• News New Blog Banner

  • Coronavirus Update: March 30, 2020

    Practice guidance for pediatric physical therapy, a new volunteer resource, accelerated Medicare payments, and more.

    Practice Guidance

    March 30: APTA Offers General and Pediatric-Focused COVID-19 Guidance for PTs, PTAs, Students
    Two new resources from APTA can help PTs, PTAs, and students looking for more detailed, profession-specific guidance related to providing care during the COVID-19 pandemic: one focused on general PT management of patients, and a second that specifically addresses pediatric physical therapy.

    March 30: New COVID-19 Volunteer Resource Connects PTs, PTAs, Students With Facilities in Need
    APTA has launched a new online service that helps connect members of the physical therapy profession with facilities looking for volunteers. The service offers two points of entry — one for facilities in need of PT, PTA, or student volunteers, and another for PTs, PTAs, and students willing to offer their services, by way of the APTA Engage volunteer portal.

    From CMS

    March 30: 39 States Have Been Granted Medicaid Waivers
    As of March 30, 39 states have received federal 1135 waivers on a range of Medicaid requirements including prior authorization, provider enrollment, public notice mandates, and fair hearing request timelines. A CMS press released dated March 27 reported that 34 waivers had been issued; by the afternoon of March 30, the number had risen to 39.

    March 28: CMS Expands Accelerated and Advance Payment Program for Medicare 
    "CMS is expanding the program for all Medicare providers throughout the country during the public health emergency related to COVID-19," CMS states in a press release. "The payments can be requested by hospitals, doctors, durable medical equipment suppliers and other Medicare Part A and Part B providers and suppliers." Qualifications include billing timelines and a requirement that the provider not be in bankruptcy, not be under active medical review or program integrity investigation, and not have outstanding delinquent Medicare overpayments.

    March 27: CMS Offers Long-Term Care Nursing Homes Telehealth, Telemedicine Toolkit
    According to CMS: "Most of the information is directed towards providers who may want to establish a permanent telemedicine program, but there is information here that will help in the temporary deployment of a telemedicine program as well." Resources include guidance on choosing telemedicine vendors, equipment, and software, as well as developing documentation tools.

    From the Department of Health and Human Services

    March 27: HHS Office for Civil Rights Issues Bulletin on Nondiscrimination Requirements
    The HHS OCR is reminding entities covered by civil rights authorities that the current COVID-19 national emergency does not change civil rights laws. "These laws, like other civil rights statutes that OCR enforces, remain in effect," the bulletin states. "As such, persons with disabilities should not be denied medical care on the basis of stereotypes, assessments of quality of life, or judgments about a person’s relative 'worth' based on the presence or absence of disabilities."

    Visit APTA's Coronavirus webpage for more information and updates.

    APTA Offers General and Pediatric-Focused COVID-19 Guidance for PTs, PTAs, Students

    Topics addressed in the new resources include when a PT should tell patients to cancel an outpatient visit and factors to consider when providing remote school-based services as part of an IEP.

    Two new resources from APTA can help PTs, PTAs, and students looking for more detailed, profession-specific guidance related to providing care during the COVID-19 pandemic: one focused on general PT management of patients, and a second that specifically addresses pediatric physical therapy.

    The general guidance resource provides perspectives on issues such as when a PT should tell patients not to come in for their outpatient PT visits, as well as management of patients diagnosed with COVID-19 in inpatient facilities, home health settings, experiencing post-intensive care syndrome, and in need of wound care. The guidance also includes information on preparation of physical space to reduce infection risk, use of PPE, and helping patients to stay active while at home.

    The pediatric physical therapy resource is directed at PTs and PTAs who manage these patients, especially in school settings. Topics include school closings and IEP services, remote learning, and a discussion of factors that need to be considered in providing pediatric physical therapy via telehealth.

    Both guidance documents will join frequently updated resources available on the APTA Coronavirus webpage, which include practice guidelines for physical therapy and COVID-19 in the acute hospital settings.

    New COVID-19 Volunteer Resource Connects PTs, PTAs, Students With Facilities in Need

    APTA's new service allows facilities to share their needs and creates matches with volunteers able to provide key services.

