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  • APTA to Congress: Now's the Time to Support Providers, Protect Patients, Expand Telehealth, and Make Lasting Changes

    In a letter to Congress, the association urges lawmakers to craft a COVID-19 relief package that not only provides emergency relief but improves care after the emergency ends.

    As Congress debates the contents of a fourth COVID-19 relief package, APTA is urging lawmakers to look at both short- and long-term solutions — for instance, not just providing hazard pay for PTs on the front lines of the crisis and temporary help for private rehab clinics, but making permanent changes that would allow PTs to participate in telehealth and expand a PT's ability to bring in a substitute when needed.

    And APTA advocates for mid-term solutions as well: specifically, suspension of a CMS plan to dramatically reduce payment for physical therapy and host of other health care services beginning in 2021.

    The recommendations from APTA are spelled out in a letter to both houses of Congress that outlines seven steps lawmakers should take to "ensure patient safety and to protect health care providers." APTA is urging members to join in a grassroots effort to press for adoption of the policies.

    "What APTA is providing to Congress is a set of common-sense provisions that keep patient access to care front-and-center — not just in the midst of this emergency but for the recovery period and long after," said Justin Elliott, APTA's vice president of government affairs.

    Elliott adds that a number of the association's suggestions have already been fleshed out and could be more easily incorporated into the relief package.

    "Many of our recommendations are included in already-existing bipartisan legislation, which means that they're familiar to many lawmakers," Elliott said. "Congress won't have to take time crafting these changes; they can just incorporate these bills into the larger relief package."

    The association's recommendations include:

    Suspension of planned CMS cuts in 2021. CMS is still moving forward with a plan to reduce reimbursement for codes that affect payment for more than three dozen health professions, including physical therapy, which is facing an estimated 8% cut. CMS says that due to budget neutrality requirements, the cuts have to be made to pay for increases it wants to make to evaluation and management codes for physicians. APTA's suggestion: include the legislative language provided to Congress by APTA that would waive budget neutrality for at least five years so that CMS can provide the increases without sacrificing payment to other professions and risking patient access to care.

    Approval of "hazard pay" and increase production and access to PPE. APTA writes that "many health care workers … are risking their health and lives every day due to potential exposure to the coronavirus," including PTs and PTAs. Funding hazard pay for these essential health care providers would be particularly helpful, given that many of them could be exempted from receiving expanded sick and family leave if their employer chooses, according to the association. APTA acknowledges that providing additional financial support to essential health care providers will not reduce risk of exposure to the virus, which is why the association also urges the federal government to do significantly more to facilitate the timely manufacturing and distribution of ventilators and PPE through a process that is transparent, equitable, based on need, and noncompetitive.

    More support for health care providers with small businesses. In its letter, APTA requests that Congress include language from the Immediate Relief for Rural Facilities and Providers Act, a bipartisan bill sponsored by Sens. Michael Bennett and John Barraso, and Reps. Terri Sewell, Phil Roe, and Kim Schrier. The legislation would provide for emergency one-time grants equal to a qualifying health care provider’s business's total payroll during the first quarter of 2019, and create a low-interest loan program.

    A permanent resolution of telehealth restrictions on physical therapy. While therapists wait for HHS to act on its new authority via the CARES Act to provide emergency waivers that would temporarily add providers of telehealth during the declared emergency, a long-term and permanent policy solution is needed that would allow physical therapy to be conducted via real-time face-to-face virtual encounters — something CMS currently says PTs and PTAs aren't allowed to do but that APTA is working to change. APTA recommends that Congress include the bipartisan CONNECT for Health Act in any future relief package as a long-term policy solution for telehealth.

    Support for IDEA. The association believes "this is not the time to roll back civil rights protections for students with disabilities" through waivers to either the Individuals with Disabilities Education Act or the Rehabilitation Act of 1973.

    Expansion of locum tenens. While CMS in 2016 enabled PTs to qualify for payment under Medicare when they bring in a replacement professional during the PT's temporary absence — known as locum tenens — that ability is restricted to outpatient services in a health professional shortage area, a medically underserved areas, or a rural area as defined by HHS. APTA's letter recommends that including the Prevent Interruptions in Physical Therapy Act, which removes the geographic restrictions, "would relieve potential staffing shortages faced by small clinics" in light of the pandemic.

    Support for physical therapy in community health centers. APTA points out that as thousands of Americans face "a long and difficult road to recovery," many will rely on community health centers to provide needed care. Currently, PTs aren't among the clinicians allowed to directly bill Medicare and Medicaid for care provided in community health centers, but APTA says they should be. That's a change that could happen with the relief package included the bipartisan Primary Health Services Enhancement Act.

    In addition to its advocacy for relief provisions with a particular connection to the physical therapy profession, APTA has also joined with 12 other professional health care organizations to press Congress to shape the next relief package through a range of policy changes. In addition to recommendations around hazard pay, telehealth, and small business support, that letter also urges lawmakers to ensure better access to PPE, increased provider safety, aid for underemployed and unemployed health care providers, and support for rural facilities.

    Join APTA in advocating for expanded telehealth, reduced regulatory barriers, and protecting health care providers on the front lines of the COVID-19 pandemic. It only takes a few minutes.

