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  • COVID Stimulus Package Includes Payment Increase, Opens Possibility of Increased Telehealth, More

    An increase to Medicare payment, temporary relief for some student loans, the potential expansion of telehealth allowances, and help for small businesses are among the provisions that are especially relevant for physical therapy.

    The $2 trillion stimulus package passed by Congress and signed into law by President Trump is comprehensive in its scope, and includes everything from sending direct payments to many individual Americans to some $32 billion in grants to airlines and airports. [Editor's note: check out these articles from National Public Radio and Axios for good summaries of the entire package]

    The legislation also includes provisions that may be of particular interest to PTs, PTAs, physical therapy students, and physical therapy patients.

    Medicare payment will increase.
    Normally, mandatory across-the-board cuts in federal spending enacted into law, known as sequestration, would require Medicare to reduce payments to providers by 2%. The stimulus temporarily lifts that reduction from May 1 through December 31, 2020. The effect: increased payments to PTs, hospitals, home health, and other care. The legislation also prevents scheduled reductions in Medicare payments for durable medical equipment through the length of the COVID-19 emergency period.

    Telehealth could expand under Medicare (if HHS can be convinced to do it).
    The package gives the Secretary of the Department of Health and Human Services the authority to waive restrictions on telehealth for providers, including PTs, who aren't currently allowed to provide and bill for telehealth services to Medicare beneficiaries. So far, that waiver hasn't happened, and APTA is urging its members and stakeholders to join a grassroots effort to press for the change.(Note that while CMS has approved the use of "e-visits" by PTs, that's a limited type of digital communication and not same as telehealth.)

    Federal student loan borrowers will be able to defer payments, and employers can offer repayment benefits tax-free.
    Payments on federal student loans can be deferred through September 30, 2020, with no accrual of interest during that period. Additionally, the stimulus allows employers to contribute up to $5,250 annually toward an employee's student loans without the benefit being taxed as employee income. The employer provision applies to any employer payments made between now and January 1, 2021.

    Providers able to order home health services now include PAs, NPs, and CNSs, potentially reducing delays in care.
    Until now, only physicians were able to certify the need for home health services. The legislation allows physician assistants, nurse practitioners, and clinical nurse specialists to order home health services for beneficiaries, reducing delays and increasing beneficiary access to care in the safety of their home.

    New loans are available to small businesses, along with payroll tax credits to boost employee retention and a deferment of Social Security tax payments.
    The stimulus creates a new type of loan through the Small Business Administration that could help to cover payroll costs (including health care), rent, utilities, and other debt obligations, at a 4% interest rate. Businesses and 501(c)(3) organizations with fewer than 500 employees are eligible, as are sole proprietors, independent contractors, and self-employed individuals.

    Some employers will also be able to take advantage of a refundable payroll tax credit for 50% of wages paid by employers to employees during the COVID-19 crisis. The offer is limited to employers whose operations were fully or partially suspended due to the pandemic, or whose gross receipts declined by more than 50% compared with the same quarter of 2019.

    The package also offers a payroll tax deferment. Employers (and the self-employed) are also able to defer payment of the employer share of the Social Security tax. The provision requires that the deferred employment tax be paid over the following two years, with half of the amount required to be paid by December 31, 2021, and the other half by December 31, 2022.

    Small businesses can receive grants and may be able to get limited debt relief on SBA loans.
    Small businesses and nonprofits that apply for an SBA economic injury disaster loan could receive an advance of $10,000 within three days of applying for the loan. Additionally, the stimulus includes $17 billion to provide immediate relief to small businesses with standard SBA 7(a), 504, or microloans, with the SBA covering all loan payments for existing SBA borrowers, including principal, interest, and fees, for six months. This relief will also be available to new borrowers who take out an SBA loan within the next six months.

    Transfers from acute care hospitals to IRFs will be easier.
    During the emergency period, acute care hospitals can transfer patients to inpatient rehabilitation facilities more easily, thanks to a waiver of the requirement that patients must participate in at least three hours of intensive rehabilitation at least 5 days a week in order to be admitted to the IRF.

    Higher education will get some relief, too.
    The legislation makes $14.2 billion available to higher education institutions to prevent, prepare for, and respond to the pandemic. The funds can be used to defray expenses associated with lost revenue, technology costs of transitioning to distance education, and providing grants to students for food, housing, course materials, and technology.

