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  • APTA, Other Organizations, Will Share Anti-Opioid Efforts

    There may be just about as many approaches to battling the opioid crisis as there are organizations committed to the fight—but now APTA and more than 100 other groups will be sharing experiences and learning from each other by way of a collaborative effort led by the National Academy of Medicine (NAM).

    The exchange of information is being managed through NAM's Action Collaborative on Countering the US Opioid Epidemic. The group includes community organizations, hospitals, nonprofit organizations, health professional societies, private insurers, and academia, all of which have committed to sharing their work and goals to counter the opioid epidemic through efforts that address prescribing guidelines, prevention, treatment, research, policies,and data, among other areas. Along with APTA, the more than 100 participants include the American Association of Colleges of Nursing, the American Pharmacists Association, Kaiser Permanente, and the Mayo Clinic.

    APTA has plenty to share. In addition to its award-winning #ChoosePT opioid awareness campaign, the association produced a white paper, hosted a Facebook Live event, sponsored a media tour, established an opioid and pain management resource on PTNow, and helped to develop a crossdisciplinary "playbook" on opioid stewardship—and that was just in 2018. APTA's efforts date back to 2016, when it unveiled #ChoosePT as the official campaign to educate the public on physical therapy as an effective nonopioid and nondrug option in the treatment of chronic pain.

    In APTA's statement of commitment to the collaborative, the association writes that "physical therapy providers intimately know that physical activity reduces risk of chronic conditions, many of which include pain," adding that "pain is personal, and treating it takes teamwork, including the membership and empowerment of the person being treated."

    "It is imperative in the fight against the opioid epidemic that everyone plays a role in not only the successful treatment of pain but the culture of pain," said Hadiya Green Guerrero, PT, DPT, APTA senior practice specialist. "Care providers must commit to utilizing each other’s expertise, including in the areas of educational and interprofessional training. APTA is eager to bring its perspective on preventing and treating pain to the table, and to learn from so many other organizations that share our commitment to ending the devastation of opioid misuse and addiction."

    NAM President Victor Dzau agrees that collaboration is the key to making a real difference.

    "Reversing the opioid epidemic requires a multi-sectoral response—no organization, agency, or sector can solve this problem on its own," Dzau said in an NAM press release. "We are thrilled to see such a robust commitment from organizations across the country in joining us to be part of the solution."

    This isn't APTA's only connection with NAM—the association is also a member of the Academy's Action Collaborative on Clinician Well-Being and Resilience.

    5 Ways to Get Up to Speed on Interprofessional Health Care in Education and Practice

    Working across health care disciplines isn't a pipe dream: it's an increasingly important fact of professional life for physical therapists (PTs) and physical therapists assistants (PTAs). And physical therapy education programs are helping future PTs and PTAs respond to this reality by adapting curricula to respond to an increasingly collaborative health care environment.

    In honor of National Interprofessional Health Care month, APTA has refreshed its resources on interprofessional practice and education, offering a range of perspectives on the topic. From research papers to PT in Motion magazine feature articles, there's a little something for everyone.

    Don't know where to start? Here's a basic roadmap for getting yourself familiar with the issue, all drawn from the APTA Interprofessional Education and Collaborative Practice Resources webpage.

    1. Get an understanding of what interprofessionalism takes.
    APTA and many other professional health care organizations anchor their approach to interprofessional education and practice in the core competencies developed by the Interprofessional Education Collaborative (IPEC). IPEC developed a document that clearly lays out 4 main competencies and related sub-competencies that are necessary for success.

    2. Find out how you're doing.
    Understanding the skills needed to be effective in interprofessional behaviors isn't the same thing as actually engaging in those behaviors. This assessment instrument from the Interprofessional Professionalism Collaborative can help you get a clearer view of the extent to which you live out interprofessional values in your day-to-day work.

    3. Keep up with the latest developments.
    The National Academies of Practice (NAP) is a leader in the promotion of interprofessional health care and home to the Journal of Interprofessional Education & Practice. Find out what's happening across disciplines, and visit individual academies member microsites—including 1 for physical therapy.

    4. Dive deeper into physical therapy's role in interprofessional practice.
    The National Interprofessional Education Consortium (NIPEC), sponsored by the American Council of Academic Physical Therapy (ACAPT), is designed as a resource for faculty at ACAPT member institutions; however, NIPEC's website contains plenty of information available to everyone, including assessments, development resources, and webinars—all specifically aimed at how physical therapy integrates with crossdisciplinary collaboration.

    5. Explore how the next generation of PTs and PTAs are being prepared for interprofessionalism.
    Physical therapy education programs are taking creative steps to hone the crossdisciplinary collaboration skills of their students. ThisPT in Motion magazine article describes how PT and PTA students are working with, and benefitting from, students and clinicians from other professions both in the classroom and in their clinical internships.

    Congressional Roundup: What's on APTA's Legislative Advocacy Radar

    Believe it or not, there's much more going on in Washington, DC, than the stuff that becomes fodder for late-night talkshow hosts. Important legislation is being considered, and APTA and its members are there to advocate for changes that help the physical therapy profession's ability to deliver patient-centered care, and improve patient care overall.

    Here's a roundup of recent federal legislative activity on APTA's radar.

    Better coverage for kids under Medicaid is now law.
    On April 18, President Donald Trump signed a law that includes APTA-supported provisions to expand a state option for health homes for children under Medicaid. That particular provision, known as the Advancing Care for Exceptional (ACE) Kids Act of 2019, is included the Medicaid Services Investment and Accountability Act of 2019 signed by Trump.

    The ACE Kids Act addresses existing challenges facing children with medically complex conditions by expanding access to patient-centered, pediatric-focused coordinated care models tailored for these children across multiple providers and services, and by easing access to out-of-state care.

    The legislation builds off of current law to establish specially designed health homes for children with medically complex conditions beginning Oct. 1, 2022. Participation is voluntary for children and their families, providers and states; however, states that opt to create these health homes will receive a higher federal matching rate for 6 months.

    The broader legislative package also provides $20 million for the Money Follows the Person demonstration for fiscal 2019. The demonstration is aimed at transitioning Medicaid beneficiaries from facilities to community-based long-term support services.

    A bill to end the physician self-referral loophole under Medicare is back.
    Reps Jackie Speier (D-CA) and Dina Titus (D-NV) have introduced a bill, known as the Promoting Integrity in Medicare Act (PIMA) of 2019 (HR 2143), that seeks to close Medicare self-referral loopholes for physicians. That loophole allows physicians to refer Medicare patients for physical therapy and other services to a business that has a financial relationship with the referring provider, a gap that has been a target of APTA advocacy efforts for several years.

    The proposed legislation would tighten up self-referral prohibitions under federal law (known as the “Stark Law”) to remove physical therapy, advanced imaging, radiation oncology, and anatomic pathology from the so-called "in-office ancillary services" exception. And it's not without supporters: in addition to APTA's advocacy for the change, previous versions of PIMA have received support from AARP and the Alliance for Integrity in Medicare, a coalition that includes APTA. The 2019 PIMA has been referred to the House Energy and Commerce Committee as well as the Ways and Means Committee.

    Student debt relief options are being considered again.
    It's back: APTA-supported legislation that would list PTs among the professions included in a federal program to provide greater patient access to health care in rural and underserved areas has been reintroduced in the Senate. If passed into law, the program could open up access to a student loan repayment program for participating PTs—and help address the nation's opioid crisis in areas that have been especially hard-hit.

    The bill (S.970) would allow PTs to participate in the National Health Service Corps (NHSC) loan repayment program, an initiative that repays up to $50,000 in outstanding student loans to certain health care professionals who agree to work for at least 2 years in a designated Health Professional Shortage Area (HPSA). An estimated 11.4 million Americans are served by the NHSC. The bill was introduced by Sens John Tester (D-MT), Roger Wicker (R-MS), and Angus King (I-ME).

