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  • Summer Reading: 8 Great APTA Blog Posts You Might've Missed

    Graduations, vacations, family reunions, binge-watching season 3 of "Stranger Things"…it's entirely understandable if you've been a little distracted over the past few months.

    Not to worry—PT in Motion News can help, when it comes to catching up on some engaging reads. While you were out dominating the Slip 'n Slide, contributors to both the #PTTransforms and APTA Pulse Blog were exploring a range of issues, from the personal to the societal.

    Wondering what you missed? Here are quotes from 8 notable posts, with links to the articles.

    "It's the path we take when we embrace the idea that every day deserves our heartfelt best effort—not just to live that day to the fullest but to shape the future more than it shapes us. Because we want to pay it forward. Because we demand that we leave something better than we had for ourselves." -2019 Presidential Address  

    "Many black professionals have been conditioned to mask parts of their natural selves in order to avoid exclusion from professional and academic opportunities, whether in school or in a career setting." -Pressure: A Commentary on the Black Physical Therapy Student Experience  

    "When [patients] leave the hospital, they're weaker and more likely to have a fall at home. This is an unintended consequence of falls regulation and misaligned incentives." -'Bedrest is Bad': New #everyBODYmoves Campaign Is Combatting Hospital Immobility  

    "Sometimes we need to take a step back and look at things from above the ground and see that one therapist over here seems to be getting patients a little bit better, a little bit quicker… The data that the Registry will collect will help us better direct patient care, as well as identify continuing education needs." -Notes From the Field: MIPS, Quality Improvement, and the Physical Therapy Outcomes Registry  

    "After having my first academic year and clinical rotation under my belt, I sought to shift gears and get back into what made me the most happy: involvement. I decided to extend myself beyond the classroom by applying for a leadership position in my state's student special interest group." -Why Doing More Than Studying Made Me a Better Student  

    "When conducting focus groups in medically underserved communities in Chicago about residents' knowledge and use of physical therapy, my colleague and I heard several things. Two statements in particular stuck with me: 'Physical therapy is for the rich and famous,' and, 'Why don't you put a physical therapy clinic in our community?'" -Our Profession Should Be Community-Minded—and Community-Invested  

    "A few days later my grade was posted. I nonchalantly logged into the grading portal to find a 65%. Was I seriously that bad at this whole physical therapist thing? Am I just walking through life overly confident in my abilities?" -I Don't Care About My Grades  

    "Witnessing the patient's request and partaking in his end-of-life directive really forced me to contemplate and consider our physical therapist scope of practice and our role in complex situations." -Reflecting and Coping With End-of-Life Care: A Student Perspective

    Proposed Home Health Rule Moves Ahead With New Payment System, Allows Therapist Assistants to Furnish Maintenance Therapy

    The US Centers for Medicare and Medicaid Services (CMS) intends to go full steam ahead with its plans to shift to a new payment system for home health beginning in 2020. The plans are accompanied by other changes that include allowing maintenance therapy to be furnished by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs), providing a payment "add on" for rural home health care, and adopting an APTA-supported "notice of admission" requirement to avoid duplicate billing. The new provisions, which include a 1.3% payment increase, are included in CMS’ proposed rule released on July 11.

    The biggest shift has been more than a year in the making: a transition to a new payment system known as the Patient-Driven Groupings Model (PDGM). The PDGM moves care from 60-day to 30-day episodes and eliminates therapy service-use thresholds from case-mix parameters. Instead, the system classifies 30-day care episodes according to a set of 5 major buckets and subsets within those buckets. Patients are assigned a status within the 5 major areas, and within some of those areas they can be assigned to more detailed clinical categories—the combination of categories assigned to a patient generates a particular case-mix grouping. APTA offers extensive information on the new system and will participate in a live August 5 webinar on the model jointly hosted by APTA, CMS, the American Occupational Therapy Association, and the American Speech-Language-Hearing Association. APTA members can participate in this webinar (free to APTA members, login required APTA members can participate in this webinar).