    The physical therapy profession has never backed away from a challenge. Now there's a new opportunity for PTs, PTAs, and physical therapy students to respond to the current COVID-19 pandemic through volunteer efforts.

    APTA has launched a new online service that helps connect members of the physical therapy profession with facilities looking for volunteers. The service offers two points of entry — one for facilities in need of PT, PTA, or student volunteers, and another for PTs, PTAs, and students willing to offer their services, by way of the APTA Engage volunteer portal.

    Volunteers could serve in a wide range of capacities as areas around the world move through acute, response, and recovery phases: PTs and PTAs with appropriate experience can help to free up needed ICU beds and ventilators by providing treatments that can reduce some patients’ need for mechanical ventilation. As areas and people recover, there will also be a need for volunteers able to help individuals get back to work through improving mobility, function, and quality of life.

    Michel Landry, BScPT, MBA, PhD, a professor and chief of the Doctor of Physical Therapy Division in the Department of Orthopaedic Surgery at Duke University School of Medicine and an affiliate in the Duke Global Health Institute, is coordinating volunteer-facility matches for the program. He can be reached through Twitter at @ptcovid19.

    For more insight into the pandemic, disaster response, epidemiological background, and the role the profession can play in care and recovery, check out this recording of a March 27 APTA FaceBook Live event at the bottom of the volunteer connection page.

    Coronavirus Update: March 27, 2020

    A Medicare payment increase, PT telehealth for UnitedHealthcare, APTA tracks telehealth payment changes, and more.

    Practice Guidance

    March 27: COVID Stimulus Package Includes Payment Increase, Opens Telehealth Possibility
    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.

    March 27: UnitedHealthcare Allows Telehealth for Physical Therapy
    UnitedHealthcare, the country's largest commercial health insurer, announced a major shift in its coverage policies during the COVID-19 pandemic: Beginning immediately, the payer will reimburse physical therapy delivered via telehealth services. The change is the most wide-ranging payer acknowledgement of PTs as qualified telehealth providers to date, and it moves UHC well past CMS' and a few other payers’ current waivers allowing for limited "e-visit" digital communications between PTs and patients.

    March 27: Charts From APTA Track Payer, Government PT Telehealth Policies
    Now available from APTA: a regularly updated set of resources that track payment and regulatory policies related to the provision of telehealth by PTs.

    March 30, 3 pm: APTA Hosts Facebook Live Event, "Implementing Telehealth in Your Practice STAT"
    APTA will host a Facebook Live version of its sold-out March 26 webinar that featured a panel discussion with experienced telehealth PTs providing insight on how they implement telehealth in their practices.

    From CDC

    March 25: CDC Releases PPE "Burn Rate Calculator"
    A new app helps providers calculate the rate at which PPE will be used in their facilities.

    In the Media

    March 27: What's Inside the Senate’s $2 Trillion Coronavirus Aid Package
    From National Public Radio: a breakdown of the six main groups that will receive relief through the stimulus.

    Visit APTA's Coronavirus webpage for more information and updates.

    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.”

    Charts from APTA Track Payer, Government PT Telehealth Policies

    The new resources from APTA are intended to be used as quick-reference guides to help you stay on top of changes in whether and how telehealth can be used in physical therapy — PTs should still check with payers and state governments.

    Keeping up with the rapidly changing telehealth environment during the COVID-19 pandemic can be dizzying. APTA can help steady things.

    Now available from APTA: a regularly updated set of resources that track payment and regulatory policies related to the provision of telehealth by PTs The resources exist in five separate files:

    The pages are intended as quick reference only; PTs should still carefully review individual payer policies and state laws and regulations before making a decision on providing telehealth to any patient.

    APTA will update the content of the summaries weekly to keep up with changes.

    Visit APTA's Coronavirus webpage for more information on the pandemic as it relates to the profession.

    UnitedHealthcare Allows Telehealth for Physical Therapy

    The major change, effective until June 18, permits PTs to be reimbursed for telehealth services using the company's typical billing codes but is subject to state laws and regulations.