    And that's not all—by a long shot.
    APTA's government affairs staff is tracking and speaking out in support of multiple pieces of legislation at various stages of consideration, all of which are consistent with the association's recently adopted public policy priorities.. [Editor's note: want to know how you can get involved in advocacy? Be sure to sign up for APTA’s PTeam, a vital grassroots link to APTA's work on Capitol Hill. All PTeam members receive a quarterly newsletter on legislative activity on Capitol Hill as well as Legislative Action Alerts on federal legislative issues. The alerts let you know when you to contact your members of Congress on particular issues of concern to your patients and the physical therapy profession.]

    These include:

    IDEA Full Funding Act (HR 1878/S 866). This bill would increase spending over the next decade to bring the federal share of funding for special education up to 40%, the amount committed when the law was first enacted in 1975.

    Critical Access Hospital Relief Act of 2019 (HR 1041/S 586). This legislation repeals the 96-hour physician certification requirement for inpatient critical access hospital services under Medicare.

    Lymphedema Treatment Act (HR 1948/S518). The bill provides for the coverage of lymphedema compression treatment items under Medicare.

    Disability Integration Act of 2019 (HR 555/S 117). The proposal would prohibit discrimination against individuals with disabilities who need long-term services and supports.

    Home Health Payment Innovation Act of 2019 (S 433). The bill would require Medicare to implement adjustments to home health reimbursement rates only after behavioral changes by home health agencies that affect Medicare spending actually occur, instead of assuming changes might happen.

    Community and Public Health Programs Extension Act (S 192) This bill provides funding extensions for community health centers and the National Health Service Corps through 2024.

    Improving Access to Medicare Coverage Act of 2019 (HR 1682/S 753). The proposal would define an individual receiving outpatient observation services in a hospital as an inpatient for purposes of satisfying the 3-day inpatient hospital-stay requirement related to Medicare coverage of skilled nursing facility services.

    PHIT Act of 2019 (HR 1679/S 680). The PHIT (Personal Health Investment Today) Act would allow a medical care tax deduction for up to $1,000 ($2,000 for a joint return or a head of household) of qualified sports and fitness expenses per year. The bill defines "qualified sports and fitness expenses" as amounts paid exclusively for the sole purpose of participating in a physical activity, including fitness facility memberships, physical exercise or activity programs, and equipment for a physical exercise or activity program.

    Concussion Awareness and Education Act of 2019 (HR 280). This legislation provides for research and dissemination of information on sports-related and other concussions, and establishes a Concussion Research Commission.

    Mobile Health Record Act of 2019 (HR 1390) This bill requires CMS to establish a program that enables Medicare enrollees to connect claims data with "trusted applications, services, and research programs." The program must allow an enrollee to access claim information through a mobile health record application that is chosen by the enrollee and approved by CMS.

    Geriatrics Workforce Improvement Act (S 299). The proposed law would reauthorize the Geriatric Workforce Enhancement Program (GWEP), which provides grants to geriatric education centers to educate and train health care professionals in the care and treatment of older people. The bill would extend the GWEP for another 5 years, with authorized funding increased to $45 million per year.

    Home Health Care Planning Improvement Act of 2019 (HR 2150/S 296). This proposal would allow Medicare payment for home health services ordered by a nurse practitioner, a clinical nurse specialist, a certified nurse-midwife, or a physician assistant. Currently, coverage is provided only for services ordered by a physician.

    Rural Hospital Regulatory Relief Act of 2019 (S 895). The bill would create a permanent extension of instructions issued by CMS to not enforce the supervision requirements for therapeutic services provided to outpatients in Critical Access Hospitals and small rural hospitals. Those instructions are set to expire on December 31, 2019.

    Veterans' Access to Child Care Act (HR 840). This bill would provide child care assistance to veterans receiving certain medical services and includes a provision to include Deparmtnet of Veterans Affairs-provided physical therapy for a service-connected disability.

    Protecting Access to Complex Rehab Manual Wheelchairs Act (HR 2293). This proposal would permanently exempt complex rehab manual wheelchairs from the Medicare Competitive Bidding Program and also would stop Medicare from applying competitive bidding payment rates to critical components (accessories) of complex rehab manual wheelchairs for 18 months.

    There's more to come.
    APTA is awaiting introduction of key legislation later this summer that would expand the use of telehealth under Medicare to include physical therapy, and a bill that would add PTs as primary health care providers in community health centers. To receive information and legislative action alerts, sign up for PTeam today and download the APTA Action App on your mobile phone.

    APTA President Sharon Dunn Named Dean of LSU Shreveport's School of Allied Health Professions

    APTA President Sharon Dunn, PT, PhD, can now add another achievement to an already lengthy list: Dean of School of Allied Health Professions at Louisiana State University (LSU) Shreveport.

    On April 23, LSU Shreveport announced that Dunn will take over the reins at the school, which includes the Department of Rehabilitation Science (physical therapy, occupational therapy, speech-language pathology and postprofessional residencies) and the Department of Clinical Sciences (cardiopulmonary science, medical laboratory science, and the physician assistant program). The school is also responsible for a children's center, a rehabilitation faculty clinic, and the Mollie E. Webb speech and hearing center.

    The current chair of LSU Shreveport's Department of Rehabilitation Science, Dunn, a board-certified clinical specialist in orthopaedic physical therapy, has been on faculty at the university's school of allied health for 24 years. She served in multiple roles in the school, including program director of the DPT program for 15 years and director of the LSUHSC Orthopaedic Physical Therapy Residency Program, where she was instrumental in developing and gaining program accreditation. Dunn became president of APTA in 2015 and was reelected to the position in 2018.

    Dunn received her bachelor of science degree in physical therapy followed by a master’s in health sciences from the School of Allied Health Professions in Shreveport. She obtained her PhD, cellular biology, and anatomy at the School of Graduate Studies at LSU Health Shreveport.

    "It is gratifying that one of our own faculty members, Dr Sharon Dunn, has been selected as the Dean of the School of Allied Health Professions. Dr Dunn brings a strong clinical and administrative background with a clear vision for the future," stated LSU Health Shreveport Chancellor G. E. Ghali, DDS, MD, in an APTA news release.

    APTA Chief Executive Officer Justin Moore, PT, DPT, believes LSU Shreveport couldn't have made a better choice.

    "Sharon has been a tireless advocate for the profession, the highest standards of health care, and patients' rights everywhere," Moore said. "Her kindness, passion, commitment, and dedication have been an inspiration to me. She is an outstanding colleague and, more importantly, friend. I offer her my warmest congratulations on her new appointment and cannot think of anyone more deserving. I know she will serve the position well."

    And as for Dunn—she's ready for the challenge.

    "I am so thrilled to have the opportunity to serve our faculty, students, and our community in my home town and at my alma mater, LSU Health Shreveport!" Dunn said. "Becoming the dean during these times of economic challenge to higher education and while LSU is engaging in a new partnership with Ochsner Health System provides exciting opportunities to integrate and collaborate across disciplines in education, practice, and research. I have much to learn, but I am enthusiastic about our team and our potential! Geaux Tigers!"

    Beyond the Sessions: 7 NEXT Opportunities Worth Checking Out

    The APTA NEXT Conference and Exposition has a reputation for on-point educational sessions and inspiring lectures, and this year's event, taking place in Chicago June 12-15, is no exception.

    But as anyone who attended a NEXT conference can tell you, there's more to it than that: NEXT offers hands-on experiences, interactive learning opportunities, and plenty of ways to network and have a great time—this year, in 1 of the most vibrant cities in the country.

    If you've already registered for NEXT, think of the items below as possibilities for your conference "must do" list. And if you haven't registered, take a look at what you could be missing (besides all the sessions and lectures, of course).

