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  • CMS Guidance Allows PTs, PTAs in Private Practice to Provide Services Via Telehealth

    In a major shift strongly advocated by APTA members, CMS will now include PTs and PTAs in private practice among the providers able to bill for services provided through real-time face-to-face technology. But there are requirements.

     

     [Editor's note: This story was updated on May 15 after CMS confirmed that PTAs were also included in the guidance information.]

     

     The change is happening, albeit incrementally: New guidance issued by CMS now allows PTs and PTAs in private practice to make full use of telehealth with their patients under Medicare Part B. Previously, only limited e-visits and other “communication technology-based services” were allowed; the change now includes PTs among the health care providers permitted to bill for real-time face-to-face services using telehealth. This policy change follows a robust advocacy campaign by APTA members and staff.

    Aside from telehealth, the revised guidance and accompanying interim final rule contain other provisions relevant to PTs and PTAs. APTA will share these details in subsequent PT in Motion News articles. Also, there are multiple details of the telehealth and other provisions that haven't been fully explained by CMS. APTA is working to find answers that fill in the gaps.

    The Basics

    • Physical therapists in private practice are eligible to bill Medicare for certain services provided via telehealth. [Editor’s Note: APTA is seeking confirmation as to whether services furnished by PTAs via telehealth are eligible for reimbursement.]
    • Services that started as of March 1, 2020, and are provided for the duration of the public health emergency are eligible.
    • These CPT codes are eligible to be billed: 97161- 97164, 97110, 97112, 97116, 97150, 97530, 97535, 97542, 97750, 97755, 97760, and 97761.
    • Patients may be either new or established.
    • These visits are for the same services as would be provided during an in-person visit and are paid at the same rate.
    • Patients may be located in any geographic area (not just those designated as rural), and in any health care facility or in their home.

    Here are the codes you can use.
    These codes are eligible to physical therapists to furnish and bill under the Medicare Physician Fee Schedule when provided via telehealth:

    ICPT codes 97161- 97164, 97110, 97112, 97116, 97150, 97530, 97535, 97542, 97750, 97755, 97760, and 97761. See the full list of codes eligible to be furnished and billed via telehealth under Medicare.

    When billing claims for telehealth services provided on or after March 1, 2020, and for the duration of the public health emergency, bill with:

    • IPlace of Service code equal to what it would have been had you furnished the service in person;
    • IModifier 95, indicating that you did indeed perform the service via telehealth; and
    • IThe GP modifier.

    APTA is seeking clarification from CMS regarding institutional billing of telehealth services.

    You will be reimbursed as if the service was delivered in person, and you can find rates for codes being reimbursed under the Medicare Physician Fee Schedule via telehealth using the APTA MPPR Fee Schedule Calculator or CMS Physician Fee Schedule Look-Up Tool.

    You can provide services from your home.
    During this public health emergency, CMS is allowing PTs in private practice (as well as other providers) to furnish telehealth services from their homes without reporting their home address on their Medicare enrollment while continuing to bill from their currently enrolled location.

    There are technology requirements. Follow them.
    Services on the Medicare telehealth services list must be furnished using, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between you and your patient.

    What if two-way audio and video technology isn't available? CMS acknowledges that there are circumstances where prolonged audio-only communication between you and the patient could be clinically appropriate yet not fully replace a face-to-face visit. In these cases, it's important to remember that during the public health emergency Medicare pays separately for audio-only telephone assessment and management services described by CPT codes 98966-98968. This APTA quick guide can help you learn more about telephone assessment and management services.

    Documentation matters. A lot.
    Keep in mind the documentation needed to have a proper compliant telehealth program. For more information, view APTA's Defensible Documentation resources. Also be sure to document the type of technology you used for the evaluation or treatment. For information about obtaining and documenting informed consent, and policies and procedures that you should have in place before furnishing telehealth, visit APTA’s implementing telehealth in your practice webpage.

    What about HIPAA?
    During this health crisis, the HHS office for Civil Rights is relaxing enforcement and waiving penalties for HIPAA violations against clinicians who in good faith use everyday applications that allow for video chats, such as Apple FaceTime and Skype. But keep in mind: HHS, the Office of the Inspector General, and the Department of Justice will monitor for health care fraud and abuse, including potential Medicare coronavirus scams.

    Another important point: You must adhere to any state laws governing privacy and security of patient data.
    For additional privacy protections while using video-based telehealth, consider providing services through technology vendors that offer HIPAA business associate agreements with their video communication products. APTA’s Health Policy and Administration hosts a list of rehabilitation telehealth vendors.

    Beneficiary cost sharing? Up to you (but waivers won't be covered by Medicare).
    Nothing in the guidance or interim rule requires you to reduce or waive copays or other cost-sharing that a Medicare beneficiary may owe for telehealth services during the health crisis, but you will not be subject to administrative sanctions if you do. This applies to face-to-face telehealth services as well as to non-face-to-face services furnished through modalities such as virtual check-ins and e-visits. However, keep in mind that Medicare will not cover the cost of any waived cost sharing.

     

    Coronavirus Update: April 29, 2020

    Expanded APTA guidance, additional relief funding, U.S. reaches 1 million COVID-19 cases, and more.

    Practice Guidance

    April 28: APTA Retools Its COVID-19 Practice Management Webpage
    As resources continue to grow, APTA has expanded and reorganized its webpage devoted to PT management of patients with diagnosed or suspected COVID-19. The page includes guidance for a variety of settings including outpatient, home health, long-term care, acute care, and school-based care, as well as information on post-intensive care syndrome and ways to help patients stay active while people are staying home during the emergency.

    COVID-19 Relief Programs

    April 23: Small Business Administration Publishes List of Lenders Participating in PPP
    A new resource from SBA lists lenders participating in the Paycheck Protection Program by state.

    From HHS and CMS

    April 27: CMS Suspends Advanced Payment Program, Taking Another Look at Accelerated Payment
    Citing the availability of new relief money, the U.S. Centers for Medicare & Medicaid Services has suspended its advance payment program for Medicare part B providers and says it's reevaluating its accelerated payment program for Part A providers.

    April 24: More Money Coming From HHS — Can PTs Qualify?
    The U.S. Department of Health and Human Services is distributing an additional $20 billion in health care provider relief funds, but the way HHS is determining distribution might make getting that money more complicated for many PTs — if PTs qualify in the first place.

    April 23: CMS Releases COVID-19 Telehealth Toolkit for Medicaid and CHIP
    A new toolkit from CMS is aimed at helping states move to greater use of telehealth in Medicaid and CHIP by helping states identify restrictions on telehealth eligibility, the types of services that could be delivered via telehealth, and practice act barriers to implementation of wider telehealth use, among other areas.

    April 22: New COVID Relief Package Adds $75 Billion to Funding for Health Care Providers
    The COVID-19-related grant funds intended for distribution to health care providers received another $75 billion as part of a $484 billion "phase 3.5" coronavirus relief bill signed into law.

    In the Media

    April 28: More than 1 Million Cases Reported in U.S.
    From NPR: "More than 1 million cases of COVID-19 have been diagnosed in the U.S., marking a grim milestone in the country with the most reported coronavirus infections in the world, according to data compiled by Johns Hopkins University."

    April 27: White House Creates Plan to Expand State Testing
    From USA Today: "The White House unveiled a blueprint on Monday designed to help states expand coronavirus testing and rapid response programs as governors weigh gradually lifting stay-at-home orders and reopening schools and businesses."

    April 24: Older Adults Can Have Atypical COVID-19 Symptoms
    From Kaiser Health Network: "Older adults with COVID-19, the illness caused by the coronavirus, have several 'atypical' symptoms, complicating efforts to ensure they get timely and appropriate treatment, according to physicians."

    April 21: The Challenges of Combatting COVID-19 in Rural Areas
    From Medpage Today: "Rural areas have specific healthcare challenges that make combatting COVID-19 harder, and those issues need to get more attention."

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

    APTA Advisory: Pay Attention to Requirements When Billing Insurers for Services Delivered via Telehealth

    It's your responsibility to stay on top of what is and isn't reimbursed, but APTA can help.

    APTA and commercial insurers have been receiving questions from PTs whose telehealth-based claims have been rejected, even though the insurer says that in general, they'll reimburse for services delivered remotely. Often the reason for the denial is clear: The provider omitted coding and other information required by the insurer, or used a code for a specific service that the insurer isn't accepting as billable in the first place.

    Here's an example: One of the more common reasons for the denials we're seeing at APTA has to do with code 97530 — therapeutic activities. Many payers— including insurance giants Aetna and Cigna—do not include 97530 among the codes that can be billed when delivered via telehealth. PTs who use this code as part of telehealth billing will have their claims denied.

    Bottom line: Many of the insurers now allowing telehealth by PTs have rules on which codes can be used, what place of service must be identified, and what modifiers should be added. Those rules must be followed in order to get paid. APTA offers an online resource, updated weekly, that can help you stay on top of the requirements. And be sure to check the payers' websites, too.

    Want more on telehealth? APTA's Telehealth webpage helps you keep up with commercial payer requirements and changes at the state level, and connects you with insights from PTs who have been using telehealth long before the current emergency.

    Physical Therapy and COVID-19 in the Media: Seven Worthwhile Reads

    The challenges of providing physical therapy during a pandemic haven't escaped the media's attention. Here are six stories on how the profession is responding — and one exploration of what could soon be a huge issue for PTs and PTAs.

    Media coverage of the COVID-19 pandemic has ranged from personal stories of individual courage and loss to big-data analyses of worldwide effects on the economy and other factors. And some of that coverage focused on physical therapy.

    Here a few recent stories you may have missed — six that highlight the profession's response to the health emergency, and a seventh on what may become one of the profession's biggest challenges in the near future.

    An overview of how the profession is responding to the pandemic so far.
    From MedPage Today, this article focuses mostly on the outpatient setting to look at the challenges faced by PTs and the possibility of telehealth as an important tool in meeting those challenges. APTA Senior Payment Specialist Alice Bell, PT, DPT, provides the big-picture view, while APTA member Karen Litzy, PT, DPT, describes her personal experiences transitioning to telehealth.

    PTs share firsthand experience of how COVID-19 has affected hospital physical therapy.
    What's it like to suddenly find yourself working with patients hospitalized with COVID-19? It can be scary, according to these PTs, but those fears must be overcome.

    An exploration of physical therapy's fit with telehealth.
    This article, from NextAvenue, focuses on Mary Milhay, from Cleveland, Ohio, who has been working with her physical therapist via telehealth to manage her knee osteoarthritis. Author Kelly James interviews several PTs who discuss the components of effective delivery of physical therapy through telehealth.

    A look at how injured elite athletes are engaging in rehab.
    The Washington Post provides a glimpse at telehealth approaches being taken to keep athletes such as Indiana University linebacker Thomas Allen on the road to recovery. What are the possible effects of no access to sophisticated training equipment and unsupervised exercise?

    The special challenges faced by school-based PTs.
    Needs are high for the services of school PTs — but, unfortunately, sometimes access to technology is low, and the nature of children's needs can't always be met sufficiently through telehealth. But PTs and other school-based therapists are finding ways to provide as much care as possible.

    Prenatal care during a pandemic.
    In the midst of social distancing and general wariness about venturing outside of the home, providers are finding ways to continue to serve expectant mothers. This story from the Today Show looks at how several professionals — including a PT — are using telehealth to continue care.

    What happens after the ICU?
    While not specifically about physical therapy and the pandemic, a valuable read nonetheless: a dive into the physical and cognitive challenges faced by patients being removed from ventilators and leaving the ICU. Experts and the patients themselves discuss post-intensive care syndrome and provide insight into what could well be a significant challenge for PTs in the coming months.

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

    Popular Institute on Bringing Rehab Science Into Practice Will Be Held Online, for Free

    Last year's CoHSTAR Implementation Science Institute was well-received; this year's online event features two days of insight on applying research to practice in a variety of settings.

    Rehabilitation clinicians, researchers, and other stakeholders are being offered a rare opportunity to learn from some of the profession's thought leaders on how to move science into actual practice — all for free, and all online.

    This year, the Center on Health Services Training and Research, also known as CoHSTAR, is offering its second annual Implementation Science Institute as a free-access virtual event in two sessions, May 11 and 21.

    The online event will feature different agendas for each session, with sessions running from 11 a.m. to 6:30 p.m ET both days. Topics include accelerating the uptake of evidence; implementing science in a variety of settings, including inpatient rehabilitation, acute care, pediatric physical therapy, and community-based programs; and making effective use of CPGs for low back pain and adhesive capsulitis. The event will also include a panel discussion on writing successful science proposals, accompanied by a discussion of funding opportunities.

    Although the event is free, spaces are limited — and last year’s in-person event was highly attended — so visit CoHSTAR's Implementation Science Institute webpage soon to learn more and register.

    CoHSTAR was established with a Foundation for Physical Therapy Research grant of $2.5 million. APTA was a major financial contributor to the development of CoHSTAR, having donated $1 million toward the center's startup in 2015. Additional contributions came from APTA components, individuals, foundations, and corporate supporters.

    CMS Suspends Advanced Payment Program, Will 'Reevaluate' Accelerated Payment

    The programs were expanded in late March to provide emergency loans in response to the COVID-19 pandemic. Now they'll take a backset to the CARES Act Provider Relief Fund grants program.

    Citing the availability of new relief money, the U.S. Centers for Medicare and Medicaid Services has suspended its advance payment program for Medicare part B providers, and says it's reevaluating its accelerated payment program for Part A providers.

    Unlike the money now being disbursed through a $175 billion CARES Act Provider Relief Fund, the programs being curtailed by CMS require recipients to pay back the funds received.

    In an April 26 press release, CMS announced it has suspended its Advance Payment Program to Part B providers and will no longer be accepting applications. At the same time, the agency is reevaluating all pending and new applications in the Accelerated Payment Program used mostly by Medicare Part A providers. Since March 28, the combined programs delivered $100 billion in payments. In addition to its press release, CMS published an updated fact sheet on the Accelerated and Advanced Payment Programs.

    According to CMS, the change in course is largely due to the infusion of $175 billion in relief funds to HHS, which is disbursing $50 billion to providers in the form of direct deposits that, unlike the AAP funds, don't need to be paid back. Beginning April 10, HHS released $30 billion to providers based on 2019 Medicare billing, with a follow-up release of $20 billion aimed at providers who didn't qualify for the first round of funds. Last week, an additional $75 billion was added to the provider relief fund by way of a new COVID-19 relief package signed into law. HHS has not announced how those funds will be used.

    APTA continues to track the status of additional relief funds and will share information as it becomes available.

    About the Relief Funds
    Unlike the $30 billion in funds based on Medicare billing, the $20 billion in relief released beginning April 24 requires certain cost report data to be on file in order to qualify. You may be able to do that retroactively through this CMS general distribution portal, and find out more through this FAQ page. Also remember that for both the $30 billion and $20 billion programs, you'll need to sign an attestation confirming receipt of the funds and acknowledging the program's terms and conditions.

    Education Leadership Partnership Student Debt Task Force Report Released

    Consistency, transparency, and financial literacy: Those are fundamentals of a new report that will help inform an upcoming APTA examination of the state of student debt.

