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  • 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."