    NEXT is all about connecting (and reconnecting) with others who share your passion for the profession—and those connections don't just happen around sessions. Plan on joining fellow attendees for the conference opening reception in the exhibit hall on Wednesday, June 12, and get things started right.

    Join the conversation.
    What would you do? The NEXT Experience Zone is the place for interactive learning, including a June 13 session on shoulder and knee issues, with speakers presenting cases and then involving the audience in discussion and, ultimately, a vote on the best course of treatment.

    Take a deep dive with a small group.
    The NEXT Inspiration Hub offers a series of discussions in a small group setting that allows for a more intimate look at topics including rural health, community collaboration, and the integration of education, practice, and research. There's even a session on how APTA can be your not-so-secret weapon in enriching your career.

    Get hands-on with GoBabyGo!
    The popular GoBabyGo! program returns to NEXT, with an opportunity for you to see firsthand how commercially available children's ride-on toys can be retrofitted to become effective assistive devices for children with mobility limitations. You'll come away inspired.

    Feel the blues.
    Join PT-PAC supporters for an evening of top-notch blues at Buddy Guy's Legends, which calls itself "the premiere blues club in the world," on Wednesday, June 12. A $50 ticket, purchased when registering for NEXT at the PT-PAC booth in the exhibit hall or outside the House of Delegates, buys you appetizers, drinks, and a night of live entertainment you won't soon forget.

    Make a kid's day.
    Again this year, APTA is working with Shoes4Kids to provide underprivileged children with new athletic shoes and socks. This service opportunity will benefit Chicago's Woodlawn Community Elementary School, which is part of the Small Schools Coalition offering students an African culture-centered curriculum in reading, language arts, math, science, cultural arts, and social science. Shoes4Kids collection bins will be located outside of the House of Delegates beginning Monday, June 10, and at NEXT through Wednesday, June 12. Find out more, and how you can help.

    Party with the Foundation.
    The Foundation for Physical Therapy Research has funded groundbreaking research and researchers for 40 years. This year’s PT Party, on Thursday, June 13, will be a celebration of this special anniversary and the research that keeps making our profession stronger. Join colleagues, friends, and Foundation family in celebration. PT Pintcast's Jimmy McKay will liven up the evening as emcee. And don't forget to wear your dancing shoes. You can register for this event online.

    APTA Sheds Light on Upcoming MIPS, Registry Deadlines

    The Merit-based Incentive Payment System (MIPS) is now a professional reality for many physical therapists—as are upcoming deadlines for reporting MIPS data and potentially switching reporting methods. Do you know what you need to do, and when you need to do it? APTA can help.

    Now available from APTA: a detailed annotated list of "MIPS Milestones" and key dates for 2019 and 2020, and a recent #PTTransforms blog post that breaks down options for reporting and how to transition to using APTA's Physical Therapy Outcomes Registry as your MIPS reporting agent.

    In addition to explaining why it's important to be paying attention to MIPS- and Registry-related deadlines—the next of which is coming up June 30—the blog post provides insight into how the Registry works, and includes tips on succeeding in the MIPS environment.

    Proposed SNF Rule Relaxes Group Therapy Requirements, Increases Payment by 2.5%

    In a proposed change strongly supported by APTA, skilled nursing facilities (SNFs) could see more flexibility when it comes to the number of residents considered acceptable for "group therapy" under Medicare. The loosened definition is part of the proposed fiscal year (FY) 2020 payment rule for SNFs recently issued by the US Centers for Medicare and Medicaid Services (CMS), a plan that also includes an overall 2.5% payment increase.

    Currently, treatment of 4 patients performing same or similar activities qualifies as "group therapy" for purposes of Medicare payment in SNFs. The proposed FY 2020 rule—which would go into effect on October 1, 2019—would allow qualified rehabilitation therapists including physical therapists (PTs) to form groups with as few as 2 and as many as 6 patients. The change would make SNF group therapy rules more consistent with other care settings and "create opportunities for site-neutral payments," according to a CMS fact sheet on the proposed rule.

    "The expanded definition of group therapy is very much in line with APTA's ongoing effort to advocate for the value of the PT's clinical judgment by allowing for more clinical flexibility in determining the most appropriate number of participants in a particular group," said Kara Gainer, APTA's director of regulatory affairs. "The change makes sense in terms of both payment and providing appropriate patient care."

    The proposed rule would also boost payments to SNFs by about $887 million in FY 2020, with average increases varying depending on, among other things, the location of a particular SNF: facilities in urban areas would likely receive a 1.8% increase on average, while SNFs in rural areas could average a 6.4% increase.

    PDPM System Moves Ahead—and Aims to Keep Up With ICD-10 Tweaks
    As anticipated, the proposed rule proceeds with implementation of the Patient-Driven Payment Model (PDPM). The model is based on a resident's classification among 5 components (including physical therapy) that are case-mix adjusted, and employs a per diem system that adjusts payment rates over the course of the stay. APTA has developed a number of resources on PDPM.

    The CMS proposal also would allow the agency to use a "subregulatory" process to keep up with nonsubstantive updates to the ICD-10 codes used in PDPM, while substantive changes will be made through the traditional notice-and-comment rulemaking process. CMS writes that the change would "help ensure SNFs have the most up-to-date ICD-10 code information as soon as possible, in the clearest and most useful format."

    Patient Assessment and Quality Reporting Data Requirements Expand
    Also not much of surprise—CMS is proposing to continue its efforts to standardize patient assessment data collection across postacute care settings as required by the 2014 IMPACT Act.

    Similar to its proposed FY 2020 rule for inpatient rehabilitation facilities (IRFs), CMS plans to require SNFs to report resident data on admissions and discharges in the following areas: cognitive function and mental status; special services, treatments, and interventions; medical conditions and comorbidity; impairment; and a new category—social determinants of health. SNFs have been reporting on some components of these areas since 2018, mostly related to function, pressure wounds, and skin integrity.

    In another proposed change that echoes the rule being considered for IRFs, the SNF Quality Reporting Program (QRP) would increase from 11 to 13 measures, adding assessments related to transfers of current reconciled medication lists at resident discharge or transfer; as well as the transfer of a similar list to the patient/resident, family, or caregiver upon discharge from a postacute facility.

    The proposed rule also requires SNFs to collect and submit minimum data sets (MDS) on all SNF residents regardless of payer, a change that CMS says "may create additional burden" but would "ensure that Medicare residents are receiving the same quality of SNF care as other residents." As for MDS reporting related to post-hospital SNF care, the proposed rule clarifies that the "5-day assessment" requirement must be completed no later than the eighth day of the SNF stay, and that the requirement will go under a new name—"initial patient assessment"—beginning in FY 2020.

    Amid all the additional requirements, CMS is proposing 1 reduction: baseline nursing facility residents would be excluded from the QRP related to discharge to community.

    What APTA's Doing—and What You Can Do
    The association will submit comments on the proposed rule by the June 18, 2019, deadline. Interested PTs, PTAs, students, and other stakeholders also are invited to provide comments, and will be able access information on how and where to submit comments at APTA's regulatory Take Action webpage in the coming days.

    Members with an interest in postacute care are also encouraged to join APTA's online postacute care community on The Hub. The community is a staff-administered collaborative space for members to ask questions, share information, and identify areas of opportunity in relation to the new postacute care payment methodologies and other CMS postacute payment reforms. If you are interested in joining this online community, please email Kara Gainer at karagainer@apta.org with “Join PAC Community” in the subject line and your member ID number in the body of the email.

    IRFs Could See 2.5% Increase From CMS in FY 2020; Additional Reporting Requirements in FY 2022

    If a proposed rule from the US Centers for Medicare and Medicaid (CMS) is adopted as planned, inpatient rehabilitation facilities (IRFs) will see a 2.5% payment increase in the 2020 fiscal year (FY), which begins October 1, 2019—an approximate boost of $195 million. But they'll also need to prepare for some expanded reporting measures in the years to come—including a requirement to report data on social determinants of health (SDOH).