    A new report from the Student Debt Task Force of the Education Leadership Partnership examines issues influencing physical therapy student debt, including ratio of debt to income, financial aid, cost of education, reimbursement for clinical services, curricular issues, and the impact of student debt on physical therapy programs.

    The partners — comprising representatives from APTA, the American Council of Academic Physical Therapy, and the Academy of Physical Therapy Education — recently released the task force’s Final Recommendations Report, which includes five recommendations:

    1. That APTA, ACAPT, and APTE promote the use of fact sheets that provide financial information on DPT and PTA programs in a consistent manner so that student and prospective students can more easily compare costs between schools.
    2. That academic programs provide access to current and prospective students to the financial literacy information available from the APTA Financial Solutions Center.
    3. That ACAPT, APTA, and APTE provide access to the report’s FAQ — which addresses loans, financial aid, cost comparison, managing debt, and financial aspects of a program’s clinical experience — to prospective and current students and encourage their members to do so.
    4. That the ELP partners’ liaisons to CAPTE discuss potential inclusion in the Annual Accreditation Report, known as the AAR, of the financial disclosure information.
    5. That the partners’ liaisons ask CAPTE to require that information from the DPT and PTA financial fact sheets be posted on an academic program’s website.

    APTA is developing a report on the state of physical therapy student debt, scheduled for release in June, in support of the association’s 2019-2021 Strategic Plan goal to foster long-term sustainability of the physical therapy profession in part by championing student and early-career issues including debt burden and career-earning potential. It’s expected that findings from this Student Debt Task Force Final Recommendations Report will inform APTA’s upcoming report.

    More Provider Money Is Coming From HHS. Can PTs Qualify?

    The latest round of COVID-19 relief funds is intended to help providers who don't bill large amounts to Medicare, but qualifications are built on data that PTs typically don't provide to HHS. There may be a workaround.

    The U.S. Department of Health and Human Services is distributing an additional $20 billion in health care provider relief funds, but the way HHS is determining distribution might make getting that money more complicated for many PTs — if PTs qualify in the first place.

    HHS announced that beginning April 24, some providers will automatically be sent payment as part of a $100 billion provider relief effort that set aside $50 billion for "general allocation" to providers. Release of that $50 billion began with a $30 billion tranche on April 10.

    While the initial $30 billion was based on Medicare fee-for-service reimbursement in 2019, the remaining $20 billion will be distributed according to 2018 net patient revenue based on cost reports submitted to CMS. Medicare-certified institutional providers are required to submit those reports annually.

    The problem for some clinicians, including PTs, is that they don't submit cost report data to CMS — but they still may qualify for relief, according to HHS.

    On its CARES Act Provider Relief Fund Webpage, the department seems to indicate that providers who didn't submit cost reports to CMS can use "a portal" that will be accessible through the relief fund webpage that would allow them to provide revenue information to possibly qualify for the money. As of the date of this report, that portal had not been established.

    In all cases providers who receive money also will be required to sign an attestation confirming that they've received the funds and agree to the terms and conditions.

    According to Kara Gainer, APTA director of regulatory affairs, the idea behind this cash infusion was to reach providers that didn't qualify for the first round of relief, such as pediatric health care facilities and clinicians who may have more Medicaid and Medicare Advantage patients. But, she adds, just as with the initial $30 billion relief package, the details of how the $20 billion will be disbursed — and who will receive it — aren't all in place.

    "Obviously the issue for PTs is how they might qualify for these funds since they don't submit a cost report to CMS," Gainer said. "Physicians are generally in the same position as PTs in this regard, so we're trying to get more details from HHS about whether they qualify for the funds and, if so, how they might receive the relief."

    Information will be shared through PT in Motion News and on the APTA website as it's made available. Providers also should continue to check the HHS CARES Act Provider Relief webpage for the opening of the portal.

    With $50 billion of the $100 billion package allotted to the general allocations, that leaves another $50 billion. According to HHS, $10 billion of that will be used for a targeted distribution to hospitals in areas that have been particularly impacted by the COVID-19 outbreak, $10 billion will go to rural hospitals and rural health clinics based on their operating expenses, and $400 million is being directed to Indian Health Service facilities. Some part of the remaining funds is being used to cover the costs of caring for uninsured patients with COVID-19, and an unspecified portion will be used for clinicians.

    HHS has not yet created a plan for disbursement of an additional $75 billion it received as part of a "phase 3.5" COVID-19 relief package signed into law on April 24.

    CARES Act Provider Relief: Sorting Out the Details

    HHS continues to shed light on how providers can know if they're receiving money as it eases concerns about who qualifies.

    The $30 billion in COVID-19 funds being sent directly to health care providers has sparked questions among providers about whether they qualify for the funds, how they'll receive them, and what kinds of restrictions might apply.

    Fortunately, there are answers out there. In addition to its initial story on release of the funds, PT in Motion News published a subsequent piece on how to find out if you're receiving any of the money. Here's more of what we know about the program.

    You don't have to be "currently taking patients" as long as you were still seeing patients after January 31 — and HHS is taking a broad view of patients with "possible" COVID-19.
    The basic requirement for the funds, according to HHS, is that you billed Medicare in 2019 and provided "diagnoses, testing, or care for individuals with possible or actual cases of COVID-19." As far as HHS is concerned, that includes everyone you treated: "HHS broadly views every patient as a possible case of COVID-19," HHS states.

    You can still qualify for the money if you stopped operations due to the pandemic.
    Again, from HHS: "If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19."

    Payment is tied to your Taxpayer Identification Number.
    Whether you're looking for funds for a large health system or as a solo practitioner, the relief payments are made to the billing organization according to its Taxpayer Identification Number, either via direct deposit or paper check. Here's how HHS breaks it down on its provider relief fund webpage:

    • Large Organizations and Health Systems. Large organizations will receive relief payments for each of their billing TINs that bill Medicare. Each organization should look to the part of their organization that bills Medicare to identify details on Medicare payments for 2019 or to identify the accounts where they should expect relief payments.
    • Employed Physicians. Employed physicians should not expect to receive an individual payment directly. The employer organization will receive the relief payment as the billing organization.
    • Physicians in a Group Practice. Individual physicians and providers in a group practice are unlikely to receive individual payments directly, because, as the billing organization, the group practice will receive the relief fund payment. Providers should look to the part of their organization that bills Medicare to identify details on Medicare payments for 2019 or to identify the accounts where they should expect relief payments.
    • Solo Practitioners. Solo practitioners who bill Medicare will receive a payment under the TIN used to bill Medicare.

    You have to be in good standing with Medicare and other federal health programs.
    Not surprisingly, providers can receive the money only if they aren't currently terminated from Medicare; aren’t excluded from participation in Medicare, Medicaid, or other federal health programs; or haven’t had their Medicare billing privileges revoked.

    You have to attest to receiving the funds — and agree to the terms and conditions — within 30 days of receiving the payment.
    Providers who received payment are required to attest that they've received the funds and agree to the program's terms and conditions within 30 days of receipt. You can do that by visiting the CARES Act Provider Relief Fund Payment Attestation Portal.

    Documentation will be important.
    Recipients of payment will be required to submit reports to HHS as needed to ensure compliance with the terms and conditions. HHS hasn't yet shared instructions about the form and content of the reports.

    Not sure if you're receiving funds? Call 866-569-3522.
    UnitedHealth Group is handling the stimulus payments for HHS — call their provider relations department to find out the status of a payment or whether you qualify. If you haven't set up direct deposit through CMS or UHG, you'll receive a paper check within the next week or two. Although CMS is not administering the program, if you are a Medicare provider and have questions that UHG can't answer, email COVID-19@cms.hhs.gov.

    Additional money may be coming to other types of providers.
    The administration is working on targeted distributions focused on providers in areas particularly impacted by the COVID-19 outbreak, including rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, and providers requesting reimbursement for the treatment of uninsured Americans. APTA sent a letter to HHS several weeks ago urging HHS to provide immediate assistance to physical therapy specialists, including pediatric physical therapy providers, that are dependent on Medicaid and have few or no patients with Medicare.

    APTA can't provide legal advice or answer questions about individual cases.
    Please note that APTA cannot provide legal advice, meaning that we are unable to provide clarification beyond what HHS has provided thus far. If you have questions beyond what has been provided, please consider consulting with a local attorney.

    APTA Advisory: TRICARE Manual Updated to Recognize PTAs as Authorized Providers

    Don't forget to use the CQ modifier if more than 10% of a service is furnished by a PTA.

    TRICARE, the health insurance system used throughout the military, announced that it has officially revised its policy manual to recognize PTAs (and occupational therapy assistants) as authorized providers, outlining the rules and requirements governing assistant qualifications, scope of practice, supervision, and reimbursement.

    Now it's up to TRICARE contractors to do the same within approximately 30 days.

    As reported earlier, beginning with date of service on April 16, PTAs are recognized as authorized providers under TRICARE and thus eligible for reimbursement for covered services rendered to TRICARE beneficiaries.

    Take note: The CQ modifier must be appended to the claim when more than 10% of an outpatient physical therapy service is furnished by the PTA. Check out APTA’s Quick Guide to Using the PTA Modifier.

    The presence of the modifier shouldn't impact claims processing. However, if claims are denied, they may need to be resubmitted if the claims are sent to contractors before they fully implement the change.

    New COVID Relief Package Adds $75 Billion to Funding for Health Care Providers

    The $484.4 billion package will shore up the Paycheck Protection Program and make another $75 billion available for provider relief through HHS.

    The COVID-19-related grant funds intended for distribution to health care providers will likely receive another $75 billion as part of a $484 billion "phase 3.5" coronavirus relief bill approved by the U.S. Senate. The legislation is expected to be approved by the U.S. House of Representatives as early as April 23.

    Known as the Paycheck Protection and Health Care Enhancement Act, the $484 billion relief measure focuses mainly on replenishing the U.S. Small Business Administration's Paycheck Protection Program, the loan program that saw its previously allotted $384 billion quickly depleted. This time around, the program will receive $310 billion.

    The U.S. Department of Health and Human Services will also get an infusion of cash to be used for provider grant programs. The CARES Act enacted in late March carved out $100 billion for health care provider assistance; the latest package adds another $75 billion. The additional funds are intended to be used to support "eligible health care providers" that include public entities, Medicare or Medicaid-enrolled providers (including PTs), and nonprofit entities that diagnose, test, or care for individuals with possible or actual cases of COVID-19.

    To date, HHS has designated about $30 billion for deposit directly into providers' bank accounts or via paper checks. More information on that program is available in this PT in Motion News story published when funds were released, along with two follow-up reports — one on how providers can verity if they're to receive the money, and another that addresses more details of the program.

    With additional funding now provided to these programs, Congress can now focus on the next COVID relief package, known as COVID Phase 4, which could be considered as early as May, according the Justin Elliott, APTA's vice president of government affairs.

    "Congress was facing a crisis-within-a-crisis in trying to quickly shore up the Paycheck Protection Program," Elliott said. "This interim coronavirus aid bill is not the last one we'll see, and we are continuing our efforts to include our policy recommendations in the COVID Phase 4 relief package."

    Those recommendations from APTA are spelled out in a letter to both chambers of Congress that outlines seven steps lawmakers should take to ensure patient safety and protect health care providers.

    APTA also continues to urge members and stakeholders to join the association in a grassroots effort to press lawmakers for changes — some temporary, others lasting — that will protect patients and support providers both during the emergency and in years to come. Among the changes recommended: a permanent recognition of PTs and PTAs as approved telehealth providers under Medicare, a suspension of requirements that CMS believes forces it to make significant payment cuts to more than three dozen health professions, and more support for health care providers with small businesses.

    Other funding in the package includes $50 billion for Economic Disaster Loans, $10 billion for Economic Disaster Loans advance grants, and $25 billion for COVID-10 testing, $11 billion of which will go directly to states.

    Coronavirus Update: April 21, 2020

    Outpatient resources, COVID-19 risk ratings by profession, tracking down providers relief funds, and more.

    Practice Guidance

    April 20: APTA Recommended Resources on Physical Therapy and COVID-19 in the Outpatient Setting
    Information around physical therapy and COVID-19 continues to evolve. Here's a recap of resources APTA has developed to help outpatient practices.

    In the Media

    April 20: These Occupations Have the Highest COVID-19 Risk (PTs and PTAs in Top 20)
    The World Economic Forum has created an infographic and listing of the professions most at risk for contracting COVID-19. PTAs are in the 17th position, with PTs at 18 and OTs at 19.

    April 19: Looking at a Second Wave of Coronavirus
    From USA Today: "Even before the first horrific phase of the COVID-19 pandemic has run its course, scientists are worried about the second wave of the disease. It could crash worse than the first, killing tens of thousands of people who did such a good job of sheltering in place they remain virgin ground for the virus. Or it could be a mere swell, with so many people having been infected without symptoms that levels of immunity are higher than realized."

    April 19: COVID-19 Is Normalizing Telehealth, and That’s a Good Thing
    Opinion piece from FastCompany: "Habits that we form now will grow into preferences and default behaviors, and patients won’t want to return to a pre-COVID-19, less-convenient form of in-person healthcare."

    COVID-19 Relief Funds

    April 17: How to Find Out if You're Getting CARES Act Provider Relief
    The $30 billion emergency fund created under the most recent COVID-19 relief package began being distributed to health care providers on April 10, but not all eligible providers have received funds yet. Those who do receive money need to agree to the program's terms and conditions. Here's what you need to know.

    From CMS

    April 19: CMS Requires Nursing Homes to Report on COVID-19 Cases
    CMS has issued new regulatory requirements that SNFs inform residents, their families, and representatives of COVID-19 cases in their facilities, as well as report cases to the U.S. Centers for Disease Control and Prevention. Nursing homes are also required to cooperate with CDC surveillance efforts related to COVID-19.

    April 19: CMS Issues Recommendations to Re-Open Some Health Care Systems
    New guidance from CMS targets communicates that are in "Phase 1" of President Donald Trump's "Opening Up America Again" plan, with "low and stable incidence of COVID-19 cases." The new recommendations call for the limited return of nonessential surgeries and medical procedures, coordinated with local and state public health officials.

    From the Department of Labor

    April 16: OSHA Will Ease Enforcement Efforts
    Acknowledging that "some employers may face difficulties" complying with OSHA standards during the coronavirus health emergency, the agency announced that OSHA inspectors will evaluate whether employers made "good faith efforts" to comply and, when compliance wasn't possible, that "employees were not exposed to hazards from tasks, processes, or equipment for which they were not prepared or trained."

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

    APTA Provides COVID-19 Outpatient Practice Resources

    Information around physical therapy and COVID-19 continues to evolve. Here's a recap of resources APTA has developed to help outpatient practices.

    While APTA points PTs, PTAs, and physical therapy students to the latest CDC guidance related to the COVID-19 pandemic, the association continues to track and respond to the needs of providers in various circumstances, including in outpatient settings. Here are recommended resources to date.

    APTA Guidance

    FAQ: Physical Therapist Management of Patients With Diagnosed or Suspected COVID-19
    "How do I decide whether or not — and how — to treat patients during the coronavirus pandemic? How can I keep my patients and employees safe? What information should I consider when determining whether in-person physical therapist services are appropriate for my patients?" These questions are top of mind for outpatient PTs and PTAs. The guidance in this FAQ includes information for outpatient clinics, keeping in mind that each practice, patient, and community are unique.

