This bill amends the Social Security Act to expand certain Medicare preventive encounters for beneficiaries who have experienced a fall in the prior calendar year. It requires that the Annual Wellness Visit (AWV) for those beneficiaries include a falls risk assessment and fall prevention services, and it adds outpatient physical and occupational therapy to the list of allowable services in the initial preventive physical exam for the same population.
The change creates a direct Medicare billing route for physical therapists and occupational therapists to furnish separate falls risk assessments and prevention services to seniors when a physician documents a fall in the previous year. The measure also tasks HHS with an annual report to Congress on falls among people 65 and older, introducing new data obligations that will shape oversight and evaluation.
At a Glance
What It Does
The bill amends two provisions of the Social Security Act so that, when a physician has determined a beneficiary fell in the prior calendar year, the AWV must include a falls risk assessment and fall prevention services and PT/OT may furnish a separate assessment and services. It also inserts outpatient PT and OT into the allowable services for the initial preventive physical exam for that same group.
Who It Affects
Directly affects Medicare beneficiaries aged 65+ with a physician-documented fall, physical therapists and occupational therapists billing Medicare, primary care clinicians who document prior-year falls, and CMS as the payer and data-collector. Post-acute and outpatient rehabilitation providers will see changes to billing opportunities and documentation expectations.
Why It Matters
This creates a formal preventive-care role for rehabilitation professionals within two established Medicare encounters and links coverage to a clinical trigger (a prior-year fall). That shift may change care pathways for seniors at risk of repeat falls, alter Medicare spending patterns for preventive vs acute care, and create new administrative and data-reporting workloads for providers and CMS.
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What This Bill Actually Does
The bill makes three practical changes. First, it modifies the statute governing the Annual Wellness Visit so that, where a physician has determined a beneficiary fell during the previous calendar year, the AWV must include a falls risk assessment and fall prevention services.
The statutory text also permits a physical therapist or occupational therapist to furnish a separate falls risk assessment and fall prevention services for that subgroup of beneficiaries.
Second, the bill updates the law on the initial preventive physical examination (sometimes called the “Welcome to Medicare” exam) to list outpatient physical therapy and outpatient occupational therapy as covered services for beneficiaries with a physician-documented fall in the prior year. That insertion puts PT/OT explicitly on the list of allowable services in the preventive exam context for this targeted population.Third, the Secretary of HHS must produce an annual report to Congress beginning January 1, 2027, that presents CDC-reported counts of falls among people 65 and older who received treatment for pain or injury related to a fall in the prior calendar year, and that compares changes across reporting years.
Together, the coverage changes and the reporting requirement are designed to create both a delivery pathway for prevention services and an empirical basis for monitoring trends.Operationally, the bill ties coverage to a physician’s determination that a fall occurred in the previous calendar year. That creates a trigger clinicians must document before PTs or OTs can deliver the separate assessment or before their services can be incorporated into the initial preventive exam.
The statutory amendments take effect for services furnished on or after January 1, 2026, which gives CMS and providers a defined implementation window to update billing, coding, and documentation practices.
The Five Things You Need to Know
The bill amends 42 U.S.C. 1395x(hhh) (Annual Wellness Visit) to require a falls risk assessment and fall prevention services when a physician documents a fall in the previous calendar year.
It authorizes physical therapists and occupational therapists to furnish a separate falls risk assessment and fall prevention services during the Annual Wellness Visit for that specific population.
The statute governing the initial preventive physical exam (42 U.S.C. 1395x(ww)(2)) is amended to add outpatient PT and OT services for beneficiaries with a physician-determined fall in the prior year.
Both coverage amendments take effect for services furnished on or after January 1, 2026.
Section 3 requires the HHS Secretary to submit an annual report to Congress starting January 1, 2027, on CDC-reported falls among individuals aged 65+ who received treatment for pain or injury related to a fall in the previous calendar year, including year-to-year comparisons.
Section-by-Section Breakdown
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Short title — 'SAFE Act'
Provides the Act’s short name: the Stopping Addiction and Falls for the Elderly Act (SAFE Act). This is a standard drafting element but signals the bill’s dual framing (falls prevention and a name referencing 'addiction') even though the operative text focuses on falls-related preventive services.