    But that's not all in the proposed rule (.pdf). CMS also plans to allow PTAs and OTAs to perform maintenance therapy services under a maintenance program established by a qualified therapist, as long as the services fall within scopes of practice in state licensure laws. In addition to supervising the services provided by the therapist assistant, the qualified therapist still would be responsible for the initial assessment; plan of care; maintenance program development and modifications; and reassessment every 30 days. CMS believes the change would bring home health in line with other care settings and give home health agencies (HHAs) more latitude in how they allocate resources.

    The rule also would phase out the split payment approach that requires HHAs to submit a Request for Anticipated Payment (RAP) at the beginning of the initial episode for 60% of the anticipated final claim payment amount. A final bill for the remaining 40% is submitted at the end of the 60-day episode. RAP submissions are operationally significant, as they establish the beneficiary’s primary HHA by alerting the claims processing system that the beneficiary is under a home health plan of care and home health services are subject to consolidated billing, meaning Medicare makes payment for all home health items and services to the single HHA overseeing the plan of care.

    Instead, CMS proposes requiring HHAs to submit a notice of admission to alert the claims processing arm of CMS that a beneficiary is under a home health episode of care. The new system is a direct result of APTA advocacy, which was fueled by members in private practice settings who shared data with the association to help APTA make its case. The change will be phased in next year and fully implemented in 2021.

    APTA and its members successfully argued that the split percentage approach is fraught with logistical inefficiencies that often result in confusion for CMS and therapy providers in outpatient settings. The proposal to replace the RAP with the notice of admission, to be submitted within 5 days of the start of care, would be needed to establish the primary HHA so the claims processing system would be alerted to a home health period of care, helping to eliminate the possibility of any lag time between a beneficiary's admission in home health and the HHA's notice of the admission to CMS. This too-common delay trips up outpatient providers who begin treatment (and billing) before CMS knows that the beneficiary has transitioned to home health. CMS describes the change as "an important step in paying responsibly and appropriately for home health services," according to an agency fact sheet on the proposed rule.

    As for payment, home health would see an overall 1.3% boost—about $250 million. The increase, initially targeted at 1.5% to comply with the Bipartisan Budget Act of 2018, was decreased by .2% to accommodate a rural add-on policy.

    Among other elements of the proposed rule:

    SPADE requirements are expanding. CMS is continuing its efforts to increase the range of standardized patient assessment data (SPADE) reported by HHAs. The use of SPADE in home health was instituted to bring HHAs up to speed with provisions of the 2014 IMPACT Act, a law that mandated more uniformity in reporting across postacute care settings. The proposed rule would follow through with the expansions, but it also includes requirements for reporting on cognitive function and mental status, comorbidities, and social determinants of health, among other categories. HHAs would be required to report these additional elements beginning in 2022 for admissions and discharges that occur between January 1 and June 30, 2021.

    A pain measure would be discontinued. Partially in response to concerns about the potential for overprescription of opioids, CMS is proposing to remove the Improvement in Pain Interfering with Activity Measure (NQF #0177) from the Home Health Quality Reporting Program (HH QRP) beginning in 2022. Under this proposal, HHAs would no longer be required to submit OASIS Item M1242, "Frequency of Pain Interfering with Patient’s Activity or Movement" for quality reporting purposes beginning in 2021.

    A pain-related question would be deleted from patient surveys. CMS proposes to remove a patient survey question that asks whether the patient and provider talked about pain in the past 2 months. The question, currently in the "Special Care Issues" composite measure, would be dropped beginning July 1, 2020. Similar to the pain measure being proposed for deletion, the survey question is being eliminated due to concerns about the ways it might influence unnecessary drug prescriptions. The changes are consistent with an earlier CMS decision to eliminate pain-related items from hospital patient surveys.

    APTA continues to review the proposed rule and will provide comments to CMS by the September 9 deadline. In the coming weeks, APTA also will post a unique template letter on its Regulatory Take Action webpage for individuals to use to submit their own comments on the proposed rule.

