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  • Coronavirus Update: March 27, 2020

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

    Practice Guidance

    March 27: COVID Stimulus Package Includes Payment Increase, Opens Telehealth Possibility
    An increase to Medicare payment, temporary relief for some student loans, the potential expansion of telehealth allowances, and help for small businesses are among the provisions that are especially relevant for physical therapy.

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

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

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

    From CDC

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

    In the Media

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

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

    COVID Stimulus Package Includes Payment Increase, Opens Possibility of Increased Telehealth, More

    An increase to Medicare payment, temporary relief for some student loans, the potential expansion of telehealth allowances, and help for small businesses are among the provisions that are especially relevant for physical therapy.

    The $2 trillion stimulus package passed by Congress and signed into law by President Trump is comprehensive in its scope, and includes everything from sending direct payments to many individual Americans to some $32 billion in grants to airlines and airports. [Editor's note: check out these articles from National Public Radio and Axios for good summaries of the entire package]

    The legislation also includes provisions that may be of particular interest to PTs, PTAs, physical therapy students, and physical therapy patients.

    Medicare payment will increase.
    Normally, mandatory across-the-board cuts in federal spending enacted into law, known as sequestration, would require Medicare to reduce payments to providers by 2%. The stimulus temporarily lifts that reduction from May 1 through December 31, 2020. The effect: increased payments to PTs, hospitals, home health, and other care. The legislation also prevents scheduled reductions in Medicare payments for durable medical equipment through the length of the COVID-19 emergency period.

    Telehealth could expand under Medicare (if HHS can be convinced to do it).
    The package gives the Secretary of the Department of Health and Human Services the authority to waive restrictions on telehealth for providers, including PTs, who aren't currently allowed to provide and bill for telehealth services to Medicare beneficiaries. So far, that waiver hasn't happened, and APTA is urging its members and stakeholders to join a grassroots effort to press for the change.(Note that while CMS has approved the use of "e-visits" by PTs, that's a limited type of digital communication and not same as telehealth.)

    Federal student loan borrowers will be able to defer payments, and employers can offer repayment benefits tax-free.
    Payments on federal student loans can be deferred through September 30, 2020, with no accrual of interest during that period. Additionally, the stimulus allows employers to contribute up to $5,250 annually toward an employee's student loans without the benefit being taxed as employee income. The employer provision applies to any employer payments made between now and January 1, 2021.

    Providers able to order home health services now include PAs, NPs, and CNSs, potentially reducing delays in care.
    Until now, only physicians were able to certify the need for home health services. The legislation allows physician assistants, nurse practitioners, and clinical nurse specialists to order home health services for beneficiaries, reducing delays and increasing beneficiary access to care in the safety of their home.

    New loans are available to small businesses, along with payroll tax credits to boost employee retention and a deferment of Social Security tax payments.
    The stimulus creates a new type of loan through the Small Business Administration that could help to cover payroll costs (including health care), rent, utilities, and other debt obligations, at a 4% interest rate. Businesses and 501(c)(3) organizations with fewer than 500 employees are eligible, as are sole proprietors, independent contractors, and self-employed individuals.

    Some employers will also be able to take advantage of a refundable payroll tax credit for 50% of wages paid by employers to employees during the COVID-19 crisis. The offer is limited to employers whose operations were fully or partially suspended due to the pandemic, or whose gross receipts declined by more than 50% compared with the same quarter of 2019.

    The package also offers a payroll tax deferment. Employers (and the self-employed) are also able to defer payment of the employer share of the Social Security tax. The provision requires that the deferred employment tax be paid over the following two years, with half of the amount required to be paid by December 31, 2021, and the other half by December 31, 2022.

    Small businesses can receive grants and may be able to get limited debt relief on SBA loans.
    Small businesses and nonprofits that apply for an SBA economic injury disaster loan could receive an advance of $10,000 within three days of applying for the loan. Additionally, the stimulus includes $17 billion to provide immediate relief to small businesses with standard SBA 7(a), 504, or microloans, with the SBA covering all loan payments for existing SBA borrowers, including principal, interest, and fees, for six months. This relief will also be available to new borrowers who take out an SBA loan within the next six months.

    Transfers from acute care hospitals to IRFs will be easier.
    During the emergency period, acute care hospitals can transfer patients to inpatient rehabilitation facilities more easily, thanks to a waiver of the requirement that patients must participate in at least three hours of intensive rehabilitation at least 5 days a week in order to be admitted to the IRF.

