prospective Payment System: Physicians
services, including those rendered by DPMs, will
be exempted from the prospective payment system
imposed on long term care facilities effective
January 1, 1999.
1998 1999 Managed Care including Health
Professional Education Projections included
Non-Discrimination policies under managed care
reform; residency funding for primary care and
special programs in podogeriatrics; and a plan
to develop a meaningful program and action plan
to meet the foot health needs of a diabetic
Native American population.
2000 Programs to alleviate student loan
burdens in improving the tax laws that affect
deductibility of student loan interest and allow
health professionals to join together and
negotiate the terms and conditions of their
contacts with health care plans without
violating the Federal antitrust laws. In
addition the Patient Bill of Rights included
APMAs provider nondiscrimination clause and a
point-of-service option.
v
2001 The Appropriations Funding Bill of 2001
earmarked $1,000,000 to increase then number of
Indian Health Service (IHS) podiatrists. Service
in the IHS can also provide loan forgiveness for
podiatrists.
2002 Medicare fees maintained and continued to
include podiatric physicians in a manner equal
to all professionals included under Section
1862r, Title XVIII, of the Social Security Act.
2003 2004 Continuing to maintain Medicare
fees, authorized podiatrists to privately
contract with Medicare, develop language for the
Hospital Conditions of Participation to permit
doctors of podiatric medicine to perform
histories and physicals for their patients,
admitted for surgery, and continued the funding
for primary care residencies.
Future legislative priorities include defining
doctors of podiatric medicine as physician
services under Title XIX as they are under Title
XVIII, of Social Security, and provisions of the
Medicare Modernization Act and Physician
Definition, Medicare Physician Fee Formula,
Association Health Plans, Professional Liability
Reform, Therapeutic Shoe Benefit Restoration,
Student Loan Interest Deductions, Patient
Safety, and Physical Therapy Caps.
