New resources from APTA help explain how the health insurance exchanges (exchanges)—a fundamental component of the Affordable Care Act—will affect providers of physical therapy services. The health care reform law created exchanges to provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options on the basis of price, quality, service, and other factors. The primary purpose of the exchanges is to enhance competition in the health insurance market, improve choice of affordable health insurance, and give small business the same purchasing clout as large business.
Find links to general resources, APTA comments and summaries of exchange rules, and related resources, particularly essential health benefits, on APTA's new Health Insurance Exchanges webpage.
Following UnitedHealth's announcement on Monday that it would maintain several health coverage protections included in the Affordable Care Act regardless of the Supreme Court's ruling on the law, Aetna Inc and Humana Inc made similar pledges later in the day, says an article by Reuters.
The 3 insurers will allow children to stay on their parents' plans up to age 26 and will maintain a provision that provides clear ways for members to appeal coverage claim decisions.
UnitedHealth and Humana said they will keep 2 other provisions—forgoing lifetime dollar coverage limits on policies and eliminating rescissions, which are generally considered to be retroactive policy cancellations, except in the case of fraud. It was not immediately clear where Aetna stood on those provisions, says the article.
Cigna Corp, another large national insurer, said it was "prepared to proceed as appropriate on behalf of our customers when the court deliberations reach their conclusion."
Despite APTA's urging for continued Medicare coverage of TENS for chronic low back pain (CLBP) and additional research regarding the circumstances when the use of TENS for CLBP is effective, the Centers for Medicare and Medicaid Services (CMS) finalized the requirement of enrollment in an approved clinical study to receive coverage for TENS for CLBP.
In its final decision memo, CMS said that the clinical study requirement is to support additional research on the use of TENS for CLBP, and this requirement will expire in 3 years. CMS says in the memo that based on its review of the evidence, "… we have determined that TENS is not reasonable and necessary for CLBP under 1862(a)(1)(A) of the Act. Neither the comments we received, nor the discussions that we have had with industry and investigators, have provided us with the persuasive scientific evidence to reach a different conclusion." Thus, at the expiration of the 3-year clinical study requirement, TENS for CLBP will not be covered, as it will be considered not reasonable and necessary.
Links to APTA's comments and summary on the National Coverage Analysis Tracking Sheet for TENS for Chronic Low Back Pain can be found on APTA's Medicare Coverage Issues webpage.
APTA members commented extensively on CMS's proposal memo in News Now coverage posted March 14 and April 3.
A week of cognitive and physical rest—which included taking time off from school or work and avoiding talking on the phone, exercising, watching TV, socializing, or working at a computer—alleviated symptoms of concussion in 49 high school and college athletes, according to a Reuters Health article based on a study in The Journal of Pediatrics.
To measure the effect of "an intensive bout of rest" after a concussion, researchers evaluated the athletes between April 2010 and September 2011 and assigned them to groups based on the time elapsed between sustaining a concussion and the onset of rest. Fourteen of the patients started the rest within a week of their injuries. Another 22 patients began resting within a month of the concussion, and 13 patients began the week of rest between 1 and 7 months after the concussion.
At the beginning of the study, all of the patients had symptoms related to the injury, such as headaches and trouble concentrating.
After the week of rest, all groups saw their symptoms improve regardless of the time between concussion and onset of rest. Among the athletes who started the rest within a week of their concussion, their symptoms improved from a score of 22 on a 132-point scale down to 7, says the article.