    Based on federal guidelines, the resource addresses some of the most common concerns of PTs and PTAs in outpatient settings, including:

    • When should I tell patients not to come in for their outpatient PT visit because of heightened risk for COVID-19 infection?
    • How do I make decisions about providing services in my outpatient facility?
    • How can I prepare my physical space and operations to reduce risk of infection?
    • Do I need to use personal protective equipment when treating patients?
    • Are there ways to encourage patients to stay active while they're at home?
    • What do I do about patients who are high risk and should not come to in-person visits?

    The FAQ also includes a summary of CMS guidance for outpatient services, including staff monitoring and return-to-work decisions, facility closings, health and safety requirements, and PPE considerations.

    APTA Telehealth Resources, Courses, and Webinars
    COVID-19 is changing the landscape of telehealth and other communication technology-based services. Explore this page for guidance on use of remote communication technologies for physical therapist services; updates on state and federal payment; advocacy opportunities; and free and members-only courses and webinars to help bring you up to speed.

    Official APTA Statements

    Letter From APTA President Sharon Dunn on the Impact of COVID-19
    In a March 20 letter to members, APTA President Sharon Dunn, PT, PhD, wrote about this "challenging time to be in health care," commending the "heroic" actions of PTs who continue care for those who urgently need it and those who close their doors to decrease the risk of spreading infection.

    APTA Statement on Patient Care and Practice Management During the COVID-19 Outbreak
    On March 17, APTA's Board of Directors released a statement encouraging PTs, PTAs, and students to "flatten the curve of the COVID-19 outbreak by following CDC guidance to minimize exposure in the clinic and practice social distancing by avoiding large social gatherings. At the same time, we know that our profession plays a crucial role in the health of our society, and there are people in our communities whose health will be significantly impacted by disruptions to care.

    "Patient care has always been specific to the individual, with the physical therapist assessing a person's needs relative to their goals. Thus, physical therapists have a responsibility to review CDC guidance, to understand who is at highest risk and how to best reduce exposure, and to use their professional judgment in the best interests of their patients and clients and their local communities — including rescheduling nonurgent care if that is the best approach, or making other adjustments when the risk of exposure to COVID-19 outweighs the benefits of immediate treatment."

    APTA's Position Statement on Communicable and/or Infectious Diseases and Conditions: Rights of Patients and Providers in Physical Therapy
    In 2019, APTA's House of Delegates passed HOD P06‐19‐74‐40, which addresses physical therapy providers' responsibilities and ethical obligations when providing care to individuals with communicable disease, or when they themselves have or are at risk for infection. According to the statement, "Physical therapy providers shall deliver quality, nonjudgmental services in accordance with their knowledge and expertise to all persons who need it, regardless of the nature of the health problem. When providing services to individuals with infectious disease, physical therapy providers shall follow guidance provided by authoritative bodies such as the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA)." This guidance is applicable to all practice settings.

    Insight From APTA Colleagues

    Facebook Live Recording: Adapting Your Outpatient Practice During the COVID-19 Crisis
    Recorded from an APTA Facebook Live Event, physical therapists Patrick Cayen PT, MBA, Josh D'Angelo, PT, DPT, and Kimberly Richards, PT, DPT, describe the changes they have made to their outpatient practices and answer questions from viewers.

    PT in Motion: "Defining Moment: Vulnerability and Courage"
    In an advance-access column from the upcoming May issue of PT in Motion, read a personal account of a Washington state outpatient physical therapist who made the hard decision to keep her clinic open during the COVID-19 pandemic.

    #PTTransforms Blog: "Flexibility in the Face of COVID-19: Lessons From a Rural Washington Critical-Access Hospital"
    In this blog post, another Washington physical therapist describes a different experience, as her facility-based outpatient clinic closed to protect patients – and its staff retrained to assist in other areas of the hospital.

    #PTTransforms Blog: "The Heart of the Storm: I'm a PT in Manhattan. Here's What it's Been Like"
    A New York City physical therapist explains how her employer reacted to the COVID-19 crisis, as patient care became more dangerous and caseloads dwindled, urging readers to "think outside the box."

    An APTA HUB Thread for Members to Share Outpatient Experiences
    APTA has created a thread on the Council on Health Prevention and Wellness forum and the Council of Health Systems Physical Therapy for members to share insights and experiences. The thread includes a post from Advocate Aurora Health on how they approach patient care for outpatient rehabilitation. Please keep in mind that individual clinics will vary in how they respond to COVID-19 based on their patient populations and available resources. If you have another great example of how you are making clinical decisions about your outpatient practice, email practice-dept@apta.org so we can share your story, or go to this dedicated online community to participate in the discussion with other HUB community members.

    Win: CMS Backs off Changes That Got in the Way of Common Code Pairings

    Advocacy efforts by APTA and its members helped CMS and its coding contractor reverse earlier changes that complicated (and sometimes thwarted) a PT's ability to provide efficient, effective care.

    Life just got a little easier for PTs dealing with CMS National Correct Coding Initiative edits, known as NCCI edits, that prevented reimbursement for certain activity and evaluation codes when used on the same day unless a modifier was appended to the claim. In response to APTA's efforts to show how the coding changes were impacting care and complicating payment, CMS has backed off on many of the edits that were making reimbursement problematic, likely in large part due to the burden being imposed on providers by the COVID-19 public health emergency.

    The NCCI edits required the use of the 59 modifier or applicable X modifier to make a claim for reimbursement for many code pairings. APTA worked to have the edits eliminated, according to Alice Bell, PT, DPT, APTA senior payment specialist, advocating both with CMS and Capitol Bridge, CMS' NCCI coding contractors.

    However, CMS recently made changes to remove restrictions on many of the most common code pairings used in PT and PTA treatment sessions.

    The work paid off, and Bell says it's a big win for the profession.

    "These coding edits were not just problematic but actually ran counter to best practice in physical therapy," Bell said. "We're grateful to CMS and Capitol Bridge for listening to our suggestions and their willingness to consider systems that best serve patient needs."

    What Happened
    Prior to the latest change, reimbursement would be denied if, for example, code 97530 (therapeutic activities) was paired with 97116 (therapeutic procedure) without use of the 59 or applicable X modifier. The same was true for pairing 97161-97163 (physical therapy evaluations) with 97140 (manual therapy) and several other common pairings (see a complete list of edits at the bottom of this story).

    Those code pairings have been eliminated. Now PTs working in private practice and institutional settings can pair many codes without adding the 59 or applicable X modifier. Additionally, NCCI edits were lifted that prevented certain emergency department codes to be paired with physical therapy and occupational therapy evaluation and reevaluation codes. These changes are retroactive to January 1, 2020.

    The Coding Changes
    In private practice and institutional settings, PTs are now able to pair the following code combinations without the use of 59 or X modifiers:

    97530 with 97116
    97161 with 97140
    97162 with 97140
    97163 with 97140
    99281-99285 with 97161-97168
    97110 with 97164
    97112 with 97164
    97113 with 97164
    97116 with 97164
    97140 with 97164
    97150 with 97110
    97150 with 97112
    97150 with 97116
    97150 with 97164

    There are additional edit changes as well, and APTA’s National Correct Coding Initiative webpage includes a table of the common edits that remain. Check back regularly as some of these edit changes may be temporary and could be reversed after the COVID-9 public health emergency ends.

    Which Payers These NCCI Edit Changes Apply to
    Medicare and Medicaid programs follow CMS’ NCCI procedure-to-procedure edits. Additionally, most insurers also follow the NCCI PTP edits. As such, APTA recognizes that providers may receive denials on the commercial side related to these edits if they fail to use the applicable 59 or X modifier. Commercial payers may not realize the files have been updated. APTA encourages providers to use the information in this article and found on the CMS PTP Coding Edits webpage to communicate with commercial payers regarding these edit changes.

    Are You Getting CARES Act Provider Relief? How to Find Out (and What You'll Need to Do After You Receive It)

    Want to know if you'll be receiving a provider relief payment? Wondering what's expected of you once you do? These resources can help.

    The $30 billion emergency fund created under the most recent COVID-19 relief package began being distributed to health care providers on April 10, but not all eligible providers have received funds yet. Those who do receive money need to agree to the program's terms and conditions.

    Here's what you need to know.

    If you're wondering whether you'll receive a payment based on your 2019 Medicare fee-for-service reimbursements total: HHS partnered with UnitedHealth Group to deliver the stimulus payments. If you haven’t yet received a payment or need to find out if you're eligible, call UHG's provider relations department at 866-569-3522.

    Tip: If you haven't set up direct deposit through CMS or UHG's Optum Pay and you qualify for funds, you'll receive a paper check at a later date. You can set up direct deposit by calling the UHG number listed above.

    If you received a stimulus payment (or know that a payment's coming to you) and wonder what happens next: Providers who received payment are required to attest that they've received the funds and agree to the program's terms and conditions within 30 days of receiving the funds. You can do that by visiting the CARES Act Provider Relief Fund Payment Attestation Portal.

    [Editor's note: you can find more details on the program in this April 22 PT in Motion News story.]

    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.

    Proposed IRF Rule Keeps It Simple: 2.9% Increase, Reduced Administrative Burdens

    Acknowledging that the COVID-19 pandemic should be the focus of attention, CMS released a proposed rule that makes no changes to quality reporting.

    In this review: Medicare Program: Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2021 (proposed rule)
    Effective date: October 1, 2020
    CMS fact sheet

    The big picture: A 2.9% increase and continued efforts to lessen administrative burden.
    In light of rapid changes being made to Medicare in response to the COVID-19 pandemic, the U.S. Centers for Medicare & Medicaid Services issued a pared-down proposed rule for inpatient rehabilitation facilities that sticks to the basics — including a 2.9% payment increase and the elimination of physician evaluations within the first 24 hours of patient admission. The 2.9% increase represents an estimated increase of about $270 million in payments to IRFs.

    In a fact sheet on the proposed rule, CMS writes that it's meeting a statutory obligation to update Medicare payment policies annually, but the COVID-19 pandemic demands widespread attention and "CMS has limited annual IRF rulemaking required by statute to essential policies."

    The final rule would go into effect on October 1, 2020. APTA will provide comments on the proposed rule before the June 15, 2020, deadline.

    Also notable in the proposed rule:

    • No changes to quality reporting. For the first time in years, CMS will leave IRF quality reporting measures untouched from what was set in place in the previous year.
    • Changes to the geographic wage index, and a limit on decreases. The proposed rule adopts geographic delineations proposed by the Office of Management and Budget to determine whether a provider is considered a rural or urban facility — a key element in determining the IRF wage index. CMS hopes to accompany that change with a 5% limit in FY 2021 in any decrease in a facility's wage index compared with its wage index for the prior fiscal year to help providers adapt to the revised OMB delineations.
    • Non-physician providers allowed to perform coverage service and documentation. CMS is proposing that non-physician practitioners — typically defined by the agency as physician assistants, nurse practitioners, and clinical nurse specialists — be permitted to perform duties currently reserved for physicians, as long as those duties are within the practitioner's scope of practice established in state law.
    • Flexibility around physician evaluations. Although the proposed rule would lift the requirement for a physician evaluation within the first 24 hours of admission, IRFs would still have the ability to conduct a visit in that timeframe if conditions warrant.
    • Another call for comments on reducing administrative burden. CMS accompanies almost every proposed rule with an invitation for comment on changes that could be made to reduce unnecessary paperwork and other administrative burdens — an invitation that APTA takes up at every opportunity.

    APTA Advisory: Check With Your TRICARE Contractor About PTA Services and Billing

    A change in TRICARE coverage long advocated by APTA officially launches on April 16 — but that doesn't mean claims will be accepted right away.

    Technically, it's true: beginning with date of service on April 16, physical therapist assistants and occupational therapy assistants will be included as authorized providers under TRICARE, the health insurance system used throughout the military — and thus eligible for reimbursement for covered services rendered to TRICARE beneficiaries. The TRICARE website even says as much.

    But according to Kara Gainer, APTA's director of regulatory affairs, before you begin submitting claims for covered services provided by PTAs to TRICARE beneficiaries, you may want to first check with your TRICARE contractor.

    "We're telling providers that, yes, the change has occurred and that PTAs are eligible for reimbursement for services rendered beginning on April 16, 2020. However, contractors may not yet have made the necessary systems changes," Gainer said. "It's important that providers find out whether their contractors are ready to process the claims and if any new coding requirements are being applied to this change."

    How long of a wait may be in store? In a member alert, the National Association for the Support of Long Term Care quotes the U.S. Defense Health Agency as saying that while PTAs and OTAs are eligible for full reimbursement, "full implementation will occur approximately 30-90 days after the effective date."

    Until the policy language is published in the TRICARE manual and adopted by the contractors, PTs and PTAs should plan to follow Medicare’s rules for supervision and reimbursement, which the Department of Defense outlined in the final rule, according to Gainer. Providers who send in claims for dates of service beginning on or after April 16 and receive a denial can resubmit, she advises, but simply checking with the contractor beforehand could reduce later hassles.

    In Gainer's opinion, the delayed implementation, while frustrating to some, is worth the wait.

    "This is a major step forward for TRICARE and the focus of significant APTA advocacy efforts," Gainer said. "Once the contractors’ systems catch up with the shift, we look forward to increased patient access to effective care through the services of PTAs."

    APTA Members Can Get Discounts on BlueJay Telehealth Solutions Amid COVID-19

    APTA members can take advantage of a special offer through July 15, 2020.

    If you’re a physical therapist looking to pivot to telehealth, your first question must be “Can I do it?” If the answer is yes, you might then ask yourself, “How do I do it?”

    That last question is now easier — and cheaper — for APTA members to answer thanks to special discounts for BlueJay telehealth solutions.

    APTA members can receive a three-month 70% discount on BlueJay Telehealth, which includes HIPAA-compliant telehealth video calls, call scheduling and reminder services, AI-powered range of motion assessment, SOAP notes, call records, and secured data storage.

    APTA members can also take advantage of a free three-month trial for BlueJay Engage, which includes patient engagement tools such as 2,000 home exercise videos and programs, secured messaging, compliance and outcomes tracking, and care team communications.

    After the three-month trial period, APTA members will receive a 10% discount on all BlueJay products and services.

    To take advantage of these deals, APTA members can visit this page for an exclusive promo code.

    “As COVID-19 disrupts traditional care models, we’re looking for solutions to support our profession’s ability to deliver care in a way that’s safe for patients and providers,” said APTA CEO Justin Moore, PT, DPT. “Telehealth is an area of great need and opportunity, and I’m grateful to BlueJay for providing this offer to assist our members in a challenging time.”

    Before charging into telehealth, physical therapists must be cautious. Insurance giants such as Cigna, Aetna, and UnitedHealthcare have each announced temporary benefit changes allowing PTs to bill for most therapy codes delivered by way of telehealth. And while Medicare does now pay for some forms of remote physical therapist services, real-time, face-to-face telehealth services furnished by PTs or PTAs still are not covered.

    It’s crucial to know what is permitted by your state agency or payer, but that isn’t enough. You need to ask specific questions to understand what you can and can't do.

    APTA has expansive resources on telehealth to help you navigate this rapidly changing landscape.

