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  • US House Members Echo APTA, Coalition Members' Call for Reduced Use of Prior Authorization by Medicare Advantage Plans

    Calling the requirements "onerous and often unnecessary," more than 100 members of the US House of Representatives are pressing for improvements to the way prior authorization (PA) is used—and often misused—in Medicare Advantage (MA) plans. The lawmakers' call for changes echoes concerns voiced earlier this year by a coalition that includes APTA.

    A bipartisan group of 103 legislators signed on to the October 10 letter to US Centers for Medicare and Medicaid Services (CMS) administrator Seema Verma, requesting that Verma direct the agency to conduct investigations around the use of prior authorization in MA, and to issue guidance "dissuading" MA plans from including requirements that include unnecessary barriers to care.

    "It is our understanding that some plans require repetitive prior approvals for patients that are not based on evidence and may delay medically necessary care," the lawmakers write. "Many of these PA requirements are for services or procedures performed in accordance with an already-approved plan of care, as part of appropriate, ongoing therapy for chronic conditions, or for services with low PA denial rates."

    The letter underscores the message delivered to Verma earlier this year by way of a letter from the Coalition to Preserve Rehabilitation (CPR), a group of 28 health provider, patient, and care professional and advocacy groups that includes APTA, the American Association of People with Disabilities, the American Occupational Therapy Association, the Brain Injury Association of America, the Epilepsy Foundation, the Michael J. Fox Foundation for Parkinson's Research, and the Paralyzed Veterans of America, among others.

    The CPR letter suggests that CMS take its cue from the private insurance industry, which has been moving away from prior authorization, or at least investigate which prior authorization policies get in the way of medically necessary care. The coalition also recommends that CMS impose greater oversight of MA plans, with "stronger directives to MA plans to limit the use of prior authorization to services that are demonstrably overutilized."

    The legislators' letter to Verma makes reference to the efforts of "key stakeholders"—presumably, CPR and other groups—and requests that "you and your staff engage with these organizations on additional opportunities to improve the PA process for all stakeholders."

    APTA will continue to monitor this issue and share developments as they arise.

    APTA Advocacy for EMG, Other Diagnostic Services Results in Payment Clarification from CMS

    Good news for physical therapists (PTs) certified by the American Board of Physical Therapy Specialties in electrophysiologic physical therapy: the US Centers for Medicare and Medicaid Services (CMS) has stated in no uncertain terms that those PTs are permitted to perform certain diagnostic services without the need for physician supervision where those services are allowed by state law. The announcement was made after APTA and other stakeholders pressed the agency to clear the air in order to end payment reductions or outright denials to PTs providing the services.

    According to the CMS statement, board-certified clinical specialists in electrophysiology physical therapy are qualified to provide services involving electromyography (EMG), nerve conduction velocity (NCV), and sensory evoked potentials (SEPs) without physician supervision, and should be paid for those services. It's a provision that's been around since 2001, according to CMS; however, the message wasn't always getting through to some Medicare Administrative Contractors and other payers, who would pay only for the technical component of the service, for some codes but not others, or nothing at all.

    In its statement, CMS reminds stakeholders that it assigns a Physician Supervision Indicator (PSI) of “09” to its collection of PT-designated diagnostic services codes, making it clear that physician supervision is not required for the global and professional component codes of these services.

    "APTA was concerned when it became clear to us that PTs weren't receiving appropriate recognition for these services, but grateful that the issue could be resolved through clear communications from CMS," said Kara Gainer, APTA director of regulatory affairs. "We hope that this statement will erase all doubts about whether a qualified PT can receive full payment for the delivery of services that have been permitted for nearly 2 decades."

    APTA-Backed Bill Protecting PTs Traveling With Sports Teams Likely to Become Law

    APTA-supported legislation that protects physical therapists (PTs) and other health care providers who travel across state lines with a sports team is now just a presidential signature away from becoming law. Known as the Sports Medicine Licensure Clarity Act, the bill met with overwhelming bipartisan support in both the US House of Representatives and the Senate, and is on track to receive approval from President Donald Trump.

    When it becomes law the legislation will provide added legal protections for sports medicine professionals when they're traveling with professional, high school, college, or national sports teams by extending the provider's "home state" professional liability insurance to any other state the team may visit. The law would apply to licensed health care professionals who travel with professional and collegiate teams or other athletes and teams sanctioned by a national governing body. The bill was introduced in the House by Reps Brett Guthrie (R-KY) and Cedric Richmond (D-LA), and in the Senate by Sens John Thune (R-SD) and Amy Klobuchar (D-MN).