    APTA-Backed Bill to Provide Diversity-Based Scholarships, Stipends Introduced in House

    APTA's efforts to create a physical therapy profession as diverse as the society it serves could be getting a significant legislative boost: a new bill introduced in the US House of Representatives seeks to provide $5 million per year in scholarships and stipends aimed at increasing the number of students from underrepresented populations in physical therapy and other allied health education programs.

    Introduced by Reps Bobby Rush (IL) and Cathy McMorris Rogers (WA), the Allied Health Workforce Diversity Act of 2019 would set aside money in the Health Resources and Services Administration specifically for use by accredited education programs in physical therapy, occupational therapy, audiology, and speech-language pathology. Those programs would in turn issue scholarships or stipends to students from underrepresented populations including racial or ethnic minorities and students from disadvantaged backgrounds including economic status and disability. APTA, the American Occupational Therapy Association (AOTA), the American Speech-Language-Hearing Association (ASHA), and the American Academy of Audiology (AAA) were instrumental in crafting language for the bill.

    The legislation falls squarely in line with APTA's strategic plan, which identifies greater provider diversity as necessary to ensure the long-term sustainability of the physical therapy profession.

    "We must build a diverse profession by ensuring there are opportunities that allow for inclusion of all individuals who want to become physical therapists and physical therapist assistants," said APTA President Sharon Dunn, PT, PhD, in a joint news release issued by APTA, AOTA, ASHA, and AAA. "The population we serve is evolving and becoming more diverse. We know that patients who receive care from providers who share their racial and ethnic backgrounds tend to respond better to treatment. That's one reason this legislation is so important, and we applaud the representatives who have introduced it."

    APTA government affairs staff will track the bill's progress and share opportunities for grassroots advocacy. The association will add information to its Legislative Action Center later this week for members to use to support the legislation.

    Survey of PTs Reveals 'Significantly Inadequate' Rates of BP and HR Measurement

    Despite the frequency with which physical therapists (PTs) in outpatient settings encounter patients who have or are at risk for cardiovascular disease (CVD), rates of blood pressure (BP) and heart rate (HR) screening remain "significantly inadequate," say authors of a new study based on a nationwide survey of PTs. The survey reveals that only 14.8% of respondents reported measuring BP and HR on initial examination of new patients, and sheds some light on factors that influence the tendency to perform the screens—or forgo them.

    The analysis, published in the July issue of PTJ (Physical Therapy), is based on survey responses from 1,812 PTs who worked in outpatient settings and were members of the APTA Academy of Orthopaedic Physical Therapy at the time of the survey. The survey was administered online and consisted of 30 multiple-choice questions that delved into CVD-risk screening behaviors and related rationales as well as demographics and education background of the respondents, and patient characteristics.

    The results showed that although 51% of PTs reported that at least half of their current caseload included patients with or at moderate-to-severe risk of developing CVD—and 28% reported that more than 50% of their patients were in this category—only 14.8% said that BP and HR screenings were a regular part of their initial examination of a new patient. When researchers dug deeper into the results, they uncovered other interesting details, including:

    • Nearly 7 in 10 PTs (68.9%) said they encountered a new patient with or at risk for CVD at least twice a week, and 29% said they encountered this kind of new patient daily.
    • In terms of how frequently BP and HR were measured at the initial visit, 63.74% of the respondents reported doing the measurements less than 50% of the time; 39.8% said they conducted the screenings less than 25% of the time; and 13% responded by saying that they never measured BP or HR.
    • The most commonly reported barriers to BP and HR screening were lack of time (37.44%) and "lack of perceived importance" (35.62%). Most respondents reported that they were adequately equipped to perform routine screening and felt confident in their ability to do so.
    • When it came to factors that were linked to more frequent BP and HR measurements, respondents with higher percentages of patients with or at risk for CVD tended to perform the screenings more often, as did PTs who had completed a residency or fellowship training program, and clinicians with more than 20 years of practice experience. Possessing a board-certified specialization credential of any kind was not linked with increased likelihood of conducting the screenings.

    Authors of the PTJ article describe the results as "surprising," particularly given the typical respondent caseload and the PTs' apparent confidence in their ability to perform BP and HR screenings. They write that current rates, while better than in the past, are still "significantly inadequate in relation to the high rates of CVD risk factors present in the patient population."