    Foundation Opens Application Call for Four Major Research Grants

    In light of market instability during the COVID-19 pandemic, some grant offerings will be postponed — but four are open for application.

    The Foundation for Physical Therapy Research has adjusted its grants program in light of the COVID-19 pandemic by postponing some of its offerings. But four major grants are moving ahead, and applications are now open. The grants now open for application are part of $800,000 in funding that will be awarded in 2020 through the Foundation. Deadline for applications is August 5, but one of the grants requires a letter of intent to be received by June 1.

    The grants now accepting applications are:

    Acute Care Research Grant. This $40,000 grant made possible by the Academy of Acute Physical Therapy is awarded to an emerging investigator seeking to advance the practice of acute care physical therapy.

    Magistro Family Foundation Research Grant. This $100,000 grant is for research "to evaluate the effectiveness of interventions most commonly delivered by physical therapists" and for the development and evaluation of innovative physical therapist interventions. The grant is funded by the Magistro Family Foundation Endowment Fund established by Charles and Noel Magistro. Note: applicants must provide a letter of intent by June 1, 2020.

    Moffat Geriatric Research Grant. One $70,000 grant, supported through the Marilyn Moffat Fund for Geriatric Research and a gift from Fox Rehabilitation, will be awarded for research on the practice and impact of front-loading and treatment intensity of physical therapy home visits for geriatric patients.

    Physical Therapy Education Research Grant. Supported by the Academy of Physical Therapy Education, this $40,000 grant will be awarded for education research related to methods for promoting the uptake of research findings into education, specifically around education interventions that address the gap between evidence and practice.

    There are no disruptions anticipated in the Foundation’s peer-review and award cycle for 2020. The organization will also work with currently funded researchers whose work has been delayed or disrupted by COVID-19 to adjust funding timelines. More information on the Foundation's grants and scholarship operations during the coronavirus crisis can be found on this Foundation webpage.

    The Good Stuff: Members and the Profession in the Media, April 2020

    APTA members are transforming society every day — and the media is paying attention. In this installment, we focus on coronavirus-related media coverage of members discussing everything from telehealth to home-based prehabilitation during a pandemic.

    Members Providing Telehealth

    Andy Miner, PT, DPT, believes the physical therapy profession's adaptability is making itself known in telehealth. (KOLN-TV, Lincoln, Nebraska)

    Sara Reardon, PT, DPT, is providing telehealth services that include pelvic floor physical therapy. (Today)

    Nicole Santoriello, PT, DPT, discusses the possibilities for physical therapy delivered via telehealth. (DuBois, Pennsylvania, Tri-County Courier Express)

    Ernest Ledesma, PT, offers his take on how his clinic provides valued telehealth services. (WTOC11, Savannah, Georgia)

    Members on Payment During the Pandemic

    Steve Alaniz, PT, explains why CMS needs to act quickly to allow PTs to provide face-to-face telehealth services. (KSAT.com, San Antonio, Texas)

    Alice Bell, PT, DPT, and Karen Litzy, PT, DPT, share insights on how the pandemic is affecting the payment environment. (MedPage Today)

    Members on Practice During the Pandemic

    Eric Dekle, PT, explains why some patients who are older are continuing in-person physical therapy visits. (WKRG News5, Mobile, Alabama)

    Jason Falvey, PT, DPT, PhD, recommends considering the value of prehabilitation in home health, even during the COVID-19 pandemic. (Home Healthcare News)

    Rebekah Doyle, PT, is among the school-based therapists working to find ways to provide services during school shutdowns. (tucson.com)

    Michele Wiley, PT, DPT, discusses the possibilities for telehealth in providing school-based therapy services.(Education Week)

    Members on Staying Healthy at Home

    Eric Robertson, PT, DPT, offers suggestions on how to make work-from-home spaces more ergonomic. (CNBC)

    Dennis Prickett, PT, offers five ways to exercise while still social distancing. (Las Cruces, New Mexico, Sun-News)

    Josh D'Angelo, PT, DPT, stresses the importance of movement and how it can be easily overlooked during pandemic isolation. (localdvm.com)

    Rachel Miller, PT, DPT, shares her thoughts on managing running injuries during the pandemic. (Runner's World)

    Got some good stuff? Let us know. Send a link to troyelliott@apta.org.

    Coronavirus Update: April 14, 2020

    Home health guidance, relief funds for providers and students, CDC recommendations on essential workers who may have been exposed, and more.

    Practice Guidance

    April 14: HPSO Provides Risk Management Considerations for Home Health Physical Therapy
    APTA's official provider of professional liability insurance for members has created a resource that emphasizes the importance of CDC guidance and PT professional judgment, but dives deeper into considerations that need to be weighed when considering home health physical therapy — particularly during the COVID-19 health emergency.

    April 13: PTJ Publishes Insights From Italian PTs on COVID-19
    In two related articles, physical therapists on the frontlines of Italy's battle with COVID-19 discuss physical therapy with infected patients in the hospital, and how PTs can help with recovery from post-intensive care syndrome.

    April 10: Resources for Staying Up-to-Speed on Telehealth, Licensure, Other State-Level Changes
    APTA offers four key ways to ensure that you're on top of state decisions that could impact your practice during the pandemic.

    April 9: CMS Opens the Possibility of Providing Care to a Patient in the Same Building, But Not in the Same Room
    During a national stakeholder call on April 8, CMS opened up the possibility that it would allow a clinician to provide services remotely to a patient in the same building, but not in the same room, and bill the encounter as an in-person visit. A follow-up question submitted by APTA via email seems to indicate that CMS thinks the allowance applies to PTs.

    COVID-19 Relief Funds

    April 14: Relief Act Opens up Possibility for Grants to College, University Students
    The $2 trillion in relief included in the CARES Act stimulus signed into law in late March included $31 billion in aid for education. Part of that money is being made available to postsecondary education to pass along to students by way of direct grants.

    April 10: HHS Deposits Money Into Some Providers' Bank Accounts
    A $30 billion emergency relief package began rolling out on April 10, making direct deposits into provider and facility accounts based on 2019 Medicare billing.

    From CDC

    April 9: CDC Issues Recommendations on Workers Who May Have Been Exposed to COVID-19
    In a recently released interim guidance document, CDC says that while critical infrastructure workers may be allowed to work after potential exposure to COVID-19 — provided they don't develop symptoms — it's important for the workers and their providers to take precautions.

    From the Department of Labor

    DOL Announces Interim Enforcement Response Plan to Protect Workers During Pandemic
    According to DOL, the new plan "outlines procedures for addressing reports of workplace hazards related to the coronavirus," with fatalities and imminent danger exposures related to the coronavirus prioritized. A DOL press release states that "Workers requesting inspections, complaining of coronavirus exposure, or reporting illnesses may be protected under one or more whistleblower statutes."

    In the Media

    April 10: NIH Seeks Participants for Study Looking at Undetected COVID-19
    A new study has begun recruiting at the National Institutes of Health to determine how many adults in the United States without a confirmed history of infection with SARS-CoV-2 have antibodies to the virus, a sign of a prior infection. NIH is seeking as many as 10,000 volunteers to provide data, which could help shed light on extent to which the novel coronavirus has spread undetected in the U.S.

    April 10: Four Reasons Coronavirus Is Hitting Black Communities so Hard
    From the Washington Post: "A Washington Post analysis of early data from jurisdictions across the country found that the novel coronavirus appears to be affecting — and killing — black Americans at a disproportionately high rate compared to white Americans." The analysis uncovered four main causes.

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

    Minimizing Risk in Home Health Physical Therapy

    A new guidance document from the country's leading provider of physical therapy professional liability insurance offers tips when considering home health physical therapy during the COVID-19 pandemic.

    The provision of home-based physical therapy during the COVID-19 pandemic is a hot topic of conversation for the profession, and now the country's leading provider of liability insurance is offering its perspectives on risk management in the home therapy setting.

    Now available: a guidance document from the Healthcare Providers Service Organization on minimizing risk in the provision of home health physical therapy. HPSO is an APTA Strategic Business Partner, and the official provider of professional liability insurance for APTA members.

    Similar to APTA's guidance, the HPSO resource emphasizes the importance of following recommendations from the U.S. Centers for Disease Control and Prevention on minimizing the spread of COVID-19. And much like APTA and the CDC, HPSO emphasizes the importance of the PT's professional judgment, writing that "As a healthcare provider, physical therapists are in the best position to know what is best for their patient, his or her overall health, and how well their conditions are managed."

    The HPSO document, however, dives deeper into the home health setting, noting that during the emergency, "some physical therapy practices may be considering expanding service offerings to include physical therapy in the patient's home."

    The HPSO resource isn't solely focused on COVID-19-related issues, and moves from considerations around establishing a home care service into a range of considerations that include incident response, standard of care, scope of practice, patient screening, equipment safety, and infection prevention, among other topics.

    "The home care environment presents a wide array of injury and liability concerns for patients, physical therapists, and employers of physical therapists," HPSO writes. "A comprehensive risk control program that identifies and addresses common exposures is essential to enhance worker and patient safety and minimize potential loss."

    Relief Act Opens up Possibility for Grants to College, University Students

    Help is on the way to colleges and universities — including more than $6 billion intended to be provided to students whose educations have been impacted by the COVID-19 pandemic.

    The $2 trillion in relief included in the CARES Act stimulus signed into law in late March included $31 billion in aid for education, with part of that money made available to postsecondary education to pass along to students by way of direct grants. APTA was among the organizations that supported the inclusion of assistance for health care education programs and their students in the CARES Act.

    The $6.28 billion allocated for students is part of a $14 billion package intended specifically for use by postsecondary institutions, and is intended to be used to reimburse students "for expenses related to disruptions in their educations due to the COVID-19 outbreak, including things like course materials and technology as well as food, housing, health care, and childcare," according to a U.S. Department of Education press release.

    To receive the funds, institutions must certify to DOE that the funds will be distributed in compliance with CARES Act requirements.

    As for how much grant money will be made available to each institution, the CARES Act stipulates the use of a formula that is "weighted significantly by the number of full-time students who are Pell-eligible but also takes into consideration the total population of the school and the number of students who were not enrolled full-time online before the coronavirus outbreak," according to DOE.

    More details on the money available to each institution, the methodology used for allocations, and a copy of the certificate of agreement that must be signed are available on the DOE's CARES Act Higher Education Emergency Relief Fund webpage.

    This assistance is in addition to CARES Act relief aimed at federal student loan borrowers who will be able to defer payments and at employers who can offer repayment benefits tax free. This APTA Student Pulse blog post provides more detail on the student loan provisions.

    Five Resources to Help You Navigate Your Finances During the Pandemic

    APTA's Financial Solutions Center has tools and insight to help you stay on track in challenging times.

    The COVID-19 pandemic is taking its toll in nearly every facet of our lives — and for many, finances are a central concern.

    APTA's Financial Solutions Center can help. Here are five resources worth checking out from Enrich, which provides financial education content to the APTA Financial Solutions Center.

    Budget worksheet. This worksheet can help you see where your money's going, and where you might be able to make temporary adjustments.

    What Should You Do With Your Stimulus Check? Many Americans will be receiving relief funds from the federal government; and health care providers who billed under Medicare in 2019 may be eligible for additional funds from HHS. This blog provides tips on the best ways to use that money in the midst of the crisis.

    A Guide for Dipping Into Your Savings. Nobody likes taking money from savings to confront an emergency. But sometimes it's necessary, and there are factors that need to be considered.

    Financial Fraud During the COVID-19 Pandemic. As disheartening as it may be, it's a reality: Scammers are using the pandemic to target fears and take your money. Here's what you need to know.

    How COVID-19 Underscores the Importance of Having an Emergency Fund. We will learn many lessons from the current health emergency. For many, the lessons will include the importance of creating an emergency fund. Even if that's out of the question at the moment, it's a good time to start thinking about how to create one in the future.

    In addition to the resources above, Enrich also offers a guide titled "Coronavirus and Your Financial Health," while Laurel Road, another Financial Solutions Center contributor, has curated resources designed to help students manage their student loans during the pandemic.

    Informal HHS Response Hints at Broad Availability of Provider Relief Money

    In an email exchange with APTA, an HHS representative indicated that virtually any PT who received Medicare fee-for-service reimbursement in 2019 could get the funds, and that businesses closed due to COVID-19 could qualify, too.

    It's not formal guidance, but the U.S. Department of Health and Human Services has indicated to APTA that the COVID-19 pandemic relief money now being deposited in providers' bank accounts may be more widely available than you might think after reading the program's terms and conditions. In short: Initial informal word from HHS is that nearly all providers who received Medicare fee-for-service reimbursement in 2019 could qualify for the money, and providers who had to or chose to shut down business before HHS released the payments may also be able to get the funds.

    Health care providers across the country began receiving deposits from HHS on April 10 as part of a $30 billion emergency relief package. Funds are being disbursed based on the provider's Medicare billing totals in 2019. More details on the program are available in this PT in Motion News story.

    The question that APTA has been pursuing centers on language in the terms and conditions of the program, which state that the money is to go to providers that "currently [provide] care for individuals with possible or actual cases of COVID-19." APTA wanted to know how HHS would interpret "possible or actual cases of COVID-19," and how the department views providers who aren't currently open — either because of mandatory shutdowns or their own professional judgment.

    In an email response to APTA, an HHS representative indicated that the department is interpreting those terms broadly, believing that "possible or active cases of COVID-19" applies to virtually any provider who treated patients during the pandemic, given the infection's ability to be carried without symptoms. The representative also told APTA that businesses not currently operating likely would be able to keep any funds they received, given that they likely have lost revenues attributable to the pandemic.

    It's potentially good news, but news that should be regarded with caution. This information doesn't change the importance of reading the terms and conditions of the program, says Kara Gainer, APTA's director of regulatory affairs.

    "The responses we received from HHS are informal, and we hope to be able to share an official position in the near future," Gainer said. "It's also important to remember that the language we asked about is just one part of the terms and conditions around the money. Anyone receiving these funds should pay careful attention to restrictions around how it's to be used, as well as potential reporting requirements."

    APTA staff will continue to monitor this program and share official guidance as it develops.

    From PTJ: Insights From Italy on the PT's Role During and After COVID-19 Infection

    In two related articles, physical therapists on the frontlines of Italy's battle with COVID-19 discuss physical therapy with infected patients in the hospital, and how PTs can help with recovery from post-intensive care syndrome.

    What role can physical therapists play in addressing the COVID-19 pandemic, and how can that best be accomplished? Authors attempt to address these questions in two Advance Access articles published in PTJ, APTA's science journal also known as Physical Therapy. The articles are open-access.

    In a Point of View, three physical therapists in Italy discuss the use of physical therapy during the COVID-19 epidemic in Lombardy, Italy, and offer "operational suggestions" for when in-person physical therapist intervention is necessary to restore a patient's function.

    Their suggestion include:

    • Suspending physical therapist services, except for respiratory therapy in the hospital, postoperative interventions, treatment after fractures, and immediate postacute care for patients with "disabling heart disease" or neurologic conditions, with the assumption that appropriate personal protective equipment is available.
    • Implementing telerehabilitation for all nonessential services.
    • Potentially reintroducing hands-on care in certain urgent situations, if the patient's health could decline due to lack of movement or respiratory dysfunction.