    Comments

    • As a PT in private practice, I fully support and recommend the implementation of all these requests.

      Posted by Michael Louis PT on 4/21/2020 10:07 AM

    • CMS needs to recognize the limitation imposed by recognizing E visits but not telehealth by PT’s. I have been offering my services to my Medicare patients to guide them through supervised meaningful movements and exercises during a time when even going out for a walk has become so limited. These patients are so grateful for this guidance and look forward to a session as often as they can get it. This will prevent an onslaught of musculoskeletal issues that will all emerge the moment lock down phase is lifted. An ounce of prevention is better than a pound of cure!! Kindly push for CMS to recognize telehealth visits. Thanks

      Posted by Jaya Kunnel on 4/21/2020 10:43 AM

    • Please allow telehealth PT visits to ensure that our patients are safe in their homes.

      Posted by Lisa Boylan on 4/21/2020 3:02 PM

    • Thanks APTA! Please keep sending these advocacy templates. You make it easy for a quick response.

      Posted by Theresa Locke on 4/21/2020 5:15 PM

    • Let's not forget about an " any willing provider" regulation in all states. Access to care should be determined by the consumer.

      Posted by David McLeary, M.S.,P.T. on 4/22/2020 8:22 AM

    • About telehealth: Currently, CMS has the waiver authority to make necessary changes that would allow PTs to provide face-to-face real-time telehealth, and there is a CMS interim final rule pending review with the White House that we are hopeful will include the Medicare telehealth policy changes for which we’ve been advocating. APTA has created a template for individuals to use to add their voice to this important debate. It's at http://www.apta.org/RegulatoryIssues/TakeAction/ Approximately 1,700 PTs, PTAs, and students have already submitted comments urging CMS to take action and add therapists as eligible telehealth providers under Medicare. As soon as the White House completes its review, the document will be published and we will know what changes CMS is implementing, including whether CMS will be adding therapists as telehealth providers under Medicare for the duration of this public health emergency. After the interim final rule is released and we've reviewed it, we will announce the new information via PT in Motion News and social media, and also update our telehealth webpage: https://www.apta.org/telehealth/. In the meantime, here is where the Medicare policy stands currently as of April 22, 2020: PTs can furnish under Medicare the following services (referred to as communication technology-based services by CMS): • Remote evaluation of recorded video/images (G2010) • Virtual check-in (G2012) • E-visits (G2061-G2063) • Telephone assessment and management services (98966-98968)

      Posted by APTA staff on 4/22/2020 9:30 AM

    • I don’t really understand the desire for permanent telehealth. Having hands-on care is essential for quality PT, and this overwhelming drive for permanent telehealth seems more like a money grab than a patient care issue. I foresee institutional providers utilizing telehealth as a means of beating smaller clinics as large institutions can use providers to provide telehealth (inferior to hands on care, by far, the majority of the time) from densely populated employment locations to provide inferior care at a cost that smaller clinics simply can’t compete with, and I have little faith in the patient population having adequate awareness of the availability of higher quality hands-on care, as experience has proved time and time again, that many patients simply operate under the premise that their choice of provider is up to the discretion of the referring provider who does not inform the patient that they have a choice of provider. Telehealth will be a victory for institutional providers at the expense of individual providers and will degrade the autonomy if individual physical therapists as they are further relegated to working in an institutional setting.

      Posted by Bill on 4/23/2020 7:45 AM

    • Do we know if the CMS interim final rule addresses the ability of facilities (who bill on UB04) to be included in the PT group who can bill Medicare for Telehealth?

      Posted by Jeanne on 4/28/2020 5:04 PM

    • @Jeanne: On April 14, CMS sent to the Office of Management and Budget Office of Information and Regulatory Affairs (OIRA) for their review an interim final rule titled “Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency.” (OIRA reviews all rules prior to publication to ensure the agency is acting within its statutory authority, to assess the economic effects of the rule on the economy, etc.). We are hopeful that this interim final rule includes the Medicare telehealth policy changes we’ve been advocating for, particularly in relation to the addition of therapists as Medicare telehealth providers. We also expect CMS will address in this rule whether they are expanding the availability of institutional settings to bill for telehealth furnished by therapists via the UB-04 form. As soon as OIRA completes its review, the document will be published and we will know what changes CMS is implementing, including whether CMS will be adding therapists as telehealth providers under Medicare for the duration of this public health emergency. As soon as the interim final rule is released and we’re able to review it, we will announce the release of the rule via PT in Motion News and social media, and also update our telehealth webpage: https://www.apta.org/telehealth/.

      Posted by APTA staff on 4/29/2020 8:22 AM

    • In this time where tele med conference calls are becoming more frequent I think it is vital to allow PT’s the ability to tele conference to. There is a lot they could do to help their patients thru exercise. I believe this is a vital treatment option for now and the future.

      Posted by Maureen Jacques on 4/30/2020 7:15 PM

    • how about a profound response to covid patients whose breathing relaxation would improve healing time . we are skilled at accessory muscle relaxation and breathing expansion. let's market it and regain our professional integrity as relieving pain and suffering as we were intended.

      Posted by Sally fentress on 5/13/2020 7:35 PM

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