APTA has announced the newly elected or reelected members of the Board of Directors and officers, and of the Nominating Committee.

Elected or reelected to the Board:

• Kyle Covington, PT, DPT, PhD, was elected APTA president for a three-year term.
• Skye Donovan, PT, PhD, was elected APTA vice president for a three-year term.
• Robin L. Dole, PT, DPT, EdD, was elected vice speaker of the House of Delegates to complete the one-year unexpired term of Kyle Covington.
• Stefanie Bourassa, PT, DPT, and Jeff Jankowski, PT, DPT, ATC, were elected as directors, each for a three-year term.
• Jamie Dyson, PT, PhD, was elected a director to complete the two-year unexpired term of Skye Donovan.
• Kim Nixon-Cave, PT, PhD, MS, FAPTA, was reelected as a director for a three-year term.
• Patrick Esmonde, MSE, was appointed by the Board as the public member for a one-year term. Esmonde is co-founder of health tech startup company Vestibular First.

The APTA Board provides strategic direction for the organization and advocates on behalf of physical therapists, physical therapist assistants, students of physical therapy, and patients nationwide to advance the profession of physical therapy and improve the health of society.

Speaking on behalf of APTA, CEO Justin Moore, PT, DPT, said, “It is my honor to welcome our new and reelected members and officers of the APTA Board of Directors, while also extending heartfelt gratitude to our departing leaders who have devoted years to advancing the physical therapy profession. We are truly ‘better together.’ This Board and its officers bring diverse insights that are essential to helping APTA best support our members and the patients they serve. These individuals are exemplary leaders and dedicated champions for policies that benefit the physical therapy community. I look forward to seeing the meaningful work they will achieve during their service on the APTA Board.”

The remaining members and officers, who will join those above as the APTA 2025 Board of Directors, are:

• Secretary: Kip Schick, PT, DPT, MBA.
• Treasurer: Zoher Kapasi, PT, MSPT, PhD, MBA, FAPTA.
• Speaker of the House: William (Bill) McGehee Jr., PT, PhD.
• Director: Colleen Chancler, PT, PhD, MHS.
• Director: Carmen Cooper-Oguz, PT, DPT, MBA.
• Director: Heather Jennings, PT, DPT.
• Director: Craig Johnson, PT, MBA.
• Director: Kelley Kubota, PT, MS.

Current President Roger Herr, PT, MPA; Vice President Susan Appling, PT, DPT, PhD; Director Cindy Armstrong, PT, DPT; Director Dan Mills, PT, MPT; and Public Member Cris Massis, MBA, will roll off the APTA Board this December. “We are grateful to these outgoing leaders for their exceptional dedication and service to APTA and the profession. Their work leaves APTA stronger and well-positioned to continue building a community that is advancing the physical therapy profession,” Moore said.

Nominating Committee

Monique Caruth, PT, DPT, was elected to the Nominating Committee. She will begin a three-year term Jan. 1, 2025, joining the committee’s four other members:

• Ken Harwood, PT, PhD, FAPTA.
• Tracy Porter, PT, DPT, EdD.
• Jennifer Marie Ryan, PT, DPT MS.
• LaDarius (L.D.) Woods, PT, DPT, PhD.

Current committee member Stephanie Weyrauch, PT, DPT, will roll off the committee this December. “APTA appreciates Stephanie’s participation in the important work of the Nominating Committee to prepare the slate of candidates for national office,” Moore said.

Trump Picks TV's Dr. Oz to Run Medicare and Medicaid

Reuters / By Ahmed Aboulenein

U.S. President-elect Donald Trump said on Tuesday that he had chosen television personality and surgeon Dr. Mehmet Oz to serve as administrator of the Centers for Medicare and Medicaid Services, a wide-reaching agency with annual spending of $2.6 trillion.

Trump, who endorsed Oz in his unsuccessful run in Pennsylvania for the U.S. Senate in 2022, said he would work closely with Robert F. Kennedy Jr., who was nominated to lead the Department of Health and Human Services.

Oz said in a post on social media website X he was looking forward "to serving my country to Make America Healthy Again under" Kennedy's leadership.

Trump said the pair would take on "the illness industrial complex, and all the horrible chronic diseases left in its wake" as well as cutting what he called waste and fraud.

"Our broken Healthcare System harms everyday Americans, and crushes our Country's budget," Trump said in a statement.

The agency runs Medicare, the federal health insurance program for people aged 65 or older and the disabled. The office also oversees Medicaid, the state-based health insurance program for low-income people, which is jointly funded by states and the federal government. The two programs provide health insurance for over 140 million Americans.

It also handles much of the enrollment in income-based government-subsidized health insurance under the Affordable Care Act, also known as Obamacare. Trump and other Republicans have previously tried to repeal the law but now say they only seek to overhaul it.

His nomination is less likely to cause negative reaction among pharmaceutical companies than Kennedy's, an outspoken critic of drugmakers, said BMO analyst Evan Seigerman.

"While Oz has been controversial and a noted TV personality, his stance on expanded Medicare coverage and tackling ... pricing challenges could be a positive for the industry in the long run," he wrote in a note.

Oz was a regular Fox News commentator during the COVID-19 pandemic and a proponent of unproven treatments for COVID-19 including hydroxychloroquine, an antimalarial drug whose use against the disease was also backed by Trump.

