APTA Nebraska Podcast
The APTA Nebraska Podcast dives into the stories, challenges, and innovations shaping physical therapy in our state. We’re here to advance, promote, and protect the practice of physical therapy, build our community, and optimize the health and quality of life for all Nebraskans.
APTA Nebraska Podcast
E26 - Chapter Updates with President Nick Weber
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A lot can change in a few weeks when policy, courts, and payment systems collide, and that is exactly what we unpack with a clear set of wins for physical therapy in Nebraska. Brad Dexter and APTA Nebraska President Nick Weber start with a quick summer check-in, then move straight into the updates our members have been watching closely: student loans, Medicaid reimbursement, and the advocacy work that makes both possible.
We break down what happened with the RISE Act and why the “professional program” designation matters for Doctor of Physical Therapy students. When the definition of “professional” gets shaky, the ripple effect is immediate, from federal loan caps to who can realistically afford a DPT program. The latest court action keeps the existing structure in place and restores confidence for students heading into the fall, while also prompting smarter conversations about borrowing only what you truly need.
Then we dig into a major Nebraska Medicaid development: the state successfully secured federal funds and the new Medicaid fee schedule shows a 20% increase across therapy codes. We talk about how this impacts physical therapy reimbursement rates, private practice viability, and patient access, especially in areas facing provider shortages. We also cover an important clarification for adult Medicaid recipients so visits do not count against annual limits unless Medicaid actually pays, protecting care for medically complex patients.
We close with what we are watching next at APTA’s House of Delegates and a state payment advocacy forum, plus a memorable reminder to celebrate the Fourth of July safely. If you care about the future of physical therapy in Nebraska, subscribe, share this with a colleague, and leave a review so more PTs can find the show.
Welcome And Summer Check-In
SPEAKER_01Welcome to the APTA Nebraska podcast, where we dive into the stories, challenges, and innovations shaping physical therapy in our state. We're here to advance, promote, and protect the practice of physical therapy, optimizing the health and quality of life for all Nebraskans. Join us as we connect with experts, share insights, and build community throughout our profession.
SPEAKER_02Welcome back to the APTA Nebraska podcast. My name is Brad Dexter, your host, and I'm joined by our oh, I'm trying to find all of the adjectives. Faithful, sturdy, steady. Throw some more in there, Nick. You have any more?
SPEAKER_00Uh wide awake this morning.
SPEAKER_02Wide awake. Um president of APT Nebraska, Nick Weber. Nick, how's it going?
SPEAKER_00I'm doing good, man. How are you?
SPEAKER_02Gosh, I should have really looked up uh in in the dictionary for some more adjectives before I jumped into that.
SPEAKER_00That was great. I appreciate the couple you added there.
SPEAKER_02Hey, um, we had a soap note that came out last month, had a lot of great information um for some of the things that are going on in the chapter uh right now. But as as is uh our rhythm every other month, we try to uh just do a podcast together to let the the membership know what else is going on, um, kind of get a vocal presence uh for those of you that um aren't able to access or maybe um read the soap note when it does come out. And this is just kind of a nice touch point um to hear what else is going on in the chapter as well. So we have a few things on the agenda today, Nick, but before we jump into them, how's your summer going?
SPEAKER_00It's going pretty good, yeah. Uh coming right up on the fourth here, but uh got a busy summer semester going on over here at Creighton and uh just uh looking forward to getting the students through the semester here and then on to the fall, I'll be here before we know it.
SPEAKER_02I uh I'm born and raised in Nebraska. So fireworks like they're just kind of part of the lifestyle um in Nebraska. But you know, as I've gotten older and met people from all over the place, it's unusual to hear the amount of fireworks that happen in Omaha or other places in Nebraska. Uh, are you a fireworks guy or where where do you land on that?
SPEAKER_00Yeah, it's funny you ask. I just took uh my daughter yesterday. She was adamant that she needed to go with when the fireworks were picked out this year, right? Okay. Uh, and we carried around a little basket, you know, as as people do. And man, that thing was full. And you know, despite it saying, you know, 75% off, or you know how it goes, like it's three for one for a while, then it's four, you know, buy one, get four free, all the things, but yeah, it was full. And uh yeah, we're just gonna burn off a few hundred dollars, I think, at the Weber household this year. So should be a fun event.
SPEAKER_02It I mean, if you're if you're gonna burn your money, uh, you know, at least seeing it it go up in in pretty sparkles is worth it, right?
SPEAKER_00For sure. As long as the you know, as long as the kids are happy, that's all that matters. Keep them safe too, right? But yeah, enjoy the enjoy their smiles in the process.
SPEAKER_02I love that. I love that. Uh any vacations planned?
SPEAKER_00Yeah, we're gonna get out uh to Colorado and then uh we're hoping to get a few camping trips in still uh before the end of the summer as well.