    Reporting requirements wouldn't change much in fiscal year (FY) 2020 (beginning October 1, 2019). However, beginning with the FY 2022 IRF Quality Reporting Program (QRP), IRFs would be required to provide certain standardized patient assessment data (SPADE) to CMS. The additional SPADE requirements are aimed at bringing IRFs up to speed with provisions of the 2014 IMPACT Act, a law that mandated more uniformity in reporting across postacute care (PAC) settings.

    Beginning in the 2022 fiscal year, IRFs would be required to report patient data on admissions and discharges dating back to October 1, 2020, in the following areas: cognitive function and mental status; special services, treatments, and interventions; medical conditions and comorbidity; impairment; and a new category—social determinants of health (SDOH). IRFs have been reporting on some components of these areas since 2018, mostly related to function, pressure wounds, and skin integrity.

    The new SDOH would gather data on race, ethnicity, preferred language, interpreter services, health literacy, transportation, and social isolation—factors that CMS writes "[have] been shown to impact care use, cost, and outcomes for Medicare beneficiaries."

    CMS also wants to introduce 2 new process measures; one having to do with whether a provider receives a current reconciled medication list at discharge or transfer, and another relating to whether the patient, family, or caregiver receives a similar list upon discharge from a PAC setting.

    Among other elements of the proposed rule:

    The compliant IRF list may go. CMS is proposing to stop publishing a list of compliant IRFs on the Inpatient Rehabilitation Facility Quality Reporting Program (IRF QRP) website.

    Reporting for some baseline nursing facility residents would decrease. Specifications of the discharge-to-community PAC measure would be altered to exclude baseline nursing facility residents.

    IRFs could make the call on who's considered a "rehabilitation physician." The proposed rule would loosen the definition of "rehabilitation physician," allowing individual IRFs to make the determination. At the same time, CMS is seeking comments on refining the definition in light of the proposed change.

    As is typical, CMS is also seeking input on several areas not related to specific impending rule changes for FY 2020, including stakeholder comments on pain interference on sleep, therapy activities, and day-to-day activities—provisions that CMS is considering adding in light of the opioid crisis. The agency also seeks general feedback on possible additional SPADE data elements including dementia, bladder and bowel continence, care preferences, advance care directives and goals of care, caregiver status, veteran status, health disparities and risk factors, and sexual orientation. Potential measures CMS would like feedback on include assessments related to opioid use, and frequency and exchange of electronic health data as well as interoperability.

    APTA will submit comments on the proposed rule by the June 17 deadline. To weigh in on the proposed rule, check out APTA's regulatory "Take Action" webpage in the coming days for information on how and where to submit comments.

    CMS Adds to DMEPOS Prior Authorization List

    Physical therapists (PTs) who are providers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) will see an expansion of the range devices that require prior authorization under Medicare, when the US Centers for Medicare and Medicaid Services (CMS) adds 12 more items to its list beginning July 22 of this year.

    Seven of the 12 new codes are related to power mobility devices, with the additional 5 related to pressure-reducing support surfaces. The additions follow last year's introduction of 31 DMEPOS items that CMS moved to a nationwide preauthorization system. Prior to that, the preauthorization policies for those devices were limited to a demonstration project in 18 states.

    CMS also added 4 new items to the master list of DMEPOS that are considered frequently subject to unnecessary use, including a particular back brace (L0650). CMS uses the master list to decide which items it will add to the prior authorization list.

    CMS offers a webpage focused on the DMEPOS prior authorization program and has published a notice and list of the 12 codes to be added. A full list of DMEPOS requiring prior authorization is also available from CMS. APTA offers more resources at its DMEPOS webpage as well as through a clinical mobility device documentation guide.

    The Good Stuff: Members and the Profession in the Media, April 2019

    "The Good Stuff" is an occasional series that highlights recent media coverage of physical therapy and APTA members, with an emphasis on good news and stories of how individual PTs and PTAs are transforming health care and society every day. Enjoy.

    When fear is the obstacle: Robert Gillanders, PT, DPT, discusses traumatophobia—fear of reinjury—and the way it can impact the lives of previously active people. (Medium).

    Kope-ing skills: Emily Younker, PTA, was involved in the physical therapy that helped 9-year-old Kope Hillary recover from injuries suffered in an ATV accident. (Wise County, Texas, Messenger).

    Roll with it: David Reavy, PT, MBA, shares consumer tips for choosing a foam roller. (Self) .

    The brain as healer: Andrew Butler, PT, PhD, FAPTA, explains his leading research in using the power of brain plasticity to help patients recover poststroke. (Georgia State University Research).

    The exercise crystal ball: Greg Hartley, PT, DPT, provides a PT's perspective on a fitness test that 1 study claims is a predictor of longevity. (The Washington Post).

    Finding a way out of the pain: Carrie Pagliano PT, DPT, explains the ways physical therapy can address vaginismus. (Huffington Post).

    Quotable: "We knew we had to stay active to keep living, and the boost we needed was going through pulmonary rehab alongside others with whom we could relate." – Charlton Harris, describing the benefits of group pulmonary physical therapy for his sarcoidosis. (Sarcoidosis News) .

    Improving care in Vietnam: Julie Gahimer, PT, is helping physical therapy students and professors in Vietnam as part of Health Volunteers Overseas. (University of Indiana Reflector).

    Yoga poses for pelvic pain: Casie Danenhauer PT, DPT, says that certain yoga moves can help ease endometriosis, pelvic pain, and menstrual cramps. (Everyday Health).

    Balance in all things: Patrick Sparto, PT, DPT, describes how physical therapy can improve balance problems. (Today.com).

    A passion for Special Olympics: Dominic Fraboni, PT, DPT, discusses the impact volunteering with Special Olympics has had on his life. (Medium).

    Backing up the value of physical therapy: Jeffrey Houser, PT, DPT, outlines the ways physical therapy can relieve low back pain. (Cleveland Clinic health essentials)

    Treating scoliosis from experience: April Gerard, PT, discovered a treatment method that helped her cope with her own scoliosis. Now she's sharing it with her patients. (Duluth, Minnesota, News Tribune) .

    Preventing rhabdo: Shannon Meggs, PT, offers advice on avoiding potentially organ-damaging rhabdomyolosis as a result of overly strenuous workouts. (Healthline.com).

    "Citizen science": Cole Galloway, PT, PhD, FAPTA, delivers the GoBabyGo! message of "crowdsourced manufacturing" to provide mobility opportunities for children. (Buffalo, New York, News).

    Quotable: "Every milestone we've reached has been because of [physical therapy]. Both of my kids took their first steps with their physical therapist," -Danielle Salamone, mother of two, advocating for the Monroe County, New York, school system to increase reimbursement for preschool special education service providers. (WHAM 13 News, Rochester, New York).

    Got some good stuff? Let us know. Send a link to troyelliott@apta.org.

    New Phys Ed Studies Say There's More Work to Do

    Despite concerns that US education policy over the past 2 decades may be squeezing out opportunities for physical activity in school, it turns out that average student attendance in physical education (PE) classes hasn't dropped since the mid-1990s—but then again, it hasn't increased either and remains below recommended levels. Those were among the conclusions in a pair of recently completed studies that also found public schools not fully embracing policies that could improve their PE programs.

    The 2 studies were conducted by the National Physical Activity Plan Alliance (NPAPA) at the request of the President's Council on Fitness, Sport, and Nutrition. APTA is an organizational partner of the NPAPA. [Editor's note: Want to learn more about the National Physical Activity Plan and the work of the NPAPA? Check out this video, and read the entire National Physical Activity Plan, a roadmap for community-level change.]