    APTA Vice President of Government Affairs Justin Elliott said that this package, though the largest, is actually the third set of relief measures enacted. And there's more to come.

    “Work has already begun on a fourth legislative relief a package that we expect will be considered by Congress in April," Elliott said. "APTA will continue to advocate for provisions that will help physical therapists, physical therapist assistants, physical therapy students, and the patients they serve.”

    Comments

    • I support these plans and ideas

      Posted by Amanda Ramon on 3/27/2020 11:36 PM

    • Serving as PTA for 13 years, I believe we have the skills to provide telehealth services.

      Posted by Erin Fontana on 3/28/2020 8:34 AM

    • I have always believed that physical therapists need to band together and strike against constant reductions in reimbursement for our services, not to mention we are the most babysat medical professionals by Medicare. Although now is not a good time to strike, perhaps when the virus prevents us from being able to treat patients than perhaps the value in what we do will become more evident to the general population and or the government.

      Posted by Anne Williams on 3/28/2020 3:15 PM

    • Please reimburse the physical therapist for their hard work. Their patients need them. Working with them by teleconference is very important service in these trying times

      Posted by Frances Hanna on 3/28/2020 5:58 PM

    • We want to see therapy services affordable and available to more people. Such a benefit for so many as an alternative to painful surgery and dangerous pharmaceuticals.

      Posted by Jennifer Rivard on 3/31/2020 11:20 AM

    • I just read this: Why has the APTA not posted yet!!??!!?? Medicare Telehealth: Clinicians can now provide more services to beneficiaries via telehealth so that clinicians can take care of their patients while mitigating the risk of the spread of the virus. Under the public health emergency, all beneficiaries across the country can receive Medicare telehealth and other communications technologybased services wherever they are located. Clinicians can provide these services to new or established patients. In addition, providers can waive Medicare copayments for these telehealth services for beneficiaries in Original Medicare. To enable services to continue while lowering exposure risk, clinicians can now provide the following additional services by telehealth: Therapy Services, Physical and Occupational Therapy, All levels (CPT codes 97161- 97168; CPT codes 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521- 92524, 92507)

      Posted by JOE on 3/31/2020 2:55 PM

    • I'm physical therapy from Colombia but I live here for 3 years and I would like helping the people in this moment and I need yourself help me with my validation license in this country. Thank you very much. Regards, Yasmin L Sher 8722033212

      Posted by Yasmin L Sher on 3/31/2020 5:25 PM

    • @JOE: Although CMS announced on March 30, 2020, that it would add some PT, OT, and SLP CPT codes to the list of services covered under the Medicare Physician Fee Schedule when furnished as telehealth, CMS did not expand the types of providers eligible to furnish telehealth under Medicare. CMS noted in the interim final rule w/ comment period that current Medicare law does not allow telehealth services to be furnished by PTs, OTs, and SLPs under 1834(m). Thus, as of this writing, telehealth services furnished by PTs (and PTAs) are not covered under Medicare. For more information, please see: http://www.apta.org/PTinMotion/News/2020/03/33/CMSInterimRuleCOVID/

      Posted by APTA staff on 4/1/2020 9:43 AM

    • Supposedly CMS has lifted qualification guidelines for ordering Oxygen for beneficiaries discharging home. However, none of the MAC representatives were willing to provide guidance on this until they were directed by CMS. Also, if you go into the DME section you'll see they have lifted signature requirements, but nothing referenced regarding testing (O2 RA Sats), Face to Face documentation, and most importantly DX requirements. Medicare will not cover Oxygen for patients with an Acute illness. COVID19 would be considered an Acute illness. Most DME's are setting up the O2 but making the beneficiary sign and Advanced Beneficiary Notice. This means that if Medicare does deny the beneficiary will be required to pay for the services. The additional challenge is knowing what the independent RACs will do a year or two later. They can audit these claims and deny for the reasons listed above. Long Story Short- CMS' appears to be purposefully vague. Likely taking advantage of companies ignorance or their good will. This has led to delayed discharges, confusion, and could result in Medicare beneficiaries paying for services that should be covered during this time.

      Posted by Ryan A Reeves on 4/2/2020 11:18 PM

    • i used telehealth with my doctor for two visits. Doctor charged 300.00, medicare declined coverage. now i am 600.00 in the hole. i am on medicare for ten years, but this is the first time you have denied me coverage. please explain

      Posted by james mayer on 4/19/2020 5:18 PM

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