    "This is a big win for PTs, but an even bigger step forward in safeguarding the health of athletes," said Michael Matlack, APTA director of congressional affairs. "Once enacted, this law will help to support the realities of health care among teams that travel across state lines."

    In its original form, the bill's coverage was restricted to only physicians and athletic trainers. Advocacy staff at APTA and representatives from the American Academy of Sports Physical Therapy (AASPT) worked closely with legislators and staff to ensure PTs and PTAs working under the supervision of a PT would also be included. Once the bill was introduced, APTA and section representatives worked in conjunction with other stakeholder groups to ensure support from as many legislators as possible. The final version of the legislation passed the House easily in 2017, and it received approval from the Senate by a 93-6 margin on October 3.

    "We are grateful not only for the support of the legislators who introduced this bill, but for the sustained hard work of APTA members and members of the American Academy of Sports Physical Therapy to help achieve overwhelming backing in Congress," said Jennica Sims, APTA's congressional affairs and grassroots specialist. "Our success with this legislation shows what happens when individual member voices are part of a collaborative advocacy effort."

    From PT in Motion Magazine: Moving Away From Opioids

    Health experts, federal agencies, and national organizations such as APTA have been sending a clear message that providers and patients should first consider nonopioid treatments such as physical therapy for chronic pain. But has it made a difference?

    Yes, according to Alice Bell, PT, DPT, APTA senior payment specialist, who represented APTA on the National Quality Forum’s “opioid stewardship action team” earlier this year. She tells PT in Motion magazine that "Across the profession, we're seeing more and more patients who are accessing physical therapy before opioids are prescribed, or who've been on opioids but realize they aren't helping to treat or manage their underlying conditions."

    In this month’s issue of PT in Motion magazine, author Chris Hayhurst writes about APTA’s ongoing efforts to build public awareness and its leadership in policy discussions around nonopioid alternatives to pain management The article includes excerpts from an APTA white paper, “Beyond Opioids: How Physical Therapy Can Transform Pain Management to Improve Health.” The white paper outlines the history of the opioid epidemic and summarizes research on physical therapy’s effectiveness in treating, managing, and preventing chronic pain.

    Moving Away From Opioid Reliance” is featured in the October 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. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.

    APTA Continues PTA Advocacy: Pushback on PTA Differential, Timeline for TRICARE Startup, More

    Physical therapist assistants (PTAs) play a crucial role on the care delivery team, and APTA is bringing that message to multiple stakeholders. Here's a rundown of some of the latest happenings in the association's advocacy for PTAs.

    Now available: an estimated timeline for PTA inclusion in TRICARE.
    In December 2017, President Trump signed a National Defense Authorization Act that included a change long advocated by APTA: inclusion of PTAs in the TRICARE program used throughout the Department of Defense (DoD) health care system. However, like many federal-level policy changes, implementation wasn't immediate, and it wasn't clear just how or when this change would happen.

    APTA can now shed a little light on the process. Informed by discussions with DoD representatives and others, the association developed a timeline that provides a sense of just how long it might take for the TRICARE policy change to take effect (scroll down to "TRICARE" header).

    The process hinges on when the proposed rule is released to the US Office of Management and Budget (OMB) for review—possibly this fall or spring of 2019. That release triggers a timeline for a series of steps that involve publication in the Federal Register, a public comment period, and agency reviews. Because the OMB release hasn't happened yet, and because various actions could take place before their deadlines, it's hard to pin down a specific date for the end of the process. The only firm date associated with the change is that it has to happen by 2021. The APTA chart helps provide a sense of the length of different steps of the process and helps visitors track progress. APTA will provide updates on the regulatory process, and alert members once the public comment period on the proposed rule has begun. In the interim, APTA is working with congressional allies to keep the pressure on for an expedited process once the proposed rule is released [Editor's note: recently, Rep Rob Wittman (R-VA) submitted a letter to DoD asking when OMB will receive the proposed rule now that 9 months have passed since the legislation was signed into law.]