    To reach their conclusions, researchers looked at nationally representative survey responses. The attendance study focused on self-reported data from students, while the research on policy implementation was based on information primarily gathered from PE instructors. The study on PE attendance is an update on previous NPAPA research, while the policy study is a first-ever investigation into the degree to which schools have adopted best-practice recommendations from SHAPE America's Essential Components of Physical Education. The attendance study was published in Research Quarterly for Exercise and Sport (abstract only available for free); the PE policy study was published in the Journal of School Health (abstract only available for free).

    PE Attendance
    Researchers found that the percentage of students attending 1 or more PE classes per week continues to hover at around 50%--more or less the same rate reported since tracking began in 1991. The latest data, from 2015, puts the average number of days a high schooler attends PE classes at 4.11 per week; however, nearly half (48.4%) of students reported attending no PE classes on average. Only 29.8% of students reported attending the recommended 5 days of PE per week.

    While authors of the study say that their findings challenged a recent Institute of Medicine report that claimed "political and economic pressures" on school systems were reducing PE curricula, they also acknowledged that, though relatively stable, the attendance numbers aren't good enough.

    "The prevalence of PE attendance among US high school students is still well below the recommended national guidance of daily PE attendance and is far from reaching the [Healthy People 2020] national health objectives," authors write.

    PE Policies
    For the policy study, researchers analyzed the degree to which schools have adopted the 7 policy recommendations contained in the SHAPE resource: providing daily PE; prohibiting waivers, substitutions, and exemptions; limiting class size; not assigning or withholding PE as punishment; ensuring full inclusion of all students in PE; and having state-regulated teachers endorsed to teach PE.

    The results were mixed at best.

    The good news: about 75% of schools said they didn't allow substitution of other activities (such as sports teams or marching band) for PE, and nearly the same rate required certified or licensed PE teachers. More than half didn't allow PE to be assigned or withheld as punishment, and just over 40% enforced maximum student-to-teacher ratios in PE classes.

    The less-good news: Only a quarter of schools prohibited exemptions from PE, and just 4% of schools provided daily PE for the recommended amount of time. A mere 0.2% of schools reported implementing all 7 policy recommendations, and about half (49.3%) were implementing only 2-3 policies. The findings also uncovered regional variations.

    "The findings of this study suggest that many elementary, middle, and high schools across the United States are not implementing essential policies to ensure effective [PE] programs," authors write. They identified the provision of daily PE, class size limits, and prohibiting exemptions from PE as the policies most in need of wider adoption.

    APTA Senior Practice Specialist Hadiya Green Guerrero, PT, DPT, says that the studies shine a spotlight on the gap between widely accepted standards and day-to-day reality in schools.

    "This study is a reminder of the overall lack of progress in improving the well-being of our children by incorporating more movement in schools," Green Guerrero said. "There are progressive policies out there, but these reports show that what's needed is more advocacy in our own communities for their adoption. We can develop any number of great ideas, but without implementation we'll continue to see an increasingly unhealthy population of children of all backgrounds."

    APTA has long supported the promotion of physical activity and the value of physical fitness. In addition to representation on the NPAPA and other organizations, the association offers several resources on obesity, including a prevention and wellness webpage that links to podcasts on the harmful effects of inactivity. Interested members also are encouraged to join the APTA Council on Prevention, Health Promotion, and Wellness to engage with a community of shared interest. APTA is also a board member of the National Coalition for Promoting Physical Activity.

    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.

    APTA Annual Report: 2018's Achievements Are Shaping the Future of the Profession

    "I'm excited about where we're headed—together."

    Those words, from a statement from APTA President Sharon Dunn, PT, PhD, in the 2018 APTA Annual Report, are exactly what the document is all about. Taken as a whole, it's a story of how creating connections can pay off—not only in meeting current challenges, but in setting a course for the profession's future.

    Now available online, the report combines elements of the association's 2018 Year in Review, published in late December 2018, with new information that takes a deeper dive into an important year for the association. In addition to recounting how members came together to fuel a long list of achievements, the 2018 Annual Report includes a recap of work at the APTA component level, membership statistics, a report from the APTA treasurer, and financial statements of activities and financial positions.

    The report emphasizes the ways in which APTA leveraged its leadership to build a passionate and impactful community of physical therapists (PTs), physical therapist assistants (PTAs), and students of physical therapy education programs, and how that community in turn powered the association's ability to lead. That synergy paved the way for some significant achievements in 2018, including:

    • Elimination of the hard cap of therapy services under Medicare Part B
    • The end of functional limitation reporting
    • A white paper, Facebook Live event, media tour, and other activities that positioned APTA as an important voice in the fight to end the opioid crisis
    • Passage of a law that provides better federal protections for PTs and PTAs traveling with teams across state lines
    • Expansion of use of telehealth by PTs and PTAs in US Department of Veterans Affairs care systems
    • Growth of the physical therapy licensure compact to 21 states by year's end
    • Finalization of plans for a new APTA headquarters, with an early 2021 completion date

    Those are just some of highlights. Check out the complete report to learn more about how APTA and its members are making a difference in the lives of PTs, PTAs, and their patients and clients—and how a sense of unified energy is propelling the association toward a future of more bold, transformative moves.

    PTJ: Falls Are 'Critical Health Hazard' for Individuals With Upper Limb Loss

    Arm motion is critical to helping compensate for losing one's balance and avoiding a fall. For individuals with upper limb loss (ULL), the lower extremities take on the burden of reacting to avoid a fall, and the lack of upper arm movement may put them at greater risk for falls than older individuals, say authors of a new study in PTJ (Physical Therapy). This "critical health hazard," they write, requires falls screening and "targeted physical therapy to enhance postural control and minimize fall risk."

    Via an anonymous online survey, researchers asked 109 individuals with an average age of 43 with ULL about their body and health characteristics, upper and lower limb loss characteristics, physical activity level, fall history in the previous year and circumstances, and upper limb prosthesis use. Participants also completed the the Activities-specific Balance Confidence (ABC) Scale. 

    Authors found:

    Falls are prevalent in this population, surpassing fall rates for older individuals and stroke survivors. Including individuals with ULL and those with upper and lower limb loss, 45.7% fell at least once in the past 12 months, while 28.6% reported 2 or more falls. Those numbers were slightly lower for respondents with only ULL, with 40.7% reporting 1 fall and 22.0% reporting 2 or more falls. The percentage of respondents experiencing a single fall is higher than for older individuals (33%) and community dwelling stroke survivors (~40%).

    Of all those who reported falls, 31.7% were injured in the most recent fall and 14.6% required medical attention.

    Most falls were due to slips, trips, and loss of balance. Of the reported falls, 30% occurred while walking outdoors, and 30% occurred while walking up or down stairs. Only 11% of falls occurred during physical exercise or playing sports. Most fell because they lost their balance (27%), tripped (25%), or slipped (18%).

    Balance confidence and self-perception play a role. Respondents were significantly more likely to fall if they had lower balance confidence and low perceived physical capabilities. They also were 6 times more likely to fall if they reported using an upper limb prosthesis.

    These results, especially the high rate of injuries, have "considerable clinical importance because it suggests the presence of a critical health hazard for individuals with ULL," authors write. "Balance confidence, use of upper limb prostheses, and perceived physical capabilities could be useful screening metrics."

    While further research is necessary on which interventions are best to address these fall risks, authors suggest that balance-targeted therapies, as well as interventions developed for older adults to better recover from trips, could also help individuals with ULL "refine their motor response to perturbations and enhance overall stability."

    "Monitoring these patients during rehabilitation would help create awareness of this health concern, and identify individuals at risk of falling in the community who could benefit from intervention," they write.

    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.