    In a related Perspective, authors describe how patients with post-intensive care syndrome, or PICS, who are recovering from COVID-19 could benefit from home and community-based PT services.

    In addition to a detailed review of the clinical presentation of PICS and appropriate outcomes measures, authors provide a number of recommendations regarding physical therapist interventions, interprofessional collaborative care, community-based rehabilitation options, and patient and caregiver education.

    Noting that a history of critical illness is a “yellow flag” for elevated risk for a variety of impairments, researchers write, "Home health care and outpatient physical therapists are ideally positioned to address the reduced functioning and participation associated with PICS."

    Proposed CMS Rule for SNFs: a 2.3% Increase and Continued Monitoring of SNF Implementation of PDPM

    Saying that releasing information now would be "premature," CMS is continuing to collect information from APTA and others on how SNFs are reacting to the new payment system rolled out last year.

    In this review: Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Value-Based Purchasing Program for Federal Fiscal Year 2021 (proposed rule)
    Effective date: October 1, 2020
    CMS fact sheet

    The big picture: PDPM continues, as does CMS monitoring of implementation, but the agency isn't ready to share data. SNFs will see a 2.3% increase in FY 2021.
    The U.S. Centers for Medicare & Medicaid Services' proposed payment rule for skilled nursing facilities presses on with the Patient Driven Payment Model adopted last year. But while APTA and other organizations have been providing the agency with information on how the system is working, CMS says that releasing any data it's collected right now would be "premature."

    In the proposed rule, CMS says it continues to monitor "the impact of PDPM implementation on patient outcomes and program outlays" but adds that "we believe it would be premature to release any information related to these issues based on the amount of data currently available."

    APTA and other therapy organizations have repeatedly stated concerns to CMS that SNFs have been reducing staff and therapy service delivery, and citing the PDPM as the reason. In fact, the new payment system doesn't lower the bar when it comes to providing medically necessary care, the criteria for skilled therapy coverage, and the use of clinical judgment, among other factors. CMS is aware of the concerns and is monitoring how the PDPM is used by individual SNFs, in part through information APTA is collecting from individual PTs and PTAs. ([If you have PDPM experiences to share, contact APTA at advocacy@apta.org.)

    The statements from CMS were just one part of a proposed rule that contains far fewer dramatic changes compared with last year's rule, and even includes a bit of good news: a 2.3% payment increase for SNFs, about $784 million. The figure was arrived at after CMS established a 2.7% market basket increase that was reduced by 4 percentage points "for multifactor productivity adjustment."

    The final rule would go into effect on October 1, 2020. APTA will submit comments on the proposed rule before the June 9, 2020, deadline and will provide a template letter for individuals to use to also submit comments.

    Also notable in the proposed rule

    • Changes would be made to the geographic wage index, and a cap on decreases would be established. The proposed rule would adopt geographic delineations proposed by the Office of Management and Budget to determine whether a provider is considered a rural or urban facility — a key element in determining the SNF wage index. CMS hopes to accompany that change with a 5% limit in FY 2021 on any decrease in a hospital’s wage index compared with its wage index for the prior fiscal year to help providers adapt to the revised OMB delineations.
    • Code-mapping adjustments are planned. CMS is responding to feedback by proposing changes to ICD-10 code mapping used in the SNF prospective payment system to classify patients into case-mix groups. The proposed changes have been posted on the CMS PDPM website.
    • Tweaks to the SNF Value-Based Purchasing Program are in the works, but no changes to VBP scoring or payment policies are planned. Proposed changes around the VBP mostly have to do with the ways CMS updates and reports information.
    • No changes to the SNF Quality Reporting Program are proposed. In the aftermath of dramatic changes implemented last year, CMS is holding the line on any big changes to quality reporting.

    APTA will provide information on how to comply with the new requirements as it becomes available.

    Advance Payment, Expedited Payment, and Loans? Commercial Insurers Reportedly Offering Relief

    Reporting on insurers including UnitedHealth, state Blue Cross, Blue Shield, and others points to new programs designed to respond to the financial pressures clinicians are facing during the pandemic.

    APTA has yet to receive firsthand confirmation, but articles in trade media and a local newspaper are reporting that a growing number of commercial insurers are speeding up claims payment and offering loan programs.

    In an April 9 story published in Modern Healthcare (subscription required), author Shelby Livingston reports that insurers including UnitedHealth Group, Pittsburgh-based Blue Cross and Blue Shield insurer Highmark, Blue Shield of California, and Blue Cross of Idaho are providing services such as advance and expedited payments, loans, and more favorable repayment terms to providers.

    A similar story in the Minneapolis Star-Tribune published April 8 included more details on UnitedHealth Group, based in Minnesota, and efforts by other Minnesota insurers. According to that reporting, UnitedHealth is accelerating about $80 million in payments and offering up to $125 million in small business loans.

    Commercial insurer efforts aren't limited to loans and claim payment — over the past few weeks an increasing number of payers are allowing PTs to bill for therapy services delivered via face-to-face telehealth.

    APTA is pursuing the reports on insurers' new measures and will share information as it becomes available.

    HHS Deposits Money Into Some Providers' Bank Accounts

    A $30 billion emergency relief package began rolling out on April 10, making direct deposits into provider and facility accounts based on 2019 Medicare billing.

     

    [Editor's notee: since publication of this story on April 10, APTA has published two additional pieces on the relief program--an April 17 story on how to find out if you qualify for the funds  and an April 22 story that provides additional details on how the system works.]

     

     Many health care providers — including PTs — caring for patients with possible or verified COVID-19 received a welcome surprise when they checked their bank accounts on April 10: an infusion of cash released as part of the most recent CARES Act pandemic relief package. The direct deposits are part of a $100 billion program that provides cash based on a provider's 2019 Medicare billing, under certain conditions.

    Think you qualify and haven't received any money yet? Hang on, the Department of Health and Human Services says the payments will be released over the coming days. 

    What Just Happened
    The $30 billion being released by HHS is part of a $100 billion Public Health Service Emergency Fund for health care providers. The funds are being made available to Medicare-enrolled individual providers and facilities that billed Medicare fee-for-service last year. The new funds are in addition to a recent $51 billion expansion to the Accelerated and Advanced Payment Program. But unlike that program, the money now being distributed doesn't have to be repaid.

    How It Works
    The money is being distributed proportionally, based on a provider's billing record for 2019. HHS decided on who gets what by determining the percentage that each provider's billing represents in terms of total Medicare payments made last year.

    An HHS resource explains it this way:

    "For example, if total Medicare fee-for-service payments in 2019 were $100, and one physician received $2 in payments from Medicare fee-for-service in 2019, then that physician accounted for 2% of total Medicare fee-for-service payments in 2019. According to this formula, that physician would receive 2% of this $30 billion."

    Who Qualifies
    There are terms and conditions related to who can receive the money — some of which are sure to prompt additional questions that can't be answered at this time.

    A guidance document from HHS states that to qualify for the relief, the provider must currently provide "care for individuals with possible or actual cases of COVID-19," and must not currently be terminated from participation in Medicare or have billing privileges revoked. APTA has asked for additional guidance from HHS explaining if providers and facilities must be front line providers caring for patients with possible or verified COVID-19 infections, or if the funds can go to any health care provider continuing to deliver services during the public health emergency.

    How the Money Can be Used
    According to the terms and conditions, payments can be used only to "prevent, prepare for, and respond to coronavirus," with the payments themselves intended for "only health care related expenses or lost revenues that are attributable to coronavirus."

    There are additional restrictions on use, including using the money for reimbursement of losses "that other sources are obligated to reimburse," as well as prohibitions on using the money to "advocate or promote gun control," lobbying, funding of abortions, and a host of other social and political issues.

    If You Don't Qualify
    HHS says that the intent behind the $30 billion program was to provide immediate relief and that "CMS has indicated that future rounds of funding from the $100 billion fund will have a more formal application process." Those future funding efforts could devote at least a part of the relief to "providers that do not typically bill Medicare."

    More Details and Clarifications
    Like many of the government actions taken in response to the pandemic, not every detail has been fully worked out, and there are bound to be questions that APTA and even the federal agency can't answer. APTA regulatory affairs staff is working to obtain as many details as possible about the program.

    In the meantime, there are resources for more (if not full) detail. Here are a few:

    [UPDATE, April 21,2020]

    This information is quoted directly from the HHS Cares Act Provider Relief Fund webpage:

    "All relief payments are being made to providers and according to their tax identification number (TIN). For example:

    • Large Organizations and Health Systems: Large Organizations will receive relief payments for each of their billing TINs that bill Medicare. Each organization should look to the part of their organization that bills Medicare to identify details on Medicare payments for 2019 or to identify the accounts where they should expect relief payments.
    • Employed Physicians: Employed physicians should not expect to receive an individual payment directly. The employer organization will receive the relief payment as the billing organization.
    • Physicians in a Group Practice: Individual physicians and providers in a group practice are unlikely to receive individual payments directly, as the group practice will receive the relief fund payment as the billing organization. Providers should look to the part of their organization that bills Medicare to identify details on Medicare payments for 2019 or to identify the accounts where they should expect relief payments.
    • Solo Practitioners: Solo practitioners who bill Medicare will receive a payment under the TIN used to bill Medicare."

    The State of States: Four Ways to Stay Up-to-Speed on Telehealth, Licensure Provisions, and Other State-Level Changes

    It can't be stressed enough: Individual states are the decision-makers around much of what PTs and PTAs can and can't do in response to the COVID-19 pandemic. These regularly updated resources can help you make fact-based practice decisions.

    Have a question about what you can and can't do amid all the regulatory and payment changes happening in response to the COVID-19 pandemic? The answer will probably be the same no matter what:

    Check with your state physical therapy licensing board and each of your payers.

    "While there have been changes at the federal and commercial insurer levels around, for example, the kinds of digital communications PTs can have with patients, state laws often take precedence," said Daniel Markels, APTA state affairs manager. "If your state laws and regulations don’t allow you to do it, even if the insurer you're working with says they'll pay for it, you can't do it. On the other hand, states have made temporary changes to various laws that may provide additional opportunities for PTs and PTAs, so it's crucial to keep up with what's happening at the state level."

    Here are four key resources to help you do just that.

    An APTA chart tracking state orders allowing PTs to provide telehealth services
    "Can I provide telehealth?" is the question on the minds of nearly every PT and PTA these days. This chart, updated weekly, breaks down the answer to that question by state, with links to specific orders. But remember: Review your state practice act and check in with your state licensing board to verify what you are and aren't allowed to do.

    An APTA chart on state actions related to telehealth in Medicaid, commercial, and workers' comp coverage, updated weekly
    States have been adjusting their Medicaid and commercial insurance regulations in a variety of ways when it comes to telehealth, including some mandates that nonfederal payers must pay for telehealth services as if the services were performed in person. But it's a patchwork, and many states don't mention PT services specifically. (Again, check with your state licensing board or specific insurance companies for the most accurate and current information.) The chart is updated weekly.

    A rundown of state licensure exemptions and requirements for PTs and PTAs related to the COVID pandemic
    This chart, created by the Federation of State Boards of Physical Therapy, provides a detailed listing of every change made to licensing laws and regs in response to the health emergency, with a particular focus on exemptions and changes to licensure requirements — everything from the issuance of temporary licenses without an examination to allowances for PTs licensed in another state. Of note is the number of states that temporarily allow a PT or PTA licensed in another state to come in and practice without having to obtain a license from the state during declared national or state emergencies.

    Contact information for state physical therapy licensing boards
    This is just what it sounds like: a regularly updated listing of every licensing board, including email addresses, websites, and phone numbers, courtesy of FSBPT.

    The Pandemic, Telehealth, and the Physical Therapy Compact

    In the U.S., the regulation of professions is a power invested with the states, not the federal government, meaning that each state has the authority to regulate and license providers. That's great for states’ rights, but it can create challenges for practice across state lines — including challenges associated with remote digital communications that know no borders.

    The current trend toward increased ability for PTs and PTAs to provide remote services, though sparked by a health crisis, was one of the motivating factors behind the creation of the Physical Therapy Compact in 2016, the system that allows PTs and PTAs licensed in one compact state to obtain practice privileges in other compact states. Currently, 28 states have enacted the required legislation to join the compact, with five more states introducing compact legislation this year. Enactment of the compact in all U.S. jurisdictions has been a top priority for APTA and FSBPT, and the current pandemic has demonstrated the need for it.

    Creators of the compact (APTA, FSBPT, and the Council of State Governments) were focused on interstate licensure portability — moving from one state to another with minimal disruptions in practice, obviously, but also on the potential growth of telehealth.

    Markels says the compact can be a useful tool in these times but warns that PTs and PTAs in the compact still need to pay careful attention to individual state laws and regs, especially related to telehealth (see the resources above).

    "If you're in the compact, and your home state — the state of your primary residence — allows telehealth, that doesn't mean you can provide telehealth services to a patient who’s in a compact state that doesn't allow it," Markels cautioned. "PTs and PTAs with compact privileges must abide by the laws and regulations of the physical therapy board in the state in which the patient is located and where services are being delivered."

    So, in other words … keep up with what the states are doing.

    APTA Advisory: CMS Opens the Possibility of Providing Care to a Patient in the Same Building — But Not in the Same Room

    Details are in short supply, but in a recent communication with APTA, CMS seems to say that a PT's evaluation or treatment visit via real-time video, if delivered to a patient in a different room of the same building, could be billed as in-person services.

    During a national stakeholder call on April 8, CMS opened up the possibility that it would allow a clinician to provide services remotely to a patient in the same building, but not in the same room, and bill the encounter as an in-person visit. A follow-up question submitted by APTA via email seems to indicate that CMS thinks the allowance applies to PTs.

    APTA provided two examples for CMS' consideration: a PT performing an evaluation via Facetime or Skype in the same building but a different room, and a PT performing a treatment visit via Facetime or Skype in the same building but a different room.

    APTA asked if the evaluation and treatment would be considered to have been done in person and thus be billable to Medicare; and whether, if the same approach is taken in a skilled nursing facility, the minutes could be coded on the minimum data set.

    CMS' response:

    "Both of these instances you mention, where a PT performs an evaluation or treatment visit via Facetime or Skype when in the same building but in different locations describe services that can be billed as in-person services."

    “While this policy has enormous potential to help ensure continued access to therapists and other health care providers when attempting to limit contact between patients and their health care providers to prevent the spread of the COVID-19 virus, this is the only information we have on this development at the moment," said Kara Gainer, APTA director of regulatory affairs. "We don't know how this might be applied across the many health care settings, including home health. And the CMS response didn't clearly answer our question about coding these minutes in the skilled nursing facility setting."

    This is important: The allowance from CMS is not a recognition of PTs as eligible telehealth providers under Medicare. Medicare still doesn’t include PTs among the providers who can provide face-to-face telehealth; and APTA continues to urge CMS to use its authority to issue a blanket waiver to include PTs among the types of providers eligible to furnish telehealth services during the COVID-19 public health emergency.

    APTA staff will continue to pursue this information from CMS and provide more information as it becomes available.

    Update, April 10, 2020: CMS' position on how to bill services delivered in the same facility but different rooms was recently reiterated in this CMS FAQ resource (see question 9 under the "Medicare Telehealth" header).