    Yes, PTAs are included in TriWest.
    APTA also has received clarification that TriWest, the entity that oversees administration of the Department of Veterans Affairs "Veterans Choice" health care program in specific regions of the country, does in fact allow for treatment by PTAs. Unlike the TRICARE change, the TriWest statement describes the current environment and is not dependent on any wait for adoption of new rules.

    APTA continues to push back on US Centers for Medicare and Medicaid Services (CMS) plans to adjust payment provided "in part" by a PTA.
    CMS is bound by law to establish PTA and occupational therapy assistant (OTA) coding modifiers that will go into effect on January 1, 2020 and include a Medicare payment differential beginning in 2022. The problem, in APTA's view, is that the CMS approach—to assign the modifier to services provided "in part" by a PTA or OTA—could significantly impact patient access to care, particularly in rural and underserved areas. The CMS approach is mentioned in its proposed 2019 physician fee schedule.

    APTA made its position clear in comments on the fee schedule, and encouraged members and other stakeholders to provide individual comments critical of the "in part" approach. Additionally, association representatives and representatives from the American Occupational Therapy Association (AOTA) met with CMS representatives in person to discuss the issue. At the same time, APTA and AOTA are advocating on Capitol Hill for Congress to commission a US Government Accountability Office study to examine how access to physical therapy and occupational therapy will be impacted by the pending 2022 Medicare payment differential.

    APTA and Laurel Road now offer an option for PTA student loan debt refinancing.
    News from the APTA Financial Solutions Center: PTAs now have another option for reducing their student loan debt. APTA has expanded its partnership with Laurel Road, a national lending and banking company, to include student loan refinancing for PTAs. Under the new offering, PTAs who have worked for at least 1 year in the profession are eligible to apply to refinance their student loans to a lower rate.

    "It's important to be a member of APTA and engaged on these critical issues that impact PTAs, the profession, and the patients we serve," said David Harris, PTA, BS, MBA, chief delegate of the PTA Caucus. "We all have a professional responsibility to do everything in our power to provide access to all those in need of physical therapy, and our APTA membership gives us all a voice on the national level. Advocacy strengthens with every membership voice."

    Student-Led Flash Action Highlights Physical Therapy's Role in Pain Management

    A physical therapist (PT) and physical therapist assistant (PTA) student-led "flash action strategy" held September 26-27 focused on bringing a clear message to Capitol Hill: physical therapy plays an important role in effective, nondrug management of pain and shouldn't be left out of any approaches to addressing the nation's opioid crisis.

    It was a message that came through loud and clear—to the tune of nearly 7,000 contacts with lawmakers and their staff.

    Despite busy semesters, students from multiple PT and PTA programs took time to participate in the nationwide effort, primarily using social media to concentrate their efforts during a 48-hour window of intense messaging. In addition to contact from students, physical therapists, and physical therapist assistants, the push included 176 contacts from physical therapy patients using APTA's Patient Advocacy Center.

    "The excitement and focused participation during this flash action campaign shows a tremendous level of engagement and commitment to the profession among APTA's student members," said Jennica Sims, APTA's congressional affairs and grassroots specialist. "It's inspiring to see the next generation of the profession taking the lead in this grassroots effort."

    PT and PTA students will bring their energy and excitement to the upcoming APTA National Student Conclave, set for October 11-13 in Providence, Rhode Island.

    APTA Working for You: Commercial Payer Updates, September 2018

    The commercial payer world is varied and continually evolving. APTA helps its members by staying on top of changes and bringing the physical therapy profession's voice to the table on a wide range of private payer-related issues. Here's a quick rundown of some of the latest news and APTA activities.

    APTA partners with the American Chiropractic Association (ACA) to submit application for a dry needling CPT code
    APTA and ACA staff and member experts are presenting the application for a dry needling CPT code at the American Medical Association CPT Meeting in Boston, September 27-29. APTA will provide an update on the results of the meeting after the meeting information is made public.

    Aetna and Magellan Health launch a new UM program in 4 states
    On September 1, 2018, Aetna rolled out a new utilization management (UM) program using Magellan/NIA as the vendor. The program is active in West Virginia, Pennsylvania, Delaware, and New York. APTA is actively engaged with Aetna and Magellan, along with chapter leadership of the included states, to mitigate impacts on patient access and administrative burden.