    As for what might be done to improve the rates, the researchers point to the link between postprofessional education (specifically, residencies and fellowships) and increased screening as one promising possibility, but they also stress other avenues for increasing clinician knowledge, such as wider use of social media to "improve clinician knowledge and practice patterns." Clinics could make a difference as well, they add, by changing policy to emphasize the importance of initial BP and HR measurements.

    APTA members Richard Severin, PT, DPT, PhD(c); Adam Wielechowski, PT, DPT; and Shane Phillips, PT, PhD, were among the authors of the study. Severin is a board-certified cardiopulmonary clinical specialist; Wielechowski is a board-certified specialist in orthopaedic physical therapy.

    [Editor's note: for an exploration of the importance of blood pressure screening and the role of PTs, check out this #PTTransforms blog post that discusses the impact of changes made to blood pressure guidelines in 2018.]

    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.

    JAMA Neurology: Telerehab Program Works as Well as Clinic-Based Program for Improved Arm Function Poststroke

    It's probably not news to physical therapists (PTs) when research backs up the idea that patients who experience arm impairments poststroke will tend to make greater functional improvements with larger and longer doses of rehabilitation. Unfortunately, PTs are also familiar with the fact that what's optimal isn't necessarily what's typical, with challenges such as payment systems, logistics, and clinic access making it difficult to achieve the best possible results. That's where telerehabilitation could make a big difference, say authors of a new study that found an entirely remotely delivered rehab program to be as effective as an equal amount of clinic-based sessions.

    The findings lend further support to the ideas behind APTA's efforts to increase telehealth opportunities for PTs and their patients—a significant component of the association's current public policy priorities. In addition, APTA provides multiple telehealth resources on a webpage devoted to the topic, and has created the Frontiers in Research, Science, and Technology Council that provides interested members and other stakeholders with an online community to discuss technology's role in physical therapy.

    The study, published in JAMA Neurology (abstract only available for free), involved 124 participants who experienced arm motor deficits poststroke. All participants were enrolled in a rehabilitation therapy program that included 36 70-minute treatment sessions, half of which were supervised, over a 6- to 8-week period. The only major difference: one group's supervised sessions were face-to-face with a physical therapist (PT) or occupational therapist (OT), while the other group received telerehab from a PT or OT via a computer with video capabilities, accompanied by the use of a gaming system.

    Researchers were interested in finding out how patients fared in each approach, using scores from the Fugl Meyer (FM) assessment of motor recovery poststroke as their primary measure. Authors of the study also measured patient adherence with therapy as well as levels of patient motivation related to how well they liked the therapy they were receiving and their degree of dedication to treatment goals.

    Using a treatment approach "based on an upper-extremity task-specific training manual and Accelerated Skill Acquisition Program," researchers set up matched programs that included at least 15 minutes per session of arm exercises from a common set of 88 possible exercises, at least 15 minutes of functional training, and 5 minutes of stroke education. The clinic-based participants received in-person instruction on the exercises and used "standard exercise hardware"; the telerehab patients received instructions via video link and engaged in functional exercise via a videogame interface. Here's what the researchers found:

    • Both groups improved at about the same rate, with the telerehab participants averaging a 7.86 FM gain, compared with an average gain of 8.36 points for the clinic-based group.
    • Improvements were also about the same for the subgroup of participants who entered rehabilitation more than 90 days poststroke, with these "late" participants averaging a 6.6-point gain for the telerehab group and a 7.4-point increase for the clinic-based group.
    • While both groups reported high levels of dedication to treatment goals, the clinic-based group tended to report better levels of motivation and satisfaction. Adherence was also high for both groups, with a 93.4% adherence rate for the clinic-based group and a rate of 98.3% for the telerehab group.
    • Both groups increased their knowledge of stroke at similar rates.

    As for the technical details of the telerehab sessions, the system included a computer linked to the internet, a table, a chair, and 12 "gaming input devices." Keyboards were not necessary. The supervised sessions began with a 30-minute videoconference between the patient and therapist, and the functional training games used were designed to match the functional task work being done with the clinic-based participants. Unsupervised sessions adhered to the same content but didn't include contact with the therapist.