Oz challenged the Biden administration's COVID-19 pandemic policies on social media, including mask policies, saying they ignored the science and were based on missing data.

In 2020, he was a proponent of expanding Medicare Advantage plans in which insurers manage healthcare benefits paid for by the government to all Americans who were not enrolled in Medicaid in a column published in Forbes magazine.

Oz promoted Medicare Advantage on his syndicated daytime television talk show, which aired between 2009 and 2022, in segments sponsored by a website selling the plans.

Shares of all major health insurers in the U.S. were marginally up after the decision with UnitedHealth (UNH.N), opens new tab, Humana (HUM.N), opens new tab and Molina Healthcare (MOH.N), opens new tab moving up between 1% and 2% in after-hours trade.

Trump promised during his campaign not to cut Medicare but is expected to let federal subsidies for Medicaid expire at the end of 2025.

After RFK Jr. was named to the job last week, Oz told Fox News that he knew the HHS secretary nominee personally. The position is subject to Senate confirmation.

Medical Loss Ratio Data for Medicaid Managed Care Programs

NAHC Report

On Friday, November 1, 2024, the Center for Medicare & Medicaid Services (CMS) released public information on medical loss ratio (MLR) data for Medicaid managed care programs. MLR is a calculation used to measure revenue received by a health plan that was used to pay for services and for quality improvement activities. Medicaid law and statute do not require states to establish a mandatory minimum MLR for managed care organizations; however, guidance on setting the payment rates (i.e. “capitation” amounts) directs actuaries to target no less than 85%, provided that the rates account for reasonable non-benefit related costs. The November data includes MLR information from plan years 2018, 2019, and 2020.

The Alliance analyzed the MLR information to better understand health plan payment policy around the country. As part of the analysis, the Alliance filtered data to include only those plans that include long-term services and supports (LTSS), as these are the services most important to our members. Overall, the national average MLRs for managed LTSS plans (MLTSS) were 93.70% in 2018; 93.54% in 2019 and 91.85% in 2020.

To develop statewide MLR estimates, we aggregated the reported MLR expenditure data for each plan in every state during a specific plan year. Then, we performed standard MLR calculation on the CMS-reported numerator and denominators to develop statewide MLR figures for MLTSS plans. The resulting state-specific MLRs varied across the country and within each plan year. Idaho (2018) had the overall minimum statewide MLR at 85.31% whereas Iowa (2018) had the highest overall statewide MLTSS MLR at 102.87%. 

CMS’ data also includes health plan-specific MLR information. The highest reported MLR during the time period was Blue Cross of Idaho’s Medicare/Medicaid Dual Eligible plan in 2019, with a reported 180%. In contrast, the lowest reported MLR was in 2018, when New York’s Prime Health Choice, LLC MLTSS plan experienced a 78% MLR.

In comparison, aggregate Medicaid MLRs for all health plans were also high and above 90% but, on average, were slightly lower than the MLTSS-specific MLRs for the same plan year. In 2018, overall Medicaid MLR was 92.61; in 2019 it was 92.90%; and in 2020 it was 90.99%.

The MLRs in Medicaid are relatively high – and exceed the 85% standard established by the Affordable Care Act for large group plans – which could lead to future rate challenges for providers as plans may be less likely to negotiate inflationary update. However, it is important to remember that the actuarial soundness requirements in Medicaid mandate that state rate-setting account for all health care service and non-service components, especially if the MLR exceeds 85%. As data from subsequent years becomes available, it is likely that it will remain consistent due to higher provider payments reflected via higher capitation rates.  

As CMS seeks to expand transparency regarding MLRs, payments, access to care, and other core components of Medicaid program information, we anticipate that there will be additional information available that will help providers understand the financial dynamics within the various states and health plans around the country. This information can hopefully be useful with legislative advocacy as well as rate negotiations with state agencies and health plans. The Alliance has established a database of MLTSS MLR information that we will continue to build upon as more becomes available. Any requests for additional analysis or specific information can be sent to [email protected].

Medicaid ‘At Risk’ Under Incoming Administration, According To CMS Leader

Home Health Care News / By Audrie Martin
 
The Medicaid program could face significant challenges under the Trump administration, according to Dan Tsai, the deputy administrator and director of the Center for Medicaid and Children’s Health Insurance Program (CHIP) Services. He expressed these concerns during a leadership update call from the Center for Medicare & Medicaid Services (CMS) on Wednesday.

“Medicaid is so important across the country,” Tsai said. “Over one in five Americans get their health care coverage through us. We are leaving the program stronger today than where we started four years ago, but that progress is at risk.” 

Tsai specifically opposed the introduction of work requirements or block grants for the program, arguing that they would create excessive bureaucratic hurdles.
“They are just plain bad policy not backed up by facts and evidence. And the cost will be people’s lives and health across the country,” he said. 

The Trump administration has indicated that these requirements and grants may be introduced during President Trump’s next term.

Tsai’s concerns follow President Trump’s appointment of Dr. Mehmet Oz to lead CMS and Robert F. Kennedy Jr. to head the Department of Health and Human Services. 

During the call, CMS leadership highlighted the agency’s accomplishments over the last four years. These included recovering from the disruptions caused by the COVID-19 pandemic, supporting the resumption of regular Medicaid and CHIP renewals after a three-year hiatus, and implementing provisions of the American Rescue Plan, the Inflation Reduction Act, the Affordable Care Act and other legislation. 

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