    UnitedHealthcare, the country's largest commercial health insurer, announced a major shift in its coverage policies during the COVID-19 pandemic: Beginning immediately, the payer will reimburse physical therapy delivered via telehealth services. The change is the most wide-ranging payer acknowledgement of PTs as qualified telehealth providers to date, and it moves UHC well past CMS' and a few other payers’ current waivers allowing for limited "e-visit" digital communications between PTs and patients.

    The new benefits are set to end on June 18 and are subject to state laws and regulations around telehealth, but, if permissible, they enable PTs, occupational therapists, and speech therapists to provide true telehealth services and use their typical billing codes. Eligible codes will be reimbursed by UHC with a place-of-service code 02 and the 95 modifier.

    The UHC change is a significant improvement for PTs. Until now, national private insurers including UHC and Aetna, have been following CMS' lead and allowing only e-visits, a limited form of digital communication restricted to only a portion of codes, and not truly considered telehealth.

    While the COVID stimulus package on the horizon allows the U.S. Department of Health and Human Services to apply a waiver permitting PTs to engage in telehealth for Medicare beneficiaries, those waivers are unlikely to happen without a strong advocacy effort from the physical therapy profession — an effort that APTA is facilitating through a template letter to send to CMS that makes the case for the change.

    Carmen Elliott, MS, APTA's vice president of payment and practice management, said that the UHC change is big news.

    "The fact that the largest insurer in the country has temporarily shifted its reimbursement policies around telehealth is important in terms of patient and provider care and safety during this pandemic," Elliott said. "But it's also a tremendous opportunity for the physical therapy profession to demonstrate its ability to operate effectively in the telehealth space."

    Coronavirus Update: March 26, 2020

    New PT practice guidelines for COVID patients in acute hospitals, Cigna opens up telehealth for PTs, a call for postacute care COVID preparedness, and more.

    Practice Guidance

    March 26: New Practice Guidelines for Physical Therapy and COVID-19 in Acute Hospital Setting
    A new set of recommendations for physical therapy related to COVID-19 in the acute hospital setting acknowledges the necessity of involvement of PTs well-trained in respiratory physical therapy, but cautions that facilities should be judicious in their use. The recommendations have been endorsed by APTA, the Cardiovascular and Pulmonary Section, and the Academy of Acute Care Physical Therapy, albeit with a few caveats that not all of the Australia-based guidance will apply in the U.S.

    The recommendations are limited to PTs and "other relevant stakeholders" in acute care settings who are providing care to patients with suspected or confirmed COVID-19. The guidance includes more than 60 recommendations ranging from shift planning to the specific types of PPE PTs should wear.

    March 26: Cigna Adopts Telehealth Policy for Physical Therapy
    Insurer Cigna announced a series of temporary changes that open the possibility for telehealth by PTs, occupational therapists, and speech-language pathologists. The measures allow for reimbursement of PT services that include codes 97161 (evaluation, low complexity, 20 minutes, telephone or virtual), 97162 (evaluation, moderate complexity, 30 minutes, virtual), and 97110 (therapeutic exercises, two unit limit). Codes must be appended with a GQ modifier and billed with a standard place-of-service code. Cigna recommends that providers follow CMS guidance on the use of a specific software program but states that it will not require the use an specific software for now.

    March 30, 3 pm: APTA Hosts Facebook Live Event, "Implementing Telehealth in Your Practice STAT"
    APTA will host a Facebook Live version of its sold-out March 26 webinar that featured a panel discussion with experienced telehealth PTs providing insight on how they implement telehealth in their practices.

    From U.S. Department of Health and Human Services

    March 25: HHS Says That Providers Can Share Patient's COVID Status With First Responders
    The U.S. Department of Health and Human Services has issued guidance that the HIPAA Privacy Rule allows health care providers to share protected health information on an individual who has been diagnosed with or exposed to COVID-19 with first responders without the individual's permission under certain circumstances. Situations under which HIPAA-covered entities can share this information with law enforcement, paramedics, and other first responders include but are not limited to: when the information is needed to provide treatment; when they are reporting to public health authorities; and when first responders may be at risk of infection.