    CDC Reiterates Limits of Opioid Prescribing Guideline

    The US Centers for Disease Control and Prevention (CDC) wants to make it clear: its guideline on the use of opioids for the treatment of chronic pain is not intended to apply to pain related to cancer treatment, palliative care, or end-of-life care. The clarification is consistent with messaging used by APTA in its #ChoosePT opioid awareness campaign and its MoveForwardPT.com consumer-focused website.

    In a February 28, 2019, letter from CDC Chief Medical Officer Deborah Dowell, MD, MPH, the agency restates its intentions around the prescribing guideline, issued in 2016, that recommends nonopioid approaches including physical therapy as a preferred first-line treatment for some—but not all—types of chronic pain.

    "The Guideline was developed to provide recommendations for primary care physicians who prescribe opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care," Dowell writes. "Because of the unique therapeutic goals, and balance of risks and benefits with opioid therapy in such care, clinical practice guidelines specific to cancer treatment, palliative care, and end-of-life care should be used to guide treatment and reimbursement decisions regarding use of opioids as part of pain control in these circumstances."

    The letter was written in response to concerns voiced by the National Comprehensive Care Network, the American Society of Clinical Oncology, and the American Society of Hematology that some payers were balking on paying for opioid prescriptions in circumstances outside the scope of the CDC guidelines.

    Even without the clarification, the original guideline is explicit in its intent, which appears in the first sentence of the document and again when the CDC describes the scope of the guideline and intended audience. Similarly, APTA makes it clear that doctor-prescribed opioids are appropriate in some cases and has included that message in both its #ChoosePT webpage and its public service announcement related to the opioid crisis.

    "The Guideline is not intended to deny any patients who suffer with chronic pain from opioid therapy as an option for pain management," Dowell writes. "Rather, the Guideline is intended to ensure that clinicians and patients consider all safe and effective treatment options."

    Foundation Announces 2019 Grant Opportunities

    The Foundation for Physical Therapy Research (Foundation) now is accepting applications for a host of 2019 Research Grants—including a new mechanism, made possible through a bequest from a lifetime APTA member, that will award up to $360,000 for a 3-year research project.

    The new Goergeny High Impact/High Priority Research Grant is the result of a $1.58 million bequest from the estate of Magdalen and Emil Goergeny. Originally from Hungary, the Goergenys immigrated to the United States in 1960, where Magdalen received physical therapist training and established a practice. The Goergenys' bequest, received after their deaths in 2013, is among the largest personal donations ever received by the Foundation.

    Application deadline for all grants is early August 2019, with 2 grants requiring letters of intent due May 31. Grant opportunities include:

    • Goergeny Research Grant (High Impact/High Priority): Up to $360,000 (2-year total of $240,000 with third year competitive renewal) for research focused on the role of physical therapy in the prevention of secondary health conditions, impairments of body structures and functions, activity limitations, and/or participation restrictions. Interested applicants must submit a letter of intent by May 31, 2019, at noon ET.
    • Magistro Family Foundation Research Grant: $100,000 for a research project investigating physical therapist interventions. Investigators at any level are welcome to apply regardless of funding history. A letter of intent is required; applicants will be invited to submit full applications based on content. Letter of intent is due May 31, 2019, at noon ET. This grant is made possible by the Magistro Family Endowment Fund.
    • Foundation Marquette Challenge Research Grant: $40,000 for an investigator-initiated research project by an emerging investigator. This grant is named in honor of the annual student fundraising effort, the Marquette Challenge.
    • Health Services Research Pipeline Grant: $40,000 awarded to support research that examines how patients obtain physical therapy-related health care, how much that care costs, and outcomes, with an emphasis on the most-effective ways to organize, manage, finance, and deliver high-quality physical therapy-related care while potentially reducing medical errors and improving safety for patients. Investigators at any level are welcome to apply regardless of funding history. This grant is made possible by APTA.
    • Pediatric Research Grant: $40,000 to an emerging investigator for research consistent with the current Academy of Pediatric Physical Therapy Research Agenda. This grant is made possible by the Academy of Pediatric Physical Therapy.
    • Women's Health Research Grant: $40,000 to an emerging investigator for research in abdominal and pelvic health physical therapy that aligns with the mission and vision of the APTA Section on Women’s Health. This grant is made possible by the APTA Section on Women's Health.

    Questions? Email the Foundation, or call 800/875-1378.

    Note: Before starting your funding application, be sure to carefully read all eligibility guidelines, instructions, and information on funding mechanism deadlines. Also, it's a good idea to start the submission process early to allow for potential questions to be answered.

    New Pilot Study Opportunities Available From CoHSTAR

    The Center on Health Services Training and Research (CoHSTAR) has opened a call for the development of multiple pilot studies that would help set the stage for larger efforts to advance a wide range of health services research. APTA was a major financial contributor to the development of CoHSTAR, having donated $1 million toward the center's startup in 2015.

    The selected pilot studies would address research questions in CoHSTAR's 4 areas of specialization—analysis of large data sets, rehabilitation outcome measurement, cost-effectiveness, and implementation of science and quality improvement research—and the CoHSTAR Pilot Study Program webpage lists examples of specific types of studies that would qualify for funding. Each pilot study will receive $25,000 in funding for direct costs.

    Priorities for funding will be given to applications that align with 1 of the 4 areas of CoHSTAR specialization, have a strong likelihood of leading to broader research with major external funding, and have good potential to result in future research with high societal or policy impact for physical therapy. Principal investigators must include at least 1 physical therapist (PT) who is a US citizen or a certified permanent resident of the United States.

    Letters of intent are due to CoHSTAR by June 1, 2019. Based on those letters, in early July CoHSTAR will invite applicants to submit a full application by August 26. Award winners will be notified on October 15. For more information, visit the CoHSTAR Pilot Study Program webpage.

    CoHSTAR was established with a Foundation for Physical Therapy Research grant of $2.5 million. In addition to APTA’s $1 million donation, funding for CoHSTAR also came from APTA components, individual PTs, foundations, and corporate supporters.

    JAMA Oncology: Telerehab Makes a Difference in Patients With Advanced-Stage Cancer

    "Collaborative telerehabilitation" isn't a regular part of care for patients with advanced-stage cancer, but maybe it should be, say authors of a study recently published in JAMA Oncology (abstract only available for free). They found that the approach, which combines remotely delivered rehabilitation instruction with outpatient physical therapy and regular communication, can reduce pain, improve function, shorten hospital says, and decrease the use of postacute care facilities.

    The findings are based on results from the Collaborative Care to Preserve Performance in Cancer (COPE) program, a randomized clinical trial designed to address what the JAMA authors describe as a "knowledge gap" in the application of collaborative care models (CCMs) focused on patient function. The COPE trial includes patients with stage III or IV solid or hematologic cancer with a life expectancy of more than 6 months, and who reported moderate functional impairment (a score of 53-60 on the Activity Measure for Postacute Care assessment, or AM-PAC).

    The 516 participants in the study were divided into 3 groups studied over 6 months: a control group that was encouraged to self-report on pain and function via telephone or web-based surveys (every other week for the first month and monthly thereafter), an "arm 2" group that received a collaborative telerehabilitation program led by 2 physical therapist (PT) fitness care managers (FCMs) with 15 years or more of specialization in cancer rehab, and an "arm 3" group that added pharmacological pain management to the collaborative telerehab model, overseen by a nurse pain care manager (PCM).

    The collaborative telerehabilitation model put patients in touch with FCMs who provided instruction on "an incremental pedometer-based walking program" as well as the Rapid Easy Strength Training (REST) resistance training program, individualized based on patients' physical impairments. Participants also reported to the FCMs on pain and function, where FCMs "encouraged the use of compensatory strategies and initiated rehabilitative analgesic modalities when indicated," authors write.

