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  • The State of States: Four Ways to Stay Up-to-Speed on Telehealth, Licensure Provisions, and Other State-Level Changes

    It can't be stressed enough: Individual states are the decision-makers around much of what PTs and PTAs can and can't do in response to the COVID-19 pandemic. These regularly updated resources can help you make fact-based practice decisions.

    Have a question about what you can and can't do amid all the regulatory and payment changes happening in response to the COVID-19 pandemic? The answer will probably be the same no matter what:

    Check with your state physical therapy licensing board and each of your payers.

    "While there have been changes at the federal and commercial insurer levels around, for example, the kinds of digital communications PTs can have with patients, state laws often take precedence," said Daniel Markels, APTA state affairs manager. "If your state laws and regulations don’t allow you to do it, even if the insurer you're working with says they'll pay for it, you can't do it. On the other hand, states have made temporary changes to various laws that may provide additional opportunities for PTs and PTAs, so it's crucial to keep up with what's happening at the state level."

    Here are four key resources to help you do just that.

    An APTA chart tracking state orders allowing PTs to provide telehealth services
    "Can I provide telehealth?" is the question on the minds of nearly every PT and PTA these days. This chart, updated weekly, breaks down the answer to that question by state, with links to specific orders. But remember: Review your state practice act and check in with your state licensing board to verify what you are and aren't allowed to do.

    An APTA chart on state actions related to telehealth in Medicaid, commercial, and workers' comp coverage, updated weekly
    States have been adjusting their Medicaid and commercial insurance regulations in a variety of ways when it comes to telehealth, including some mandates that nonfederal payers must pay for telehealth services as if the services were performed in person. But it's a patchwork, and many states don't mention PT services specifically. (Again, check with your state licensing board or specific insurance companies for the most accurate and current information.) The chart is updated weekly.

    A rundown of state licensure exemptions and requirements for PTs and PTAs related to the COVID pandemic
    This chart, created by the Federation of State Boards of Physical Therapy, provides a detailed listing of every change made to licensing laws and regs in response to the health emergency, with a particular focus on exemptions and changes to licensure requirements — everything from the issuance of temporary licenses without an examination to allowances for PTs licensed in another state. Of note is the number of states that temporarily allow a PT or PTA licensed in another state to come in and practice without having to obtain a license from the state during declared national or state emergencies.

    Contact information for state physical therapy licensing boards
    This is just what it sounds like: a regularly updated listing of every licensing board, including email addresses, websites, and phone numbers, courtesy of FSBPT.

    The Pandemic, Telehealth, and the Physical Therapy Compact

    In the U.S., the regulation of professions is a power invested with the states, not the federal government, meaning that each state has the authority to regulate and license providers. That's great for states’ rights, but it can create challenges for practice across state lines — including challenges associated with remote digital communications that know no borders.

    The current trend toward increased ability for PTs and PTAs to provide remote services, though sparked by a health crisis, was one of the motivating factors behind the creation of the Physical Therapy Compact in 2016, the system that allows PTs and PTAs licensed in one compact state to obtain practice privileges in other compact states. Currently, 28 states have enacted the required legislation to join the compact, with five more states introducing compact legislation this year. Enactment of the compact in all U.S. jurisdictions has been a top priority for APTA and FSBPT, and the current pandemic has demonstrated the need for it.

    Creators of the compact (APTA, FSBPT, and the Council of State Governments) were focused on interstate licensure portability — moving from one state to another with minimal disruptions in practice, obviously, but also on the potential growth of telehealth.

    Markels says the compact can be a useful tool in these times but warns that PTs and PTAs in the compact still need to pay careful attention to individual state laws and regs, especially related to telehealth (see the resources above).

    "If you're in the compact, and your home state — the state of your primary residence — allows telehealth, that doesn't mean you can provide telehealth services to a patient who’s in a compact state that doesn't allow it," Markels cautioned. "PTs and PTAs with compact privileges must abide by the laws and regulations of the physical therapy board in the state in which the patient is located and where services are being delivered."

    So, in other words … keep up with what the states are doing.

    Comments

    • Thanks for the info ..some of the HHagencies in Northern California are doing 50-75%paycut to clinicians because of telehealth .How ethicsl is that

      Posted by Neha on 4/11/2020 9:37 AM

    • Hi can Cota/Pta provide Telehealth services?

      Posted by Norika on 4/13/2020 7:55 PM

    • @Norika: This hinges on your state practice act and any other applicable state or local laws as well as payer policy.

      Posted by APTA staff on 4/14/2020 8:27 AM

    • I billed my first telehealth visit to Medicare and it was denied due to invalid procedure modifier. I billed CPT code G2063 and added the CR modifier in addition to the other modifiers we usually bill for this patient (GP, 59, KX). What did I do wrong? My practice is in New Jersey.

      Posted by Richard Stoneking on 4/16/2020 9:19 AM

    • @Richard: Please note that G2063 is not considered a Medicare telehealth service, but rather, an e-visit, which is considered by a Medicare to be a communication technology based service. It is a non-face-to-face digital communication via an online patient portal. You should not append the 59 modifier when billing this code. However, the other modifiers likely are correct (KX should be appended only if you’ve exceeded the $2,080 PT/SLP combined threshold). It is our understanding that the MACs have not updated their claims processing systems to reflect the change in policy allowing PTs to bill e-visit codes G2061-G2063 during the public health emergency and/or the fact that CMS has described these codes as sometimes therapy services, meaning the GP modifier is required. APTA has brought this issue to the attention of CMS numerous times, including on a recent national open door forum, and asked that they work with the MACs to immediately address this issue. Please check with your MAC before submitting claims to ascertain when their systems might be set up to properly process these claims when billed by PTs.

      Posted by APTA staff on 4/17/2020 9:04 AM

    • How does a PT supervise a PTA during a telehealth visit? (2) During the pandemic , can a third party be present during the telehealth session to act as an interpreter?(3) Do we need a special malpractice policy for telehealth services? I Contacted the NYState board of physical therapy and they were unable to provide me with answers to these questions. I hope someone else can. Ty

      Posted by Renee Fishweicher on 5/1/2020 5:41 PM

    • Wondering if this is allowed: I currently live and practice in NY state however d/t covid-19 my wife and I plan to move to Toronto, Canada. I'd like to continue working TeleTherapy sessions for my NY state patients however want to make sure its all legal to do so. According to the NYS website it only matters that the patient is in NY and I am licensed and continue to be registered to practice in NY state. So anyone know if there is any issue with this?

      Posted by Brad Parker on 5/13/2020 11:49 PM

    • @Renee: Please submit your question to advocacy@apta.org.

      Posted by APTA staff on 5/16/2020 7:19 AM

    • @Brad: Please submit your question to advocacy@apta.org.

      Posted by APTA staff on 5/16/2020 7:19 AM

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