    In the Media

    March 25: JAMA Viewpoint Stresses the Need to Address Postacute Care Challenges Related to COVID-19
    Authors of an opinion piece in JAMA warn that postacute care facilities may be overwhelmed in much the same way hospitals could soon experience as the COVID-19 pandemic progresses through the population. They stress the need for immediate capacity-building, and urge policymakers to implement additional policies such as paid sick leave for staff, enhanced Medicare rates, and reimbursement for hospital-at-home models "at parity with institutional hospital care."

    Visit APTA's Coronavirus webpage for more information and updates.

    Practice Guidelines Emerge for Physical Therapy and COVID-19 in Acute Hospital Setting

    The Australian-based recommendations, endorsed by APTA, the APTA Cardiovascular and Pulmonary Section, and the APTA Academy of Acute Care Physical Therapy, emphasize proper PT training, careful patient screening, and the use of PPE.

    A new set of recommendations for provision of physical therapist services related to COVID-19 in the acute hospital setting acknowledges the necessity of involvement of PTs well-trained in respiratory physical therapy, but cautions that facilities should be judicious in their use. The recommendations have already been endorsed by APTA, its Cardiovascular and Pulmonary Section, and the APTA Academy of Acute Care Physical Therapy, albeit with a few caveats that not all of the Australia-based guidance will apply in the U.S. The guidance will be published soon in the Australian Journal of Physiotherapy.

    The recommendations are limited to PTs and "other relevant stakeholders" in acute care settings who are providing care to patients with suspected or confirmed COVID-19. The guidance focuses on workforce planning and preparation including screening for physical therapy as well as the actual delivery of interventions and personal protective equipment requirements, and includes more than 60 recommendations ranging from shift planning to the specific types of PPE PTs should wear.

    Among the recommendations:

    • Facilities should consider organizing separate teams to manage COVID-19 versus noninfectious patients.
    • PTs who are practicing within the ICU should have specialized knowledge of working in that setting, while other PTs in the facility who have ICU experience but aren't currently working in the ICU, as well as PTs without recent cardiorespiratory experience, should be facilitating rehabilitation and discharge planning for non-ICU/non-COVID-19 patients.
    • PTs with "advanced" ICU skills should be supported to screen patients with COVID-19, with some being identified as "clinical leaders."
    • Staff who are pregnant should avoid exposure to COVID-19.
    • Physical therapist examination and interventions should be provided only when there are clinical indications for need such as “mobilisation, exercise and rehabilitation e.g. in patients with comorbidities creating significant functional decline and/or (at risk) for ICU acquired weakness” with guideline authors writing that "unnecessary review of patients with COVID-19 within their isolation room/areas will also have a negative impact on PPE supplies."
    • If aerosol generating procedures (AGPs) are required, they should be conducted in a negative-pressure room, or at least in a single room with the door closed, with a minimum number of staff, all wearing PPE. Coming and going should be minimized during the AGP.
    • PTs should not implement AGPs, including humidification or noninvasive ventilation, without first obtaining agreement with a "senior doctor."
    • PTs should take droplet and airborne precautions, including the use of a high filtration mask, when providing mobilization exercise and there is a risk of the patient coughing or expectorating mucous.
    • Direct physical therapist interventions should be considered only when there are "significant functional limitations (e.g. [risk for] ICU-acquired weakness, frailty, multiple comorbidities, advanced age)" in the patient.
    • Staff should be trained in donning and doffing PPE, including N95 fit-checking.
    • For COVID-19 infected patients who may require AGPs, airborne precautions should be followed that include an N95/P2 mask, fluid-resistant long-sleeve gown, goggles/face shield, and gloves. The guidelines also recommend hair cover and shoes that are impermeable to liquids.

    The recommendations also include guidance on patient screening for the appropriateness of PT involvement and an overview of medical management of patients with COVID-19.

    Because the guidelines were developed in relation to the Australian physical therapy environment, some of the recommendations aren't directly applicable to typical U.S. acute settings, where respiratory therapists tend to perform some of the activities associated with physiotherapists in Australia.

    Still, says Bill Boissonnault, PT, DPT, DHSc, FAPTA, APTA's executive vice president of professional affairs, the resource should be carefully reviewed by physical therapists and facilities in the U.S.