SPEAKER_02Yeah, we're uh we're also kind of round in the corner hoping to do one or two camping trips. Uh summer camping trips around Nebraska are a little tough sometimes. You don't know what the weather's gonna do. Um, but Minnesota, Colorado, a little better space.
SPEAKER_00If you can get out of that humidity, that's that's a key.
SPEAKER_02Absolutely. All right, hey, enough chit chat. There's no snack talk today, um just vacations and and summers so far. Um, Nick, can we get into a few of the things that uh have been going on in the life of the chapter?
RISE Act And Student Loans
SPEAKER_02I know uh we've gotten some good news lately. Um why don't we start off uh maybe more of a national level? The RISE Act is something that we had talked about that was encapsulated into the big beautiful bill, and it was impacting um the, well, I guess who could be labeled as a professional. Um and so can you talk just a little bit more about that? Maybe give us a brief reminder and then uh talk about where things have landed here as we've rounded the corner into July.
SPEAKER_00Yeah, you're right. You know, you mentioned the SOAP note coming out. And I think just in the like maybe the two weeks since that's been published, uh, we've had at least two or three kind of major events uh professionally happen since then. So uh related to the RISE Act, uh, yeah, so the courts stepped in. Um, some were predicting this might happen. Uh, but essentially the court said, you know, you can't pick and choose which definition of professional that you use. Uh, you can certainly go and change the definitions if you want, but when the most kind of recent precedent establishes some professions as professionals, you can't just ignore that. So essentially uh what's happened now at this point is uh the caps for loans have stayed in place. But the professions like physical therapy that had precedent and had been previously defined as a professional program are now going to be uh held to that standard or push, you know, labeled as such uh until something changes, right? So of course uh legislation could occur and remove that label. But yeah, we we were moved into the professional designation. So now uh rather than our students being capped at $20,000 annually, uh they'll be in that larger group at the $50,000. So uh I know we're excited about just the change and and the opportunity that that gives uh more students to get into the profession. So hopefully that removes some of the stress and anxiety, especially for those students that we're getting ready to start here just in the fall.
SPEAKER_02Yeah, you know, a lot of um, I don't know, we always we always talk about like intended and unintended consequences of legislation a lot of the time, right? You know, so some of what's behind that legislation in the first place is um trying to regulate some of the spending uh from an educational standpoint, right? And just recognizing that it's getting really expensive for students. And so that is that is an issue, right? Um, but there were some really unintended consequences for particularly our profession and some of the students um being able to access uh funds to attend a DPT program at this point, too.
SPEAKER_00Yeah, and I think you know, to that point, as stressful as this process has been and trying to work with the Department of Education and consider that what you're saying about you know getting tuition costs under control and trying to advocate for that reason, uh, but then also not hinder future generations and giving everyone equal opportunities to kind of get into the profession of their choosing. Um my hope, I think, you know, what I saw happen in the in the interim was that schools started to to do more and create more um education around, you know, do you need to take out all these loans? Trying to inform students, like make wise decisions, uh recognize that maybe even though FAFSA grants you so much money that you don't have to take it all out. Or if you want to go back and take it later, you know, you don't you couldn't do that. Um so there's a lot of education that came about um trying to inform students to make better decisions around their loans. Um and and now hopefully with the caps still in place, um, they continue to do that and be thoughtful about you know what is the appropriate amount of money to take out and what's reasonable, what can I pay back based on my trajectory?
SPEAKER_02Yeah, that's great. Uh let's shift gears
Medicaid Funding And 20% Increase
SPEAKER_02a little bit. We'll come um more state uh focused now. And uh maybe a couple wins in the Medicaid front, right? So uh you were telling me that Nebraska's acquired federal funds for uh the Medicaid program. Do you want to share a little bit more information with us?