    "In an era when prescribed doses of poststroke rehabilitation therapy are declining, adversely affecting patient outcomes, these and prior findings suggest that outcomes could be improved for many patients…if larger doses of rehabilitation therapy were prescribed," authors write. "Our study found that a 6-week course of daily home-based [telerehab] is safe, is rated favorably by patients, is associated with excellent treatment adherence, and produces substantial gains in arm function that were not inferior to dose-matched interventions delivered in the clinic."

    Authors acknowledged that patient satisfaction with telerehab might be improved by increasing the amount of time spent with the therapist—providing that therapist is properly trained. "Current results underscore the importance of maintaining a licensed therapist's involvement during [telerehab]," they write.

    Ultimately, it's still too early to determine just how generalizable the findings are to other populations and conditions, the researchers say, but all indicators seem to point to the need for increasing the availability of telerehab and its inclusion in health plans.

    "The US Bipartisan Budget Act of 2018 expanded telehealth benefits," authors write. "Eventually, home-based [telerehab] may plan an ascendant role for improving patient outcomes."

    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.

    From PT in Motion Magazine: Social Determinants of Health

    Health care is one thing. But the context of that care, the constellation of factors that can affect health for individuals and entire communities? That's something else entirely—and physical therapists (PTs), physical therapist assistants (PTAs), and physical therapy education programs are engaged.

    Now available in the July issue of PT in Motion magazine: "Addressing Social Determinants of Health," an exploration of the ways the physical therapy profession is responding to the concept that improving the health of society demands providers, researchers, educators, and policymakers get involved with the economic, environmental, and behavioral factors that can shape health. These factors, broadly referred to as social determinants of health (SDOH), can seem overwhelmingly systemic, but that isn't stopping some APTA members from taking them on in a variety of creative, impactful ways.

    The article shares the work of several PT-led organizations, including Move Together, which works to provide physical therapy infrastructure to areas in need (among other programs); Mama LLC, a physical therapy consulting service focused on improving women’s health domestically and internationally; and the Arlington, Virginia, Free Clinic, led by Nancy White, PT, DPT, which has embraced SDOH-conscious practices in its programs. Author Christine Lehmann also looks at SDOH-related research being performed by PTs, as well as the ways physical therapy education is responding to the concept.

    As the article explains, SDOH can include cultural and economic variables, but other factors such as the built environment and climate change can even come into play. At the same time, the concept also calls for PTs and PTAs to change their day-to-day approach to working with patients by considering—and acknowledging—the realities of a patient's environment, from micro to macro.

    "Addressing Social Determinants of Health," featured in the July issue of PT in Motion magazine, is open to all viewers—pass it along to nonmember colleagues to show them 1 of the benefits of belonging to APTA. Also open to all: "Looking at Physical Therapy Holistically," an article on how PTs are addressing both the body and mind in treatment, and "Providing Onsite Physical Therapist Services," a look at PTs who bring their services to patients.

    APTA, AOTA, ASHA Create Guide to Assess Habilitative, Rehabilitative Insurance Benefits

    Insurers' habilitation and rehabilitation benefits come in all shapes and sizes—which is exactly the problem, according to APTA, the American Occupational Therapy Association (AOTA), and the American-Speech-Language-Hearing Association (ASHA). That's why the 3 organizations collaborated on a guide to assessing benefit adequacy that emphasizes transparency, access, and affordability throughout benefit plans that can be all over the map.

    The guide, available on APTA's Essential Health Benefits webpage, forgoes offering a laundry list of specific benefits in favor of establishing a set of principles that the associations believe lead to appropriate coverage of habilitative and rehabilitative services. Those principles are rooted in the idea that the benefits are necessary not just to improve function but also to maintain it, and that physical therapy, occupational therapy, and speech-language pathology are the "key" services in any habilitation/rehabilitation benefit package. The collaborative document echoes many of the themes included in APTA's public policy priorities, which emphasize increased patient access, cost and coverage transparency, and use of telehealth in service delivery.