    "These guidelines are solid, sensible, and timely," Boissonnault said. "During this crisis, the focus needs to be on connecting the PTs trained for ICU and respiratory physical therapy with only the COVID-19 patients who meet the criteria for treatment. Within the acute hospital setting, we can best respond to the pandemic by making careful, informed decisions that avoid needlessly risking the spread of this disease but also provide needed physical therapy care for patients. These recommendations can help facilities achieve that goal."

    In addition to endorsement from APTA, its Cardiovascular and Pulmonary Section, and the APTA Academy of Acute Care Physical Therapy, the recommendations also have received support from the World Confederation for Physical Therapy, The Australian Physiotherapy Association, the Canadian Physiotherapy Association, AIR (the association of Italian respiratory physical therapy), the UK's Association of Chartered Physiotherapists in Respiratory Care, and the International Confederation of Cardiorespiratory Physical Therapists.

    Visit APTA's Coronavirus webpage for more information on the pandemic as it relates to the profession.

    Coronavirus Update: March 25, 2020

    UnitedHealthcare allows e-visits, HHS presses states to ease regulations, HPA shares an interoperability opportunity, and more.

    Practice Guidance

    March 24: UnitedHealthcare Follows CMS Lead on "E-Visits"; Still Excludes "Telehealth" by PTs
    Although developments are happening too rapidly for posting on its website, UnitedHealthcare has announced that it will follow the CMS 1135 waiver policy allowing for a particular type of digital communication between a PT and patient known as an "e-visit." E-visits are not considered telehealth, and UHC explicitly statedthat it will still exclude reimbursement for outpatient therapy services delivered under telehealth. APTA offers an extensive Q&A resource on e-visits, including details on coding and the required "patient portal."

    E-visits through UHC will be paid as carve-outs, separate from the per-visit flat rate. Insurer fee schedules may take up to 60 days to complete fee schedule updates.

    UnitedHealthcare is the second major insurer to adopt the CMS e-visit policy for PTs: earlier in March, Aetna made a similar move. See the second item in the March 19 APTA Coronavirus Update for details and links.

    March 25: HPA Curates Resources on Interoperability, Telehealth Providers
    HPA the Catalyst, APTA's component focused on health policy and administration, now offers information for providers on how to gain free access to on-demand patient record retrieval service across the continuum from Kno2, one of the interoperability providers for most of the EHR vendors in postacute care and outpatient settings. Also available: a matrix on audio and video telecommunicationsto help you evaluate telehealth vendors, created by the HPA Technology Special Interest Group and the Frontiers in Science, Rehabilitation, and Technology Council.

    March 26, 2 pm: APTA Hosts Facebook Live Event on International PT Response to COVID-19
    Join APTA and physical therapists from the UK and Canada for a live discussion of how the physical therapy profession is responding to the COVID-19 pandemic internationally. Participants will include Michel Landry, BScPT, PhD, a professor at Duke University and affiliate in the Duke Global Health Institute, who will provide an overview of disaster management and epidemiology, and share experiences from working in other disasters.

    From Health and Human Services

    March 25: HHS Tells States to Ease State Laws and Regs
    The U.S. Department of Health and Human Services is calling on states to take "immediate actions" to relax laws and regulations that HHS thinks could get in the way of effective health care responses to the COVID-19 pandemic. The recommended actions include licensure exemptions and disciplinary moratoriums, waiver of telemedicine practice prohibitions, relaxation of scope-of-practice requirements, and easing of malpractice liability.

    From the Department of Labor

    March 24: Labor Department Provides More Information on Paid Sick Leave, FMLA Expansion
    With requirements now in place for employers with 500 or fewer employees to provide paid sick leave and expanded FMLA benefits, the Department of Labor is rolling out guidance for both employers and employees. The latest resources — a fact sheet for employers, a fact sheet for employees, and a questions and answers document — shed light on a number of issues, including how to count hours for part-time employees, employee information on qualifying reasons for leave, and how small business can obtain exemptions from the mandates.

    Visit APTA's Coronavirus webpage for more information and updates.