SPEAKER_00Yeah, this is a big win for us. Um so this really goes back to 2025, and there's a lot of details into this story, but even if you go back to 2024, uh there was some legislation in 2024 to really support uh the hospital systems in Nebraska. Um, as you as you will recall, there was some uh concern that we might lose some critical access hospitals just due to the financial troubles they were in around that time. So then when 2025 came around, um, we recognized, hey, now it's time to support the non-hospital providers. Uh and so, in working with uh the Nebraska Medical Association, the Hospital Association, and all the other different uh professional associations in our state, one of the things we were trying to do was to boost the Medicaid rates, recognizing that a lot of providers were losing were leaving the Medicaid system. Uh, but at the same time, recognizing that the situation the state was in with the budget deficits and stuff that we've heard a lot about, and not being just like, you know, naive and going to the state and saying, hey, we need increases in the Medicaid system, but trying to help the state find resources to support those programs. And so uh there was legislation back in 25, I think it was LB527, that looked at the opportunity of doing certain assessments that other states were already doing to draw down federal funds. And that legislation passed. And when it passed, I think it was kind of late spring, early summer in 25, big victory for the state, thinking, hey, we're gonna be able to draw down all these federal funds, and and then that should support the Medicaid system, and we'll see provider rates go it go up. Well, then, you know, right July 1, I think it was, uh, HR1 dropped the one big beautiful bill that summer, and it kind of put a hold on all those kind of programs where the administration said, hey, we're not that you know, states are taking advantage uh in certain ways of federal funding and we're gonna crack down on this. And so not to say that Nebraska was trying to pull any strings, we were just trying to draw down funds that were there. Uh but then this kind of this big hold got put on everything. And so for honestly, almost 18 months, we kind of thought we're never gonna be able to get these funds out. Um, and I was kind of worried that just it was never gonna come to be. Well, like two weeks ago, I got notification that the administration had released the funds to the state and to be on the lookout for any potential increases. Well, just so happened right around July 1st is when uh the state releases the new uh Medicaid fee schedules. And sure enough, uh there was a 20% increase across all the therapy codes. So huge victory for us. Great to see the state um utilize resources and work with the administration um to demonstrate need and you know, put things in place to make sure the funds get utilized appropriately and really support a good cause because uh we were losing a lot of providers in the Medicaid system. So uh hopefully this will bring providers back to it and definitely uh support those providers out there that are already taking patients with Medicaid insurance and looking forward to this kind of support, help those private practices, especially.
SPEAKER_02Yeah, you know, if I actually had a button for the podcast, it would it would have cued the applause as you were talking there. Uh instead, you just got the screen effects from me with you know the the confetti uh excitement as you were talking there. Hey, um this isn't something that just right happens behind the scenes or sorry, just happens without uh a ton of work going into it. You said it it is really tied to some of the work that was done in 2025 and groundwork was laid before that. Uh I'm putting you on the spot a little bit, but do you want to do you want to drop any names of people that have really helped to support this or get on board with it, um help move it forward?
SPEAKER_00Well, you know, I think it there's a there's a lot. Let me start with that. Uh I'm sure I won't do it justice by uh trying to name people because I'm sure I'll leave people off. But let me say this. I think the well, the lesson that's learned from this was that uh with every uh opportunity to communicate to legislators or to other professions, I'll give you an example. We kind of have just a couple check-ins with like the Rural Health Association, the hospital association, the medical association on an annual basis. And just using those opportunities where maybe the agenda has different topics, but to bring awareness to them that hey, I know I know physicians have these provider provider deserts throughout the state, but so do other professions like PT, OT, speech. Um and and share with them, like, hey, you know, if you're referring someone to physical therapy, but there's no provider there. Like that affects your patient. Um and so, you know, they have as an example, the medical association has way more resources. I mean, they have paid people that advocate for them, right? Um, versus on our side, everything's volunteer-based. That by just informing them, we were able to kind of motivate them to support our cause here. Uh, and and really they they did a lot of the legwork here and and getting this legislation across the finish line. And so, you know, my hats off to them for all their work on this kind of stuff and making, you know, really working even nationally to pull down these funds and and not giving up on this issue. Um, so really thankful for them, but very thankful for the people on our side that took advantage of those opportunities to inform not just legislators, but other providers in our state uh on what's kind of going on within our profession and the challenges that we face. And like I said, utilizing their resources to support us.
SPEAKER_02Hey, well, well said. Um, one of the things I just picked up as you're talking there is uh just the value of uh interprofessional conversations, right? Um understanding one another. Uh it's easy to operate in silos at times, but uh doing the work to try to uh really collaborate and work interprofessionally is is crucial, um not just in our day-to-day work, but certainly um in some of the avenues that you're talking about, the conversations that you're having, um, it's really valuable and that goes a really, really long way. So um hey, thanks for your work there. I know there's many others too. So um, and then another thing that we were talking about, Nick, was uh some of the language around adult Medicaid recipients. So one of the issues that has been present in the past, you know, if if if adult Medicaid recipients have uh 60 visits annually, um typically, even if primary insurance would pick up a visit, you were losing a visit with that Medicaid patient, correct?
SPEAKER_00That's right. So there are scenarios where uh patient will have Medicaid insurance, but it'll be secondary, right? And so um in those pre in previous years, uh no matter who which payer was really picking up the tab on a certain visit, it was counting against the visits in the Medicaid system. So the the state kind of clarified that language for 26, 27 fiscal year and said that unless Medicaid essentially pays part of the tab for that visit, it's not going to count against the visits. Which, you know, there's a lot of scenarios out there where an adult actually needs 60 plus visits. Um and so if if there's any reason where um uh the primary insurance is is exhausted, then Medicaid will kick in and not also be exhausted. Um so it's there for those people that have medical necessity and need extended care. So excited for the state. Um you know, just the fact that they they listened to those scenarios again, they're probably rare. Um, but when they're there, important that those individuals can get the care that they need uh and not have their visits exhausted when a payer wasn't even really contributing to their care prior to that.
