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  • 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."