Amend Annual Wellness Visit to require falls assessment for patients with prior-year falls
Changes the statutory language for the AWV so that beneficiaries who a physician has determined fell in the previous calendar year must receive a falls risk assessment and fall prevention services as part of the AWV. The provision also inserts PTs and OTs into the list of professionals who may furnish a separate falls risk assessment and prevention services for those beneficiaries, which creates a discrete billing pathway for rehabilitation professionals within the AWV framework.
Add outpatient PT and OT to initial preventive physical exam services for those with prior-year falls
Amends the statutory list of allowable services in the initial preventive physical exam to include outpatient physical therapy and outpatient occupational therapy for beneficiaries with a physician-documented fall in the prior calendar year. Practically, that attaches PT/OT to another front-end Medicare preventive touchpoint, allowing those services to be provided in the immediate post-enrollment or early-care continuum for at-risk seniors.
Annual HHS reporting to Congress on falls among seniors
Directs the Secretary of HHS to file an annual report beginning January 1, 2027, with counts of falls (as reported by the CDC) among individuals 65 and older who received treatment for pain or injury related to a fall in the previous calendar year, and to include prior years’ data and year-to-year changes. The reporting requirement creates a formal monitoring mechanism that CMS and Congress can use to evaluate trends after the coverage changes take effect.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Medicare beneficiaries aged 65+ who have a physician-documented fall — they gain a statutorily supported access point to falls risk assessments and targeted prevention services under the AWV and initial preventive exam.
- Physical therapists and occupational therapists — the bill creates explicit Medicare billing opportunities for PTs and OTs to provide separate falls assessments and prevention services within two preventive encounters.
- Primary care clinicians — can delegate structured falls assessments to rehabilitation professionals and integrate prevention planning into the AWV, potentially reducing downstream acute care workload.
- Health systems and integrated care organizations — may be able to embed evidence-based fall-prevention programs into preventive workflows, which could reduce avoidable emergency visits and downstream costs if interventions succeed.
- Policymakers and researchers — gain an annual, statute-driven data stream to track CDC-reported falls among treated seniors and to measure changes over time.
Who Bears the Cost
- CMS / the Medicare Trust Funds — will underwrite additional preventive services billed by PTs and OTs and may face higher near-term outpatient spending (offsets depend on downstream effects).
- Physicians and their practices — must document that a patient fell in the prior calendar year to trigger coverage, adding documentation and verification duties that could slow access.
- Smaller rehabilitation providers and outpatient clinics — will face administrative burdens to comply with Medicare billing rules, update systems, and possibly invest in documentation workflows to support the new coverage paths.
- CMS operations and analytics teams — responsible for implementing new coverage codes/claims edits and producing the annual report to Congress, increasing agency workload without specified resources.
Key Issues
The Core Tension
The bill tries to be both targeted and preventive: it limits expanded coverage to beneficiaries with a physician-documented prior-year fall to control costs and avoid overuse, but that same gatekeeping can restrict access for at-risk seniors who lack a formal physician determination, increase documentation burdens, and shift short-term costs to Medicare while leaving long-term savings uncertain.
The bill ties expanded coverage to a physician’s determination that a fall occurred in the previous calendar year, but it does not define the documentation standard for that determination. Implementation will require CMS to specify acceptable documentation and potentially new billing codes or modifiers to distinguish these targeted services from other PT/OT care.
Without clear coding and medical-record standards, providers will face claim denials or inconsistent payment.
Another tension lies in scope and definition: the statute mandates a "falls risk assessment" and "fall prevention services" but leaves the contents, intensity, and minimum qualifications for those services undefined. That creates uncertainty about which interventions qualify for Medicare payment, how PT/OTs should sequence assessments versus therapy, and whether current payment rates are adequate for the time and resources required for effective prevention programs.
Finally, the reporting mandate depends on CDC-reported fall counts tied to Medicare-treated pain or injury, which may not align cleanly with Medicare claims data and could produce reporting lags or mismatches that complicate evaluation of the policy’s impact.
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