    The resource addresses how best to ensure adequate scope of coverage and access, appropriate provider qualifications, and essential benefit information needed for consumers to determine if a plan meets their needs. It also provides tips and recommendations for consumers as well as plan providers and policymakers.

    However, the guide isn't just a collection of broad statements—APTA, AOTA, and ASHA also dig into some specifics when it comes to adequate habilitation and rehabilitation coverage, including:

    • Using the definition of habilitative and rehabilitative services adopted by the US Department of Health and Human Services
    • Creating separate rather than combined visit limits for physical therapy, occupational therapy, and speech-language pathology
    • Ensuring direct access to all 3 therapies
    • Providing clear information to consumers on whether benefits can be delayed due to utilization management practices, whether telehealth is permitted, and if same-day physical therapy, occupational therapy, and speech-language pathology services are allowed

    As for recommendations for plan improvements, the 3 organizations offer 14 ideas they believe would advance "optimum value" and increase patient access to therapy services. Those suggestions include wider use of telehealth, recognition of the role of therapy providers in population and preventive health, ending policies that limit coverage of each therapy discipline to 1 condition, and stronger acknowledgement that "rehabilitative maintenance therapy and habilitative services are allowed for individuals with chronic, progressive conditions…to prevent further deterioration of function."

    APTA Members Can Now Get $175 Off MedBridge Subscription

    MedBridge, a leading provider of health care continuing education, is now a part of APTA's Member Value Program (MVP). That's good news for APTA members, who can now save $175 off the regular $375 subscription to the company's extensive list of offerings.

    The addition of MedBridge allows APTA to expand the range of educational resources offered to its physical therapist (PT), physical therapist assistant (PTA), and student members by opening up discounted access to more than 1,000 MedBridge-sponsored video courses and live webinars. For more information, APTA's MedBridge discount webpage.

    "This offering increases the value of APTA membership and supports our members in their ongoing commitment to provide the best possible care,” said APTA CEO Justin Moore, PT, DPT.

    APTA's Member Value Program provides discounts and other opportunities for APTA members, in addition to standard member benefits. To maximize the value of membership, visit the APTA Member Benefits and Value page.

    APTA Survey: PTs Say Administrative Burdens Delay Access, Affect Clinical Outcomes

    Think that administrative burdens are hurting your ability to provide the best possible care? You're not alone: results of a recent APTA survey of physical therapists (PTs) nationwide reveal that nearly 3 in 4 believe that overreaching documentation and administrative mandates negatively affect patient outcomes—and 8 in 10 point to excessive requirements as a contributor to clinician burnout.

    The results are now part of an infographic that helps with the association’s efforts for legislative and policy changes to rein in excessive requirements around areas including prior authorization and claim denial appeals. Among the findings:

    Prior authorization requirements delay care and affect clinical outcomes.

    • Three quarters of respondents said that prior authorization requirements delay access to medically necessary care by 25% or more.
    • 72% of survey participants estimated that they wait at least 3 days for a prior authorization decision from an insurer.
    • Just over 1 in 4 respondents said that the wait time is usually more than a week.
    • Approximately 3 in 4 PTs agreed or strongly agreed that prior authorization requirements negatively impact patients' clinical outcomes.

    Claim denial appeals are time-consuming (and often contradictory).

    • 40% of respondents told APTA that payers who say they don't require prior authorization later deny approximately 25% of claims for lack of prior authorization.
    • 65% of PTs said that it takes more than 30 minutes of staff time to prepare an appeal for 1 claim.
    • When it comes to rates of claim denials, appeals, and final dispensation, respondents estimated that 13% of filed claims are denied; of that 13%, 66% are appealed. And in the end just over half of the appeals—52.34%—are overturned.

    Administrative burden is adding to cost—and burnout.

    • The survey revealed that large percentages of both front desk staff and clinicians spend more than 10 minutes per patient requesting approval for continued visits, ranging from 64.6% of clinicians working with Medicaid fee-for-service beneficiaries, to 77.3% of front desk staff requesting continued visits for Medicaid managed care patients.
    • More than three-quarters of facilities—76.5%—reported that they've had to add nonclinical staff to handle administrative burden.
    • 85.2% of respondents agree or strongly agree that administrative burden contributes to clinician burnout.