    Visit APTA's telehealth webpage for regularly updated information and resources.

    Study: Physical Therapy Bests Steroid Injections for Treatment of Knee OA

    A new study in the New England Journal of Medicine finds a significant difference in WOMAC scores after one year and more positive patient perceptions of improvement for patients treated through physical therapy versus glucocorticoid injections.

    In this review: Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee (New England Journal of Medicine, April 9, 2020)

    [Editor's note: this review was revised to include remarks from Gail Deyle,one of the study's authors.]

    The Message
    A study of beneficiaries in the military health system concludes that patients with knee osteoarthritis treated through physical therapy experienced lower pain and higher physical function after one year than did patients who received steroid injections. In addition to challenging assumptions about the effectiveness of the widely used injections, the results also hint at the possibility that benefits of physical therapy for knee OA may be more long-lasting than earlier believed.

    The Study
    Researchers analyzed data from 156 patients (average age, 56, 48% female) diagnosed with knee OA between 2012 and 2017 who were active duty or retired service members or their family members from two military hospitals. The patients were divided into two treatment groups: One received physical therapist services, and the other received intraarticular glucocorticoid injections. Physical therapist services were provided in up to eight sessions over an initial four- to six-week period with the possibility of one to three sessions later on; steroid patients received an injection of a mixture of triamcinolone acetonide and lidocaine at outset, with the possibility of receiving as many as three injections over the one-year study period. Patients completed the Western Ontario and McMaster Universities Osteoarthritis Index, known as WOMAC, as well as the Global Rating of Change assessments at baseline and at the four-week, eight-week, six-month, and one-year marks. Researchers compared the results among patients at baseline and one year. APTA members Gail Deyle, PT, DPT, DSc, and Dan Rhon, PT, DPT, were among the authors of the study.

    Findings

    The physical therapy group reported a bigger improvement in WOMAC scores. Patients in the physical therapy group averaged a 37 on the WOMAC after a year — a 70-point drop in the 0-to-240 scale in which lower scores indicate less pain and better function. The injection group also reported improvements in WOMAC scores but to a lesser extent — from an average score of 108 at outset to 55.8 after one year.

    Perceived improvement was also greater in the physical therapy group. Both groups reported a perception of improvement, but the physical therapy group averaged a plus-five score ("quite a bit better"), while the injection group averaged a plus-four ("moderately better").

    Step and up-and-go test results were better for the physical therapy group. Patients in the physical therapy group performed better than injection group patients by an average of one second for the alternate step test, and by 0.9 seconds for the timed up-and-go test.

    The rate of improvement, based on WOMAC, seemed to keep increasing for the physical therapy group. Researchers note a fairly typical pattern of short-term improvement in pain and function for the physical therapy group, but they also note an increasing rate of improvement at one year — a finding inconsistent with other studies that have indicated that improvement tends to level off after a year or even begin moving back in the direction of baseline WOMAC scores.

    Why It Matters
    Authors of the study point out that "clinical practice guidelines vary regarding the use of glucocorticoid injections … with a recent clinical practice guideline providing the highest level of endorsement." Use of injections to treat knee OA could be as prevalent as 50% of patients, they write, while the use of physical therapy for treatment of knee OA declined between 2007 and 2015, despite increasing practice guideline acknowledgment of its effectiveness.

    More From the Study
    Although authors didn't perform a cost and utilization analysis comparing the two approaches, they did track average cost for all knee-related medical care during the one-year period, and found similar totals — $2,113 for the injection group and $2,131 for the physical therapy group.

    As for the physical therapist intervention, PTs generally "would implement hands-on, manual techniques immediately before the patient performed reinforcing exercises to help the patient perform the movement with little or no pain." Those exercises depended on the functional deficits and pain being experienced by the patient. Patients received up to eight sessions over a four- to six-week period and could request an additional one to three sessions at the four-month and nine-month reassessments. Patients averaged 11.2 treatment visits.

    Authors point out that the trend toward increased improvement after one year, as opposed to a significant short-term increase and then a gradual slow down in improvement as patients approached the one-year mark, was a result that differed from previous studies. They speculate that the pattern "may have been the result of educational sessions, additional provider contact at four months and nine months, and the use of interim treatment visits as needed."

    "What was different in this trial was the use of a small number of interim visits to reinforce home exercise performance, provide additional manual treatment, and have discussions on knee osteoarthritis management as needed," said Deyle. "The primary reason we were showing increasing benefit with physical therapy that far out from baseline was most likely the interim visits. Intermittent work with a physical therapist to better control symptoms of knee osteoarthritis is the key to reducing the need for invasive higher-risk strategies. No one would question the value of regular periodic treatment by a pulmonary specialist for a disorder like chronic obstructive pulmonary disease—this is essentially the same concept of care."

    Deyle believes there's an opportunity for more research to be done around physical therapy versus more common treatment for knee OA, but says that the pervasive use of steroid injections will make it hard to establish trial cohorts.

    "Trials like these comparing medical interventions to physical therapy are very difficult to perform because patients are frequently offered steroid injections in primary care and specialty clinics," Deyle said. "Even when enrolled in a clinical trial, providers still offer injections at nearly every visit, so finding patients who had not received but were willing to receive injections was difficult. What I'd like to see is a comparative study of patients with knee osteoarthritis randomized to primary contact with a physical therapist, receiving the care detailed in this trial, compared with the normal primary care pathway."

    Keep in Mind …
    The researchers acknowledge several limitations in their study, including differences in the number of visits with providers in the two groups (the physical therapy patients had more visits), some crossover between the groups (18% of the injection group also received physical therapy, and 9% of the physical therapy patients received injections), and a recruitment effort that allowed recruitment based on an initial physical therapy visit as well as from a primary care physician visit — a difference that may have "influenced patients' perceptions of the interventions." Authors of the study also point out that the physical therapy group had a higher proportion of patients with severe OA.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    CDC Issues Recommendations on Workers Who May Have Been Exposed to COVID-19

    The latest guidance says that critical workers, including health care providers, who may have been exposed to COVID-19 may continue to work under very controlled circumstances that include mask use (but must leave if they begin experiencing symptoms).

    As the COVID-19 pandemic continues to grow, discussions are expanding beyond how to avoid exposure to the virus and toward what should happen after potential exposure occurs. The U.S. Centers for Disease Control and Prevention says that for "critical infrastructure workers" including health care providers, that response should include consistent employer efforts to pre-screen, monitor, disinfect, and support the use of masks and other PPE.

    In a recently released interim guidance document, CDC says that while critical infrastructure workers may be allowed to work after potential exposure to COVID-19—provided they don't develop symptoms — it's important for the workers and their providers to take certain precautions. According to CDC, "potential exposure" is defined as "being a household contact or having a close contact within six feet of an individual with confirmed or suspected COVID-19," with a timeframe of 48 hours before the infected individual became symptomatic.

    The CDC recommendations call for:

    Pre-screening. "Employers should measure the employee’s temperature and assess symptoms prior to them starting work. Ideally, temperature checks should happen before the individual enters the facility."

    Regular monitoring. "As long as the employee doesn’t have a temperature or symptoms, they should self-monitor under the supervision of their employer’s occupational health program."

    Use of masks. "The employee should wear a face mask at all times while in the workplace for 14 days after last exposure. Employers can issue facemasks or can approve employees’ supplied cloth face coverings in the event of shortages."

    Social distance. "The employee should maintain 6 feet and practice social distancing as work duties permit in the workplace."

    Disinfection and cleaning. "Clean and disinfect all areas such as offices, bathrooms, common areas, shared electronic equipment routinely."

    CDC also advises that employees who begin feeling sick during the day should be sent home immediately and their workspaces thoroughly cleaned. Employers should also collect information on the employee's activities for two days before the symptoms emerged, and consider others in a facility who were within six feet of the infected employee during that time to be exposed.

    Bill Boissonnault, PT, DPT, DHSc, FAPTA, APTA's executive vice president of professional affairs, says that the CDC recommendations make it clear that providers and their employers shouldn't take chances — or cut corners — when it comes to responding to the COVID-19 emergency.

    "These guidelines need to be taken seriously," Boissonnault said. "It's everyone's responsibility to take whatever precautions possible to limit the spread of the virus — including wearing PPE and making PPE available to workers."

    he recommendations echo recent CMS guidelines for outpatient facilities that acknowledge the role employer discretion plays in minimizing risk of infection while providing necessary care — but strongly support the use of masks and other PPE when potential exposure has occurred. The U.S. Occupational Safety and Health Administration advises employers that they are "obligated to provide their workers with PPE needed to keep them safe while performing their jobs," leaving employers to decide the types of PPE to be issued "based on the risk of being infected with the SARS-CoV2 virus while performing job tasks that may lead to exposure."

    The advisories from CDC and CMS are also consistent with guidance APTA provides on management of patients to minimize the risk of COVID-19 transmission.

    Coronavirus Update: April 8, 2020

    Expanded APTA resources on patient management, weekly CDC COVID-19 summaries, and an adjusted coronavirus model.

    Practice Guidance

    April 8: APTA Updates COVID-19 Resources on PT Management of Patients
    APTA has expanded a webpage featuring questions, answers, and links to resources that can help guide PTs and PTAs in exercising their professional judgment on how best — or whether to — provide services to patients while avoiding the spread of infection from anyone suspected of having or diagnosed with COVID-19. The page covers topics including when a patient should be told to cancel a planned PT visit, preparation of clinical space and operations, and how to make decisions about a facility closing, with resources that now include CMS guidance specifically related to outpatient settings. Other areas covered include PPE, suggestions for encouraging patients to stay active while sheltering in place, and potential unemployment benefits.

    From CDC

    April 8: CDC Launches Weekly Summary of COVID-19 Activity
    Titled "COVIDView," the weekly posting tracks testing, outpatient and ED visits, symptom reporting, mortality, and more.

    In the Media

    April 8: Adjusted Coronavirus Model Decreases Prediction of Deaths to 82k by August
    From CNN: “An influential model tracking the coronavirus pandemic in the United States now predicts that fewer people will die and fewer hospital beds will be needed compared to its estimates from last week. As of Monday [April 6], the model predicted the virus will kill 81,766 people in the United States over the next four months, with just under 141,000 hospital beds being needed. That's about 12,000 fewer deaths -- and 121,000 fewer hospital beds -- than the model estimated on Thursday [April 2]."

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

    Updated APTA COVID-19 Resources on PT Management of Patients Now Available

    The updated webpage includes new links and more information on outpatient facilities.

    As responses to the COVID-19 pandemic continue to evolve rapidly, especially around the growing role of PTs and PTAs in telehealth, APTA is committed to providing the resources you need to stay up to speed.

    The latest effort: an expanded webpage featuring questions, answers, and links to resources that can help guide PTs and PTAs in exercising their professional judgment on how best — or whether to — provide services to patients while avoiding the spread of infection from anyone suspected or diagnosed with COVID-19.

    The page covers topics including when a patient should be told to cancel a planned PT visit, preparation of clinical space and operations, and how to make decisions about facility closing, with resources that now include CMS guidance specifically related to outpatient settings. Other areas covered include PPE, suggestions for encouraging patients to stay active while sheltering in place, and potential unemployment benefits.

    In addition to what's offered on the PT management page, APTA offers a regularly updated collection of guidance resources related to specific settings and circumstances, including pediatric physical therapy, acute hospital physical therapy, long-term care facilities, and wound care.

    Support From APTA Strategic Business Partners and Member Value Programs Amid COVID-19

    Free courses and significant discounts are among the offers being provided to support the physical therapy community during the national health crisis.

    As the COVID-19 pandemic continues to disrupt our society, many of APTA’s Strategic Business Partners and Member Value Programs are stepping forward with special offers to assist the profession and APTA members.

    MedBridge is augmenting its standard $175 discount for APTA members on a continuing education subscription with a $10 introductory three-month offer for students. APTA members go here to take advantage.

    GEICO is pausing cancellation of coverage due to nonpayment and policy expiration through the end of April.

    HPSO is offering relevant telehealth information, plus newsletters, case studies, and weekly emails to APTA members.

    Laurel Road, part of APTA’s Financial Solutions Center, is providing a free webinar on April 14, Student Loan Repayment During Uncertain Times, and also has a COVID-19 information page.

    DJO/Chattanooga is extending its $225 discount from APTA’s Combined Sections Meeting for the Chattanooga Continuum Bundle Including Foot Switch and Electrodes. Add the bundle to your cart and then select View Cart to enter promo code STIM20 before proceeding to checkout.

    Hocoma is offering APTA members free installation, comprehensive onsite training, and transportation on all new orders placed by June 30. Call 877-944-2200 for the representative in your area and reference “APTA Member Special Offer” when requesting your quote.

    Net Health Revenue Cycle Management is offering a no-risk, limited time revenue recovery program to collect existing accounts receivable for practices experiencing a slowdown in cash flow related to COVID-19.

    Normatec/Hyperice is offering a 20% discount on Hyperice’s most popular percussion and vibration technologies. The discount will be applied automatically in your cart.

    Performance Health is offering a free webinar, Managing During a Crisis, on April 8.

    PhysicalTherapy.com is offering a free CEU course (one course per license number). Use promo code 1FREECOURSE at checkout. You will not need a credit card.

    RockTape is offering its live FMT Virtual Classes at 50% off the normal registration fee for an in-person course. Those who already registered for an in-person course can change to the virtual course and receive a refund for the discount amount.

    TrueLearn is offering all APTA student members a 25% discount on any PT Board Exam SmartBank subscription.

    Updated APTA Web Resources on Telehealth, Disaster Management Now Available

    APTA has been providing frequently updated information on the COVID-19 pandemic. Two association webpages now contain new and consolidated information and resources related to telehealth and the profession’s role in national and world crises.

    As responses to the COVID-19 pandemic continue to evolve rapidly, especially around the growing role of PTs and PTAs in telehealth and in responding to disasters, APTA is committed to providing the resources you need to stay up to speed.

    The association has retooled two important webpages to help guide you through the changed and changing health care landscape: an updated telehealth page and a disaster management page that includes a new guidance document on the role of the PT and PTA in preparing for and responding to disasters.

    The telehealth webpage addresses the misinformation around recent changes to private payer and CMS provisions covering different telehealth modalities. It includes recommended resources on what CMS does and doesn't cover, how to approach making a decision about providing telehealth services, and questions to ask payers. The page also links to an extensive question-and-answer resource specifically related to e-visits, one of the telehealth modalities permitted for use by PTs.

    The disaster management page has been redesigned with an eye toward both preparing for and responding to a disaster or national emergency. The page showcases APTA’s resource "The Role of the PT and PTA in Disaster Management," a guide to PT and PTA participation in disaster preparation, response, relief, and recovery that addresses essential clinical skills, ethical considerations, and documentation related to disaster response, and more.

    Commercial Insurers Take the Telehealth Lead

    Aetna, UnitedHealthcare, and Cigna have moved forward with face-to-face telehealth delivered by PTs during the COVID-19 pandemic. Will the innovations gain traction?

    For many PTs and PTAs, it's an all-too-familiar pattern: CMS makes a rule change or payment adjustment, and sooner or later commercial insurers follow suit. But the COVID-19 pandemic is flipping that narrative, as some insurers innovate their way past CMS to increase patient access to care. One such innovation: allowing PTs and PTAs to provide telehealth services by reimbursing for real-time face-to-face modalities as well as non-real time and non-face-to-face services.

