Many issues surrounding the COVID-19 pandemic — such as those related to practice closings, use and billing of telehealth or e-visits, and safety precautions — aren't different between physical therapist services provided to adults and those provided to children and youth. For information about general issues regarding practice, billing, and payment, APTA's coronavirus and telehealth webpages include numerous resources to answer your questions, and the association updates them frequently.
As in day-to-day practice, however, physical therapist services to the pediatric population may have special considerations during this health crisis. APTA has put together this information for PTs and PTAs who manage these patients, particularly in school settings.
School Closings and IEP Services
The U.S. Department of Education Office of Special Education Programs has stated that if a local education authority closes school for the general education population, they are not required to continue to provide services to students with disabilities during the same period.
If your school district is requiring you continue to provide services, follow their guidance on best practices on how to deliver those services. Reimbursement will be dependent on the school district.
Concerning school re-openings and resumption of IEP services, OSEP has stated that an IEP Team, and, as appropriate to the student, the personnel responsible for ensuring free appropriate public education to a student for the purposes of Section 504, would be required to make an individualized determination as to whether compensatory services are needed under applicable standards and requirements.
This means the IEP Team should be at the table when determining what, if any, compensatory services are due.
Remote Learning and IEP Services
OSEP has stated that if a school district continues to provide educational opportunities to the general student population during a school closure, the school must ensure that students with disabilities also have equal access to the same opportunities, including the provision of free appropriate public education. IEP teams may, but are not required to, include distance learning plans in a child's IEP that could be triggered and implemented during a selective closure due to a situation such as the current COVID-19 outbreak. Such contingencies may include provision of special education and related services at an alternate location, or provision of online or virtual instruction, instructional telephone calls, and other curriculum-based instructional activities. They also may identify which special education and related services, if any, could be provided at the child's home.
You're expected to use your ethical and clinical reasoning to determine if telehealth services are appropriate for a student, based on your assessment of that student. Considerations may include but are not limited to:
Your competence in providing telehealth service.
The complexity of the student's needs and disability.
The nature and complexity of the planned intervention.
The requirements of school-based practice.
Appropriate qualification and/or training for an onsite e-helper.
Consensus of the IEP team, student, family, and e-helper.
Your competence and fluidity with technology, as well as the competency of the student, parent(s) and other family or caregiver(s), and the e-helper.
Student-specific information, the student's environment, and context.
Compliance with laws, regulation, and policy at the federal, state, and local levels.
The Council of Administrators for Special Education (CASE) has recommended that special education providers focus on certain priorities when navigating the COVID-19 crisis rather than seeking a clear-cut answer to questions about rules and regulations. These priorities include: putting the safety and welfare of students, staff, and community first; delivering services to as many students as you reasonably can in the best way you know how; providing thorough documentation; and making good faith efforts to comply with IDEA. Your students can't wait for federal, state, and local governments to issue guidance on every possible scenario, so use your clinical judgment and document what you did and why you did it.
As for equipment you might need to provide distance-learning services, such as video conferencing software, make sure it is HIPAA-compliant. Despite recent guidance from the Office of Civil Rights that it would exercise its enforcement discretion and waive potential penalties for HIPAA violations when providers use "everyday communications technologies" during the COVID-19 pandemic, you have an ethical obligation to ensure the privacy and confidentiality of the students receiving your services. Consider the potential legal and ethical implications if confidentiality and privacy are not maintained. APTA's Health Policy & Administration Section has posted a listing of vendors that provide audio and video telecommunications technologies. Because information was compiled solely from information on the vendors' websites, contact each potential vendor to confirm their information.
Additional APTA Resources
As part of our advocacy efforts, we have compiled research studies on telehealth (.pdf) and testimonials from APTA members on how they have balanced in-person and telehealth visits.