    As for what changes would make the most difference, just over half of respondents believe that standardizing documentation requirements would be a big help. Other popular adjustments were elimination of the requirement for the Medicare plan of care signature and recertification (38.8%), standardization of coverage policies across payers (38.1%), unrestricted direct access (36.1%), and standardization of the prior authorization process (36%).

    "APTA has long argued that excessive administrative burden negatively impacts care—what's important about this survey is the consistency of responses and the level of shared perception among PTs who experience this issue every day," said Kara Gainer, APTA director of regulatory affairs. "Administrative burden isn't a nebulous issue for providers—it is a very real barrier to delivering care, with identifiable pain points and very specific areas in need of change."

    The association continues to place the reduction of administrative burdens high on its advocacy list and has again identified the issue as among it 2019-2021 public policy priorities. One recent opportunity: a request for information (RFI) from the US Centers for Medicare and Medicaid Services (CMS) on reducing administrative burden. APTA will provide comments by the August 12 deadline and has made it easy for individual clinicians to submit comments by way of a template letter that can be personalized to suit specific circumstances. APTA is also developing a template letter that can be used by patients and will post a link to it on the association's regulatory "take action" webpage.

    At the same time, a legislative advocacy opportunity emerged in the form of a congressional bill aimed at improving access to health care for older Americans through, among things, reducing administrative burdens on providers. Known as the "Improving Seniors' Timely Access to Care Act of 2019," (H.R. 3107), the bill was introduced into the US House of Representatives by Reps Suzan DelBene (WA), Mike Kelly (PA), Roger Marshall (KS), and Ami Bera (CA). APTA staff will add information to the Legislative Action Center in the coming weeks for members to use to advocate in support of this legislation.

    “Current prior-authorization programs hinder patient access to medically necessary services and must be modified,” said Katy Neas, APTA executive vice president for public affairs. "But this is just 1 element of the wider administrative burden issue, and APTA will continue to advocate for change on multiple fronts."

    Expanded Health Reimbursement Arrangement Rule May Widen Use of the Employer Offering

    A final rule from the US Department of Health and Human Services (HHS) will expand small employers' ability to offer Health Reimbursement Arrangements (HRAs), a change that may make it easier for more Americans to purchase health insurance that they don't receive from their jobs. While it's still too early to tell if the change will significantly impact patients seen by physical therapists (PTs), APTA's advice is to keep an eye open, and be aware of the nuances of HRA payment.

    The new rule, set to go into effect January 1, 2020, will allow qualified small employers to offer what's being called an "Individual Coverage HRA" as an alternative to traditional group coverage plans. The idea behind HRAs is that employers provide a monthly tax-free allowance to employees, who can be reimbursed for health care-related expenses up to the allowance limit. The changes set to go into effect next year would permit HRAs to be used to pay for health insurance purchased on the individual market, and allow employers to offer "excepted benefit" HRAs to supplement employer-sponsored insurance—even if the employee isn't enrolled in the group plan.

    HHS believes that the change will open up coverage options for more than 11 million employees and family members and increase insurance portability, according to an HHS press release. APTA submitted comments to the proposed rule that largely supported the changes, but recommended that any individual health insurance paid via an HRA must be a policy deemed compliant with the Affordable Care Act. The final rule supports APTA's position.

    Those numbers are just estimates, however, and there's no way of knowing just how the use of HRAs will shake out next year, said Kate Gilliard, APTA regulatory affairs senior specialist.

    "PTs need to understand that these HRAs will be out there, and that whether the patient can use the HRA for copays depends on how it's set up with the employer," Gilliard said. "Some HRAs are only good for premium payments, so we're advising our members to verify the details of a patient's HRA. If it's found appropriate for use, the HRA can be processed just like a health savings account or flexible spending account."

    APTA regulatory affairs staff will monitor rollout of the rule and share new information in PT in Motion News and elsewhere.