    Over the past weeks, insurance giants Cigna, Aetna, and UnitedHealthcare have each announced temporary benefit changes allowing PTs to bill for most therapy codes delivered by way of telehealth. Unlike CMS, which is permitting coverage of some services furnished remotely by PTs — including e-visits, virtual check-ins, remote evaluation of recorded video or images, and telephone assessment and management services — the commercial benefit changes represent a key upgrade: They provide for reimbursement of services using interactive video that allows clinicians and patients to see and hear each other in real time, with patients performing movements that their PT or PTA can observe and adjust remotely. APTA consulted with the payers as they considered the changes.

    "This is a significant moment," said Carmen Elliott, APTA's vice president of payment and practice management. "It's not just an important step in responding to the current health emergency — it's a forward-thinking shift that will help the profession show its value in the full range of telehealth once the current crisis is over."

    Elliott thinks the insurers deserve credit for their willingness to innovate.

    "In each instance, these payers put public health and safety first while responding to the needs of their policyholders," Elliott said. "They could've taken a wait-and-see attitude and followed the lead of CMS, but they decided to take a quicker approach."

    While the three major insurers moved relatively quickly to allow for providing robust telehealth in therapy, CMS has taken a more incremental approach. In March, it announced waivers for e-visits, virtual check-ins, remote evaluation of recorded video/images, and telephone assessment and management services. However, the agency stopped short of waivers to allow PTs to deliver therapy in a synchronous, real-time face-to-face visit. More recently, the agency took another halting step forward by approving the use of many common therapy codes for telehealth — yet not including PTs, PTAs, occupational therapists, or speech-language pathologists among the providers who could use them in face-to-face provision of remote services.

    "Part of the reason these commercial insurers felt they could move so quickly and decisively has to do with what they've already seen in terms of physical therapy's effectiveness in many areas, not just telehealth," said Katy Neas, APTA executive vice president of public affairs. "APTA has been working to establish collaborative relationships with insurers such as UnitedHealthcare whenever possible, and helping to educate them on physical therapy's benefits to patients and the health care system overall. We're sending the message that the physical therapy profession is a profession of innovators. Insurers are beginning to see that and take action in response."

    That spirit of innovation has ramped up across the country during the COVID-19 pandemic as PTs and PTAs find ways to care for patients outside of the traditional clinic setting. It' was the subject of a recent APTA-sponsored Facebook Live event, "COVID-19: Adapting Your Practice," that brought together four PTs who have adopted fresh strategies to meet the needs of their patients. A recording of the event is available.

    Elliott says that the insurers have been taking steps to embrace at least one element of the profession's innovative capabilities, and thinks other payers should take note.

    "We hope that CMS and other payers are tuned into what's happening right now with Aetna, UnitedHealthcare, and Cigna," Elliott said. "Patients are getting access to the care they need without putting themselves or their therapists at risk, and PTs are showing that telehealth can be an important part of the physical therapy toolkit. We know PTs will establish a track record by providing telehealth at this critical time with the potential for positive ripple effects far into the future."

    Visit APTA's Telehealth webpage for regularly updated information on payment, information on coding, and general guidance on what to consider when evaluating whether telehealth is right for you.

    Coronavirus Update: April 6, 2020

    HIPAA enforcement relaxed, PTs and PTAs among the health care workers who could be "exempted" from expanded sick leave, COVID-19's link to CVD, and more.

    HIPAA

    April 2: HHS Allows Disclosure of Some Protected Information
    The U.S. Department of Health and Human Services has issued notification that it is "exercising discretion" in how it applies HIPAA privacy rules during the COVID-19 national health emergency. HHS says it won't impose penalties against covered entity or business associate disclosure of private health information if the disclosure was made in "good faith" by the business associate as a part of public health efforts, and if the business associate notifies the covered entity of the disclosure within 10 days. Those "good faith" disclosures include information shared with the CDC "for purposes of preventing or controlling the spread of COVID-19," or with CMS in efforts to provide "assistance for the health care system."

    From CMS

    April 3: New CMS Nursing Home Recommendations Stress Collaboration, Consistent Staffing Assignment
    The U.S. Centers for Medicare & Medicaid Services issued new recommendations for nursing homes around the COVID-19 pandemic that urge states to attend to the personal protection equipment needs of long-term care facilities, and press nursing homes to establish separate staff teams for COVID-19-positive residents. The recommendations also include universal testing in the facilities and use of PPE "to the extent PPE is available."

    From the U.S. Department of Labor

    April 3: PTs, PTAs Could be "Exempted" From Receiving Additional COVID-19 Leave
    Emergency paid sick leave and expanded family and medical leave provisions will be implemented broadly in response to the COVID-19 pandemic, but PTs, PTAs, and other health care providers employed in certain settings can be prevented from receiving the additional relief if their employers say so: That's how the U.S. Department of Labor has laid out its plans for implementing the Families First Coronavirus Response Act signed into law on March 18. The exemption provisions could also be applied to first responders.

    April 3: OSHA Issues Guidelines to Permit Extended Use and Reuse of Respirators
    In a memorandum to its compliance safety and health officers, OSHA announced that it is seeking greater "enforcement discretion" that would allow for extended use and reuse of respirators. In the case of N95 masks, the same worker is now permitted to continue using the respirator "as long as the respirator maintains its structural and functional integrity" and the filter remains undamaged. The relaxed requirements also allow for use of N95 respirators that have passed their expiration dates—although the agency does not recommend the use of expired N95s when performing surgery on patients with diagnosed or suspected COVID-19, or when procedures are likely to create poorly controlled respiratory secretions.

    In the Media

    April 6: COVID-19 Virus May Damage Heart
    From Kaiser Health News: “As more data comes in from China and Italy, as well as Washington state and New York, more cardiac experts are coming to believe the COVID-19 virus can infect the heart muscle. An initial study found cardiac damage in as many as 1 in 5 patients, leading to heart failure and death even among those who show no signs of respiratory distress." Some cardiac specialists think that the virus could damage the heart in multiple ways.

    April 5: Researchers Investigating Links Between COVID-19 and Neurologic Effects
    According to Medscape, U.S. neurologists "are now reporting that COVID-19 symptoms may also include encephalopathy, ataxia, and other neurologic signs." In late March, doctors in Michigan reported on the first case of encephalitis linked to COVID-19, while researchers in China linked the development of Guillain-Barre syndrome to COVID-19 in a 61-year-old woman in China.

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

    PTs, PTAs Could Be 'Exempted' From Receiving Additional COVID-19 Leave

    A final rule from the Department of Labor includes PTs and PTAs among the health care providers whose employers — depending on the setting — could opt to deny expanded sick and FMLA leave.

    In this review: U.S. Department of Labor, Temporary Rule: Paid Leave under the Families First Coronavirus Response Act
    Fact sheet: employee paid leave rights
    Fact sheet: employer paid leave requirements
    Families First Coronavirus Response Act: Questions and Answers

    Emergency paid sick leave and expanded family and medical leave provisions will be implemented broadly in response to the COVID-19 pandemic, but PTs, PTAs, and other health care providers employed in certain settings can be prevented from receiving the additional relief if their employers say so: That's how the U.S. Department of Labor has laid out its plans for implementing the Families First Coronavirus Response Act signed into law on March 18. The exemption provisions could also be applied to first responders.

    At issue is a requirement in the Families First Act that employers with fewer than 500 employees provide up to 80 hours of paid sick leave and additional FMLA leave related to COVID-19—and in particular, instances in which an employer would have the option to exempt employees from the extra leave provisions. In health care, DOL is allowing that option to be exercised by employers from a list of health care settings, to be applied on a case-by-case basis to any of their health care providers.

    For the physical therapy profession, the term "health care provider" is key, because PTs and PTAs fall into that category for purposes of the rule.

    The rule provides the exemption option to employers in the following settings:

    • Doctor’s office.
    • Hospital.
    • Health care center.
    • Clinic.
    • Post-secondary educational institution offering health care instruction.
    • Medical school.
    • Local health department or agency.
    • Nursing facility.
    • Retirement facility.
    • Nursing home.
    • Home health care provider.
    • Facility that performs laboratory or medical testing, pharmacy, or "any similar institution."

    The list applies to any permanent or temporary institution, and extends to any listed setting that contracts with a health care provider or contracts with an entity that employs a health care provider. Bottom line: PTs and PTAs employed or under contract with a facility on the list could face the possibility of being exempted from receiving the additional leave.

    It's Optional and Intended for Case-by-Case Use
    According to the DOL, the agency is encouraging employers to be "judicious" in use of the exemption "to minimize the spread of the virus associated with COVID-19." Additionally, DOL says that the exemptions are intended to be used on a "case-by-case" basis, meaning that employers could apply the exemptions to certain types of health care providers and allow others to receive the extended benefits.

    It's Not the Only Exemption Path
    The requirements to provide the extended leave don't apply to business with 500 or more employees, and employers with 50 or fewer employees can apply to opt out if providing the extra leave would jeopardize the viability of the business.

    The "Health Care Provider" Definition is Intentionally Broad
    In the rule DOL states that it considered using a more narrow definition of "health care provider," but decided to go with the broad definition to give employers flexibility to maintain staffing to respond to the health emergency. According to DOL, a more narrow definition could leave health care facilities without staff to perform critical services needed to battle COVID-19.

    New CMS Nursing Home Recommendations Stress Collaboration, Consistent Staffing Assignment

    The new recommendations underscore existing CDC and CMS guidance and call for extensive use of masks and other PPE.

    The U.S. Centers for Medicare & Medicaid Services issued new recommendations for nursing homes around the COVID-19 pandemic that urge states to attend to the personal protection equipment needs of long-term care facilities, and press nursing homes to establish separate staff teams for COVID-19-positive residents. The recommendations also include universal testing in the facilities and use of PPE "to the extent PPE is available."

    According to CMS, the recommendations were created after CDC and CMS experts working in nursing homes "emphasized that even more must be done" to underscore guidance already provided by CMS around response to the pandemic.

    The recommendations address five major areas:

    Compliance with existing CDC and CMS guidance. The recommendations stress the importance of following instructions from the CDC and CMS in areas such as hand hygiene, infection control, and conservation of PPE.

    Collaboration between states and nursing homes to meet PPE needs. CMS emphasizes the importance of state and local health departments to stay in close communication with long-term care facilities to "address … needs for PPE and/or COVID-19 tests."

    Symptom screening for all. The agency reiterates its position that every person entering a nursing home be asked about COVID-19 symptoms and have their temperature checked. Symptom assessment and temperature checks should also be performed on every resident.

    Appropriate PPE use. The recommendations urge the use of facemasks by all nursing home personnel on site, as well as donning of full PPE when caring for any resident known or suspected to have COVID-19. CMS also calls for all residents "to cover their noses and mouths when staff are in their rooms," and suggests that they could use tissues or non-medical masks to do this.

    Separate staff teams for residents with COVID-19, and consistent assignment. CMS recommends that facilities try to assign the same staff to the same residents to increase the chances of "detect[ing] emerging condition changes that unfamiliar staff may not notice" and to decrease the number of different staff interacting with residents. Residents diagnosed with COVID-19 should be separated from other patients, and have separate staff teams "when possible."

    CMS also recommends that state agencies, hospitals, and nursing home associations help to "ensure coordination among facilities to determine which facilities will have a designation [as a facility for COVID-19 patients] and provide adequate staff supplies and PPE."

    APTA Learning Center Offers Free Online Courses

    The opportunities include both live and recorded telehealth webinars, as well as self-paced courses on a range of topics — all free to APTA members.

    In these challenging times, PTs, PTAs, and students face multiple pressures — including the pressure to keep up with changing practice dynamics in the wake of a global pandemic.

    APTA's Learning Center can help. The association's online continuing education platform now offers a collection of webinars and courses that can provide you with insight into telehealth, where some of the most significant changes are happening to the profession in response to the COVID-19 emergency. APTA has also collected self-paced courses on a variety of other topics that are perfect for when you need to give yourself time away from the current crisis.

    All listed offerings are free to APTA members; some are free to everyone. Unless otherwise noted, all offerings include the opportunity to earn CEUs.

    Courses include:

    Live Online Telehealth Webinar

    Recorded Webinars on Telehealth


    Self-Paced Courses on Other Topics

    From ChoosePT.com: Telehealth, Now More Than Ever

    A new Move Forward Radio podcast features a PT who relies on telehealth to meet the needs of veterans in rural areas.

    As a lead telehealth physical therapist for the U.S. Department of Veterans Affairs, Christi Crawford, PT, DPT, works hard to meet the physical therapy needs of veterans who live in rural areas. The VA offers a growing number of video-to-home personalized care and other remote services to reduce the need for patients to travel long distances for in-office care.

    Crawford's perspectives are timely. Because of the coronavirus pandemic, interest in telehealth services is changing the way patients see their health care providers.

    Now available through ChoosePT.com's Move Forward Radio podcast: an interview with Crawford on the many benefits and opportunities telehealth offers for patients, caregivers, and providers; what types of services work well through remote visits; and how to determine whether a patient or client is a good candidate for telehealth services.

    For patients in rural areas, "the increased access to someone that specializes in the area they need is so crucial," says Crawford. "Telehealth can get people back to what they need to do to stay healthy and functional."

    Noting the obstacles to care that the current pandemic presents and APTA's advocacy efforts for current legislation being considered by Congress, Crawford sees "change coming quickly. It's so important that telehealth for physical therapy becomes a reimbursable service. It's going to take our community of PTs and patients to use their voices" to ensure that it does.

    Move Forward Radio is hosted at ChoosePT.com, APTA's official consumer information website, and can be streamed online or downloaded as a podcast via the Apple Podcast app, Google Play, or Spotify. Other recent additions to the Move Forward Radio podcast library include:

    Latest Relief Package: Unemployment Provisions

    The CARES Act signed into law on March 27 is aimed at providing relief in a wide range of areas in response to the COVID-19 pandemic. Here's what the package offers related to unemployment benefits.

    [Editor's note: APTA welcomes comments and questions posted to PT in Motion News stories, but we cannot answer individual questions about unemployment benefits. Please visit the links listed at the bottom of this story to find answers to your questions about current unemployment provisions.]

     The recently enacted CARES Act aimed at providing relief during the COVID-19 pandemic contains some important provisions related to unemployment that include relaxing some of the qualifications to receive benefits, allowing for circumstances specifically related to the pandemic, and adding $600 to weekly benefit checks.

    Called the Pandemic Unemployment Assistance Program, the new provisions allow for financial assistance to individuals who wouldn't ordinarily receive unemployment benefits, such as the self-employed, independent contractors, part-time workers, and those who have already finished their unemployment benefits. This new offering is effective January 27 through December 31, 2020.

    To receive the benefit, individuals in categories that normally wouldn't qualify for benefits must prove that they can no longer work due to activity related to COVID-19. Examples include:

    • Diagnosis of COVID-19, a COVID-19 diagnosis of a member of the household, or providing care for a member of the household who has been diagnosed with COVID-19.
    • Primary caregiving responsibility for a family member who is unable to attend school or another facility that has been closed due to the national emergency.
    • Inability to work because of a quarantine imposed by the national emergency or self-quarantine advised by a health care provider.
    • Inability to begin recently gained employment or being forced to end employment as a direct result of the national emergency.