    The participants in the telerehab model also were referred to local outpatient PTs "to further adapt their conditioning and analgesic regimens," with the outpatient PTs and FCMs working together to advance step and REST goals. Participants in arm 2 reported on progress, pain, and function weekly for the first month of the study and were then allowed to drop back to every other week or even once a month. FCMs received an alert if participants reported loss of function or increased pain, or if they failed to achieve the recommended 4 REST sessions per week.

    The arm 3 participants received the same rehabilitation approach but at the direction of a PCM, with the only real difference being that during the monitoring phase participants could request a call from the PCM, who could recommend the prescription of pharmacological treatments to address pain and function.

    Among the findings:

    • Physical function, as measured by the AM-PAC, improved for the arm 2 and 3 groups versus control by about 1.3 points—a difference that exceeded the minimum clinically important difference (MCID) threshold of 1 point.
    • Both the arm 2 and arm 3 groups reported clinically significant, albeit similar, reductions in pain compared with control as measured by the Brief Pain Inventory—pain interference dropped by 0.4 for arms 2 and 3, while pain intensity dropped by 0.4 for arm 2 and 0.5 for arm 3.
    • When it came to quality-of-life measures, a slightly different picture emerged: arm 2 telerehab-only participants reported significant improvement over control via the 5-item EQ-5D-3L assessment, but arm 3 participants (telerehab plus pain management) did not.
    • Hospitalization days were on average 57% higher for the control group (7.4 days) than for arm 2 participants (4.2 days), and 18% higher than for arm 3 participants (7.2 days). Authors note that the differences had to do with shorter, not fewer, hospitalizations in arms 2 and 3.
    • Among patients who were hospitalized, arms 2 and 3 were 4.3 times more likely to be discharged home than was the control group.

    "Although modest, the COPE interventions' effect sizes of 0.23 for mobility and -0.24 for pain are nonetheless notable given the remote, low-touch delivery; the known positive effect of the control condition; and the trial's vulnerable, high-needs participants," authors write. "Furthermore, our findings agree with reports suggesting that surprisingly modest functional losses and gains among individuals with borderline dependency…can profoundly affect their requirement for inpatient care."

    The researchers were surprised by the data that showed the addition of pharmacological pain management to be less effective than telerehab alone when it came to improving function and about equally effective in decreasing pain. They believe more study is needed but speculate that the greater reliance on nonpharmacological approaches in both arms, as well as a "more seamless integration of pain- and function-directed treatments in arm 2, may have contributed to the outcomes.

    Authors also note that in addition to reduced pain and improved function, results of the COPE trial shed more light on possible avenues for reining in the costs of care for individuals with late-stage cancer.

    "Our findings of reduced hospital use among participants in the telerehabilitation arms add to growing evidence that proactively addressing functional impairment among vulnerable patients reduces hospital utilization," authors write "Reducing the requirement for institutional care among patients with late-stage cancer has the potential for high financial return given that hospitalizations account for a large proportion of health care spending in this population, drive regional variation in costs of care, and are not associated with survival or [quality of life]."

    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.

    CMS Home Health Preclaim, Postpayment Review System Again Ready to Launch in Illinois

    After false starts, restarts, postponements, and more than a little pushback from APTA and other stakeholders, CMS is ready to once again roll out a home health agency (HHA) payment program in Illinois that would force HHA providers in the state to participate in preclaim or postpayment reviews—or choose a third option that would involve "minimal" postpayment review but cut payment by 25%.

    Called the "Review Choice Demonstration for Home Health Services," the program will require HHAs in Illinois to choose 1 of 3 program options: submit documentation for 100% of Medicare patients while they are receiving care (a "preclaim review"), submit 100% of all claims for a postpayment review, or opt for "minimal" postpayment review and swallow a 25% payment cut. HHAs can begin making their choice on April 17 but must submit a final decision to CMS by May 16. The system will begin on June 1.

    If parts of the system sound familiar (particularly to HHAs in Illinois), that's because they are: CMS first introduced the project in Illinois in 2016, with plans to roll out the system to 4 additional states in 2017. In the face of criticism from most HHA organizations about the excessive burden of the demonstration, CMS put the brakes on the rollout. In June 2018, CMS announced that it would move ahead with a revised demonstration in 5 states—but then held off again and announced that once the delay was over, the program would begin in Illinois.

    According to CMS, the 3-option system will serve as a kind of audition for HHAs, which, after 6 months of compliance, would be allowed additional choices including "relief from most reviews except for a review of a small sample of claims." The demonstration is intended to offer more flexibility and choice for providers, as well as reward providers who show compliance with Medicare home health policies.

    APTA staff and members of the Home Health Section submitted extensive feedback to CMS on the demonstration as it was being considered and reconsidered—and considered again. Like many other stakeholders that provided comments to CMS, APTA argued that the program was excessively burdensome and could decrease patient access to care.

    With the demonstration program ready to begin, many HHAs are wondering the same thing: will the program be expanded to other states and, if so, when?

    "At this point, it's nearly impossible to say how or if CMS will move to expand this system," said Kara Gainer, APTA director of government affairs. "Although some tweaks were made to the project, we believe it's still based on a flawed approach that could put unsustainable pressure on some HHAs. We will closely monitor the demonstration as it plays out in Illinois and take every opportunity to press CMS for significant improvements before it's applied to other states."

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    Student Loan Repayment Program to Include PTs? Health Services Corps Bill Reintroduced in US Senate

    It's back: APTA-supported legislation that would list physical therapists (PTs) among the professions included in a federal program to provide greater patient access to health care in rural and underserved areas has been reintroduced in the Senate. If passed into law, the program could open up access to a student loan repayment program for participating PTs—and help address the nation's opioid crisis in areas that have been especially hard-hit.

    The bill (S.970) would allow PTs to participate in the National Health Service Corps (NHSC) loan repayment program, an initiative that repays up to $50,000 in outstanding student loans to certain health care professionals who agree to work for at least 2 years in a designated Health Professional Shortage Area (HPSA). An estimated 11.4 million Americans are served by the NHSC. The bill was introduced by Sens John Tester (D-MT), Roger Wicker (R-MS), and Angus King (I-ME).

    APTA is a strong supporter of legislation that extends student loan forgiveness to PTs, particularly as a way to improve access to physical therapist services in areas already experiencing shortages. But according to APTA Vice President of Government Affairs Justin Elliott, there's an additional important reason that the association is advocating for the bill's passage.

    "The opioid epidemic has been especially devastating in rural and medically underserved areas," said Elliott. "And while the role of physical therapy as an important nonpharmacological alternative in the prevention, treatment, and management of pain is well-established, the current services corps law doesn't include any physical rehabilitation component. Allowing PTs to participate in the NHSC could help increase patient access to better ways to manage pain, especially for individuals who have or at risk of developing a substance use disorder."

    Advocacy for S.970 (and its yet-to-be-introduced companion in the US House of Representatives) was a major focus of Capitol Hill visits conducted by APTA members as part of the APTA Federal Advocacy Forum held from March 31 to April 2. APTA encourages members to join the push for the bill by contacting their senators to urge them to become cosponsors by way of a prewritten letter, available at the APTA Legislative Action Center, that helps to deliver a unified message (member login required).

    APTA staff will closely track the progress of this legislation—be on the lookout for more opportunities to advocate for this important change.

    2019 House of Delegates Motions Now Posted

    APTA members now can access the first official packet of motions that will be considered by the 2019 APTA House of Delegates (House) when it convenes June 10-12 in Chicago, Illinois.

    Called "Packet 1," the compilation contains 70 House motions and is provided as the official notice of all motions. On May 10, “Packet I” will be replaced with a document titled “Packet I with Background Papers” that will include background papers on various motions.

    In addition, reports to the 2019 House have been posted to the Motions, House Reports, and Background Papers file library. These reports include updates from the APTA Board of Directors related to charges from the House, as well as the APTA Secretary's report, and updates on activities of the House officers, Nominating Committee, and Reference Committee.