SPEAKER_02Yeah. Uh it's great stuff. Big wins. Uh this is this is a great episode. There's lots of good stuff going on. I love it.
SPEAKER_00Yeah, we just feel like we got a little momentum right now. Hopefully we can continue to build on this and uh looking forward to getting the legislative committee together here soon and and see what should be on tap for 27.
SPEAKER_02Should shoot off some fireworks to celebrate.
SPEAKER_00I think that's that's gonna happen, right? Yeah.
SPEAKER_02That's
House Of Delegates Preview
SPEAKER_02right. Hey, uh just to kind of wrap things up, House of Delegates is coming up. Um, I think you guys are traveling out what next week or the week following? Is that right? Next week. Yeah, next week. Um is there anything that's on the docket that you're kind of excited to to listen to or speak into? Um anything that you're looking forward to?
SPEAKER_00Well, there's just a lot going on. Uh so we'll be in Portland and the two days prior to House of Delegates, uh, APTA is hosting a state payment advocacy forum this year. Uh I'm thankful to have been invited to speak uh about some of our Medicaid wins. And that's really what this kind of event is about is states sharing how they achieved their their victories with an up so for like an opportunity to learn from each other. And so we've got a group of people going from Nebraska, uh, and hopefully we can learn a lot and bring back what other states have done and things that maybe we haven't accomplished yet, and try to utilize that in future years to see if we can continue to kind of use this momentum to move forward. So looking forward to that event. And then immediately following, we got the two days for House of Delegates. Uh a lot of good things on the docket this year. You know, again, um, like previous years, there's a lot of stuff that's proposed. I doubt we'll get to maybe even half of it, but that's okay. Hopefully, we have a lot of good discussions and some fruitful things come out of it, and then we'll kind of see where that goes.
SPEAKER_02Excellent. Well, uh, for our audience, we'll have a recap of House of Delegates later in July or early August. Um, we'll have a podcast that comes out with some of our delegates from their time out there and just some of the work that's being done at a national level, too. Uh, Nick, before we sign off, anything else you want to leave the audience with?
Firework Safety Story And Wrap
SPEAKER_00Hope everyone has a happy fourth and a safe fourth. You know, don't be one of those people that blows up a firework in your hand, please. Hate when that happens. No, kidding. Uh, hopefully that doesn't happen to anyone. I actually have to tell you the story really quick, Brad. Uh I went to visit this surgeon, hand surgeon, one time. And I was just spending some time in the clinic with him. And his administration comes in, like, this is probably like early spring, and they're like, hey, you know, someone else needs the fourth of July off. Would you be willing to work this day? And in my head, I was like, There's no way this guy's saying yes to this. Like, I'm sure he's got holiday plans already. But he like joyfully was like, Yes, absolutely, I will work the 4th of July. And I was like, What? So I asked him after the person left, like, wow, that was really nice of you. Like, I can't, you know, guys, uh, you're pretty flexible. It's nice of you to see you work that way with your administration and stuff. She's like, Oh no. He's like, listen, the best, you know, hand injuries come in on the fourth of July. And it's a great opportunity as a hand surgeon to really hone in your skills. And I was like, okay, that's that's a little bit sadistic, but I got it. Uh uh, because I personally don't love managing those conditions post-surgically, they're super challenging, but it's all in the eye of the beholder, right? And kind of the lens you work through.
SPEAKER_02So oh man.
SPEAKER_00But just it has forever made me just cringe at the thought of you know, or just the fear of fireworks. So be safe.
SPEAKER_02Yeah, everyone be safe. Um, hopefully, by the time this podcast posts, um the US has moved into the round of eight in the World Cup. That would be fantastic, right? Big win last night.
SPEAKER_00Um, to do it without one of their best players, but we'll see.
SPEAKER_02Yeah, they're gonna have to do it without one of their best players, but uh they've exceeded expectations to this point. So it's fantastic. I love it. All right. Well, thank you everyone for joining. Thank you for listening, Nick. Thanks for the great work you're doing, and and to many others uh in the chapter as well. Um look forward to continuing to bring you guys more podcasts here in the future.
SPEAKER_00Thanks, Brett.
SPEAKER_01Thanks for tuning in to the APTA Nebraska podcast. Stay connected with us for more conversations that elevate our profession and improve the lives of Nebraskans. Don't forget to subscribe, share, and join the discussion. Because together, we're driving the future of physical therapy forward.