    APTA hosts another successful Insurers' Forum
    On September 14, 2018, APTA hosted its annual Insurers' Forum. Thirty-four payer representatives and case managers from around the country attended the meeting, an event that brings together representatives from the payer policy, case management, and health care industry to discuss trends in physical therapy that affect payment.

    Again this year, the forum was well-received as an opportunity "to collaborate with other PTs on the insurance side," as one attendee stated.

    APTA staff to lead a National Quality Forum work group on opioid stewardship
    APTA Senior Payment Specialist Alice Bell, PT, DPT, has been identified as a work group lead for the National Quality Partnership Opioid Stewardship Member Network. This group will expand on the work of the National Quality Partnership Opioid Stewardship Workgroup to promote adoption of effective strategies for opioid stewardship. Bell will moderate the first webinar of this group, titled "Partnering With Patients for Pain Management: the Path to Opioid Stewardship," and to held on October 2. To join the Opioid Stewardship Member Network, email the NQF Member Network.

    Aetna's policy clarifications increase access to PT Care
    Major commercial insurer Aetna recently provided clarification on policies related to payment for physical therapy, and it's good news for physical therapists (PTs) and their patients.

    The clarifications help to answer questions related to the company's physical therapy policy, specifically around payment for evaluations and the ways direct access provisions can affect payment. A recent PT in Motion News story covered the highlights.

    More on the Aetna clarifications: evaluations could be eligible for payments sooner than the 180-day wait period
    Although Aetna's policy reads that "physical therapy evaluations will be eligible for payment once every 180 days," Aetna representatives have informed APTA that evaluations performed within 180 days of the original evaluation may be allowed upon reconsideration or appeal, providing the evaluation is for a new or unrelated condition.

    APTA attends National Business Group on Health's "Workforce Strategy" conference
    As part of APTA's ongoing efforts to engage employers and better understand their challenges, APTA staff attended the "Workforce Strategy: The Future of Work, Life and Health" conference sponsored by the National Business Group on Health, (NGBH). The agenda included topics such as employee engagement, digital health, results of health-related pilot projects and emerging innovations for better health and well-being. The importance of determining centers of excellence using data was stressed. Several presenters mentioned physical therapy for low back pain in lieu of surgery and the need to assess the cost savings of avoiding the surgery. The members of the NBGH represent the human resources and health benefits interests for some the largest companies in the US, most with a global footprint. Its goal is to help employers optimize business performance through creative health improvement and health care management initiatives.

    Tiered coding for PT evaluations: new APTA podcast series answers common questions
    As the payment landscape for 2019 comes into focus, it's becoming clear that physical therapists (PTs) will continue coding evaluations according to a 3-tiered system based on patient complexity.

    In its latest efforts to help underscore the importance of continued accurate coding, APTA produced a series of free podcasts on the CPT evaluation codes. The 5-part series covers a general overview of the coding change and addresses common questions related to determining levels of stability, documenting elements, the relationship of examination time to code selection, and coding in reevaluation. With episodes ranging from 5 to 8 minutes in length, the individual podcasts are convenient for quick listens on the go or during breaks at the clinic.

    APTA offers a range of resources for learning more about commercial payment and staying connected: sign up for the Coding, Billing, and Payment online community to join the conversation and share experiences; stay informed by visiting APTA's commercial insurance webpage to access information and download tools including customizable appeals letters; and subscribe to the Payment edition of APTA's Friday Focus newsletter series to receive a monthly compilation of payment-related news and resources. Questions? Email advocacy@apta.org.

    Get Involved: Flash Action September 26-27 Will Focus on Physical Therapy's Role in Pain Management

    Led by students in physical therapist (PT) and physical therapist assistant (PTA) programs, APTA members will focus their energies on advocating for the effectiveness of physical therapy in pain management when this year's Flash Action Strategy (FAS) takes place September 26-27—and you're invited to be part of the action.

    The innovative concentrated advocacy effort will use the APTA Legislative Action Center to contact members of Congress to press for better patient access to nonopioid pain treatments including physical therapy. The effort makes use of APTA's #ChoosePT opioid awareness campaign and emphasizes the importance of team approaches to pain management.

    Getting involved is easy. APTA has prepared resources and will provide a prewritten letter on this issue when the flash action effort starts on Wednesday, September 26. You also can watch the announcements on the APTA Student Assembly Facebook page and Twitter feed (@APTASA) for updates on this important advocacy initiative. In the meantime, spread the word using graphics available for download on the FAS webpage.