    In addition to the expanded range of individuals who may qualify for unemployment benefits, the program adds $600 per week to regular unemployment benefits for up to 39 weeks. The additional money will be provided to everyone receiving unemployment benefits.

    Individuals able to telework or receive paid sick leave are ineligible for the program. If a state has a defined workshare program or short-time compensation, the CARES Act provides additional funding to keep employees working on a reduced-hours schedule and receive prorated unemployment benefits.

    For more information visit the U.S. Department of Labor website, which includes an unemployment benefits finder by state and information on unemployment insurance relief during the COVID-19 pandemic.

    Aetna Now Covers Telehealth Delivered by PTs

    Aetna joins UnitedHealthcare among the commercial insurers that have expanded coverage from more limited e-visit provisions.

    UPDATE (April 3): Aetna has advised that telehealth services delivered by physical therapists may be billed on a UB04 using the modifier GT or 95. Please contact advocacy@apta.org with any issues or questions associated with this billing.

    Private insurer Aetna announced that it will now cover a range of services delivered by PTs through telehealth—a significant expansion of its earlier COVID-19-related policy that limited coverage to e-visits. The change comes after APTA engaged in collaborative work with the company to rethink its temporary benefits policy.

    The insurer, officially known as CVS Health/Aetna, will cover the telehealth-based delivery of the services and procedures by PTs for CPT codes 97161, 97162, 97163, 97164, 97110, 97112, 97116, 97535, 97755, 97760, and 97761. The telehealth care must be provided as a two-way synchronous (real-time) audiovisual service. Providers are required to append the GT modifier to the codes. Aetna's expansion follows a similar move by UnitedHealthcare.

    Aetna will also continue its policy that reimburses PTs for the provision of e-visits, virtual check-ins, and telephone services. The use of the GT or 95 modifier is not required for e-visit CPT codes (98970, 98971, 98972), the store-and-forward code (G2010), virtual check-in codes (G2012), and telephone assessment CPT codes (98966, 98967, 98968). Visit Aetna's provider website and follow instructions for accessing detailed policy information on the provider portal.

    Check out APTA’s frequently updated telehealth webpage for the latest information on payer and regulatory changes.

    Coronavirus Update: April 1, 2020

    CMS moves toward telehealth for physical therapy, FCC announces telehealth initiative, new resources available for physical therapy educators, and more.

    Practice Guidance

    March 31: CMS Rule Includes Therapy Codes in Telehealth, But Stops Short of Allowing PTs to Conduct Telehealth Services
    Rule changes recently announced by CMS in response to the COVID-19 pandemic add codes commonly associated with therapy to those that may be delivered through telehealth, but CMS has made no related changes to allow PTs, occupational therapists, and speech-language pathologists to actually provide services through telehealth.

    The apparent contradiction may be partly because the new rules were written prior to the passage of the CARES Act last week — the $2 trillion COVID-19 relief package that granted CMS the authority to use waivers to expand the range of providers permitted to conduct services through telehealth. To date, CMS has not extended telehealth authority to PTs, OTs, and SLPs. But with coding rules now in place, such an expansion would be easier to implement quickly. APTA is pursuing the CMS disconnect.

    March 31: Joint Commission Statement Supports Provider Use of Personal Face Masks From Home
    The commission issued a statement supporting the use of standard face masks and/or respirators provided from home when health care organizations cannot provide access to protective equipment that is commensurate with the risk that health care workers are exposed to amid the COVID-19 pandemic.

    Telehealth

    March 30: FCC Announces $200 Million Plan for Telehealth
    The Federal Communications Commission announced a COVID-19 Telehealth Program to support health care providers responding to the ongoing coronavirus pandemic. As part of the CARES Act, Congress appropriated $200 million to the FCC to support health care providers’ use of telehealth services in combating the COVID-19 pandemic. If adopted by the commission, the program would help eligible health care providers purchase telecommunications, broadband connectivity, and devices necessary for providing telehealth services.

    Physical Therapy Education

    March 31: American Council of Academic Physical Therapy Establishes Collaboration Center
    A new offering from ACAPT offers possibilities for open-source resource sharing and communication among the clinical education community.

    Advocacy

    March 31: Tell Congress That Improvements in Telehealth, Reimbursement Should be Part of Pandemic Response
    The COVID-19 relief package signed into law last week wasn't the last word on temporary changes that could help blunt the impact of the pandemic: There's another package being worked on in Congress right now, and the physical therapy community needs to make its voice heard. Visit a dedicated page in the APTA legislative action center to quickly contact your lawmakers and remind them to help the profession respond to the pandemic by establishing telehealth for PTs and addressing reimbursement reductions.

    Research

    March 30: Case Fatality Rate for COVID-19 Near 1.4 Percent, Increases With Age
    A new study published in The Lancet shows that both hospitalization and fatality rates in patients with COVID-19 are higher in older patients. In an analysis of patient data from inside and outside of China, researchers estimated that it takes 17.8 days on average from onset of symptoms until death, and 24.7 days until hospital discharge. The fatality rate in China was 1.38%, but substantially higher in patients older than 60 years of age and as high as 13.4% among those aged 80 years and up.

    March 13: PubMed Central Provides Links to Open-Access COVID-19-Related Research
    The online archive is providing links to all research that has been designated as open-access by various publishers.

    In the Media

    March 31: U.S. Stockpile of PPE Nearly Gone
    From Reuters: "An emergency stockpile of medical equipment maintained by the U.S. government has nearly run out of protective gear that could be useful to combat the coronavirus pandemic, according to two officials with the U.S. Department of Homeland Security."

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

    Latest Relief Package: Options for Small Businesses

    The CARES Act signed into law on March 27 is aimed at providing relief in a wide range of areas in response to the COVID-19 pandemic. Here's what the package offers to small businesses.

    The federal government has acknowledged that small businesses may be especially hard hit by the COVID-19 pandemic and has responded by establishing provisions aimed at lessening some of the impact. The latest measure, known as the CARES Act, includes some of the most extensive small business relief to date. Here's an overview of the small business-related relief provisions in the CARES Act.

    Details on these provisions, as well as on other pandemic-related resources, are available from the U.S. Small Business Administration, the U.S. Chamber of Commerce, the U.S. Department of the Treasury, and the Internal Revenue Service.

    Paycheck Protection Program Loans
    The legislation creates the Paycheck Protection Program, a new loan product within the Small Business Administration’s 7(a) Loan Program. Existing and new SBA lenders will be able offer these loans to eligible small businesses.

    The new loan, with an interest rate of up to 4%, will be 100% guaranteed by the SBA. Funds may cover payroll costs, including continuation of group health care benefits during periods of paid sick, medical, or family leave, and insurance premiums; employee salaries and commissions; payments of interest on any mortgage obligation, rent, and utilities; and interest on any other debt obligation incurred before February 15, 2020.

    Businesses and charitable nonprofits with fewer than 500 employees, sole proprietors, independent contractors, and self-employed individuals are eligible for the loans.

    A business can borrow up to 2.5 times the average monthly payroll based on the business’s prior year’s payroll, capped at $10 million. All borrower and lender fees for Paycheck Protection loans will be waived, as well as collateral requirements, the Credit Elsewhere Test, and all requirements for personal guarantees. Deferrals of principal, interest, and fees for six months will be built into the loans.

    Emergency Economic Injury Grants
    The CARES Act allows $10,000 of SBA economic injury disaster loans (EIDLs) to be provided to small businesses and nonprofits without a requirement for repayment. EIDLs are loans of up to $2 million that carry interest rates up to 3.75% for companies and up to 2.75% for nonprofits, as well as principal and interest deferment for up to four years. The loans may be used to pay for expenses that could have been met had the disaster not occurred, including payroll, paid sick leave to employees, increased production costs due to supply chain disruptions, and business obligations, including debts, rent and mortgage payments.

    The $10,000 grant portion of an EIDL does not need to be repaid, even if the grantee is subsequently denied an EIDL for amounts beyond the $10,000. Eligible grant recipients must have been in operation on January 31, 2020. The grant is available to small businesses, private nonprofits, sole proprietors and independent contractors, tribal businesses, as well as cooperatives and employee-owned businesses.

    Loan Forgiveness
    The relief package establishes that the borrower of an SBA loan is eligible for loan forgiveness equal to the amount spent by the borrower on payroll costs, interest payment on any mortgage incurred prior to February 15, 2020, payment of rent on any lease in force prior to February 15, 2020, and payment on any utility for which service began before February 15, 2020. The loan forgiveness period extends to eight weeks after the origination date of the loan.

    Debt Relief for Existing and New SBA Borrowers
    The stimulus package includes $17 billion to provide immediate relief to small businesses through standard SBA 7(a), 504, or microloans. Under this provision, SBA will cover 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 six months after March 27, 2020.

    The measure also encourages banks to provide further relief to small business borrowers by allowing them to extend the duration of existing loans beyond existing limits, and enables small business lenders to provide a temporary extension on certain reporting requirements for new and existing borrowers. While SBA borrowers are receiving the six months of debt relief, they also may apply for a Paycheck Protection Program loan that provides capital to keep their employees on the job. Borrowers may not apply the six months of SBA payment relief to Paycheck Protection loan payments.

    Employee Retention Credit for Employers Subject to Closure due to COVID-19
    The CARES Act provides a refundable payroll tax credit for 50% of wages paid by employers during the COVID-19 crisis. The credit is available to employers whose operations were fully or partially suspended due to a COVID-19-related shut-down order, or whose gross receipts declined by more than 50% compared with the same quarter in the prior year.

    For employers with greater than 100 full-time employees, the credit is based on wages paid to employees while they are not providing services due to the COVID-19-related circumstances described above. For eligible employers with 100 or fewer full-time employees, all employee wages qualify for the credit, whether the employer is open for business or subject to a shut-down order. The credit is provided for the first $10,000 of compensation, including health benefits, paid to an eligible employee between March 13, 2020, and December 31, 2020.

    Delay of Payment of Employer Payroll Taxes
    The stimulus package allows employers and self-employed individuals to defer payment of the employer share of the Social Security tax on employee wages. The provision allows for half of the amount to be paid by December 31, 2021, and the other half by December 31, 2022.

    Modification of Limitation on Losses for Taxpayers Other Than Corporations
    This provision of the act modifies the loss limitation applicable to pass-through businesses and sole proprietors, so they can use excess business losses to access critical cash flow.

    Modification of Limitation on Business Interest
    The relief legislation temporarily increases the amount of interest expense businesses are allowed to deduct on their tax returns from 30% to 50% of taxable income (with adjustments) for 2019 and 2020. This provision allows businesses to increase liquidity with a reduced cost of capital.

    Modifications for Net Operating Losses
    Net operating losses are typically subject to a taxable income limitation, and they cannot be carried back to reduce income in a prior tax year. The legislation allows a net operating loss arising in a tax year beginning in 2018, 2019, or 2020 to be carried back five years. The provision also temporarily removes the taxable income limitation to allow an NOL to fully offset income. These changes will allow companies to amend prior year returns to take advantage of operating losses.

    APTA Wants To Hear From You About Your COVID-19 Experiences

    Are you on the frontlines of the COVID-19 pandemic? APTA would like to hear from PTs, PTAs, and students about their experiences.

    The COVID-19 pandemic continues to change lives in dramatic ways, with more to come even after the crisis ends. APTA wants to know how you're doing.

    For example:

    • How are you meeting the needs of your patients under current conditions?
    • Are you volunteering to make a difference in your community?
    • Are you transitioning to or retraining for a new setting?
    • What challenges are you overcoming in your clinic or facility that are specific to your setting or patient population?
    • What advice would you give to other PTs facing similar challenges?

    “APTA is committed to helping all PTs, PTAs, and students navigate this crisis," says Heidi Kosakowski, PT, DPT, APTA senior practice specialist. "One PT’s experience could help another in their decision-making process — and help APTA elevate the collective voice of our members.”

    If you would like to share your story, you can submit via APTA Engage. Responses may be published in APTA publications or on APTA's website.

    APTA House of Delegates Packet Posted

    The online resource provides information on 41 motions, including seven proposed amendments to the APTA bylaws.

    APTA members can now access the first official packet of motions that will be considered by the 2020 APTA House of Delegates (House) when it convenes June 1-3, 2020.

    Called "Packet 1," the compilation contains 41 motions to the 2020 House of Delegates and is provided as the official notice of all motions. In May, “Packet I” will be replaced with a document titled “Packet I With Background Papers,” which will also include background papers on various motions.

    There are seven bylaws amendments that are coming before the 2020 House of Delegates. These amendments are:

    • RC 1-20 Amend: Bylaws of the American Physical Therapy Association to Grant Life Members the Privilege of Serving as Delegates to the House of Delegates
    • RC 2-20 Amend: Bylaws of the American Physical Therapy Association, Article IX. Finance, Section 3: Dues
    • RC 3-20 Amend: Bylaws of the American Physical Therapy Association and Standing Rules of the American Physical Therapy Association to Change the Date That National Elected Leaders Assume Office
    • RC 4-20 Amend: Bylaws of the American Physical Therapy Association and Standing Rules of the American Physical Therapy Association to Allow a Public Member to Serve on the APTA Board of Directors
    • RC 5-20 Amend: Bylaws of the American Physical Therapy Association, Article XIV. Amendments
    • RC 6-20 Amend: Bylaws of the American Physical Therapy Association to Allow Sections to Vote in the House of Delegates
    • RC 7-20 Amend: Bylaw Amendment and Standing Rule Amendment to Restructure APTA Board of Directors by Removing the Officers of the House of Delegates

    Due to the COVID-19 pandemic, the 2020 House of Delegates will be conducted in a virtual format over the scheduled June 1-3 dates. APTA will share additional information with delegates as it becomes available via the House of Delegates online hub.

    Delegates should continue using the Motions Discussion forum in the House of Delegates online hub to participate in discussion.

    Contact APTA’s Justin Lini with any questions.

    APTA Wants Your Physical Activity Videos

    A new project will collect and share videos that help Americans remain physically active during social distancing and isolation.

    APTA is seeking physical therapists willing to record video of themselves leading exercises specific to their area of practice or clinical expertise that can be safely and easily done at home.

    Approved videos will be posted to ChoosePT.com, APTA’s official consumer information website, and shared on our social media platforms geared toward consumers. Last year, ChoosePT.com attracted nearly 4 million unique visitors.

    Participants can choose to create either a 20-minute video featuring a series of exercises, or several shorter videos featuring one exercise (with possible modifications for various fitness levels). Check out this video, produced by APTA member Megan Brown, PT, DPT, for ChoosePT.com for an example.

    "The goal is to encourage Americans to keep moving while they are at home following the CDC’s guidelines to prevent the further spread of COVID-19," said Jason Bellamy, APTA's executive vice president of strategic communications. "This is also an opportunity to help APTA raise awareness about physical therapists’ roles as movement experts and to connect the public with ChoosePT.com, where visitors can learn about the value of physical therapy and find a PT in their area."

    Interested? Let us know through this dedicated page on APTA Engage, the association's online center for volunteer opportunities. APTA staff will follow up with instructions for recording your video.