    Higher education will get some relief, too.
    The legislation makes $14.2 billion available to higher education institutions to prevent, prepare for, and respond to the pandemic. The funds can be used to defray expenses associated with lost revenue, technology costs of transitioning to distance education, and providing grants to students for food, housing, course materials, and technology.

    APTA Vice President of Government Affairs Justin Elliott said that this package, though the largest, is actually the third set of relief measures enacted. And there's more to come.

    “Work has already begun on a fourth legislative relief a package that we expect will be considered by Congress in April," Elliott said. "APTA will continue to advocate for provisions that will help physical therapists, physical therapist assistants, physical therapy students, and the patients they serve.”

    UnitedHealthcare Allows Telehealth for Physical Therapy

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

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

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

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

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

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

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

    Coronavirus Update: March 26, 2020

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

    Practice Guidance

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

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

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

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

    From U.S. Department of Health and Human Services

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

    In the Media

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

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

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

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

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

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

    Among the recommendations:

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

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

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

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

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

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

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

    Coronavirus Update: March 25, 2020

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

    Practice Guidance

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

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

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

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

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

    From Health and Human Services

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

    From the Department of Labor

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

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

    APTA Components Step up to the COVID-19 Challenge With Ever-Growing Resources

    From helping physical therapy faculty move their courses online to conducting a webinar on providing acute care physical therapy during a pandemic, association chapters and sections are keeping the profession informed and creating an impressive array of tools.

     

    "We are going through this, day by day, doing our best to make a positive impact on society in a moment in time when there are no easy solutions."

    That's how APTA President Sharon Dunn, PT, PhD, described the physical therapy community's response to the COVID-19 pandemic. And APTA's components — its sections, academies, and chapters — as well as its councils and academic groups, have been taking on the challenge by offering resources informed by their particular perspectives and expertise.

    Here's a roundup of just some of what's available so far from APTA components.

    [Editor's note: offerings from these and other APTA components are growing by the day — APTA's Chapters and Sections webpage provides direct links to all component websites.]

    American Council of Academic Physical Therapy's COVID-19 Response Webpage
    ACAPT's webpage collects a wealth of information, both from the council and related organizations including APTA, with a focus on online and distance learning. The place to go for lots of great information from individual universities and faculty members.

    APTA Colorado: Coronavirus Information for Providers
    The regularly updated site from APTA Colorado includes key information from local public health agencies, small business resources, and opportunities to volunteer. Another recent addition: a slide deck from a presentation on physical therapist practice and mechanical ventilation.

    APTA Geriatrics Webinar: Resources for Teaching Online Geriatric Content
    This webinar, which was held March 19 but is now available as a recording, is targeted at PTs and PTAs in academic programs who teach geriatric content and are interested in resources and strategies for delivering this content online. Topics include how to continue with labs and practicals, as well as online test-taking.

    California Physical Therapy Association: COVID-19 Webpage
    The California Chapter provides a mix of information specific to California and more general resources and guidance, including a recorded webinar on social distancing and APTA resources on telehealth. Upcoming: a March 26 virtual meeting, "Telehealth: Moving Digital Practice Forward in Physical Therapy."

    HPA The Catalyst: COVID-19 Updates and Resources
    APTA's component focused on health policy administration offers a COVID-19 webpage featuring an in-depth set of questions and answers related to telehealth and physical therapy, as well as links to a source for free access to an on-demand patient record retrieval service and a compiled listing of audio and video telecommunications services, an excel file that helps you sort out telehealth and e-visit vendors that may be a good fit for your practice.

    APTA Academy of Pediatric Physical Therapy: COVID-19 Updates
    The Academy's website has been reconfigured with a focus on COVID-19 and includes regular updates. Special features on the site: a multi-resource update on providing pediatric physical therapy via telehealth, and updates on the status of the Individuals with Disabilities Education Act—IDEA—as various legislative relief packages are being worked out on Capitol Hill.

    APTA Private Practice Section: Critical Resources for Managing Your Business During the COVID-19 Pandemic
    The Private Practice Section's extensive resources include frequently updated information on telehealth, plus perspectives on topics including cash flow modeling, paid sick leave, and making determinations around what is and isn't "essential care." The section has also created a special open-access issue of its Impact magazine solely devoted to COVID-19.

