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

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

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

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

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

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

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

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

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

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

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

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

    New CMS Nursing Home Recommendations Stress Collaboration, Consistent Staffing Assignment

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

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

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

    The recommendations address five major areas:

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

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

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

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

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

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

    APTA Learning Center Offers Free Online Courses

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

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

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

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

    Courses include:

    Live Online Telehealth Webinar

    Recorded Webinars on Telehealth


    Self-Paced Courses on Other Topics

    From ChoosePT.com: Telehealth, Now More Than Ever

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

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

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

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

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

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

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