    Delegates should continue using the Motions Discussion forum in the House of Delegates online Hub community to participate in discussion. Chief, section, and assembly delegates wishing to cosponsor a motion or request that a motion be placed on consent should visit the Motions, House Reports, and Background Papers file library.

    Contact APTA’s Justin Lini with any questions.

    Statehouse Roundup: Licensure Compact Progress; Chapters Press for Changes to Direct Access, Pain Management Policy, Payment, and More

    Providing all goes as hoped during current state legislative sessions, the Physical Therapy Licensure Compact could pass the halfway mark in its progress toward adoption in every state, with a potential for 28 states to be participating in the system that allows physical therapists (PTs) and physical therapist assistants (PTAs) licensed in 1 compact state to obtain practice privileges in others.

    "Thanks to the hard work of APTA state chapters and state licensing boards, we've been able to keep up the momentum around the compact," said Angela Shuman, APTA's director of state affairs. "As more states join, it will make the case even stronger for the remaining non-compact states to sign on."

    Compact bills are now being considered in Georgia, Maryland, Massachusetts, Michigan, Nevada, and Pennsylvania. If the legislation is successful, those states will join 23 others already in the system: Arizona, Arkansas, Colorado, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota, Oklahoma, Oregon, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, and West Virginia.

    But that's not all that's been going on at the state level during an extremely active legislative season. Here's a roundup of other activity:


    • Direct access. Efforts to expand direct access to physical therapist (PT) services and remove restrictions on existing laws continue, with Wyoming becoming the 19th state to adopt unrestricted direct access—"a very, very big win," according to Shuman. Other states that are considering positive direct access changes include Alabama, Indiana, Missouri, North Carolina, South Carolina, and Texas.
    • Dry needling. Legislation is being considered in Hawaii, New Jersey, and Washington that would lift prohibitions on dry needling by qualified PTs, while advocates in Indiana are seeking to include the treatment as part of a sweeping revision of the physical therapy practice act. Meanwhile, PTs and supporters in Nevada are fighting an attempt to make dry needling the exclusive practice of oriental medicine practitioners.
    • Telehealth. "There's a lot going on right now related to telehealth," Shuman said. "State legislatures are considering everything from changing practice standards that would increase telehealth options for all health providers to legislation that would require insurers to cover remotely delivered services in the same manner they cover in-person visits." States that are considering other changes include Florida and South Dakota, which are debating the adoption of statewide telehealth standards; and North Dakota, where the legislature is asking the governor sign a bill that adds a definition of telehealth to the physical therapy practice act.
    • Concussions. Bills to add PTs as providers authorized to remove student athletes from activity due to a concussion, as well as make return-to-activity decisions, are being considered in Colorado, Massachusetts, and Texas. A similar change in West Virginia already has been signed into law.
    • Disability determinations. PTs in Florida and Texas soon may be permitted to make disability determinations for license plates and placards; the provision is now law in Minnesota.
    • PTA Issues. Montana is considering a law that would allow PTAs to be supervised through telecommunications, while New York is looking to change the status of PTAs from "certified" to a licensed profession. In North Dakota, a bill that changes supervision requirements for assistive personnel has been sent to the governor to be signed into law.
    • Mandatory reporting. Legislators in Michigan are considering including PTs and PTAs as mandatory reporters of suspected child abuse.

    Payment and referral

    • Copays and patient cost-sharing. Four states—Georgia, Rhode Island, New Mexico, and New York—are moving on legislation that would set limits on out-of-pocket patient costs, with New Mexico's bill already on the governor's desk.
    • Utilization management and other insurance issues. Lawmakers in California, Michigan, Washington, and Oregon are considering changes that would decrease unnecessary delays in care caused by prior authorization and other utilization management practices by insurance companies. The California legislation focuses on workers' compensation.
    • Medicaid. PTs and supporters in Iowa are fighting a proposal to implement multiple procedure payment reduction (MPPR) in Medicaid, while legislators in Maine are looking at improving provider reimbursement for physical therapy.
    • Tax breaks for PTs. It isn’t payment per se, but a move that would keep more money in the pockets of PTs and PTAs: New Mexico may adopt a law that would provide state tax credits for PTs and PTAs working in rural areas.
    • Referral sources. Oklahoma is considering a change that would allow nurse practitioners to make referrals to physical therapy; North Dakota and South Carolina are discussing similar legislation that would apply to physician assistants.

    The Opioid Crisis

    • Nonpharmacological approaches to pain management. "There's so much going on in this space at so many levels," Shuman said, "but the trend is definitely toward changes that increase patient access to nonopioid and nondrug options for pain."

      Several APTA chapters have been directly involved in policy discussions, including in Connecticut, which is establishing guidelines for nonpharmacological pain treatments that include physical therapy; and Minnesota, which is considering a bill that would direct a new Health Services Policy Committee to seek consultation with PTs as it develops recommendations on pain management. In Tennessee, changes are being considered that would add physical therapy as an "alternative treatment" that prescribers may discuss with patients before prescribing opioids, while in Indiana, lawmakers are considering requiring certain health insurers to include physical therapy as a medically necessary (and thus covered) service in the treatment of chronic pain.

    Practice acts, licensing boards, and the National Physical Therapy Exam (NPTE)

    • Improving terms and protecting titles. Terms such as "PT," "DPT," "physiotherapy," and "doctor of physical therapy" could be reserved for the exclusive use of PTs in Alaska and Indiana if legislation moves ahead in those states. North Dakota has sent a similar bill to its governor to be signed into law.
    • Licensing boards. PTs could be getting better representation and autonomy in the state regulatory arena. Indiana is looking at moving away from its current regulatory system based on a physical therapy committee under the state's medical board and toward a freestanding board of physical therapy. Connecticut and North Dakota are making changes to the composition of their physical therapy boards, with Connecticut possibly eliminating rules that require a physician to be a member of the board and North Dakota reducing physician board members from 2 to 1—and adding a PTA member. The North Dakota bill is now on the governor's desk.
    • The NPTE. Indiana, South Carolina, and North Dakota are discussing imposing a lifetime limit of 6 NPTE attempts, while Utah, Pennsylvania, and South Carolina are considering changes that would allow PT students to take the NPTE before they graduate.

    From PT in Motion Magazine: Regenerative Medicine and the PT

    Patient, heal thyself.

    Maybe that's not exactly what regenerative medicine is all about, but it's close: with its emphasis on enhancing the body's own genetically driven capabilities to repair damage and reestablish neural connections, regenerative medicine is pushing the boundaries of what we know about the healing capacities hidden in our own DNA. And physical therapists (PTs) are bringing an important perspective and set of unique skills to the field.

    "PTs on Rehab's Leading Edge," in the April issue of PT in Motion magazine, takes a look at the current state of regenerative medicine, robotics, and genomics in physical rehabilitation, and finds a growing appreciation for what PTs bring to the table and the ways movement and exercise can affect health at the cellular level.

    The article covers current approaches including the use of platelet-rich plasma and neural retraining through the use of robotic exoskeletons, but also explores what the future may hold as researchers such as Richard Shields, PT, PhD, FAPTA, and Steve Wolf, PT, PhD, FAPTA, work to better understand the science of regenerative medicine and prepare the next generation of PTs for what will one day be a very different health care environment.

    "As the field of medical regenerative medicine progresses, so too will physical therapy," Shields tells PT in Motion. "How are you going to manipulate the genetics? You're likely going to do it through various forms of technology that allow us to apply loads and movement, whether through robotics or just plain exercise. Understanding how to dose for cellular response is going to be the new frontier."

    "PTs on Rehab's Leading Edge" is featured in the April issue of PT in Motion magazine and is open to all viewers—pass it along to nonmember colleagues to show them one of the benefits of belonging to APTA.