    APTA Rhode Island: Updates Regarding COVID-19
    The Rhode Island Chapter's COVID-19 page is arranged in an easy-to-follow format that divides regularly updated content into various buckets: telehealth, APTA statements, outpatient practice resources, school-based physical therapy resources, and more. Latest additions include resources on home care, with a section on care for the elderly coming in the near future.

    FiRST Council Telehealth Discussion Board
    Since its inception, APTA's Frontiers in Rehabilitation, Science, and Technology Council has been at the forefront of the conversation around telehealth in physical therapy. Its discussion board remains the go-to for insight and illuminating exchanges on what has become a crucial topic.

    Academy of Acute Care Physical Therapy and HPA, The Catalyst webinar: Acute Care Physical Therapy and COVID-19 — How Can We Add the Greatest Value?
    The APTA sections focused on acute care and health policy joined forces to deliver a March 19 webinar, now available as a recording that takes a close look at how to provide the best care in hospitals in light of the COVID-19 pandemic. Topics include managing and triaging physical therapy resources, caring for the critically ill, physical therapy in the ED and more. The slide presentation from the webinar is also available for download.

    Know of more component resources to share? Post them to APTA's Component Leaders discussion page or share them in the comments below.

    HHS to States: Ease State Laws and Regs Now

    The Department of Health and Human Services says that federal waivers can only go so far, and calls on states to quickly act to relax licensure, telehealth, and other requirements that may impede an effective response to the COVID-19 pandemic.

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

    In a March 24 letter to U.S. state governors, HHS Secretary Alexander Azar wrote that the requests are being made "to carry outa whole-America response to the COVID-19 pandemic," adding that "your help is needed to ensure health professionals maximize their scopes of practice and are able to travel across state lines or provide telemedicine to their communities or where they are needed most."

    While the federal government has initiated modifications of some Medicare, Medicaid, and CHiP requirements under so-called 1135 waivers, HHS explains that those exceptions only go so far: states still hold the cards when it comes to much of what providers can and can't do as part of the response to the pandemic. That's why HHS is urging states to take action.

    Among the HHS recommendations:

    Exceptions to various licensure requirements. HHS is calling on states to, among other actions, waive licensing fees, allow for free temporary licenses, and suspend disciplinary actions for certain licensure violations that prevent licensed providers from providing treatment.

    Telemedicine provisions. States should "waive statutes and regulations mandating telehealth modalities and/or practice standards not necessary for the application standard of care to establish a patient-provider relationship, diagnose, and deliver treatment recommendations utilizing telehealth technologies."

    Scope-of-practice waivers. HHS calls for easing scope-of-practice restrictions around supervision, collaboration, and disciplinary enforcement.

    Malpractice liability assistance. States should "provide guidance on liability protections available to health care professionals" that include :volunteers, services provided through telehealth, and services associated with expanded scopes of practice" during the emergency, according to HHS, which recommends that states work with state insurance commissioners to "modify or temporarily rescind any provision … issued in our state that may prevent insurance coverage of a health care professional's work."

    "I do not want state variations in liability protections to confuse or deter health professionals in this COVID-19 emergency," Azar writes. "I also ask that you take quick action to expand the flexibilities offered in this time of emergency by waiving restrictions such as state licensure, scope of practice, certification and recertification requirements."

    Coronavirus Update: March 24, 2020

    APTA joins effort for stepped up NPE response by Congress; new template letter for telehealth; wound care considered "essential," and more.

    Practice Guidance

    March 24: APTA Joins Push for PPE, More Consistent Recommendations for Use
    A letter endorsed by 19 health care professional organizations not only urges Congress to step up efforts to supply providers with PPE, but to get CDC and other agencies on the same science-based page, and to take steps to ensure that shortages won't happen again.

    "We need proper support to care for patients safely and effectively," the letter states. "This includes clear, evidence-based protocols and highest level of protection in order to care for infected individuals as well as prevent the spread of the coronavirus in health care facilities and the community. Congress and the Administration must exhaust every option available to increase PPE production and prioritize distribution to frontline providers and health care facilities."

    March 24: New Coalition Connects Health Care Organizations With PPE Suppliers
    The PPE Coalition and the US Digital Response Team are collaborating on Project N95, connecting personal protective equipment manufacturers with state and local governments and health care providers and institutions who submit a request. According to their website, they hope to have millions of units available for distribution within the coming weeks.

