State of the Science in the Prevention and Management of Osteoarthritis, the summary of a collaborative project on osteoarthritis (OA) that included experts in physical therapy, nursing, epidemiology, rheumatology, public policy, geriatrics, pharmacotherapy, and complementary modalities, is available in this month's American Journal of Nursing (AJN). 

In July 2011, association members Carol Oatis, PT, PhD, and Maura Iversen, PT, DPT, MPH, ScD, and Anita Bemis-Dougherty, PT, DPT, MAS, of APTA's Department of Clinical Practice, represented the US Bone and Joint Initiative at a symposium hosted by AJN, the Hospital for Special Surgery, and the National Association of Orthopaedic Nurses to recommended ways in which nurses could take on greater leadership roles in research, policy, education, and clinical practice for the early diagnosis and management of OA.

The objectives of the symposium were to:

• Identify gaps in the science and barriers to the early identification of OA and the implementation of interventions that promote mobility, decrease pain, and slow progression.
• Describe the state of the science of current interventions for preventing immobility and managing the effects of OA.
• Achieve consensus on the priorities for developing the best nursing practices—in the clinical, educational, research, and policy arenas—in order to meet the needs of diverse populations with OA in a variety of settings. 
• Disseminate the analysis and recommendations to clinicians, nurse leaders, educators, researchers, specialty nursing organizations, other health care professionals, policymakers, consumer advocacy groups, and the general public.

Five main themes emerged from the symposium that address the burden of OA, the need for national initiatives to raise awareness of OA, assessment of  risk and progression of OA, interventions that relieve symptoms and minimize disease progression, and support for self-management as an aspect of OA treatment.  

Today, the US Department of Health and Human Services issued a final rule offering a framework to help states set up Affordable Insurance Exchanges (Exchanges) that meet their residents' needs by establishing standards for health insurance plans that participate in Exchanges, determinations of an individual's eligibility to enroll in Exchange health plans and in insurance affordability programs, and employer eligibility for and participation in the Small Business Health Options Program. 

The rule also provides flexibility to states in determining how they will monitor Qualified Health Plan (QHP) networks for sufficient access to services and to ensure ongoing compliance. In the rule, the Centers for Medicare and Medicaid Services (CMS) encourages states to coordinate with state departments to identify tools and strategies to monitor QHP compliance with certification standards, including standards related to network adequacy. APTA commented extensively on this provision in the proposed rule, calling the standard "too broad" and recommending that CMS adopt 4 additional requirements to "ensure that enrollees have timely and geographically accessible care as well as access to sufficiently diverse provider types from diverse health care settings." However, in the final rule, CMS states that it is "… not prescribing specific oversight and enforcement strategies" to monitor QHPs. 

Additionally, essential health benefits (EHB), which are mandatory and include the category of rehabilitative/habilitative services, must be offered in QHPs. This final rule provides states guidance and flexibility in implementing EHBs in the Exchanges. A separate proposed rule will be issued this year regarding EHBs.

Today's rule combines policies from 2 Notices of Proposed Rulemaking (NPRMs) published last summer. One rule, published July 15, 2011, outlined a proposed framework to enable states to build Exchanges. A second NPRM, published August 17, 2011, outlined proposed standards for eligibility for enrollment in qualified health plans through the Exchange and insurance affordability programs, including premium tax credits.

APTA will post a summary of the rule on its Web site shortly.

The Foundation for Physical Therapy will soon accept applications for the special issue Request for Application (RFA) titled The Influence of Physical Therapy Referral Characteristics and Practices on Quality, Cost Effectiveness, and Utilization Patterns. Investigators with extensive experience and publication in health services research should e-mail Karen Chesbrough, MPH, scientific program administrator, to express interest in applying and request a copy of the RFA.