    APTA Media Tour Brings #ChoosePT Message to Local, National Media Outlets

    PT in Motion News
    Sarah Wenger, PT, DPT, at left, joined Prevention magazine executive editor Sarah Smith for a live social media broadcast that looked at the #ChoosePT campaign and the role of physical therapy in pain management and other health issues. The interview was part of an APTA nationwide satellite media tour.

    Don't touch that dial: thanks to a recent satellite media tour, APTA's #ChoosePT opioid awareness campaign and the physical therapy profession are receiving local media coverage in more than 30 outlets across the country. And that's not even counting exposure the profession received from a social media broadcast.

    The "tour" involved linking up with TV and radio stations across the country to arrange for short remote interviews with Sarah Wenger, PT, DPT, a clinician and educator with extensive experience in working with patients experiencing chronic pain. Wenger, who was a panelist on APTA's "Beyond Opioids" Facebook Live broadcast in February, is also a board-certified specialist in orthopaedic physical therapy.

    By the beginning of the tour day on September 21, 30 interviews were booked—18 for television and 12 for radio. The interviews varied but generally touched on #ChoosePT, the move toward nonopioid, multidisciplinary approaches to pain treatment, why physical therapy is a key player, and what patients can expect. A few were broadcast live, but the majority of interviews were recorded for later playback—meaning there's a chance you could hear an interview in the coming days and weeks. Check out this video of a live interview from Fox2 Now, in St Louis, for an example.

    In addition to television and radio coverage, Wenger was also the guest for a 30-minute Facebook Live broadcast hosted by Prevention magazine executive editor Sarah Smith. That more in-depth interview allowed Smith and Wenger to discuss at length the more personal, patient-centered relationships physical therapists and physical therapist assistants try to build with their patients.

    Wenger also explained the role of physical therapy in responding to patients in pain.

    "We at APTA definitely believe that it's not opioids or physical therapy, or that physical therapy is the single treatment," Wenger said. "We really do see ourselves as part of the interdisciplinary team. We can work with people who are taking opioids, we can work with people who are weaning off, and we can work with people who are pursuing treatment instead of opioids."

    "The level of interest in the #ChoosePT message in the media is truly encouraging," said Erin Wendel-Ritter, APTA manager of media relations and consumer communications and organizer of the tour. "And we couldn't have asked for a better spokesperson for the campaign and the profession—Sarah handled every interview with enthusiasm and candor, and consistently made the case for physical therapy's role in pain management."

    Want to keep an ear or eye out for #ChoosePT coverage in your area? Here's a list of the outlets and programs that recorded interviews for later broadcast (actual broadcast times not available):

    Radio Interviews
    National Podcast: "The Ron Van Dam Show"
    Boston (WBZ-AM)
    Omaha (KFAB-AM)
    Portland, Oregon (KLCK-AM)
    Roanoke, Virginia (WBTM AM)
    Seattle (KORE-FM)
    Toledo, Ohio (WFIN-AM)

    Television interviews
    National: "NewsWatchTV," ION
    National: "Daily Flash"
    New Orleans (WWL CBS)
    Albuquerque (KOB NBC)
    Baltimore (WMAR ABC)
    Huntsville, Alabama (WYAM IND)
    Odessa, Texas (KOSA CBS)
    Raleigh, North Carolina (WEKS IND)
    Sacramento, California (KXTV ABC)
    San Antonio (KENS CBS)
    Savannah, Georgia (WSAV NBC)
    St Louis (KDKZ IND)
    Tampa (WFTS ABC)
    Terre Haute, Indiana (WTWO NBC)
    Washington, DC (WNC IND)

    Donations Now Being Accepted for Florence Relief

    An online giving program established last year to help hurricane victims in Texas, Florida, and Puerto Rico is now focusing its efforts on providing aid to people affected by Hurricane Florence, which recently inflicted billions in damage in the Carolinas.

    Now's your chance to help.

    "Rehab Therapists Give Back," an online giving program designed to provide physical therapists, physical therapist assistants, and other rehabilitation professionals with an opportunity to come together as a unified community to help those in need, is now accepting donations for Florence relief. Accessible through a GlobalGiving website, the initiative allows donors to contribute any amount. Electronic medical records system vendor WebPT and APTA were founding funders of the program.

    Questions? Contact RTGB@webpt.com.