    March 24: APTA Offers Template Letter to CMS Advocating for Telehealth for PTs, PTAs
    APTA has developed a template letter for you to use in advocating to CMS for Medicare coverage of telehealth furnished by PTs and PTAs to ensure that patients continue to have access to the rehabilitative care they need amid the COVID-19 pandemic. Instructions are included at the top of the letter.

    March 24: Multiprofessional Group Including APTA Says Wound Care Is an Essential Activity
    The Alliance of Wound Care Stakeholders, a group that includes APTA, the American Association of Nurse Practitioners, the Amputee Coalition, and others, issued a statement countering hospital decisions to shut down outpatient-based wound care departments as "non-essential" during the coronavirus pandemic.

    "Nonhealing wounds, left untreated and unmanaged, can result in significant medical issues including infection, sepsis, the need for limb amputation, and even death," according to the statement. "As a result many procedures provided by wound clinics are essential — not elective — to protect the health of patients and prevent an escalation of their disease."

    From the CDC

    March 23: CDC Study on Cruise Ship COVID Transmissions Finds Virus Present on Surfaces 17 Days After Last Contact
    Testing on the Diamond Princess, the Grand Princess, and other ships found SARS-CoV-2 present on some surfaces after passengers — some asymptomatic — had vacated the ship 17 days earlier.

    From CMS

    March 23: CMS Approves Medicaid Waivers in 11 States
    Alabama, Arizona, California, Illinois, Louisiana, Mississippi, New Hampshire, New Jersey, New Mexico, North Carolina, and Virginia have received section 1135 waivers on a range of requirements including prior authorization, provider enrollment, public notice mandates, and fair hearing request timelines.

    In the Media

    Health Care, Tech, Nonprofits Collaborate in COVID-19 Response
    A group of high-tech firms, large health care systems, nonprofits, and others are partnering to utilize data analytics to evaluate the effectiveness of community mitigation efforts, identify at-risk populations who need diagnostic testing, and optimize health care delivery and supply chain operations.

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

    APTA Joins Push for PPE, More Consistent Use Recommendations

    A letter endorsed by 19 health care professional organizations not only urges Congress to step up efforts to supply providers with PPE, but to get CDC and other agencies on the same science-based page, and to take steps to ensure that shortages won't happen again.

    The federal government needs to not only do more to ensure that personal protection equipment is available to all health care workers, it needs to do a better job of providing consistent science-based advice on the use of PPE: That's the message APTA and 18 other health care professional organizations sent to Capitol Hill as the COVID-19 pandemic triggers shortages of crucial protective supplies.

    In a March 20 letter to the U.S. House of Representatives and the U.S. Senate, APTA and other organizations including the American Nurses Association, the American Academy of Physician Assistants, the American Association of Nurse Practitioners, and the American Occupational Therapy Association urged legislators to take steps to "ensure that personal protection equipment … is available to all health care systems, facilities, and providers to ensure safe working environments during the current COVID-19 pandemic and any future crisis."

    The letter doesn't simply address supply shortages, however. The organizations also press for "more definitive and aligned statements from the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) about the transmission of coronavirus." Right now, the letter states, "the recent guidelines from both agencies differ on what masks or respirators are needed for health care providers."

    "Before any new guidance is released, the appropriate agency must have clear scientific evidence that the change in standards is proven to keep clinicians and their patients safe," the letter states, adding that "we urge Congress to include language in the next supplemental package to ensure the CDC communicates to the public the data-driven transmission science behind this decision."

    In addition for increased PPE availability and more consistent, science-based usage recommendations, the organizations also press for a list of additional actions by Congress, including mandating that a sustainable inventory of PPE be maintained at the Strategic National Stockpile, requiring that the Department of Health and Human Services develop better reporting rules around PPE use, and commissioning studies from the Government Accountability Office to review "root causes" of the current shortages as well as worldwide supply chain issues that could be improved in anticipation of future pandemics.

    According to Justin Elliott, APTA vice president of government affairs, the PPE letter is just one piece of the association's advocacy efforts around the coronavirus pandemic. Other efforts include grassroots communication efforts to increase telehealth opportunities for PTs and PTAs, and a push to press Congress for additional relief to physical therapy providers and patients.

    "In these extraordinary times, we need to not just react to current challenges but also be forward-thinking, looking at every possible avenue to ensure safety," Elliott said. "PPE is certainly one key element, but we're also keenly aware of opportunities to reduce transmission risk through new ways of thinking about providing care, including via telehealth. At the same time, we need to anticipate the potential harm this crisis could do to clinicians' livelihoods."

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